Download NUR 210 Exam 1 Study Guide Principles of Pharmacology - Galen (2025 / 2026 ) and more Exams Pharmacology in PDF only on Docsity!
lOMoARcPSD|
NUR 210 Exam 1 Study Guide
Principles of Pharmacology - Galen
100% Guarantee passing score
NUR 210 PHARMACOLOGY
Exam 1 Unit 1-
Unit 1 (chp 1, 3, 7, 9, 10)
Unit 2 (Chp 18, 24, 25)
Unit 3 (Chp 17, 19, 22, 23)
Unit 1
- Nursing Process -
ADPIE
o Concept
o Assessment
o Patient problems (diagnosis)
o Planning
o Nursing interventions
o Evaluation
Pharmacokinetics, Pharmacodynamics, & Pharmacogenetics
- Pharmacokinetics
o What the body does to the drug
o Kinetics = movement
o Movement throughout body to drug
o Drug Phases: Absorption, distribution, metabolism, excretion
o Absorption
▪ Happens in small intestine
▪ Disintegration
Breakdown of oral drug to small particles
▪ Dissolution
Process of combining small drug particles with liquid to
form a solution
▪ Drug absorption
Drug movement from GI tract to bloodstream
▪ Factors affecting:
Fillers in pill can effect how fast/slow gets absorbed
Enteric coating = extended release to be absorbed slower
What else is in stomach will effect absorption
● **CANT TAKE ANYTHING WITH ANTACID
● NO ALCOHOL OR GRAPEFRUIT
▪ Route of administration
● Order: IV, IM, Subcutaneous, Oral, Topical
▪ First-pass effect
● Only occurs in oral medications
● When drugs are absorbed in small intestine then go through
portal vein to liver
● Lose part of medication as it goes through process
● Active or free drug – medication that is still working
● Inactive drugs – you lose it through this process
● Never have 100% of medication when taking ORAL
medication due to this effect because it travels through GI
tract
▪ Bioavailability
● Percentage left of medication
● Oral will never be 100% due to first-pass metabolism
o Other routes always 100%
● Drug form (extended release vs immediate)
● Depends on route of administration/absorption
● Gastric mucosa and motility
● Administration with food and other drugs
● Changes in liver metabolism
o Distribution
▪ Mainly blood stream
▪ Movement of drug from circulation to body tissue
▪ Drug should be easily distributed if good perfusion
▪ **PROTEIN BINDING
● Protein in body is albumin
● Depends on how nourished you are
● Some drugs that are protein binding drugs
o Once it binds to protein it becomes inactive
● Dose that gives therapeutic desired response in 50% of
population
▪ TD 50 = Toxic effect (on 50% of population)
● Toxic response in 50% of population
▪ Therapeutic index
● In between ED50 and TD
▪ Therapeutic drug monitoring
● Peak = when drug reaches highest concentration in your
body
**o Oral medication 2-3 hours after is peak
**o IV 30-60 minutes to reach peak
o You would draw labs at this time to check peak level
Trough = lowest plasma concentration in blood (how much
is left)
o **Doesn’t matter what route of administration
o **Draw lab right before you give dose
o If trough is too high body is not
absorbing/excreting like it should
▪ Becomes toxic
o If trough is too low, antibiotic is not doing what it
should, dose needs to be increased
▪ Drug toxicity
● Drug level exceeds therapeutic range
o Onset
▪ Time it takes for drug to reach minimum effective concentration
o Duration
▪ How long a drug exerts a therapeutic effect
o Receptor theory
▪ Drug binds to receptor to do what it needs to do
● Ex. Attach to pain receptor to relieve pain
● To either activate receptor or block receptor depending
on desired effect/medication
▪ Agonist
● Activates receptors
● Produce desired response
● Continue to agonize = do what you want
▪ Antagonist
● Precent receptor activation
● Block response or produce a desired response
● Ex. Narcan for overdose of morphine
o Side effect
▪ Secondary drug effect
▪ Usually get better with continued use
▪ Expected effects
o Adverse reactions
▪ Mild to severe
▪ Undesirable effects
▪ Usually get worse with continuing use
▪ Provider needs to be notified – not expected effects
o Drug interactions
▪ Altered drug effect due to interaction with another drug
o Pharmacokinetic interactions
▪ Changes occurring in absorption, distribution, metabolism, and
excretion
o Additive (NO QUESTIONS)
▪ Sum of effects of two drugs
Ex. 2+2=
o Synergistic (NO QUESTIONS)
▪ Effect is much greater than effects of either drug alone
Ex. 2+2<
o Drug-nutrient interactions
▪ Food may increase, decrease, or delay drug response
o Drug-laboratory interactions
▪ Drugs may cause changes in test results
o Drug-induced photosensitivity
▪ Skin reaction caused by sunlight exposure, which can cause a burn
to the skin
Geriatric Considerations
- Physiologic changes
o Reduction in total body water and lean body mass
o Reduction in kidney mass and function
o Reduction in liver mass and blood flow
▪ Verify with two forms of ID
▪ Compare stated name and birthday with ID and MAR
▪ Scan bar code on ID band
▪ Check color coding on ID band
▪ Verify name with family member if present
▪ Check “name-alert”
o Right drug
▪ Check 3 times
▪ Scan med label
▪ Check that order is prescribed by licensed health care provider
▪ Be familiar with health record, allergies, labs, and vitals
▪ Know why patient is receiving medication and if correct for patient’s
diagnosis
▪ Check dose calculations
▪ Know beginning and end date of medication
▪ Read back verbal orders
o Right dose
▪ Verify dosage calculation
▪ Verify the drug is safe for patient
▪ Weigh patient if dose is dependent upon weight
▪ Validate dose of certain drugs with 2 RNs
o Right time
▪ Use health care agency policy
▪ Use of military time reduces error
▪ Drugs affected by food are given 1 hour before or after
▪ Give food with drugs that irritate the stomach
▪ Check for scheduled procedures
▪ Check expiration date
▪ Administer antibiotics at even intervals
▪ Hold antihypertensives prior to dialysis if ordered
o Right route
▪ Necessary for adequate absorption
▪ Assess patient’s ability to swallow oral medication
▪ Do not crush or mix medications without validation or consultation
▪ Offer patient water but not juice (iron may be taken with orange
juice)
▪ Use aseptic technique
o Right documentation
▪ Record drug administration immediately
▪ Record drug name, dose, route, time, date, nurse’s signature or
initials according to policy
▪ Document patient’s response to drug especially analgesics,
sedatives, and antiemetics
- FDA Black Box Warning
o Most serious warning of possible side effects
o All drugs have to legally have
o Oral
▪ Sublingual, buccal, tablets, capsules, liquids
o Transdermal, topical
o Instillation
▪ Drops, sprays
▪ Eye drops – pull down below eye to expose conjunctival sac, apply
drops and apply gentle pressure over lacrimal duct after
administration to avoid getting in systemic
▪ Eye ointment – squeeze ¼ inch strip into conjunctival sac,
close eye for 2-3 minutes to let absorb, may have blurry vision
after
▪ Eardrops
● Pediatric – pull ear down and back
● Adults – pull ear up and back
● Leave head tilted for 3-5 minutes
▪ Nose drops – tilt head back and toward effected side, keep
tilted back for 2 minutes
▪ Nasal sprays - tilt head forward and look at feet, blow nose
BEFORE but don’t after
▪ ***don’t let it touch the body
o Inhalation
▪ Shake, puff, shake, puff
▪ Wait 2 minutes in between each puff if same med
▪ Wait 5 minutes if different medications
▪ Rinse mouth after to avoid thrush
o Nasogastric and gastrostomy tubes
▪ Always check proper placement
● Auscultation or residual
▪ Place in high fowler position or elevate head of bed at least 30
degrees
▪ Make sure drug is crushable
▪ **each medication separately, 5cc with each medication, then
flush with 10- 15cc between each medication, then flush 30cc
after finished
● Count all liquid if strict I&O
▪ If NG on suction, turn suction off, give meds and leave off for 30
minutes
o Suppositories
▪ Vaginal
● Lithotomy position
● Give pad after
● Nighttime best time to lay flat as long as possible
▪ Rectal
● Left recumbent position best
● Go up to middle knuckle
o Parenteral
● Antidote
**o Flumazenil
▪ Interactions
● Other CNS depressants
● Alcohol
▪ Contraindications
● Respiratory depression
● Allergy
● ****Kavakava**
o Herbal supplement that helps insomnia
▪ Caution
● Older adults
● Depression, suicidal ideation
● Severe liver and kidney problems
▪ Assessment
● Determine whether patient has a history of insomnia
or anxiety disorders
● Review drug history, medical history
● Assess patient’s mental status
● Vital signs
o BP, HR and respirations
▪ Nursing interventions
● Monitor vital signs
● Teach patient to use nonpharmalogic methods to induce sleep
● Observe patient for adverse reactions, especially older and
debilitated patient
● Advise patients to report adverse reactions such as
respiratory depression, feelings of depression
● Teach patient that these drugs should be gradually
withdrawn, not to be stopped abruptly
o Non-Benzodiazepines
▪ Zolpidem (Ambien)
● Action
o Neurotransmitter inhibition, CNS depression
o Duration of action is 6-8 hours
● Us
e o Treat short term (less than 10 days) insomnia
▪ Can become dependent
o Smaller doses in older adults
▪ Normal dose 10mg, older adults and females
may be 5mg
o Take RIGHT before bed
● Side effects
o Drowsiness, lethargy, dizzy, memory impairment
o Anterograde amnesia
● Adverse Reactions
o Residual drowsiness (hangover)
▪ ****occurs due to REM Rebound**
▪ In such a deep sleep you go through REM really
quickly
o Drug dependence
o Drug tolerance
o Excessive
depression o
Respiratory
depression o
Hypersensitivity
● Contraindications
o Allergy to benzodiazepines
▪ Still part of same class
o Respiratory depression
o Severe renal or liver disease
o Children, older adults
● Interactions
o Other CNS depressants
o Alcohol
o Food decreases, absorption
● Assessment
o Vital signs
o Possible reasons for sleep disturbances
o Drug and medical history
● Interventions
o Monitor vital signs, LOC
o Observe for side effects, adverse reactions
o Give it at bedtime
● Teaching
o Use non-pharmalogic interventions first
o Avoid other CNS depressions
o Take at bedtime
o Do not drive while on
o Report feelings of hangover or unwanted effects
- Intravenous Anesthetics
o Midazolam (Versed)
▪ Induction and maintenance of anesthesia or conscious
sedation for minor surgery or procedures
▪ Patients are sedated and relaxed but responsive to commands
▪ Grabs onto extra GABA receptor so it is even stronger than normal
benzos
▪ Adverse effects
● Respiratory and cardiovascular depression
● ****Cannot give to someone with history of cardiovascular**
disease
o Alert MD
- Balanced Anesthesia
o COX 2 – triggers inflammation and pain
o NSAIDS block COXs resulting in
▪ Decreased stomach lining protection (risk for ulcer) and chance
for bleeding – not desired response
▪ Decreased inflammation and pain – desired response
- Anti-inflammatory drug groups
o Nonsteroidal anti-inflammatory drugs (NSAID)
o Antigout drugs
- NSAIDS
o Action
▪ Inhibit biosynthesis of prostaglandins (anti-inflammatory)
▪ Analgesic effect (main reason to take)
▪ Antipyretic effect
▪ Inhibit platelet aggregation (anti-platelet)
▪ Inhibit COX enzymes
o Non-selective NSAIDS (inhibits COX 1 and 2)
▪ Aspirin
▪ Ibuprofen
o Second-generation NSAIDs (mainly inhibits COX 2) (doesn’t effect
stomach or blood clotting)
▪ Celecoxib
o Aspirin
▪ Action
● Inhibits COX 1 and COX 2
▪ Us
e ● Pain and arthritic inflammation
● Analgesic, antipyretic, anti-inflammatory
● Decreases platelet aggregation (anti-platelet)
▪ Mainly an anti-platelet
▪ Takes a high dose to reach pain relief
▪ Side effects
● Dizziness, drowsiness, headache
● GI distress
▪ Adverse reactions
● Tinnitus, hearing loss (sign of toxicity)
● Bleeding, GI ulceration
● ****Thrombocytopenia – LIFE THREATENING**
● ****Reye’s syndrome (in children) – LIFE THREATENING**
**o DO NOT GIVE ASPIRIN TO CHILDREN
● Bronchospasms
o Asthmatics are highly sensitive to NSAID
● Reverse aspirin overdose with activated charcoal or Bicarb
▪ Drug-lab-food interactions
● Drugs
o Increased bleeding with anticoagulants and other
NSAIDS
