Pharmacology Nursing

Nurse Licensure Examination

Review
Ramon Carlo T. Almirañez, RN, RM, USRN, HAAD-RN
Pharmacology
- Study of drugs, their origin, nature, properties
and their effects upon living organisms

Drug therapy
- prevent, cure, or control various disease
states
Routes of Drug Administration
1. Enteral
- Oral, Sublingual, Rectal
2. Parenteral.
- Intravenous, Intramuscular, Subcutaneous,
Intradermal.
3. Inhalation
4. Intranasal
5. Intrathecal
6. Topical
7. Transdermal
Pharmacokinetic Phase

• Absorption
• Distribution
• Metabolism (Biotransformation)
• Elimination (Excretion)
Pharmacokinetics
• Absorption
- transfer of a
drug from its
site of adminis
tration to the
blood stream
Pharmacokinetics
• Absorption
- Factors influencing absorption
(pH, blood flow, total surface area & contact
time)
- Water-soluble vs lipid-soluble drugs
- First-pass effect (1st pass hepatic metabolism)
Pharmacokinetics
• Distribution (process by which drug reversibly le
aves the blood stream & enters the ECF or ICF
- Capillary permeability
- Free drugs
- Protein-binding (reversible)
- Volume of drug distribution (hypothetical
volume of fluid into w/c drug is disseminated)
Pharmacokinetics

• Metabolism
- GI tract
- Liver (cytochrome P-450 system)
- Half-life (t 1/2) – time it takes for ½ of the dr
ug concentration to be eliminated
• Excretion (Elimination)
- Kidneys (Creatinine clearance)
- Liver
- Feces, bile, breast milk, saliva, sweat, lungs
Pharmacodynamic Phase

• Study of drug concentration and its effec

ts on the body
• Primary effects
• Secondary effects
 Pharmacodynamics
• Dose-response
– relationship b/
w minimal vs max
imal amount of dr
ug dose needed t
o produce the de
sired drug respon
se
• Maximal efficacy
• Onset, peak, and
duration of action
Pharmacodynamics

• Receptor theory
• Agonists vs antagonists
 Pharmacodynamics
• Non-specific drug
effect
Pharmacodynamics
• Non-selective
drug effect
Therapeutic Index

• Loading dose
- large, initial dose to achieve a rapid MEC in
the plasma
• Side effects
- physiologic effects not related to desired drug
effects
• Adverse reactions
- more severe than side effects
• Toxic effect
Therapeutic Index

• Placebo effect
- psychologic benefit from a compound
that may not have the chemical structure
of drug effect
Antibiotics

Question: Why do we have to use antibiotics?

> They inhibit bacterial DNA.

> They inhibit protein synthesis.
>They interfere with the formation of the bacterial
cell wall.
Antibiotics

Antibiotics are usually prescribed by physicians in

cases of infections.
It could be:
➢skin/skin structure infection
➢respiratory tract infections
➢Gonococcal
➢community-or hospital-acquired infections.
➢given in cases of meningitis
➢surgical prophylaxis
Antibiotics

Nursing Considerations:
1. Take blood cultures before starting antibiotics
2. Assess for ototoxicity (change in hearing, ringing
in the ears, dizziness or unsteady gait)
3. Assess for nephrotoxicity (monitor BUN and
Creatinine)
4. Lab Value Alert: Normal BUN and CREA
BUN: 10 -20 mg/dL
Creatinine: 0.6 to 1.2 mg/dL
Antibiotics

Nursing Considerations:
5. Drink 2 to 3 liters of fluid daily
6. Absorption is reduced by milk products and
antacids
7. Minimize using higher generation in less severe
infections and in those in which risk factors for
multidrug resistance are not present
8. Dilute solution and administer slowly to decrease p
hlebitis on IV site.
ACE Inhibitors
Angiotensin Converting Enzyme (ACE) Inhibitor
These are the diseases that ACE Inhibitors treat:
1. Hypertension
2. Congestive heart failure
“And, they lower the risk of stroke and heart Attack.”
- If your client is on ACE inhibitors, you should see these
desirable outcomes:
> Blood pressures controlled within normal limits
> Improved survival rates for clients suffering from
acute MI
> Decreased workload on cardiovascular system
> Decrease or absence of chest pain
ACE Inhibitors
Angiotensin Converting Enzyme (ACE) Inhibitor
Side Effects:
1. Postural hypotension (commonly known as ‘head rush’
or ‘dizzy spell’)
2. Fatigue
3. Loss of appetite
4. Nausea, vomiting, diarrhea
5. Hyperkalemia
6. Insomnia
7. Could exacerbate non-productive COUGH
8. Angioedema

Ace Inhibitor Cough.jpg Angioedema.png

ACE Inhibitors
Angiotensin Converting Enzyme (ACE) Inhibitor
Now, what should be your nursing considerations in
giving medications?
1. It cause retention of potassium. Hence, monitor the
electrolytes.
2. Elderly clients are at highest risk for postural hypotension.
3. Do not to abruptly discontinue medications because
rebound hypertension can occur.
4. Monitor the blood pressure frequently.
5. If your client has impaired renal function, you have to be
cautious if they will be using these drugs
6. Notify the client’s physicians if dizziness still persists.
ACE Inhibitors
Mrs. Sommers, a 53-year-old female diagnosed
with Congestive Heart Failure is taking Fosinopril
(Monopril) 10 mg tablet once a day. Which of the
following results would require the need to notify
the physician?
a. Creatinine 1.0 mg/dL
b. Potassium 7.8 mEq/L
c. Albumin 5 U/L
d. BUN 10 mg/dL
ACE Inhibitors
You are the nurse caring for Mrs. Jones, a 44-year-
old client with hypertension. An hour after taking
Ramipril (Altace), you took her blood pressure and no
ted that it is 80/50. Which of the following
nursing interventions should you do first?
a. Call the attending physician
b. Elevate her legs by adjusting the bed and placing
her on a Trendelenburg position
c. Give her Furosemide (Lasix)
d. Give supplemental oxygen via nasal cannula at 3
lpm
 Anti-Anginals
Anti-Anginals
- Peripheral Vasodilator
- Decreases the cardiac workload
- Generic name usually ends in “Nitrate”

Drug Uses:
1. Angina
2. Controls perioperative blood pressure
 Anti-Anginals
Anti-Anginals

Side Effects:
Headache, blurred vision and dry mouth
Postural Hypotension
Syncope
Reflex tachycardia
 Anti-Anginals
Anti-Anginals
Nursing Considerations:
1. Let them know that the purpose of transdermal patch is to
prevent chest pain and they allow the client to maintain ADLs.
2. Advise your client that alcohol will potentiate postural
hypotension. So remember, as a nurse, you have to tell your
clients to limit alcohol consumption.
3. Report to physician continuous headaches, blurred vision or
dry mouth.
4. Topical application is used for sustained protection against
angina attacks.
5. Avoid skin contact with topical form.
 Anti-Anginals

How will the nurse evaluate the efficacy of

Isordil?
a. relief of chest pain in 3-5 minutes
b. relief of tremors at rest
c. asking for the fourth tablet of Isordil
d. increase in urine output
 Anti-Anginals
How should the nurse ensure that the potency of
nitroglycerin is not compromised?
a. Keep the medicine in a tightly closed, dark glass
container
b. A new supply of medication is purchased every
year
c. Sublingual tablets are swallowed for immediate
absorption
d. Take the 1st dose of nitroglycerin after 15 minutes
of observed pain
Anti-Platelet Drugs
These drugs inhibit the aggregation of plat
elets in the clotting process and prevent
thrombus formation.
Used to treat:
- Cerebrovascular Accident
- Myocardial Infarction
- Rheumatic Heart Disease
- Pericarditis
- Pulmonary Embolism
- Deep Vein Thrombosis
Anti-Platelet Drugs
Drug Samples:
Aspirin
Clopidogrel (Plavix)
Pentoxifylline (Trental)
Cilostazol (Pletal)
Ticlopidine (Ticlid)
Anti-Platelet Drugs
Side Effects:
- Bruising
- Hematuria
- GI bleeding
- Melena
Contraindications:
- Peptic Ulcers
- Bleeding problems
Cholinergics Vs. Anti-Cholinergics

Cholinergics Vs. Anti-Cholinergics

PNS SNS
 Cholinergics

Adverse effects associated with the use of

Cholinergic drugs include
a. constipation and insomnia.
b. diarrhea and urinary urgency.
c. tachycardia and hypertension.
d. dry mouth and tachycardia.
 Cholinergics

The nurse is administering neostigmine to a

client with myasthenia gravis. Which nursing
intervention should the nurse implement?
a. Give the medication on an empty stomach
b. Warn the client that he’ll experience mouth dryness
c. Schedule the medication before meals
d. Administer the medication for complaints of
muscle weakness or difficulty swallowing.
 Anti-cholinergics
A home care nurse is visiting a client with a
diagnosis of Parkinson’s disease. The client is taking
benztropine mesylate (Cogentin) orally daily. The
nurse provides information to the spouse regarding
the side effects of this medication and tells the
spouse to report which side effect if it occurs?
a. inability to urinate
b. decrease appetite
c. shuffling gait
d. irregular bowel movement
 Anti-cholinergics
2. A client has received atropine sulfate preoperatively.
The nurse monitors the client for which effect of the m
edication in the immediate postoperative period?
a. Diarrhea
b. Bradycardia
c. Urinary retention
d. Excessive salivation
 Anti-cholinergics
A nurse is monitoring a client for adverse reaction to
Atropine eye drops. Systemic Absorption to atropine
sulfate through the conjunctiva can cause which adverse
reaction?
a. Tachycardia
b. Increased salivation
c. Hypotension
d. Apnea
Pharmacology Nursing
Nurse Licensure Examination
Review
Ramon Carlo T. Almirañez, RN, RM, USRN, HAAD-RN
 Adrenergics
Agonist Vs. Blockers

SNS
Alpha and Beta adrenergics
- Epi and nor-epi
PNS
Non Selective Adrenergic Blockers
- Amiodarone, Carvedilol, Labetalol
- ephedrine Non Selective Alpha Adrenergic
- Dobu and dopa Blockers
Alpha Selective - Phentolamine
- Phenylephrine Alpha1 Selective Adrenergic Blockers
- Clonidine - “Zosin”
Beta Specific Beta Blockers – “olol”
- Albuterol
- Isoproterenol
- Terbuthaline
 Adrenergic Agonists
1. The instructor determines that teaching about
adrenergic drugs has been successful when the class
identifies the drugs as also being called
a. sympatholytic agents.
b. cholinergic agents.
c. sympathomimetic agents.
d. anticholinergic agents.
 Adrenergic Agonists
2. The adrenergic agent of choice for treating the
signs and symptoms of allergic rhinitis is
a. norepinephrine.
b. phenylephrine.
c. dobutamine.
d. dopamine.
 Adrenergic Agonists
3. An adrenergic agent being used to treat shock
Infiltrates into the tissue with intravenous
administration. Which action by the nurse would be
most appropriate?
a. Watch the area for any signs of necrosis and
report it to the physician.
b. Notify the physician and decrease the rate of
infusion.
c. Remove the IV and prepare phentolamine for
administration to the area.
d. Apply ice and elevate the arm.
 Adrenergic Agonists
4. Phenylephrine, an alpha-specific agonist, is found
in many cold and allergy preparations. The nurse
Instructs the patient to be alert for which adverse ef
fects?
a. Urinary retention and pupil constriction
b. Hypotension and slow heart rate
c. Personality changes and increased appetite
d. Cardiac arrhythmias and difficulty urinating
 Adrenergic Agonists
5. Adverse effects associated with adrenergic
agonists are related to the generalized stimulation
of the sympathetic nervous system and could
include
a. slowed heart rate.
b. constriction of the pupils.
c. hypertension.
d. increased GI secretions.
 Adrenergic Blockers
6. The physician is treating a client in the cardiac ca
re unit for atrial arrhythmia and prescribes proprano
lol (Inderal), 10 mg PO three times a day. Propranol
ol inhibits the action of sympathomimetics at beta1
-receptor sites. Where are these site mainly located?
a. Uterus
b. Blood vessels
c. Bronchi
d. Heart
 Adrenergic Blockers
7. Adrenergic blocking drugs, because of their
clinical effects, are also known as
a. anticholinergics.
b. sympathomimetics.
c. parasympatholytics.
d. sympatholytics.
 Adrenergic Blockers
8. Phentolamine (Regitine), an alpha-adrenergic
blocker, is most frequently used
a. to prevent cell death after extravasation of
Intravenous dopamine or norepinephrine.
b. to treat COPD in patients with hypertension or
arrhythmias.
c. to treat hypertension and BPH in male patients.
d. to block bronchoconstriction during acute
Asthma attacks.
 Adrenergic Blockers
9. Which of the following clients are not advised to
take Beta-Adrenergic blockers
a. Chronic obstructive pulmonary disease
b. Myocardial infarction
c. Angina pectoris
d. Chronic kidney disease
 Adrenergic Blockers
10. After suffering an acute myocardial infarction (Ml), a clie
nt with a history of type 1 diabetes is prescribed metoprolol
(Lopressor) I.V. Which nursing interventions are associated
with I.V. metoprolol administration? Select all that apply:
1. Monitor glucose level closely.
2. Monitor the client for heart block and bradycardia.
3. Monitor blood pressure closely.
4. Mix the drug in 50 ml of dextrose 5% in water and infuse
over 30 minutes.
5. Know that the drug isn’t compatible with morphine.
Classification of Chemotherapeutic agents

a. Alkylating agents
– Non-phase-specific and act by
interfering with DNA replication
▪ Cyclophosphamide (Cytoxan)
▪ Busulfan (Myleran)
▪ Cisplatin
Classification of Chemotherapeutic agents

b. Antimetabolites
–Interfere with metabolites or
nucleic acids necessary for RNA and
DNA synthesis
• 5-fluorouracil (5-FU)
• Methotrexate
• Cytarabine
Classification of Chemotherapeutic agents

c. Cytotoxic antibiotics
–Disrupt or inhibit DNA or RNA
synthesis
• Bleomycin (Blenoxane)
• Doxorubicin (Adriamycin)
Classification of Chemotherapeutic agents

D. Plant alkaloids
– Vinca alkaloids are phase-specific, inhibiting
cell division
• Vincristine

- Taxanes
• Docetaxel
Situation 1 (Questions 1-5)

A 50 year old female is diagnosed with cer

vical cancer and is admitted in 3A ward for
chemotherapy.
1. A nurse is caring for a client receiving
chemotherapy. Which assessment finding
places the client at the greatest risk for an
infection?
a. White blood cell (WBC) count of 9,000
cells/mm3
b. Stage 3 pressure ulcer on the left heel
c. Temperature of 98.3° F (36.8° C)
d. Ate 75% of all meals during the day
2. A client is receiving chemotherapy to tre
at breast cancer. Which assessment finding
indicates a chemotherapy-induced
complication?
a. Urine output of 400 ml in 8 hours
b. Serum potassium level of 2.6 mEq/L
c. Blood pressure of 120/64 to 130/72 mm
Hg
d. Sodium level of 142 mEq/L
3. A nurse is caring for a client who is
receiving chemotherapy and has a platelet
count of 30,000/mm3. Which statement by
the client indicates a need for additional
teaching?
a. “I will floss my teeth every morning.”
b. “I use an electric razor to shave.”
c. “I take a stool softener every morning.”
d. “I removed all the throw rugs from the
house.”
4. A client has just begun treatment with
bisulfan (Myleran), 4 mg by mouth daily, for
chronic myelogenous leukemia. The client
receives bisulfan until his white blood cell
(WBC) count falls to between 10,000/mm3
and 25,000/mm3, then the drug is stopped.
When should treatment resume?
a. When the WBC falls to 5,000/mm3
b. When lost hair begins to grow back
c. When the WBC count rises to 50,000/mm3
d. When the client displays anemia
5. A client who’s receiving chemotherapy for breast
cancer develops myelosuppression. Which
instructions should the nurse include in the client’s
discharge teaching plan? Select all that apply.
1. Avoid people who have recently received
attenuated vaccines.
2. Avoid actives that may cause bleeding.
3. Wash hands frequently.
4. Increase intake of fresh fruits and vegetables.
5. Avoid crowded places such as shopping malls.
6. Treat a sore throat with over-the-counter (OTC)
products.
 – ugar (taas)
- alt (taas)
T – aas BP
E – ye problem (glaucoma)
– isk for infection
- etention of water
O – steoporosis
I – ncrease weight
D – ecrease muscle mass (muscle wasting)

C – ushing-like manifestation (overuse)

A – drenocortical insufficiency (abrupt withdrawal)
 – ugar (taas)
- alt (taas)
T – aas BP
E – ye problem (glaucoma)
– isk for infection
- etention of water
O – steoporosis
I – ncrease weight
D – ecrease muscle mass (muscle wasting)

C – ushing-like manifestation (overuse)

A – drenocortical insufficiency (abrupt withdrawal)
Oral Hypoglycemic Agents
Biguanides
Metformin (Glucophage)
- inhibit production of glucose by the liver
- used in type 2 diabetes
Contraindications:
1. Impaired renal/liver function
2. Alcohol abuse
3. Infection
Oral Hypoglycemic Agents
Adverse Effects:
1. Lactic Acidosis
2. Renal Failure
3. Hypoglycemia
4. GI Distrubance
Nursing Responsibilities:
1. Monitor for lactic acidosis and hypoglycemia
2. Monitor for renal function
3. Stop the metformin 48h prior and resume
48h after use of contrast agent
Drugs for Shock
Dopamine
• This is a sympathomimetic drug often us
ed to treat Hypotension in shock states t
hat are not caused by Hypovolemia.
Drugs for Shock
Dopamine
• Dopamine is indicated to treat Hypotension, to
increase heart rate and to increase urine output
(given less than 5 mg/kg/min)
• The nurse typically prepares the dopamine drip-
dopamine (at a concentration of 400-800 mg) is
mixed in 250 mL D5W and administered as drip
via an infusion pump for precise dosage adminis
tration.
• Sodium bicarbonate will inactivate the dopamine
Drugs for Shock
Dopamine: Nursing consideration
– Check the IV site hourly for signs of drug
infiltration of dopamine, which can cause tissue
necrosis.
– Phentolamine should be infiltrated in multiple
areas to reduce tissue damage.
– Drug is effective if Urine output is increased
and BP is increased
Practice Computation
A man weighs 165 lb. and is being treated
for shock. The nurse is preparing a dopamine
hydrochloride infusion to start at 5 mcg/kg/min. The
nurse has prepared the following to infuse:
dopamine 400 mg in 250 mL D5W. Which of the
following rates of infusion should the nurse choose?
a. 14 mL/hr
b. 16 mL/hr
c. 22.5 mL/hr
d. 37.5 mL/hr
Practice Computation
A client with sepsis and hypotension is being treated
with dopamine (Inotropin). The nurse asks a colleague
to double-check the dosage that the client is
receiving. There are 400 mg of dopamine in 250 ml,
the infusion pump is running at 23 ml/hour, and the
client weighs 79.5 kg. How many micrograms per
kilogram per minute is the client receiving? Record
your answer using two decimal places.

mcg/kg/min = ? 7.71 mcg/kg/min