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UTA NURS 5334 ADVANCED PHARMACOLOGY
FINAL EXAM LATEST VERSION 2025-2026|
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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 Distribution movement of absorbed drug in bodily fluids throughout the body to target tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein binding, size of molecule (smaller molecules are more able to diffuse) Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugs can pass) Protein binding unbound drug is free which is active, crosses membrane. Low plasma proteins result in more free drug. Competition: when 2 highly bound drugs are given it increases the level of both drugs Metabolism
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 avoid wrapping the site and heating the site, avoid application to open skin Which medication will not cause rebound headaches from overuse? propranolol (preventative) What is the best option for menstural migraine?
low dose estrogen about 3 days prior to menses What food can trigger migraines? Hot dog d/t nitrates What medication is a Seratonin 1B1D receptor agonist? Sumatriptan Butterbur can help as prevention for migraine therapy. What side effect can occur? Liver damage What are the 3 main classes of opiod receptors? Mu kappa delta Which of the following will reserve he effects caused by opioid agonist? naloxone 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?
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. SSRIs Fluoxetine, paroxetine, sertraline, citalopram. effects don't start for several weeks (4-6 weeks) can cause weight gain, vivid dreams, bruxism, bleeding disorders, ED/sexual dysfunction, hyponatriemia, most can cause n/v that might go away. need to taper off these meds. can be used for panic disorder, pms, anxiety, ptsd, post menopausal women SNRI serotonin norepinephrine reuptake inhibitors, opposite of SSRI (weight loss and increase in energy) Desvenlafaxine (Pristiq, Khedezla) Duloxetine (Cymbalta) ― also approved to treat anxiety and certain types of chronic pain Venlafaxine (Effexor XR) ― also approved to treat anxiety and panic disorder S/E:Nausea Dry mouth Dizziness Headache Excessive sweating Other possible side effects may include: Tiredness Constipation Insomnia Changes in sexual function, such as reduced sexual desire, difficulty reaching orgasm or the inability to maintain an erection (erectile dysfunction) Loss of appetite Brupropion (wellbutrin) 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
Anticholinergic (drying effects) Used for motion sickness Can cause sedation, anticholinergic effects Phenylephrine Sudafed PE; sympathomimetics Propranolol (Inderal) Beta adrenergic blocker for hypertension Dobutamine (Dobutrex) sympathomimetic Indication : short term management of heart failure Action : Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart. Nursing Considerations :
- Monitor hemodynamics: hypertension, ↑HR, PVCs
- 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 beta 2 receptor activation will lead to _______ however, administering a non-cardioselective beta blocker can lead to _____? bronchodialiation/bronchoconstriction Alpha 2 agonist such as clonidine will _____ BP? lower A ______ inotrope will increase contractility; a ______ chronotrope will decrease HR; while a _______ dromotrope will decrease conduction via the AV node? positive, negative, negative Epinephrine is used in many emergency situations, such _______, Cardiac______ and hypo_______ anaphylaxis, cardia arrest, hypotension what "onset of actions symptoms" should be reviewed with patients who have been newly prescribed an SSRI? they can feel a bit of nausea but this resolves in about 1 week Jaycee has been on Escitalopram for a year and is willing to try tapering off the SSRI. What is the initial dosage adjustment when starting to taper off antidepressants? reduce the dose by 50% for 3-4 days One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: GI problems, drowsiness and nausea, seizures and coma are serious problems.
dilates renal blood vessels what are the functions of cholinergic drug receptors? Blocks the action of acetylcholine. Cholinesterase inhibitors prevent the breakdown of acetylcholine Examples of anticholinergic drugs bethanechol, atropine, oxybutynin, scopolamine, ipratropium bromide They turn everything off and dry everything Side effects of anticholinergics dry mouth, blurred vision, constipation, photophobia, urinary retention "I can't see, can't pee, can't spit, can't shit" understand alzheimer's medications understand parkinsons medications Know psychiatric drugs (1st and 2nd line) for: depression anxiety bipolar OCD Sterling's Law of the Heart the more the cardiac muscle is stretched, the stronger the contraction Calcium Channel Blockers agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension s/e: constipation, lower extremity edema, increased risk of heart block and gingival hyperplasia Know the stages of hypertension/heart failure bond williams classification Renin Inhibitors Aliskiren (Tekturna) binds tightly with renin and inhibits the cleavage catalyzes the conversion of angiotensin i (inactive) to angiotensin II (highly active) ACE inhibitors
contstricts renal blood vessels acts on the Kidney to promote retention of sodium and water and excretion of potassium "PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension ARBS block access of angiotensin II cause dilation of arterioles and veins Prevent angiotensin II from inducing pathologic changes in cardiac structure Reduce excretion of potassium Decrease release of aldosterone Increase Renal excretion of sodium and water DO not inhibit Kinase II do not increase levels of bradykinin Aldosterone Antagonists selective blockade of aldosterone receptors in the kidney promotes excretion of sodium and water and thereby reduces blood volume (spiralonlatome) Calcium Channel Blockers do what to the heart have exact same effect on heart as beta blockers. They suppress calcium influx and reduce force of contraction and slow heart rate and suppress conduction through the AV node what are common side effects of CCBS are: constipation, LE edema, gingival hyperplasia what are the therapeutic uses for nifedipine? Migraines, angina, HTN beta blockers _____ the adverse cardiac effects of nifedipine but can ____ the adverse cardiac effects of verapamil and diltiazem decrease; intensify john is taking hydralazine for elevated BP. He comes in with arthralgia. What blood test might be elevated? ANA
What role does ASA play in STEMI? ASA caused a substantial reduction in mortality What role does morphine play in STEMI? in addition to relieving pain, morphine can improve hemodynamics by promoting ventilation, the drug reduces cardiac preload What role does Nitro play in STEMI?
- reduce preload and thereby reduce oxygen demand
- increase collateral blood flow in the ischemic region of the heart
- control hypertension caused by stemi-associated anxiety
- limit infract size and improve LV function however, despite these useful effects, nitroglycerin does not reduce mortality What role does BB play in STEMI? decreases myocardial oxygen demand; reduce cardiac pain, infract size, and short term mortality; recurrent ischemia and reinfarction are also decreased Which must heparin bind to in order to exert its anticoagulant effects? Antithrombin III- heparin binds to antithrombin III then inactivates thrombin and factor Xa Which one of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation? cholestyramine A 58 yo female reports that she recently stopped taking her blood pressure meds because of swelling in her feet that began shortly after she started treatment. Which of the following is most likely to cause peripheral edema? Felodipine (CCB) Jack is taking Colesevelam. The NP tells him to: He needs to increase fluid and fiber A 54 yo male is noted to have hyperlipidemia, and is prescribed atorvastatin. This drug reduces plasma cholesterol by which processes? Inhibiting cholesterol biosynthesis A 42 yo woman is noted to have type 2 Diabetes. She has HTN with BP 150/94. The UA shows mild albuminuria. Which of the following drugs would be the best choice to treat HTN? Enalapril Brad has HTN and is found to have enlarged prostate on exam. His BP has been running in the 150/ range. Which of the following meds would offer treatment for both?
terazosin Which best describes the action of ACE inhibitors on the failing heart? Reduces preload Which of the following is the most accurate statement regarding digoxin? Increases vagal tone and decreases AV node conduction Which of the following is a limiting adverse effect of ACE inhibitors? hyperkalemia Which of the following medications can be used to treat gestational diabetes? Metformin and insulin What is the 4 step approach in the treatment of DM type 2? Step 1: lifestyle +metformin step 2: continue step 1 and add second drug step 3: step up to 3 drugs (including metformin) step 4: more complex insulin regimen John comes in with random glucose of 250? Does he need any further testing? NO Jane has type 1 diabetes and is taking a beta blocker. what does she need to be aware of? Beta blockers impair glycogenolysis and glycogenolysis is a means which the body can respond to and counteract a fall in blood glucose Gina is taking canagliflozin for her diabetes. The NP tells her this may increase her risk for? UTIs SGLT-2 inhibitors cannot be given if GFR <35. t or f? FALSE: can be given with GFR less than 35 opitmally at what interval should the TSH be reassessed after a levothyroxine dosage is adjusted? 6 - 8 weeks which of the following can induce thyroid dysfunction? Amiodarone Irma is an 80 yo with CAD. She has an elevated TSH with a low free T4. She weighs 80kg. What dosage of levothyroxine are you going to initiate? 12.5-25 mcg
hypoglycemia before lunch intermediate acting insulin is peaking before lunch is eaten or patient not eating enough breakfast hypoglycemia in the afernoon its from the peak and tail of the intermediate acting insulin hyperglycemia in the afternoon intermediate acting insulin needs to be increased or die of lunch is too large hyperglycemia after evening meal short acing insulin needs to be increased hypoglycemia overnight (2-3 am) afternoon NPH is peaking and causing low BS, patient needs less intermediate acting insulin John is a type 1 diabetic and is on insulin glargine at HS and insulin lisper ac each meal. He is having his wisdom teeth removed. How should he manage his insulin? continue the glargine and take lisper only as a supplement Which of the following should be used with caution in a person with a sulfa allergy? glyceride and pioglitazone What is the most common adverse effect noted with alpha-glucosidase inhibitor use? GI upset what of the following should be monitored with a TZD? ALT-liver toxicity The meglitinides are particularly helpful adjuncts in type 2 diabetes to minimize risk of: postprandial hyperglycemia You are prescribing levothyroxine to an elderly 82 yo. Which of the following should you keep in mind?? the levothyroxine dose needed by the elderly is 75% less of what is needed by a young adult Methimazole is primarily excreted by: urine In patients taking anti-thyroid drugs should avoid which of the following? Seafood Vitamin C
An important substance needed for proper repair of the skin and tissues; promotes the production of collagen in the skins dermal tissues; aids in and promotes the skins healing process. Found in citrus fruits and vegetables. Antioxidant property and can help with iron as well Niacin Vitamin B3; deficiency can lead to dermatitis, which causes scaling and cracking of the skin, GI and central nervous system disturbances (ataxia) large dose can be used to treat low HDL- s/e of flushing (combative with ASA) Riboflavin (B2) essential for carbohydrate fat and protein metabolism. Necessary for tissue maintenance. And healthy eyes and good for MIGRAINE headaches and can take up to 3 months (400mg Daily) Thiamin Vitamin B1 needed in energy production. Alcoholism is the most common cause of deficiency Paradoxine (B6) coenzyme in AA metabolim, isoiazide interferes with B6 metabolism; deficiency is rare in US except in alcoholics Protein and starchy vegatables Black Cohosh uses menopause vasomotor symptoms; not to be given with selective estrogen modulators Co Q 10 Co Q-10 deficiency (statins), antioxidant, hypertension, heart failure, migraine prevention, Parkinson's cranberry juice helps prevent UTIs, may increase INR in patients taking warfarin Feverfew uses Bolded: Prevention of migraines S/e: platelet agreggations Extras: Rheumatoid arthritis
