Pharm Exam 4 Study Guide

Chapters 47 & 48
Review non-pharmacological measures for diarrhea and
constipation
Diarrhea
Clear liquids
Oral solutions (Gatorade, pedialyte)
IV electrolyte solutions
BRAT diet (bananas, rice, applesauce, toast)
Constipation
Diet (HIGH FIBER)
Water
Exercise
Routine bowel habits
Know about promethazine (Phenergan) MOA, common uses,
reactions, side effects
Phenothiazine antiemetic
Side effects moderate sedation, hypotension, EPS, CNS
effects, mild anticholinergic symptoms (dry mouth, urinary
retention, constipation)
It is relatively free from EPS at the lower antiemetic doses
Common uses chemotherapy, pre op, post op
MOA inhibits chemoreceptor trigger zone
Travelers Diarrhea
Acute diarrhea
o Usually caused by E. coli
o Fluoroquinolone antibiotics
o Imodium
o Can be reduced by drinking bottled water, washing
fruit, and eating cooked vegetable. Meats should be
cooked until they are well done.
Bulk Laxatives
Psyllium (Metamucil)
MOA absorbs water into intestines, increases bulk and
peristalsis with results in 8-12 hours
Mix in glass of water or juice, stir and drink immediately,
followed by 1 glass of water
Side effects abdominal cramps, excess laxative: NVD,
gas
Peptic Ulcer Disease (PUD)

Pharm Exam 4 Study Guide

Non pharmacological treatment measures

o Avoid tobacco, alcohol, and hot, spicy, and greasy
foods
o Take any NSAIDs with food or decrease dosage
o Sit upright while eating and at least 30 min- 1 hour
after eating
o Wear loose fitting clothing
o If overweigh, lose weight
Common Causes
o H. pylori is the #1 cause of peptic ulcers
o Mechanical, genetic, environmental
o NSAIDs and steroids
o Stress ulcer, following a critical situation
Medical treatment
o Histamine 2 blockers
Zantac, Pepcid, Axid, Tagamet
o PPIs (proton pump inhibitors)
Prilosec, prevacid, protonix

Chapters 40 & 41
Know commonly used drugs: Benadryl, Pseudoephedrine,
Dextromethorphan
Diphenhydramine (Benadryl)
o MOA Competes with histamine for receptor sites
preventing a histamine response. Reduces nasopharyngeal
secretions, itching, sneezing
o Uses Treats acute and allergic rhinitis, antitussive
o Patient safety points contraindicated in acute asthma
attack, severe liver disease, narrow angle glaucoma,
urinary retention
Increases CNS depression with alcohol and other CNS
depressants, avoid use of MAOIs
Side effects Drowsiness, dry mouth, dizziness,
blurred visions, wheezing, photosensitivity, urinary
retention, constipation, GI distress, blood dyscrasias
Pseudoephedrine (Sudafed)
o MOA stimulates alpha adrenergic receptors, produces
nasal vasoconstriction, shrinks nasal mucous membranes,
reduces nasal secretion, rebound nasal congestion
o Uses Used primarily for allergic rhinitis hay fever and
acute coryza

Pharm Exam 4 Study Guide

o Patient safety points Caution patients to use for 3-5 days,
then discontinue use to prevent rebound nasal congestion.
Frequent use may lead to tolerance
o Side effects nervousness, restlessness, jitters, alpha
adrenergic effect (hypertension, hyperglycemia)
Dextromethorphan (Benylin)
o Antitussive
o MOA Acts on the cough-control center in the medulla to
suppress the cough reflex. Three types nonnarcotic,
narcotic, or combination preparations.
o Patient safety points avoid using heavy
machinery/driving with 1st generation antihistamines
Inform pt of contraindications based on health history
Watch BP for those taking decongestants
Warn pts that antitussives with narcotics can lead to
tolerance and physical dependency
Encourage water intake with expectorants
NO OTC cold preparations for children <2
Review asthma and COPD (patho)
Asthma inflammatory disorder of the airway walls associated
with a varying amount of airway obstruction.
o Triggered by stress, allergens, pollutants
o Manifestations
bronchospasm,
wheezing,
mucus
secretions, dyspnea
COPD Decrease in total lung capacity from fluid accumulation
and/or loss of elasticity of the lung tissues
Commonly used drugs:
Albuterol Selective Beta 2 receptor agonist
o Bronchodilator
o rapid onset of action, longer duration of action
o few side effects
Atrovent Anticholinergic bronchodilator
o ipratropium bromide
o used to treat asthma, dilates bronchioles
o aerosol inhaler
o Caution in narrow-angle glaucoma
Pulmicort Intranasal gluticocorticoid, budesonide

Singulair Leukotriene receptor agonists

o
MOA:reduce inflammatory process and decrease
bronchoconstriction
o used for prophylactic and maintenance for chronic asthma
o Side effects: dizziness, HA, GI distress, abx liver enzymes,
nasal congestion, cough, pharyngitis

Pharm Exam 4 Study Guide

Mucomyst Mucolytic
o Liquefies and loosens thick mucous secretions
o Administer 5 minutes after a bronchodilator
o SHOULD NOT BE MIXED WITH OTHER DRUGS
o Also an antidote for acetaminophen (give orally or dilute in
soft drink or juice)
Inhaled gluticocorticoids
o anti-inflammatory effect
o Not helpful in treating a severe asthma attack
o May take 1-4 weeks for an inhaled steroid to reach its full
effect

Chapters 29, 30, & 31

Commonly used antibiotics
Amoxicillin Broad spectrum penicillin
o Against gram-positive and gram-negative
o Check/obtain culture and sensitivity before drugs are given
o Assess renal fxn, esp in older adults
o Monitor for bleeding
o MONITOR CLOSELY DURING THE FIRST DOSE
o Increase fluids
o Take 1 hour before or 2 hours after meals
o Broad spectrum PCNs may decrease effectiveness of oral
contraceptives.
o Consider
safety
issues
hypersensitivity
and
superinfection
Azithromycin Macrolides
o Zithromax (brand name)
o NOT GIVEN IM, only Oral or IV
o Binds to 50S ribosomal subunits and inhibits protein
synthesis
o Broad spectum
o Uses moderate-to-severe infections
Respiratory
GI tract
Skin
soft tissue
STIs
o Treats
mycoplasmal pneumonia
Legionnaires disease

Pharm Exam 4 Study Guide

o Side effects
Tinnitus, ototoxicity
GI distress
Superinfection
Hepatoxicity
o Drug interactions
Levels of warfarin, theophylline, and carbamazepine
increase
Erythromycin levels increase with fluconazole and
ketoconazole ****RISK OF SUDDEN CARDIAC DEATH
INCREASES****
Azithromycin levels may be reduced by antacids
o Nursing interventions
C&S before therapy
Monitor liver enzymes and for S/S of jaundice
Advise pt to take full regimen
Take 1 hour before or 2 hours after meals w/ full glass
of water
Take antacids 2 hours before or 2 hours after
medication
Pt
could
develop
conjuncitivis
while
using
azithromycin, dont wear contact lenses while taking
Report s/s of super infection
Take once daily
Reprt
onset
of
loose
stools
or
diarrhea,
pseudomembranous colitis should be ruled out
Rocephin Cephalosporins, broad spectrum (effective against
gram positive and gram negative)
o Side effects pruritus, GI distress
With high doses increased bleeding, seizures
*****NEPHROTOXICITY***** assess renal fxn
o Drug interactions Alcohol **IMPORTANT TEACHING
POINT**
May cause flushing, dizziness, headache, nausea,
vomiting, muscular cramps
o Interventions assess for allergy
Perform C&S before therapy (culture and sensitivity)
Assess liver and renal fxn
Administer IV over 30 minutes or as ordered to
prevent pain/irritation
Monitor for superinfection
May ingest buttermilk, yogurt, or acidophilus
supplement to prevent super infection
Keep out of reach of children

Pharm Exam 4 Study Guide

Tetracycline
o MOA inhibits protein synthesis
o Broad spectrum
o Fights H. pylori
o Treats acne (oral, topical)
o Bacterial resistance
o Route oral, IM, IV
o Side effects
Photosensitivity
Discoloration of permanent teeth **do not give to
children younger than 8 or to women in the last
trimester**
Stomatitis, GI distress
Pseudomembranous colitis
Blood dyscrasia
Super infection
CNS toxicity, hepatoxicity
Nephrotoxicity in high doses
o Adverse effects
GI disturbance
Liver failure
Vertigo
Deposition of drug in bones and teeth
AVOID IN PREGNANCY
Phototoxicity
o Interactions
Milk products and antacids
Oral contraceptives
Digoxin absorption is increased, leading to toxicity
o Interventions
C&S
1 hour before or 2 hours after meals
Monitor kidney and liver fxn
Educate women of child bearing age about side
effects teratogenic effect
Store out of light/heat
Use sunscreen
Use effective oral hygiene to prevent stomatitis
(mouth ulcers)
Use a back up method for birth control if taking oral
contraceptives

Pharm Exam 4 Study Guide

Gentamicin
o Aminoglycoside Major toxic effects of aminoglycosides
are ototoxicity and nephrotoxicity
o Nursing interventions
Check C&S
Monitor renal fxn, hearing loss, balance
Use sunscreen photosensitivity
Monitor for super infection
Monitor peak and trough levels
Peak 5-8mcg/ml
Trough 0.5-2mcg/ml
Monitor I&Os
If fluid intake is not restricted, encourage pt to
increase fluids
Bactrim
o Trimethoprim-sulfamethoxazole
o Synergistic effect both drugs together in one compound
cause bacterial resistance to develop much more slowly.
o Used for urinary, intestinal, and lower respiratory tract
infections. Otitis media, prostatitis and gonorrhea. Also
used to prevent Pneumocysitis carinii in patients with AIDS
o Side effects/Adverse reactions
Moderate rashes
Anorexia
NVD
Stomatitis
Crystalluria
Photosensitivity
***Agranulocytosis, aplastic anemia
***Allergic myocarditis
LIFE THREATENING CONDITIONS
o Nursing interventions
Administer with full glass of water 1 hour before or 2
hours after meals
Increase fluid intake
Monitor for sore throat, bruising, bleeding
CBC
Superinfection
Do not take with antacids
Avoid direct sunlight
Can increase hypoglycemic effect with oral
antidiabetic drugs
Increases anticoagulant effect with warfarin

Pharm Exam 4 Study Guide

Chapters 51 & 52
Review Conditions

HypothyroidismDecrease in thyroid hormone secretion

o Characterized by Bradycardia, weight gain, extreme
fatigue, hair loss, cold intolerance, thick tongue, slow
speech
o Myxedema Adult
o Cretinism child
Hyperthyroidism Increase in circulating T4 and T3 levels
o Graves disease and hyperthyroidism caused by hyper
function of the thyroid gland.
o Characterized by tachycardia, palpitations, excessive
perspiration, heat intolerance, nervousness, irritability,
bulging eyes, weight loss
Diabetes insipidus High urinary output
o low levels of ADH
o Hypernatremia
o Dehydrated
o Lose too much fluid
o Presents with excessive thirst
Hypoparothyroidism PTH deficiency, vitamin D deficiency,
renal impairment, diuretic therapy, hypocalcemia ***
Hyperparothyroidism Malignancies of the parathyroid glands
o Ectopic PTH hormone secretion from lung cancer
o Prolonged immobility, during which calcium is lost from
bone

Review

Pituitary gland Anterior and posterior

o Anterior
Growth hormone targets tissues and bone (no
gland)
TSHThryotropin thyroid stimulating hormone
target gland is the thyroid
ACTH
stimulates
the
release
of
cortisol,
aldosterone, and androgen from the adrenal cortex
o Posterior
Oxytocin
ADH
Thyroid gland regulates protein synthesis, enzyme activity,
stimulates mitochondrial oxidation

Pharm Exam 4 Study Guide

o Thyroxine (T4)
o Triiodothyronine (T3)
Parathyroid gland
Negative feedback loop

Thyroid Labs TSH level

Addisons vs. Cushings disease
Addisons adrenal HYPOsecretion, levels controlled by negative
feedback
o Bronze pigmentation of the skin
o Change in body hair distribution
o GI disturbances
o Weakness
o Hypoglycemia
o Postural hypotension
o Weight loss
Cushings
o Personality changes
o Moon face
o Increased susceptibility to infection
o Males gynecomastia, Females amenorrhea, hirsutism
o Fat deposits on back
o Hyperglycemia
o CNS irritability
o Fluid retention
o Thin extremities
o GI distress, increased acid
o Thin skin
o Purple striae
o Bruises and petechiae
Insulin Administration
Nursing interventions
o Monitor vital signs and glucose levels
o Instruct patient to report hypo/hyperglycemia
o Encourage compliance with diet, insulin, exercise
o Wear medical alert tag

Pharm Exam 4 Study Guide

o Teach pt how to check blood glucose
o Teach pt how to administer insulin
o Must check insulin dose with another nurse if in an
inpatient setting
o Teach family members to administer glucagon by injection
if pt has a hypoglycemic episode
Types of insulin

Rapid acting (clear) onset of action 5-15 minutes

o Peak 30-60 minutes
Duration 2-4 hours
Short acting (clear) Regular (humulin R, Novlin R)
o Onset of action 30-60 minutes
o Peak 2-3 hours
o Duration 3-4 hours
Intermediate acting (cloudy) insulin isophane NPH
o Onset of action 2-4 hours
o Peak 4-12 hours
o Duration 18-24 hours
Long acting onset in 1 hour, duration of 24 hours, administer
at bedtime
Combinations composed of short and intermediate acting, or
rapid and intermediate acting
Commonly used oral antidiabetic drugs
Metformin
o MOA decreases hepatic production of glucose from
stored glycogen
Diminishes the increase in serum glucose following a
meal
Blunts the degree of postprandial hyperglycemia
Decreases absorption of glucose from the small
intesting
Increases insulin receptor sensitivity as well as
peripheral glucose uptake at the cellular wall
Januvia
o Action is to increase the level of incretin hormones,
increase insulin secretion, and decrease glucagon secretion
to reduce glucose production
o Used as adjunct treatment with exercise and diet to reduce
both fasting and post prandial plasma glucose
Byetta
o Incretin mimetics

Pharm Exam 4 Study Guide

o Actions are to enhance insulin secretion, increase beta-cell
responsiveness, suppress glucagon secretion, slow gastric
emptying, and reduce food intake
o Given via pen injection
Glimeperide and Glucotrol
o Second generation sulfonylureas
o Used to treat type 2 diabetes
o Stimulate pancreatic beta cells to secrete more insulin
Glucagon
o Hyperglycemic drug
o Hyperglycemic hormone secreted by the alpha cells of the
islets of Langerhans
o Increases blood sugar by stimulating glycogenolysis
o Used to treat insulin-induced hypoglycemia when other
methods of providing glucose are not available
o Parenteral use (subQ, IM, IV)
Nursing interventions for oral antidiabetics
Administer with food to decrease GI upset
Monitor BG levels
Advise pt that hypoglycemic episodes may occur, esp with
sulfonyreas
Teach pt s/s of hypo and hyperglycemia
Teach pt about compliance to lifestyle changes
Teach pt to report side effects NVD and rash
Caution pt not to drink alcohol
Explain use of orange juice, hard candy, sugar containing drinks
when hypoglycemic reactions begin