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

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

Final Exam: NSG 124/ NSG124 (NEW 2024/
2025 Update) Pharmacology | Review with
Questions and Verified Answers| 100%
Correct| Graded A- Herzing
Q: 4 types of Laxatives include:
Answer:

• bulk forming
• surfactant
• stimulant
• osmotic
  Q: Bulk forming laxatives
  Answer:
• type of laxative that swells in water to form a viscous solution
• softens fecal mass
• works similar to dietary fiber
• must be taken with a full glass of water
• Ex: psyllium (Metamucil)
  Q: Surfactant laxatives
  Answer:
• type of laxative that works by lowering surface tension
• facilitates penetration of fluid into the feces
• must be taken with a full glass of water
• available in capsules, tablets, syrup, liquid
• Ex: docusate sodium (Colace)
  Q: Stimulant laxatives

Answer:

• stimulates peristalsis (intestinal motility)
• increase amount of water and electrolytes in intestines
• full glass of water NOT required
• Ex: bisacodyl (Dulcolax)
  Q: Osmotic laxatives
  Answer:
• draws water into the colon to stimulate evacuation
• used for bowel prep before diagnostic/surgical procedures
• warning in patients with hypertension, heart failure
• Ex: polyethylene glycol (MiraLax)
  Q: Proton pump inhibitors (PPIs)
  Answer:
• drug to treat gastric and duodenal ulcers, GERD
• enteric coated, dissolves in intestine versus stomach
• not to be given for heartburn because of delayed response
• Ex: omeprazole (Prilosec)
  Q: H2 receptor antagonists
  Answer:
• treats peptic ulcers, GERD, heartburn
• suppresses secretion of gastric acid
• Ex: Famotidine (Pepcid)
  Q: Ondansetron (Zofran)

Answer:

• antiemetic, serotonin receptor antagonist
• treats nausea and vomiting
• take with full glass of water
• SE: headache, diarrhea, dizziness
  Q: Vancomycin
  Answer:
• 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
  Q: Vancomycin adverse effects
  Answer:
• 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
  Q: Culture collection order (timeline)
  Answer:
• obtain blood culture first
• obtain urine culture second
• administer antibiotics
  Q: antimicrobials key takeaways
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Morphine adverse effects – respiratory depression- sedation- constipation- orthostatic hypotension- urinary retention- bradycardia
Naloxone (Narcan) pure opioid antagonist, reverses opioid induced respiratory depression
Medications for muscle spasticity – Baclofen- Diazepam- Dantrolene- Tizanidine
Baclofen (Lioresal) – relieves muscle spasms and spasticity due to MS or spinal cord injury- GI and CNS side effects- do not stop abruptly
Epinephrine – vasopressor, bronchodilator- adrenergic drug that acts on both alpha and beta receptors to relax smooth muscle- used to treat allergic reactions (anaphylaxis) and cardiac arrest- use caution in patients with hyperthyroidism and hypertension
H1 receptor antagonists (2nd generation) – drug class used to treat mild allergic reactions- not sedating- use caution in patients with renal impairment- Ex: fexofenadine (Allegra – cannot take with fruit juice), loratadine (Claritin)
4 types of Laxatives include: – bulk forming- surfactant- stimulant- osmotic
Bulk forming laxatives – type of laxative that swells in water to form a viscous solution- softens fecal mass- works similar to dietary fiber- must be taken with a full glass of water- Ex: psyllium (Metamucil)
Surfactant laxatives – type of laxative that works by lowering surface tension- facilitates penetration of fluid into the feces- must be taken with a full glass of water- available in capsules, tablets, syrup, liquid- Ex: docusate sodium (Colace)
Stimulant laxatives – stimulates peristalsis (intestinal motility)- increase amount of water and electrolytes in intestines- full glass of water NOT required- Ex: bisacodyl (Dulcolax)
Osmotic laxatives – draws water into the colon to stimulate evacuation- used for bowel prep before diagnostic/surgical procedures- warning in patients with hypertension, heart failure- Ex: polyethylene glycol (MiraLax)
Proton pump inhibitors (PPIs) – drug to treat gastric and duodenal ulcers, GERD- enteric coated, dissolves in intestine versus stomach- not to be given for heartburn because of delayed response- Ex: omeprazole (Prilosec)
H2 receptor antagonists – treats peptic ulcers, GERD, heartburn- suppresses secretion of gastric acid- Ex: Famotidine (Pepcid)
Ondansetron (Zofran) – antiemetic, serotonin receptor antagonist- treats nausea and vomiting- take with full glass of water- SE: headache, diarrhea, dizziness
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
Culture collection order (timeline) – obtain blood culture first- obtain urine culture second- administer antibiotics
antimicrobials 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- most antibiotics are nephrotoxic, monitor creatinine levels
Fluroquinolone drugs “- broad spectrum antibiotics- end in “”floxacin””- Ciprofloxacin- Gemifloxacin- Levofloxacin”
Fluoroquinolones adverse effects – tendinitis (tendon rupture)- phototoxicity- QT elongation- myasthenia gravis
Cephalosporins – take with food- CSF distribution best in 3rd, 4th, & 5th generations- do not give to patients with Penicillin allergy- eliminated by the kidneys except for Ceftriaxone which is eliminated by the liver
Metformin (Glucophage) – Biguanide drug- reduces glucose production by liver- may cause weight loss, nausea, vomiting, diarrhea- decreases absorption of vitamin B12 and folic acid (B12 deficiency can cause peripheral neuropathy/numbness)
insulins that are clear and can be given SQ or IV Regular, Aspart, Lispro, Apidra
When mixing insulins, which type would be drawn into the syringe first? clear
NPH insulin can be mixed with what types of insulin? rapid and short acting insulins
True/False: all clear insulins that can be mixed can be administered IV True
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.Ex: Lispro, Apidra, Aspart
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.Ex: Regular, Humulin R, Novolin R
Intermediate insulin onset, peak, duration Onset: 1-2 hrsPeak: 4-12 hrsDuration: 14-24 hrs(NPH) Nurses Play Hero to(2) eight 16-year-olds.Ex: NPH, Humulin N
Long acting insulin onset, peak, duration Onset: 1-2 hrsPeak: NeverDuration: 24 hrs2 long nurse shifts never peak but last 24 hours.Ex: detemir (Levemir), glargine (Lantus)
hypoglycemia is blood sugar less than _ <70 mg/dL hypoglycemia symptoms – tremors- palpitations- anxiety- restlessness- sweating- pallor True/False: Glucagon is given SQ when a patient is hypoglycemic with loss of consciousness. True 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 Thiazide diuretics – decrease sodium, potassium, and water reabsorption- increase urine output- reduce blood pressure- treats heart failure and hypertension- Ex: Hydrochlorothiazide 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 reabsorption of sodium, potassium, and chloride- treats edema, heart failure, hypertension 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 Hyperkalemia S/S Deadly – remember MURDERM – muscle crampsU – urine output low or noneR – respiratory distressD – decreased cardiac contractility (weak pulse, low HR)E – EKG changesR – reflexes (hyperreflexia) UTI symptoms – dysuria- urgency- cloudy urine- odor to urine What is the best treatment option for UTIs caused by E. coli? Sulfamethoxazole/trimethoprim (Bactrim) 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 adverse effects – fluid retention- worsening of HF- fatigue- orthostatic hypotension- bradycardia- sexual dysfunction beta blockers contraindications “””ABCDE””AsthmaBlock (heart block)COPDDiabetes mellitusElectrolyte (hyperkalemia)” 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 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, Nifedipine, Diltiazem (Very Nice Drugs) calcium channel blockers adverse effects – heart failure- dysrhythmias- Stevens-Johnson syndrome- peripheral edema- bradycardia- dizziness- constipation 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 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 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- apply patch to chest area w/o hair, remove at night- 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 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 or IV for immediate action- monitor aPTT (45-60 seconds), Hgb, Hct, platelet count, vitals 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) Clopidogrel (Plavix) general info – platelet aggregation inhibitor- prevents MI and strokes- take with food to avoid GI upset- SE: abdominal pain, dyspepsia, diarrhea, SJS 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 Lithium general info – treats bipolar disorder, alcoholism, schizophrenia- affects acetylcholine, GABA, Dopamine, and Norepinephrine- therapeutic level: 0.5- 1.5 mEq/L- check blood levels every 3-6 months- contraindicated in pregnancy 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- Antidote: Flumazenil- Ex: diazepam (Valium), alprazolam (Xanax) Benzodiazepines adverse effects – drowsiness- dizziness- risk for falls- memory issues- confusion- depressed mood- suicidal ideation- shallow breathing Muscarinic agonists – mimics effects of parasympathetic nervous system- cholinergic agonists- Ex: Carbachol (glaucoma), Pilocarpine (glaucoma), Bethanechol (urinary retention) Bethanechol (Urecholine) – muscarinic agonist- treats urinary retention in post partum and post surgical patients- improves urinary output by strengthening urinary tract muscle tone allowing for complete bladder emptying- Antidote: Atropine- SE: N/V, orthostatic hypertension, urinary urgency Muscarinic antagonists “- mimics effects of sympathetic nervous system- causes decreased secretions in the body- “”Can’t see, can’t pee, can’t spit, can’t shit””- Ex: Atropine, Benztropine” interferon beta-1a (Avonex) – antiviral, immunomodulator- treats MS- slows progression of neurologic dysfunction- flu-like side effects- give Tylenol or aspirin for SE myasthenia gravis – autoimmune neuromuscular disorder characterized by weakness of voluntary muscles and rapid fatigue of muscle- body develops antibodies to acetylcholine- treated with cholinesterase inhibitors (pyridostigmine), glucocorticoids, thyroidectomy Levodopa/Carbidopa – given together to increase dopamine, allows for lower dose of Levodopa- used for Parkinson’s disease- decreases tremors and muscle rigidity, improves gait, speech, and writing- DO NOT give with MAOIs- SE: dyskinesia & blepharospasm signs of toxicity, also may have orthostatic hypotension, anxiety, headache Phenytoin (Dilantin) – treats tonic/clonic seizures- monitor liver function- therapeutic range: 10-20 mcg/mL- teratogenic- SE: gingival hyperplasia, CNS effects, GI effectsb Donepezil (Aricept) – treats mild to moderate Alzheimer’s disease- cholinesterase inhibitor- increases acetylcholine in the brain- improves memory, decreases dementia- DO NOT give with Amitriptyline- SE: mostly GI Memantine (Namenda) – treats moderate to severe Alzheimer’s disease- antagonist of glutamate receptors- more tolerated than cholinesterase inhibitors- SE: dizziness, headaches, confusion, diarrhea 1 tsp = mL 5 mL
1 tbsp = tsp = _ mL = oz 3 tsp, 15 mL, 0.5oz
1 oz = mL 30 mL 1 cup = oz = mL 8 oz, 240 mL 1 kg = lbs = g 2.2 lbs, 1000 g 1 inch = cm 2.5 cm
1 L = mL 1000 mL 1 mg = mcg 1000 mcg
1 g = _ mg 1000 mg
antagonist drug that blocks or impedes the normal activity of a given neurotransmitter
agonist a drug that mimics or increases a neurotransmitter’s effects
non-proprietary/generic name “the generally recognized or “”common”” name for a drug”
proprietary/brand name a drug with a registered name or trademark
analgesic drug that relieves pain
addiction compulsive drug seeking and use, despite adverse consequences
toxicity severe adverse drug reaction, not necessarily due to excessive dosing
withdrawal Physical and mental symptoms that occur when a dependent person stops taking a drug
tolerance reduced reaction to regular use of the same dose of a drug, requiring larger doses to obtain same therapeutic effect
dependence the condition that results when the brain/body develops a chemical need for a drug and cannot function normally without it
immunocompromised having an impaired/weakened immune system
percutaneous medication medication administered through the skin (injection, absorption)
enteral route administration of drugs orally, and through nasogastric or gastrostomy tubes
parenteral route dispensation of medications via a needle into the skin layers: IV, IM, SubQ
subtherapeutic level drug concentrations below the minimum effective concentration
supratherapeutic level drug concentration above the minimum effective concentration
therapeutic level the concentration of a drug in the blood serum that produces the desired effect without toxicity
drug half-life the time required for the amount of drug in the body to decrease by 50%
reflex tachycardia temporary increase in heart rate that occurs when blood pressure falls
thrombolytic drug that breaks down blood clots
platelet aggregation inhibitor drug that prevents platelets from clumping together
narrow therapeutic range drugs that have a minimum and a maximum effective dose very close to each other
parkinsonism Having tremor, muscle rigidity, stooped posture, and a shuffling gait
acute dystonia acute involuntary contraction of muscles, usually of the head, neck, face, extremities
tardive dyskinesia involuntary repetitive movements of the facial muscles, tongue, and limbs (jerky motion)
neuroleptic malignant syndrome Life-threatening muscle rigidity, fever, and rhabdomyolysis.
orthostatic hypotension Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions
nystagmus involuntary, jerking movements of the eyes
photosensitivity sensitivity to light
adverse effects unpredictable drug effect that is not the desired therapeutic effects; may be unpleasant or even dangerous
teratogenic effect drug induced birth defect
antipyretic a drug that relieves fever
antiplatelet reduces the tendency of platelets to stick together and form a clot
hypnotic drug that exerts a sleep-inducing effect
sympathomimetic drug that mimics the effects of the sympathetic nervous system, excitatory
adrenergic drug that stimulates a receptor responding to norepinephrine (noradrenaline) or epinephrine (adrenaline)
normal potassium range 3.5-5.0 mEq/L
normal sodium range 135-145 mEq/L
normal calcium range 8.2-10.2 mg/dL
normal glucose range 70-120 mg/dL
normal magnesium range 1.5-2.5 mEq/L
Lithium therapeutic range 0.5-1.5 mEq/L
Digoxin therapeutic range 0.5-2 ng/mL
Phenytoin therapeutic range 10-20 mcg/mL
Normal hematocrit values Male: 41 – 50%Female: 36 – 48%
Normal hemoglobin values Male: 13.8 – 17.2Female: 12.1 – 15.1
Normal WBC range 4,500 – 11,000 /uL
Normal platelet range 150,000 – 400,000 /uL