Pharmacology Final Exam Review 2

Pharmacology Final Exam Review Nitroglycerine -Should be refrigerated and kept in a dark bottle without cotton because cotton absorbs the med. -It needs to be renewed every 3 months Nitrates -Best for coronary artery disease -Act on vascular smooth muscle causing it to relax -Cause arterial and venous circulation -Decrease myocardial oxygen use and increase scleral vessel circulation to the heart -Universal vasodilators -Used for angina The heart is fed by the coronary arteries Vasodilating agents are for peripheral vascular disease -Beta-blockers and calcium channel blockers Narrowing or constriction of smooth muscle in the coronary arteries and peripheral vascular systems reduces the amount of blood flow to the heart. This lack of blood supply results in diminished oxygen and nutrient flow to the heart causing chest pain or angina and peripheral vascular disease Peripheral Vascular Dilators -Relax smooth muscle of the peripheral arteries to increase peripheral circulation -They are used in the treatment of leg pain from vasoconstriction When using a transdermal Nitro patch, very little if any alcohol consumption is advised. You must also remove the old ointment completely before applying new ointment. Shaving the chest where you are going to put the patch is not necessary unless there is too much hair then you much shave it Acute Angina Attack -Take one Nitro and wait 3-5 minutes and if the pain is still there you take another one and wait 3-5 minutes and the you can take a third, but on the third you must call 911 because you might be having a mild MI Antidysrhthmics -An adverse effect is dysrhythmias, which is ironic High LDL levels can lead to coronary artery disease; atherosclerosis

Antihyperlipodemics especially with the elderly, disturbed liver function and constipation is a constant threat The most significant consequence of hyperlipidemia is atherosclerosis Long term use of antihyperlipidemics the nurse needs to monitor liver function and give the patient vitamins A,D, and K supplements which are taken at bedtime Cardio Tonics -Sometimes referred to as cardiac glycosides -They make the heart beat slower and stronger -2 main actions are to increase the strength of the contraction of the heart and to slow the heart rate -They very powerful and can be toxic to the heart -We look for Digitalis toxicity (confusion, nausea, tachycardia, and seeing halos around dark objects) When a patient is on Digoxin the nurse is looking for anorexia, nausea, vomiting, and weakness along with tachycardia and seeing halos around dark objects The Therapeutic range for Digoxin is 0.5-2 In the ER when a patient has PVC’s (premature ventricular contractions), it’s a ventricular dysrhythmia. The dug Lidocane is given Hypertension- a disorder in which the BP is elevated above normal limits for age BP above 140/90 is associated with accelerated vascular damage of the heart, brain and kidneys, which leads to increase risk of death Primary Hypertension- affects 80%-90% of people with hypertension and the cause is unknown Secondary Hypertension- when the BP is elevated as a result of another disease process or problem Diuretics- used to decrease blood pressure by producing sodium and water loss and lowering the rigidity of arteries Diuretics are used because they are popular, safe, well tolerated, and inexpensive A common adverse reaction to diuretics would be hypokalemia except for potassium sparing diuretics Lasix- is a loop diuretic and what you would have to do is report weight gain and edema of the feet. The nurse must also check the serum electrolyte levels

Aldactone- is a potassium sparing diuretic Vasodilators reduce systolic and diastolic BP by direct relaxation of smooth muscle, which lowers vascular resistance Manoxidil- side effect of abnormal hair growth Calcium channel blockers should not be suddenly stopped because it can cause very severe rebound angina attacks Lifestyle Changes to Help Reduce Hypertension Risks Can be changed: losing weight, increasing physical activity, reduce fat, salt, and calories in the diet, stop smoking, reduce alcohol intake Cannot be changed: age and race (the black race is more vulnerable) Signs of Dehydration Dry skin, increased resps, Hypotension, decreased urinary output, poor skin turgor and sunken fontanels in newborns For urinary incontinence the drug Ditropan is given For BPH the drug Flomax is given For a UTI then drug Pyridium is given which is a baldder analgesic -Drink 3 liters of water and cranberry combination per day -Report to the Dr headache, rash, vertigo -Urine turns red orange and stains clothing and toilets If a patient came in with fever dehydration and diarrhea you would expect that patient to be treated with minerals and electrolytes 3 General Procedures that Underlie all Procedures -Accuracy -Acceptance of responsibility -Asepsis Enteral Route- Meds given directly into the GI tract -Oral, NG tube, and rectal Tablets- dry powdered drugs compressed into small shapes Capsules- gelatin containers that hold powders or a liquid medication, they cannot be crushed, opened, or chewed Lozenges- medications that are sucked If a patient refuses their medication you circle it and document it in the nurses note If the patient has several medications you give the most important one first -Cardiac meds and antibiotics

Always pour liquids at eye level NG Tube, G Tube, and Peg Administration- you need to check for placement by injecting 5-10mls of air into the tube and listen for a gurgling sound in the abdominal area Parenteral Route- ID, IM, SQ, IV IV it the fastest way to get something into the body ID- 25-27 gauge, 3/8- ½ inch needle, 0.01-0.1ml SQ- 25-27 gauge, ½-1 inch needle, 0.5-2ml Insulin- 25gauge insulin syringe, 5/8 inch needle IM- 20-22 gauge, 1-2 inch needle, 3ml If you aspirate and blood appears withdraw the needle discard everything and start over When giving a PPD test it’s on a 5-15 degree angle and it should make a bleb or a wheal when you inject the medication In an infant IM is 1 ml or less, 1 inch needle, in the thigh muscle (vastuslateralis) In an adult IM injection site is the dorsal gluteal muscle is used because it is free of nerves and major blood vessels. The deltoid is used infrequently because its too small and can only accommodate a small amount of medication If you see an IV that is infiltrated (redness, swelling, and warmth along the vein) stop the IV and call the Dr.. The same goes for if you suspect and allergic reaction during IV administration Eye Drops Check the order, wash you hands, clean the eye with normal saline, tell the patient to look up, pull the lower lid down and instill the medication in the lower conjunctival sac, and apply pressure to the inner corner of the eyelid for 1-2 minutes with cotton or tissue Adult Ear Drops Pull the earlobe up and out. Have the patient lie on the unaffected side, instill the drops, and have them lay there for about 5 minutes 2 Major Neurotransmitters Nor epinephrine and acetylcholine 3 Naturally Occurring Catacolmines Nor epinephrine- secreted from the nerve terminals Epinephrine- secreted from the adrenal medulla Dopamine- in the brain and GI tract Migraines are called vascular headaches

Diagnosis of a vascular headache is confirmed if it is relieved by 1ml of Ergotamine administered IM Stopping antimigraine medications abruptly can cause a rebound headache The action of antimigraine medications it that they block nerve impulses at the receptors of the sympathetic nervous system Imetrex is an antimigraine agent it can be given intranasally, IM, or PO Caffeine is sometimes added to the Ergotamine derivatives to speed up absorption orally or rectally Pregnant women, anyone with a history of depression, or uncontrolled hypertension should not take antimigraine agents Zeranton causes mood changes, hyper activity, alopecia, and night terrors -Urine turns pink It takes several weeks before and anticonvulsant can be assessed Adverse effects of anticonvulsants are course facial features, and excess body hair The drug Seconal has a sedation effect on the brain Benzodiazepines are diazapine, chlorizepon and chlorizepate When a patient is on anticonvulsants good oral hygiene is important because of gum hyperplasia Herbs can be used to treat motion sickness -Peppermint and ginger Common Symptoms Seen in Parkinson’s Disease Fine muscle tremors, slow movement, rigidity, muscle weakness, shuffling The most common antivertigo is Dramamine, which is taken 30-60 minutes before traveling Zofran is used for nausea and vomiting when chemo is administered -NOT given IV push -Administered over 20-30 minutes -Given 30 mins before chemo Simemet is a combination of carbadopa and levadopa

Antiparkinson’s meds are best tolerated after meals to avoid GI upset Avoid vitamin B6 when taking anitparkinson’s medications Patient cannot drive while on antiparkinson’s medications Sweat and saliva darken on exposure to air when taking antiparkinson’s medications Antiemetic Compazine cannot exceed 40mg per day Thorazine is given for nausea and vomiting and hiccups Do not drive or operate heavy machinery on antivertigo meds Antianxiety meds do not cure they just reduce symptoms Cheese, sour cream, yogurt, raisins, bananas, avocados, chicken liver, pickled herring, soy sauce, meat tenderizers all contain tyramine and should not be eaten while taking MAO inhibitors SSRI’s are for long term therapy Prozac and Selexapro are for minor depressive episodes Lithium is an anitpsychotic and the patient cannot become dehydrated because it will for toxicity in the body A blood clot is a thrombus or thrombi Blood clots that are fixed are thrombi and blood clots that move are emboli Emboli eventually end up traveling to the heart lungs or brain because that is the normal route of circulation and major damage can occur Heparin and Coumadin are used as anticoagulants A low molecular weight of Heparin is called Lovenox and that is used post surgery to prevent clots from forming or present clot from getting larger they do not make clots go away Coumadin is long term therapy Heparin is short term therapy -Injected, and spots need to be rotated to prevent Lipodystrophy Heparin antidote is protamine sulfate Coumadin antidote is Vitamin K

-Foods high in Vitamin K are dark green leafy veggies, bananas, onions, fish cabbage veggie oils, cheese eggs liver When a patient is on anticoagulants you need to look for signs of internal bleeding -black tarry stools, constipation, distended belly APTT is the lab test to monitor Heparin PT and INR is the lab test for Coumadin Patients must schedule check ups for PT and INR checks, take the medication on time, avoid vitamin K, report side effects of blood in the urine or stool, unexplained bleeding, take caution in activities that can cause bleeding when taking Coumadin Effects of Anticoagulants Bleeding gums, epistaxis, coughing up blood In an emergency and the patient has a blood clot streptokynase is given to dissolve the clot Plavix is an anitplatelet agent Hormones are chemicals that are made in an organ or gland and carried throught the blood stream to another part of the body Hormones can be natural or synthetic Hormones can be used to replace or increase natural chemicals in the body Anabolic- builds up or constructs Catabolic- decreases complexity Look for hypoglycemia when insulin peaks Draw up clear then cloudy when combining insulin Oxytocin causes the uterus to contract Tocolytics are used to stop preterm labor While Taking Steroids Avoid alcohol Do not stop taking steroids suddenly No immunizations Take with food Dose may need to be increased if there is injury or illness

Adrenal Corticoid agents are widely used for short term treatment to reduce inflammation -Severe poison ivy Androgens may be used to treat cancer Some malignant tumors are estrogen dependent Mixedema is the most severe form of hypothyroidism -Non pitting edema, doughy skin, puffy face large tongue, decreased body hair and dry skin Synthroid is taken before breakfast and is effective when the patients pulse increases Hyperthyroidism- patient loses weight, increase in metabolic rate Hypothyroidism- patients gains weight, appetite decreases, dry skin, dry hair, constipation, slow Opioids- comes from opium, seed of the poppy plant -Morphine and codine For acute severe pain Morphine Sulfate is given Talk to the patient about fears of getting addicted to pain meds Pain Scale- numbers, words, colors, faces Narcan is used for narcotic overdose with resps below 12 No opioids for chronic pain because you have to take the medication all the time Aspirin is the number one anticoagulant and pain reliever Musculoskeletal relaxants for spasms is Flexeril -Avoid antihistamines, allergy, or cold meds at the same time -Used for Ms, Cerebral Palsey, arthritis, bursitis -When used long term they need to be gradually reduced to prevent withdrawal -Not given to children Greatest common concern is GI distress or GI bleed when taking aspirin Aspirin is used for mild to moderate pain and it decreases the risk of heart attack and stroke and used for RA Tylenol is an antipyretic it acts on the heat regulator in the brain Mucamist is the antidote for Tylenol

Tylenol can be toxic especially in children, and an overdose can be fatal, liver toxicity can occur Need to take NSAID’s with food or milk to avoid GI disturbances Methotrexate is used for RA, breast cancer, lymphosarcoma, and psoriasis Penacillimine binds heavy metals like in lead and copper poisoning and only has a 30% benefit -Cannot be used together with Gold or cytotoxic drugs Gout is a form of arthritis over production of uric acid forms crystals in the kidneys and they come down and go into the joint spaces and tear and bruise the tissue -Swelling inflammation and severe pain Alopurinal is a preventative medication for gout if you tend to get it a lot Nspaz is atropine sulfate is the most effective of the anticholinergic with minimal side effects when high doses are used Antacid neutralizes the acidity of gastric contents If taking tetracycline, avoid antacids 6-8weeks for proton pump inhibitors to take effect Peptic ulcers tend to reoccur, teach the pt to avoid stress, sporadic eating, and infection -May be caused by H.pylori -Ranitidine is used to treat Proton pump inhibitor is used for short term treatment of active duodenal ulcers -Take before meals GERD- Medication is Reglan, which increases gastric motility IBS- The drug of choice is Benzyl, optimal dosing is take it 30-60 mins before meals and at bedtime Antacids prevent the absorption of tetracycline Aluminum magnesium hydroxide gel increased the absorption of Aspirin and Coumadin is absorbed 50% faster when taken at the same time Antacids lose effectiveness overtime

Adverse reactions in anticholinergic therapy is common because high doses are usually required are, anxiety, dysphasia, dry mouth, urinary retention No Pepto Bismol if the patient is allergic to Aspirin If a patient call and reports diarrhea for 3 or more days, do not give them your advise put the Dr. on the phone or take a message and have the Dr. call them back with what they should do Imodium is a very common antidiarrheal medication If the patient is on fluid restrictions and is constipated bulk-forming laxatives is not the first choice because they require water to surround the stool Saline laxatives are used to cleanse the bowel for exams Stimulant laxatives increase peristalsis by stimulation of the colon nerves (Senna) Check for low potassium, hypokalemia Bisacodyl must be swallowed whole, never chew, bite, or crush -Never take with milk or antacids If the patient has been talking a laxative for over a month there is an increased risk for electrolyte imbalance Dulcolax take with plenty of liquids An alternative to taking laxatives all the time drink 6-8 glasses of water a day if the diet permits it Simethicone is and antiflatulent, it breaks up and prevents mucus-surrounded pockets of gas from forming in the intestine Disulfram (Antabuse) produces a severe sensitivity to alcohol Charcoal is used to absorb poisons