VNRS B50A-Advanced Pharmacology Part A

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VNRS B50A-Advanced Pharmacology Part A

• Stephanie Engler, RN
• Monday 115-230pm
• sengler_at_bakersfieldcollege.edu

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Welcome to Pharmacology!

• Syllabus
• Content is board approved- some review, but we
  will be digging deeper!
• Expectations from this class.
• Please do your homework
• Be ready to participate in class
• Please bring 3 scantrons to class
• How can I help you succeed???

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To be successful in this class

• Come to class with homework prep questions
  answered- find on website
• Bring lecture notes to class- print from website
• Bring a blank concept map to class for additional
  note taking
• Study from your lecture notes and additional
  notes in class- use your text book for
  clarification of material covered
• Participate in group round tables when
  available- good time to review exams and ask
  questions

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Lets get started

• Unit 1- Introduction
• See class handout
• Unit 2- Medications Administered for
  Gastrointestinal Disorders
• GI review-http//www.youtube.com/watch?vZ7xKYNz9A
  S0featurefvsr
• Liver disease, Pancreatitis Insulin notes
• Groups- answer discussion ?s

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GI meds and plan of carePlan for the day

• Quick Notes Review
• Case Study
• NCLEX Questions

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Gastric acid

• System
• Esophagus
• Stomach
• Liver/gallbladder
• Pancreas
• Small/large intestine
• Gastric acid production
• Parietal cells- H production
• Receptors- histamine2
• Function
• Stomach pH 1-4
• Digestion
• Defense against infection

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What do we do with the overproduction of this
acid????

• Give antacids to neutralize!
• Milk of Magnesia (magnesium hydroxide)
• TUMS (calcium carbonate)
• Heartburn, gastritis, peptic ulcer disease (PUD)
• Suppress gastric acid!
• H2 receptor blockers- bind to H2 receptor
• Pepcid (famotidine)
• Decrease HCl acid production
• Decrease heartburn
• GERD, erosive esophagitis, PUD,
• H. pylori, gastritis, prevent stress ulcers

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What do we do with the overproduction of this
acid????

• Suppress gastric acid!
• Proton pump inhibitors (PPI)- blocks proton pump,
  stops HCl production
• Prevacid (lansoprazole)
• Prilosec (omeprazole)
• Protonix (pantoprazole)
• Decrease HCl production, decrease heartburn
• Caution with hepatic disease!!!!

• Gastric barrier- adheres to gastric mucosa/ binds
  to ulcer
• Carafate (sucralfate)
• Decrease heartburn
• http//www.youtube.com/watch?v_fa60VhclNofeature
  related

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Gastrointestinal Case Study

• History of present illness (HPI)
• Mr. D- 70 year old male- enters your clinic with
  a complaint of severe upper abdominal pain that
  occurs mostly in the evening hours. It is
  relieved by food, although he vomits his meals
  several times each week. Wife states
  intermittent confusion in last month.
• Past medical history (PMH)
• He has a history of peptic ulcers and alcohol
  abuse
• Smoking has been reduced to two packs per week
• He is taking no drugs, other than Rolaids for his
  indigestion
• Workup Vital signs- BP- 106/60, HR- 108, RR-
  12, Temp- 98.6, O2- 98 on 2L NC, 2/10 pain

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Gastrointestinal Case Study

• Lab results
• blood in stool
• Na 138
• K 3.2
• Glucose 100
• Ca 8.0
• BUN 12
• Creat 1.2
• AST 100
• ALT 150
• Albumin 1.8
• Hgb 10.2
• Hct 28.6

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NCLEX

• Which of the following best describes the
  mechanism of the action of sucralfate (Carafate)?
• Kill H. pylori
• Reduce the secretion of acid
• Increase the secretion of bicarbonate
• Add a gel-like protective mucus over the ulcer

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NCLEX

• The nurse would administer amoxicillin (Amoxil)
  or clarithromycin (Biaxin) for peptic ulcers in
  order to
• Kill H. pylori
• Reduce the secretion of acid
• Increase the secretion of bicarbonate
• Add a gel-like protective mucus over the ulcer

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NCLEX

• Which class of drugs acts by neutralizing stomach
  acid?
• H2-receptor blockers
• Serotonin receptor blockers
• Proton-pump inhibitors
• antacids

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NCLEX

• Which of the following is the most effective
  class of drugs used to treat diarrhea?
• Phenothiazines
• Antihistamines
• Anticholinergics
• Opioids

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respiratory meds and plan of carePlan for the
day

• Respiratory Review (AP/ Structures)
• Mediators of inflammation
• Respiratory defense mechanisms
• Homework Review

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respiratory meds and plan of care
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respiratory meds and plan of care

• The respiratory system has built-in methods to
  prevent harmful substances from entering the
  lungs
• Your nose moistens and warms the air.
• The hair (cilia) in your nose helps filter out
  large particles.
• Mucus produced by cells in the trachea and
  bronchial tubes keeps air passages moist and aids
  in trapping dust, bacteria, and other substances.
• Cilia in the air passages move in a sweeping
  motion upwards towards the throat and mouth to
  get the mucus and bacteria etc out of the lungs.

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respiratory meds and plan of care

• Mediators of inflammation
• 1. Bradykinin, complement, prostaglandin.
• 2. Leukotrienes.
• 3. Histamine.
• 4. Mast cells.
• Respiratory defense mechanisms
• 1. Cough.
•  
• 2. Reflex bronchoconstriction.
•  
• 3. Filtration, mucociliary response.
•  
• 4. Alveolar macrophages -Macrophages engulf and
  digest
• foreign materials in a process known as
  phagocytosis.

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respiratory meds and plan of care

• Asthma- caused by inflammation in the airways,
  causes the airways of the lungs to swell and
  narrow, leading to wheezing, shortness of breath,
  chest tightness, and coughing.
• Chronic obstructive pulmonary disease (COPD)-
• Chronic obstructive airways disease Chronic
  obstructive lung disease Chronic bronchitis
  Emphysema Bronchitis chronic
• Chronic bronchitis- which involves a long-term
  cough with mucus
• Emphysema- which involves destruction of the
  lungs over time
• Pneumonia- an inflammation of the lungs caused by
  an infection

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respiratory meds and plan of care

• Drugs affecting the respiratory system
• Bronchodilators
• Adrenergic agonists-
• Proventil (albuterol)- short acting
• Xopenex (levalbuterol)- short acting
• Serevent (salmeterol)- long acting
• Leukotriene inhibitors
• Anticholinergics
• Decrease Inflammation
• Glucocorticoid steroids
• Antihistamines
• Decrease secretions

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Medications for the Integumentary system

• Burns- see handout
• Eczema- corticoidsteroid creams
• Psoriasis-
• corticoidsteroid creams,
• topical retinoids (Tazarotene),
• Vit D analogues (Dovonex)

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psoriasis eczema
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burns
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respiratory meds and plan of care

• Remember to Study
• Therapeutic Effects
• Side Effects
• Nursing Actions
• Patient Education
• Is this drug short or long acting?
• Know glucocorticoid steroids!
• Indications
• Precautions
• Side effects
• Nursing actions
• Drugs and their route

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nclex

• Which of the following would the nurse identify
  as being involved with asthma?
• Acute infection
• Hyperactive airways
• Alveolar collapse
• Progressive loss of lung compliance

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nclex

• Which term would be used to describe the movement
  of air in and out of the body?
• Perfusion
• Respiration
• Ventilation
• Gas exchange

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nclex

• Sympathetic nervous system stimulation of the
  respiratory tract would result in which of the
  following?
• Diaphragmatic contraction
• Bronchoconstriction
• Increased respiratory rate
• Inspiratory movement

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nclex

• After reviewing information about respiratory
  tract disorders, a group of students demonstrate
  understanding of the material when they identify
  which of the following as the most common cause
  of COPD?
• Infection
• Allergen exposure
• Genetic inheritance
• Cigarette smoking

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nclex

• A nurse administers an antitussive agent
  cautiously to a patient with asthma for which
  reason?
• The airway needs to be maintained.
• The drug can lead to addiction.
• A loss of respiratory reserve can occur.
• The patient may experience increased sedation.

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nclex

• Which agent would the nurse instruct a patient to
  use orally?
• Pseudoephedrine
• Phenylephrine
• Tetrahydrozoline
• Xylometazoline

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nclex

• A patient is taking pseudoephedrine. The nurse
  would assess the patient for which of the
  following adverse effects?
• Anxiety
• Lethargy
• Hypotension
• Dry skin

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ncex

• When describing the effects of antihistamines,
  which of the following would the nurse address as
  being decereased?
• Hypersensitivity
• Dry mouth
• Gastrointestinal upset
• Sedation

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nclex

• A patient is using an inhaled bronchodilator as a
  treatment of exercise-induced asthma. The nurse
  would instruct the patient to use the inhaler at
  which time?
• Immediately after beginning to exercise
• 15 minutes before engaging in exercise
• Right before and after exercise
• Midway during the exercise routine

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nclex

• While reviewing a patients history, an allergy
  to which of the following would alert the nurse
  to a possible problem with the use of
  ipratropium?
• Eggs
• Dairy
• Peanuts
• Shellfish

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nclex

• A patient is experiencing an acute asthmatic
  attack. Which agent would be most effective?
• Inhaled steroid
• Leukotriene receptor antagonist
• Mast cell stabilizer
• Beta-2 selective adrenergic agonist

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nclex

• Milk of Magnesia (MOM) is used to neutralize acid
  in the stomach. MOM is not indicated for which
  disease process
• Heartburn
• Gastritis
• GERD
• Peptic ulcer disease

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nclex

• Once H. pylori is detected in patients with a
  peptic ulcer, the normal procedure is to (select
  all that apply)
• Administer Prilosec (omeprazole)
• Administer Prevacid (lansoprazole)
• Administer Cleocin (clindamycin)
• Administer Biaxin (clarithromycin)

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nclex

• A patient is admitted with suspected liver
  disease. The nurse would anticipate which of the
  following labs to be ordered (select all that
  apply)
• Lipase
• LFTs
• Blood coagulation times
• electrolytes

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nclex

• General side effects seen in patients taking
  anti-emetic agents are (select all that apply)
• Drowsiness
• Confusion
• Depression
• hypotension

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nclex

• A nurse is doing patient teaching to a patient
  experiencing heartburn. The patient states that
  he currently smokes approx. 20 cigarettes per
  day. The nurse would want to educate the patient
  on which gastrointestinal disorder
• PUD
• GERD
• H. pylori
• Gastritis

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NCLEX

• Which of the following is the most effective
  class of drugs used to treat diarrhea?
• Phenothiazines
• Antihistamines
• Anticholinergics
• Opioids

43
NCLEX

• Which class of drugs acts by neutralizing stomach
  acid?
• H2-receptor blockers
• Serotonin receptor blockers
• Proton-pump inhibitors
• antacids

44
NCLEX

• The nurse would administer amoxicillin (Amoxil)
  or clarithromycin (Biaxin) for peptic ulcers in
  order to
• Kill H. pylori
• Reduce the secretion of acid
• Increase the secretion of bicarbonate
• Add a gel-like protective mucus over the ulcer

45
NCLEX

• Which of the following best describes the
  mechanism of the action of sucralfate (Carafate)?
• Kill H. pylori
• Reduce the secretion of acid
• Increase the secretion of bicarbonate
• Add a gel-like protective mucus over the ulcer