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Pharmacology Concepts and Implementations, Exams of Nursing

Herzing University Nursing

A wide range of pharmacological concepts and their practical implementations. It discusses the correct answers and contraindications for various drug classes, including sucralfate, cholinergic agonists, adrenergic blockers, antiprotozoal drugs, antifungal drugs, and more. Detailed information on the mechanisms of action, indications, contraindications, adverse effects, and implementation guidelines for these drugs. It also covers topics related to drug interactions, toxicity, and overdose management. This comprehensive resource would be valuable for students and healthcare professionals studying or working in the field of pharmacology.

Typology: Exams

2023/2024

Available from 08/28/2024

bryanryan 🇺🇸

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NURS 309 final exam Questions And Answers With

Complete Solutions

- admin BEFORE MEALS

- may open capsule and sprinkle granules in pudding or

applesauce

- DO NOT CHEW GRANULES

- Omeprazole must be SWALLOWED WHOLE

- if ordered, antacids may be given concurrently Correct

Answers PPIs implementation

- administer NSAIDs as directed with food or milk to dec

harshness on the stomach

- IBUPROFEN --> MAX 24 HR DOSE - 3200 mg!!!!!

- do not give aspirin or salicylates to children < 16 y/o

- administer Colchisine on an empty stomach, if tolerated

- administer Allopurinol with meals

- with gout treatments, INC FLUIDS TO 3 L PER DAY!!!!

- educate pt on s/s of bleeding (coffee ground emesis), MI,

stroke, and salicylism

- avoid alcohol

- dietary restrictions to prevent gout: 3L fluids daily, AVOID

***ALCOHOL/RED MEAT/SEAFOOD*** Correct Answers

anti-inflammatory and antigout medication implementation

- administer OTHER MEDS 2 HOURS BEFORE OR AFTER

antacid - for if they require a lower gastric pH

- chewables - chew thoroughly, do not swallow

- liquids - shake well

- FOLLOW WITH 8 OZ. OF WATER

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NURS 309 final exam Questions And Answers With Complete Solutions

admin BEFORE MEALS
may open capsule and sprinkle granules in pudding or applesauce
DO NOT CHEW GRANULES
Omeprazole must be SWALLOWED WHOLE
if ordered, antacids may be given concurrently Correct Answers PPIs implementation
administer NSAIDs as directed with food or milk to dec harshness on the stomach
IBUPROFEN --> MAX 24 HR DOSE - 3200 mg!!!!!
do not give aspirin or salicylates to children < 16 y/o
administer Colchisine on an empty stomach, if tolerated
administer Allopurinol with meals
with gout treatments, INC FLUIDS TO 3 L PER DAY!!!!
educate pt on s/s of bleeding (coffee ground emesis), MI, stroke, and salicylism
avoid alcohol
dietary restrictions to prevent gout: 3L fluids daily, AVOID ALCOHOL/RED MEAT/SEAFOOD Correct Answers anti-inflammatory and antigout medication implementation
administer OTHER MEDS 2 HOURS BEFORE OR AFTER antacid - for if they require a lower gastric pH
chewables - chew thoroughly, do not swallow
liquids - shake well
FOLLOW WITH 8 OZ. OF WATER

may take with/in addition to PPIs for breakthrough symptoms
separate from H2 antagonists by 1-2 HOURS dietary measures:
avoid spices, caffeine, alcohol, and extremes in food temperature --> trigger foods that cause GERD/heartburn
weight loss - for GERD
no heavy meals - do not overfill stomach
DO NOT LIE DOWN FOR 2 HOURS AFTER EATING!!! Correct Answers antacid implementation
amphotericin B: severe systemic fungal infections (ex: jiroveci) - most potent and toxic
fluconazole - crosses the BB barrier, useful fro cryptococcal meningitis
nystatin - not well absorbed in the GI tract!!!!!, useful in oral fungal infections (ex: magic mouthwash)
topical antifungals - used for skin and vaginal fungal infections Correct Answers different types of antifungal drugs and what they tx
angina - chest pain bc heart is not getting enough O2 d/t vasoconstriction or plaque
cardioprotective effects: inhibits stimulation from circulating catecholamines - protect heart from SNS activity
dysrhythmias - controls rate
migraine HA
HTN
HF - reduce amount of work the pump has to do, so it's not strained

CV (palpitations, orthostatic hypotension, tachycardia, edema, chest pain) - all deal with drop in BP
CNS (dizziness, HA, anxiety, depression, weakness, numbness, fatigue) - the CNS trying to correct mess ups
GI (NVD, constipation, abd pain - why to not give to a pt with PUD) Correct Answers other than first-dose phenomenon, what are other AEs of alpha-adrenergic blockers?
dec muscle rigidity and muscle tremors - PARKINSON'S disease
drug-induced extrapyramidal reactions such as those associated with antipsychotic drugs - when the brain loses control of muscles and there is no control of movement Correct Answers CNS indications for using anticholinergics
dec secretions from the nose, mouth, pharynx, and bronchi
relaxes smooth muscles in the bronchi and bronchioles --> expansion
dec airways resistance
bronchodilation - inc diameter anticholinergics are used to tx:
asthma
exercise-induces bronchospams
chronic bronchitis
COPD Correct Answers respiratory indications for using anticholinergics
dermatophytic infections are difficult to eradicate
esp toenail fungus

therapy may be prolonged - SEVERAL WEEKS to 1 YEAR --

stay on drug until you grow a whole new nail Correct Answers topical fungal infections info

DO NOT give BISMUTH SUBSALICYLATE to CHILDREN or TEENAGERS, esp with or following a VIRAL ILLNESS
because pepto-bismol contains aspirin --> can cause REYE SYNDROME*******
use adsorbents carefully in OAs and those with dec bleeding time, clotting disorders, recent bowel sx, and confusion
pt should notify provider if diarrhea PERSISTS --> if they have to use it for more than 1-2 DAYS, then there is something else going on and they have risk for dehydration do not admin anticholinergics to pts with:
a hx of narrow-angle glaucome
GI obstruction --> makes it worse
myasthenia gravis (needs ACh and these block the effects of ACh)
paralytic ileus
toxic megacolon - would further dec the colon/GI muscle tone maintain HYDRATION while using antidiarrheals!!! ****if the drugs are WORKING: there will be DEC FREQUENCY and FORMED STOOLS Correct Answers ANTIDIARRHEALS implementation
do not touch the tip of the dropper - sterile
apply ointments as a thin layer on the conjunctival sac

heart block
bradycardia
pregnancy - can effect the baby
pulmonary disease (esp nonselective) - beta2 can cause bronchoconstriction
raynaud's - can exacerbate the disease Correct Answers what are some contraindications for beta-adrenergic blockers?
if necessary, remove cerumen by irrigation before instilling ear drops - so they can be more effective
clean the outer ear thoroughly
WARM EAR DROPS to room temp before admin - COLD ear drops may cause VOMITING and DIZZINESS
allow time for ear drops to flow down the ear canal
have pts lie on the side OPPOSITE to the AFFECTED ear for about 5 MINS after admin
a small cotton ball may be inserted into the ear canal - to hold the drops in - do not force the cotton into the ear canal
gently MASSAGE the TRAGUS of the ear to encourage flow of the medication
DO NOT PUT Q-TIPS INSIDE OF THE EAR - will further impact cerumen when administering drops:
adults - hold the pinna up and back
children <3 - hold the pinna down and back Correct Answers otic drugs implementation
inhibit acetylcholinesterase, inc ACh concentrations at receptor sites
cause skeletal muscle contractions

used for dx and tx of myasthenia gravis (weakness/rapid fatique of muscles under voluntary control)
used to reverse neuromuscular blocking drugs PYRIDOSTIGMINE
used to reverse anticholingeric poisoning: ANTIDOTE DONEPEZIL, galantamine, rivastigmine
used for tx of mild to moderate Alzeimer's disease
slows down the progression of the disease
they lack ACh, so if given the drug, ACh is broken down less and they will have more Correct Answers indications for indirect-acting cholinergic agonists
interrupt and inhibit the stimulation at the alpha1 receptors
cause both arterial and venous dilation - less blood being shunted to major organs - dec peripheral vascular resistance and dec BP Correct Answers what is the mechanism of action of alpha-adrenergic blockers?
known drug allergy
angle-closure glaucoma - they can worsen or cause this bc they inc the IOP
ACUTE asthma or other respiratory distress
myasthenia gravis
acute CV instability
GI or GU obstruction (ex: BPH) - if it's obstructed and you further slow peristalsis, you can worsen the obstruction Correct Answers contraindications for using anticholinergics
obtain specimens for C&S before applying medications

high-risk settings (employees and/or residents) - prisons, shelters, nursing homes, hospitals
high risk comorbidity - diabetes, renal failure, malnutrition, lung disease
HIV and other immunocompromised states - chemotherapy, organ transplant
children <4 Correct Answers pts at high risk for TB
reconstitute and admin per manufacturer's recommendation
for IV infusion: monitor VS, PE, IV SITE Q15-30 MINS FOR SIGNS OF EXTRAVASATION, I&O frequently
for IV: use an infusion pump and inline inline filter
for NYSTATIN - follow directions for liquid and troches Correct Answers implementation for antifunfal drugs
reduce IOP
useful for glaucoma and intraocular sx
meds that are applied topically to the eyes - echothiophate, carbachol, pilocarpine - topical because of poor oral absorption BETHANECHOL
inc tone and motility of bladder and GI tract - stimulates urination and bowel movements
relaxes sphincters in the bladder and GI tract, allowing them to empty
used for postsurgical atony of the bladder and GI tract (motility is slowed after sx bc of the anesthesia)
oral or subq
cevimeline - tx excessively dry mouth (xerostomia) resulting from an immune disorder known as Sjogren's syndrome

succinylcholine - given IV after anesthesia - used as a neuromuscular blocker in general anesthesia - used for intubation and to paralyze patients, pt still conscious
nicotine - used as a nicotine replacement for smoking cessation, patch/lozenge/gun/inhaled (patches used often in hospitals to relieve withdrawal) Correct Answers indications for direct-acting cholinergic agonists
reflex neurogenic bladder
incontinence
dec force of detrusor and tighter sphincter Correct Answers GU indications for using anticholinergics
result of overstimulation of the PSNS
CV (bradycardia, hypotension, syncope, conduction abnormalities - AV block and cardiac arrest)
CNS (HA, dizziness, convulsions, ataxia)
GI (abd cramps, inc secretions - problem if too much, NV)
respiratory (inc bronchial secretions - bad in COPD bc they have trouble clearing the airway, bronchospasms)
lacrimation, sweating, salivation, miosis Correct Answers AEs of cholinergic agonist drugs
systemic and topical fungal infections
choice of drug depends on the type and location of the infection Correct Answers indications for antifungal drug tx
transmitted by mosquito and blood
caused by Plasmodium protozoa
symptoms: chills, fever, diaphoresis, fatigue, prolonged sleep, HA, nausea, join pain

stimulate various alpha and beta receptors (selective or nonselective) Correct Answers what are some CV indications for adrenergic agonist drugs? "rest and digest" SLUDD!!!!!
salivation (to digest food), lacrimation, urination, digestion, defecation also pulmonary and cardiac effects - opposite of adrenergic agonist stimulation
stimulate intestine and bladder (inc gastric secretions, inc GI motility, inc urinary frequency)
stimulate pupils (constriction of the pupil - mioisis, reduced IOP - helpful in glaucoma)
inc salivation and sweating
CV (dec HR, vasodilation)
respiratory (bronchial constriction, narrowed airways)
at recommended doses, cholinergics primarily effect muscarinic receptors (desired effects)
at high doses, cholinergics stimulate nicotinic receptors (undesirable effects, pts who are on multiple cholinergic agonists) Correct Answers drug effects of cholinergic agonist drugs

inotropic effect
chronotropic effect
dromotropic effect

release of renin in the kidneys - activates the RAAS system Correct Answers what happens when beta1-adrenergic receptors are stimulated?

2 lb in a day or > 5 lb in a week

likely r/t fluid Correct Answers what amount of weight gain in and day and in a week should you notify your provider of?

- inotropic effect
- chronotropic effect
- dromotropic effect Correct Answers 3 things that happen with beta1-adrenergic stimulation:
________ = inc force of contraction
________ = inc HR
_______ = inc in the conduction of the cardiac electrical nerve impulses through the AV node - inc in the speed of electricity
perform drug-susceptability testing (C&S) on the 1st mycobacterium sputum that is isolated from a pt to prevent the development of MDR-TB
even before the results of the susceptibility tests are known, begin a regimen with multiple antitubercular drugs

adjust drug regimen after the results of testing are known Correct Answers 2 things to consider when talking about tb drug therapy a + tb skin test does NOT ALWAYS mean the person has tb - they could have an allergy to the tb serum Correct Answers does a + tb skin test mean the person has tb?

prophylaxis - daily for suppressive therapy (herpes), daily up to 1 year contraindications: hypersensitivity AEs:
nausea, diarrhea, HA, burning with topical application interactions: more common with systemic administration EDUCATION:
HSV CAN BE TRANSMITTED DESPITE TX AND THE ABSENCE OF SYMPTOMS!!!!!! - can be spread even not during blisters adrenergic blockers - additive adrenergic drugs - clash hypoglycemic drugs - beta blockers can mask symptoms of hypoglycemia Correct Answers interactions of beta-adrenergic blockers adrenergic drugs, aka adrenergic agonists Correct Answers drugs that stimulate the sympathetic nervous system - fight or flight adrenergic-blocking drugs - additive adrenergic drugs - clash warfarin - anticoagulant, inc risk for bleeding antihypertensives - severe drop in BP erectile dysfunction drugs - drops BP alcohol Correct Answers what are some interactions of alpha- adrenergic blocking drugs? adsorbents: bismuth subsalicylate:

keep water from being absorbed/flowing into the GI tract
coat the walls of the GI tract, bind to the causative bacteria or toxin, which is eliminated through the stool
for milder cases of diarrhea antimotility drugs: anticholinergics
dec intestinal tone and peristalsis of GI tract, slows the movement of fecal matter through the GI tract
this allows more water to be absorbed from the gut, into the bloodstream, so the stool can be more formed
for more severe cases of diarrhea antimotility drugs: opiates: diphenoxylate, loperamide (OTC)
dec bowel motility and reduce pain by relief of rectal spasms
dec transit time through the bowel, allowing more time for water and electrolytes to be absorbed
for more severe cases of diarrhea probiotics: lactobacillus
tx diarrhea caused by disruption of GI nl flora caused by the use of ABs
work by supplying missing bac Correct Answers ANTIDIARRHEALS mechanism of action affective domain Correct Answers domain of learning - expresses feelings, needs, beliefs, values, and opinions affects the heart's conduction system - electrical, not muscle
low doses: slow the HR
high doses: block inhibitory vagal effects on SA and AV node pacemaker cells - results in inc HR

alpha-adrenergic receptors beta-adrenergic receptors dopaminergic receptors Correct Answers what are the 3 types of receptors for the sympathetic neurotransmitters? amphotericin B ("amphoterrible") Correct Answers ANTIFUNGAL

potent!!!
indication: SEVERE SYSTEMIC fungal infections contraindications:
hypersensivity
SEVERE BONE MARROW SUPPRESSION
renal insufficiency (CKD) precautions:
same as above, but may be used if no other options are available AEs - amphoterrible!!!:
NEPHROTOXICITY, cardiac arrhythmias, NEUROTOXICITY, pulmonary infiltrates (water in the lungs), hypOkalemia, hypOcalcemia, hypOchloremia, hypOmagnesemia
infusion related rxns are common (not an allergic rxn): chills, fever, HA, BRONCHOSPASM, HYPOTENSION
often have order to pre medicate to prevent/minimize this rxn: antipyretics, antihistamines, antiemetics, corticosteroids
longer infusion times can reduce rxns interactions:
digitalis, nephrotoxic drugs, thiazide diuretics angle-closure glaucoma
an EMERGENCY!!! - requires urgent intervention to drain

open-angle glaucoma

more common Correct Answers types of glaucoma antacids Correct Answers ACID-CONTROLLING DRUGS
neutralizes stomach acid on contact and inc gastric pH
treats heartburn and GERD quickly
does not last long
many aluminum and calcium based formulations also include magnesium, which contributes to the acid neutralization and counteracts the constipating effects of Al and Ca indications:
symptomatic relief of PUD, gastritis, gastric hyperacidity, and heartburn (reduces the symptoms)
DO NOT use long term because it can mask the symptoms of a serious disorder (gastric CA or bleeding peptic ulcers) contraindications/precautions:
hypersensitivity
renal insufficiency, electrolyte imbalances, GI obstruction
these are salts (Mg, Ca+) and can affect the kidneys and electrolytes
meds slow the process of the stomach so it can cause an obstruction AEs:
Mg: diarrhea - potent, loosens stool
Ca: constipation, renal stones, hypercalcemia
overuse: METABOLIC ALKALOSIS interactions:
drugs that require acidic pH for absorption of secretion - it will not work

Pharmacology Concepts and Implementations, Exams of Nursing

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