2022/2023 HESI Pharmacology version 2 Study Guide Brand New Questions Covered Guaranteed A+++
1. Nitroglycerine Administration: Math Problem
2. Math:
... [Show More] IV dose rate
3. Nutrition: • Multiple Sclerosis – Herbal Gingko Reaction Chp12: Muscle relaxant
Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg 3 times daily, for antioxidant and immune support. Ginkgo supplements may increase bleeding in sensitive individuals, such as those taking blood-thinning mediations (including aspirin).
Beware of bleeding interactions/side effects
• Isoniazid (Anti TB drugs) and Tyramine - Foods that contain tyramine!
Aged, mature cheeses (cheddar, blue, Swiss)
Smoked/pickled or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté)
Yeast extracts
Red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans)
4. Med Administration
• Baclofen – muscle relaxant:
o Makes you sleepy o Don’t stop taking abruptly
o Baclofen is a muscle relaxant and antispastic, available as 10 mg and 20 mg tablets for oral administration.
o Baclofen is a white to off-white, odorless or practically odorless crystalline powder.
o This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages.
o The determination of optimal dosage requires individual titration. Start therapy at a low dosage and increase gradually until optimum effect is achieved (usually between 40-80 mg daily).
o The following dosage titration schedule is suggested:
5 mg t.i.d. for 3 days
10 mg t.i.d. for 3 days
15 mg t.i.d. for 3 days
20 mg t.i.d. for 3 days o Thereafter additional increases may be necessary but the total daily dose should not exceed a maximum of 80 mg daily (20 mg q.i.d.).
• Ditrophan(OXYBUTRIN) – Side Effects o Ditropan reduces muscle spasms of the bladder and urinary tract. o Administer: 5mg 2-3 times/day
o Take with full glass of water and do not crush the tablet, take whole
o Oxybutynin is used to treat symptoms of overactive bladder, such as frequent or urgent urination, incontinence (urine leakage), and increased night-time urination.
o Oxybutynin may also be used for other purposes not listed in this medication guide.
o serious side effects:
hot, dry skin and extreme thirst;
severe stomach pain or constipation; pain or burning when you urinate; or
urinating less than usual or not at all.
o You may experience these side effects: Dry mouth (suck sugarless lozenges and use frequent mouth care); GI upset; blurred vision; drowsiness (avoid driving or performing tasks that require alertness); decreased sweating (avoid high temperatures; serious complications can occur because you will be heat intolerant).
o Report blurred vision, fever, rash, nausea, vomiting.
• Peptic Ulcer Disease – Med Timing o Antacids
Take 2-3hrs after meal Neutralizes and short lived.
Needs frequent treatment
Maalox and Mylanta can cause diarrhea
Aluminum can cause constipation o H2 blockers – reduce the production of histamines
Take an hour before meals
Eg. Cimetidine
Ranitidine
Famotidine - Pepcid o PPI – Proton Pump Inhibitors: suppresses
Take 30 mins before meals
Prevacid
Nexium
o Sucralfate (Carafate) and misoprostol (Cytotec) o H. pylori treatment
Commonly used antibiotics are tetracycline,
amoxicillin,
metronidazole (Flagyl),
clarithromycin (Biaxin), and levofloxacin (Levaquin).
Eradication of H. pylori prevents the return of ulcers (a major problem with all other ulcer treatment options)
o Antihistamines: H2 Blockers:- used to reduce gastric acid Peptic Ulcer Disease o Examples: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) o Antihistamines: H2 Blockers : More effective in preventing the actions of histamine rather than reversing them
o Should be given early in treatment, before all the histamine binds to the receptors
• Spiriva and COPD: SPIRIVA - Anticholigenics o Ipratropium bromide (Atrovent) and tiotropium (Spiriva) o Slow and prolonged action o Used to prevent bronchoconstriction o NOT used for acute asthma exacerbations!
• Vancomycin: Peak and Trough: MRSA o The reference range for vancomycin trough levels is 10-20 µg/mL (15-20 µg/mL for complicated infections). The reference range for vancomycin peak levels is 25-50 µg/mL.[1]
o Treatment of choice for MRSA and other gram-positive infections
o Oral vancomycin is indicated for the treatment of antibiotic-induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis
o Must monitor blood levels to ensure therapeutic levels and prevent toxicity o May cause ototoxicity and nephrotoxicity o Red man syndrome may occur
o Flushing/itching of head, neck, face, upper trunk o Antihistamine may be ordered to reduce these effects
o Additive neuromuscular blocking effects in patients receiving neuromuscular blockers o Should be infused over 60 minutes o Rapid infusions may cause hypotension
• Xenical – Weight Management
• 120mg 3 x a day with main meal
• reduce fat – oily stools
•
5. Ambien (ZOLDIPEM): CNS Depressants: NON BENZODIAZEPINE HYPNOTICS
• Share many characteristics of benzodiazepines
• Used to treat insomnia – short term medications
• Dosage: 5mg
• Zolpidem may impair your thinking or reactions. You may still feel sleepy the morning after taking zolpidem, especially if you take the extended-release tablet, or if you are a woman. Wait at least 4 hours or until you are fully awake before you drive, operate machinery, pilot an airplane, or do anything that requires you to be awake and alert.
• Avoid taking zolpidem during travel, such as to sleep on an airplane. You may be awakened before the effects of the medication have worn off. Amnesia (forgetfulness) is more common if you do not get a full 7 to 8 hours of sleep after taking zolpidem.
• Do not take this medicine if you have consumed alcohol during the day or just before bed.
6. Teaching: MULTAQ – Afib Meds: Drenedarone: Antidysrhythmic drugs
• Used for the treatment and prevention of disturbances in cardiac rhythm
• Multaq = class III
• Used for dysrhythmias that are difficult to treat
• Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter that is resistant to other drugs
• Need to build up in your system, May take more than one week to work
• This doesn’t mean MULTAQ is not working. When taking MULTAQ, you can go more days without having an atrial fibrillation (AFib) episode, and it can reduce the risk that AFib will put you in the hospital
• Even if you’ve been better for a long time, it doesn’t mean you no longer have AFib. AFib is a chronic disease and cannot be cured
• Call your doctor right away if you notice your pulse is irregular. This may be a sign that you are in AFib
• Always talk to your doctor if you experience symptoms that concern you. That way, your doctor can determine if further follow up is necessary • Teachings:
• Obtain a thorough drug and medical history
• Measure baseline BP, P, I&O, and cardiac rhythm
• Measure serum potassium levels before initiating therapy
7. Cardio Vascular:
• Calcium Channel Blocker: Antihypertensive drugs o Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction
o Results in:
Decreased peripheral smooth muscle tone
Decreased systemic vascular resistance
Decreased blood pressure
Crestor Evaluate Effects –
• cholesterol meds. Take to lower your cholesterol
o Reduces total cholesterol and LDL cholesterol, and also lowers plasma triglycerides and apolipoprotein B while increasing HDL.
o Adult Dosing: PO 10 mg once daily (5–40 mg/d), max dose 40 mg/d. If taking cyclosporine, start with 5 mg/d.
Assessment & Drug Effects
• Monitor for and report promptly S&S of myopathy (e.g., skeletal muscle pain).
• Withhold drug and notify physician if CPK levels are markedly elevated (10xULN) or if myopathy is diagnosed or suspected.
• Lab tests: CPK levels for S&S of myopathy; periodic LFTs; more frequent INR values with concomitant warfarin therapy.
• Monitor CV status, especially with a known history of hypertension or heart disease.
• Monitor diabetics for loss of glycemic control.
Patient & Family Education
• Do not take antacids within 2 h of taking this drug.
• Do not breast feed while taking this drug.
o Females should use reliable means of contraception while taking this drug to prevent pregnancy.
• Digoxin & Lasix: Contraindication
• furosemide (Lasix) ↔ digoxin
• MONITOR: Although diuretics and digitalis glycosides are frequently and appropriately used together, diuretic-induced hypokalemia and hypomagnesemia may predispose patients on digitalis to arrhythmias.
• MANAGEMENT: Digoxin, potassium and magnesium levels should be followed closely. Hypokalemia and hypomagnesemia should be treated appropriately. Digitalis dose adjustments may be required.
• Patients should be advised to notify their physicians if they experience signs of possible digoxin toxicity or electrolyte disturbances, such as weakness, lethargy, muscle pains or cramps, nausea, anorexia, visual disturbances, or irregular heartbeats.
• Labetalol : Antihypertensive medication: Lowers Blood Pressure o Acts as an adrenergic receptor blocking agent that combines selective alpha activity and nonselective beta-adrenergic blocking actions. Both actions contribute to blood pressure reduction.
o Contraindications
Bronchial asthma; uncontrolled cardiac failure, heart block (greater than first degree), cardiogenic shock, severe bradycardia. Safe use during pregnancy (category C), lactation, or in children is not established.
o Cautious Use
Nonallergic bronchospastic disease (COPD), well-compensated patients with history of heart failure; pheochromocytoma; impaired liver function, jaundice; diabetes mellitus; peripheral vascular disease.
o Administration: Oral
Give with or immediately after food consistently. Food increases drug bioavailability.
o Adverse Effects (1%)
CNS: Dizziness, fatigue/malaise, headache, tremors, transient paresthesias (especially scalp tingling), hypoesthesia (numbness) following IV, mental depression, drowsiness, sleep disturbances, nightmares.
CV: Postural hypotension, angina pectoris, palpitation, bradycardia, syncope, pedal or peripheral edema, pulmonary edema, CHF, flushing, cold extremities, arrhythmias (following IV), paradoxical hypertension (patients with pheochromocytoma).
o Labetalol is a is a mixed alpha/beta adrenergic antagonist, which is used to treat high blood pressure.
[1] o Inform patients to report the following to their physician: Weight gain of more than 2 pounds in 1 day or 5 pounds in 1 week
• Nitroglycerine: CARDIO VASCULAR; USED TO DECREASE BP
• Nitroglycerin – Anti ANGINA Meds, chronic heart failure
Prototypical nitrate : POTENT VASODILATOR
Large first-pass effect with oral forms
Used for symptomatic treatment of ischemic heart conditions (angina)
IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies
Available form: Sublingual tablets, sprays and patches
• Nitroglycerin Teaching
Instruct patients in proper technique and guidelines for taking sublingual nitroglycerin for anginal pain
Instruct patients never to chew or swallow the sublingual form
Instruct patients that a burning sensation felt with sublingual forms indicates that the drug is still potent
Instruct patients to keep a fresh supply of sublingual medication on hand; potency is lost in about 3 months after the bottle has been opened
To preserve potency, medications should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler • If anginal pain occurs:
Stop activity and sit or lie down, and take a sublingual tablet
If no relief in 5 minutes, call 911/Emergency Services immediately and take a second sublingual tablet
If no relief in 5 minutes, take a third sublingual tablet
Do not try to drive to the hospital
8. Operative: Succinylcholine side effect
Neuromuscular blocking drugs (NMBDs) used in adjunct with anesthesia
Depolarizing drugs (succinylcholine, d-tubocurarine)
Overall effect o Orderly and systematic reduction of sensory and motor CNS functions o Progressive depression of cerebral and spinal cord functions
Succinylcholine
o Works similarly to neurotransmitter acetylcholine (ACh), causing depolarization
o Metabolism is slower than ACh, so as long as succinylcholine is present, repolarization cannot occur
o Result: flaccid muscle paralysis
o Nerve cell membrane is not depolarized; muscle fibers are not stimulated o Skeletal muscle contraction does not occur
First sensation is muscle weakness, followed by total flaccid paralysis
Small, rapidly moving muscles affected first (fingers, eyes), then limbs, neck, trunk
Finally, intercostal muscles and diaphragm affected, resulting in cessation of respirations
Recovery of muscular activity usually occurs in reverse order
Transient muscle fasciculation may result in later muscle soreness o ˜Main use: facilitating controlled ventilation during surgical procedures o ˜Endotracheal intubation (short-acting)
o ˜To reduce muscle contraction in an area that needs surgery o ˜Diagnostic drugs for myasthenia gravis
˜Respiratory muscle paralysis occurs with these drugs
˜Emergency ventilation equipment must be immediately available
9. Endocrine:
• Lantis Peak :Lantus is an insulin use to treat diabetes o Starts to act 1-2h o Peaks : 6hrs
o Ends: 18-26 hrs / Low most likely at 5-10hrs
o designed for flatter and longest action, background insulin action for keeping your Blood Glucose flat when fasting
• Victoxa Type 2 Diabetes: liraglutide – Injectable diabetic drugs: Incretin Mimetics o Once a day daily insulin meds o Long acting glucagon like peptide o Used for treatment of Type 2 Diabetes
o Liraglutide is a once-daily GLP-1 derivative for the treatment of type 2 diabetes. liraglutide has a half-life after subcutaneous injection of 11–15 hours, making it suitable for once-daily dosing.
o Victoza® is a clear, colorless solution. Each 1 mL of Victoza® solution contains 6 mg of liraglutide. Each pre-filled pen contains a 3 mL solution of Victoza® equivalent to 18 mg liraglutide (free-base, anhydrous) and the following inactive ingredients: disodium phosphate dihydrate, 1.42 mg; propylene glycol, 14 mg; phenol, 5.5 mg; and water for injection.
o Incretin mimetic
Mimics the incretin hormones [Show Less]