Pharm Test 2 Review PDF

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Exam 2 Review...

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NUR2474 Test # 2 Review Please review general tips from Quiz review document (test taking strategies, select all that apply questions, etc.). The test will utilize Respondus browser and monitor (using webcam). No notes or textbook allowed on the test. Calculator will be enabled in the browser. https://quizlet.com/_9uvl7u?x=1qqt&i=2z3d5j -quizlet for exam https://quizizz.com/join/quiz/60a433bd51fa3f001bf5dd6d/start?studentShare=true - practice NCLEX questions

https://quizlet.com/_9v1hs2?x=1jqt&i=2z3d5j more practice NCLEX questions

General tips for studying: 1. 2. 3. 4.

Memorize names of medication categories from the presentation Memorize key drugs from categories above (there are many questions with specific drug names) Use generic names When reviewing particular drugs note category, indications, common side effects, toxicity signs (if applicable), reversal agents, mechanism of action (e.g. agonizing or antagonizing which receptors) 5. Read question instructions (there will be ‘select all that apply’ questions)

Topics to review: 1. Educating patients on how to use metered dose inhalers (wait 1 min between puffs, etc.). a. For any patient prescribed an inhaler, the RN should ensure the client can self administer the medication. i. Teach back needed b. The patient should wait 1-2 minutes between puffs c. The patient should wait 5 minutes between 2 different inhalers d. The patient should take a bronchodilator before a corticosteroid medication (B before C) e. The patient must keep track of doses on their inhaler f. If opening a new inhaler, the patient should shake it and test before use. g. If dexterity is limited, a spacer can be used to get more medication in the airway. h. If the patient uses a steroid, they must wash their mouth out after use. i. If not, fungal infection may occur i. The patient should hold breath 10 seconds after receiving a puff. 2. Know the difference between short and long term treatments for asthma and COPD a. Short term asthma treatment: i. Bronchodilator: albuterol 1. Acts as a rescue inhaler during asthma attacks. 2. Onset is in 5 minutes and will last longer. ii. Xanthine Derivatives: theophylline 1. Dilates airways 2. Can have high drug interactions in the body

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iii. IV/ inhaled glucocorticoids. b. Long term asthma treatment: i. Bronchodilator: salmeterol. 1. Used to control symptoms of asthma 2. Never is used alone (often with steroid) ii. Anticholinergics: ipratropium bromide 1. For long term asthma prevention 2. Works very slowly. 3. Fast onset, short duration * Tiotropium has longer duration that Ipratropium iii. Corticosteroids: fluticasone or Budesonide 1. Non bronchodilation 2. Can take several weeks to show c. COPD treatment: i. Bronchodilator- short acting albuterol ii. Steroid iii. Must keep o2 saturation between 88-92% Know classifications for respiratory drugs (what’s used as a rescue inhaler, and what is for long term management) a. Rescue inhalers: albuterol, epinephrine, metaproterenol, IV steroid b. Long term: salmeterol, ipratropium, theophylline, montelukast ,fluticasone Treatment of acute asthma a. Oxygen use b. Short acting bronchodilator- albuterol c. Corticosteroid- ipratropium bromide IV d. Will relieve hypoxemia, reduce airway inflammation, and relieve obstruction. Administration of bronchodilator (MOA,SE,Considerations) a. MOA: mimics the sympathetic NS and opens up the lungs and stimulates beta receptors b. Fast acting: used for acute asthma relief, Long acting is for chronic asthma management and COPD c. AE: tachycardia, angina, tremors, nervous and shaky feeling, hyperglycemia. d. Considerations: ensure patient takes medication as prescribed and does not overuse short acting bronchodilator. Never use it alone with asthma treatment. Administration of glucocorticoids (IV vs inhaled, nursing interventions, pt. education) a. MOA: works to stop the inflammatory process in the lungs, preventing bronchoconstriction. Stabilizes WBC membranes that release bronchial constricting substances, increases bronchial smooth muscle beta adrenergic stimulation. b. Inhaled: used for asthma and is the most tolerated and fast acting, but can also be IV for systemic effects on the body. c. AE: throat and mouth irritation, dry mouth, oral fungal infections. d. Must be used with another drug for asthma control. e. Nursing interventions: must teach patients to rinse mouth out after steroid use to prevent oral fungal infections, take bronchodilator 5 mins before steroid. Tiotropium administration, onset, and therapeutic level timeframes

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a. It is an anticholinergic medication used to treat maintenance therapy and bronchospasm in patients with COPD. Will block muscarinic receptors in lungs b. Inhaled form. c. Not for asthma d. Therapeutic effects start 30 min post inhalation, peaks in 3 hrs, and lasts 24 hrs. With consistent dosing, bronchodilation will improve after 8 days. e. AE: dry mouth. Can minimize by drinking fluids or sucking on hard candy. OTC sympathomimetics (e.g., decongestants) use in cardiac patients a. Sympathomimetics stimulate the immune system. b. OTC decongestants such as pseudoephedrine are sympathomimetics. c. Patients with cardiac problems must have caution with use of these drugs and hypertension treatment. Treatment principles of cold symptoms in children (treat individual symptoms) a. Many medications used OTC to treat colds are combination medications. b. In children, it can be dangerous if used as a combination medication for a cold. c. The parent should treat the symptoms only with individual agents and only with agents indicated for pediatric use. Ulcer prevention with chronic NSAID use (identify specific med class) a. NSAIDs inhibit prostaglandin biosynthesis and reduce blood flow, mucus and bicarb. b. They increase risk of ulcers forming. c. Best treatment of NSAID ulcers is with H2 receptor blockers and PPI. d. Must also stop NSAID use as well. Antacids and Cimetidine (patient education) a. Antacids are used to help neutralize acid secretions and promote gastric mucosal defenses in many ways and reduce pain associated with acid related disorders. i. Many different types such as Magnesium Salts, calcium carbonate, sodium bicarbonate, simethicone, etc. ii. AE: 1. Al/Ca= constipation 2. Mg= diarrhea 3. HCO3= metabolic alkalosis 4. Cal carbonate= increased acidity and renal calculi. b. Antacids also reduce the ability for other drugs to be absorbed into the body. c. Cimetidine is a H2 receptor blocker that works to block H2 receptors, reduce H ion secretion in parietal cells, suppress acid secretion and increase stomach pH i. AE: CNS confusion and depression in older adults, decreased libido, impotence and gynecomastia. ii. IV bolus= hypotension and dysrhythmias d. Antacids will reduce absorption of cimetidine. i. The patient must wait 1 hr before taking cimetidine and antacids e. Call HCP before buying OTC medications General GERD treatment principles a. GERD there is a problem with the lower esophageal sphincter, allowing for acid to go up into the esophagus from the stomach.

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b. Will use PPI if anything to help. c. Once patient stops PPI, they can relapse and have GERD symptoms d. Relapse of GERD is often why medications are taken for long term maintenance. However, short term use may occur also. PPI’s Omeprazole MOA, SE, Indications, use in older adults a. Proton Pump Inhibitors such as omeprazole and pantoprazole, help to prevent movement of hydrogen ions from cells into the stomach. causes all gastric acid secretions to be blocked (no HCl is produced!) b. Helps to treat GERD, esophagitis, short term gastric and duodenal ulcers, NSAID ulcers, stress ulcers, H. pylori formed ulcers. c. AE: HA, GI effects- D,N,V, pneumonia, osteoporosis, fractures, hypomagnesemia, c.diff, gastric cancer. d. Can be administered various ways: PO,IV, NG e. Use in older adults: encourage older adults to consume adequate calcium and vitamin D, as therapy can increase risk for fractures and osteoporosis. Sucralfate (mechanism of action, interactions) a. Sucralfate is a cytoprotective drug that is used to treat stress ulcers and PUD. b. It works by attaching and binding to the base of ulcers, forming a proactive barrier over the area. It can then protect areas from pepsin that can break down proteins and make ulcers worse. c. AE: constipation, nausea, dry mouth. d. Can impair absorption of other drugs- must give other drugs 2 hrs before this one. Antacids may interfere with effects. e. Will bind with phosphate and reduce levels in renal patients. General principles of treating constipation a. Constipation occurs when the patient has hard stools, infrequent stools, excessive straining, and unsuccessful defecation. b. Key thing is to assess patients to determine if it is real constipation, ileus or a bowel obstruction BEFORE giving medications. i. No laxative if Small Bowel Obstruction, ileus- do x ray, bowel sounds, etc. c. A cause of constipation is poor diet that is deficient in fiber and fluids. can be corrected this way. d. If diet does not help, laxatives may be used to soften the stool. i. They can reduce painful bowel elimination. ii. Decrease strain to prevent vasovagal stimulation. iii. Empty the bowel before treatment procedures iv. Obtain a fresh stool sample. v. Assist with loss of bowel tones. Bulk forming laxatives administration principles a. Bulk forming laxatives work by absorbing water to increase bulk and soften stool. It also causes bowel distention to initiate reflex bowel activity. b. Administration: the patient must take a bulk forming laxative with a full cup (240ml) of juice or water. Opiate use related constipation and treatment

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a. Opiates work to decrease bowel motility and reduce pain by relief of muscle spasms. They also decrease transit time of stool through the bowel, allowing more time for water and electrolytes to be absorbed. b. Used for patients with frequent diarrhea, to decrease stool in ileostomy and decrease diarrhea from opioid withdrawal. c. If a patient takes too much of an opiate due to its dependent effects, a patient may experience s/s similar to morphine and may cause an increased constipation. The patient will need naloxone to help reverse this cause. Senna side effects a. Senna is a stimulant of the intestines and works to increase peristalsis via intestinal nerve stimulation. b. A big side effect of Senna use is that the patient may have a yellow/brown or pink color to the urine that is harmless. Stool softeners and surgical patients a. Stool softeners will help the stool pass easier through the hypoactive bowel. It will not stimulate bowel activity. b. Will help with post surgical constipation. Ondansetron side effects a. Ondansteron is a serotonin agonist that blocks receptors located in the vagal nerve, GI tract, and chemoreceptor trigger zones in the CNS. b. Used to treat CINV, prevention of post-op nausea and vomiting. c. Side Effects: HA, diarrhea, dizziness, prolonged QT interval, risk of torsades de pointes. Concurrent use of Digoxin and Furosemide (monitoring, interactions) a. Furosemide, a loop diuretic, causes excretion of both sodium and potassium from the body. b. A patient taking digoxin is at risk for having a life threatening arrhythmia due to low potassium levels. c. Nausea and vomiting may also play into the role of having hypokalemia. d. Because of this interaction, the patient should cease use of furosemide and use a potassium sparing diuretic that will hold onto potassium. e. We must monitor digoxin levels, potassium levels, telemetry, and advise the client to eat foods rich in potassium or a supplement to increase potassium in the body if needed. Potassium wasting vs potassium sparing diuretic use (specific med examples from each) a. Potassium wasting diuretic is Loop Diuretic or Thiazide diuretic. i. These drugs work to block absorption of Na, K ,Cl and water. ii. Causes rapid diuresis. iii. Treats: HF, Hypertension, edema, renal disease, liver failure. iv. AE: hypotension ,dehydration, hyponatremia, hypokalemia, hypochloremia. v. May need K supplements to help maintain normal K levels. b. K sparing diuretic is spironolactone. i. This drug works to block absorption of Na and water, and causes the body to hold onto K. ii. Makes Na and water become excreted from the body, K is held on. iii. Used for hypertension and HF

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iv. AE:hypotension, hyperkalemia (the person holds onto more potassium), drowsiness, metabolic acidosis, gynecomastia, breast tenderness, irregular menstrual cycle, impotence. v. We must monitor ECG so we can assess for arrhythmia related to high K levels, no salt substitutes should be used. Concurrent use of Furosemide and gentamicin a. Furosemide is a diuretic that is ototoxic b. Gentamicin is an antibiotic that is also ototoxic. c. Must have caution when taking these drugs together. d. Teach patients to recognize tinnitus and report it to HCP if taking these 2 medications. Angioedema (common meds that cause it, interventions) a. Angioedema is an adverse effect with ACE inhibitors and A2RB use. b. S/S: facial and tongue swelling. Can be fatal. c. Can be treated with epinephrine for initial reaction. d. The patient with angioedema must discontinue ACE inhibitors or A2RB drugs and never use them again. ACE inhibitors and coughing (interventions) a. A side effect with ACE inhibitor use includes a dry cough. This is due to bradykinin being at increased levels. b. If a patient does not like coughing, we must notify HCP and switch the patient to another medication. ACE inhibitors side effects and patient education a. SE: 1st dose hypotension, dry cough, angioedema, hyperkalemia, fetal injury. b. Education: i. Change positions slowly due to 1st dose hypotension. ii. Teach about relief methods for dry cough like sucking on hard candy or cough drop. However, if they cannot handle the medication because of a cough, they must notify the provider to switch medication. iii. Teach about s/s of angioedema and what to report to the provider. The patient will not take ACE drugs again if this occurs. iv. Educate patients to avoid foods high in potassium. They also must avoid salt substitutes as they are full of potassium. v. For fetal harm, they should notify HCP if they are pregnant or plan to be pregnant while on the medication. vi. Will interact with K sparing diuretics and cause even more increased levels of potassium, so must educate patients to not take spironolactone. Nifedipine and metoprolol concurrent use (review why and who needs it) a. Nifedipine works on the blood vessels, causing dilation. However, a response that may occur is reflex tachycardia. This response may cause more pain in those with angina. b. Because of this, one may use a beta blocker like metoprolol to prevent reflex tachycardia. Beta blockers mechanism of action, SE, contraindications a. MOA: beta blockers bind to beta 1 and 2 receptors and block responses.

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i. This causes decreased HR, decreased contractility, decreased cardiac output, decreased SA to AV node conduction. It also decreases peripheral resistance and decreases renin release. b. Indicated for those with hypertension, angina, PSVT, HF, cardioprotection, migraines, anxiety. c. SE: low HR, AV block slowed conduction, bronchoconstriction and bronchospasm, hypoglycemia, orthostatic hypotension, impotence, depression. d. Do not use it with patients who have heart lock or bradycardia, COPD or asthma. e. May prevent reflex tachycardia with Nifedipine CCB all things a. Calcium channel blockers work in 2 ways. i. On the heart- vascular smooth muscle and heart- verapamil and diltiazem ii. On the vessels- only smooth muscle- nifedipine. b. Calcium channel blockers work to block calcium channels in smooth muscle, causing vasodilation, block calcium channels in myocardium, decrease contraction and HR and conduction, decrease afterload, increasing perfusion. c. Treats: hypertension, angina, SVT, Afib, aflutter. d. AE: hypotension, reflex tachycardia- use metoprolol, dizziness, peripheral edema, gingival hyperplasia e. Must monitor BP and HR and hold the med if apical HR is higher than 100 and SBP is less than 90, change positions slowly, monitor weight, give regular oral care. f. NO GRAPEFRUIT JUICE! Treatment of HTN in diabetes a. In patients who are diabetic and hypertensive, the target BP is the same as the population (less than 120/80). b. Preferred drugs are ACE,A2RB,CCB, low dose diuretics. c. Some of the medications may suppress glycemic index and cause hypo/hyperglycemia. d. Use diuretics with care. Furosemide indications (side effects, toxic effects) a. Indications :HF ,Hypertension, pulmonary edema, edematous states b. SE: hypotension, dehydration, hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia c. Can be ototoxic- s/s of tinnitus, hearing loss. d. Hypokalemia may occur, we must monitor ECG and give K supplements and food. e. Interacts with digoxin- causing lowered potassium levels, lithium will increase, antihypertensives will be additives and cause more hypotension. Digoxin therapeutic levels (specific number!) and potassium, how to give digoxin a. Therapeutic level is 0.5-2.0 b. K level 3.5-5, Digoxin can cause arrhythmias if used with medications that rid potassium. If one has low K levels, arrhythmia may occur. c. To give: assess vitals first and potassium levels, obtain apical heart rate for 60 seconds. Will hold drugs if HR is less than 60 and the BP less than 90/60. d. Digoxin toxicity i. S/S:

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1. Early: N,V,D, GI effects, anorexia, abdominal pain. 2. Late: decrease HR, vision changes- halos, green yellow blue vision, flickering lights. ii. Give digibind IV as antidote iii. Monitor lab values of serum digoxin level since they go down slowly. Amiodarone (side effects, indications, MOA) a. Amiodarone is a potassium channel blocker that works to reverse dysrhythmias, v fib, unstable ventricular tachycardia. b. It works on the heart to reduce automaticity in SA node, reduce contractility, reduce conduction velocity, widens QRS, prolongs PR and QT intervals c. AE: pulmonary toxicity, cardiotoxicity, teratogenesis, corneal deposits, optic neuropathy. d. Do not use grapefruit juice with K channel blockers as it can increase levels of drug e. Do not use cholestyramine as it can reduce drug levels. f. Remember that all drugs that treat dysrhythmias can also cause other dysrhythmias! g. Goal: put patient in healthy sinus rhythm Magnesium elimination in the body a. Magnesium is excreted in the kidneys. b. May take in larger amounts when a loop diuretic is used. HMG-COA reductase inhibitors (timeframes for administration, max effect, etc.) a. These drugs are the most effective in lowering LDL and elevating HDL, reducing TG levels. b. Also has cardiac benefits of promoting plaque stability or less growth, reducing risk for CV events, and increasing bone formation. c. Must give at night once a day because it will mimic the body’s production of cholesterol. d. AE: HA, rash, GI effects e. Rare: myopathy or rhabdomyolysis- muscle breakdown, liver toxicity, new onset diabetes and cataracts with older patients. f. Do not use other lipid lowering drugs or in pregnancy. g. NO GRAPEFRUIT JUICE! Concurrent use of Colesevelam and Insulin a. Colesevelam is a bile acid sequestrant that binds with bile in the gut, preventing absorption. b. This drug is also used for adjunct therapy in patients with type 2 diabetes and insulin to prevent hypoglycemia. Lovastatin patient education a. At night, once a day b. Inform about the risk of myopathy and to notify the provider if muscle pain occurs. Cholesterol lowering agents patient education a. May take a couple weeks to see lipid level changes. b. Best course of action is to...