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Pharmacology Exam 3 Blueprint

Here is the pharmacology blueprint 3 covering units 9 - 12
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Pharmacology (NSG 124)

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Academic year: 2022/2023
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NSG124 Pharmacology Study Test Plan Exam 3

Unless otherwise specified, know the specific categories for all medications/medication classes in the modules

Module 9 & 10 Location Student Notes  Therapeutic uses  Adverse effects

NSG124.09.

RAA Drugs

ANGIOTENSIN-CONVERTING

ENZYME INHIBITORS

  1. Mechanism of Action: reduce levels of angiotensin II and increase levels of bradykinin which causes dilated blood vessels, reduced blood volume, prevent/reverse pathologic changes in the heart/blood vessel
  2. Therapeutic Uses: hypertension, heart failure, acute MI, left ventricular dysfunction, diabetic/nondiabetic nephropathy
  3. Prevention: MI, stroke, and death in patients at high cardiovascular risk
  4. Adverse Effects: first-dose hypotension, cough, hyperkalemia, renal failure, fetal injury, angioedema, & neutropenia

ANGIOTENSIN II RECEPTOR BLOCKERS

  1. Therapeutic Uses: hypertension, heart failure, diabetic nephropathy & retinopathy, MI
  2. Prevention: MI, stroke, and death in patients at high cardiovascular risk
  3. Adverse Effects: angioedema, fetal harm, renal failure

ALDOSTERONE ANTAGONIST

  1. Mechanism of Action: block receptors for aldosterone
  2. Therapeutic Uses: hypertension, heart failure  Identifying High-Risk patients  Minimizing adverse effects

NSG124.09.01 (x2) Nursing Care for RAA Drugs

ACE INHIBITORS (captopril, lisinopril)

  1. High-Risk Patients: 2nd – 3rd trimesters of pregnancy, patients with bilateral renal artery stenosis, history of hypersensitivity

  2. Minimizing Adverse Effects:

  • Cough: consult prescriber if cough is bothersome or consistent (dry, nonproductive, irritating)
  • Hyperkalemia: avoid potassium supplements and potassium-containing salt substitutes unless prescribed
  • Angioedema: seek IMMEDIATE medical attention
  • Neutropenia: instruct prescriber of signs of infection (fever, sore throat)
  • First-Dose Hypotension: withdraw diuretics 2 – 3 days before initiating therapy
  • Orthostatic Hypotension: move slowly
  • Renal Failure: use with caution

ANGIOTENSIN II RECEPTOR BLOCKERS (losartan)

  1. High-Risk: 2nd – 3rd trimesters of pregnancy, patients with bilateral renal artery stenosis, history of hypersensitivity
  2. Minimizing Adverse Effects:
  • Angioedema: seek IMMEDIATE medical attention
  • Fetal Injury: warn women of risk in pregnancy
  • Renal Failure: use with caution

DIRECT RENIN INHIBITOR (aliskiren)

  1. High-Risk: 2nd – 3rd trimesters of pregnancy
  2. Minimizing Adverse Effects:
  • Hyperkalemia: avoid potassium supplements and potassium-containing salt substitutes unless prescribed
  • Fetal Injury: warn women of risk of pregnancy
  • Angioedema: seek IMMEDIATE medical attention  Ongoing evaluation and interventions  Minimizing adverse

NSG124.09.02 (x3) Nursing Care for Calcium Channel

VERAPAMIL

  1. Mechanism of Action: blocks calcium channels in blood vessels and

hypotension, cyanide poisoning, thiocyanate toxicity  Beta-Adrenergic Blockers  Calcium Channel blockers  Ongoing evaluation and interventions

NSG124.09.04 (x3) Nursing Care for Antihypertensive Agents

  1. Beta-Adrenergic Blockers: (1) blockade of cardiac beta receptors decreases heart rate and contractility (2) suppress reflex tachycardia (3) blockade of beta receptors (4) long- term beta blockers reduce peripheral vascular resistance
  2. Calcium Channel Blockers: promote arteriole dilation  Mechanism of inotropic action  Summary of hemodynamic effects  Predisposing factors

NSG124.09.05 (x3) Nursing Care for Antihypertensive Agents

DIGOXIN

  1. Mechanism of Inotropic Action: increased myocardial contractility by inhibiting an enzyme known as Na/K -ATPase
  2. Hemodynamic Benefits: cardiac output improves, heart rate decreases, heart size declines, constriction of arterioles and veins decreases, water retention reversal, blood volume decline, peripheral/pulmonary edema decreases
  3. Predisposing Factors of Dysrhythmias: hypokalemia, elevated digoxin levels, heart disease Quinidine, Lidocaine, Amiodorone  Therapeutic goal  Administration  Pre-administration assessment  Ongoing evaluation and interventions

NSG124.10.01 (x3) Nursing Care for Antidysrhythmic Agents

QUINIDINE

  1. Therapeutic Goal: long-term suppression of atrial and ventricular dysrhythmias
  2. Administration: take with meals, do NOT crush/chew sustained-release formulations
  3. Pre-administration Assessment: obtain baseline ECG, liver function labs, blood pressure
  4. Ongoing Evaluation & Interventions:
  • Plasma Levels: between 2 – 5 mcg/mL
  • Minimizing Adverse Effects: diarrhea, cinchonism, cardiotoxicity, arterial embolism
  • Minimizing Adverse Interactions: increase digoxin levels

LIDOCAINE

  1. Therapeutic Goal: acute management of ventricular dysrhythmias
  2. Administration: usual dose is IV & emergency use IM
  3. Pre-administration Assessment: baseline ECG, blood pressure
  4. Ongoing Evaluation & Interventions:
  • Plasma Levels: 1 – 5 mcg/mL
  • Minimizing Adverse Effects: convulsions, respiratory arrest, seizures

AMIODARONE

  1. Therapeutic Goal: atrial fibrillation, life-threatening recurrent ventricular fibrillation or recurrent hemodynamically unstable ventricular tachycardia
  2. Administration: oral therapy used to maintain dysrhythmias & IV for acute therapy of dysrhythmias
  3. Pre-Administration Assessment: baseline ECG, eye examination, chest x-ray, potassium/magnesium levels, thyroid/pulmonary/liver function
  4. Ongoing Evaluation & Interventions:
  • Monitor changes in ECG
  • Pulmonary Toxicity: inform signs of lung injury and REPORT immediately
  • Cardiotoxicity: signs of HF and REPORT immediately
  • Pregnancy: avoid pregnancy and breastfeeding
  • Ophthalmic Effects: report reductions in visual acuity or peripheral vision
  • Dermatologic Effects: advise patients to wear sunscreen and protective clothing  Beneficial actions  Adverse effects  Drug interactions  Cautions

NSG124.10.02 (x4) Atherosclerotic drugs

HMG-CoA REDUCTASE INHIBITORS (statins)

  1. Beneficial Action: reduction of LDL cholesterol, elevation of HDL cholesterol, reduction of triglyceride levels -ALSO: diabetes, post-MI therapy,

Heparin  Dabigatran Etexilate (Pradaxa)

  1. Administration: IV or SubQ
  2. Monitor: aPTT 1 – 2 & anti-Xa 0.
  • 0 IU/mL

LOW MOLECULAR WEIGHT

HEPARIN

  1. Therapeutic Use: prevention of DVT following abdominal/hip/knee surgery, treatment of DVT/PE, prevention of ischemic complications
  2. Admin/Dose/Monitor: subQ, dosing based on body weight, extended half- life

DABIGATRAN ETEXILATE (Pradaxa)

  1. Therapeutic Use: atrial fibrillation, knee/hip replacement, DVT/PE treatment
  2. Admin/Dose/Monitor: can be down with or without food  Administration  Evaluating treatment  Minimizing adverse effects  Minimizing adverse interactions

NSG124.10.04 (x5) Anticoagulant Nursing Considerations

HEPARIN

  1. Administration: dose is prescribed in units not mg. IV & SubQ – NOT IM.
  2. Evaluating Treatment: aPTT should increase 1- to 2- fold above baseline & anti-Xa level 0 to 0 IU/mL
  3. Minimizing Adverse Effects: hemorrhage, thrombocytopenia, spinal/epidural hematoma, hypersensitivity
  4. Minimizing Adverse Interactions: antiplatelet drugs

WARFARIN, A VIT K ANTAGONIST

  1. Administration: oral, INR between 2
  • 3
  1. Evaluating Treatment: monitor INR and PT
  2. Minimizing Adverse Effects: hemorrhage
  3. Minimizing Adverse Interactions: avoid all drugs not approved through provider

 Description and mechanism  Therapeutic uses

NSG124.10.

Thrombolytic Drugs

ALTEPLASE (tPA)

  1. Description/Mechanism: binds with plasminogen to form an active complex and digests the fibrin meshwork of clots
  2. Therapeutic Uses: acute MI, acute ischemic stroke, acute massive PE  Management of STEMI  Oxygen  Aspirin  NSAIDS  Morphine  Beta-blockers  Nitroglycerin

NSG124.10.

Myocardial Infarction Agents

MANAGEMENT OF STEMI

  1. Oxygen: administered through nasal cannula above 90%
  2. Aspirin: suppresses platelet aggregation producing antithrombotic effect
  3. NSAIDs: discontinue IMMEDIATELY
  4. Morphine: for associated pain and improving hemodynamics
  5. Beta-Blockers: reduce cardiac pain, infarct size, short-term mortality
  6. Nitroglycerin: reduces preload/oxygen demand, increases collateral blood flow, controls hypertension caused by anxiety, limits infarct size and LV function  Therapeutic goal  Baseline data  Ongoing evaluation and interventions

NSG124.10.06 (x3) Nursing Care for Deficiency Anemia Agents

IRON PREPARATIONS

  1. Therapeutic Goal: prevention of treatment of iron deficiency anemias
  2. Baseline Data: degree of anemia, lab finding, cause of deficiency
  3. Ongoing Evaluations & Interventions:
  • forewarn of GI reactions: N&V, constipation, diarrhea
  • dark green/black stools
  • increase iron-rich consumption
  • take between meals to maximize uptake

CYANOCOBALAMIN (Vit. B12)

  1. Therapeutic Goal: correction of megaloblastic anemia and other sequelae of B12 deficiencies
  2. Baseline Data: extent of deficiency, assess GI & neuro, baseline lab data, schilling test to assess absorption
  3. Ongoing Evaluations &

GAD, social phobia, panic disorders 3. Adverse Effects: nausea, headache, anorexia, nervousness, sweating, insomnia, sexual dysfunction, diastolic hypertension, hyponatremia,

DULOXETINE (SNRI) 1. Mechanism of Action: inhibits serotonin and NE reuptake, doesn’t inhibit reuptake of dopamine 2. Therapeutic Uses: major depression, fibromyalgia, GAD, diabetic neuropathy pain, chronic musculoskeletal pain, stress urinary incontinence 3. Adverse Effects: generally, well tolerated Monoamine oxidase inhibitors  Therapeutic uses  Adverse effects

NSG124.11.

MAOI Inhibitor Agents

MONOAMINE OXIDASE

INHIBITORS

  1. Mechanism of Action: inhibit MAO- A in nerve terminals which increase NE and serotonin availability
  2. Therapeutic Uses: depression, bulimia, agoraphobia, ADHD, OCD, panic disorders
  3. Adverse Effects: CNS stimulation, orthostatic hypotension, hypertensive crisis from (tyramine)  Promoting adherence  Minimizing adverse reactions  Minimizing adverse effects

NSG124.11.01 (x2) Antidepressant Agent Nursing Consideration

ALL ANTIDEPRESSANTS

  1. Reduce Suicide Risk: advise support member to monitor for symptoms of clinical decline
  2. Promote Adherence: effects usually develop in 1 – 3 weeks, educate patients about the importance of taking medications

SSRI/SNRI

  1. Minimizing Adverse Effects:

  • Sexual Dysfunction: inform patients about problems and encourage them to report problems

  • Dizziness/Fatigue: exercise/perform tasks with caution

  • Rash: notify prescriber of development

  • Dysrhythmias: do NOT exceed 40mg/day

  • Bruxism: alert patients of sequelae of bruxism (headache, jaw pain, dental problem)

  1. Minimizing Adverse Interactions:
  • MAOIs/other drugs: increase risk of serotonin syndrome
  • TCAs/Lithium: increase drug levels
  • Antiplatelet/Anticoagulants: increase GI bleeding

MAOIs

  1. take DAILY and do NOT discontinue abruptly
  2. Minimizing Adverse Effects:
  • Hypertensive Crisis: monitor symptoms (ex. headache, tachycardia, N&V, confusion), avoid tyramine food/sympathomimetic drugs
  • Orthostatic Hypotension: sit/lie down if hypotension occurs
  1. Minimizing Adverse Interactions
  • All drugs: avoid if not approved by prescriber
  • Indirect-Acting Sympathomimetics: cause hypertensive crisis Buspirone  Actions and therapeutic uses Benzodiazepines

NSG124.11.

Antianxiety Agents

BUSPIRONE (ANXIOLYTIC

DRUG)

  1. Therapeutic Uses: anxiety (short term)
  2. NO abuse potential, does NOT intensify CNS depressant effects
  3. Adverse Effects: dizziness, nausea, headache, nervousness, sedation, light- headedness, excitement

BENZODIAZEPINES (ativan)

  1. Therapeutic Uses: GAD and panic disorders
  2. IMMEDIATE benefits, abuse dependence is possible,
  3. Adverse Effects: sedation, psychomotor slowing  Therapeutic uses  Monitoring plasma

NSG124.11.03 (x2) Bipolar Disorders &

LITHIUM

  1. Therapeutic Uses: acute manic in
  • Agranulocytosis: monitor for infection
  • Metabolic Effects: monitor caloric intake and exercise, monitor for diabetes
  • Seizures/Sedation: reduce hazardous activities and driving  Classification  Tolerance and physical dependence  Therapeutic use

NSG124.12.

Barbiturates

BARBITURATES

  1. Need to Knows: high risk for respiratory depression, high potential for abuse, significant tolerance/physical dependence, often induce hepatic drug-metabolizing enzymes
  2. Classifications: (1) ultrashort-acting: anesthesia induction (2) short- intermediate acting: sedatives and hypnotics (3) long-acting: primarily antiseizure drugs
  3. Tolerance & Dependence:
  • Tolerance: reduced drug responsiveness developing over course of drug use
  • Dependence: continued use is required to avoid an abstinence syndrome – adaptive neurochemical changes that occur in response to chronic exposure
  1. Therapeutic Uses: seizure disorders, induction of anesthesia, insomnia, acute manic states, delirium  Recordkeeping  DEA schedules  Labeling

NSG124.12.

Controlled Substance Act & Healthcare Impact

RECORDKEEPING

  1. Written record MUST be made of all transactions
  2. Must be reported to DEA every two years

DEA SCHEDULES

  1. Schedule I: a high potential for abuse and no approved medical use in US (ex. heroin, marijuana)
  2. Schedule II: must be typed or filled out in ink and signed by prescriber (ex. codeine, fentanyl, hydrocodone, oxymorphone, cocaine)
  3. Schedule III: may be oral written or

electronic – may be refilled 5 times (ex. ketamine, testosterone, butobarbital, dronabinol (THC)) 4. Schedule IV: may be oral written or electronic – may be refilled 5 times (ex. clonazepam, diazepam, zolpidem, tramadol) 5. Schedule V: may be prescribed without a prescription (ex. pregabalin, diphenoxylate + atropine)

LABELING

  1. Schedules II/III/IV must have the label “caution federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed”  Drugs used to facilitate withdrawal  Drugs used to maintain abstinence

NSG124.12.

Alcohol Pharmacology & Alcohol Use Disorder

DRUGS to FACILITATE WITHDRAWAL

  1. Goals: minimize symptoms of withdrawal, prevent seizures/delirium tremens, facilitate transition to a program
  2. Drug Options:
  • Benzodiazepines (lorazepam): decrease withdrawal symptoms, stabilize vital signs, prevent seizures/delirium tremens
  • Beta-Adrenergic Blockers (atenolol): improve vital signs, decrease craving, decrease autonomic component of withdrawal symptoms
  • Central Alpha2-Adrenergic Agonist (clonidine): decreases autonomic component of withdrawal symptoms
  • Antiepileptics (carbamazepine): decreases withdrawal symptoms, seizure prevention

DRUGS to MAINTAIN ABSTINENCE

  1. Goal: prevent or minimize future drinking
  2. Drug Options:
  • Disulfiram: works by causing unpleasant alcohol consumption

irritation, cough

  • Advantages: user-controlled dose, mimics hand-to-mouth motion of smoking
  • Disadvantages: prescription required, slow onset and low levels, frequent puffs necessary

NICOTINE-FREE PRODUCTS

  1. Bupropion:
  • Adverse Effects: insomnia, dry mouth, agitation
  • Advantages: pill, no nicotine, promotes weight loss, first choice for smokers with depression
  • Disadvantages: prescription required, small risk for seizures
  1. Varenicline:
  • Adverse Effects: nausea, sleep disturbances, headaches, abnormal dreams
  • Advantages: pills, no nicotine, most effect for cessation
  • Disadvantages: prescription required, neuropsychiatric disturbances
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Pharmacology Exam 3 Blueprint

Course: Pharmacology (NSG 124)

875 Documents
Students shared 875 documents in this course

University: Herzing University

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NSG124 Pharmacology Study Test Plan Exam 3
Unless otherwise specified, know the specific categories for all medications/medication
classes in the modules
Module 9 & 10 Location Student Notes
Therapeutic uses
Adverse effects
NSG124.09.01.02
RAA Drugs
ANGIOTENSIN-CONVERTING
ENZYME INHIBITORS
1. Mechanism of Action: reduce levels
of angiotensin II and increase levels of
bradykinin which causes dilated blood
vessels, reduced blood volume,
prevent/reverse pathologic changes in
the heart/blood vessel
2. Therapeutic Uses: hypertension,
heart failure, acute MI, left ventricular
dysfunction, diabetic/nondiabetic
nephropathy
3. Prevention: MI, stroke, and death in
patients at high cardiovascular risk
4. Adverse Effects: first-dose
hypotension, cough, hyperkalemia,
renal failure, fetal injury, angioedema,
& neutropenia
ANGIOTENSIN II RECEPTOR
BLOCKERS
1. Therapeutic Uses: hypertension,
heart failure, diabetic nephropathy &
retinopathy, MI
2. Prevention: MI, stroke, and death in
patients at high cardiovascular risk
3. Adverse Effects: angioedema, fetal
harm, renal failure
ALDOSTERONE ANTAGONIST
1. Mechanism of Action: block
receptors for aldosterone
2. Therapeutic Uses: hypertension,
heart failure
Identifying High-Risk
patients
Minimizing adverse
effects
NSG124.09.01.03 (x2)
Nursing Care for RAA
Drugs
ACE INHIBITORS (captopril,
lisinopril)
1. High-Risk Patients: 2nd – 3rd
trimesters of pregnancy, patients with
bilateral renal artery stenosis, history of
hypersensitivity

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