NURSING PHARMACOLOGY FINAL EXAM PREDICTOR WITH EXPERT VERIFIED ANSWERS TEST BANK |LATEST, Exams of Nursing

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NURSING PHARMACOLOGY FINAL EXAM

PREDICTOR WITH EXPERT VERIFIED ANSWERS

TEST BANK |LATEST UPDATED 2024|

ACCURATELY PREDICTED QUESTIONS AND

ANSWERS | GUARANTEED PASS A+ GRADE.

What are the major functions of the M3 receptor? Increase exocrine gland secretions (e.g., lacrimal, salivary, gastric acid), increase gut peristalsis, increase bladder contraction, increase bronchoconstriction, pupillary sphincter muscle contraction (miosis), ciliary muscle contraction (accommodation) What are the major functions of the D1 receptor? Relaxes renal vascular smooth muscle What are the major functions of the D2 receptor? Modulates transmitter release, especially in the brain What are the major functions of the H1 receptor? Increase nasal and bronchial mucus production, increase vascular permeability, contraction of bronchioles, pruritis, pain What are the major functions of the H2 receptor?

Increase gastric acid secretion What are the major functions of the V1 receptor? Increase vascular smooth muscle contraction What are the major functions of the α1 receptor? Increase vascular smooth muscle contraction, increase pupillary dilator muscle contraction (mydriasis), increase intestinal and bladder sphincter muscle contraction! What are the major functions of the α2 receptor? Decrease sympathetic outflow, decrease insulin release, decrease lipolysis, increase platelet aggregation, decrease aqueous humor production What are the major functions of the β1 receptor? Increase heart rate, increase contractility, increase renin release, increase lipolysis What are the major functions of the β2 receptor? Vasodilation, bronchodilation, increase lipolysis, increase insulin release, decrease uterine tone (tocolysis), ciliary muscle relaxation, increase aqueous humor production What are the major functions of the M1 receptor? CNS, enteric nervous system What are the major functions of the M2 receptor? Decrease heart rate and contractility of atria What are the major functions of the V2 receptor?

Increase H2O permeability and reabsorption in collecting tubules of kidney (V2 is found in the "2" kidneys) What receptors are associate with Gq? H1, α1, V1, M1, and M What receptors are associated with Gs? H2, B1, B2, V2, D What receptors are associated with Gi? M2, α2, D Bethanechol

• Direct cholinergic agonist
• Activates bowel and bladder smooth muscle
• Used in postoperative and neurogenic ileus
• Resistant to AChE Carbachol
• Direct cholinergic agonist
• Carbon copy of acetylcholine
• Constricts pupils and relieves intraocular pressure in glaucoma Methacholine

• Direct cholinergic agonist
• Stimulates muscarinic receptors in airways when inhaled
• Used as a challenge test for diagnosis of asthma Pilocarpine
• Direct cholinergic agonist
• Contracts ciliary muscle of eye (open angle glaucoma), contracts pupillary sphincter (closed angle glaucoma)
• Potent stimulator of sweat, tears and saliva
• AChE resistant Donepezil
• Anticholinesterse - increases ACh
• Alzheimer disease Galantamine
• Anticholinesterse - increases ACh
• Alzheimer disease Rivastigmine
• Anticholinesterse - increases ACh
• Alzheimer disease Edrophonium
• Anticholinesterse - increases ACh
• Historically used to diagnose myasthenia gravis (MG is now diagnosed by anti-AChR Ab test.

Neostigmine

• Anticholinesterse - increases ACh
• Used in postoperative and neurogenic ileus and urinary retention, myasthenia gravis, and postoperative reversal of neuromuscular junction blockade Physostigmine
• Anticholinesterse - increases ACh
• Used in anticholinergic toxicity
• Crosses the blood-brain barrier (CNS) Pyridostigmine
• Anticholinesterse - increases ACh
• Increases muscle strength
• Used in myasthenia gravis (long acting)
• Does not penetrate CNS Atropine
• Muscarinic antagonist
• Used in bradycardia and for ophthalmic applications
• Also used as antidote for cholinesterase inhibitor poisoning
• Actions include increase pupil dilation, cycloplegia, decreased airway secretions, decreased acid secretions, decreased gut motility, decreased bladder urgency in cystitis
• Toxicity: increased body temp (due to decreased sweating), rapid pulse, dry mouth, dry and flushed skin, cycloplegia, constipation, disorientation;

• Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants
• See also homatropine and tropicamide Benztropine
• Muscarinic antagonist
• Works in CNS
• Used in Parkinson disease and acute dystonia Glycopyrrolate
• Muscarinic antagonist
• Parental use: preoperative use to reduce airway secretions
• Oral use: drooling, peptic ulcer Hyoscyamine
• Muscarinic antagonist
• Antispasmodics for IBS Dicyclomide
• Muscarinic antagonist
• Antispasmodics for IBS Ipratropium
• Muscarinic antagonist
• Used in COPD and asthma

Tiotropium

• Muscarinic antagonist
• Used in COPD and asthma Oxybutynin
• Muscarinic antagonist
• Reduced bladder spasms and urge urinary incontinence Solifenacin
• Muscarinic antagonist
• Reduced bladder spasms and urge urinary incontinence Tolterodine
• Muscarinic antagonist
• Reduced bladder spasms and urge urinary incontinence Scopalamine
• Muscarinic antagonist
• Motion sickness Tetrodotoxin
• Poisoning can result from ingestion of poorly prepared puffer fish (exotic sushi)
• Highly potent toxin that binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization - blocks action potential without changing resting potential (same mechanism as Lidocaine)

• Causes nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes.
• Treatment is primarily supportive. Ciguatoxin
• Consumption of reef fish (e.g. barracuda, snapper, eel...)
• Causes ciguatera fish poisoning.
• Opens Na+ channels causing depolarization. Symptoms easily confused with cholinergic poisoning.
• Temperature-related dysesthesia (e.g., "cold feels hot; hot feels cold") is regarded as a specific finding of ciguatera.
• Treatment is primarily supportive. Scombroid poisoning
• Caused by consumption of dark-meat fish (e.g., bonito, mackerel, mahi-mahi, tuna) improperly stored at warm temperature.
• Bacterial histidine decarboxylase converts histidine to histamine. Histamine is not degraded by cooking.
• Acute-onset burning sensation of the mouth, flushing of face, erythema, urticaria, pruritus, headache. May cause anaphylaxis-like presentation (i.e., bronchospasm, angioedema, hypotension).
• Frequently misdiagnosed as allergy to fish.
• Treat supportively with antihistamines; if needed, antianaphylactics (e.g., bronchodilators, epinephrine). Albuterol

• β2 > β1 direct agonist
• Acute asthma Salmterol
• β2 > β1 direct agonist
• Long term asthma or COPD control Dobutamine
• β1 > β2, α direct agonist
• Uses: heart failure (HF) (inotropic > chronotropic), cardiac stress testing. Dopamine
• D1 = D2 > β > α direct agonist
• Uses: unstable bradycardia, HF, shock; inotropic and chronotropic α effects predominate at high doses. Epinephrine
• β > α direct agonist
• Uses: anaphylaxis, asthma, open-angle glaucoma; α effects predominate at high doses. Significantly stronger effect at β2-receptor than norepinephrine. Isoprterenol
• β1 = β2 direct agonist
• Uses: electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemia

Norepinephrine

• α1 > α2 > β1 direct agonist
• Hypotension (butrenal perfusion). Significantly weaker effect at β2-receptor than epinephrine. Phenylephrine
• α1 > α2 direct agonist
• Uses: hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant) Amphetamine
• Indirect general sympathetic agonist
• reuptake inhibitor; also releases stored catecholamines
• Narcolepsy, obesity, ADHD. Cocaine
• Indirect general sympathetic agonist
• Reuptake inhibitor
• Causes vasoconstriction and local anesthesia.
• Never give β-blockers if cocaine intoxication is suspected (can lead to unopposed α1 activation and extreme hypertension). Ephedrine
• Indirect general sympathetic agonist
• Releases stored catecholamines
• Nasal decongestion, urinary incontinence, hypotension. Norepinephrine vs. isoproterenol

• Norepinephrine increases systolic and diastolic pressures as a result of α1-mediated vasoconstriction causing increased in mean arterial pressure and reflex bradycardia. - However, isoproterenol (no longer commonly used) has little α effect but causes β2-mediated vasodilation, resulting in decreased mean arterial pressure and increased heart rate through β1 and reflex activity. Clonidine
• α2-agonist
• Uses: hypertensive urgency (limited situations); does not decrease renal blood flow; ADHD, Tourette syndrome
• Toxicity: CNS depression, bradycardia, hypotension, respiratory depression, miosis α-methyldopa
• α2-agonist
• Used for hypertension in pregnancy
• Toxicity: Direct Coombs ⊕ hemolysis, SLE-like syndrome Phenoxybenzamine
• Nonselective α-blocker
• Irreversible
• Used preoperatively for pheochromocytoma to prevent catecholamine (hypertensive) crisis
• Toxicity: orthostatic hypotension, reflex tachycardia Phentolamine

• Nonselective α-blocker
• Give to patients on MAO inhibitors who eat tyramine containing foods
• Toxicity: orthostatic hypotension, reflex tachycardia Prazosin
• Selective α1-blocker
• Uses: urinary symptoms of BPH; PSTD
• Hypertension
• Toxicity: 1st-dose orthostatic hypotension, dizziness, headache Terazosin
• Selective α1-blocker
• Uses: urinary symptoms of BPH;
• Hypertension
• Toxicity: 1st-dose orthostatic hypotension, dizziness, headache Doxazosin
• Selective α1-blocker
• Uses: urinary symptoms of BPH;
• Hypertension
• Toxicity: 1st-dose orthostatic hypotension, dizziness, headache Tamsulosin

• Selective α1-blocker
• Uses: urinary symptoms of BPH;
• Toxicity: 1st-dose orthostatic hypotension, dizziness, headache Mirtazapine
• Selective α2-blocker
• Used in depression
• Toxicity: sedation, increased serum cholesterol, increased appetite α-blockade of epinephrine vs. phenylephrine Shown in the picture are the effects of an α-blocker (e.g., phentolamine) on blood pressure responses to epinephrine and phenylephrine. The epinephrine response exhibits reversal of the mean blood pressure change, from a net increase (the α response) to a net decrease (the β response). The response to phenylephrine is suppressed but not reversed because phenylephrine is a "pure" α-agonist without β action. Effects of β-blockers
• Angina pectoris—decrease heart rate and contractility, resulting in decrease O2 consumption
• MI—β-blockers (metoprolol, carvedilol, and bisoprolol) mortality
• SVT (metoprolol, esmolol)—decrease AV conduction velocity (class II antiarrhythmic)
• Hypertension—decrease cardiac output, decrease renin secretion (due to β1-receptor blockade on JGA cells)
• HF—decrease mortality in chronic HF
• Glaucoma (timolol)—decrease secretion of aqueous humor

Nonselective β-blockers

• Nadolol, pindolol (partial agonist), propranolol, timolol
• Mostly go from N to Z β1-selective antagonist
• acebutolol (partial agonist), atenolol, betaxolol, esmolol, metoprolol
• Mostly go from A to M Nonselective α- and β-antagonists
• Carvedilol, labetalol Nebevolol
• Combines cardiac-selective β1-adrenergic blockade with stimulation of β3-receptors, which activate nitric oxide synthase in the vasculature Toxicity of β-blockers
• Impotence, cardiovascular adverse effects (bradycardia, AV block, HF), CNS adverse effects (seizures, sedation, sleep alterations), dyslipidemia (metoprolol), and asthma/COPD exacerbations
• Avoid in cocaine users due to risk of unopposed α-adrenergic receptor agonist activity
• Despite theoretical concern of masking hypoglycemia in diabetics, benefits likely outweigh risks; not contraindicated Acetaminophen toxicity antidote N-acetylcysteine (replenishes glutathione)

AChE inhibitor/organophosphate toxicity antidote Atropine > pralidoxime Amphetamines toxicity antidote NH4Cl (acidify urine) Antimuscarinic, anticholinergic agents toxicity antidote Physostigmine salicylate, control hyperthermia Benzodiasepines toxicity antidote Flumazenil β-blocker toxicity antidote Glucagon Carbon monoxide toxicity antidote 100% O2, hyperbaric O2 Penicillamine Cyanide toxicity antidote Nitrite + thiosulfate, hydroxocobalamin Digitalis toxicity antidote Anti-dig Fab fragments Heparine toxicity antidote Protamine sulfate

Iron toxicity antidote Deferoxamine, deferasirox Lead toxicity antidote EDTA, dimercaprol, succimer, penicillamine Mercury, arsenic, gold toxicity antidote Dimercaprol (BAL), succimer Copper, arsenic, gold toxicity antidote Penicillamine Methanol, ethylene glycol (antifreeze) toxicity antidote Fomepizole > ethanol, dialysis Methemoglobin toxicity antidote Methylene blue, vitamin C Opioids toxicity antidote Naloxone, naltrexone Salicylates toxicity antidote NaHCO3 (alkalinize urine), dialysis TCAs toxicity antidote NaHCO3 (plasma alkalinization)

tPA, streptokinase, urokinase toxicity antidote Aminocaproic acid Warfarin toxicity antidote Vitamin K (delayed effect), fresh frozen plasma (immediate) Drugs that cause coronary vasospasm Cocaine, sumatriptan, ergot alkaloids Drugs that cause cutaneous flushing Vancomycin, Adenosine, Niacin, Ca2+ channel blockers (VANC) Drugs that cause dilated cardiomyopathy Anthracyclines (e.g., doxorubicin, daunorubicin); prevent with dexrazoxane Drugs that cause Torsades de pointes Class III (e.g., sotalol) and class IA (e.g., quinidine) antiarrhythmics, macrolide antibiotics, antipsychotics, TCAs Drugs that cause adrenocortical insufficiency HPA suppression 2° to glucocorticoid withdrawal Drugs that cause hot flashes Tamoxifen, clomiphene Drugs that cause hyperglycemia

Tacrolimus, Protease inhibitors, Niacin, HCTZ, Corticosteroids Drugs that cause hypothyroidism Lithium, amiodarone, sulfonamides Drugs that cause acute cholestatic hepatitis, jaundice Erythromycin Drugs that cause diarrhea Metformin, Erythromycin, Colchicine, Orlistat, Acarbose Drugs that cause focal to massive hepatic necrosis Halothane, Amanita phalloides (death cap mushroom), Valproic acid, Acetaminophen Drugs that cause hepatitis Rifampin, isoniazid, pyrazinamide, statins, fibrates Drugs that cause pancreatitis Didanosine, Corticosteroids, Alcohol, Valproicacid, Azathioprine, Diuretics (furosemide, HCTZ) Drugs that cause pseudomembranous colitis Clindamycin, ampicillin, cephalosporins

Drugs that cause agranulocytosis Ganciclovir, Clozapine, Carbamazepine, Colchicine, Methimazole, Propylthiouracil Drugs that cause aplastic anemia Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil Drugs that cause direct Coombs- positive hemolytic anemia Methyldopa, penicillin Drugs that cause gray baby syndrome Chloramphenicol Drugs that cause hemolysis in G6PD deficiency Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin Drugs that cause thrombocytopenia Heparin Drugs that cause thrombotic complications OCPs, hormone replacement therapy Drugs that cause gingival hyperplasia Phenytoin, Ca2+ channel blockers, cyclosporine Drugs that cause gout Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine

Drugs that cause myopathy Fibrates, niacin, colchicine, hydroxychloroquine, interferon-α, penicillamine, statins, glucocorticoids Drugs that cause osteoporosis Corticosteroids, heparin Drugs that cause photosensitivity Sulfonamides, Amiodarone, Tetracyclines, 5 - FU Drugs that cause Stevens-Johnson syndrome Anti-epileptic drugs (especially lamotrigine), allopurinol, sulfa drugs, penicillin Drugs that cause SLE-like syndrome Sulfa drugs, Hydralazine, Isoniazid, Procainamide, Phenytoin, Etanercept Drugs that cause teeth discoloration Tetracyclines (TETra=bad TEeTh) Drugs that cause tendonitis, tendon rupture, and cartilage damage Fluoroquinolones

Drugs that cause cinchonism (symptoms are tinnitus and slight deafness, photophobia and other visual disturbances, mental dullness, depression, confusion, headache, and nausea) Quinidine, quinine Drugs that cause Parkinson-like syndrome Antipsychotics, Reserpine, Metoclopramide Drugs that cause seizures Isoniazid (vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, Enflurane Drugs that cause tardive dyskinesia Antipsychotics, metoclopramide Drugs that cause diabetes insipidus Lithium, demeclocycline Drugs that cause fanconi syndrome Expired tetracycline Drugs that cause hemorrhagic cystitis Cyclophosphamide, ifosfamide Drugs that cause interstitial nephritis Methicillin, NSAIDs, furosemide Drugs that cause SIADH Carbamazepine, Cyclophosphamide, SSRIs

Drugs that cause dry cough ACE inhibitors Drugs that cause pulmonary fibrosis Bleomycin, amiodarone, methotrexate, busulfan Drugs that cause antimuscarinic reaction Atropine, TCAs, H1-blockers, antipsychotics Drugs that cause disulfiram-like reaction Metronidazole, certain cephalosporins, griseofulvin, procarbazine, 1st-generation sulfonylureas Drugs that cause nephrotoxicity/ototoxicity Aminoglycosides, vancomycin, loop diuretics, cisplatin. Cisplatin toxicity may respond to amifostine. Cytochrome P-450 inducers Chronic alcohol use, St. John's wort, Phenytoin Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine Cytochrome P-450 substrates Anti-epileptics, Theophylline, Warfarin OCPs Cytochrome P-450 inhibitors Acute alcohol abuse, Ritonavir, Amiodarone, Cimetidine, Ketoconazole, Sulfonamides, Isoniazid (INH), Grapefruit juice, Quinidine, Macrolides, (except azithromycin)

Sulfa drugs Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antibiotics, Sulfasalazine, Sulfonylureas. Patients with sulfa allergies may develop fever, urinary tract infection, Stevens- Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, and urticaria (hives). Symptoms range from mild to life threatening.

- azole Ergosterol synthesis inhibitor - bendazole Antiparasitic/antihelmintic - cillin Peptidoglycan synthesis inhibitor - cycline Protein synthesis inhibitor - ivir Neuraminidase inhibitor - navir Protease inhibitor

- ovir DNA polymerase inhibitor - thromycin Macrolide antibiotic - ane Inhalational general anesthetic - azine Typical antipsychotic - barbital Barbiturate - caine Local anesthetic - etine SSRI - ipramine, - triptyline TCA - triptan 5 - HT1B/1D agonists

- zepam, - zolam Benzodiazepine - chol Cholinergic agonist - curium, - curonium Nondepolarizing paralytic - olol β-blocker - stigmine AChE inhibitor - terol β2-agonist - zosin α1-antagonist - afil PDE-5 inhibitor - dipine Dihydropyridine CCB