Download NURS 5334 Final Exam (100 out of 100) Questions and Verified Elaborations (Latest Update) and more Exams Pharmacology in PDF only on Docsity!
NURS 5334 Final Exam (100 out of 100)
Questions and Verified Elaborations
(Latest Update)
Prescribing basics Prescribing is regulated by state BON Proper RX Providers name and address, Telephone DEA Pt name/DOB/Addres Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity and signature. Drug Schedules: Most addictive to least 1 : Heroin,LSD, MJ 2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine, fentanyl, adderall, ritalin 3: codeine, ketamine, testosterone 4: xanax, valium, soma, ambient, tramadol 5: antidiarrheal, antitussives, lomotil, lyrica Pharmicodyamics The effects of drug on the body. Receptors are large molecules usually proteins, that interact and mediate the action of drugs
agonist produce receptor stimulation and a conformational change every time they bind. Do not need all available receptors to produce a maximum response Partial agonist drugs that have properties in b/w those of full agonist and antagonist. They bind to receptors but when they occupy the receptor sites, they stimulate only some of the receptors. antagonist drugs with affinity for a receptor but with no intrinsic activity. Affinity allows the antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from causing receptor activation. The block action of drugs (ex. Narcan) Bioavailabity % of administered dosage of the drug that survives the first pass through the liver and reaches the blood stream half life Time required for the amount of a drug in the body to decline by 50%, drugs with shorter half lives must be administer frequently. 4.5-5.5 times the half life to get steady state and to be limited from the body what the body does to the drug absorption, distribution, metabolism, excretion
Inhibitors compete with other drugs for a particular enzyme affecting the metabolism (decreased) of the substrate and decreases the excretion of the substrate and increasing the circulating drug inducer competes with other drugs for a particular enzyme affecting metabolism of the substrate (increases) decreasing the efficacy of the drug excretion renal: passive glomerular filtration, active tubular secretion, tubular reabsorption, gi tract, lung, sweat and salivary, mammary genomics study of the complete set of genetic information present in a cell, an organism, or species pharmacogenetics the study of the influence of hereditary factors on the response of individual organisms to drugs, and the study of variations of DNA and RNA characteristics as related to drug response Pharmacogenetics tests Mentioned on drug labels can be classified as "test required," "test recommended," and "information only." Currently, four drugs are required to have pharmacogenetics testing performed before they are prescribed: cetuximab, trastuzumab, maraviroc and dasatinib
wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to initial dosing Carbamazepine and Asisans Initiating carbamazepine therapy in these patients (allele HLA-B*1502) are at high risk for developing Steven Johnson syndrome or toxic epidermal necrolysis (TEN) The ability of the anesthetic to penetrate the axon membrane is determined by 3 properties. What are they? Molecular size, Lipid solubility, degree of ionization at tissue pH Why is epinephrine given with local anesthetics? Decreases local blood flow (decreased risk of bleeding) Delays systemic absorption of the anesthetic prolongs anesthesia reduces the risk of toxicity What is the most widely used local anesthetic? Lidocaine What is a possible fatal reaction to benzocaine Methemoglobinemia What is included in application guidelines for topical anesthetics
Which of the medications are used to treat OIC? Naloxegol, methylinaltrexone, lubiprostone Tolerance is defined as increased does of a med needed to obtain the same response Which medication is used for opioid abuse? Naltrexone Euphoria induced by morphine: An exaggerated sense of well-being caused by the activation of mu receptors Which medication is given nasally for migraines? Butorphanol Which of the following describes the mechanism of NSAIDs? Inhibition of the cyclo-oxygenase enzyme Second generation COX 2 inhibitors: Suppress inflammation and cause less risk for gastric ulceration than COX 1, increase risk for heart disease
Which of the following medications should not be given with ASA? Glucocorticoids Which medication is given for acetaminophen overdose? Acetylcysteine What are non endocrine therapeutic uses for glucocorticoids? RA, SLE, IBS, Bursitis, OA, Gout, disorders of the eye What is the danger of prolonged use of glucocorticoids? adrenal insufficiency Methotrexate can cause fatal toxicities of: Bone marrow, liver, kidneys, lungs. Hemorrhagic enteritis and GI perforation Jane is on etanercept for RA. The NP knows Jane should be checked for TB yearly What is first line treatment for gout? Colchicine, indomethacin
Celebrex second generation non ASA nsaids, lower risk for GI but can still cause renal impairment. given for OA, RA, dysmenorrhea. S/E: abdominal pain, renal impairment, sulfa allergies. Drug interaction: warfarin, Decrease effects of furosemide, (increases)lithium, ACE inhibitors. Acetaminophen Analgesic and antipyretic. Hepatotoxicity risk. No more than 3 g in 24 hr period. for overdose: acetylesistine. Can blunt immune response of vaccines glucocosteroids Risk for Cushings disease, diabetes, OA, risk for GI bleeds. If given over 7 days, needs to be tapered off unless on inhaled Corticorsteriods. Used in labor to mature lungs of infants. Therapeutic use: allergic condition, asthma and immune suppression. RA very different from OA. Autoimmune disease.Symmetrical morning stiffness that last for over an hour. Shortens life span of patients. Increases risk for CVD and stroke. When testing these patient, you want to do a full immunological test because it comes with other autoimmune diseases.
- First line treatment are NSAIDS and first line DMARD (methotrexate, minocycline) Gout Monoarticular arthritis, d/o r/t kidney don't excrete enough uric acid. Only way to diagnosis is joint aspiration and look for the uric crystals Prevention is best
Gout preventions Migraines trial and error of medication and triggers. start with over the counter and move to more aggressive over time. +2 a month, preventative medication is okay. Abortive medications: NSAIDS, ergoalcoloids (cause vasoconstriction), triptans (Seratonin 1b1d receptor agonist) Sumitriptan, cause vasoconstrictions, maximum dose is 200mg a day. can cause coronary vasospasm Preventative: Beta blockers, antiseizure medications (depikote and topimax), tricyclic antidepressants, Calcium Channel blockers, botox, vitamin b2/Co Q enzyme and butterbur. cluster headaches intensely painful headaches that affect one side of the head and may be associated with tearing of the eyes and nasal congestion, occur in series, 5-15 minutes prophylaxis tx with regular Headaches Depression tx SSRI, SNRI, Bupropion are first line treatments. Least side effects of any medications Mild/moderate depression or anxiety are okay to treat but anything else needs to be referred to a psychiatric NP tricyclic antidepressants Weigh gain, drowsiness, and terrible anticholinergic effects. beers list, Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine.
stimulate, appetite suppressant, helps with sexual side effects of SSRIs, S/E: dry mouth, constipation and increase risk of seizure disorder St. John's Wart (Hypericum perforatum) don't want to give this to patients with SSRIs, a lot of drug reactions, dosed at 300mg TID, CYP inducer lithium Excretion is reduced with sodium levels are low. S/E: GI disturbances, n/v/d, ataxia, thirst, tremor, high urine output, death. Very narrow therapeutic index Benzodiazepines drugs that lower anxiety and reduce stress: alprazolam, diazepam alcohol abuse nicotine abuse Prior to starting antidepressants, patients should have what lab testing to rule out hypothyroidism A 32 yo male is starting paroxetine for depression. He is complaining of not being able to obtain an erection. What can the NP do to help?
add bupropion A 6 yo us being treated with ethosuximide. She should be monitored for: Blood dycrasias which are uncommon but possible. Sandy is taking lamotrigine for seizures and wants an rx for OCPs which can interact with lamotrigine and cause: reduced lamotrigine levels, requiring an increase in the dose of lamotrigine The tricyclic antidepressants should be prescribed cautiously in patients with CAD Atropine Cause pupil finalization in eye exam Bethanechol (Urecholine) GI/GU stimulation following surgery, parasympathomimetic Pyridostigmine (Mestinon) Category: Cholinergic, Anticholeristinase, Use: Myasthenia Gravis, Precautions: May cause cram,ps, increased peristalsis
- Skin reactions may occur with hypersensitivity
- Beta blockers may negate therapeutic effects of dobutamine
- Monitor cardiac output
- Monitor peripheral pulses before, during, and after therapy
- DO NOT confuse dobutamine with dopamine Acetylcholine binds to both _____ and ______ receptors nicotinic and Muscarinic Norepinephrine binds to both ____ and ____ receptors alpha and beta Atropine is considered to be the antidote to ______ toxicity Cholinergic Sympathomimetic is the same as _______ agonist adrenergic Sympatholytic means the same as Anti-_____ adrenegic Muscarinic antagonist means the same as anti-_____ cholinergic
cholinergic means the same as _____ agonist and parasympathetic_____ muscarinic and mimetic Bradycardia, urinary urgency, bronchoconstriction, and pupillary constriction are the signs of _______ toxicity cholinergic Pupillary dilation, tachycardia, urinary retention and dry mouth are signs of muscarinic _________ drugs such as atropine antagonist An anticholinergic drug will _______ acetylcholine availability to the tissue? increase Alpha 1 agonist______ BP, while alpha 1 antagonists ________ BP? increase, decrease beta 1 receptor activation will lead to _____ heart rate? Beta 1 blockade will _____ Heart rate? increases/decrease
GI problems, drowsiness and nausea, seizures and coma are serious problems. monitoring of a patient on gabapentin to treat seizures includes: Recording seizure frequency, duration and severity Sam, aged 65, is started on L-dopa for his Parkinson's disease (PD). He asks why this is necessary. You tell him: the primary goal of therapy is to replace depleted stores of dopamine A 55yo patient develops parkinson's disease characterized by unilateral tremors only. The NP will refer the patient to a neurologist and should expect initial treatment to be Ropinirole (lesser symptoms need lighter drug) Inattention and sleep-wake cycle disturbance are hallmark symptoms of: delirium 3 types of information needed for neuropharmacologic drugs: type or types of receptors through which the drug acts. Normal response to the activation of those receptors (Agonist vs antagonist) What the drug in question does to receptor function cholinergic receptors and adrenergic receptors are mediated each by? Cholinergic by acetylcholine and adrenergic by epinephrine and norepinephrine
what are the subtypes of cholinergic and adrenergic receptors? cholinergic: nicotinic and mu Adrenergic: Alpha1, alpha2, beta1, beta 2 and dopamine what are the functions of alpha1 receptors? Vasoconstriction, ejaculation and contraction of bladder neck and prostate what are the functions of alpha 2 receptors? minimal clinical significance what are the functions of Beta 1 receptors? Heart: increases heart rate, force of contraction, velocity of conduction in AV node. Kidney: renin release what are the functions of beta 2 receptors? Bronchial dilation relaxation of uterine muscle vasodilation glycogenolysis what are the functions of Dopamine receptors? dilates renal blood vessels
