NLL

BOOST REVIEW:
PHARMACOLOGY
EXAM 1
TERMINOLOGY
• Pharmacokinetics: absorption, distribution, metabolism, excretion
• Pharmacodynamics: what drugs do to the body and how they do it
• Efficacy vs. potency
• Therapeutic range vs. therapeutic index
• Polypharmacy
 Parasympathetic
  Sympathetic (Adrenergic)
(Cholinergic)
Function Fight or flight Rest, digest, and secrete
Epinephrine, norepinephrine, Acetylcholine
Neurotransmitters & Receptors
dopamine Alpha 1, beta 1, beta 2 Muscarinic
Alpha
Eyes Mydriasis: big pupils Miosis: small pupils
1
Alpha
Vessels in skin and viscera Vasoconstrict  
1
Vessels in heart, lung, & skeletal
Beta 2 Vasodilate  
muscles
Heart Beta 1 Increased HR and CO Decreased HR
Bronchoconstriction, increased
Lung Beta 2 Bronchodilation
secretion
Liver Beta 2 Glycogenolysis  
Salivation, increased secretion,
GI tract    
peristalsis, defecation
Kidney Beta 1 Vasodilate & increase renin  
Uterus Beta 2 Muscle relaxation  
A PATIENT IS PRESCRIBED A
BETA BLOCKER FOR A CARDIAC
CONDITION. YOU KNOW THIS
MEDICATION BLOCKS THE A. angiotensin II and angiotensin I;
BETA RECEPTORS IN THE BODY
SO ____________ AND sympathetic nervous system
__________ CANNOT BIND TO B. dopamine and norepinephrine;
THE RECEPTOR SITE AND
ELICIT A _______ ________  parasympathetic nervous system
_________ RESPONSE. C. norepinephrine and epinephrine;
sympathetic nervous system
D. dopamine and acetylcholine;
parasympathetic nervous system
 BETA 1 RECEPTORS CAN BE FOUND IN THE?
SELECT ALL THAT APPLY:

 A. GI tract
 B. Uterus
 C. Heart
 D. Lungs
 E. Kidneys
 F. Vascular smooth muscle
 Muscarinic Drugs
  Atropine (Atropin) Bethanechol (Urecholine) Pyridostigmine (Mestinon)
Type Anticholinergic Cholinergic Cholinesterase inhibitor
Uses  To induce mydriasis “Down to urinate” Myasthenic gravis
 To increase HR  Detrusor muscle
 To slow GI motility  Trigone
 To reduce secretions  Urinary sphincter

Side Effects  Blurred vision and  Hypotension Undertreatment (myasthenic

photophobia  Diarrhea crisis):
 Tachycardia  Bronchoconstriction  Muscle weakness
 Constipation    Ptosis
 Dry mouth and anhidrosis  Difficulty chewing and
(no sweat) swallowing
 
Overtreatment (cholinergic
crisis):
 Skeletal muscle weakness
 Rest, digest, and secretion
Contraindicati   Obstructive urinary or GI  
ons disorders
THE NURSE PROVIDES PREOPERATIVE TEACHING FOR A CLIENT ON THE SIDE
EFFECTS OF ATROPINE GIVEN AS A PREOPERATIVE MEDICATION. THE NURSE
INFORMS THE CLIENT TO EXPECT:

A. Decreased heart rate.

B. Dry mouth.
C. Sedation.
D. Increased urination.
A PATIENT ON PYRIDOSTIGMINE COMPLAINED OF FREQUENT
DIARRHEA AND SALIVATION. WHICH IS THE BEST NURSING ACTION
FOR THIS SITUATION?

A. Educate client about drug therapy to alleviate anxiety as these are expected

drug effects.
B. Withhold the dose of the drug and refer to physician.
C. Arrange for increasing the dose of the drug as it is not effective.
D. Document patient response and endorse accordingly for bedside care.
 Adrenergic Drugs
Metoprolol (Lopressor)  Albuterol (Proventil)  Epinephrine

Type Antiadrenergic  Adrenergic  Adrenergic 

Uses  To reduce HR and contractility  Bronchodilation   Mydriasis

 To reduce RAAS  Increase HR and BP
 Bronchodilation 
Good for HF, MI, and angina  Increase glucose 

Side Effects  Bradycardia   Hypertension, tachycardia  Hypertension, tachycardia

 Hypotension   Hyperglycemia   Hyperglycemia 
 Masks symptoms of  Photophobia, blurred vision 
hypoglycemia 

Contraindicatio Hold for BP <90/60 and HR <60

ns
WHAT SIGNS AND
SYMPTOMS BELOW WOULD
DEMONSTRATE A PATIENT
IS EXPERIENCING AN
OVERDOSE OF A BETA A. Blood pressure 70/30
BLOCKER MEDICATION?  B. Heart rate 35 beats per minute
SELECT ALL THAT APPLY
 C. EKG shows atrial fibrillation with
rapid ventricular rate (RVR)
 D. Patient is maniac and agitated
 E. Blood pressure 200/100
 F. Patient is severely drowsy
EPINEPHRINE, AS AN ADRENERGIC (SYMPATHOMIMETIC) DRUG,
PRODUCES WHICH THERAPEUTIC EFFECT?

A. Urinary retention

B. Bronchial constriction

C. Decreased intestinal motility

D. Increased heart rate and contractility

 Diuretics
  Mannitol Furosemide HCTZ Spironolactone
MOA Osmotic gradient Blocks reabsorption of Blocks reabsorption of Inhibits
via sugar on PCT sodium and water at loop sodium and water at early aldosterone at
of Henle DCT late DCT
Uses  Fluid overload  Fluid overload  Fluid overload  Fluid overload
 Low GFR  Low GFR    HF
 Intracranial  
HTN
 

Side Effects  Dehydration  Dehydration  Dehydration Similar chemical

structure to estrogen and
 Hypotension  Hypotension  Hypotension testosterone triggering a
 Ototoxicity   variety of unpredictable
effects.

Contraindicati  Heart failure  Hypokalemia  Hypokalemia Hyperkalemia

ons  Hypokalemia  Hyponatremia  Hyperglycemia
 Hyperglycemia  Hypercholesterolemia
THE NURSE IS PROVIDING
DISCHARGE INSTRUCTIONS
FOR A PATIENT
PRESCRIBED THE THIAZIDE
DIURETIC A. Drink at least 8-10 glasses of water per
HYDROCHOLOTHIAZIDE day 
(DIURIL). WHICH
INSTRUCTION SHOULD THE B. Weigh monthly and report the weight
NURSE INCLUDE?  to the HCP 
C. Eat bananas or oranges regularly 
D. Try to sleep in an upright position 
EACH OF THE FOLLOWING CLIENTS HAS A HEAD INJURY. TO WHICH CLIENT
WOULD THE NURSE QUESTION ADMINISTERING THE OSMOTIC DIURETIC
MANNITOL (OSMITROL)?

A. The 34-year-old client who is HIV positive.

B. The 84-year-old client who has glaucoma.
C. The 68-year-old client who has congestive heart failure.
D. The 16-year-old client who has cystic fibrosis.
WHICH MEDICATION SHOULD THE NURSE
QUESTION ADMINISTERING? 

A. Mannitol (Osmitrol) to the client with a serum osmolality of 280 mOsm/kg

B. Metoprolol (Lopressor) to a client with a BP of 96/70
C. Spironolactone (Aldactone) to a client with a potassium level of 3.5 mEq/L
D. Furosemide (Lasix) to a client with a potassium level of 3.0 mEq/L
 HTN Drugs
Lisinopril and Nifedipine Hydralazine
Valsartan
Type ACEi/ARB CCB
MOA Inhibits Block calcium channels = Powerful arteriole
aldosterone vasodilation vasodilator
Blocks angiotensin
II receptors
Uses ·    HTN with CKD ·    HTN HTN with pregnant women
·    HF ·    Anti-anginal
Side Effects ·    Dry cough
·    Angioedema
Contraindication ·    Category X
s ·    Hyperkalemia

Also: Hydrochlorothiazide and Metoprolol 

MIRA IS MANAGING HER HYPERTENSION WITH LISINOPRIL.
WHICH OF THE FOLLOWING STATEMENTS STATED BY HER
INDICATES A NEED FOR FURTHER INSTRUCTION?

 A. "I should not take my pills with food."

 B. "I need to increase my intake of orange juice, bananas, and green
vegetables."
 C. "I will avoid coffee, tea, and colas."
 D. "I will use salt substitutes that are not high in potassium."
 Anti-hyperlipidemic Drugs
Atorvastatin Ezetimibe (Zetia)
MOA 1.     Inhibits HMG Co-A reductase Inhibits dietary cholesterol absorption and
2.     Increases LDL receptors on reabsorption of cholesterol from bile
hepatocytes
Uses HLD (hyperlipidemia) HLD (hyperlipidemia)
Side Effects ·    SAMS – myopathy and rhabdomyolysis
·    Increases blood sugar
Contraindication ·    Liver problems
s ·    Category X
·    Grapefruit juice

Nitroglycerine
Mechanism of Converts nitrate to nitric oxide = vasodilation of veins
action
Uses Angina pectoris
Side Effects Orthostatic hypertension
Headache
Contraindicatio Anti-hypertensive medications
ns
THE CLIENT IS TO BEGIN TAKING ATORVASTATIN (LIPITOR) AND THE NURSE
IS PROVIDING EDUCATION ABOUT THE DRUG. WHICH SYMPTOM RELATED
TO THIS DRUG SHOULD BE REPORTED TO THE HEALTH CARE PROVIDER?

A. Constipation
B. Increasing muscle or joint pain
C. Hemorrhoids
D. Flushing or "hot flash"
 Antiplatelet
Drug MOA Use Side Effect Contraindications Alternatives
Aspiri Inhibits Antiplatelet: 81-325 mg/day GI irritation, <12 y/o = Reye’s Ticlopidine and clopidogrel
n COX à Antipyretic/analgesic: 325-650 mg/4-6 hours bleeding/bruising, syndrome
TXA2 tinnitus
Anticoagulant
Drug MOA Use Lab Test Antidote Side Effects Contraindication
s
Heparin Activates antithrombin III which Many aPTT Protamine HIT: platelet
inactivates activated factors ·  Normal = 40s sulfate <140k
·  Therapeutic = 60-
80 s
·  Overtreatment =
>80s
Warfarin Inactivates hepatic vitamin K AF, INR Vitamin K Category X
dependent clotting factors VII, IX, valves, ·  Normal = 1s (pregnancy)
X, prothrombin joint ·  Therapeutic = 2-
4.5s
·  Overtreatment =
>4.5s
PT
·  Normal = 12s
Thrombolytics
·  Therapeutic = 18-
Drug MOA 24s Use Side Effects
Alteplase (tPA) tPA converts plasminogen to MI: <12 hours (best at 2 hours)
·  Overtreatment = Recognize overt and occult bleeding
plasmin. Plasmin dissolves Ischemic stroke:
>24 s within 4.5 hours
Dabigatran clots.
Inhibits thrombin Pulmonary
AF, embolism
joint None Idarucizumab GI upset
Declot central line
A CLIENT IS BROUGHT TO THE EMERGENCY DEPARTMENT STATES
THAT HE HAS ACCIDENTALLY BEEN TAKING TWO TIMES HIS
PRESCRIBED DOSE OF WARFARIN (COUMADIN). AFTER OBSERVING
THAT THE CLIENT HAS NO EVIDENCE OF ANY OBVIOUS BLEEDING.
THE NURSE SHOULD DO WHICH OF THE FOLLOWING?

A. Draw a sample for activated partial thromboplastin time (aPTT) level.

B. Draw a sample for prothrombin time (PT) level and international
normalized ratio (INR).
C. Prepare to administer Vitamin K.
D. Prepare to administer Protamine sulfate.
HEART FAILURE DRUGS
• ACEIs and ARBs, BB, Diuretics
• Angiotensin receptor neprilysin inhibitor (valsartan + sacubitril = Entresto)
• Allows more natriuretic peptides to flow in bloodstream
• Digoxin: positive inotropic agent and negative chronotropic
• MOA: (1) Blocks Na-K ATPase enzyme, (2) Accumulation of intracellular sodium, (3)
Accumulation of intracellular calcium, (4) Increased contractility
• Oral and parental dosing: Therapeutic range = 0.5-2.0 ng/ml
• Contraindication with hypokalemia (K+ = 3.5-5)
• Side effects: 
• Noncardiac toxicities: angelic halo
• Cardiac toxicities: bradycardia and dysrhythmias especially with hypokalemia
A PATIENT IS TAKING DIGOXIN. WHAT MEDICATION ON
THE PATIENT'S MEDICATION LIST INCREASES THE
PATIENT'S RISK OF EXPERIENCING DIGOXIN TOXICITY?*

A. Furosemide
B. Metformin
C. Nitrogylcerin
D. Warfarin