Exam 3: NSG 124/ NSG124 (NEW 2024/ 2025 Update) Pharmacology | Review with Questions and Verified Answers| 100% Correct| Graded A- Herzing

Exam 3: NSG 124/ NSG124 (NEW 2024/ 2025 Update) Pharmacology | Review with Questions and Verified Answers| 100% Correct| Graded A- Herzing

Exam 3: NSG 124/ NSG124 (NEW 2024/ 2025
Update) Pharmacology | Review with
Questions and Verified Answers| 100%
Correct| Graded A- Herzing
Q: Calcium Channel Blockers general info
Answer:

• first line drug for hypertension
• blocks calcium ions access to cells causing decreased demand for oxygen, decreased
  contractility
• avoid GRAPEFRUIT juice
  Ex: Amlodipine, Verapamil, Diltiazem, Nifedipine
  Q: calcium channel blockers adverse effects
  Answer:
• heart failure
• dysrhythmias
• Stevens-Johnson syndrome
• peripheral edema
• bradycardia
• dizziness
  Q: alpha-adrenergic blockers general info
  Answer:
• relaxes blood vessels, leading to decreased blood pressure
• DO NOT take with male enhancement drugs
  Ex: Doxazosin, Prazosin, Terazosin
  Q: alpha-adrenergic blockers adverse effects

Answer:

• dizziness
• drowsiness
• headache
• stuffy nose
• hypotension
• nervousness
  Q: beta-adrenergic blockers (beta blockers) general info
  Answer:
• LOL medications
• decreases cardiac workload
• slows heart rate and decreases blood pressure
• treats HF, dysrhythmias, hypertension, angina
• prophylaxis for MI
• can mask symptoms of hypoglycemia
• DO NOT give to asthma patients
  Ex: Metoprolol, Labetalol, Atenolol, Propranolol
  Q: beta blockers nursing considerations
  Answer:
• check blood sugar
• check heart rate
• assess for fluid overload
• DO NOT give to asthma patients
  Q: beta blockers adverse effects
  Answer:
• fluid retention
• worsening of HF
• fatigue
• orthostatic hypotension
• bradycardia
• sexual dysfunction
  Q: beta blockers contraindications
  Answer:
  “ABCDE”
  Asthma
  Block (heart block)
  COPD
  Diabetes mellitus
  Electrolyte (hyperkalemia)
  Q: hypertension
  Answer:
• persistently high blood pressure
• blood pressure of 140/90 or higher
  Q: primary hypertension symptoms
  Answer:
• headache
• visual disturbances
• nausea/vomiting
• disorientation
  Q: primary hypertension lifestyle modifications
  Answer:
• reduced sodium
• DASH diet (Dietary approaches to stop hypertension)
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ACE inhibitors general information “- angiotensin converting enzyme inhibitors- blocks the conversion of angiotensin I to angiotensin II- medications end in “”PRIL””- treats heart failure and hypertension- contraindicated in 2nd and 3rd trimester of pregnancy- take 1 hour BEFORE or 2 hours AFTER meals”
ACE inhibitors adverse effects – persistent cough (most common)- first dose hypotension- orthostatic hypotension- angioedema (most dangerous)- neutropenia- proteinuria- renal failure- hyperkalemia
Angiotensin Receptor Blockers (ARBs) general information “- blocks angiotensin II from reaching its receptors, causing vasodilation- medications end in “”SARTAN””- treats hypertension, heart failure, diabetic nephropathy, prevents strokes- contraindicated in 2nd and 3rd trimester of pregnancy and patients with 1 kidney- can be taken WITHOUT regard to meals”
Angiotensin Receptor Blockers (ARBs) adverse effects – typically well tolerated- dizziness- muscle weakness/cramps- decreased sensitivity to touch- hyperkalemia- insomnia- angioedema
Aldosterone antagonists adverse effects – generally well tolerated- hyperkalemia
Aldosterone antagonists general information – blocks receptors for aldosterone- treats hypertension and heart failure after an MI- contraindicated for patients with impaired renal function- Ex: Eplerenone
direct renin inhibitors general information – blocks renin from triggering the Renin-Angiotensin-Aldosterone system- treats hypertension- NEVER use with an ACE inhibitor or ARB- contraindicated with chronic renal disease and pregnancy- Ex: Aliskiren
direct renin inhibitors adverse effects – headache- dizziness- fatigue- diarrhea- hyperkalemia- hypotension- stuffy nose
central acting adrenergic agents general info – Alpha II receptor agonists- causes decrease of vessel constriction leading to dilation- treats hypertension- may cause fluid retention- Ex: Clonidine, Methyldopa
central acting adrenergic agents adverse effects – drowsiness- lethargy- dry mouth- nasal congestion
direct vasodilators general information “- relaxes smooth muscle in blood vessels- treats hypertension, heart failure, hypertensive emergencies (Nitroprusside)- give Hydralazine and Minoxidil in combination with a beta blocker (“”LOL”” medications) to avoid reflex tachycardiaEx: Hydralazine, Nitroprusside, Minoxidil”
direct vasodilators adverse effects – reflex tachycardia- sodium and water retention- Stevens-Johnson syndrome
Calcium Channel Blockers general info – first line drug for hypertension- blocks calcium ions access to cells causing decreased demand for oxygen, decreased contractility- avoid GRAPEFRUIT juiceEx: Amlodipine, Verapamil, Diltiazem, Nifedipine
calcium channel blockers adverse effects – heart failure- dysrhythmias- Stevens-Johnson syndrome- peripheral edema- bradycardia- dizziness
alpha-adrenergic blockers general info – relaxes blood vessels, leading to decreased blood pressure- DO NOT take with male enhancement drugsEx: Doxazosin, Prazosin, Terazosin
alpha-adrenergic blockers adverse effects – dizziness- drowsiness- headache- stuffy nose- hypotension- nervousness
beta-adrenergic blockers (beta blockers) general info – LOL medications- decreases cardiac workload- slows heart rate and decreases blood pressure- treats HF, dysrhythmias, hypertension, angina- prophylaxis for MI- can mask symptoms of hypoglycemia- DO NOT give to asthma patientsEx: Metoprolol, Labetalol, Atenolol, Propranolol
beta blockers nursing considerations – check blood sugar- check heart rate- assess for fluid overload- DO NOT give to asthma patients
beta blockers adverse effects – fluid retention- worsening of HF- fatigue- orthostatic hypotension- bradycardia- sexual dysfunction
beta blockers contraindications “””ABCDE””AsthmaBlock (heart block)COPDDiabetes mellitusElectrolyte (hyperkalemia)”
hypertension – persistently high blood pressure- blood pressure of 140/90 or higher
primary hypertension symptoms – headache- visual disturbances- nausea/vomiting- disorientation
primary hypertension lifestyle modifications – reduced sodium- DASH diet (Dietary approaches to stop hypertension)- alcohol restriction- increased exercise- smoking cessation
The DASH diet includes which food groups? fresh fruits and vegetables, whole grains, low-fat dairy, and lean meats (fish, poultry)
Antihypertensive therapy general patient education – watch for fluid overload- monitor blood sugar- lifestyle modifications- monitor HR and B/P- never stop taking medication abruptly- change positions slowly due to dizziness and orthostatic hypotension
Nitroglycerin general info – vasodilator used to treat angina (chest pain)- decreases B/P- increases heart rate
Nitroglycerin adverse effects headache, orthostatic hypotension, reflex tachycardia
Nitroglycerin patient education – sublingual may burn under tongue- take aspirin or acetaminophen for headache- avoid alcohol- check B/P regularly- keep in original container- take when sitting or lying down- take up to 3 at 5-minute intervals- call 911 if no relief after 1st dose
Nitroglycerin is used for what symptom? Angina
Digoxin general info – Inotropic agent, cardiac glycoside- treats heart failure, A-fib- also treats angina, hypertension but not 1st line drug- improves pumping ability of heart- LOWERS heart rate and blood pressure
Digoxin adverse effects – blurred vision- vision changes (yellow/green halos)- dysrhythmias- mental changes
Digoxin nursing considerations – monitor labs (K, Mg, Ca)- hypokalemia, hypomagnesemia, hypercalcemia cause toxicity of Digoxin- caution when given with other cardiac meds- therapeutic range: 0.5 – 2 ng/mL
Amiodarone general info – potassium channel blocker- indicated for life-threatening ventricular dysrhythmias, recurrent ventricular fibrillation, and recurrent atrial fibrillation- decreases heartrate and contractility
Amiodarone adverse effects – hypotension- hepatotoxicity- pulmonary toxicity- bradycardia- worsening dysrhythmias
Lidocaine (Xylocaine) general info – class 1B drug, sodium channel blocker- given for life-threatening ventricular arrhythmias- IV drip only- onset of effect is 1-2 minutes- decreases myocardial irritability- DOES NOT have Epinephrine
Quinidine general info – class 1A drug, sodium channel blocker- treats atrial dysrhythmias and supraventricular tachycardia- slows impulse conduction in the heart- wide QRS on EKG- decreases B/P, increases heartrate
Quinidine adverse effects – dysrhythmias- dizziness- headache- nausea, vomiting- visual disturbances
Quinidine nursing considerations – baseline EKG- check liver function tests- check blood pressure- take with food or milk for GI upset
Dobutamine general info – Beta 1 receptor agonist drug- treats cardiogenic shock and heart failure- side effect of tachycardia- increases B/P when given in high doses- decreases B/P when given in low doses
Atropine general info – anticholinergic drug- treats bradydysrhythmias and asystole- blocks acetylcholine
Atropine adverse effects – tachycardia when given in high doses- urinary retention- bradycardia when given in low doses- blurred vision- photophobia- dilated pupils- increased intraocular pressure- hyperpyrexia (temp above 106.7)
Dopamine general info – Inotropic agent- causes heart to beat with more force- treats hypovolemic shock, heart failure, and cardiogenic shock- DO NOT give with MAOIs
Dopamine adverse effects – tachycardia- dysrhythmias- angina
Nursing education for post MI patients – meds will include antiplatelets, anticoagulants, ACE inhibitors, Beta blockers, or statins- lifestyle changes: quit smoking, avoid alcohol, eat healthier, increase activity- decrease salt intake- avoid unhealthy/greasy/fatty foods
Heparin general info – anticoagulant that inactivates clotting factors- treats DVT, thrombophlebitis, PE, DIC- prophylaxis for MI, heart failure, stroke- antidote: protamine sulfate- given subQ for DVT prevention
Heparin adverse effects – thrombocytopenia (low platelet count)- osteoporosis
Heparin nursing considerations – monitor aPTT (45-60 seconds), Hgb, Hct, platelet count- obtain baseline vitals- okay in pregnancy- contraindicated in patients with thrombocytopenia and bleeding disorders
Heparin patient education – carry medical ID indicating use- monitor for signs of bleeding (black tarry stools, bruising)- avoid alcohol, NSAIDs, herbals- use electric razor and soft toothbrush- avoid contact sports- avoid IM injections
Warfarin general info – anticoagulant- MOA: prevents synthesis of vitamin K dependent clotting factors- given orally only- used for prevention of venous thrombosis, PE, thromboembolism w/ prosthetic heart valves- antidote: vitamin K- monitor INR by obtaining a PT test (should be 2-3)
Warfarin adverse effects – hemorrhage- many food and drug interactions
Warfarin patient education – avoid leafy green vegetables- carry ID indicating use- monitor for signs of bleeding (black tarry stools, bruising)- avoid alcohol, NSAIDs, herbals- use electric razor
Dabigatran (Pradaxa) general info – anticoagulant- direct thrombin inhibitor- treats DVT and PE- prophylaxis for strokes and systemic embolisms
Dabigatran (Pradaxa) adverse effects – GI upset- bleeding
Dabigatran (Pradaxa) patient education – do not stop abruptly- take with full glass of water- carry ID indicating use- monitor for signs of bleeding (black tarry stools, bruising)- avoid alcohol, NSAIDs, herbals- use electric razor
aspirin general info – antiplatelet drug- MOA: inhibits platelet aggregation- treats ischemic strokes and MI w/ ST elevation- prophylaxis for MI- given indefinitely after MI- DO NOT use for hemorrhagic stroke
aspirin adverse effects – GI bleeding- hemorrhagic stroke
aspirin patient education – take with full glass of water and food- monitor for signs of bleeding (black tarry stools, bruising)- avoid alcohol
Alteplase (tPA) general info – thrombolytic (clot busting) drug- MOA: activates conversion of plasminogen to plasmin- treats MI, ischemic stroke, massive PE- IV only- given in ER or critical care by experienced personnel only- check INR, aPTT, platelet, fibrinogen
Alteplase (tPA) adverse effects – intracranial bleeding- fever
Ferrous Sulfate (Iron) general info – treats iron deficiency anemia- therapeutic response should be increased activity tolerance- monitor Hgb, Hct, retic- liquid iron should be diluted with water or juice
Ferrous Sulfate (iron) adverse effects – GI disturbance- teeth staining- toxicity
low-density lipoprotein (LDL) – bad cholesterol- promotes atherosclerosis
High-density lipoprotein (HDL) – good cholesterol- protects against atherosclerosis
very low density lipoproteins (VLDL) – bad cholesterol, contains triglycerides- promotes atherosclerosis
Hyperlipidemia excessive amounts of lipids in the blood
Hypercholesterolemia excessive cholesterol in the blood (type of hyperlipidemia)
risk factors for hypercholesterolemia – African American race- hypertension- cigarette smoking- low HDL
Statins general info – drugs used to lower cholesterol in the bloodstream- most effective for lowering LDL and total cholesterol- raises HDL- decreases triglycerides- used for post MI therapy – reduces risk for repeat MI- once daily dosing at night has greatest impact b/c cholesterol synthesis increases at night- avoid grapefruit juice
What is the number one cause of death in diabetic patients? hypercholesterolemia
Statins adverse effects – hyperglycemia and new onset diabetes (causes increased insulin resistance)- hepatotoxicity- memory loss- cataracts- weakness of skeletal muscles (myopathy)
Colesevalem (Welchol) general info – bile-acid sequestrant- MOA: inhibits reabsorption of bile acid in intestines, results in decreased cholesterol- treats hypercholesterolemia- take 1 hour before or 4 hours after other meds
Colesevalem (Welchol) adverse effects – constipation- bloating- cramping- flatulence
Ezetimibe (Zetia) general info – cholesterol absorption inhibitor- obtain liver function lab tests (avoid in patients with liver issues)- reduces total cholesterol- patients should take at the same time every day
Ezetimibe (Zetia) adverse reactions – headache- diarrhea- nausea- hypersensitivity reaction
Gemfibrozil (Lopid) general info – Fibrate drug class- treats high cholesterol and high triglycerides- raises HDL- take on empty stomach 30 minutes before morning and evening meals
Gemfibrozil (Lopid) adverse effects – gallstones- myopathy- liver injury- lower back pain- dysuria
What is the most common psychiatric disorder? Depression
T/F: Antidepressants need to be taken for 1-3 weeks before a therapeutic response will occur. True
nursing considerations for antidepressant therapy – early treatment may increase suicidal tendencies- watch for worsening mood, change in behavior, suicidal ideation
antidepressant drug classes – selective serotonin reuptake inhibitors (SSRIs)- serotonin/norepinephrine reuptake inhibitors (SNRIs)- tricyclic antidepressants (TCAs)- monoamine oxidase inhibitors (MAOIs)- atypical antidepressants
SSRIs general info – selective serotonin reuptake inhibitors- first line drug class for depression- treats depression, anxiety, OCD, premenstrual dysmorphic disorder- less side effects than other antidepressants- take with food to avoid GI upset- DO NOT take with MAOIs- Ex: Fluoxetine
SSRIs adverse effects – insomnia- GI symptoms (nausea, vomiting)- anxiety- nervousness
Serotonin syndrome symptoms – occurs when SSRI or SNRI is taken with an MAOI or within 2 weeks of each otherremember SHIVERSS – shiveringH – hyperreflexiaI – increased temperatureV – vital signs instabilityE – encephalopathyR – restlessnessS – sweating
SNRIs general info – serotonin/norepinephrine reuptake inhibitor- 1st line treatment for depression, generalized anxiety, panic disorders, social phobias, ADHD- take with food to decrease GI symptoms- contraindicated for pregnancy- DO NOT use with MAOIs- Ex: Venlafaxine
SNRIs adverse effects – anxiety- nervousness- tremors- insomnia- anorexia- GI effects (weight loss, nausea, vomiting, constipation, diarrhea)- hypertension- tachycardia
Tricyclic Antidepressants (TCAs) – oldest antidepressant drug class- blocks serotonin and norepinephrine reuptake- treats depression, bipolar disorder, ADHD, panic disorder, OCD, neuropathic pain- AVOID grapefruit juice and alcohol- avoid activities requiring alertness (due to sedation S/E)- Ex: Imipramine, Amitriptyline
TCA adverse effects – sedation (most common)- orthostatic hypotension (most common)- cardiac dysrhythmias (most severe)- tachycardia- decreased sexual desire- dry mouth
Monoamine Oxidase Inhibitors (MAOIs) general info – prevents removal of Norepinephrine, Serotonin, and Dopamine- treats depression- many food and drug interactions- only used when SSRIs, SNRIs and TCAs are unsuccessful- low tyramine diet (avoid chocolate, avocadoes, aged cheese, beer, wine)- Ex: phenelzine, selegiline
MAOI adverse effects – hypertensive crisis (stroke)- anxiety- insomnia- orthostatic hypotension- confusion- profuse sweating- tremors
atypical antidepressants general info – blocks Serotonin, Norepinephrine, and Dopamine reuptake- treats depression, seasonal depression, smoking cessation- commonly taken with SSRI when a more complete resolution of depression is needed- Ex: Bupropion
atypical antidepressants adverse effects – seizures- agitation- tachycardia- tremors- blurred vision- dizziness- headache- insomnia
Common medications for mood stabilization Lithium, Carbamazepine, Valproic acid
bipolar disorder general info – episodes of depression alternating with episodes of mania- lithium is used for treatment- manic phase: physical and mental hyperactivity, constant talking, excessive happiness, racing thoughts, restlessness, decreased need for sleep, unattainable plans- depression phase: sadness, lack of energy, increased need for sleep, uncontrollable crying, appetite change, suicidal thoughts
Lithium general info – treats bipolar disorder- affects acetylcholine, GABA, Dopamine, and Norepinephrine- therapeutic level: 0.5- 1.5 mEq/L- check blood levels every 3-6 months- contraindicated in pregnancy
Lithium adverse effects – metallic taste- hand tremors- nausea- polyuria- polydipsia- diarrhea- muscle weakness- fatigue- edema- weight gain
Nursing considerations for labs on a patient taking Lithium – draw blood in the AM- labs need to be checked every 3-6 months- draw blood 12 hours after PM dose
Benzodiazepines general info – used for anxiety, insomnia, alcohol withdrawal, delirium tremens, seizure prevention, muscle spasms- treats panic disorders (alprazolam)- contraindicated in pregnancy and narrow angle glaucoma- avoid tasks requiring alertness- avoid alcohol- do not stop abruptly- take with full glass of water or food if GI upset- Ex: diazepam, alprazolam
Benzodiazepines adverse effects – drowsiness- dizziness- risk for falls- memory issues- confusion- depressed mood- suicidal ideation- shallow breathing
Schizophrenia – chronic psychotic illness, disordered thinking, reduced ability to comprehend reality- patients will have paranoia, delusions, hallucinations- episodes can be acute, residual, or long term- treated with 1st and 2nd generation antipsychotics
1st generation antipsychotic agents general info – 1st generation – block post synaptic Dopamine receptors in the brain- treats schizophrenia- effect does not happen until 48-72 hours after taking- obtain baseline EKG prior to administration- do not stop abruptly- do not drive or operate machinery- avoid alcohol- Ex: Chlorpromazine
antipsychotic agents extrapyramidal adverse effects Early signs:- Parkinsonism – shuffling gait, drooling, muscle rigidity- acute dystonia – spasms of tongue, face, extremities, back, neck- akathisia – restlessness, constant desire to moveLate signs:- tardive dyskinesia – stiff jerking movements of face and body, lip smacking, tongue protrusion, facial grimaces
1st generation antipsychotic agents other adverse effects – EKG changes- agranulocytosis- pancytopenia (decreased blood cells)- hiccups for prolonged time (2 weeks or longer)- neuroleptic malignant syndrome (high fever, sweating, unstable B/P)
2nd generation antipsychotic agents general info – blocks Dopamine receptors and serotonin- treats schizophrenia, levodopa-induced psychosis- milder adverse effects than 1st generation- used for patients who have not responded to other antipsychotics- obtain frequent WBC levels- Ex: Clozapine
2nd generation antipsychotic agents adverse effects – agranulocytosis- seizures- extrapyramidal symptoms- diabetes- weight gain- dyslipidemia (abnormal amount of lipids, cholesterol, triglycerides)
zolpidem general info – non-benzodiazepine drug- short-term treatment of insomnia- enhances GABA in the body – relieves stress and improves sleep- reduce dose for hepatic dysfunction and elderly- avoid alcohol and CNS depressants
Zolpidem adverse effects – daytime drowsiness- dizziness- nausea- amnesia- sleep driving- diarrhea- short term memory loss
barbiturates general info – CNS depressant- treats headaches, insomnia, seizures- also used for anesthesia- do not stop abruptly- Ex: phenobarbital
Barbiturates adverse effects – CNS depression- cognitive impairment with sedation- respiratory depression- increased risk for suicidal ideation
Varenicline (Chantix) general info – nicotine receptor agonist, prevents Dopamine stimulation by nicotine- used for smoking cessation- assess smoking history- obtain baseline blood pressure- start 7 days before quitting smoking- treatment lasts 12 weeks, may need additional 12 weeks
Varenicline (Chantix) adverse effects – suicidal/homicidal ideation- mood swings- depression- seizures- myocardial infarction- angioedema- Stevens Johnson syndrome
Drug abuse use of a drug in a fashion inconsistent with medical or social norms
substance use disorder a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual uses a substance despite significant substance-related problems
Controlled Substances Act (CSA) – federal statute that regulates drugs into schedules I – V- federal legislation addresses drug abuse
Drug Schedules – 5 categories that drugs are classified into based upon the drug’s accepted medical use and its potential for abuse and addiction- Schedule I – highest potential for abuse and physical dependence (no medical use in the US)- Schedule V – lowest potential for abuse and physical dependence