VNRS B50A-ADVANCED PHARMACOLOGY PART A

Stephanie Engler, RN Monday 1:15-2:30pm [email protected]

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???

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

LET’S GET STARTED………… • Unit 1- Introduction See class handout • • • Unit 2- Medications Administered for Gastrointestinal Disorders GI review-

http://www.youtube.com/watch?v=Z7xKYNz9AS0&feature=f vsr

Liver disease, Pancreatitis & Insulin notes Groups- answer discussion ?’s

GI MEDS AND PLAN OF CARE PLAN FOR THE DAY:

• Quick Notes Review • Case Study • NCLEX Questions

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

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

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=_fa60VhclNo&feature=related

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

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

NCLEX Which of the following best describes the mechanism of the action of sucralfate (Carafate)?

a. Kill H. pylori b. Reduce the secretion of acid c. Increase the secretion of bicarbonate d. Add a gel-like protective mucus over the ulcer

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

NCLEX Which class of drugs acts by neutralizing stomach acid?

a. H2-receptor blockers b. Serotonin receptor blockers c. Proton-pump inhibitors d. antacids

NCLEX Which of the following is the most effective class of drugs used to treat diarrhea?

a. Phenothiazines b. Antihistamines c. Anticholinergics d. Opioids

RESPIRATORY MEDS AND PLAN OF CARE PLAN FOR THE DAY:

• Respiratory Review (A&P/ Structures) • Mediators of inflammation • Respiratory defense mechanisms • Homework Review

RESPIRATORY MEDS AND PLAN OF CARE

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.

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

.

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

• • • • 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

MEDICATIONS FOR THE INTEGUMENTARY SYSTEM • Burns- see handout • Eczema- corticoidsteroid creams • Psoriasis • corticoidsteroid creams, • topical retinoids (Tazarotene), • Vit D analogues (Dovonex)

PSORIASIS & ECZEMA

BURNS

RESPIRATORY MEDS AND PLAN OF CARE

Remember to Study:

1. Therapeutic Effects 2. Side Effects 3. Nursing Actions 4. Patient Education 5. Is this drug short or long acting?

6. Know glucocorticoid steroids!

• Indications • Precautions • Side effects • Nursing actions • Drugs and their route

NCLEX Which of the following would the nurse identify as being involved with asthma?

A. Acute infection B. Hyperactive airways C. Alveolar collapse D. Progressive loss of lung compliance

NCLEX Which term would be used to describe the movement of air in and out of the body?

A. Perfusion B. Respiration C. Ventilation D. Gas exchange

NCLEX Sympathetic nervous system stimulation of the respiratory tract would result in which of the following?

A. Diaphragmatic contraction B. Bronchoconstriction C. Increased respiratory rate D. Inspiratory movement

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?

A. Infection B. Allergen exposure C. Genetic inheritance D. Cigarette smoking

NCLEX A nurse administers an antitussive agent cautiously to a patient with asthma for which reason?

A. The airway needs to be maintained.

B. The drug can lead to addiction.

C. A loss of respiratory reserve can occur.

D. The patient may experience increased sedation.

NCLEX Which agent would the nurse instruct a patient to use orally?

A. Pseudoephedrine B. Phenylephrine C. Tetrahydrozoline D. Xylometazoline

NCLEX A patient is taking pseudoephedrine. The nurse would assess the patient for which of the following adverse effects?

A.Anxiety

B. Lethargy C. Hypotension D.Dry skin

NCEX When describing the effects of antihistamines, which of the following would the nurse address as being decereased?

A. Hypersensitivity B. Dry mouth C. Gastrointestinal upset D. Sedation

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?

A. Immediately after beginning to exercise B. 15 minutes before engaging in exercise C. Right before and after exercise D. Midway during the exercise routine

NCLEX While reviewing a patient’s history, an allergy to which of the following would alert the nurse to a possible problem with the use of ipratropium?

A.Eggs

B. Dairy C. Peanuts D.Shellfish

NCLEX A patient is experiencing an acute asthmatic attack. Which agent would be most effective?

A.Inhaled steroid B. Leukotriene receptor antagonist C. Mast cell stabilizer D.Beta-2 selective adrenergic agonist

NCLEX Milk of Magnesia (MOM) is used to neutralize acid in the stomach. MOM is not indicated for which disease process: A.Heartburn

B. Gastritis C. GERD D.Peptic ulcer disease

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

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): A. Lipase B. LFT’s C. Blood coagulation times D. electrolytes

NCLEX General side effects seen in patients taking anti-emetic agents are: (select all that apply) A.Drowsiness

B. Confusion C. Depression D.hypotension

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: A.PUD

B. GERD C. H. pylori D.Gastritis

NCLEX Which of the following is the most effective class of drugs used to treat diarrhea?

a. Phenothiazines b. Antihistamines c. Anticholinergics d. Opioids

NCLEX Which class of drugs acts by neutralizing stomach acid?

a. H2-receptor blockers b. Serotonin receptor blockers c. Proton-pump inhibitors d. antacids

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

NCLEX Which of the following best describes the mechanism of the action of sucralfate (Carafate)?

a. Kill H. pylori b. Reduce the secretion of acid c. Increase the secretion of bicarbonate d. Add a gel-like protective mucus over the ulcer