Pharmacology Exam 1- Rasmussen

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Drugs that PRODUCE a response

Drug that PREVENT or block a response

Therapeutic WINDOW is what?
level of the drug between minimal effective concentration in the plasma for obtaining desired drug response and the minimal toxic concentration

The time it takes for one half of the drug concentration to be eliminated from the body is called?
half life

what is a patient on two highly protein bound drugs at risk for?
accumulation and toxicity

a decreased responsiveness over the course of therapy, which may lead to the need to increase dosages to attain the same effect

what is it called for drugs to share many common features
classification or class

what makes drugs fit into the same “Class”
-related by chemical structure
-work in the same way
-used for the same purpose

another name for antagonist
adrenergic blocker

who do you NOT give antagonist or adrenergic blocker to?
asthma client

Beta Blockers commonly seen in what clients?

antagononist suffix

antagonist S/S
decreased heart rate
rest and digest

agonist S/S
increased heart rate
fight or flight
increased blood sugar

Before administering antagonist what do you check
Heart rate
Blood Pressure

decreased weight

Cant see
Cant pee
Cant spit
Cant poop
increased heart rate

what type of drug is Reglan?

how do you treat cholinergic crisis

cholinergic crisis S/S
abd cramping

anticholinergic drugs are contradicted in who?
-coronary artery disease (Increase heart rate)
-GI obstruction (constipates)
-supraventricular tachycardia (increased heart rate)

CNS stimulant drugs are contradicted in who?
-coronary artery disease (cause vasoconstriction=heart attack)
-Hypertension (additive hypertension=stroke)

Hemorrhagic stroke
-increased B/P
-increased heart rate
-increased respiratory rate
-unresponsive to deep pain

Anorexiants can leas to what?
16X greater for stroke

Most common side effects of Ritalin
-weight loss
-decreased appetite

Benzodiazapines increase activity to what neurotransmitter

Reversal to benzodiazapines

Ambien Side effects
-suicidal ideation
-abnormal behavior

Drug of choice for treating status epilepticus

Dilantin can do what?
-cause gum disease
-treat seizures
-cause high blood pressure
-cause birth defects
-decrease effectiveness of anticoagulants

When a client is on Dilantin what are some nursing interventions?
-monitor for narrow therapeutic index (frequent blood test)
-take as prescribed
-oral care
-teach pt to use barrier contraceptives along with oral

What is therapeutic level for Depakote?

If Depakote levels are high (>100) what needs to be done?
-hold medication
-check liver function (blood test)
-discuss with physician
-neuro assessment
-check vitals

what does Depakote treat?
-bipolar disorder

Benzodiazapines can lead to what?

Barbituates reversal tx
activated charcoal

Example of a Barbituates?

what disease process goes with “dopamine depletion”
parkinsons’ disease

what disease process goes with “rigidity”
Parkinson’s disease

what disease process goes with “Confusion”

what disease process goes with “bradykinesia”
Parkinson’s disease

what disease process goes with “memory loss”

what disease process goes with “Acetylcholine accumulation”
Parkinsons disease

what disease process goes with “amyloid plaques”
alzeimers disease

what disease process goes with “acetylcholinerase inhibitor drugs”
Parkinsons disease

what disease process goes with “facial masking”
Parkinsons disease

what disease process goes with “motor neuron degeneration”
Parkinsons disease

what disease process goes with “neurofibillary tangles”
Alzheimers disease

what disease process goes with “anticholinergic drugs”
Parkinsons disease

Aricept improves what
Cholinergic function


Can you crush contin

Can you crush potassium

can you crush iron

Can you crush calcium antacids

what disease process goes with “Lack of ACh receptor sites”
Myasthenia Gravis

what disease process goes with “respiratory muscle weakness”
myasthenia gravis

what disease process goes with “anticholinestrase inhibitor drugs”
myasthenia gravis

what disease process goes with “immunosupressants”
myasthenia gravis and multiple sclerosis

what disease process goes with “anti-acetylcholine antibodies”
myasthenia gravis

what disease process goes with “brain lesions”
multiple sclerosis

what disease process goes with “diplopia”
multiple sclerosis

what disease process goes with “spactisity”
multiple sclerosis

what disease process goes with “myelin sheath damage”
multiple sclerosis

what disease process goes with “remission/exacerbation”
multiple sclerosis

what disease process goes with “spinal cord lesions”
multiple sclerosis

your patient is receiving tx for MG with Mestonin. What should you see if it is working?
maintenance of muscle strength

What to avoid when taking cyclobenzaprine (Flexeral)

Pt taking an MAOI and eating blue cheese, red wine with dinner? What should you tell them they are at risk for
Hypertensive crisis

Pt is taking Lithium, you should advise them to avoid what other drugs
-ACE inhibitor

Serotonin Syndrome S/S

Extrapyramidal effects are most common with which class of antidepressants?

What to keep in mind with Lithium
-it has a narrow therapeutic range
-do not crush
-check serum levels
-take same time everyday

What drugs contain acetomenophen
-Alka Seltzer Plus

What drugs do not contain acetomenophen

What drug should not be given during an acute gout flare up

injectable NSAID

Ibuprofen should always be taken with what?
Food or milk

(COX 1)

ALL opioids can reversed by what

Max daily dose of acetaminophen for adults

2grams (elderly or liver & kidney damage)

Common side effects of opioids are:
-respiratory depression
-increased intracranial pressure

Schedules C2 drugs
need to count in and out of shift

Extra Pyramidal Symptoms
-tardive dyskinesia
-acute dystonia

Neuroleptic Malignant Syndrome
-sudden high fever
-blood pressure fluctuations
-altered mental status
-acute renal failure

the ONLY non-sedating anti-anxiety medication is:

Typical antipsychotics may be prescribed for short term use why?
it is faster working

Extra pyramidal side effects are most commonly seen in which class of medications
typical antipsychotics

How do you know if a neuroleptic is working
behavior decreases

-loss of function

What do you need to teach with DMARDS
good hygiene

What is Pharmaceutics
Pharmaceutics: applies only to tablets or capsules given by mouth (PO). process in which the tablet or capsule becomes a solution, so that it can cross the biologic membrane, of the stomach or small intestine.

Drugs generally disintegrate and are absorbed faster in what?
very acidic fluids.

Very Old and very young people have less gastric acidity so… What is the result?
Lower/slower absorption > Drug in the system longer

If a drug is enteric coated and meant to be absorbed in where?
what would happen if you crushed it before taking it?
Small intestine, Absorbed in stomach

Pharmacokinetic Phase:
this is the process of drug movement to achieve drug action. Sometimes referred to as what the body does to the drug.
4 processes: Absorption, Distribution, Metabolism (Biotransformation), Excretion (Elimination)

Protein bound drugs are destroyed by?
digestive enzymes

Insulin is a protein bound drug, so CANNOT be given by which route?

Absorption- Drugs absorbed most easily are?
Fat soluble and Non-Ionized

First Pass effect is what?
The liver can inactivate or change drugs into different forms.

Bioavailability is what
the percentage of the administered dose that reaches systemic circulation

Bioavailability for IV administered drugs is what %
100%, why? Direct bloodstream/vein contact

After a pill is taken by mouth what organ has a major impact on its bioavailability
Absorption- most oral drugs are absorbed through the action of mucosal villi in the small intestine. If the villi are damaged by disease or surgical intervention, the absorption of the drug is delayed or does not occur.

High fat foods increase what?
absorption time

Exercise can decrease drug absorption because:
blood flow is in peripheral muscles instead of GI tract

Protein binding is what?
Protein Binding- As drugs circulate in the blood and plasma, some of them have a high affinity for binding to the plasma proteins. Drugs that are stuck onto the proteins, aren’t free to go to their target receptor sites and do their jobs.

If a patient is on two drugs that are both strongly protein bound what happens?
They compete for binding sites on the protein, which means more free drugs will be released into active circulation, which can lead to accumulation and toxicity.

The blood brain barrier is what?
Blood Brain Barrier- a filtering mechanism of the capillaries that carry blood to the brain and spinal cord tissue, blocking the passage of certain substances.

Excretion/Elimination- Accomplished mostly through where?
the kidneys

Peak is what?
when the drug reaches its highest plasma or blood concentration

Pharmacodynamics Phase is what?
the way the drug affects the body

Onset is what?
the time until minimum effective action

Duration of Action is what
the length of the time the drug has a pharmalogic effect

Receptor Theory is what
Drugs act through receptors to produce or block a response. The better a drug fits at the receptor site, the more biologically active it is, like a key fitting into a lock.

Agonists examples
Drugs that produce a response are agonists
Epinephrine (Adrenalin)

Antagonist Examples
Drugs that prevent or block a response are called antagonists Example: Histamine receptor antagonist (Atropine)

Peak is what
the point at which plasma drug levels are highest

Trough is what
point at which plasma drug levels are lowest.

Loading Dose is what
Given to achieve a rapid minimum effective concentration in the plasma. After the loading dose is given, a prescribed daily dose is provided.

Brand Names are what?
Drug manufactures choose the brand names of their products. There can be many brands of a particular drug.

Additive Effect
when two drugs with similar action are administered

Additive effect BAD example
Undesired Effect- Hydralazine & nitroglycerine

Additive effect GOOD example
Desired effect: Beta blocker & diuretic, aspirin & codeine

Synergistic effect
when two or more drugs are given together and the combined effect is substantially greater than the combined effect of the two.

Synergistic effect BAD example
Undesired effect- Diazepam & alcohol

Synergistic effect GOOD example
Desired effect- amoxicillin & clavulanate

Antagonistic effect
when two drugs are given that have opposite effects are administered together with the two drugs canceling each other out.

Antagonistic effect BAD example
Undesirable effects- bet stimulant: isoproterenol & beta blocker

Antagonistic effect GOOD example
Desirable effects- morphine & naloxone

• Some drugs like MAOI antidepressants have specific food interactions such as:
aged cheese, blue cheese, cured meat, summer sausage, pepperoni, salami, smoked/processed meats, pickled foods, sauces, soybeans, pop peas, dried fruit, meat tenderizers, yeast, alcoholic foods

Over the Counter drugs- Cough & Cold Remedies DONTS:
Most contain smpathomimetics… these products should not be taken by patients with hypertension or thyroid disease without consulting their health care provider

Sleep Aids DONTS
contain Antihistamines, should not be taken with CNS depressant medications due to increased CNS depression

The dietary Supplement Health & Education Act of 1994:
Herbal remedies are classified as dietary supplements. Premarket testing for safety & efficacy is not requiring. Manufacturing is not standardized. Not approved by the FDA and not meant to be used as a drug.

Brain and spinal cord

Peripheral Nervous System
Somatic Vs Autonomic

Mostly Voluntary, Skeletal Muscle Movement

Mostly involuntary, acts on Smooth Muscles and Glands

Autonomic Nervous System
Sympathetic (Adrenergic) & Parasympathetic (Cholinergic)

-receptors alpha 1 & 2, Beta 1 & 2
-fight or flight

-Receptors: nicotinic, muscarinic
-rest or digest

Adrenergics Agonists AKA
“Adrenergics”, sympathomimetic

Adrenergic Agonist
Response: Increased BP. Increased HR, Bronchodilation, Increases Blood Sugar, Pupil Dilation, Alertness

Adrenergic Agonist Drugs:
Epinephrine (Adrenaline) & Albuterol (asthma/COPD)

Beta Blockers (Adrenergic Blocker)
specifically block beta receptor sites; also inhibit the release of norepinephrine and epinephrine.

Beta Blocker effects:
decreased blood pressure, decrease heart rate, broncoconstriction.

Beta Blocker Drugs
Atenolol (Tenormin), Metoprolol (Lopressor), Labetolol – uses to treat hypertension, migraine prophylaxis, angina, myocardial infarction, heart failure.

Beta Blocker side effects:
depression, sexual dysfunction, cool extremities

Cholinergic Agonists: AKA
Cholinergic, Parasympathomimetics

Direct acting
act on receptors to activate a tissue response

Indirect acting
inhibit the action of the enzyme cholinesterase, permitting ach to persist and attach to the receptor

Cholinergic Effects
stimulates urination, increases salvation and tear production, increases GI peristalsis

Cholinergic drugs:
Bethanacol chloride (urecholine), Metoclopramide hcl (Reglan)

Anticholinergics AKA
“Cholinergic antagonists”, parasympatholytics

Anticholinergics Drugs:
-Atropine- for bradycardia, reduces salivation, dilates pupils
-Benztropine- Parkinsons
-Telterodine Tartate- decreases urinary frequency, urgency, incontinence

Caution when giving anticholinergic medications in patients with:
glaucoma, urinary retention

Cholinergic crisis and TX
Salivation, Lacrimation, Urination, Defecation (treat with atropine)

stimulates the release of the norepinephrine and dopamine from the brain and sympathetic nervous system

Amphetamines- Common side effects:
insomnia, restlessness, nervousness, tremors, irritability, tachycardia, hypertension, weight loss

Amphetamines Drugs:
Methylphenidate (Ritalin)
Dexmethylphenidate (Focalin)
***used to treat ADHD, Narcolepsy ***

Amphetamines Drug adverse reactions:
tachycardia hypertension, palpitations, weight loss, hepatoxicity

Amphetamine Drug Phentermine:
CNS Stimulation

Insomnia Treatments:
non pharmalogic, antihistamines, sedative/hypnotics

Insomnia Drugs:
Zolpidem (Ambien)

Insomnia Drugs Adverse Reactions:
tolerance, dependence, hypotension, suicidal ideation

Benzodiazepines do what?
Increase the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to the GABA receptors

Benzodiazepines Drugs
-Lorazepram (Ativan) treats anxiety, seizures
-Diazepam (Valium) treats anxiety, muscle
-Alprazolam (Xanax) treats anxiety, insomnia

Benzodiazepine Side effects:
lethargy, memory impairment, dizziness, decreased libido

Benzodiazepine Reversal Agent
Flumazenil (Romazicon)

-seizure disorder results from abnormal electrical discharges from the cerebral neurons
-causes a loss of consciousness and involuntary muscle contractions

Epilepsy Drug Treatments:
Anticonvulsants (Hydantoins, Barbituates, Benzodiazepines, Valproate)

Hydantoins: (Phenytoin “Dilatin”) Side effects & adverse reactions:
Slurred speech, confusion, depression, elevated blood sugar, fetal abnormalities

Benzodiazepines: (Lorazepram “Ativan”) treats what?
treats anxiety, seizures

(Diazepam “Valium”)- treats what?
treats anxiety, muscle relaxer

Benzo Side Effects and Benzo Adverse Reactions
Benzo Side Effects- drowsiness, lethargy, dizziness
Benzo Adverse Reactions: Depression, impaired coordination

Gabapentin & Pregablin Drugs
used to treat nerve pain

1. Valproate Drugs: (Valproic Acid “Depakote”) treat what?
mania from bipolar
*****check liver enzymes!

Parkinsonism: caused by
an imbalance of nuerotransmitters dopamine and acetycholine

Parkinsonism Treatment:
anticholinergics, dopamine replacements, dopamine agonists, MOA-B inhibitors, COMT inhibitors

Parkinsonisms Drug: ” Dopamine Replacement Drug”: Carbidopa/levodopa
Levodopa is converted to dopamine before it reaches the brain.

Alzheimers Disease:
incurable dementia by chronic, progressive nuerodegerative conditions with marked cognitive dysfunction

Alzhemiers Disease Symptoms:
memory loss, confusion, inability to communicate, aggressive behavior, depression

Alzhemiers Disease Acetylcholinesterase Inhibitor (Rivastigime & Donepezil)
prevent breakdown of acetylcholine

Rivastigmine Side effects/Adverse effects:
Renal/hepatoxicity, suicidal ideation, stevens Johnson syndrome.

Myasthenia Gravis:
a lack of nerve impulses & muscle responses at nerve and muscle junctions; autoimmune disease.
Treatment= Anticholinesterase inhibitors

Myasthenic crisis: EMERGENCY
Not enough acetylcholine, severe generalized weakness, may involve respiration muscles


Cholinergic Crisis: EMERGENCY
TOO much acetylcholine. Symptoms: muscle weakness,, increased salivation.

Treatment: Atropine (anticholinergic)

Multiple Sclerosis:
Autoimmune disorder that attacks the myelin sheath of nerve fibers in the brain and spinal cord, causing lesions called plaques

MS 3 Phases:
acute attack
Remission/Exacerbation/Chronic Progressive

MS Treatments:
Biological immune modifiers
immunosuppressant cyclophosphamide

MS Symptom Management:
Skeletal Muscle Relaxer (Diazepam, Bclofen, Tizanidine, Methacarbamol)

Cyclobenzaprine (Flexeril): Side effects:
Side effects: anticholinergic effects, dizziness, headaches.

causes dilation of arterioles & increases capillary permeability, allowing fluid into the injured areas

such as bradykinin increases capillary permeability & the sensation of pain

increase vasodilation, capillary permeability, pain & fever

decreases inflammation, decreases platelet aggregation, higher doses are usually enteric coated to protect the stomach

Ibuprofen- Nonsteroidal Anti-inflammatory:
fewer side effects than aspirin, can still cause GI upset, should not be taken during pregnancy

Celecoxib: NSAID:
COX2 Inhibitor; requires a prescription; (adverse reaction: peripheral edema); used to treat osteoarthritis, RA

DMARDS: Disease Modifying Antirheumatic Drugs:
-includes immunosuppressive agents

Rheumatoid Arthritis:
a chronic inflammatory disorder that typically affects the joints of the hands & feet

Immunomodulators: Infiximab (Remicade)
tumor necrosis factor blocker:
treats RA & Chrons disease
report dizziness

inflammatory condition in which uric acid accumulates and urate crystals form in tissues, tendons, joints. Most commonly affects the big toe.

GOUT: Anti-inflammatory (Colchicine)
used during acute attack for inflammation

Urocosurics (Probenicid)
1. Urocosurics (Probenicid)- promotes excretion of uric acid, should not be given during acute attack
– Increase fluid intakes, lab tests may be needed

Uric Acid Inhibitor (Allopurinol)
Inhibits uric acid synthesis; prevents acute attacks

relief from pain

Mild to moderate pain is usually relieved with
the use of nonopiod analgesics.

Moderate to severe pain usually requires
an opioid.

Nonopioid Analgesics:
COX2 inhibitors

not an NSAID
not an anti-inflammatory
hepatoxicity at high doses
Patients should not receive more than 650mg per dose. Or a maximum doe of 3,000mg/day.

High Purine Foods:
Alcoholic beverages, some seafood/fish…some meats like turkey, bacon, liver

Ketorolac (Toradol):
Analgesic & anti-inflammatory
commonly given IV & IM
treats moderate to severe pain
not to exceed 5 days total treatment.

COX1 inhibitor-
can still cause GI bleeding even if given IV. Can cause fetal abnormalities in first trimester of pregnancy

Opioid Analgesics (TRUE):
Morphine & Codeine (True opiates, derived from opium):
-act primarily on MU receptors of the CNS
-Suppress pain impulses
-suppress respiration
-suppress cough
-antidiarrheal effects

Morphine Sulfate adverse reactions:
-life threatening respiratory depression (all opioids)
-increased intracranial pressure

Other opioids
fentanyl patch
oxycontin (continuous release)

The half life of Naloxone is shorter than the half life of most opioids meaning what?
may need to have a second dose of naloxone

Buprenorphrine/Naloxone (Suboxone):
-combination opioid and opioid antagonist
-Used to help pts taper off heroin or other opioid drugs when addicted.
-If the pills are crushed for snorting or injecting, the naloxone capsules break open and cancel out the opioid effects at the receptor sites.

-caused by inflammation and dilation of the blood vessels in the cranium.
Drugs: beta blockes, anticonvulsants, antidepressants, triptans, NSAIDS/naproxen

TRIPTANS: Sumatriptan (lmitrex)
rescue drug for migraine attack; causes vasoconstriction of cranial arteries

Mood Stabilizers:
Lithium: used to curb mania; narrow therapeutic range! Blood levels must be monitored closely, Avoid Ace inhibitors, HCTZ; Avoid NSAIDS.

Bipolar disorder treatment
Mood stabilizers

Bipolar Affective Disorder:
A brain disorder that causes unusal shifts in mood, energy, activity levels, and the ability to carry out daily tasks.

Serotonin Syndrome:
occurs when you take medication that cause high levels of the chemical serotonin to accumulate in your body

GABA- when reduced can lead to…

Serotonin does what?
Regulates sleep

Dopamine does what?
involved in the regulation of cognition
emotional responses

Norepinephrine does what?
-associated with control of arousal
-attention, vigilance
-affect and anxiety

refers to any drug that modifies psychotic behavior & exerts an antipsychotic effect

Anxiolytics- AKA
“Antianxiety”, “Sedatives/hypnotics”

losing contact with reality; commonly seen in schizophrenia. Includes difficulty processing information and coming to a conclusion, delusions, illusions, hallucinations, incoherence, aggressive behavior or catatonia

Positive symptoms:
Negative symptoms:
-Positive symptoms: Exaggeration of Normal function, agitation, incoherent speech, hallucinations, delusions, paranoia
-Negative symptoms: Loss of Function & Motivation, poverty of speech content, poor self care, social withdrawal

Typical (Traditional):
-Typical (Traditional): work best on negative symptoms; side effects: EPS “Extrapyramidal symptoms of parkinsonism” & NMS “Neuroleptic Malignant Syndrome”
-Atypical: Work on both negative & positive symptoms; fewer side effects

Typical Antipsychotic:
-Haloperidol (Haldol): contraindicated in Parkinsons Disease due to anticholinergic effects

Chlorpromazine (Thorazine):also treats chronic hiccups & is used as an antimetic

Atypical Antipsychotics:
Aripiprazole (Abilify)
-Side effects: drowsiness, unsteady, gait, headache, insomnia, depression, diabetes
-Takes weeks to take full effect
-In Emergency situation a TYPICAL antipsychotic like Haldol may be given
-Life threatening adverse effects: Suicidal ideation, NMS, Agranulocytosis, Neutropenia, leukopenia

-Tardive Dyskinesia
-Acute Dystonia

Neuroleptic Malignant Syndrome (NMS):
-Muscle rigidity
-sudden high fever
-altered mental status
-blood pressure
-acute renal failure

– Lorazepam “Ativan”
– Sedation is a common side effect = so no driving
-Do not stop meds abruptly
-Alcohol will cause added CNS depressive effects

-Buspirone (Buspar)
– non sedating
– may take 2 weeks for full effects
-Grapefruit juice can lead to buspirone build up and toxicity

Mood changes & loss of interest in normal activities; second most common chronic clinical condition after hypertension
3 types: reactive, major, bipolar

-Tricyclic Antidepressants
-Monoamine Oxidase Inhibitors (MOAI)
-Selective Serotonin Reuptake Inhibitors (SSRI)
-Serotonin Norepinephrine reuptake inhibitors (SNRI)

Tricyclic Antidepressants
-Amitriptyline (Elavil)
-side effects: sedation, hypotension, cardiotoxicity, seizures
– Avoid use with MOAIS
-Suspected overdose = EKG/Cardiac monitoring

Monoamine Oxidase Inhibitors (MOAI)
– Tranylcypromine (Parnate)- not commonly used due to life threatening food/med interactions (Hypertensive crisis)
-Avoid Tyramine containing foods!
-Avoid CNS Stimulants or sympathomimetics

Selective Serotonin Reuptake Inhibitors (SSRI)
-Fluoxetine (Prozac)
-takes 1 to 4 weeks for effects
-monitor for suicide ideation
-limit grapefruit juice

Serotonin Norepinephrine reuptake inhibitors (SNRI)
-Venlafaxine (Effexor)
– If taken with st Johns wort = life threatening serotonin syndrome & NMS

Serotonin Syndrome:
occurs when you take medication that cause high levels of the chemical serotonin to accumulate in your body

Bipolar Affective Disorder:
-A brain disorder that causes unusal shifts in mood, energy, activity levels, and the ability to carry out daily tasks.
-Treatments: Mood stabilizers, antidepressants, anticonvulsants

Mood Stabilizers:
-Lithium: used to curb mania; narrow therapeutic range! Blood levels must be monitored closely, Avoid Ace inhibitors, HCTZ; Avoid NSAIDS.

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