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Pharmacology Final Exam - Filled Review Guide
1) Core labs, dosing principles, CBC, immunocompromised,
antiinfectives
Normal lab values and core pharmacology
Hgb: overall about 12-17.5 g/dL. Male 13.5-17.5. Female 12-16. Main idea: oxygen-carrying RBC. Hct: overall about 35-48%. Male 38-48. Female 35.5-44.9. Main idea: proportion of red blood cells. WBC: 4,000-11,000/mm3. Platelets: 150,000-400,000/mm3. RBC: overall about 4.2-6 million/mm3. Female 4.2-5.2. Male 4.5-6. INR: about 1 normally; 2-3 is common therapeutic range on warfarin. PT: 11-15 seconds. A1c: normal is less than about 5.7%; diabetes is diagnosed at 6.5% or higher. Phenytoin therapeutic level: 10-20 mcg/mL. Half-life: time required for a drug concentration in the blood to decrease by half. Most drugs are metabolized in the liver and excreted by the kidneys. Renal impairment: many drugs need lower dosing. Hepatic impairment: many drugs also need lower dosing.
CBC nursing interpretation
Low RBC / Hgb / Hct = anemia risk -> fatigue, pallor, shortness of breath, lower oxygen-carrying capacity. Low WBC = infection risk -> avoid sick people, monitor temperature, teach infection precautions, think immunocompromised. Low platelets = bleeding risk -> avoid IM injections when possible, minimize extra sticks, monitor for bruising and bleeding.
Hematologic growth factors
Epoetin alfa: artificial EPO; stimulates RBC production; used for anemia. Monitor hemoglobin and blood pressure. Increases Hct. Filgrastim: increases neutrophils; used for neutropenia. Monitor WBC/neutrophil counts and bone pain. Memory clue EPO = erythrocytes. FIL = fighting infection cells.
Immunocompromised / HIV / HAART
Examples of immunocompromised clients: those on immunosuppressants, autoimmune therapy, transplant clients, people on steroids, clients with HIV, many chemotherapy/cancer clients, and some sickle cell clients depending on clinical status. HIV directly attacks CD4 helper T cells. CD4 count: higher is better. <200 AIDS Viral load: lower is better. HAART / antiretroviral therapy uses more than one drug to reduce resistance. Adherence is critical to slow progression to AIDS.
Sulfonamide antibiotics
Treat bacterial infections. Key adverse effects: hypersensitivity / sulfa allergy, photosensitivity, crystalluria, folate deficiency, teratogenicity, and serious skin reactions including Stevens-Johnson syndrome. Teaching: drink about 2 liters of fluids daily, wear sunscreen, and avoid use in pregnancy unless specifically directed. Nursing considerations Watch for rash. Encourage hydration. Always ask about sulfa allergy. Think SUN, STONE, SKIN
Amphotericin B
IV antifungal. Nickname clue: "Ampho-terrible." Protect from light; brown IV bag. Infusion reaction can occur. Major adverse effects: nephrotoxicity / renal failure, hypokalemia, hypomagnesemia, and crystallization. Nursing considerations: monitor kidney function, urine output, potassium, magnesium, and infusion reaction. Verify compatibility carefully. 2) CNS, pain, gout, thyroid, GI, NSAIDs
Benzodiazepines
Uses: anxiety / panic attacks, seizures, status epilepticus, alcohol withdrawal. Effects: CNS depression. Adverse effects: hypotension, sedation, constipation, respiratory depression, abuse/dependence potential. Major interaction: other CNS depressants, especially alcohol. Antidote: flumazenil (Romazicon).
Morphine sulfate
Use: severe pain, post-surgery pain, cancer pain. Adverse effects: constipation, hypotension, respiratory depression. Opioid overdose antidote: naloxone (Narcan). Nursing considerations: monitor pain, respiratory rate, blood pressure, and bowel pattern. Question / hold if respirations are too low.
Gout drugs
Colchicine: used for acute gout attacks; also can treat pericarditis. Anti-inflammatory. Main adverse effect is GI upset / diarrhea. Allopurinol: used for maintenance / prevention, not for acute pain. Decreases uric acid production. Helps with tumor lysis syndrome. Can decrease ammonia levels. Watch for Stevens-Johnson syndrome. Teach increased fluids. Memory clue Colchicine = crisis now. Allopurinol = all-year prevention.
Beta blockers
Watch for bradycardia. Can mask hypoglycemia symptoms. Use caution with asthma/COPD because nonselective beta blockers can worsen bronchospasm. Ophthalmic beta blockers such as timolol can add to systemic beta-blocker effects.
Diuretics
Lower BP by decreasing vascular volume. Risks: dehydration and electrolyte imbalance. Furosemide is a loop diuretic works quickly, increases urinary output, and acts faster / more potently than thiazides. Adverse effects: Otoxicity Na loss Loops, thiazides, and carbonic anhydrase inhibitors can cause hypokalemia; potassium-sparing drugs can cause hyperkalemia.
ACE inhibitors (-pril)
Key adverse effects: cough, angioedema, potassium elevation. (literally ACE: angioedema, Cough, Elevated K) Monitor potassium and blood pressure. Peaked t waves if too much K Angioedema is an emergency. Do not give with ARBs think ACE vs ARB alternatives rather than stacking them together. Do not stop abruptlyrebound hypertension
Anticoagulants
Warfarin antidote: vitamin K. Monitor INR. Heparin antidote: protamine sulfate. Monitor for bleeding. Heparin = aPTT. Warfarin = PT/INR. Warfarin is contraindicated in pregnancy. LMWH (Enoxaparin) teaching pearl: SC abdomen, do not expel air bubble, do not massage.
Epinephrine / adrenergic drugs
Epinephrine increases heart rate and blood pressure and can cause tachycardia. Adrenergic drugs act like epinephrine: vasoconstriction, positive inotropic effect (more squeeze), positive chronotropic effect (more HR), positive dromotropic effect (more AV-node conduction). Can stimulate the CNS. Excess effect risk: severe hypertension.
Adenosine
Used to reset the heart in certain dysrhythmias. Can briefly cause asystole / a pause so the SA node can reset. Client may feel impending doom or strange chest sensations. Very short acting and given as a fast IV push.
Cholinergic drugs
Act like acetylcholine: rest and digest / the chill pill.
Cholinergic toxicity signs: SLUDGE = salivation, lacrimation, urination, diarrhea, GI upset, emesis; everything wet. Atropine is the antidote for cholinergic crisis.
Nitroglycerin
Treats angina. Vasodilator. Routes: sublingual works fast; also patch, IV, topical, transdermal. Main side effects: headache and hypotension. Contraindication with other alpha drugs Key teaching: sit or lie down during an attack, and if chest pain is not relieved after the first 5 minutes, call 911, then continue 2 more doses, separated by 5 min each 4) Respiratory, TB, neuro, eye/ear, bone, immune, herbs
Antihistamines / decongestants / expectorants
Older antihistamines such as diphenhydramine are more sedating and dry things up more. Newer antihistamines like loratadine are less sedating and often once-daily. Topical nasal decongestants work fast but can cause rebound congestion if overused. Oral decongestants take longer and pseudoephedrine can raise BP and cause insomnia. Guaifenesin (Mucinex) thins secretions, so they are easier to cough up; fluids help it work. Recommend to drink lots of water Antitussives are for dry / nonproductive cough, not productive cough.
Albuterol
Short-acting bronchodilator for bronchospasm / asthma. Can cause tremor and tachycardia. Think rescue inhaler. Give it before you give a corticosteroid to open up bronchiolesbronchodilation
Anti-Parkinson drugs
Selegiline: MAO-B inhibitor. Tyramine interaction can cause hypertension. Tyramine like aged food/drinks: wine, cheese, sausage (a whole charcuterie board lol) Avoid interacting drugs like meperidine, SSRIs, and dextromethorphan. Benztropine: anticholinergic; dries things up. Helps tremor and rigidity more than bradykinesia. Levodopa/carbidopa: core dopamine replacement. On-off and wearing-off are major clues. Do not stop antiparkinson drugs abruptly.
Tuberculosis drugs
Isoniazid (INH): used for active and latent TB and sometimes prophylaxis; used in combination therapy. INH adverse effects: hepatotoxicity, jaundice, fatigue, elevated liver enzymes, peripheral neuropathy. INH interferes with vitamin B6 -> give pyridoxine (B6). Rifampin: used with other anti-TB drugs. Rifampin teaching: red-orange body fluids are expected, can stain contacts, and decreases effectiveness of oral contraceptives so backup contraception is needed. Paroxetine (SSRI antidepressant): can be used for TB. adverse: drowsiness and GI upset Can be used in combo with INH Avoid alcohol and other hepatotoxic drugs with rifampin, paroxetine or INH. TB therapy is long-term and strict adherence is critical.
