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Nurs 200 Pharmacology Study tools

by: Brittany Bedard

Nurs 200 Pharmacology Study tools NURS 200

Brittany Bedard
Lansing Community College

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Notes and study questions for pharmacology Exam 1
Irie lott
Study Guide
pharmacology, Nursing, Science
50 ?




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This 8 page Study Guide was uploaded by Brittany Bedard on Friday February 19, 2016. The Study Guide belongs to NURS 200 at Lansing Community College taught by Irie lott in Winter 2016. Since its upload, it has received 54 views. For similar materials see Pharmacology in Nursing and Health Sciences at Lansing Community College.

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Date Created: 02/19/16
Nurs200 – Pharmacology Unit I Study Questions Students: Study Questions are a tool, but do not replace the reading outline. Remember that the reading outline is the comprehensive guide to what will be covered on the exam. 1. What medications inhibit COX1/COX2? What are those medications used for? What adverse effects may occur from such inhibition? All NSAIDS- 1st gen inhibits COX1 and COX2 (Ibuprofen,Aspirin)- used to treat inflammatory disorders (arthritis) alleviate mild to moderate pain (suppress fever, relieve dysmenorrhea) suppress inflammation but creates bleeding risk.Adverse effects: Bleeding risk, GI irritation, aspirin toxicity (salicylism), Reyes syndrome
 2nd gen inhibits primarily COX 2 (celecoxib)- suppress inflam. and pain.Adverse effects- renal function impairment, hypertension and edema. Risk for MI and stroke, stopped being used as frequently due to cardiac issues.
 Acetaminophen (NOT an NSAID)- COX 2 blockade but not as strong as second gen NSAIDS. Used for pain and fever not anit-inflammatory. Main adverse effect: Liver failure 2. What types of patients should not receive NSAIDs? Children w/ viral infections, people with bleeding risk, pregnant women. 3. What desired effects does acetaminophen have? How is it metabolized? Used for pain and fever, metabolized by the liver and excreted in the urine. Half life is two hours. 4. What are some of the issues/problems that surround the use of over-the-counter drugs? Patients fail to report use, mask signs and symptoms of underlying conditions, drug interactions, high doses and toxicity. 5. Define the following terms and be able to discuss the different aspects of each: a. Absorption - Movement from administration site to the blood. Rate of dissolution: some faster or sooner than others. Blood flow: drugs administered to sites of heavy blood flow diffuse faster. Surface area: larger surface area=easier to absorb. Lipid solubility-more lipid soluble they can readily cross membranes and be absorbed quicker. pH portioning= absorption increases when pH are different. b. Distribution: movement of the drug thru the body. Depends on blood flow to the tissues, abscess and tumors can reduce blood flow and affect drug therapy.After the drug is delivered it must exit the vasculature. BBB has tight capillary membranes and p-glycoprotein to keep drugs from reaching the brain. Protein binding- if bound to albumin drugs are bond cant leave to go to where they need to go.Albumin only has so many binding sites which can cause drug interactions due to competing for binding sites. Free concentration will rise when drugs are competing.All must enter cells to go through metabolism and excretion. c. Metabolism- Most drug metabolism is done in the liver by hepatic microcosmal enzyme system. Six possible consequences of drug metabolism: accelerated renal excretion, drug inactivation, increased therapeutic action, activation of pro-drugs, increased or decreased toxicity. First pass=when hepatic inactivation happens rapidly in certain oral drugs these would then be administered parenternally. d. Excretion-removal of drugs by the body primarily by the kidneys, also done by GI, lungs and breast milk. Kidney damage or failure can decrease this. e. Miniumum effective concentration- If plasma levels are below the MEC then therapeutic effects will not occur. Drug levels in plasma need to be above MEC. Nurs200 – Pharmacology Unit I Study Questions f. Toxic concentration- Drug is too high and will be toxic. g. Therapeutic range- range between the MEC and toxic concentration. Drugs with lower therapeutic ranges pose more risk of toxicity. h. Therapeutic index- Measure of drugs safely used in lab animals. Compares the lethal response to therapeutic response and safety is judged by large or small space between lethal and therapeutic ranges. i. Single dose vs multiple dose drug levels- Single dose= Drug levels rise during absorption and decline and metabolism and excretion, delay in effects depends on absorption speeds. Multiple drug doses can cause plateau when the amount of drug administered and secreted between doses levels out. 6. Apatient has a drug level of 100units/mLand the drug's half-life is 2 hours. If no more drug is given, how long will it take for the blood level to reach a range of 25 units/mL? Four hours 7. Describe all the different ways that drugs exert their actions on the body.
 Some drugs have selective actions and bind to only a certain site but others are not selective and can bind anywhere causing drug to drug reactions or blocking bodily functions from happening on their own. 8. Describe all the ways that drugs can interact with each other. Explain the “grapefruit juice effect.” Grapefruit juice raises drug levels by inhibiting metabolism especially in calcium channel blockers. Drugs can intensify effects- increased therapeutic effects ore increased adverse effects, reduce effects- reduced therapeutic effects and reduced adverse effects. Some drug interactions are intentional for positive reasons and some are accidental and have to be watched carefully to avoid. 9. Describe the symptoms of an anaphylactic allergic reaction. Soft tissue swelling (throat and tongue), bronchoconstriction, shock=low BP 10. An appropriately written medication order should contain what elements? 
 Date, Patient name and another identifier, Dose, Route, Drug, frequency, special administration instructions sometimes. 11. Discuss the phases of the nursing process:
 Assessment,Analysis and planning (nursing diagnosis), intervention, evaluation. 12. Name and define the pregnancy safety categories. A-least likely for risk, animal studies show no risk and there are tests on real women proving no risk
 B- slightly more risk, animal studies show no risk but no tests on women. C-Animal fetus show risk of harm but no tests on women. D- proven risks in women but benefits might outweigh risks. X- Worst absolutely do not give to pregnant women, risks in women and animals are proven. 13. Describe how medication administration is different for the very young (infant) and the older adult when each of these is compared to the older child/adult. Children's drug amounts will be based off of their weight whereas adults are pretty standard doses. Nurs200 – Pharmacology Unit I Study Questions 14. Compare & contrast the symptoms of hypothyroidism and hyperthyroidism. Which drugs are used to treat each condition? What are the potential adverse effects of each? 
 SEE THYROID HANDOUT. 15. What is the prototype drug for treating hypothyroidism? Write a teaching plan for a patient with a new prescription for thyroid replacement hormone.
 Hypothyroidism drug=levothyroxine. 16. How is thyroid replacement therapy evaluated for effectiveness?
 Thyroid levels are monitored as well as symptoms of too much of drug causing adverse effects aka: treating for hypothyroidism by giving levothyroixine which then creates hyperthyroidism. 17. What is the prototype drug for treating hyperthyroidism? Discuss important nursing implications for this drug.
 Methimazole- DO NOT USE IN PREGNANT WOMEN! Tuesday, January 19, 2016 Unit 1 Nursing Pharmacology-Drug Administration - Know 3 main issues with anaphylaxis shock:
 Soft tissue swelling (tongue,throat), bronchoconstriction, shock=LOW BP. Anaphylaxis is an emergency, must be treated asap. - Drugs are going to have more than one indication: must know why patients are getting this drug (consider pre-existing conditions, medical history etc.), must know the proper dose, and proper route of the drug being administered. - Rights of Administration: must make sure patient, drug, dose, route, time and preparation, are all correct if so proceed to documentation and storage. However; if these are not correct then do not administer the drug. - All nurses must read and understand medication orders carefully and verify dosing calculations. If you don't understand the reason for using this drug: DO NOT administer it until you know and understand why. - Medication orders should have: Date, patient name & identifiers, the drug, the dose, the route, the frequent, and sometime special administration instructions. If an order is unclear: always call the prescriber to clarify. - The nurse should provide the education to the patient to safely take medications, but it is up to the patient to choose to adhere to the rules or not. - PRN- means pro re nata. This term means give to patients if you see fit, assess them then make the decision. Example: pain meds. Start w/ a low dose and go slow. - Always have a proactive nursing outlook, “what could go wrong?” know ways to fix if worst does happen. - Drug administration summary: Assessment, drug rights, teaching, only then we administer, document, reassess. - We can take verbal medication orders, but they must be clarified. - Know the pregnancy risk categories and the differences, there are 5 of them. Category X we definitely do not ever give. Category D do not want to give to pregnant women because of risk but sometimes the benefits to the mother outweigh this. Category A is the safest followed by B and C. Every drug is always a precaution. 1 Tuesday, January 19, 2016 - Pediatric dosing is all weight based because children's bodies are not standardized yet like adults. - Geriatrics many drug interactions that can be dangerous, patients bodies are not predictable and neither is their schedule of taking medications (they could forget/take too much without knowing) - BEERS criteria-list of medications that are risky to use in the geriatric population, help prescribers know what drugs are most safe. Unit 1 COX/Inflammatory Response - Know the inflammation sheet included in the supplemental for the course. - Cyclooxygenase (COX): synthesizes prostaglandins which are found in all tissues. - COX 1- daily housekeeping of the body (local police) the day to day actions.
 GI system: protects gastric mucosa
 Platelets: stimulates aggregation
 Kidneys: promotes vasodilation
 Uterus: promotes contractions - COX 2-produced at sites of injury & in the brain (batman)
 Blood vessels: promotes vasodilation
 Tissue injury: promotes inflammation and sensitizes receptors to pain
 Brain: mediates fever and pain perception - The drugs we will be learning this unit are all Cyclooxygenase Inhibitors
 NSAIDS- 1st GEN (Ibuprofen, Aspirin)
 2nd GEN (Celexocib)
 Acetaminophen- NOT an NSAID. - First Generation NSAIDS (Aspirin and Ibuprofen)
 Inhibit COX 1 and COX 2
 Used to treat inflammatory disorders (arthritis)
 Alleviate mild to moderate pain (suppress fever, relieve dysmenorrhea)
 Suppress inflammation but have many risks for bleeding. - ASPIRIN: Over the counter, anti inflammatory, antipyretic, analgesic. 
 2 Tuesday, January 19, 2016 Pharmacokinetics: none as of now.
 Adverse effects: (Standard dose for fever and pain relief is generally well tolerated.)
 GI irritation: nausea, dyspenia, heartburn, bleeding
 Clotting system: risk for bleeding and blood loss.
 Salicylism (aspirin toxicity): ringing in the ears, acidosis, nausea, vomiting, diarrhea, mental confusion and lethargy
 Reye’s syndrome: fatty liver degeneration and subsequent encephalopathy (acute vomiting and lethargy, confusing) ASPIRIN SHOULD NOT BE GIVEN TO CHILDREN ESPECIALLY NOT TO HELP FEVER.
 Contraindications: allergy, bleeding abnormalities, impaired renal function, surgical procedures, children with viral infections and pregnant women (this drug is a category d)
 Drug to Drug interaction: 
 interact w many other drugs by interfering with absorption and or metabolism. 
 Alcohol and glucocorticoids: can increase risk of GI ulcer/bleeding
 Anticoagulants: increase bleeding risk
 Nursing considerations for aspirin:
 Assess risk for bleeding, monitor platelet count, limit aspirin use to children (assess for viral infection)
 Administer w food for GI upset
 Evaluation: Patient should be evaluated to see if the symptoms being treated have stopped with use of the drug. - MAKE FLASH CARDS FOR ASPIRIN AND IBUPROFEN. - Allergy to drug is ALWAYS a contraindication. - Pregnancy is ALWAYS a contraindication. - Renal/Liver function is ALWAYS a contraindication. (due to extraction and secretion) - SECOND GENERATION NSAIDS- Primarily block COX-2
 Are just as effective as tradition NSAIDS at suppressing inflam. and pain.
 Somewhat lower risk of GI side effects
 Can impair renal function (limits vasodilation) and cause hypertension and edema.
 Increase the risk for MI and stroke (limits vasodilation and has no effect on platelet adhesion)
 Use of celecoxib has declined due to cardiovascular risks. - Prototype:Celecoxib 3 Tuesday, January 19, 2016 - ACETAMINOPHEN 
 Action/indications- effects come from COX-2 blockade, but with lower affinity than NSAIDS
 Does NOT provide anti-inflammatory effects.
 Used for pain & fever - Main adverse effects: LIVER failure.
 Unit 1 Thyroid - Responsible for T3 and T4, which are produced based off of a negative feedback system. (How much produced is based off of how much is already in the body) - Bound vs. unbound hormones: Bound=cannot travel to do their jobs, so unbound must do duties. - Metabolism-regulating the rate - Has effects on the following: heat production and body temp, cardiac output, oxygen consumption, metabolism, growth and development. - Hypothyroidism- Low thyroid hormones
 Signs and symptoms: weight gain, fatigue, brittle nails, hair loss, cold intolerance.
 Diagnosed by checking TSH- which would be high because negative feedback. Hormone levels are low, body is alert and thinks it needs more=high levels. - Hyperthyroidism- High thyroid hormones.
 Signs: Increased body temp, tachycardia, thin skin, palpations, hypertension, flushing, intolerance to heat, weight loss, oily skin, goiter, amenorrhea.
 TSH-LOW!!! - Hypothyroidism is treated by giving prototype: Levothyroxine (synthroid)
 Actions- mimicking normal thyroid hormone function
 Indications- replacement therapy for hypothyroid states
 Pharmacokinetics- Oral administration in the morning before breakfast. Half life around 7 days.
 Adverse effects: skin reactions, symptoms of hyperthyroidism, cardiac stimulation, CNS effects.
 4 Tuesday, January 19, 2016 Contraindications- Allergy, thyrotoxicosis, Acture MI
 Drug to Drug interactions- Take 2 hours before or after the following drugs: calcium supplements, antacids, cholestyramine (cholesterol drug), carafate (ulcer treatment), Oral anticoagulant (warfarin)
 - Anti-Thyroid Agents (drug for HYPERthyroid) prototype:methimazole (tapazole)
 Actions: prevents the formation of thyroid hormone which decreases all serum levels, does not destroy existing hormones. 
 Indications: hyperthyroidism treatment, in preparation for thyroid surgery/radiation therapy
 Pharmacokinetics: Oral administration
 Adverse effects: Hypothyroidism effects, do not use in pregnancy!!! Category D 1st trimester. Decreased WBC (agranulocytosis) - Nursing conditions for thyroid drugs
 Assessent: thyroid hormone levels, heart rate, blood pressure, amount of weight gain/loss (any other symptoms)
 Implementation: When and how to administer?
 Evaluation: reassess thyroid hormone levels and presence or absence of disease symptoms. 5


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