VNRS B50A-ADVANCED
PHARMACOLOGY PART A
Stephanie Engler, RN
Monday 1:15-2:30pm
sengler@bakersfieldcollege.edu
WELCOME TO PHARMACOLOGY!
• Syllabus
• Content is board approved- some review,
but we will be digging deeper!
• Expectations from this class….
• Please do your homework
• Be ready to participate in class
• Please bring 3 scantrons to class
• How can I help you succeed???
TO BE SUCCESSFUL IN THIS
CLASS………
• Come to class with homework prep
questions answered- find on website
• Bring lecture notes to class- print from
website
• Bring a blank concept map to class for
additional note taking
• Study from your lecture notes and
additional notes in class- use your text book
for clarification of material covered
• Participate in group “round tables” when
available- good time to review exams and
ask questions
LET’S GET STARTED…………
Unit 1- Introduction
• See class handout
Unit 2- Medications Administered for Gastrointestinal
Disorders
• GI reviewhttp://www.youtube.com/watch?v=Z7xKYNz9AS0&feature=f
vsr
• Liver disease, Pancreatitis & Insulin notes
• Groups- answer discussion ?’s
GI MEDS AND PLAN OF CARE
PLAN FOR THE DAY:
• Quick Notes Review
• Case Study
• NCLEX Questions
GASTRIC ACID
System
• Esophagus
• Stomach
• Liver/gallbladder
• Pancreas
• Small/large intestine
Gastric acid production
• Parietal cells- H+ production
• Receptors- histamine2
Function
• Stomach pH 1-4
• Digestion
• Defense against infection
WHAT DO WE DO WITH THE
OVERPRODUCTION OF THIS ACID????
****Give antacids= to neutralize!
•
Milk of Magnesia (magnesium
hydroxide)
• TUMS (calcium carbonate)
Heartburn, gastritis, peptic ulcer
disease (PUD)
****Suppress gastric acid!
H2 receptor blockers- bind to H2
receptor
• Pepcid (famotidine)
• Decrease HCl acid production
• Decrease heartburn
GERD, erosive esophagitis, PUD,
H. pylori, gastritis, prevent stress
ulcers
WHAT DO WE DO WITH THE OVERPRODUCTION
OF THIS ACID????
****Suppress gastric acid!
Proton pump inhibitors (PPI)blocks proton pump, stops HCl
production
• Prevacid (lansoprazole)
• Prilosec (omeprazole)
• Protonix (pantoprazole)
Decrease HCl production, decrease
heartburn
• Caution with hepatic disease!!!!
Gastric barrier- adheres to
gastric mucosa/ binds to ulcer
• Carafate (sucralfate)
Decrease heartburn
• http://www.youtube.com/watch?
v=_fa60VhclNo&feature=related
GASTROINTESTINAL CASE STUDY
History of present illness (HPI):
Mr. D- 70 year old male- enters your clinic with a complaint of
severe upper abdominal pain that occurs mostly in the evening
hours. It is relieved by food, although he vomits his meals several
times each week. Wife states intermittent confusion in last month.
Past medical history (PMH):
 He has a history of peptic ulcers and alcohol abuse
 Smoking has been reduced to two packs per week
 He is taking no drugs, other than Rolaids for his indigestion
Workup: Vital signs- BP- 106/60, HR- 108, RR- 12, Temp- 98.6, O2- 98
on 2L NC, 2/10 pain
GASTROINTESTINAL CASE STUDY
Lab results:
+blood in stool
Na 138
K+ 3.2
Glucose 100
Ca 8.0
BUN 12
Creat 1.2
AST 100
ALT 150
Albumin 1.8
Hgb 10.2
Hct 28.6
NCLEX
Which of the following best describes the
mechanism of the action of sucralfate
(Carafate)?
a.
b.
c.
d.
Kill H. pylori
Reduce the secretion of acid
Increase the secretion of bicarbonate
Add a gel-like protective mucus over the
ulcer
NCLEX
The nurse would administer amoxicillin
(Amoxil) or clarithromycin (Biaxin) for peptic
ulcers in order to:
a.
b.
c.
d.
Kill H. pylori
Reduce the secretion of acid
Increase the secretion of bicarbonate
Add a gel-like protective mucus over the
ulcer
NCLEX
Which class of drugs acts by neutralizing
stomach acid?
a.
b.
c.
d.
H2-receptor blockers
Serotonin receptor blockers
Proton-pump inhibitors
antacids
NCLEX
Which of the following is the most effective
class of drugs used to treat diarrhea?
a.
b.
c.
d.
Phenothiazines
Antihistamines
Anticholinergics
Opioids
RESPIRATORY MEDS AND PLAN
OF CARE
PLAN FOR THE DAY:
• Respiratory Review (A&P/ Structures)
• Mediators of inflammation
• Respiratory defense mechanisms
• Homework Review
RESPIRATORY MEDS AND PLAN
OF CARE
RESPIRATORY MEDS AND PLAN OF
CARE
The respiratory system has built-in methods to prevent
harmful substances from entering the lungs:
•Your nose moistens and warms the air.
•The hair (cilia) in your nose helps filter out large particles.
•Mucus produced by cells in the trachea and bronchial tubes
keeps air passages moist and aids in trapping dust, bacteria,
and other substances.
•Cilia in the air passages move in a sweeping motion
upwards towards the throat and mouth to get the mucus
and bacteria etc out of the lungs.
RESPIRATORY MEDS AND PLAN OF
CARE
Mediators of inflammation
1. Bradykinin, complement, prostaglandin.
2. Leukotrienes.
3. Histamine.
4. Mast cells.
Respiratory defense mechanisms
1.
Cough.
2. Reflex bronchoconstriction.
3. Filtration, mucociliary response.
4. Alveolar macrophages -Macrophages engulf and digest
foreign materials in a process known as phagocytosis.
RESPIRATORY MEDS AND PLAN OF
CARE
Asthma- caused by inflammation in the airways, causes the airways of the
lungs to swell and narrow, leading to wheezing, shortness of breath, chest
tightness, and coughing.
Chronic obstructive pulmonary disease (COPD)Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic
bronchitis; Emphysema; Bronchitis – chronic
• Chronic bronchitis- which involves a long-term cough with mucus
• Emphysema- which involves destruction of the lungs over time
Pneumonia- an inflammation of the lungs caused by an infection
RESPIRATORY MEDS AND PLAN OF
CARE
• Drugs affecting the respiratory system
• Bronchodilators
• Adrenergic agonists• Proventil (albuterol)- short acting
• Xopenex (levalbuterol)- short acting
• Serevent (salmeterol)- long acting
• Leukotriene inhibitors
• Anticholinergics
• Decrease Inflammation
• Glucocorticoid steroids
• Antihistamines
• Decrease secretions
MEDICATIONS FOR THE
INTEGUMENTARY SYSTEM
• Burns- see handout
• Eczema- corticoidsteroid creams
• Psoriasis• corticoidsteroid creams,
• topical retinoids (Tazarotene),
• Vit D analogues (Dovonex)
PSORIASIS
&
ECZEMA
BURNS
RESPIRATORY MEDS AND PLAN OF
CARE
1.
2.
3.
4.
5.
6.
Remember to Study:
Therapeutic Effects
Side Effects
Nursing Actions
Patient Education
Is this drug short or long acting?
Know glucocorticoid steroids!
• Indications
• Precautions
• Side effects
• Nursing actions
• Drugs and their route
NCLEX
Which of the following would the nurse identify
as being involved with asthma?
A. Acute infection
B. Hyperactive airways
C. Alveolar collapse
D. Progressive loss of lung compliance
NCLEX
Which term would be used to describe
the movement of air in and out of the
body?
A.
B.
C.
D.
Perfusion
Respiration
Ventilation
Gas exchange
NCLEX
Sympathetic nervous system
stimulation of the respiratory tract
would result in which of the following?
A.
B.
C.
D.
Diaphragmatic contraction
Bronchoconstriction
Increased respiratory rate
Inspiratory movement
NCLEX
After reviewing information about respiratory tract
disorders, a group of students demonstrate
understanding of the material when they identify
which of the following as the most common cause of
COPD?
A.
B.
C.
D.
Infection
Allergen exposure
Genetic inheritance
Cigarette smoking
NCLEX
A nurse administers an antitussive
agent cautiously to a patient with
asthma for which reason?
A. The airway needs to be maintained.
B. The drug can lead to addiction.
C. A loss of respiratory reserve can
occur.
D. The patient may experience
increased sedation.
NCLEX
Which agent would the nurse instruct a
patient to use orally?
A.
B.
C.
D.
Pseudoephedrine
Phenylephrine
Tetrahydrozoline
Xylometazoline
NCLEX
A patient is taking pseudoephedrine.
The nurse would assess the patient for
which of the following adverse effects?
A.Anxiety
B. Lethargy
C. Hypotension
D.Dry skin
NCEX
When describing the effects of antihistamines,
which of the following would the nurse address
as being decereased?
A.
B.
C.
D.
Hypersensitivity
Dry mouth
Gastrointestinal upset
Sedation
NCLEX
A patient is using an inhaled bronchodilator as
a treatment of exercise-induced asthma. The
nurse would instruct the patient to use the
inhaler at which time?
A.
B.
C.
D.
Immediately after beginning to exercise
15 minutes before engaging in exercise
Right before and after exercise
Midway during the exercise routine
NCLEX
While reviewing a patient’s history, an allergy to
which of the following would alert the nurse to a
possible problem with the use of ipratropium?
A.Eggs
B. Dairy
C. Peanuts
D.Shellfish
NCLEX
A patient is experiencing an acute asthmatic
attack. Which agent would be most effective?
A.Inhaled steroid
B. Leukotriene receptor antagonist
C. Mast cell stabilizer
D.Beta-2 selective adrenergic agonist
NCLEX
Milk of Magnesia (MOM) is used to neutralize
acid in the stomach. MOM is not indicated for
which disease process:
A.Heartburn
B. Gastritis
C. GERD
D.Peptic ulcer disease
NCLEX
Once H. pylori is detected in patients
with a peptic ulcer, the normal
procedure is to: (select all that apply)
A.Administer Prilosec (omeprazole)
B. Administer Prevacid (lansoprazole)
C. Administer Cleocin (clindamycin)
D.Administer Biaxin (clarithromycin)
NCLEX
A patient is admitted with suspected liver
disease. The nurse would anticipate which
of the following labs to be ordered (select
all that apply):
A.
B.
C.
D.
Lipase
LFT’s
Blood coagulation times
electrolytes
NCLEX
General side effects seen in patients
taking anti-emetic agents are: (select all
that apply)
A.Drowsiness
B. Confusion
C. Depression
D.hypotension
NCLEX
A nurse is doing patient teaching to a
patient experiencing heartburn. The
patient states that he currently smokes
approx. 20 cigarettes per day. The
nurse would want to educate the
patient on which gastrointestinal
disorder:
A.PUD
B. GERD
C. H. pylori
D.Gastritis
NCLEX
Which of the following is the most
effective class of drugs used to treat
diarrhea?
a. Phenothiazines
b. Antihistamines
c. Anticholinergics
d. Opioids
NCLEX
Which class of drugs acts by
neutralizing stomach acid?
a. H2-receptor blockers
b. Serotonin receptor blockers
c. Proton-pump inhibitors
d. antacids
NCLEX
The nurse would administer amoxicillin
(Amoxil) or clarithromycin (Biaxin) for
peptic ulcers in order to:
a. Kill H. pylori
b. Reduce the secretion of acid
c. Increase the secretion of bicarbonate
d. Add a gel-like protective mucus over the
ulcer
NCLEX
Which of the following best describes
the mechanism of the action of
sucralfate (Carafate)?
a. Kill H. pylori
b. Reduce the secretion of acid
c. Increase the secretion of bicarbonate
d. Add a gel-like protective mucus over
the ulcer