NU 314: Final Exam Study Guide

Review the introductory rules and regulations from 1st 6 chapters

1970 Controlled Substances Act. Defines drugs as to their potential for abuse (Schedule I-V)
I: high abuse potential and no accepted medical use (heroine, marijuana)
II: high abuse potential with severe dependence liability (narcotics, amphetimines, barbituates)
III: less abuse potential than schedule II drugs and moderate dependence liability (Ritalin, Percocet)
IV: less abuse potential than schedule III and limited dependence liability (Xanax, Ativan)
V: limited abuse potential (may be purchased OTC, some cough syrups)
Pregnancy categories - most fall in (B) NO drug should be administered during pregnancy unless it is clearly needed
A: adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester of pregnancy,
and there is no evidence of risk in later trimesters.
B: Animal studies have not demonstrated a risk to the fetus but there are no adequate studies in pregnancy women,
or animal studies have shown an adverse effect, but adequate studies in pregnant women have not
demonstrated a risk to the fetus during the first trimester of pregnancy, and there is no evidence of risk in
later trimesters.
C: Animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans; the
benefits from the use of the drugs in pregnant women may be acceptable despite its potential risks, or there
are no animal reproduction studies and no adequate studies in humans.
D: There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may
be acceptable despite its potential risks.
X: Studies in animals or humans demonstrate fetal abnormalities or adverse reaction; reports indicate evidence of
fetal risk. The risk of use in a pregnant woman clearly outweighs any possible benefit.
Clinical phases for new drugs:
New Drug Evaluation
Preclinical trials: tested on animals
Phase I: healthy human volunteers usually males
Phase II: informed patients, IRB review (actual patients who have the disorder)
Phase III: wide scale in the clinical setting with patients who have the disorder, could be 100s-1,000s of people
Phase IV: continual evaluation of drug after if has been released for marketing and general sale
Half life. Review how to calculate
Half life: time it takes for half of a drug to be excreted from the body
If a patient takes 50 mg with a half life of 12 hours, in 12 hours 25 mg will be in the body
If a patient takes 20 mg with a half life of 2 hours, in 2 hours 10 mg will be in the body two hours later, 5
mg will be left, in 2 more hours, 2.5 mg will be left.
First pass effect
First Pass Metabolism: passes stomach, enters portal venous system, taken to liver before entering bloodstream
Only oral drugs
Absorption, distribution, metabolism, excretion
absorption: what happens to a drug from the time it enters the body until it enters the circulating fluid; intravenous
administration causes the drug to directly enter the circulating blood, bypassing the many complications of
absorption from other routes
distribution: movement of a drug to body tissues; the places where a drug may be distributed depend on the drugs
solubility, perfusion of the area, cardiac output, and binding of the drug to plasma proteins
metabolism: most drugs are metabolized in the liver, some drugs are metabolized in other areas

excretion: removal of a drug from the body; primarily occurs in the kidneys, but can also occur through the skin,
lungs, bile, or feces
Off label use of drugs
off-label uses: uses of a drug that are not part of the stated therapeutic indications for which the drug was approved
by the FDA; off-label uses may lead to new indications for a drug
Commonly done for groups of patients for which there is little premarketing testing, particularly pediatric and
geriatric groups. Drugs often used for off-label indications include the drugs used to treat various psychiatric
problems.
Opioid analgesics: side effects, tolerance
ActatspecificopioidreceptorsitesintheCNS
Produceanalgesia,sedation,andasenseofwellbeing
Sideeffects:
Respiratorydepressionwithapnea
Cardiacarrest
Constipation;particularlyinpeopleusingchronicnarcotics,suchascancerpatients
Reversalofnarcoticdepression/OD(P)Naloxone(Narcan)
Signs/symptoms, treatment of anaphylaxis
This allergy involves an antibody that reacts with specific sites in the body to cause the release of chemicals
including histamine, that produce immediate reactions (mucous membrane swelling and constricting bronchi) that
can lead to respiratory distress and even respiratory arrest.
S&S: Hives, rash, difficulty breathing, increased BP, dilated pupils, diaphoresis, panic feeling, increased
heart rate, respiratory arrest
Administer epinephrine subcutaneously. Massage area for increased speed of absorption. Repeat every 1520 minutes as appropriate.
Respiratory:
Indications, be able to decipher between them
Decongestants
Decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions
Used to relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic
rhinitis and to promotion of drainage in the sinuses and improving air flow
(P) Ephedrine
Antitussives
Block the cough reflex
Used to control nonproductive cough
(P) Dextromethorphan
Expectorants
Increase productive cough to clear airways
Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of the fluids
Used for symptomatic relief of respiratory conditions characterized by a dry, non-productive cough
(P) Guaifenesin (Musinex)

Mucolytics
Increase or liquefy respiratory secretions to aid clearing of airways
Used in: Patients who have difficulty coughing up secretions, Patients who develop atelectasis, Patients
undergoing diagnostic bronchoscopy, Postoperative patients, Patients with tracheostomies
(P) Acetylcysteine
Treatment of allergic rhinitis
Topical Nasal Steroid Decongestants
(P) Flunisolide
Anti-inflammatory action
3-4 days before you see the maximum effect
Antihistamine
(P) Diphenhydramine
Selectively block the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response
Anticholinergic and antipruritic effects
Treatment of acute asthma attack (emergency)
Goal is to relieve airway obstruction and hypoxemia, and normalize lung function as quickly as possible
Initial therapy consists of:
Give oxygen to relieve hypoxemia
Giving a systemic glucocorticoid to reduce airway inflammation
Giving a nebulized high-dose SABA to relieve airflow obstruction
Giving nebulized ipratropium to further reduce airflow obstruction
Inhalers: sympathomimetics, steroids, bronchodilators. Uses, side effects
Sympathomimetics
(P) Epinephrine
Acute asthma attack
Bronchospasm in acute or chronic asthma
Prevention of exercise-induced asthma
Side effects: cardiac arrhythmias, GI upset, hypertension, bronchospasm
Steroids
(P) Budesonide
Decreases the inflammatory response in the airway
Prevention and treatment of asthma
Treat chronic steroid-dependent bronchial asthma
Side effects: sore throat, hoarseness, coughing, dry mouth, pharyngeal and laryngeal fungal infections
Bronchodilators/ Xanthines
(P) Aminophylline
Direct effect on the smooth muscles of the respiratory tract, both in the bronchi and in the blood vessels
Symptomatic relief or prevention of bronchial asthma & for reversal of bronchospasm associated with COPD
Side effects: GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death
Teaching: how to self administer an inhaler
Shake the canister, exhale, and then place the spacer, or device in mouth. Then compress the canister while
inhaling, hold breath as long as possible, and then exhale through pursed lips. Then rinse mouth and wash
the spacer.

Spacer: More medication gets into your lungs than if you use a puffer on its own. They reduce the local side effects
of inhaled steroids in preventer medications, because less of the medication sticks in your mouth and throat. You
dont need to coordinate pressing your puffer and breathing in at the same time.
GI terms:
peristalsis: the type of GI movement that moves a food bolus forward; characterized by a progressive wave of
muscle contraction
mass movement: an extended, prolonged peristalsis that strips a portion of colon of contents entirely; large intestine
uses a process of mass movement
churning: the stomach uses its three muscle layers to produce a churning action
segmentation: GI movement characterized by contraction of one segment of the small intestine while the next
segment is relaxed; the contracted segment then relaxes, and the relaxed segment contracts; exposes the
chime to a vast surface area to increase absorption
Upper GI
Drugs for peptic ulcer and H.Pylori
Peptic Ulcers are caused by a bacterial infection by Helicobacter pylori bacteria
H2 blockers: indications, side effects
Block the release of hydrochloric acid in response to gastrin
This blocking leads to a reduction in gastric acid secretion and reduction in overall pepsin production
Short-term treatment of active duodenal ulcer or benign gastric ulcer
Side effects: GI effects, CNS effects, cardiac arrhythmias and hypotension
Interactions: Warfarin, phenytoin, beta blockers, alcohol, quinidine, lidocaine, theophylline, chloroquine,
benzodiazepines, nifedipine, pentoxifylline, tricyclics, procainamide, and carbamazepine
(P) Ranitadine (Zantac)
Misoprostol: indications, side effects
Misoprostol (Cytotec)
Inhibits gastric acid secretion and increases bicarbonate and mucous production in the stomach
Prevention of NSAID-induced gastric ulcers
Treatment of duodenal ulcers
Side effects: GI effects Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, and constipation
GU effects Miscarriages, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea,
and other menstrual disorders
Proton pump inhibitors: indications, side effects
Suppress the secretion of hydrochloric acid into the lumen of the stomach
Act at specific secretory surface receptors to prevent the final step of acid production and thereby decrease the
level of acid in the stomach
Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis, and benign active gastric disease
Long-term treatment of pathological hypersecretory conditions
Side effects: CNS effects - dizziness, headache, asthenia, vertigo, insomnia, apathy. GI Effects - diarrhea,
abdominal pain, and tongue atrophy. Upper respiratory tract symptoms - cough, stuff nose, hoarseness, and epistaxis
Other - rash, alopecia, pruritis, dry skin, back pain, and fever
(P) Omeprazole (Nexium)

Combinations for H. Pylori

Antibiotic and something to calm the stomach to decrease the acid, possibly a PPI or H2 inhibitor, bismuth

Lower GI
Gastrointestinal: Poop and puke
Polycarbophil (FiberCon) uses, patient teaching
Bulk stimulant
Short term treatment of constipation (mild laxative)
Take with plenty of water
Psyllium Mucilloid (Metamucil) uses, patient teaching
Bulk stimulant
Mild laxative, short-term treatment of constipation
Take with plenty of water
Treatment of diarrhea
Anti-diarrheal drugs slow the motility of the GI tract through direct action on the lining of the GI tract
Bismuth (pepto-bismol) indications, side effects, patient teaching
Anti-diarrheal drug
Coats the lining of the GI tract and soothes irritation stimulating local reflexes to cause excessive GI activity and
diarrhea.
Indications: Relief of symptoms of acute or chronic diarrhea, Reduction of volume of discharge from ileostomies,
Prevention and treatment of travelers diarrhea
Side effects: Constipation, Abdominal distension, Abdominal discomfort, Nausea, Dry mouth, Toxic megacolon,
Fatigue, Weakness, Dizziness
Metoclopramide (reglan) indications
Gastrointestinal stimulants
Blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine.
Leads to increased GI activity and rapid movement of food through the upper GI tract.
Methylnaltrexone (Relistor) indications
Only to treat opioid-related constipation for patients with chronic pain and receiving palliative care.
Selective opioid antagonist that does NOT cross the blood-brain barrier, so does not effect the CNS-related opioid
analgesia; but does block the opioid receptors of the bowel.
Needs to be given via subcut. Injection daily
No studies for its use for more than 4 months
Prochlorperazine (Compazine) indications
Phenothiazines
Control of severe nausea and vomiting; including that specifically associated with anesthesia
Treatment of chemo-induced n/v
Emesis can be
Anticipatory
Acute (begins within minutes to hours)
Delayed (a day or more after CTX, can last several days

Drugs are much more effective before the nausea starts

For low risk: single dose dexamethasone
Often a combination is needed for higher risk CTX
Aprepitan + dexamethasone+ a 5-HT3 antagonist such as ondrasetin (Zofran)
Dronabinol (Marinol) indications, side effects
One of the active ingredients in marijuana; can be given orally. Controlled substance
Indications: Treatment and prevention of nausea and vomiting
Side effects: Linked to interference with normal CNS stimulation or response Drowsiness, Dizziness, Weakness,
Photosensitivity, Hypotension, hypertension, and cardiac arrhythmias
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Isoproterenol: uses, side effects
Treatment of shock, cardiac arrest, and certain ventricular arrhythmias; treatment of heart block in transplanted
hearts; prevention of bronchospasm during asthma
Side effects: Restlessness, anxiety, and fear, Tachycardia, angina, MI, and palpitations, Difficulty breathing, cough,
and bronchospasm, Nausea, vomiting, and anorexia
Treatment of BPH
DOXAZOSIN or TERAZOSIN
Treatment of benign prostatic hypertrophy
Adverse effects: postural hypotension
Endocrine:
Anticholinergic effects
BlocktheactionofacetylcholineintheCNStohelpnormalizetheacetylcholinedopamineimbalance
Lyse,orblocktheeffectsoftheparasympatheticnervoussystem
DecreasesGIactivityandsecretions
Noshit,nospit,nosee,nopee
Sympathetic vs. parasympathetic
Sympathetic:fightorflight,alphaandbetareceptors(bronchodilates,tachycardia,increasedRRandBP)
Epinephrineandnorepinephrine
Parasympathetic:restanddigest,muscarinicandnicotinicreceptors
Acetylcholine
Action of hormones including mineralocorticoids and glucocorticoids
Increase blood volume (aldosterone effect)
Cause the release of glucose for energy
Slow rate of protein production (reserves energy)
Block activities of the inflammatory and immune systems (reserves a great deal of energy)
Fludrocortisone (Florinef)
Mineralocorticoids
Partial replacement therapy in cortical insufficiency conditions, treatment of salt-losing adrenogenital syndrome;
off-label use: treatment of hypotension.

Give in the AM
Taper when discontinuing from high doses

Increased dose under stress/surgery

Glucocorticoids: general uses, side effects, precautions

Short-term treatment of many inflammatory disorders
To relieve discomfort
To give the body a chance to heal from the effects of inflammation
Side effects: Related to route of administration, Systemic use is associated with endocrine disorders
Precautions: Diabetes, Acute peptic ulcer,
Chronic use can lead to: Immunosuppression, Impaired wound healing, Increased blood sugar, cholesterol, and
triglycerides, Cushings disease
Coagulation: anticoagulants:
Drug/drug interactions with Coumadin: usually increases the action of Coumadin. What lab test do we look @ to
evaluate coumadins effect?
COUMADIN
Maintains a state of anticoagulation when patient is susceptible to potentially dangerous clot formation
TONS of drug/drug interactions; some increase bleeding effects(salicylates, metronidazole, ranitidine, thyroid drugs,
glucagon,androgens), some decrease anticoagulation (vitamin E and K, phenytoin, barbiturates, rifampin),
and some increase activity and effects of other drugs (phenytoin)
Lab tests to look at are: PT and INR
Diabetes/treatment, including gestational diabetes: which hypoglycemics are used to treat this?
Keep blood sugar levels as close to normal range as possible to prevent the progression of the complications of
diabetes such as renal failure, eye problems and non-healing ulcers.
Gestational diabetes can become Type 2 if it persists after childbirth treat with regular insulin
R-Insulin. Onset, peak, duration. **can be given IV in emergencies
Regular insulin (Humulin)
Onset: 30-60 minutes
Peak: 1-5 hours
Duration: 6-10 hours
** THIS IS THE ONLY INSULIN THAT CAN BE GIVEN IV
Statins: general indications, side effects, lab monitoring, drug interactions
Indications:
Adjunct to diet in the treatment of elevated cholesterol, triglycerides, and LDL; increase HDL-C in patients
with primary hypercholesterolemia; treat familial hypercholesterolemia and two+ risk factors for CAD
Side effects:
GI symptoms: Flatulence, abdominal pain, cramps, nausea, vomiting, and constipation
CNS: Headache, dizziness, blurred vision, insomnia, fatigue
Liver failure
Rhabdomylosis (muscle pain)
Lab monitoring:
Do CPK test (creatine phosphokinase)
Check liver function test every 6 weeks after starting statin therapy
Want to see a decrease in LDL and an increase in HDL and a decrease in cholesterol
Drug interactions:
Erythromycin, cyclosporine, gemfibrozil, niacin
Digoxin or warfarin
Estrogen
Grapefruit juice

Antibiotics:
Aminoglycosides: major side effects
Treat serious infections
All IV, IM
Nephrotoxic, ototoxic
(P) Gentamycin
Bactericidal
Inhibits protein synthesis
Crosses placenta, breast milk
Caution in liver/kidney disease
Watch peak/trough levels
Tetracyline: pt teaching, precautions
(P) Tetracycline
Used when penicillin is contraindicated
Bacteriostatic
Acne treatment
Tooth discoloration
Doxycycline: indications, side effects, pt teaching
Treatment of a wide variety of infections, including travelers diarrhea and STDs; periodontal disease
Tooth discoloration
Tinidazole (Tindamax): indications, side effects, pt teaching
(P) Tinidazole
Treats trichomoniasis, giardiasis, and amebiasis
Metallic taste, antibuse type effect
Neurology:
Acute tonic-clonic seizure, treatment of

(P)Phenytoin
Controloftonicclonic,psychomotorseizures,prophylacticduringneurosurgery
Cardiacantiarrhythmiceffects,gingivalhyperplasia(regulardentistappointments),stevensjohnson,severe
livertoxicity,birthdefects,bonemarrowsuppression
*narrowtherapeuticwindow,monitorbloodlevelsregularlyandadjustdosetoreducetoxicity
Types, Classification of Seizures
Tonicclonicseizures:dramaticmusclecontractions
Absenceseizures:35secondlossofconsciousness
Myoclonicseizures:short,sporadicmusclecontractions
Febrileseizures:childrenwithhighfeversusually24yearsold,selflimitedbytreatingfever
Jacksonianseizures:spreadfromonepartofthebodytootherparts,maybecomegeneralized
Psychomotorseizures:sensory,motor,andbehavior
StatusEpilepticus:prolongedseizureswithnorecoveryphasejustkeephappening

Miscellaneous:
Botox: uses, precautions, pt teaching
Botulinum toxin
Improvement of appearance in frown lines, Reduction of severity of abnormal head position and neck pain
associated with cervical dystonia
Precautions: Epilepsy, Cardiac dysfunction, Conditions marked by muscle weakness
Eye drops for glaucoma
Prostaglandin Analogs
Latanoprost (Xalatan)
Beta-Adrenergic Blockers
Timolol (Timoptic), Betaxol, Carteolol, Levobunolol, Metipranolol
Eye drops for dry eye
Artificial Tears (Demulcent)
Restasis (Cyclosporine)
Omega3
Cycloplegics and mydriatics
Cycloplegics: paralyze ciliary muscles
Mydriatics: dilate pupil