Exam 2: NSG 124/ NSG124 (NEW 2024/ 2025 Update) Pharmacology | Review with Questions and Verified Answers| 100% Correct| Graded A- Herzing

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Exam 2: NSG 124/ NSG124 (NEW 2024/ 2025 Update) Pharmacology | Review with Questions and Verified Answers| 100% Correct| Graded A- Herzing

Exam 2: NSG 124/ NSG124 (NEW 2024/ 2025
Update) Pharmacology | Review with
Questions and Verified Answers| 100%
Correct| Graded A- Herzing
Q: Penicillins – mechanism of action
Answer:

  • weakens cell wall, causes water uptake and cell rupture
  • bactericidal (kills cells)
    Q: Ampicillin
    Answer:
    Penicillin preferred drug for gram-negative bacteria
    Q: patient education for Penicillins
    Answer:
  • take with full glass of water
  • take 1 hour before or 2 hours after meals
  • most common reaction is an allergic reaction (hives, shortness of breath, wheezing)
    Q: cephalosporins – mechanism of action
    Answer:
  • binds to penicillin-binding proteins, disrupts cell wall synthesis causing cell lysis (breakdown
    of the outer layer)
  • bactericidal (kills cells)

Q: 1st generation cephalosporins – therapeutic use
Answer:

  • used for simple respiratory, ear, skin, urinary tract infections
  • not as effective for gram-negative bacteria
  • do not give to patients with Penicillin allergy
    Q: 1st generation cephalosporin medications
    Answer:
  • cefazolin
  • cephalexin (Keflex)
  • cefadroxil
    Q: 2nd generation cephalosporins – therapeutic use
    Answer:
  • more effective for gram-negative bacteria
  • not effective against meningitis due to poor CSF concentration
  • do not give to patients with Penicillin allergy
    Q: 2nd generation cephalosporin medications
    Answer:
  • cefaclor (Ceclor)
  • cefotetan
  • cefoxitin
  • cefprozil
  • cefuroxime
    Q: 3rd generation cephalosporin medications

Answer:

  • cefdinir
  • cefditoren
  • cefixime
  • cefotaxime
  • cefpodoxime
  • ceftazidime
  • ceftibuten
  • ceftriaxone
    Q: 3rd generation cephalosporin – therapeutic use
    Answer:
  • preferred therapy due to effectiveness against many bacteria
  • effective against gram-negative bacteria
  • good CSF penetration
  • do not give to patients with Penicillin allergy
    Q: 4th generation cephalosporins – therapeutic use
    Answer:
  • highest effectiveness of gram-negative bacteria
  • treats severe skin infections, hospital acquired pneumonia
  • good CSF penetration
  • do not give to patients with Penicillin allergy
    Q: 4th generation cephalosporin medications
    Answer:
  • cefepime
    Q: 5th generation cephalosporin – therapeutic use
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antibacterial kills bacteria or prevents its growthEx: Ciprofloxacin
antifungal kills or inhibits growth of fungiEx: Amphotericin B
antiviral kills viruses or prevents its growthEx: Acyclovir
antiprotozoal kills or inhibits parasitic infectionsEx: Metronidazole
4 types of antimicrobials – antibacterial- antiviral- antifungal- antiprotozoal
antimicrobials (antibiotics) key takeaways – always obtain cultures before administering antibiotic- patients may receive combination therapy until organism is identified- ensure patients always complete the full course of antibiotics
Culture collection order (timeline) – obtain blood culture first- obtain urine culture second- administer antibiotics
narrow spectrum antibiotics – effective against a few specific bacteria- covers either gram-positive OR gram-negative
broad spectrum antibiotics – effective against a wide variety of bacteria- covers both gram-positive AND gram-negative
patient education for antimicrobials – difference between viral and bacterial infections- medication considerations: refrigeration, light sensitivity- combination therapy used until causative agent is identified- how and when to take medication
Penicillins – mechanism of action – weakens cell wall, causes water uptake and cell rupture- bactericidal (kills cells)
Ampicillin Penicillin preferred drug for gram-negative bacteria
patient education for Penicillins – take with full glass of water- take 1 hour before or 2 hours after meals- most common reaction is an allergic reaction (hives, shortness of breath, wheezing)
cephalosporins – mechanism of action – binds to penicillin-binding proteins, disrupts cell wall synthesis causing cell lysis (breakdown of the outer layer)- bactericidal (kills cells)
1st generation cephalosporins – therapeutic use – used for simple respiratory, ear, skin, urinary tract infections- not as effective for gram-negative bacteria- do not give to patients with Penicillin allergy
1st generation cephalosporin medications – cefazolin- cephalexin (Keflex)- cefadroxil
2nd generation cephalosporins – therapeutic use – more effective for gram-negative bacteria- not effective against meningitis due to poor CSF concentration- do not give to patients with Penicillin allergy
2nd generation cephalosporin medications – cefaclor (Ceclor)- cefotetan- cefoxitin- cefprozil- cefuroxime
3rd generation cephalosporin medications – cefdinir- cefditoren- cefixime- cefotaxime- cefpodoxime- ceftazidime- ceftibuten- ceftriaxone
3rd generation cephalosporin – therapeutic use – preferred therapy due to effectiveness against many bacteria- effective against gram-negative bacteria- good CSF penetration- do not give to patients with Penicillin allergy
4th generation cephalosporins – therapeutic use – highest effectiveness of gram-negative bacteria- treats severe skin infections, hospital acquired pneumonia- good CSF penetration- do not give to patients with Penicillin allergy
4th generation cephalosporin medications – cefepime
5th generation cephalosporin – therapeutic use – treats MRSA- good CSF penetration- do not give to patients with Penicillin allergy
5th generation cephalosporin medications – ceftaroline IV only
cephalosporins adverse effects – mostly hemolytic (bleeding, thrombophlebitis, anemia)- allergic reaction- maculopapular rash
Vancomycin – inhibits cell wall synthesis- treats MRSA, C. difficile- monitor renal function with creatinine levels- obtain trough level (30 minutes prior to next dose)- infuse slowly, at least over 60 minutes
Vancomycin adverse effects – nephrotoxicity- red man syndrome (rash, hives, flushing, itching) – do not stop infusion, just slow it down- thrombophlebitis (inflammation of the vein wall) – switch IV sites
tetracycline – therapeutic use – severe acne- Lyme disease- peptic ulcers- periodontal disease- not used often due to bacterial resistance
macrolides – mechanism of action – inhibits protein synthesis- broad spectrum antibiotics
macrolides – medications – erythromycin- azithromycin- clarithromycin
macrolides – therapeutic use – pertussis/whooping cough- diphtheria- chlamydia- pneumonia
Aminoglycosides – given IV only due to poor GI absorption- treats gram-negative aerobic bacilli- DO NOT use with IV penicillin- causes nephrotoxicity, ototoxicity- obtain trough level (30 minutes prior to next dose)Ex: gentamicin, tobramycin, amikacin
sulfonamides – treatment for UTIs- stop medication if adverse effects occurEx: trimethoprim/sulfamethoxazole (Bactrim)
sulfonamides patient education – take with full glass of water- take on an empty stomach to increase absorption- stop medication if adverse effects occur
sulfonamides adverse effects – Stevens-Johnson syndrome- hematologic effects- kernicterus (bilirubin induced brain damage)- renal damage- hyperkalemia (increased potassium)
Stevens-Johnson Syndrome A severe reaction (possibly to medication) starts with flu-like symptoms followed by a painful rash that spreads and blisters.
Tuberculosis caused by Mycobacterium tuberculosis
Tuberculosis is a ____ infection. primary
tests for tuberculosis – TB skin test- chest x-ray- sputum culture
Isoniazid (INH) primary drug for treatment of TB
Isoniazid (INH) adverse effects peripheral neuropathy, hepatotoxicity
Rifampin primary drug for treatment of TB
Rifampin adverse effects – causes red/orange urine, sweat, tears- GI issues- flu like reactions – fever, chills, muscle aches
Fluoroquinolones – Ciprofloxacin- Levofloxacin- Gemifloxacin
Fluoroquinolones side effects – tendinitis- phototoxicity- QT elongation- myasthenia gravis
Metronidazole (Flagyl) Antibacterial drug used to treat C Diff, H Pylori, and prophylaxis for surgery
Amphotericin B – HIGHLY TOXIC anti-fungal- treats systemic, oral, cutaneous fungal infections- given IV for systemic infections- applied topically for cutaneous infections
Amphotericin B adverse effects – nephrotoxicity- GI effects- hypokalemia- anemia- fever/chills
Antifungal drugs – Fluconazole – vaginal candidiasis, oral thrush- Itraconazole – histoplasmosis- Clotrimazole – topical candida (Athlete’s foot)
antiviral drugs “- treat viruses: shingles, herpes, varicella- usually ends in “”vir””- ex: Valacyclovir/Acyclovir”
Acyclovir (Zovirax) – antiviral agent given IV, topical, oral- treats herpes and varicella- minimal adverse effects except for NEPHROTOXICITY
Interferon Alfa – treats Hepatitis B, Hepatitis C, and some cancers- subQ administration- adverse effects are flu like symptoms – fever, fatigue, headache
Interferon Beta 1-A – treats multiple sclerosis- adverse effects are flu like symptoms – fever, fatigue, headache
disinfectant applied to objects
antiseptic applied to living tissue
hypoglycemia is blood sugar <70 mg/dL Hypoglycemia symptoms – tremors- palpitations- anxiety- restlessness- sweating- pallor hyperglycemia is blood sugar _______ >120 mg/dL
diabetes microvascular complications nephropathy, retinopathy, neuropathy
tests to confirm type II diabetes fasting plasma glucose, oral glucose test, hemoglobin A1C
type I diabetes symptoms – polyuria (frequent urination)- polydipsia (excessive thirst)- polyphagia (extreme hunger)
True/False: type II diabetic patients are the only ones who can take oral medication for diabetes True
True/False: Biguanides decrease glucose production from the liver True
True/False: Megilitinides decrease insulin secretion by the pancreas False
True/False: Sulfonylureas increase insulin secretion by the pancreas True
Metformin (Glucophage) – Biguanide drug- reduces glucose production by liver- may cause weight loss, nausea, vomiting, diarrhea
Patients on Metformin who report numbness and/or tingling should have what blood level checked? Vitamin B12
rapid acting insulin onset, peak, duration Onset: 10-30 minPeak: 30 min-3 hrDuration: 3-5 hr15 minutes feels like an hour after 3 rapid responses.
short acting (regular) insulin onset, peak, duration Onset: 30 min-1 hrPeak: 2-5 hrDuration: 5-8 hrShort-staffed nurses went from 30 patients to(2) 8 patients.
short acting insulin should be given within _ of eating or after eating? 15 minutes insulins that can be given SQ or IV and are clear Regular, Aspart, Lispro, Apidra Intermediate insulin onset, peak, duration Onset: 1-2 hrsPeak: 4-12 hrsDuration: 14-24 hrsNurses Play Hero to(2) eight 16-year-olds. NPH insulin can be mixed with what types of insulin? rapid and short acting insulins When mixing insulins, which type would be drawn into the syringe first? clear Long duration insulin onset, peak, duration Onset: 1-2 hrsPeak: NeverDuration: 24 hrs2 long nurse shifts never peak but last 24 hours. True/False: Glucagon is given SQ when a patient is hypoglycemic with loss of consciousness. True True/False: all clear insulins that can be mixed can be administered IV True True/False: long acting insulin cannot be mixed and cannot be administered IV True pre-filled insulin syringes – stored in the refrigerator- gently shaken before administration- stored vertically with needle up insulin contributes to metabolism of these 3: fats, protein, carbohydrates hypothalamus function – controls pituitary secretions- receives input from the CNS- coordinates other body systems somatostatin is administered to do what inhibits release of growth hormone True/False: prolactin promotes secretion of sex hormone and milk production True True/False: the nurse administers desmopressin to decrease ADH False Levothyroxine should be taken: – in the morning (before first meal)- with a full glass of water Levothyroxine side effects – tachycardia- dysrhythmias- palpitations- weight loss- nervousness- insomnia- drug reactions with SSRIs and Warfarin hyperthyroidism (Grave’s disease) first line treatment Methimazole Nursing education for patients with Addison’s – take medication at the same time every morning- taper down to stop medication- increase medication during times of stress (pre-surgery) glucocorticoids are used for: adrenocortical replacement (Ex: Addison’s disease) glucocorticoids adverse reaction – edema- loss of potassium- increased blood pressure- weight gain Cushing’s syndrome caused by: excess of corticosteroids Ketoconazole – antifungal used to treat Cushing’s syndrome- regulates cortisol secretion intravascular fluid fluid within blood vessels intracellular fluid fluid within cells extracellular fluid fluid outside the cell; includes both interstitial fluid and plasma True/False: ECF has two compartments: interstitial fluid and intravascular fluid. True interstitial (intercellular) fluid fluid in the spaces between cells hypertonic contraction – loss of water exceeds loss of sodium- higher concentration of solutes outside the cell than inside the cell- fluid shift from the cell (ICF) to ECF- cells shrink- treatment with 0.45% saline or water (hypotonic solution) hypertonic solution examples 3% NaCl5% NaCl hypotonic contraction – loss of sodium exceeds loss of water- lower concentration of solutes outside the cell than inside the cell- fluid shift from ECF into the cell (ICF)- cells expand and burst- treatment with 0.9% normal saline (isotonic solution) or for severe cases, 3% saline (hypertonic solution) hypotonic solution examples 0.45% NaCl0.33% NaCl2.5% Dextrose in waterWater cause of hypotonic volume contraction is: excessive sodium loss through the kidneys isotonic contraction – sodium and water are lost in equal proportion- concentration of solutes inside and outside the cell is equal- fluid shifts between ICF and ECF will NOT occur- treatment with 0.9% normal saline, lactated ringers, 5% Dextrose in water (isotonic solutions) isotonic solution examples 0.9% NaCl (Normal Saline)Lactated Ringers5% Dextrose in water normal potassium range 3.5-5.0 mEq/L Potassium Chloride (PO-Clor Con, Micro-K) – administered PO or IV- take with water to prevent GI upset- NEVER give IV push- avoid salt substitutes Diuretics treat what? – hypertension – CHF- liver disease – kidney disease Types of Diuretic Drugs – natriuretic: sodium and water excretion by stopping sodium reabsorptionex: Loop, Thiazide, Potassium sparing- osmotic: stops water reabsorption, promotes water excretion by increasing osmotic pressureex: Mannitol, Isosorbide Prior to giving diuretics, evaulate what? – weight check- lab values- blood pressure/heart rate- medication list After giving diuretics, evaluate what? – blood pressure/heart rate- urine output- lab studies for potassium and sodium When should diuretics be administered? in the morning True/False: Labs important to monitor after giving Furosemide (Lasix) are calcium and sodium. False Hydrochlorothiazide (HCTZ) is a diuretic. thiazide
Thiazide diuretics MOA – decrease sodium, potassium, and water reabsorption- increases urine output- reduces blood pressure
Thiazide diuretics side effects – hyponatremia- hypokalemia- hypotension- hypercalcemia- hyperglycemia- weakness
True/False: Two common loop diuretics are Furosemide (Lasix) and Bumetanide (Bumex). True
Loop diuretics – most powerful diuretics- acts on ascending loop of Henle- blocks sodium, potassium, and chloride- treats edema, heart failure, hypertension
Loop diuretics side effects – hypokalemia- hyperglycemia- hyponatremia
hyponatremia signs and symptoms S – stupor/confusion/comaA – anorexiaL – lethargyT – tendon reflexes decreasedL – limp muscles/weaknessO – orthostatic hypotensionS – seizures/headacheS – stomach cramps
hypokalemia signs and symptoms Low and Slow – 7 L’s- Lethargy (confusion)- Low, shallow respirations- Lethal cardiac dysrhythmias- Lots of urine- Leg cramps- Limp muscles- Low BP & heartrate
Loop diuretics patient education – increased urine output- avoid alcohol- may cause hyperglycemia- encourage high potassium/low sodium diet
Potassium sparing diuretics – causes more potassium to return to the blood- can be used in combination with other diuretics- take with food to increase absorption- avoid salt substitutes- ex: spironolactone, triamterene, amiloride
potassium sparing diuretic side effects – hyperkalemia- gastric bleeding- dizziness- headache
hyperkalemia signs and symptoms Deadly – remember MURDERM – muscle crampsU – urine output low or noneR – respiratory distressD – decreased cardiac contractility (weak pulse, low HR)E – EKG changesR – reflexes (hyperreflexia)
True/False: Cystitis affects the bladder. True
True/False: Pyelonephritis affects the ureters. False
True/False: Women are more likely to get UTIs. True
UTI treatment depends on the culture for sensitivity and resistance and can range from ___ days. 7-14
UTI symptoms include – dysuria- urgency- cloudy urine
What is the best treatment option for UTIs caused by E. coli? Sulfamethoxazole/trimethoprim (Bactrim)

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