Pharmacology EXAM 1 Study Guide PDF

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Pharmacology 323 Exam 1 Help Sheet

This guide should be used as one tool to direct you in your studying. Test questions will come from all required readings, lectures and power point. This guide does not encompass every single question that will be on the exam. You are responsible for all course content. Make sure you use Professor Call’s Pharmacology Help Sheet to focus your studying. KNOW: General Pharmacological Principles 

Anaphylactic reactions – what physical assessment findings will be present? Skin rashes, itching, hives, swelling of lips, tongue, throat, low BP, tachycardia, rapid/ weak pulse.

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5 rights of drug administration: -PATIENT -DRUG -ROUTE -DOSAGE -TIMING -DOCUMENTATION -PREPARATION

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Pregnancy categories (i.e., ABCDX) A: NO RISK TO FETUS B: ANIMAL STUDIES SHOW ADVERSE EFFECTS ON ANIMAL BUT NOT PREGNANT WOMEN FETUS C: ANIMAL STUDIES SHOW ADVERSE EFFECT ON FETUS BUT NO ADEQUATE STUDIES IN WOMEN. D: EVIDENCE OF HUMAN FETAL RISK! BUT POTENTIAL BENEFITS MAY BE USEFUL DESPITE THE RISKS X: STUDIES IN ANIMALS AND HUMANS DEMONSTRATE FETAL ABNORMALITIES OR ADVERSE REACTION. Peak and trough times and reasons why this is done: PEAK IS USUALLY DRAWN AT HIGHEST CONCENTRATION OF A DRUG AND TROUGH IS DRAWN AT LOWEST CONCENTRATION IN THE BLOOD

STREAM. THIS IS DONW TO ENSURE THERE IS NO DRUG TOXICITY IN THE BLOOD. PEAK IS USUALLY DRAWN 1 HR AFTER INFUSION IS COMPLETE *MAY VARY BY DRUG AND HOSPITAL PROTOCOL. TROUGH USUALLY DRAWN ANOUT 30 MINUTES BEFORE NEXT DOSE. 

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All phases of pharmacokinetics and how this could be impacted across the lifespan o Including:  Protein binding significance: MEDS COMPETE WITH PROTEIN BINDING SITES ( USALLY ALBUMIN) MEDICATION MUST DETACH FROM BINDING SITE ( OR NOT BIND IN THE FIRST PLACE) IN ORDER TO REACH THE TARGET TISSUE.  First Pass: DRUG METABOLISM AFTER IT LEAVES TH EGI INTO THE HEPATIC PORTAL VAIN INTO THE LIVER, RENDERING LOSS OF POTENCY BECAUSE OF THIS ROUTE.  Differences in water percentage in older adults versus children: CHILDREN HAVE HIGHER WATER PERCENTAGE THAN OLDER ADULTS.  Drug characteristics that cross the blood brain barrier: WEAKLY CHARGED/SMALL PARTICLES/LIPID SOLUBLE (BARBITUATES RAPIDLY CROSS) THNGS THAT OPEN THE BBB ARE: HYPERTENSION ,UN-FULLY FORMED BBB AT BIRTH, HYPEROSMOLOLITY(HIGH CONCENTRATION OF A SUBSTANCE), MICROWAVES, RADIATION, INFECTION,TRAUMAS TO THE BRAIN, IE PRESSURE,INFLAMMATION, ISCHEMIA.  Critical concentration (minimal effective concentration): THE CONCENTRATION A DRUG MUST REACH IN THE TISSUES THAT RESPOND TO THE PARTICULAR ORGAN TO CAUSE A THERAPEUTIC EFFECT.  P450 cytochrome – what happens when an inhibitor or accelerator is introduced? i.e., grapefruit: IF AN INHIBITOR IS INTRODUCED, THE DRUG PRESENTED CAN RISE TO TOXIC LEVELS, BECAUSE IT IS A MOLECULE THAT BINDS TO AN ENZYME AND DECREASES ITS ACTIVITY AN INDUCER CAN DO THE OPPOSITE- THIS CAN SPEED UP THE METABOLIZATION OF THE DRUG, RENDERING A DRUG LESS POTENT. ***MAKING IT SO THE PRESENCE OF ONE DRUG COULD POSSIBLY SPEED UP OR SLOW DOWN THE METABOLISM OF ANOTHER DRUG.  Factors influencing how a drug is absorbed: “I IS OR MTI” -IV -IM -SUBCUTANEOUS -ORALLY

-RECTAL -MUCOUS MEMBRANES(SUBLINGUAL, BUCCAL) -TOPICAL -INHALATION Half- life and how to calculate T ½: THE AMOUNT OF TIME IT TAKES A DRUG TO DECREASE TO ONE HALF OF THE PEAK LEVEL.    

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Labs important to liver and metabolism: ALT/AST LEVELS OR CMP(COMPREHENSIVE METABOLIC PANEL) CHECKING FOR ALBUMIN LEVELS IN THE LIVER. Labs important to renal and excretion: BUN ( UREA LEVELS) CREATININE ( MUSCLE BREAKDOWN EXCRETED IN URINE LEVELS) Drug resistance, how this develops?

DEVELOPS WHEN ANTIBIOTICS AREN’T USED PROPERLY. OVER TIME BACTERIA ADAPT TO ANTI-INFECTIVE DRUGS. WAYS TO REDUCE: 1: LIMIT USE OF ANTIMICROBIAL AGENTS TO THE TREATMENT OF SPECIFIC PATHOGENS SENSITIVE TO THE DRUG BEING USED.2: MAKE SURE DOSES ARE HIGH ENOUGH, AND DURATION OF DRUG THERAPY IS LONG ENOUGH; USE ENTIRE DIRECTED ROUNDS OF MEDS. 3: BE CAUTIOUS ABOUT INDISCRIMINATE USE OF ANTI-INFECTIVE. Nurse scope of practice in administering drug o Can a nurse independently adjust the dose? NO o Can a nurse independently change a medication order? NO Drug Actions, Adverse Effects, Assessments, Labs, Nursing Interventions o Vancomycin (CEPHLEXIN) -A GLYCOPEPTIDE ANTIBIOTIC: o USED FOR: ENDOCARDITIS, SKIN, LUNG, BONE, C-DIFF & STAPH INFECTIONS ** USED IF ALLERGIC TO PENICILLIN & CEPHALOSPORINS. **CAN CAUSE HEARING LOSS. ** PHLEBITIS AT IV SITE. ** NEED PEAK/TROUGH.** OTOTOXIC & NEPHROTOXIC.  Red man syndrome: NURSING INTERVENTIONS: ***DON’T GIVE DRUG TOO FAST,CHECK RENAL FUNCTION, CHECK IV SITE, ASSESS FOR ANTIBIOTIC RESISTANCE.  Significance of peak and trough and times to draw: DUE TO NARROW THERAPEUTIC WINDOW. o Rifampin + (ISONIAZID) – AN ANTIFUNGAL o USED FOR: TUBERCULOSIS AND LEPROSY ( COMMONLY GIVEN)

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Body fluid color changes? CHECK FOR DARK URINE, ORANGE-RED STAIN URINE, CLAY STOOLS, JAUNDICE,LIVER TOXICITY, BCP RENDERED INEFFECTIVE, HEPATITIS Signs of toxicity? ABDOMINAL PAIN, NAUSEA, JAUNDICE. ***MONITOR ALT/AST ( LIVER ENZYMES). COMMON NAMES: RIFABUTIN ( MYCOBUTIN) ISONIAZID (GENERIC) TB MEDICATION PYRAZINAMIDE ( GENERIC) ETHANBUTOL ( MYAMBUTOL) STREPTOMYCACIN ( GENERIC)

o Ciprofloxacin -AN ANTIBIOTIC ( FLUOROQUINALONE) LEVOFLOXACIN IS ANOTHER ONE. (WIDELY USED) FOR GRAM BACTERIAS o USED FOR: UTI’S, RESPIRATORY AND SKIN INFECTIONS.  Assessments? ***ACHILLES/TENDON JOINT PAIN(ESPECIALLY FOR OVER AGE 60+) ***NEPHROTOXICITY, ***PHLEBITIS AT IV SITE.  Is this a strong or weak antibiotic? STRONG ANTIBIOTIC. o Aminoglycosides: GENTIMICIN/STREPTOMICIN/TOBRAMICIN – AN ANTIBIOTIC  How to help avoid renal adverse effects (i.e., what do you teach pt?)WATCH FOR:***OTOTOXICITY & NEPHROTOXICITY ENCOURAGE PATIENTS TO DRINK LOTS OF WATER!! o Fosamprenavir (LEXIVA)- IS AN INTIVIRAL DRUG o USED FOR: TREATMENT OF HIV INFECTIONS (PROTEASE INHIBITOR).  What stage in replication process does this inhibit virus proliferation? THE LAST STAGE OF THE PROCESS WHERE THE CREATION OF NEW VIRAL PROTEINS ARE MADE. o Macrolide ( AZITHROMYCIN) (CLARITHOMYCIN),(ERYTHROMYCINACE)  Why is this dangerous to the heart? IT CAN CAUSE EKG CHANGES RESULTING IN PAINFUL ARRHYTHMIAS. o Tobramycin: AN ANTIBIOTIC AMINOGLYCOSIDE: o ***OTOTOXICITY & NEPHROTOXICITY PEAK AND TROUGH NEEDED, ENCOURAGE LOTS OF H20, POSSIBLE HEARING LOSS OLD MED CALL PROVIDER IF HEARING LOSS OCCURS (PERMANENT DAMAGE)

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o Metronidazole: (FLAGYL) IS AN (OTHER) ANTIPROTOZOAL AND ALSO AN ANTIBIOTIC FOR ANAEROBIC BACTERIA COMMONLY USED FOR GI SURGERIES. o USED FOR: PELVIC ANTI-INFLAMMATORY DISEASE, BACTERIAL VAGINOSIS, ENDOCARDITIS EFFECTIVE FOR : GIARDIASIS, TRICHOMONIASIS, AMEBIASIS. USED FOR C-DIFF IF VANCOMYCIN IS NOT AVAILABLE. MOUTH/CREAM/OR IV  Beverages to avoid and why? ***AVOD ALCOHOL! ***AVOID OTHER ANTICOAGULANTS(INCREASED BLEEDING) o Carboplatin: ANANTINEOPLASTIC AGENT (CANCER MEDS) o USED FOR: PALLIATIVE OR INITIAL TREATMENT OF OVARIAN CANCER. o SPECIAL CONSIDERATIONS: DOSE AND TIMING DUE TO DETERMINED BY BONE MARROW RESPONSE; ALOPECIA IS COMMON. o Mebendazole AN ANTIHELMINIC(WORMS) DRUG o USED FOR: HOOKWORMS, PINWORMS, ROUNDWORMS,WHIPWORMS.  Signs of pinworm infection: ***ANAL ITCHING (COMMON IN CHILDREN) TAKE STOOL SAMPLES TO ASSESS FOR WORM OVA. TEACH ABOUT SPREAD OF OVA, WASH SHEETS AND UNDERWEAR IN CHLORINE WATER, TRIM NAILS, o Tetracycline AN AMINOGLYSOSIDE ( DOXYCYCLINE)/ (TETRACYCLINE) o USED FOR: TREATMENT OF ACNE OR SKIN INFECTIONS  Food to avoid and why? AVOID FOODS CONTAINING IRON OR CALCIUM MINERALS *** AVOID THE SUN, DON’T GIVE TO PREGNANT OR LACTATING WOMEN. o Clotrimazole (note that suffix zole can include multiple classes) IS AN ANTIFUNGAL. o USED FOR: SYSTEMIC FUNGAL INFECTION o NOT SAFE FOR: ***CHILDREN, DON’T PUT ON OPEN AREAS, HEPATIC DYSFUNCTION LIKELY BUT CAN EFFECT RENAL AS WELL. OBSERVE FOR SIGNS OF IMPROVEMENT OR SIGNS OF FUNGAL INFECTION. o Posaconazole: (NOXAFIL) IS AN ANTIFUNGAL AGENT: o USED FOR: PROPHYLAXIS OF INVASIVE ASPERGILLLUS AND CANDIDA INFECTIONS IN ADULT AND CHILDREN >13Y WHO ARE IMMUNOSUPPRESSED TO ANTI-NEOPLASTIC, CHEMOTHERAPY, 5

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GRAFT VS -HOST DISEASE FOLLOWING TRANSPLANTS, OR HEMATOLOGICAL MALIGNANCIES. **TAKE WTH FOOD. Ribavirin AN ANTIVIRAL MEDICATIONS USED FOR INFLUENZA A AND RESPIRATORY VIRUS. WATCH FOR DIZZINESS,INSOMNIA, NAUSEA, ORTHOSTATIC HYPERTENSION ***CONTRAINDICATED IN PREGNANCY-USE ADDITIONAL FORM OF BIRTH CONTROL Cephalosporins and generations:  how are they different: WITH EACH GENERATION COMES AN INCREASE IN ATTACKING GRAM NEGATIVE BACTERIA CROSSING THE BBB. 4TH GEN: CEFDITOREN (SPECTRACEF) AND CEFTORALINE ( TEFLARO) MOST RECENT. MONITOR FOR C-DIFF. ***WATCH GI TRACT  beverage to avoid with cefaclor? ***NO ALCOHOL 72 HRS. (2ND GENERATION- CEFLACOR) Augmentin –why are there 2 components? AUGMENTIN : AN AMINOGLYCOSIDE ANTIBIOTIC MADE OF: PENICILLIN + CLAVULANTE (A BETA LACTAMASE INHIBITOR) STOPS FROM BACTERIA BREAKING DOWN BETA LACTAM RING (PROTECTS RING)- STOPPING SUPERINFECTIONS FROM OCCURING. GIVEN FOR: STUBBORN UPPER RESPIRATORY INFECTIONS THAT AE RESISTANT TO PENICILLIN....