Pharmacology - Introduction to Pharmacology and Nursing Process Notes

Notes for 2nd year Nursing

A patient is prescribed a medication to treat a health problem.

Which factor should the nurse consider as influencing the patient's response to the medication?
Sex of the Patient

The nurse explains the difference between a generic and trade-name medication to a patient.
Which statement should indicate that additional teaching is required?
"The formulations are the same, but the dosages are different."

Aspirin
-Shown to reduce cardiac death after myocardial infarction (MI)

-Should be administered at the first sign of MI

-If not given before arriving in the emergency department, aspirin is one of the first drugs given if
there are no contraindications

-Daily tablet (81 mg or 325 mg): prophylactic therapy for adults who have strong risk factors for
developing coronary artery disease or cardiovascular accident

-Effective after MI

-The 81- and 325-mg strengths appear to be equally beneficial for the prevention of thrombotic
events.

Acetic acid derivatives (NSAIDS)

-diclofenac sodium (Voltaren)

-indomethacin (Indocin)

-sulindac (Clinoril)

-tolmetin (Tolectin)

-etodolac (Lodine)

-ketorolac (Toradol)

-meclofenamate (generic only)

-mefenamic acid (Ponstel)

What is a Cyclooxygenase-2 (COX-2) inhibitor

celecoxib (Celebrex)

What are some Enolic acid derivatives?

-nabumetone (Relafen)

-meloxicam (Mobic)
-piroxicam (Feldene)

(Used to treat mild to moderate OA, RA, and gouty arthritis; Nabumetone is better tolerated
gastrointestinally than some other NSAIDs)

What are some Propionic acid derivatives

-fenoprofen (Nalfon)

-flurbiprofen (Ansaid)

-ibuprofen (Motrin, Advil, others)

-ketoprofen (Orudis KT)

-naproxen (Naprosyn, Aleve)

-oxaprozin (Daypro)

What are the mechanisms of action for NSAIDs?

-Inhibition of the leukotriene pathway, the prostaglandin pathway, or both

-Blocking the chemical activity of the enzyme COX

*COX-1: has a role in maintaining the gastrointestinal (GI) mucosa
*COX-2

What are the mechanisms of action for Aspirin?

-Irreversible inhibitor of COX-1 receptors within the platelets themselves

-Reduced formation of thromboxane A 2, a substance that normally promotes platelet aggregation

-Other NSAIDs lack these antiplatelet effects

What are some situations where NSAIDs should be avoided(contraindications)?

-Known drug allergy

-Patients with documented aspirin allergy must

not receive NSAIDs.

-Conditions that place the patient at risk for bleeding:

Vitamin K deficiency
Peptic ulcer disease

WHat are some adverse effects from NSAIDs?

-GI: heartburn to severe GI bleeding

-Acute renal failure

-Noncardiogenic pulmonary edema

-Increased risk of MI and stroke

-Altered hemostasis
-Hepatotoxicity

-Skin eruption, sensitivity reaction

-Tinnitus, hearing loss

Misoprostol (Cytotec)
prevents GI bleed, also used to cause miscarriage

True or False:
Many of the adverse effects of NSAIDs are NOT secondary to their inactivation of protective
prostaglandins that help maintain the normal integrity of the stomach lining
False

Synthetic prostaglandin E1 analogue

inhibits gastric acid secretion and has a cytoprotective component

Serious NSAIDs interactions can occur when given with:

-Anticoagulants

-Aspirin

-Corticosteroids and other ulcerogenic drugs

-Protein bound drugs

-Diuretics and ACE inhibitors

-Others

A patient who was taking a trade-name drug receives a prescription for the generic equivalent of the
same drug.
For which patient statement should the nurse intervene?
"I will need to take extra doses now."

A patient is prescribed a biosimilar drug.

Which patient statement should indicate the patient needs additional teaching?
"The biosimilar medication I am taking is an exact duplicate copy of the original medication."

A patient reports taking dietary supplements.

In which way should the nurse categorize these supplements?
Complementary and alternative medication (CAM) therapy

A pharmaceutical company develops a biosimilar product.

For which reason should the company prepare a presentation for the Food and Drug Administration?
Reduce the amount of testing required before the medication goes to market

The nurse is reviewing a list of newly prescribed medications.

Which should the nurse recall when reviewing these medications?
One generic medication often has many different trade names.

The nursing student is enrolled in a pharmacology course.

Which should the student expect when studying this content?
Utilize information from other foundation courses

The nurse is reviewing a list of medications prescribed for a patient.

For which reason should the nurse review the bioavailability of these medications?
Determine if a generic or trade medication could be prescribed.

A new nurse is confused as to why a patient is receiving epinephrine since it has more than one use.
Which response should the nurse make?
"Most medications have multiple classifications."

Inflammation
Localized protective response stimulated by injury to tissues, which serves to destroy, dilute, or wall
off (sequester) both the injurious agent and the injured tissue
*Pain, fever, loss of function, redness, and swelling
*Endogenous compounds, including proteins of the
complement system, histamine, serotonin, bradykinin,
leukotrienes, and prostaglandins

Nonsteroidal Antiinflammatory Drugs (NSAIDs)

-Large and chemically diverse group of drugs
with the following properties:
*Analgesic
*Antiinflammatory
*Antipyretic fever reducing
*Aspirin-platelet inhibition

Gout
Condition that results from inappropriate uric acid metabolism
*Underexcretion of uric acid
*Overproduction of uric acid

Where are uric acid crystals deposited?

Tissues and joints, resulting in pain

What are some Antigout Drugs?

-allopurinol (Zyloprim)

-febuxostat (Uloric)

-colchicine (Colcyrs)
-probenecid (Benemid)

-sulfinpyrazone (Anturane)

What are some reasons to use antigout drugs (indication)?

-Allopurinol (Zyloprim)
*Used to prevent uric acid production and to prevent
acute tumor lysis syndrome
*Exfoliative dermatitis, Stevens-Johnson syndrome,
and toxic epidermal necrolysis

-Probenecid (Benemid)
*Inhibits the reabsorption of uric acid in the kidneys
and thus increases the excretion of uric acid

-Febuxostat (Uloric)
*Nonpurine selective inhibitor of xanthine oxidase
*More selective for xanthine oxidase than allopurinol
*May pose a greater risk of cardiovascular events than
allopurinol

-Colchicine
*Reduces inflammatory response to the deposits of
urate crystals in joint tissue
*Used for short-term management or prevention of
gout
*May cause short-term leukopenia and bleeding into
the GI or urinary tracts

Lesinurad (Zurampic)
-Uric acid transporter inhibitors

-Inhibits the transporter proteins involved in renal uric acid reabsorption resulting in lower serum uric
acid levels and increase renal clearance of uric acid

-Given in combination with xanthine oxidase inhibitor

-Teaching: at least 2 liters of fluid a day

Probenecid
-Inhibits the reabsorption of uric acid in the kidney,
increasing the excretion of uric acid

-Uricosuric

-Must have good renal function

Glucosamine and Chondroitin

-Herbal Products

-Used to treat the pain of OA

-Adverse effects
*GI discomfort
*Drowsiness, headache, skin reactions (glucosamine)

-Drug interactions
*Enhances effects of warfarin
*May increase insulin resistance (glucosamine)

NSAIDs are also used for the relief of:

-Mild to moderate headaches

-Myalgia

-Neuralgia

-Arthralgia

-Alleviation of postoperative pain

-The pain associated with arthritic disorders, such as rheumatoid arthritis (RA), juvenile arthritis,
ankylosing spondylitis, and osteoarthritis (OA)

-Treatment of gout and hyperuricemia

What are properties all NSAIDs share?

-Antipyretic

-Analgesic

-Antiinflammatory

Salicylates
a group of chemicals that derived from salicylic acid, an organic compound that encourages
exfoliation of skin and unclogging of pores, as well as reduction of sebum.

Renal function depends partly on:

Prostaglandins

True or False:
Disruption of prostaglandin function by NSAIDs IS sometimes strong enough to precipitate acute or
chronic renal failure
True

True or False:
Use of NSAIDs cannot compromise existing renal function
False

Renal toxicity can occur in patients with:

Dehydration, heart failure, liver dysfunction, or use of diuretics or angiotensin-converting enzyme
(ACE) inhibitors

True or False:
All NSAIDs (except aspirin) share a black box warning regarding an increased risk of adverse
cardiovascular thrombotic events, including fatal MI and stroke.
True

True or False:
NSAIDs may counteract the cardioprotective effects of aspirin
True

Salicylic acid (aspirin)

-Inhibits platelet aggregation.

-Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders.

-Examples: aspirin, diflunisal (Dolobid), choline

magnesium trisalicylate (Trilisate), salsalate
(Salsitab), Diflunisal (Dolobid), choline magnesium
trisalicylate (Trilisate), and salsalate (Salsitab)

-Reye's syndrome

-Topical cream (Aspercreme), rectal

suppositories, and oral liquids

-Combination products: aspirin-acetaminophen-caffeine combinations such as Excedrin, aspirin-

antacid combinations (e.g., Bufferin)

-Enteric-coated aspirin (Ecotrin)

What are some aspirin uses?

-Headache, neuralgia, myalgia, and arthralgia

-Pain syndromes resulting from inflammation: arthritis, pleurisy, and pericarditis

-Systemic lupus erythematosus: antirheumatic effects

-Antipyretic action

Reye's Syndrome
-Acute and potentially life-threatening condition involving progressive neurologic deficits that can
lead to coma and may also involve liver damage.

-Triggered by viral illnesses such as influenza as well as by salicylate therapy itself in the presence of a
viral illness.

-Survivors of this condition may or may not have permanent neurologic damage.

Cardiovascular effects of Salicylate Toxicity:

Increased heart rate

Central Nervous System effects of Salicylate Toxicity:

Tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness

Gastrointestinal (GI) effects of Salicylate Toxicity:

nausea, vomiting, diarrhea

Metabolic effects of Salicylate Toxicity:

Sweating, thirst, hyperventilation, hypoglycemia, or hyperglycemia

Indomethacin (Indocin)
-An Acetic Acid Derivative

-Analgesic, antiinflammatory, antirheumatic, and antipyretic properties

-Uses: RA, OA, acute bursitis or tendonitis, ankylosing spondylitis, acute gouty arthritis, PDA, and
treatment of preterm labor

-Oral, rectal, intravenous use

Ketorolac (Toradol)
-An Acetic Acid Derivative

-Some antiinflammatory activity

-Used primarily for its powerful analgesic effects which are comparable to those of narcotic drugs
such as morphine

-Indication: short-term use (up to 5 days) to manage moderate to severe acute pain

-Adverse effects: renal impairment, edema, GI pain, dyspepsia, and nausea

A patient provides a list of products used routinely for health care.

Which item should be identified as least likely to be medically therapeutic?
Toothpaste

The nurse reviews information about biosimilar medication with a group of new colleagues.
Which statement should indicate that teaching was effective?
"They have the same mechanism of action as the reference medication."

A patient is prescribed a new medication.

For which reason should the nurse study the prototype for this medication?
Predict the action and adverse effects of medications in the same class

A patient asks about hormone replacement therapy to treat cancer.

Which information should the nurse include about biologics?
"They are usually very expensive."
The nurse is attending a continuing education program to refresh knowledge of pharmacology.
Which approach should the nurse use?
Study prototype medications.

The nurse is asked to explain pharmacotherapeutics.

Which response should the nurse make?
"It is the application of drugs for the purpose of treating diseases."

The nurse is reviewing medications prescribed for a patient.

Which factor should the nurse consider that influences if a generic or trade-name medication is
prescribed?
The difference in bioavailability

The nurse is caring for a patient with liver disease.

Which should the nurse consider when providing this patient with prescribed medication?
Enhanced response to the medication

The nurse is explaining the purpose of pharmacotherapy with colleagues.

Which response should the nurse make?
"The purpose of pharmacology is to focus on the patient and to improve the quality of life."

The nurse is teaching a patient about prescribed medications.

Which patient statement should cause the nurse to intervene?
"I only take generic forms of medications."

patient is prescribed a new medication for a heart problem.

Which outcome should the nurse expect for this patient?
Improve the quality of life

The nurse prepares to administer an antihypertensive drug to a patient.

Which should the term "antihypertensive" indicate to the nurse?
Therapeutic classification

The nurse administers an anticoagulant to a patient at risk for a thrombus.

Which action should the nurse expect from this medication?
Prevent blood clotting

A patient is taking a medication that contains acetaminophen, aspirin, and caffeine.

Which type of medication should the nurse identify that this patient is taking?
Combination

A patient is prescribed medications to treat multiple chronic illnesses.

For which patient statement should the nurse provide teaching?
"I take over-the-counter herbal supplements."
The nurse is assessing the effect of a medication provided to a patient.
For which reason should the nurse anticipate the patient response may be enhanced?
Liver disease

A patient is prescribed multiple medications to treat active tuberculosis.

Which question should the nurse ask about these medications?
"How do the medicines make you feel after you take them?"

The nurse notes that several patients are prescribed the same medication.
Which should the nurse consider before administering the medication to the patient?
The medication may be used for more than one health problem

Ibuprofen (Motrin, Advil)

-Propionic Acid Derivative

-Most commonly used NSAID

-Uses: analgesic effects in the management of RA, OA, primary dysmenorrhea, gout, dental pain,
musculoskeletal disorders, antipyretic actions

Naproxen
-Second most commonly used NSAID

-Somewhat better adverse effect profile than ibuprofen

-Fewer drug interactions with ACE inhibitors given for hypertension

Celecoxib (Celebrex)
-First and only remaining COX-2 inhibitor

-Indicated for OA, RA, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea

-Adverse effects include headache, sinus irritation, diarrhea, fatigue, dizziness, lower extremity
edema, and hypertension

-Little effect on platelet function

-Celecoxib is not to be used in patients with known sulfa allergy.