NUR 210 Exam 2 Study Guide (2026/2027) (PDF) | Pharmacology | Galen College, Exams of Pharmacology

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NUR 210

EXAM 2 STUDY GUIDE

Principles Of Pharmacology

Galen College of Nursing

Exam 2 Pharm Study guide

Chapter 15 Adrenergic agonists Sympathetic responses Stimulation of sympathetic nervous system or use of adrenergic drugs can cause dilation of pupils and bronchioles; increased heart rate; constriction of blood vessels; relaxation of muscles in GI tract, bladder, and uterus. Effects of adrenergic agonists at receptors Alpha 1 receptor Increases cardiac contractility, vasoconstriction Dilates pupils, decreases salivary gland secretion Increases bladder and prostate contraction Alpha 2 receptor Inhibits norepinephrine release Promotes vasodilation and decreased bp Decreases GI motility and tone Beta 1 receptors Increases cardiac contractility, heart rate Increases renin secretion and increases bp Beta 2 receptors Decreases GI tone and motility Bronchodilation Increases blood flow t=in skeletal muscles Relaxes smooth muscle of uterus Activates liver glycogenolysis Increases blood glucose Dopaminergic Located in the renal, mesenteric, coronary, and cerebral arteries Vasodilation-increases flow Neurotransmitter inactivation Inactivation by Reuptake of transmitter back into neuron Enzymatic transformation or degradation MAO inside neuron COMT outside neuron Diffusion away form the receptor Drugs halt termination of neurotransmitter by inhibiting Norepinephrine reuptake Norepinephrine degradation After the transmitter has performed its function, the action must be stopped to prevent prolonging the effect

Anaphylaxis, anaphylactic shock Bronchospasms, status asthmaticus Cardiogenic shock, cardiac arrest Side effects/adverse reactions Cardiac dysrhythmias, palpitations, tachycardia, hypertension, dizziness, headache, sweating, insomnia, restlessness, tremors, hyperglycemia Drug interactions Beta blockers Decreases epinephrine action Digoxin Causes cardiac dysrhythmias TCAs and MAOIs intensify and prolong effects Nursing interventions Monitor BP, heart rate, urine output Report tachycardia, palpitations, tremors, dizziness, hypertension Monitor IV site for infiltration Antidote: phentolamine mesylate (regitine) Avoid cold medications, and diet pills if hypertensive, diabetic, CAD, or dysrhythmic Avoid adrenergic when breastfeeding Avoid continuous use of adrenergic nasal sprays Pt should be placed on cardiac monitor for early detection of dysrhythmias. Monitor urine output for early detection of decreased renal perfusion Albuterol Selective Acts on beta 2 adrenergic receptors Promotes bronchodilation Uses Treats bronchospasm, asthma, bronchitis, COPD Caution Severe cardiac disease Hypertension, hyperthyroidism DM, pregnancy Renal dysfunction Side effects/adverse reactions Tremors, nervousness, restlessness, dizziness, tachycardia, palpitations, cardiac dysrhythmias Drug interactions May increase effect with other sympathomimetics, MAO inhibitors, and TCAs Antagonize effect with beta blockers Nursing process: adrenergic agonist Assessment Determine the patients health history Assess the patients drug history

nursing interventions monitor iv site frequently when administering norepinephrine or dopamine because extravasation of these drugs causes tissue damage and necrosis within 12hrs monitor ECG for dysrhythmias when adrenergic agonists are given IV explain that continuous use of nasal sprays or drops that contain an adrenergic agonist may result in rebound nasal congestion evaluation Adrenergic antagonists Block effects of adrenergic neurotransmitter Block alpha and beta receptor sites Directly by occupying receptors Indirectly by inhibiting release of neurotransmitters epinephrine and norepinephrine Types Alpha-adrenergic antagonists Selective Nonselective Beta-adrenergic antagonists Selective Nonselective Also called adrenergic blockers and sympatholytics Effects of adrenergic antagonists at receptors Alpha 1 Vasodilation, dizziness Orthostatic hypotension, reflex tachycardia Pupil constriction Suppresses ejaculation Reduces contraction of smooth muscles in bladder neck and prostate Beta 1 Reduces cardiac contractility Decreases pulse Beta 2 Bronchoconstriction Contracts uterus Inhibits glycogenolysis Leads to hypoglycemia Alpha adrenergic antagonists Drugs that inhibit a response at alpha-adrenergic receptors site Selective Block alpha 1 Nonselective Block alpha 1 and 2 Action Promotes vasodilation

Affect skeletal muscles Types of cholinergic agonists Direct acting Acts of receptors to activate tissue response Indirect acting Inhibits action of enzyme cholinesterase Also called parasympathomimetic Acetylcholine is a neurotransmitter located at the ganglions and parasympathetic terminal nerve endings. It innervates the receptors in organs, tissues, and glands Effects of cholinergic agonists Parasympathetic response Stimulation of parasympathetic nervous system cause constriction of pupils, bronchiole constriction, increased bronchial secretions, decreased heart rate, vasodilation, increased peristalsis, and gastric secretions, bladder muscle contraction, and increased salivation Cardiovascular Decreases HR and BP; vasodilation, slow conduction of AV node GI Increase tone, motility, peristalsis, and relax sphincter muscles GU Increase ureter tone, contract bladder and relax sphincter muscles, stimulate urination Eye Constrict pupils, increase accommodation Lungs Bronchial constriction, increase secretions Glands Increase salivation, perspiration, and tears Striated muscle Increase neuromuscular transmission, maintain muscle strength and tone Direct acting cholinergic agonists Primarily selective to muscarinic receptors Muscarinic receptors located in smooth muscles Heart, gi, gu, glands Metoclopramide Used to increase gastric emptying Treats gastroparesis, nausea, GERD Pilocarpine Used to constrict pupils The canal of Schlemm is open to allow drainage of aqueous humor (fluid) to treat glaucoma by relieving intraocular pressure in the eye Bethanechol chloride Used to increase urination Bethanechol

Side effects/ adverse reactions Blurred vision, miosis Hypotension, bradycardia, sweating Increased salivation and gastric acid, n/v, diarrhea, abdominal cramps Cardiac dysrhythmias Contraindications Bradycardia, hypotension, COPD, peptic ulcer, parkinsonism, hyperthyroidism Assessment Assess baseline vitals for future comparisons Obtain patient history of health problems such as peptic ulcers, urinary obstruction, or asthma Planning Pt will have increased bladder tone Nursing intervention Monitor bp, and hr Teach pt to rise slowly from a lying position to avoid dizziness and orthostatic hypotension Auscultate breath sounds for rales, crackling sounds form fluid congestion n the lungs Monitor the pt for possible cholinergic crisis (overdose), including symptoms of muscular weakness and increased salivation Indirect acting cholinergic agonists Functions Inhibit cholinesterase enzyme into choline and acetic acid Allow Ach to activate muscarinic and nicotinic cholinergic receptors Effects Skeletal muscle contraction, increased tone Greater GI motility, bradycardia, miosis Bronchial constriction promote urination Contraindications Intestinal and urinary Reversible cholinesterase inhibitors Uses Produce pupil constriction In glaucoma Increases muscle strength in myasthenia gravis Examples Neostigmine (prostigmin) is short acting Pyridostigmine (mestinon) is moderate acting Ambenonium (mytelase) is long acting Edrophonium (tensilon) is short acting and often used for diagnostic purposes Side effects Muscle cramps, bradycardia, hypotension, blurred vision, hypersalivation, seizures Irreversible cholinesterase inhibitor

Trihexyphenidyl HCl Action Decreases involuntary movement, tremors, and muscle rigidity Side effects Tachycardia, headache, blurred vision, ocular hypertension, dry mouth/skin, constipation, urinary retention Use Parkinson’s disease Pseudoparkinsonism Nursing process anticholinergics-atropine Assessment Assess urine output as urinary retention may occur Obtain the pts drug history Planning Pt secretions will be decreased before surgery Interventions Monitor pt v/s. report if tachycardia occurs Determine fluid intake and output Provide mouth care Assess bowel sounds Chap 20 Parkinson disease treatment Anticholinergics Block cholinergic receptors Dopamine replacements Stimulate dopamine receptor s Dopamine agonists Stimulate dopamine receptors MAO-B inhibitors Inhibit MAO-B enzyme that interferes with dopamine COMT inhibitors Inhibit COMT enzyme that inactivates dopamine Antiparkinson Drugs Anticholinergics Action Inhibits release of actylcholine Reduces rigidity and some of the tremors Minimal effect on bradykinesia Side effect Dizziness, drowsiness, anxiety, headache, insomnia, paresthesia, restlessness, blurred vision, ocular hypertension, weakness, dry mouth, GI distress, anhidrosis, urinary retention Assessment

Obtain health history especially glaucoma, Gi dysfunction, urinary retention, angina, or myasthenia gravis Obtain drug history Planning Pt will have decreased involuntary symptoms caused by Parkinson disease Interventions Counsel patients who take an anticholinergic to have routine eye exams because contraindicated in glaucoma Encourage pt to relieve dry mouth with hard candy, ice chips, or sugarless gum Monitor urine output for early detection of urinary retention Increase fluid intake, fiber, and exercise to avoid constipation Dopaminergic Carbidopa-levodopa Action Converts to dopamine and increases mobility Side effects Fatigue, insomnia, dry mouth, blurred vision, orthostatic hypotension, palpitations, dysrhythmias, GI distress, urinary retention, dyskinesia, psychosis, severe depression Catechol-O-methyltransferase inhibitors Tolcapone Action Inhibit COMT enzyme that inactivates dopamine Side effects Dizziness, drowsiness, headache, GI distress, excess dreams, insomnia, sudden sleep onset, orthostatic hypotension, impulse control disorder, hepatic dysfunction Acetylcholinesterase/cholinesterase inhibitors Rivastigmine Action Allow more acetylcholine in neuron receptors Increase cognitive function, slows disease process Side effects Dizziness, headache, confusion, depression, dry mouth, GI distress, dehydration, weight loss, bradycardia, orthostatic hypotension, dysrhythmia, hepatotoxicity, suicidal ideation, Stevens Johnson syndrome Assessment Assess pts mental and physical abilities Obtain history especially hepatic or renal dysfunction Assess for memory and judgement losses Planning Pt memory will be improved Pt will maintain self-care w/assistance

Relieves muscle spasm and spasticity Have sedative effect Direct acting Dantrolene Decreases muscle spasm pain and increases range of motion Side effects Drowsiness, dizziness, headache, nausea, vomiting Cyclobenzaprine Action Relax skeletal muscles Use Relieves muscle spasm Side effects Anticholinergic effects (blurred vision, dry mouth, tachycardia, urine retention, constipation), drowsiness, dizziness, headache, nervousness, GI distress, unpleasant taste, dysrhythmias Assessment Observe pt drug history for possible drug interactions Note whether pt has history of narrow angle glaucoma Planning The pt muscular pain will be reduced within 1 week Intervention Observe for CNS side effects Teach pt not to stop abruptly but taper off over 1 week Teach pt to avoid alcohol and cns depressants Chapter 37 Heart failure Nonpharmacologic treatment Limit salt and saturated fat intake Limit or avoid alcohol intake; stop smoking Perform mild exercise Laboratory tests Atrial natriuretic peptide (ANP) 20-77 pg/mL; 20-77 ng/L Brain natriuretic peptide (BNP)***** Desired value: less than 100 pg/mL Positive value: greater than 100 pg/mL Cardiac glycosides Digoxin Action Positive inotropic Increases myocardial contractility Boost cardiac muscle Negative chronotropic

Decreases heart rate Decreases myocardial oxygen demand Negative dromotropic Decrease conduction Heart cells not so excited Increases stroke volume Increases cardiac output Side effects Bradycardia, cardiac dysrhythmias, anorexia, n/v, diarrhea (losing potassium risk for toxicity) Adverse reactions Headache, blurred or yellow vision, dizziness, weakness Common signs of toxicity Anorexia, vomiting, diarrhea, blurred vision, green or yellow halos, brady cardia, PVCs, cardiac dysrhythmias Carful with hypo and hyper thyroidism Renal dysfunctions Bradycardia, hypokalemia( risk for toxicity) Digitalis toxicity Antidote Digoxin immune fab (digibind) Digoxin drug interactions Diuretics Hypokalemia Cortisone Sodium retention Antacids Decrease digitalis absorption Nursing process digoxin Assessment Obtain baseline pulse rate for future comparisons (apical pulse for 1 min) Asses for evidence of digitalis toxicity Planning The pt will check pulse rate daily before taking digoxin (HR less than 60 hold med) Intervetions Ascertain apical pulse rate before administering digoxin (teach pt radial pulse) Determine signs of peripheral and pulmonary edema Monitor serum digoxin levels Monitor serum potassium level and report if hypokalemia Instruct pt to report side effects Eat food high in potassium* (potatoes, oranges, tomatoes, avocados, strawberries, fish, mushrooms, etc.) Evaluation

Monitor effects of IV nitroglycerin Administer SL nitroglycerin tablet if chest pain occurs (3x within 15 min) Advise pt not to ingest alcohol while taking nitro Instruct pt how to check their pulse Evaluation Antidysrhythmic drugs Dysrhythmias Mechanism of drug action Class 1 Sodium channel blockers 1a: slow conduction, prolongs repolarization 1b: slow conduction, shortens repolarization 1c: prolonged conduction with little/no effect on repolarization Class 2 Beta-adrenergic blockers Reduce calcium entry Decrease conduction velocity, automaticity and recovery time Class 3 Prolong repolarization Prolong action potential duration Class 4 Calcium channel blockers Block calcium influx Slow conduction velocity Decrease myocardial contractility Increase refraction in atrioventricular node Assessment Obtain baseline v/s and ecg for future comparison Planning The pt will no longer experience abnormal heart rhythm Interventions Monitor v/s Monitor ecg for abnormal patterns and report findings Tell pt to report side effects and adverse reactions to HCP Advise pt to avoid alcohol, caffeine and tobacco Chapter 40 Anticoagulants Prevent the formation of clots that inhibit circulation Antiplatelets Prevent platelet aggregation Thrombolytics Attach and dissolve blood clots that have already formed Anticoagulants Venous and arterial disorders at high risk for clot formation

Action Prevent new clots form forming Use DVT, PE, MRI, artificial heart valves, strokes Heparin Action Blind with antithrombin 3 Inhibit action of thrombin Inhibit conversion of fibrinogen to fibrin Inhibit clot formation *** Use Most commonly to prevent venous thrombosis (superficial or deep) Administration Subq, IV No heparin in pill form Frequent lab monitoring is needed Laboratory values PTT 1.5-2 times control value ( control 60-70 sec) *** aPTT 30-85 sec (control 20-35 sec) *** side effects bleeding antidote protamine sulfate*** Low molecular weight heparin (enoxaparin; lovenox) Lower risk of bleeding Frequent lob monitoring not required Action Inactivates Xa factor Use Prevent DVT and acute PE after orthopedic or abdominal surgery Precautions Don’t take aspirin concurrently***** Oral anticoagulants Warfarin Action Inhibit hepatic synthesis of vitamin K, thus affecting the clotting factors 2, 7, 9, and 10 Use Prevent thromboembolic conditions of thrombophlebitis, PE, and embolism formation Monitor therapeutic range PT INR Antidote

Side effects/adverse reactions Anaphylaxis Dysrhythmias Hemorrhage Clot bluster!! Meet criteria to receive this med Up to 4hrs to give Nursing process: thrombolytics Assessment Assess baseline v/s for future comparisons Obtain a medical and drug history Planning Pt blood clot will be dissolved Interventions Monitor v/s Observe for s/s of active bleeding Observe for signs of allergic reaction to thrombolytics Avoid administering aspirin or NSAIDs for pain or discomfort when receiving a thrombolytic Avoid venipuncture/arterial sticks Chapter 41 Nonpharmacologic methods for cholesterol reduction Reduce saturated fats and cholesterol in diet Reduce total fat intake to 30% or less of caloric intake Reduce cholesterol intake to 300mg/day or less Exercise Stop smoking Antihyperlipidemic Types Hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors AKA STATINS STATINS Action Inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis Decreases LDLs, increases HDLs Side effects/adverse effects GI distress, constipation, muscle cramps, fatigue Cataracts, liver impairments Rhabdomyolysis (adverse), myopathy Abrupt discontinuation may lead to rebound effect Laboratory tests Homocysteine 4-17(fasting) High levels

Linked to cardiovascular disease, stroke, Alzheimer disease May promote blood clotting Can damage inner lining of blood vessels Three vitamins that lower serum homocysteine levels Vitamin B6, vitamin b12, folic acid High sensitivity c-reactive protein 0.175mg mg/L Low risk: <1 mg/L Moderate risk: 1-3 mg/L High risk: >3 mg/L Detects inflammatory process due to atherosclerotic plaque buildup especially coronary arteries Nursing process: statins Assessment Assess v/s and baseline serum chemistry values Obtain a medical history Planning Pts cholesterol level will be less than 200 mg/dL in 6-8wks Interventions Monitor the pts blood lipid levels Monitor lab value for liver function Observe s/s of GI upset Inform pt that it may take several wks before blood lipid levels decrease Instruct pt to have annual eye exam and report changes in visual acuity Drugs to improve peripheral blood flow PVD due to Arteriosclerosis Hyperlipidemia s/s numbness and coolness sin extremities claudication, leg ulcers treatment peripheral vasodilators increase blood flow classifications statins improve claudication symptoms decrease serum lipids selected antihypertensives ace inhibitors-ramipril alpha blocker- prazosin calcium channel blocker-nifedipine antiplatelet clopidogrel, aspirin, cilostazol antiplatelet: cilostazol