Pharmacology Exam 2-2 - Study Guide

Study Guide Pharm Exam 2 Test contains: 50 questions, 4 math problems, 4 select all that apply, 1 ordered-response. 75 mins to complete. Classification Generic name Brand name Expectorant guaifenesin Mucinex Mucolytic acetylcysteine Mucomyst Expectorants- Reduces surface tension, stimulates and thins secretions, improves cough productivity. Therapeutic use: Symptomatic relief of dry, nonproductive cough; helps cough out excess secretions. Guaifenesin (Mucinex) is the most commonly used expectorant. Safe for asthma; NOT for COPD. Mucolytics- Breaks down the thick secretions Acetylcysteine loosens up thick respiratory secretions. Avoid asthma patients- Can worsen bronchospasm. -This drug is the Antidote for acetaminophen (Tylenol) poisoning. Drug Name Dimenhydrinate (dramamine) Diphenhydramine (Benadryl) MOA H1(histamine) receptor agonist; Relieves motion sickness and nausea. First generation/sedating antihistamine. Use for mild allergic reactions, insomnia, anaphylaxis. Adverse effects Sedation/drowsiness, urinary retention, constipation and dry mouth. Anticholinergic effects; can also cause drowsiness. Patient education Avoid driving. Increase fluid intake, increase physical activity. Suck on hard candy for dry mouth. Void Q 4 hr. How do you educate patients to relieve this? Take sips of water, suck on hard candies, increase fluids: 2-3 L each day, from food or beverages, and increase fiber. BRONCHOdilators: B Beta 2 Agonist →Albuterol A Anticholinergics→Ipratropium M Methylxanthines→ Theophylline ·Beta 2 Agonist: Albuterol - Short-acting beta 2 adrenergic agonist Works FAST for Acute Asthma. Administration: Shake it before you take it→exhale completely, place lips around mouthpiece, breathe in deeply over 2-3 seconds while pushing down on the canister, hold breath for 10 seconds, Exhale slowly through pursed lips. Patient education: Use albuterol inhaler BEFORE fluticasone. Expected effects: Tachycardia, mild hand tremors and increased cough. Report if not working after 3 doses; report increased HR and chest pain, arm and jaw pain. Avoid caffeine, NSAID, beta-blockers. *How does albuterol help with breathing,not just bronchodilation? Bronchospasms are relieved, histamine release is inhibited and ciliary motility is increased. ☠ Methylxanthines→Theophylline-Relaxes smooth muscles of the bronchi. *Therapeutic use: Long-term asthma and COPD. Administration: *Slowly, via an IV pump, or chewable tablets. Therapeutic range 10-20 mcg/mL. Adverse effects:The 3 Ts→ Toxic over 20 mcg/mL; Tonic-clonic seizures; Tachycardia and dysrhythmias Tachycardia, dysrhythmias. SNS effect similar to caffeine effects. GI distress, restlessness and tonic-clonic seizures. Alert provider of tachycardia before giving next dose. #1 Priority sign of toxicity: Seizures Patient education: Avoid caffeine (stimulants), take with water in the AM, avoid high protein diets(it decreases duration of action).Do not chew or crush. ☠ 1 *For acute asthma (status asmaticus): Administer Albuterol FIRST, wait 5 minutes before giving the corticosteroid. ⟥Anti-Inflammatory Agents: S Steroids Beclomethasone, methylprednisolone, fluticasone L Leukotriene inhibitor Montelukast M Mast-cell stabilizers Cromolyn Steroids- The 3rd medication used during acute asthma attack. ⟥Beclomethasone Patient education: Rinse mouth after using; do not swallow water; rinse metered dose inhaler after each use. Use as prevention not for acute attacks. . Adverse effects: Drug changes the flora of the mouth= Thrush (candidiasis), mouth sores, redness, white patches (report to provider). Treat with antifungal meds: mycostatin & nystatin. ⟥Prednisone (Glucocorticoid) *Oral glucocorticoids are used short term 3-10 days after an asthma attack. -Corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. Adverse effects: Oral glucocorticoids can suppress production of glucocorticoids. Abrupt withdrawal can lead to a syndrome of adrenal insufficiency (suppression of adrenal function) -Cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication. -Avoid NSAIDs. ⟥Fluticasone/salmeterol Inhaled Used for daily management of asthma= For asthma maintenance and prevention. Regular schedule; not PRN. Teach: Gargle after each use, use a spacer to reduce the amount of drug in the mouth and throat. Adverse effects: Candidiasis and mouth sores Report any white patches inside the mouth or on the tongue. Corticosteroid inhaler; decreases swelling and irritation of airway. Used to treat forms of arthritis, severe allergies, autoimmune disorders, & acute asthma exacerbation (after albuterol). glucocorticoid and long-acting beta 2 adrenergic agonist/ Combination inhaler. ⟥Leukotriene inhibitor Montelukast (Singulair) Used to prevent asthma symptoms.NOT for acute asthma attack MOA: Blocks the action of leukotrienes (proinflammatory chemicals that cause inflammation, fluid retention, mucous secretion, and constriction) in the lungs. Therapeutic response-Bronchodilation, decreased mucus production, ease of breathing; maintenance for asthma. Administration: Montelukast granules should be taken directly or mixed with certain soft foods (applesauce, carrots, rice or ice cream) Adverse effects-Drowsiness; take once a day, during the evening. Causes diarrhea. Can cause neuropsychiatric effects: depression, behavior changes, hallucinations, suicide ideation. Patient education- Given daily during the evening, except when being used for exercise-induced bronchospasm. It should then be given 2 hr before exercise, and not given again for 24 hr. ⟥Mast-cell stabilizer: Cromolyn: Reduces massive inflammation. Therapeutic use: Prevents activity-induced bronchospasm. Patient education: Take cromolyn 10-15 minutes before exercise/ exertion for max effects. -Sequence of using this with albuterol→Use after albuterol or after a bronchodilator. ·Pseudoephedrine (Sudafed)- Decongestant Contraindications: Patients with closed-angle glaucoma. -Can be altered with epinephrine into methamphetamine = Legal restrictions apply to this drug. Adverse effects: Restless, insomnia, anxiety and numbness. 2 ACE Inhibitors (angiotensin converting enzyme) pril ●What are they used for? HTN, HF, MI and reduces the risk of left ventricular dysfunction. Use for clients that are at risk for cardiac events. -For diabetic and non-diabetic neuropathy. Drug of choice for diabetics because of the renal protective effects. ●What are the therapeutic effects? Vasodilation, excretion of water, RETENTION of potassium, by action of the kidneys= can cause HYPERkalemia -Reduction in pathological changes in vessels and heart result from presence of angiotensin II and aldosterone. ●What do you look out for/teach your patients? Not considered prodrugs; not activated by the liver. o Lisinopril - causes dry cough (d/c and notify provider). Due to increase in bradykinin o Captopril - causes dry cough, hyperkalemia, numbness, tingling and paresthesia. ●Avoid NSAIDs, avoid salt substitutes-KCl. Adverse effects: Rash and dysgeusia (altered taste), angioedema, and neutropenia (Check WBC Q 2 weeks X 3 months). ARBs: Angiotensin Receptor Blockers tan · What are they used for? (RAAS system) ♦Hypertension(all ARBs) ♦Delay progress of diabetic nephropathy, and ♦HF retinopathy ♦Stroke prevention (losartan only) ♦Protect against MI ·What are the therapeutic effects? ❖ Block the action of angiotensin II in the body (constriction) ❖ Vasodilators - arterioles and veins ❖ Excretion of Sodium and water (by decreasing the release of aldosterone) ·What to look out for/teach patients? Angioedema(medical emergency). Losartan adverse effects & Interventions: Observe for manifestations of dyspnea, skin wheals, facial and throat swelling. Notify provider, treat with IV epinephrine, discontinue use of any ARB. Beta Blockers: lol Lowers HR and Lowers BP Bradycardia: Hold meds is less than 60 bpm, slow positions changes to avoid orthostatic hypotension Breathing problems: Never give to asthma patients=bronchospasm. Bad for health failure patients. (JVD); BP decreases. Blood sugar masking 70 mg/dL or less. Hides the s/s of diabetes. ·What are they used for? Decrease HR, contractile force and impulse conduction through the AV Node, decreases cardiac output and suppresses reflex tachycardia. What are the therapeutic effects? Blocks beta receptors in heart, which can cause a decrease in HR & contractility. 3 Atenolol (Cardioselective) Watch for bradycardia, due to blockage of beta receptors, heart failure (SOB), edema, coughing at night, rebound excitation, angina pain and MI. Propranolol (Inderal)- Non-selective-treats HTN, atrial fib and angina. adverse effects: Dizzy, fatigue, cold hands and feet, difficulty sleeping (insomnia) and nightmares. Calcium Channel Blockers: CCB - Decrease HR & BP Negative chronotropic, inotropic and dromotropic ·What are they used for? HTN, cardiac dysrhythmias (A-Fib, A-Flutter and SVT), angina pectoris. ·What are the therapeutic effects? Decrease HR & BP; decreases cardiac workload. What do you look out for/teach your patients? Count HR and BP. Low BP (< 100 systolic or Big drops) & HR <60 bpm Change positions= Orthostatic hypotension. Bad headaches. Hold medication. ❖ Verapamil - [Constipation] → Increase fiber and oral fluids. Observe for suppression of cardiac function (slow pulse, activity intolerance) Observe swelling in the lower extremities: peripheral edema. ❖ Nifedipine- [Reflex tachycardia]. Causes postural hypotension (dizziness and light headed). Instruct the client to get up slowly. Digoxin-Cardiac Glycoside: Decreases HR. Treats A-Fib, A-Flutter, second-line drug for congestive HF. Toxicity in the cardio system: dysrhythmias, bradycardia. Toxicity in the CNS: fatigue, weakness, confusion. Toxicity in the GI system: anorexia, nausea and vomiting. The drug is withheld if: * [Remember A.T.P. ] Apical pulse taken for 60 seconds→Withhold the drug if pulse is below 60 bpm. Toxicity, digoxin levels greater than >2.0 ng/mL. [Therapeutic digoxin level is 0.5- 2.0 ng/mL] s/s of toxicity: Vision changes (blurry vision/difficulty reading), nausea and dizziness. Potassium levels below < 3.5 mEq/mL, can trigger toxicity. [Normal Potassium range: 3.5-5 mEq/L] *Monitor: Creatinine levels Over 1.3 Kidney damage or dehydration. No pee pee [Normal Creatinine is 0.5-1.1] Treat Digoxin toxicity: Stop digoxin and potassium-wasting diuretics ASAP. Digoxin Immune Fab -Forms an immune complex; indicated for HYPERkalemia > 5 mEq/L Which lab can increase the toxicity of a drug? Low serum levels of potassium. 4 Diuretics: Loop or Thiazide→Furosemide or HCTZ =potassium “spilling/wasting” Diuretic Dru Name Effect Mai Advers effect Thiazide diuretics Potassium “wasting” Hydrochlorothiazide, methyclothiazide, indapamide Dilates arterioles, depletes Na⁺ and water. ⬇Hypokalemia, ⬇Sodium, Mg ⁺, Ca⁺ Hyperglycemia, and hyperlipidemia. Severe interaction with digitalis. Loop diuretics/ High-ceiling loop Furosemide (#1 diuretic), Bumetanide, ethacrynic acid Reduce edema, treat fluid in lungs, glaucoma, renal dz. ⬇Hypokalemia, Ototoxic (tinnitus) nephrotoxicity w/ long term use; alkalosis (pH > 7.45) Potassium- SPironolactone (Aldactone), triamterene, and amiloride. Antagonist of aldosterone. Prevents Hypokalemia, in treating HTN. ⬆Hyperkalemia, Endocrine effects: gynecomastia, deep voice, impotence, irregular menstrual cycle, hirsutism, and drowsiness. Metabolic acidosis-Restlessness. Avoid potassium foods: Peaches, bananas, avocados, dried apricots, potatoes, kale, melons Avoid salt substitutes, and green leafy greens. SParing s/s Hypokalemia: nausea, vomiting, leg cramps, generalized weakness. s/s of Hyperkalemia: Dyspnea, dysrhythmias. ★ How do you recognize phlebitis? (inflammation of the veins) redness, tenderness, or localized swelling. Adverse effects of Ginkgo Biloba - If taken with a Thiazide diuretic, like HCTZ, it can cause Hypertension. 5 Adrenergic Agonist: Mimics the function of the SNS, heart inotrope, thus increases cardiac output. · Example of drugs: Dopamine and Dobutamine, epinephrine, etc. Where are these receptors located? Kidney, brain and heart. CNS stimulant, specific areas of the brain or spinal cord. Stimulate excitatory neurons. Why is it used? Activates receptors in the kidney; cause the renal blood vessel to dilate. →This increases renal perfusion and reduces the risk of renal failure. Used for ADHD, narcolepsy, obesity, migraines. What ways will you know if it is working? Improved perfusion as evidenced by urine output: > 30mL/hr, with adequate kidney function. Improved mental state. Systolic BP will be maintained at > 90 mm Hg Vasodilators→ Nitroglycerin, Nitroprusside, Hydralazine, and Isosorbide Use with caution if the patient already has hypotension, since this drug decreases BP. In older adults: Bradycardia Administration routes -Sublingual tablet, spray, sustained release oral capsule, transdermal, topical ointment, IV. What instructions do you give patients about transdermal patches? Do not cut patches, remove at night, clean skin with soap and water after removal, and place onto hairless areas. Rotate sites. Nitrate free periods - 9-12 hours a day or else the body will get used to it and won’t be as effective. How frequently do you take this drug for acute angina pectoris? Every 5 minutes; max of 3 doses. Call 911 if pain is not relieved after the 1st dose. Then take the second tablet. ↳What else do you monitor for? Headache; orthostatic hypotension→check BP. Side effects from taking Nitroglycerin & how do you manage them: ❖ Headache→Take Tylenol ❖ Orthostatic Hypotension→Get up/ Rise slowly ❖ Reflex Tachycardia→Administer Beta Blockers [metoprolol], or a CCB [verapamil]. ❖ Tolerance→Use lowest effective dose. ATI Practice Questions: 1. A nurse is caring for a client who has a dry nonproductive cough. Which of the following types of medication should the nurse recommend? a. Expectorant- help mobile secretions b. Mucolytic- liquefy secretions c. Bronchodilator-opens air passages d. Antitussive- suppress the cough reflex 2. The nurse is caring for a client who has bronchitis and a prescription for a mucolytic agent. Which of the following findings should the nurse identify as an adverse effect of this type of medication question? a. Fluid overload b. Bronchospasm c. Electrolyte imbalance d. Tachycardia 3. A nurse is providing teaching to the parents of a school age child with asthma medication for bronchospasm. Which of the following inhaled medications should the nurse instruct the parents to use to relieve an acute asthma attack? a. Salmeterol b. Cromolyn c. Fluticasone d. Albuterol 4. A nurse is assigned to care for several clients who are post- operative. The client taking which of the following medications is a risk of delayed wound healing? a. Nifedipine to treat HTN b. Prednisone to treat persistent arthritis exacerbation. c. Albuterol to treat asthma d. Chlorpromazine to treat schizophrenia 6 5. A nurse is providing discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects? a. Drowsiness b. Constipation c. Oliguria d. Tachycardia 6. A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching? a. The client holds his breath for 10 seconds after inhaling the medication. b. The client takes a quick inhalation while releasing the medication from the inhaler. c. The client exhales as the medication is released from the inhaler. d. The client waits 10 min between inhalations. 7. A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects. a. Hyperglycemia b. Adrenocortical insufficiency c. Severe dehydration d. Rebound pulmonary congestion 8. A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide? a. Check the pulse after medication administration. b. Take the medication with meals. c. Rinse the mouth after administration. d. Limit caffeine intake. 9. 5 mg/kg PO every 12 hr for 5 days. The client weighs 88 lb. How many mg should the nurse administer per dose? 200mg 10. A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching? a. "If my breathing begins to feel tight, I will use the cromolyn immediately. b. "I will be sure to take the albuterol before taking the cromolyn." c. "I will use both medications immediately after exercising." d. "I will administer the medications 10 minutes apart." 11. A nurse in an emergency department is preparing to administer theophylline by continuous intravenous (IV) infusion to a client who is an experiencing an asthma attack. Which of the following actions should the nurse take? a. Infuse the medication with an IV pump. b. Cover the IV container with dark paper. c. Administer a test dose first. d. Infuse the medication at 35 mg/min. 12. A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol. For which of the following adverse effects should the nurse instruct the client to report to the provider? a. Sedation b. Increased appetite c. White coating in the mouth d. Dry oral mucous membranes 13. A nurse is evaluating teaching on a client who has a new prescription for montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching? a. "I'll rinse my mouth after taking this medication." b. "I'll take this medication when I get an asthma attack." c. "I'll take this medication once a day in the evening." d. "I'll use a spacer device when I inhale this medication." 7 14. A nurse is teaching a client who has asthma how to use a metered-dose inhaler (MDI). The nurse identifies the sequence of steps the client should follow. a. Inhale deeply and then exhale completely b. Place lips firmly around mouthpiece c. Breathe in deeply over 2-3 seconds while pushing down on the canister d. Hold breath for 10 seconds e. Exhale slowly through pursed lips f. Wait 60 seconds between each puff 15. A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take? a. Suggest that the client use a salt substitute. b. Obtain a 12-lead ECG. c. Advise the client to add citrus juices and bananas to her diet. d. Obtain a blood sample for a serum sodium level. Rationale: This client's potassium level is above the expected reference range of 3.5-5.0 mEq/L and is at risk for dysrhythmias as well as cardiac arrest. 16. Captopril and lisinopril are NOT prodrugs. Meaning patients suffering from ____ ______ can benefit from their use because they do not need to be metabolized by the liver. (Liver dysfunction). 8