NUR 210 & 242 Exams 1–4 Study Guide (2026/2027) (PDF) | Pharmacology | Galen College, Exams of Pharmacology

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NUR 210, 242

EXAM’S 1-4 STUDY GUIDE

Pharmacology and Medsurge

Galen College of Nursing

TABLE OF CONTENTS

• EXAM 1 STUDY GUIDE…………………….
• EXAM 2 STUDY GUIDE…………………….
• EXAM 3 STUDY GUIDE…………………….
• EXAM 4 STUDY GUIDE…………………….

Exam 1 Study Guide

Chap. 2 Two drug phases 1.Pharmacokinetic phase 2.Pharmacodynamic Phase Pharmacokinetic Phase: is the process of drug movement through the body necessary to achieve drug action. Includes Absorption, Distribuion, Metabolism, and Excretion. Pharmacodynamic Phase: is the study of the effects of drug on the body. ( Receptor binding, post receptor effects, and chemical reactions). Digestion starts in the mouth-Salvia starts the breakdown!!!! Pharmacokinetic Phase: Absorption is the movement of the drug through the blood stream after its administration. Disintegrations is the breakdown of the oral drug into smaller particles. Dissolution is the time it takes the drug to disintegrate and dissolve to become available for absorption. Acidic is faster than alkaline environment. Absorption methods Passive transport Diffusion: is across the semipermeable membrane high to low concentration. Requires no energy. It stops when the concentration is equation on both sides of the membrane. In oral drugs GI (higher concentration) moves to the blood stream (lower concentration). Facilitated diffusion: is the same principal but requires a carrier protein to move the drug. Active Transport Requires carrier and energy to move the drug against the concentration gradient. Pinocytosis Taking a bit out of the particles and bringing them into the cell. Lipid soluble drugs and nonionized drugs are absorbed faster than water soluble and ionized drugs Factors affecting absorption Blood circulation (poor circulation, vasoconstrictors, shock or disease), Pain, stress, solid, hot foods, high fat foods slow gastric emptying, Exercise decreases Blood flow, pH, Route of administration (IV, Oral, IM) Drug movement from GI tract to liver From mouth to the gut to portal vein and the liver drugs may be metabolized to an inactive form and excreted reducing the amount of the active drug available to achieve desired effect. This is first pass effect (first pass metabolism) Bioavailability is the percentage of the drug left for activity. May be affected by absorption and first pass metabolism for oral drugs. Bioavailability is always less than 100%. Factors affecting Bioavailability Drug form Route of administration

Gastric mucosa and motility Administration w/food and other drugs Changes in liver metabolism Drug distribution: is the movement of the drug form the circulation to tissues. Protein binding ( highly and weakly protein bound drugs) Drugs drugs( unbound) Volume of drug distribution Competition over protein binding sites leads to more free drug Low plasma protein levels causes more free drugs floating around Low albumin same thing (elderly considerations) BBB (blood brain barrier) Water soluble drugs do not cross the BBB You want to be careful with those who are pregnant some drugs cross the placenta and cause damage Drug metabolism (biotransformation: changing the drug chemically to form that is ready for excretion) Half life: from administration to reduction of the drug in the body to a half. Affected by.- previous dose, metabolism, and elimination. Ex. Ibuprofen= 2hr 6am 200mg in two hrs= 100mg 8am 100mg in 2 hrs= 50mg 10am 50mg in 2hrs= 25mg 12pm 25mg in two hrs=12.5mg 2pm 12.5mg in 2 hrs= 6.25mg 4pm Steady state=plateau=amount administered= amount eliminated usually achieved by 4- 5 th^ half life if given consistently Loading dose= large initial dose of medication (seizure medications) smaller doses to follow consistent time intervals. Drug excretion (elimination) Kidneys Creatinine clearance BUN Glomerular filtration rate lower in older and female due to decreased muscle mass Urine pH 4.6- Liver (bile) Feces Lungs Saliva, sweat, breast milk Pharmacodynamics Phase: Primary effect-desirable response Secondary effect- desirable or undesirable response Ex. Benadryl (primary effect= treatment of allergies, Secondary effect= CNS depression (sedation))

Common, chronic conditions, gener, ethnicity, age, may influence secondary effects of the drug. Adverse reactions More severe than side effects Undesirable effects Rare unexpected, undesirable effects with normal dose Drug Toxicity Drug level exceeds therapeutic range Overdose or drug accumulation Underlying condition, age, genetics Pharmacogenetics Biologic variations Study of genetic factors influencing individual response Tolerance Decreased drug responsiveness over time Tachyphylaxis Acute, rapid decrease in drug responsiveness regardless of time Placebo effect Drug response not attributed to chemical drug properties Pharmacodynamics Drug interactions Altered drug effect due to interaction with another drug. Pharmacokinetic interactions Changes occurring in absorption, distribution, metabolism, and excretion Drugs can block, decrease, increase the adsorption of other drugs Increasing or decreasing gastric emptying time Changing gastric pH Forming drug complexes Metabolism-inducers or inhibitors drugs may require higher or lower dose of one medication Don’t forget herbal products!!! Additive Sum of effects of two drugs Synergistic Effect is much great than effects of either drug alone Antagonistic One drug reduces or blocks effect of other drug. Drug-nutrient interactions Food may increase, decrease, or delay drug response Drug-laboratory interactions Drug may cause misinterpretation of test results Drug-induced photosensitivity Skin reaction caused by sunlight Photoallergic reaction, immune mediated, delayed, may result from a larger dose of the drug

Phototoxic reaction is when a phototoxic drug interacts with skin and produce damage. Not immune mediated MAOIs with tyramine rich foods like cheese, wine, organ meats, beer, yogurt, sour cream and bananas. GRAPEFRUIT!!! Chap. 6 Geriatric considerations Aging population Physiologic changes Reduction in total body water and lean body mass Reduction in kidney mass and function Reduction in liver mass and function Reduction in physiologic processes that maintain equilibrium Pharmacokinetics Absorption Distribution Metabolism Excretion GI changes: decrease in a small bowel surface Slower gastric emptying Reduced gastric blood flow Decreased acid production Swallowing difficulties poor nutrition, tube feeding Decline in muscle mass, increase in fat Reduced albumin levels Slower metabolism due to decreased liver blood flow: assess LFT’s (AST, ALT, bilirubin, alkaline phosphatase. GFR states to decline >40 y/o, at 65 we have 30% less nephrons. Assess kidney function, GFR, BUM, serum creatinine Pharmacodynamics Age relate changes in the central nervous system and cardiovascular system Changes in the number of drug receptors Changes in the sensitivity of receptors to drugs Compensatory response to physiologic changes is decreased Reduced response to drugs Blunting in compensatory reflexes leading to orthostatic hypotension and increased fall rates Nursing implications: older adult drug dosing and monitoring Polypharmacy Risk factors Pharmacotherapy Using more medications than medically necessary Reduce the risk and incidence through teaching Beers criteria for potential inappropriate drug use

Knowledge, deficient related to cognitive limitation Planning Patient will collaborate with health care providers to develop a therapeutic regimen that is congruent with health goals and lifestyle Patient will list resources that can be used for more information and support Nursing interventions Monitor laboratory results Observe the patient for adverse reactions when multiple drugs are taken Recognize a change in usual behavior or an increase in confusion Remind patient and family to tell pharmacist about OTC preparations that the patient is taking Advise patient and family to request non-childproof caps Evaluation Chap 8. The nursing process and patient-centered care Quality safety education for nurses (QSEN) Guides nurses in the practice of safe, comprehensive care QSEN competencies Patient and family-centered care Collaborating teamwork Evidence-based practice Quality improvement Safety Informatics Nursing process Five step decision making approach Assessment Diagnosis Planning Implementation Evaluation Nursing process-assessment Subjective data Current health history Patient s/s Current medications and concerns Allergies Financial barriers Tobacco, alcohol, and caffeine use Cultural dietary barriers Home safety needs Caregiver needs and support system Objective date Physical health assessment

Laboratory and diagnostic test results Physicians notes Measurement of vital signs Patients body language Nursing diagnoses Planning Effective goal setting characteristics Patient centered Realistic and measurable Reasonable deadlines Acceptable to both patient and nurse Dependent on patients decision making ability Shared with other health care providers, family, and caregivers Identifies components for evaluation Implementation Education Drug administration Patient care Interventions needed for established gaols Factors promoting patient teaching Pt must be ready to learn Nurse and patient must be fully engaged Timing is important Conductive quiet environment Eliminate barriers (pain) Have interpreter if language barrier Have family member present if patient is forgetful. Tailor teaching to patients education level Utilize several sessions to avoid overload Utilize community resources Evaluate pts understanding of instruction Pt teaching General Side effects Self-administration Diet Cultural considerations Evaluation Determine if goals were met Determine if teaching objectives were met Determine need for followup Refer to community resources Document successful goal attainment Chap 9

Determine drug effectiveness Determine side effects and adverse drug reactions Right to refuse Nurse should explain risks involved Nurse should reinforce reasons and benefits of the drug Nurse should document refusal immediately Follow up Is required Nurses rights when administering medications Nurses rights Right to a complete and clear order Right to have the correct drug, route (form), and dose dispensed Right to have access to information Right to have policies to guide safe medication administration Right to administer medications safely and to identify system problems Right to stop, think, and be vigilant when administering medications If in doubt call HCP to clarify Check the drug book or consult pharmacy Always follow your agency’s policies and procedures If there are any problems w/ medication administration inform proper authorities (follow chain of command) Take your time! If you feel pressured discuss it with your supervisor. Don’t give a med without knowing what it does! Safety in medication administration Culture of safety Ana encourages organization to avoid punitive approaches in drug error reporting Individuals should be encouraged to report drug error. So the system can be repaired and fixed The joint commission has taken steps to support safety and quality care in the workplace TJC developed national patient safety goals TJC focuses on health care safety problems and resolution Drug reconciliation Develop an accurate list of current medications Advise pt to always carry a list of personal drug information I the case of emergency Advise patient to update drug list whenever a change occurs Advise patient to bring a list of medications to each doctor appointment Disposal of medicaitons Follow specific information on drug label or insert Transfer drug from original container to undesirable substance (kitty litter) Place mixture in container Remove all identifying information on label before disposing of empty container Do not flush drug down toilet unless specifically instructed Return drugs to community drug take back program

Consult pharmacist if any disposal questions Sharps safety Counterfeit drugs May look like desired drug May have no active ingredient May have wrong ingredient May be improperly package or contaminated Purchase drugs only from licensed pharmacies Dosage forms Always consult pharmacist, health care provider, or reliable drug source regarding crushing drug. Do not crush extended or sustained release drugs High alert medicaitons Can cause significant harm if given in error Look alike and sound alike drug names Ex. Ephedrine- epinephrine Other factors to prevent medication errors Distraction-free environment Medication safety zone Guidelines for medication administration Check pt meds w/ health care providers order for accuracy Check for allergies Prepare meds for only one pt at a time Calculate meds dose and perform a double check of the calculation Check expiration date on drug labels and only use current drugs Never leave meds unattended Administer only drugs that you have prepared Identify patient with at least two pt identifiers Stay w/pt until all meds have been taken Record effectiveness and results of med administered Chap 10 Forms and routes of drug administration Sublingual, buccal Oral Tablets, capsules, liquids, suspensions, elixirs Transdermal, topical Instillation Drops, sprays Inhalation Nasogastric and gastrostomy tubes Suppositories Parenteral Drop instillation

The period of REM sleep episodes becomes longer during the sleep process If sleep is interrupted the cycle begins again with stage 1 of NREM sleep It is difficult to rouse a person during REM sleep Individuals perform better during their waking hrs if they experience all types and stages of sleep Most of recallable dreams are experienced during the REM sleep If a person is roused from REM sleep, frequently, a vivid bizarre dream may be recalled Sleep disorder Insomnia More common in female pts Treatment: sedative-hypnotics Non pharmacologic management Arise at specific hr in morning Limit daytime naps Avoid caffeine, alcohol and nicotine 6 hrs before bedtime Avoid heavy meals, large amounts of fluids, load noise, and strenuous exercise before bedtime Take warm bath, read, listen to quiet music, or drink warm milk before bedtime Sedative-Hypnotics Sedatives Treat sleep disorders Sedative-hypnotics Barbiturates Benzodiazepines Nonbenzodiazepines General side effects Residual drowsiness (hangover) Vivid dreams, nigthmares Drug dependence Drug tolerance Excessive depression Respiratory depression Hypersensitivity Barbiturates Long-intermediate-short-ultrashort-acting Restrict to short-term use because of side effects, including drug tolerance Limit use to 2 wks or less Interactions Alcohol, opioids, other sedative-hypnotics Decreases effects of oral anticoagulants, glucocorticoids, tricyclic antidepressants, quinidine Long acting Phenobarbital-seizures Intermediate

For anxiety Short acting For procedures Benzodiazepines Hypnotics Ending in pam or lam Ex. Midazolam, lorazepam For sleep disorders and anxiety Lorazepam and diazepam Action Interacts with neurotransmitter GABA to reduce neuron excitability Use Reduce anxiety, treat insomnia, delirium, seizures Lorazepam and diazepam are used to stop active seizures (not maintenance drugs!!) (IV) Assessment Determine whether the patient has history of insomnia or anxiety disorders Nursing diagnosis Sleep deprivation related to adverse effect of insomnia Planning Patient will receive adequate sleep when taking benzodiazepines Nursing interventions Observe the patient for adverse reactions, especially an older or debilitated patient Teach pt to use nonpharmacologic methods to induce sleep Advise pt to report adverse reactions Teach pt that benzodiazepines should be gradually withdrawn Include family in education Not meant to be longterm Evaluation Nonbenzodiazepines Hypnotics Zolpidem (Ambien) Action Neurotransmitter inhibition Take 30 min before bed time Duration of action 6 to 8 hrs Female pt 5mg (high dose not tolerated ) Male pt may take up to 10mg Use Treat short term lesss than 10 days insomnia Not prescribed to elderly May develop dependence Real life maybe taking for years

Preoperative medications include an opioid analgesic and anticholinergic to decrease secretions Intravenous anesthetics Droperidol, etomidate, ketamine Rapid onsets and short durations of action Midazolam (versed) (conscious sedation) Induction and maintenance of anesthesia or conscious sedation for minor surgery or procedures (mechanical ventilation or intubation) Patient are sedated and relaxed but responsive to commands Respiratory rate first thing effected Adverse effects Respiratory and cardiovascular depression (critical), infection Topical anesthetics Lidocaine Use Mucous membranes broken or unbroken skin surgaces, and burns Forms Solution, liquid spray, ointment, cream, gel, and powder Decreases the sensitivity of nerve endings of the affected area Local anesthetics Block pain at the site where the drug is given Consciousness is maintained Use Dental procedures, suturing skin lacerations Short term (minor) surgery at a localized area Blocking nerve impulses (nerve block) below the insertion of a spinal anesthetic Diagnostic procedures such as lumber punctures and thoracentesis Regional blocks Two groups Esters Amides Amides have a very low incidence of allergic reactions Procaine hydrochloride Lidocaine hydrochloride Rapid onset, longer duration of action Causes fewer hypersensitivity reactions Spinal anesthesia Local anesthetic injected in the subarachnoid space Adults below first lumbar space (L1) Children below third lumbar space (L3) Side effects/adverse reactions Respiratory distress Headache Hypotension

Spinal column nerve blocks Spinal block Penetration of the anesthetic into the subarachnoid membrane between the pia mater and arachnoid membrane Epidural block Placement of local anesthetic in the epidural space posterior to the spinal cord or dura mater Caudal block Placed through the sacral hiatus Saddle block Placed a the lower end of the spinal column to block the perineal area Nursing process: Anesthetics Assessment Obtain a drug and health history, noting drugs that affect the cardiopulmonary system Nursing diagnosis Pain acute relate to injury Breathing pattern, ineffective related to CNS depression Planning Patient will participate in preoperative preparation and will understand postoperative care Nursing interventions Monitor the postoperative state of sensorium (sensation) Observe preoperative and postoperative urine output Monitor vital signs following general and local anesthesia for hypotension and respiratory depression Administer an analgesic w/caution until the pt fully recovers from the anesthetic Evaluation Chapter 24 Inflammation Pathophysiology Protective response to tissue injury and infection A vascular reaction occurs causing fluid, blood elements, leukocytes, and chemical mediators (prostaglandins) to accumulate at the injured site. Inflammatory phase Vascular phase Occurs 10 to 15 minutes after injury Associated with vasodilation and increased capillary permeability Fluid and blood substances move to injured site Delayed phase Leukocytes infiltrate inflamed tissue Cyclooxygenase (cox) enzyme Converts arachidonic acid into prostaglandins Has two enzyme forms