1. VNRS B50A-Advanced Pharmacology Part A
Stephanie Engler, RN
Monday 1:15-2:30pm

2. 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???

3. 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

4. Let’s get started………… Unit 1- Introduction See class handout
Unit 2- Medications Administered for Gastrointestinal Disorders
GI review-
Liver disease, Pancreatitis & Insulin notes
Groups- answer discussion ?’s

5. GI meds and plan of care Plan for the day:
Quick Notes Review
Case Study
NCLEX Questions

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

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

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

15. respiratory meds and plan of care Plan for the day:
Respiratory Review (A&P/ Structures)
Mediators of inflammation
Respiratory defense mechanisms
Homework Review

16. respiratory meds and plan of care

17. 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.

18. 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.

20. 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

21. 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

22. Medications for the Integumentary system
Burns- see handout
Eczema- corticoidsteroid creams
Psoriasis-
corticoidsteroid creams,
topical retinoids (Tazarotene),
Vit D analogues (Dovonex)

23. psoriasis & eczema

24. burns

25. 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

26. Progressive loss of lung compliance
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

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

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

29. 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

30. The airway needs to be maintained. The drug can lead to addiction.
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.

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

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

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

34. Immediately after beginning to exercise
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

35. 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?
Eggs
Dairy
Peanuts
Shellfish

36. Leukotriene receptor antagonist Mast cell stabilizer
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

37. 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

38. Administer Prilosec (omeprazole) Administer Prevacid (lansoprazole)
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)

39. Blood coagulation times electrolytes
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
LFT’s
Blood coagulation times
electrolytes

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

41. 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

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

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

44. Reduce the secretion of acid Increase the secretion of bicarbonate
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. Reduce the secretion of acid Increase the secretion of bicarbonate
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