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NCLEX Pharmacology

A Quick Review on Pharmacology

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NCLEX Review on Pharmacology

The fact is that pharmacology will always be a big part in your NCLEX Exam, and can be a huge catalyst in whether you pass or fail your NCLEX Exam.  It is quite important for us to focus a lot on the content that pertains to medications, if we are reviewing for the NCLEX.  The NCSBN (who is responsible for developing the NCLEX Exam) defines the category of Pharmacological and Parenteral Therapies as a sub-category within the Physiological Integrity area (of the exam)  in which the nurse is basically providing care related to the administration of medications and parenteral therapies.

To be more specific, Pharmacological and Parenteral Therapy has contents that  includes but is not limited to:

  • Adverse Effects/Contraindications/Side Effects/Interactions
  • Expected Actions/Outcomes
  • Medication Administration
  • Blood and Blood Products
  • Parenteral/Intravenous Therapies
  • Central Venous Access Devices
  • Pharmacological Pain Management
  • Dosage Calculation

First, I want to take a step back and look at Pharmacology from a technical sense and look at it more in depth.

What is Pharmacology?

♠ PHARMACOLOGY

Pharmacokinetics- The study if how drugs are being absorbed, distribuited, metabolized and excreted by the body.
Pharmacodynamics- is the study of how drugs are being used by the body.
Pharmacotherapeutics- the study of how the client responds to the particular drugs.

What’s in a drug name?
Chemical Name:
This tells you the chemical makeup of the drug.
Generic Name
This name is given by the company that developed the drug.
Trade Name
This is the name given to the drug by the company in which the medication originated.

The Seven Rights of Administering Drugs

  • Right Client
  • Right Route
  • Right Drug
  • Right Dose
  • Right Amount
  • Right Time
  • Right Documentation
  • Right to refuse treatment

Any drug can have a CHEMICAL NAME, A GENERIC NAME AND A BRAND OR TRADE NAME.

  • The generic name of a drug is suggested by the manufacturer, and accepted by the international committee.
  • How the drug is being affected affects the body and the patient’s response is called the effect.
  • Efficacy refers to the degree to which a drug is able to induce it’s maximal effects.
  • Adverse Effect is any unexpected or unintended response to a therapeutic use of a drug, it is also called side effect.

During this review, I want to focus specifically towards the drugs that is mostly in patients with hypertension.

DRUGS USED WITHIN THE CARDIAC SYSTEM

Cardiac Pharmacology

♣ Pharmacology Drugs for Hypertension:

DIURETICS

  • - Helps get rid of the sodium and fluid in the body.
  • - Used to lower the blood pressure.
    – Promotes the excretion of sodium and water
    – Diuretics interferes with the sodium absorption in the kidney.
    – Increases the urine output.  Decreases the preload and afterload..

If the patients blood pressure drop to low, it is important to give IV fluids to pt.

LETS GO OVER THE CATEGORIES OF DIURETICS ♠

♦ TYPES OF DIURETICS

♣ POTTASIUM SPARING DIURETICS

It promotes the excretion of soduium and water, while the retention of pottasium

Used for:

  • Hypertension
  • Edema
  • Hyperaldosteronism
  • Hypokalemia

Medication:

  • SPIRONOLACTON (ALDACTONE)
  • AMILORIDE (MIDAMOR)
  • TRIAMTERENE

Now lets go to the side effects:

First, of course the person can have too much potassium or HYPERKALEMIA:

Signs of HYPERKALEMIA

  • irregular heartbeat
  • nervousness
  • tingling in hands and feet
  • shortness of breath
  • tiredness or weakness

OTHER SIDE EFFECTS:

  1. Nausea and vomiting
  2. Cramping and diarrhea
  3. Dizziness & headache

Loop Diuretics

  • BUMETANIDE (BUMEX)
  • FUROSEMIDE (LASIX)

Osmotic Diuretics

MANNITOL

  • Thizade Diuretics

HYDROCHLOROTHIAZIDE (HYDRODIURIL)
CHLOROTHIAZIDE (DIURIL)
CAUSES THE DEPLETION OF SODIUM AND WATER.
♣ CAN INDUCE HYPERGLYCEMIA

Very Important for the NCLEX:

SIDE EFFECTS OF DIURETICS

  • Frequent urination
  • Electrolyte abnormalitie
  • Muscle cramps or weakness
  • Blurred vision
  • confusion
  • headache
  • increased perspiration (sweating)
  • restlessness

BETA (ADRENERGIC)  BLOCKERS

- Helps lower blood pressure, puls rate and cardiac output.
– Can be used to treat headaches.
– Can be used to treat glacauma and prevent myocardial infarctions.
– Acts on the system, by blocking the symathetic vasomotor response.

For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).

SIDE EFFECTS:

  • Orthostatic hypotension
  • bradycardia
  • nausea and vomiting
  • diarrhea

NOTE: Some of the symptoms may MASK signs of Hypoglycemia

♠ HYPOGLYCEMIC SYMPTOMS

NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:

Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker.  Monitor the client for signs of edema.  The nurse should also assess the lungs sounds for signs of rales and ronchi.  When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protein, BUN and creatinine) which can indicate nephrotic syndrome.  Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever.  It is also very important to taper off the medication properly.

Cardiac Pharmacology

♣ Calcium Channel Blockers

  1. - PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
  2. - THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
  3. - MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
  4. - USED TO TREAT ANGINA.
  • Remember:

- Blocks the calcium channels in the heart, causing a decrease in contractility.
Decreases the workload of the heart.

Used for:
Hypertension

Medications:

  • Nifedipine (Procardia)
  • Amplodipine (Norvasc)
  • Do not give Norvasc with grapefruit, causees increase in drug level.
  • Verapamil (Isoptin)
  • Diltiazem (Cardizem)

SIDE EFFECTS:

Constipation
Nausea
Headache
Rapid heartbeat (tachycardia)
Drowsiness

Remember:

  • Make sure to monitor the heart rate and the blood pressure.
  • Hold medication if HR is less than 60 or if BP is less than BP.

♠ ACE INHIBITOR

  1. - ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
  2. - ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
  3. MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.

SIDE EFFECTS:

  • COUGH
  • TACHYCARDIA
  • NAUSEA AND VOMITING.

Remember:
GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.

NCLEX Review Pharmacology

Drugs Used for treating Hypertension:

♣ ACE INHIBITORS

♥ BETA BLOCKERS

♦ CALCIUM CHANNEL BLOCKERS

 REMEMBER FOR YOUR NCLEX EXAM:

  • ACE INHIBITOR
  1. - ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
  2. - ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
  3. MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.
  4. SIDE EFFECTS: COUGH, TACHYCARDIA, NAUSEA AND VOMITING.
  5. GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.
  • BETA BLOCKERS
  1. - REDUCES THE CARDIAC OUTPUT AND DECREASES THE SYMPATHETIC NERVOUS SYSTEM RESPONSE.
  2. - BLOCKS THE BETA RECEPTOR, CAUSING A DECREASE IN BLOOD PRESSURE.
  3. - MEDICATIONS INCLUDE THE “OLOL’S”: METROPOLOL, PROPANALOL, ACEBUTOLOL, NADOLOL.
  4. - USED FOR HYPERTENSION, MYOCARDIAL INFARCTION AND ANGINA.
  5. - ADVERSE EFFECTS CAN INCLUDE: BRADYCARDIA, HYPOTENSION AND HYPOGLYCEMIA (DISTRUPTS THE LIVER’S ABILITY TO CONVERT GLYCOGEN TO GLUCOSE).
  • CALCIUM CHANNEL BLOCKERS
  1. - PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
  2. - THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
  3. - MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
  4. - USED TO TREAT ANGINA.

 

 

CARDIAC GLYCOSIDES

Digoxin

  • IS A CARDIAC GLYCOSIDE
  • AN ANTIARRYTHMIC
  • IT INCREASES CARDIAC OUTPUT
  • SLOWS DOWN THE HEART RATE

Watch for Digoxin Toxicity:

Assessment and Signs of Digoxin Toxicity:

  • VISION CHANGES (HALO EFFECT)
  • NAUSEA AND VOMITING
  • BRADYCARDIA AND ANOREXIA
  • ANOREXIA

 

Anticoagulants

Avoid Herbs such as  ‘G’ HERBS (GINSING, GINGER, GINKO, GARLIC) when using anticoagulant drugs.

Aspirin

  • CAN ALSO BE USED AS A BLOOD THINNER
  • IRRITATES THE STOMACH AND INTESTINES
  • WATCH OUT FOR “BLACK TARRY” LOOKING STOOLS (COULD BE A SIGN OF INTESTINAL BLEEDING)
  • NEVER GIVE YOUR CHILDREN ASPIRIN, CAN CAUS  REYE’S SYNDROME.

Heparin:

  • MAKE SURE TO CHECK THE PTT
  • ANTIDOTE IS PROTAMINE SULFATE
  • CAN BE SAFELY GIVEN DURING PREGNANCY.

Coumadin

  • CHECK THE PT AND THE INR
  • ANTIDOTE IS VITAMIN K

Lovenox

  • LOVENOX, ALSO CALLED ENOXAPARIN, IS A FORM OF HEPARIN CALLED FRACTIONATED HEPARIN.

NCLEX Review: Pharmacology Adverse Reactions/ Side Effects

CARDIOVASCULAR DRUGS

ACE Inhibitors

  • HYPOTENSION (MOST COMMON)
  • COUGH ♣(COMMON NCLEX QUESTION)
  • CHECK ELECTROLYTES FOR (HYPERKALEMIA)

Calcium Channel Blocker

  • FATIGUE, HEADACHE
  • DROWSINESS
  • DYSRHYTMIAS
  • DO NOT GIVE TO PT’S WITH 2ND OR 3RD DEGREE HEARTBLOCK

Vasodilators

  • PALPITATIONS, CRAMPS
  • NAUSEA & VOMITING
  • BONE MARROW SUPPRESSION
  • CONTRAINDICATED IN PT’S W/ CAD
  • TAKE W/ FOOD TO DECREASE GI UPSET.

Diuretics

  • THIAZIDE
  • LOOP
  • OSMOTIC

Watch for electrolyte imbalance and dehydration.

Pottasium Sparing Diuretics

  • NAUSEA AND VOMITING
  • WATCH FOR ELECTROLYTE IMBALANCE SUCH AS
  • HYPERKALEMIA AND HYPONATREMIA.

ENDOCRINE SYSTEM PHARMACOLOGY

  • PROPYLTHIOURACIL (PTU) : HYPERTHYROID MEDICATION
  • FATIGUE, DROWSINESS
  • BRADYCARDIA, HEADACHE

Cortisone, Prednisone (Cortisole Replacement)

  • WEIGHT GAIN ♣
  • DECREASED IMMUNITY ♥
  • NAUSEA & VOMITING

Iodine Product (Loguls Solution)

  • USED FOR THYROID STORM
  • NAUSEA & VOMITING
  • BRADYCARDIA, HEADACHE

Levothyroixine (Synthroid) : Hypothyroid Medication

  • TACHYCARDIA ♦
  • NAUSEA & VOMITING

Glimepride (Amaryl), Glipizide (Glucotrol)

  • USED TO TREAT HYPERGLYCEMIA
  • BE CAREFUL TO WATCH FOR HYPOGLYCEMIA ♣

ENDOCRINE SYSTEM DRUGS

Corticosteroids (decreases inflammation)

  • INCREASED BP
  • HYPERGLYCEMIA ♥
  • WATCH OUT FOR CUSHING’S SYNDROME

Bronchodilators (relaxed bronchial muscle)

  • HEADACHE, TACHYCARDIA
  • PALPITATIONS
  • NAUSEA AND VOMITING

TUBERCULOSIS DRUGS

Isoniazid (INH)

  • B6 DEFICIENCY
  • OBSERVE PT. FOR JAUNDICE
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