Pharm Quiz Reviews PDF

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DO NOT ALTER QUIZ REVIEWS!- No quiz module 9! NUR2474 Pharmacology Module 1 Quiz Review Tips: 1. 15 questions = 25min 2. Learn how to identify and answer negatively worded questions (positively vs negatively worded questions) 3. Learn how to apply priorities test taking strategy (ABC, Maslow’s Hierarchy of Needs, Nursing Process) Topics review: 1. Characteristics of medications a. Based on properties of the ideal drug: i. Effectiveness: Why we take a certain drug to fix an issue in the body. Does the drug work for what we need to correct? ii. Safety: the drug cannot produce harmful adverse effects and be safe to use and not kill us. iii. Selectivity: The drug elicits the only response for what it is given for. One thing only (i.e.: antihypertensive lowering BP but also lowering amount of acid in the stomach). iv. Reversible action: is there an antidote available if something goes wrong. I.e.: naloxone given for opioid reversal. v. Predictability: how it affects the body and exactly what occurs. vi. Ease of administration: whether its PO, IV, IM, SC is it easy to make a mistake or hard to and causes extra pain, need of supplies, etc. vii. Freedom of drug interactions: does the drug interact with other drugs or foods in certain ways that decrease its action or make it unsafe to use. viii. Low cost: cheaper drugs will be easier for people to afford and maintain. ix. Chemical Stability: is it stable and easy to store. x. Simple generic name: some can be complicated and hard to pronounce. This is important so that people do not get confused with certain drugs. Generic= given by the government, Brand= company b. NO DRUG IS IDEAL!!!!! 2. Properties of medicines to consider when prescribing to patients a. Pharmacokinetics: how the drug moves its way through the body. i. Absorption: movement of drug from site of administration to various tissues 1. Ex: PO med- intestines- liver (broken down)- blood; IV med: straight into blood stream, IM med: straight into the muscle and then to bloodstream. ii. Distribution: movement of the drug throughout the blood to its site of action. If not enough blood or poor circulation, the medication cannot move well or work efficiently.

1. Ex: The PO med travels in the blood stream to the site of pain. iii. Metabolism: the chemical change of the drug to a more or less potent form to act on the tissue. 1. Intended med response occurs here iv. Excretion: elimination of drug via kidneys, feces, sweat, air v. Half-life: time it takes for a drug to decrease in amount by ½. Shows us how fast or slow a drug is absorbed and what type of dosing schedule we should initiate. vi. 1st Pass Effect: amount of the drug that is inactivated at metabolism that is decreased in what is taken 1. Why we may give a loading dose for first dose of a medication. vii. Bioavailability: amount of drug available after passing through the liver. viii. Onset: amount of time for first therapeutic effect to be seen ix. Peak: time it takes for full therapeutic effect to been seen x. Duration: how long the therapeutic effect lasts. 3. Patient specific variabilities affecting response to medications a. Body weight and composition b. Age: infants have immature organs while older adults have organ degeneration and slower response and reaction times w/ increased diseases and multiple drug treatments c. Diseases: kidney disease- makes it harder for excretion and for increased drug levels in the body from retention; liver disease- reduced metabolism and increased toxicity occurs if the liver cannot break down a med sufficiently; acid/base imbalance- ph. change and alter the kinetics of a drug; dehydration or imbalance electrolytes can cause impact on drug use. d. Tolerance: how much of a med your body needs to become therapeutic and work over time. Decreased responsiveness over time. 4. Pharmacodynamics a. The biochemical changes in the body from a drug. b. Focused on the therapeutic, side and adverse effects on the body and secondary effects c. Agonist: are molecules that activate receptors. They increase a response that can be good or bad. d. Antagonist: they block receptor activation. e. Partial antagonist: has some receptor activity but can also block the activity. 5. Routes of medication administration and their qualities (benefits vs dangers) a. PO: easiest to give, but can be a danger for one with dysphagia, longer time it takes for action, decreased bioavailability due to 1st pass effect. b. SC: goes directly into the tissues and blood stream, has some pain associated with it and have to rotate sites. c. IM: goes directly into the muscle. Have to know how to properly give the injection and that it may cause mild pain in some people d. IV: goes directly into the vein and acts the fastest due to skipping absorption and distribution. Have to have a skill set to inset an IV and to maintain it. Can cause mild pain to patients too. e. Topical: easy to apply but you have to do so with gloves. May need to dose multiple as it can wear off.

f. If it can be reversed= it can be safe to use! 6. TORB and VORB is and the 6 rights of medication administration a. TORB: telephone order read back- very important to ensure you have received all parts of the medication order and that no mistakes or spelling errors are made when getting the medication orders. b. VORB: Verbal Order Read back- you should read back the order multiple times to yourself or to the provider to ensure you have the correct medication order and that it makes sense. c. Parts of a medication order: drug name, patient name, dose with measure, route, frequency, indication, and provider signature i. If one part is missing- call the doctor for clarification. d. 6 rights: right patient, drug, dose, time, route, documentation. i. Need to always do thorough assessment and data collection before giving a medication or to not give it (ie: if heart rate is too low, do not give Beta Blocker) 7. Pre- and post- medication administration assessment and interventions a. Assessment: what data you collect based on what you see or what the patient reports (ex: they are in pain, they have a fever, etc) b. Analysis: where you decide to give or not to give the medication based on your assessment. c. Planning: how you will be giving it (PO/IV/IM/SC) d. Implementation: the process of you actually giving the medication- remember your 6 rights and 3 medication checks and how to identify your patient with name and DOB e. Evaluation: you will come back later to assess your patient and ask them if the medication is working appropriately. If not, reevaluate your options, use other no pharm stuff and call the doctor. 8. Therapeutic threshold a. The amount of drug needed to create a therapeutic effect and the amount of drug needed to reach toxicity. b. Level at which effective- therapeutic range- level at which toxic = we must have that balance within the therapeutic rang. c. Important that if a drug has a narrow therapeutic range that we draw daily labs to see how much of it is in the blood and if we need to titrate, add or decrease dosage. d. If not in the range, it can be toxic and cause harm and if not it does nothing for the person. 9. Addiction vs tolerance a. Physical tolerance: Because there is efficient breakdown of the medication in the body, the body gets used to the medication and desensitizes itself, causing the therapeutic effect to not be seen. Because of this we need to increase the dose of the medication for the therapeutic effect to be seen. b. Physical Dependence: if one stops a drug suddenly, they will go into withdrawal effects and a physical reaction- why we have to wean them off medications. c. Addiction: when one abuses a medication, takes it not as prescribed but for pleasure. 10. Allergies assessment vs side effects vs adverse events

a. Allergic Reaction: the most severe adverse reaction from a medication causingthe immune system to reaction. S/S: itchy rashes, hives, SOB, wheezes and if not controlled, it can cause death. We must always stop treatment first, call the doctor and give epinephrine, have an airway and give oxygen. We also need to know what happens when one is allergy to a medication and ask about what happens when the med is given (Nausea- can give it, but rash- do not give). b. Adverse Reaction: an unintended and harmful reaction from the medication given. Can be life threatening (I.e.: use of an opioid may make one sleepy but also cause respiratory depression). We need to monitor for these and report immediately. c. Side effect: an unintended, harmful effect from the medication. 11. Opioids (general side and adverse effects) a. Used for heavy duty pain b. Side Effect: sleepy c. Adverse effect: respiratory depression d. Before you give it, you need to do a pain assessment 0-10 to determine what is the best course of action to control the pain. Pain is emergency and must be treated. If you do give opioids, you have to monitor and assess vital signs. e. Always reassess after administration and make changes as needed. 12. Penicillin’s family (side effects vs allergy) a. Used to treat infections b. Side effect: diarrhea, seizures c. Adverse Effect: anaphylaxis d. We need to always double check when we give the med if there is an allergy to any medication in the family and to know what happens when they take it.

NUR2474 Pharmacology Module 2 Quiz Review Topics review: 1. General features of Alzheimer’s Disease on Donepezil a. Features of Alzheimer’s: memory loss, confusion, feeling disoriented, impaired judgement, personality changes, self-care difficulty. b. Donepezil works by preventing Ach from being in activated, therefore increasing its availability in the body. It will slow the Alzheimer’s disease progression, but not treat the disorder. c. The patient with the medication will show increased cognition and decreased confusion. 2. Questions on key neuro meds see table below (mechanism of action, side/adverse effect, administration, etc.): Especially, Donepezil, Interferon beta, Carbamazepine, Methylphenidate a. Donepezil: used for mild to moderate Alzheimer’s i. It works by preventing Ach from being in activated, therefore increasing its availability in the body. It will slow the Alzheimer’s disease progression, but not treat the disorder. ii. SE: Cholinergic effects (SLUDGE), GI effects- N, D, bradycardia, fainting, falls, fractures, dizziness, HA, bronchoconstriction. b. Interferon beta: reduces the frequency and severity of MS attacks, lesions detectable and delays disability.

i. It works by inhibiting leukocytes from crossing the BBB and protects myelin from damage and suppresses the immune system. ii. SE: flu like reactions- chills, fever, malaise, hepatotoxicity, myelosuppression, injection site reactions, depression, suicidal thoughts. iii. Remember: teach patient that they do not have the flu, just flu like symptoms, and to rotate sites and give hydrocortisone and Benadryl for itching and rash, teach they may have increased infection risk and will need caution. c. Carbamazepine: used to treat epilepsy, bipolar disorder, and neuralgias. i. It works by suppressing the neural discharge in high focal points where seizures occur in the brain. ii. SE: nystagmus, ataxia, leukopenia, anemia, thrombocytopenia, birth defects, hypo-osmolality, rash and photosensitivity. iii. Interacts with grapefruit juice. d. Methylphenidate: used to treat ADHD and increase focus and attention. i. It works by inhibiting norepinephrine and dopamine in the CNS/PNS to relax and focus. ii. SE: CNS and CV stimulation, weight loss, psychosis and at risk for abuse. iii. Give med in the morning after breakfast and give 2nd dose before 4pm so they can sleep. Do not stop the drug suddenly as it can cause abuse and withdrawal.

Prototype Medication Name

Prototype Medication Class

Levodopa

Dopaminergic Drugs

Carbidopa

Dopaminergic Drugs

Donepezil

Cholinesterase Inhibitors

Memantine

NMDA Receptor Antagonists

Interferon beta

Immunomodulators

Phenytoin

Traditional Antiepileptic Agents

Oxcarbazepine

Newer Antiepileptic Agents

Baclofen

Centrally Acting Muscle Relaxer for Spasticity

Cyclobenzaprine

Centrally Acting Muscle Relaxer for Localized Muscle Spasm

Amphetamine sulfate

Amphetamines

Methylphenidate

Amphetamine-like Drugs

Carbamazepine

Anticonvulsant

3. Review basic medication administration formula: D/H * Q = X amount of medication (where

D=desired dose, H = dose on hand, Q = quantity/volume per dose on hand, X= amount of medicine to give) 4. General treatment considerations for seizure patients on Carbamazepine a. Keep a seizure log from when time of seizure, duration, and s/s of it. b. Weight the benefits and risk so that we can have the best therapeutic benefit to the patient c. Remember to keep strict adherence for time and dose and draw labs for right therapeutic range. 5. General treatment considerations for ADHD patients on Methylphenidate a. Give in the am with meals, last dose before 4pm, ensure kids have a large meal when appetite is stimulated, no stopping the drug.

NUR2474 Pharmacology Module 3 Quiz Review Test tips: Be cautious of negatively worded questions! They are easy, but often misinterpreted due to not paying attention to them. Topics review: 1. General features of schizophrenia and Chlorpromazine (class, mechanism of action, adverse effects, administration/withdrawal teaching, and review early and late EPS specifically). a. A low potency 1st generation antipsychotic, works slower and not as effective in reducing symptoms quickly. b. Blocks dopamine, acetylcholine, histamine and NE receptors in the brain to inhibit psychotic manifestations. c. SE: i. EPS: acute dystonia, oculogyric crisis, opisthotonus crisis, joint dislocation, impaired respirations, anticholinergic effects. ii. Parkinsonians: bradykinesia, mask life face, drooling, tremor, rigidity, shuffling gait, cog wheeling, stooped posture. iii. Akathisia: pacing and squirming from an uncontrollable need to be in motion. iv. TD: movements of the tongue and face that are slow and wormlike. Will appear late in EPS. v. Neuroleptic malignant syndrome: rare but serious reaction that causes death without treatment. Lead pipe rigidity (severe rigid muscle), high fever, sweating, instability HR fluctuations, BP fluctuations, altered LOC, seizures and coma. Depth can be from respiratory or cardiac collapse. d. Toxicity: rare, but can product hypertension, CNS depression and EPS, where we will treat with BB/benzos, IV fluids, gastric lavage. e. Do not give with anticholinergic drugs, CNS depressants, Levodopa and carbidopa. 2. Review strategies and treatments for EPS. a. EPS: occurs with 1st generation antipsychotics. Based on the CNS pyramidal tract and movement. i. Acute Dystonia: slow movement.

ii. iii. iv. v. vi.

3.

4.

5.

6.

Oculogyric crisis: abnormal upward deviation of the eyes. Opisthotonus: spasms with a backward arch motion. Joint dislocation: movement of joint out of socket. Impaired Respiration: the diaphragm cannot move and move slowly. Anticholinergic medication: will slow and dry the body ( can’t see, cant spit, cant pee, cant poop). Review general teaching topics for patients on antipsychotics (adherence). a. With any antipsychotic or psych medication, we must educate the patient on what things to monitor, report adverse s/s, may need direct observation of the s/s related to the med, must teach them to take exactly as prescribed with the correct dosing, ways to decrease side effects, and the importance of contacting the provider when stopping medications. General features of depression and Fluoxetine (class, mechanism of action, adverse effects, teaching, administration/withdrawal, and review serotonin syndrome). a. Fluoxetine is an SSRI b. Used for depression, bipolar, OCD, panic disorder, and many off label uses. c. Mechanism of action: inhibits serotonin reuptakes, makes more available at the synapse for a longer time. d. AE: serotonin syndrome, withdrawal effects, neonatal abstinence syndrome, teratogenesis, EPS, bleeding disorders, sexual dysfunction and weight gain. e. Teach patient to always have the provider withdraw the medication and to not have the patient do it. Must not take MAOIs, care w/ blood thinners, no ETOH. The RN should assess for suicide and mood. Teach me about dangers with pregnancy and risk for fetal defects. f. Given in the morning for the best result, never stop cold turkey, always gradually taper the drug when stopping the med with, the provider. g. Serotonin Syndrome: a toxic level of serotonin is in the body. It starts 2-72 hrs. after treatment. i. S/S: AMS, anxiety, hallucinations, confusion, incoordination, hyperreflexia, sweating, tremor, fever. ii. Will resolve spontaneously after D/C the medication. iii. Increased risk with use of MAOIs Review basic medication administration formula: D/H * Q = X amount of medication (where D=desired dose, H = dose on hand, Q = quantity/volume per dose on hand, X= amount of medicine to give). Review implication of Lithium therapy (class, mechanism of action, adverse effects, teaching, administration/withdrawal, blood levels, etc.) a. Lithium is a mood stabilizer that can help relieve symptoms of mania in bipolar disease. b. AE: will be seen at a therapeutic level: GI effects, tremors, polyuria, renal toxicity, goiter and hypothyroidism, teratogenesis. c. Administration: will take 5 to 7 days to see first effects and 2-3 weeks to see the full effects. Will interact with Na diuretics and will be excreted. Need good kidney function. d. Blood level: therapeutic- 0.8-1.4, great than 1.5 is toxic.

i. Toxic AE: these therapeutic s/s will be larger and more advanced. If not taken care of, patient can die. ii. We must draw blood levels early in the treatment to determine the dosing and then one established, we need to draw blood levels every 3-6 levels to maintain the correct blood levels. e. Must educate patient on to take the medication even when the mania stops and to never withdraw or stop the med cold turkey and to call the dr to monitor it. f. Will need the mood stabilizer for mania, antidepressant for the depression and antipsychotic for psychosis in the bipolar disorder. 7. Review care of patients with insomnia (general treatment principles, alternative therapies, scripts for small amount of pills, etc.) a. We must complete a thorough assessment when seeing one for insomnia, as the sleeping disorder may not be the pure cause of the insomnia. b. We will have to treat the cause. i. We can give a small amt of insomnia medication until cause identified, then we will switch them off to another class that will treat the cause if not from a sleep disorder. 1. Ie. If insomnia due to back pain or neck pain, we may give a pain med and not a insomnia pill. c. Meds we can give for insomnia at small dose: trazadone, doxepin, melatonin, zolpidem for short term. 8. Review Paroxetine (class, mechanism of action, adverse effects, teaching, administration/withdrawal, etc) as it relates to anxiety disorder. a. Paroxetine is a SSRI that is used for anxiety disorder. b. It prohibits reuptake of serotonin, leaving more available at the synapse. c. SE: Serotonin syndrome, withdrawal, neonatal abstinence syndrome, teratogenesis, EPS, bleeding disorders, sexual dysfunction, weight gain. d. Sexual dysfunction and weight gain may be for why younger adults do want to take the med. Will want to switch the medication.

Prototype Medication Name

Prototype Medication Class

Chlorpromazine

Traditional Antipsychotics (low-potency)

Haloperidol

Traditional Antipsychotics (high-potency)

Clozapine

Atypical Antipsychotics

Fluoxetine

Selective Serotonin Reuptake Inhibitors

Venlafaxine

Serotonin/Norepinephrine Reuptake Inhibitors

Imipramine

Tricyclic Antide...