Pharmacology of Commonly Prescribed Medications, Exams of Nursing

Download Pharmacology of Commonly Prescribed Medications and more Exams Nursing in PDF only on Docsity! NURS 368 FINAL EXAM STUDY GUIDE WITH COMPLETE SOLUTIONS 2023-2024 Chapters 6& 7: Infection & Immunity (15 Questions) Viruses, requirement to replicate. a) Requires a living host to replicate Acquire immunity, types and examples, major disadvantage of each type if any! Natural Active - Pathogens enter body and cause illness; antibodies form in host - Ex: person has chickenpox once Artificial Active - Vaccine is injected into person; no illness recuts, but antibodies form - Ex: person has measles vaccine and gains immunity Natural passive - Antibodies passed directly from mother to child to provide temporary protection - No memory in the recipient (temporary) - Ex: placental passage during pregnancy or ingestion of breast milk Artificial passive - Antibodies injected into person (antiserum) to provide temporary protection or minimize severity of infection - No memory in the recipient (temporary) - Ex: rabies antiserum or snake antivenom; gamma globulin if recent exposure to microbe Interventions to minimize indirect transmission of infection Disinfecting contaminated items, handwashing Pathogen, meaning/description a) Definition: disease-causing microbes often referred to as germs Vector-borne infection, transmission a) when an insect/animal serves as an intermediary host in a disease b) ex: malaria c) mosquito, ticks, mites, lice, snails, blackflies Hypersensitivity reaction, types, and examples Type I Allergic Reaction - Ex: hay fever; anaphylaxis - IgE bound to mast cells; release of histamine & chemical mediators - Immediate inflammation & pruritus Type II Cytotoxic Hypersensitivity - Ex: ABO blood transfusion incompatibility - IgM or IgG reacts w/ antigen on cell-complement activated - Cell lysis and phagocytosis Type II Immune Complex Hypersensitivity - Ex: autoimmune disorders: systemic lupus erythematosus, glomerulonephritis - Antigen-antibody complex deposits in tissue-complement activated - Inflammation, vasculitis Type IV Cell Mediated or Delayed Hypersensitivity - Ex: contact dermatitis, transplant rejection - Antigen binds to T lymphocyte; sensitized lymphocyte releases lymphokines - Delayed inflammation Opportunistic infection, risks for development a) microbes are not pathogenic under normal circumstances but may cause disease if transferred to another location in the body where balance is not maintained, or body’s defense is impaired b) infections that occur more often or more severe in people with weakened immune system c) Factors that increase risk a. Immunocompromised b. Cancer c. AIDS/HIV d. Taking antibiotics, corticosteroids, chemotherapy, other immunosuppressive drugs Severe vomiting leading to metabolic acidosis, why? (do not be too fast, reverse is supposed to be the case) Severe vomiting= metabolic alkalosis (loss of acid) Metabolic acidosis= loss of bicarb Dysphagia - difficulty swallowing Oral cancer, location Esophageal cancer: primarily squamous cell carcinoma, most commonly found in distal esophagus Hiatal hernia, common cause Patho: part of the stomach protrudes through the opening (hiatus) in the diaphragm into the thoracic cavity a) food often lodges in the pouch created by the herniated portion, resulting in inflammation of the mucosa, reflux of food up the esophagus, and dysphagia, as the mass of food enlarges and obstructs the passageway b) factors contributing include: a. shortening of the esophagus b. weakness of the diaphragm c. increased abdominal pressure (pregnancy) Gastroenteritis due to salmonella, common cause Source: fecal contamination of food or undercooked or raw eggs, poultry, shellfish; contaminated work surfaces Patho: inflammation of stomach and intestines New Content Chapter 9: Musculoskeletal System Disorders Musculoskeletal (5Questions) Strain, meaning. A tear in a tendon (tendon= hold a muscle and a bone together) Client with Buck’s traction: nursing priority assessment - keep traction weight bag hanging and not on bed or floor - free bandages from wrinkles - tilt bed to maintain counter traction Nursing priority intervention in a client with a crush injury to the lower extremity - stop bleeding - raise the extremity Clients to provide interventions to prevent infection (recognize from a list of clients) - Immunocompromised patients - hand washing - PPE Suitable exercise recommendation for client at risk for osteoporosis a) regular weight-bearing exercise program such as walking or weightlifting Chapter 18: Urinary System Disorders (10 Questions) Test to determine functioning kidneys. - Urinalysis: - Elevated serum urea (blood urea nitrogen BUN) - Elevated Serum creatinine - C&S - Clearance tests - Radiologic tests - Cystoscopy - Biopsy Nephrotic syndrome (nephrosis) Patho: kidney disorder that causes body to pass too much protein in the urine Signs: a) Urinalysis: a. Proteinuria b. Lipiduria c. Casts (fatty, epithelial, hyaline) b) Massive edema (anasarca) w. weight gain and pallor c) Ascites, pleural effusion, swollen legs and feet Hydronephrosis , characteristics - Asymptomatic unless mild flank pain occurs as the renal capsule is distended or unless infection develops - Patho: swelling of kidney due to buildup of urine Nephrolithiasis/urolithiasis, content and % a) Kidney stones b) 75% are composed of calcium salts, with remainder consisting of uric acid or urates, struvite, or cystine Acute renal failure, early clinical manifestation a) elevated serum urea nitrogen BUN and creatinine b) metabolic acidosis and hyperkalemia c) oliguria and anuria Uremia associated with acute renal injury, etiology. a) End stage renal failure with more than 90% of nephrons lost b) Glomerular filtration rate is negligible Oliguric phase of acute renal failure, indicative assessment finding a) need dialysis Chronic renal failure, key indicator - Uremia - Oliguria, acidosis, azotemia Cholinergic agents as a class (Parasympathomimetic) A. Effects: a. Slows HR b. Decreased BP: vasodilation c. Increased motility of smooth muscle of stomach and intestine d. Increased peristalsis e. Contraction of urinary bladder; stimulated urination f. Pupil constriction or miosis g. Increased salivation, perspiration, and tears Anti-infective agents as a class Indications: - Treat infection - Antibacterial, antifungals, antimalarials, antivirals Patient teaching: - Take full course of antibiotics - Use alternate method of birth control when taking antibiotics - Monitor VS - Report signs of superinfection Cefepime I. Class: antibiotic: cephalosporin II. Indications: a. Pneumonia, treating bacteremia and respiratory, skin, intrabdominal, and urinary tract infections b. Administered IV III. Side/Adverse effects: a. Headache, rash, N/V, diarrhea, phlebitis, superinfection, pruritus IV. Patient teaching: a. Observe for hypersensitivity reactions b. Report signs of superinfection c. Take complete course of medication d. Use alternative method of birth control because it will cancel effect Vancomycin I. Class: antibiotic: glycopeptide II. Indications: a. C. diff, bacteremia, septicemia, endocarditis, MRSA, CDAD, respiratory, skin, and bone/joint infections III. Side/Adverse effects: a. Fever, headache, fatigue, back pain, peripheral edema, N/V, flatulence diarrhea, abdominal pain, hypokalemia, superinfection IV. Patient teaching: a. Use alternative method of birth control because it will cancel effect Cefotaxime I. Class: antibiotic: cephalosporins II. Indications: a. Treating bacteremia, septicemia, meningitis, typhoid fever and gynecologic, skin, bone/joint, intraabdominal, respiratory, and urinary tract infections III. Side/Adverse Effects: a. Rash, pruritus, fever, N/V, diarrhea, colitis, superinfection IV. Patient teaching: a. Observe for hypersensitivity reactions b. Report signs of superinfection c. Take full course d. Use alternate birth control method because it can cancel effect Doxycycline I. Class: antibiotic: tetracycline II. Indication: a. Acne, anthrax, amebiasis, gingivitis, plague, STIs, rickettsia, respiratory, urinary tract, and skin infections, E. coli, MRSA, C.diff III. Side effects: a. Abdominal pain, dysphagia, dry mouth, N/V, headache, photosensitivity hyperpigmentation IV. Adverse effects: a. Superinfection, angioedema, HTN, anaphylaxis, stevens-Johnson syndrome V. Patient teaching: a. Inform pregnant patients to avoid because of teratogenic effects b. Take full course c. Use alternative method of birth control because it will cancel effect Rifampin I. Class: antitubercular II. Indications: a. TB; Used in combination with other antitubercular drugs b. First line drug- more effective c. Combination therapy: four drugs are used (minimum of 3) III. Side effects/Adverse effects: a. Orange bodily fluids b. Discoloration of soft contact lenses c. Thrombocytopenia d. GI intolerance IV. Patient teaching: a. Urine may be orange b. Do not wear contact lenses c. Avoid sunlight d. Do not drink alcohol or take antacids e. Take as prescribed due to risk of drug resistance Anticholinergic agents as a class I. Effects: a. Increased HR b. Decreased GI motility and peristalsis c. Decreased bladder contraction: urinary retention d. Pupil dilation (mydriasis), decrease in accommodation e. Decreased salivation, perspiration, bronchial secretions f. Dry mouth g. Bronchodilation h. Decreased rigidity and tremor i. Drowsiness, disorientation, hallucinations j. Can treat symptoms of parkinsonism II. Patient Teaching: a. Patients with narrow-angle glaucoma to avoid atropine-like drugs i. Can cause mydriasis and increase IOP b. Do not drive c. For dry mouth: brush teeth and gargle Haloperidol I. Class: antipsychotic II. Indications: a. Acute psychosis, ADHD, schizophrenia, Tourette syndrome III. Side effects: a. Drowsiness, edema, headache, blurred vision, depression, confusion, euphoria, cataracts, tremor, dry mouth, restlessness IV. Adverse effects: a. Orthostatic hypotension, EPS, tachycardia, laryngeal edema, bronchospasm, dysrhythmias, hepatic failure V. How to Give: a. When giving IM: i. Precautions should be taken to prevent soreness and inflammation at injection site (because medication is a viscous liquid): use a large-gauge needle (21 gauge), with a z-track method ii. Injection site should not be massaged, and sites should be rotated iii. Medication should not remain in syringe for more than 15 minutes VI. Patient teaching: a. Do not drink alcohol b. Stop smoking c. Monitor lab values of WBC MAOIs as a class I. Indications: a. Treats depression only if another antidepressant is not effective i. Mild, reactive, and atypical depression II. Side effects and Adverse effects: a. Hypertensive crisis if certain foods are eten b. CNS stimulation (insomnia) c. Orthostatic hypotension d. Anticholinergic effects III. Patient teaching: a. Avoid foods that contain tyramine: i. Aged cheese, cream, yogurt, coffee, chocolate, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, red wines ii. They have sympathomimetic like effects and can cause hypertensive crisis b. Do not take OTC before checking with doctor i. Vasoconstrictors and cold medications can cause hypertensive crisis 1. Pseudoephedrine c. Frequent BP monitoring d. Do not drink alcohol Polystyrene sulfonate (Kayexalate) I. Indications: a. Severe Hyperkalemia II. Contraindications: a. Do not take if you have hypokalemia or bowel obstruction b. If you cannot tolerate a small increase in sodium intake III. Side effects: a. GI distress IV. Adverse effects: a. Hypokalemia, electrolyte imbalance, anorexia V. Patient teaching: a. Low sodium diet Phenazopyridine I. Class: urinary analgesic II. Indications: a. Cystitis, dysuria, urgency III. Side/Adverse effects: a. Headache, dizziness, contact lens discoloration, urine discoloration, skin pigmentation, rash IV. Patient teaching: a. Do not use long term for urinary tract pain b. Urine may be harmless reddish orange because of the dye c. Can alter blood glucose urine therefore a blood test should be used to monitor glucose levels Dicyclomine I. Class: anticholinergic II. Indications: a. IBS III. Side/Adverse effects: a. Dry mouth, nervousness, dizziness, drowsiness, blurred vision, weakness, and nausea IV. Patient teaching: a. Do not take if you have narrow-angle glaucoma i. May cause mydriasis and IOP b. Do not drive Oxycodone w/ acetaminophen (Percocet) I. Class: opioid CSS II II. Indications: a. For moderate to severe pain III. Side/Adverse effects: a. Dizziness, drowsiness, headache, confusion, N/V, constipation, urticaria IV. Patient teaching: a. Take with food or liquid b. Report difficulty breathing, blurred vision, headaches c. Monitor VS frequently to detect respiratory distress and hypotension d. Check for pupil changes and reaction e. Antidote: naloxone