Pharmacology Final Exam Review

Exam Breakdown

• One-third of the exam covers material after Exam 2.
• Two-thirds of the exam covers material from Exams 1 and 2.

Muscle Relaxants

Central Acting Skeletal Muscle Relaxants

• Key Medications: Baclofen, Cyclobenzaprine, Carisoprodol, Diazepam
• Baclofen:
  • Increases potassium permeability → decreased muscle contraction
  • Indications: Multiple sclerosis, muscle rigidity, spinal cord injuries
  • Adverse Effects: CNS depression, dizziness, constipation, hypotension, urinary retention
  • Nursing Considerations: Do not stop abruptly, start at low dose, take on empty stomach
• Diazepam: Used for anxiety and as a muscle relaxant
  • Indications: Anxiety, muscle relaxation
  • Adverse Effects: Drowsiness, potential rebound effect if stopped abruptly

Direct Acting Skeletal Muscle Relaxants

• Key Medications: Dantrolene, Botulinum toxin (Botox)
• Dantrolene: Indicated for malignant hyperthermia
  • Adverse Effects: Muscle weakness, drowsiness, dizziness, hepatotoxicity
  • Indications: Muscle spasms in multiple sclerosis, cerebral palsy, malignant hyperthermia

General and Local Anesthetic Agents

General Anesthesia

• Balanced Anesthesia: Use of multiple drugs to prevent toxicity and adverse effects
• Medications: Barbiturates, Non-barbiturates, Nitrous oxide, Volatile agents
• Stages of General Anesthesia: Induction (loss of pain sensation), Combative excitement (danger period), Maintenance (relaxation, loss of reflexes)
• Phases of General Anesthesia: Induction (Stage 1 & 2), Maintenance (Stage 3), Recovery (post-Stage 3)

Local Anesthesia

• Lidocaine: Local anesthetic and anti-arrhythmic
  • Indications: Infiltration anesthesia, nerve blocks
  • Adverse Effects: Local reactions, hypotension, incontinence, paresthesia, seizures

Neuromuscular Junction Blocking Agents

Depolarizing Agents

• Succinylcholine: Paralyzes patient for intubation
  • Adverse Effects: Hyperkalemia, muscle pain, malignant hyperthermia
  • Malignant Hyperthermia Treatment: Dantrolene
  • Nursing Interventions: Monitor vital signs, initiate cooling measures, administer 100% O2, administer dantrolene

Non-Depolarizing Agents

• Medications: Pancuronium, Atracurium, Cisatracurium
• Indications: Muscle relaxation during surgery, mechanical ventilation

Upper Respiratory Tract Medications

• Antitussives: Dextromethorphan (Robitussin)
  • Indications: Nonproductive cough
  • Adverse Effects: Drowsiness, dry mucous membranes
  • Drug Interactions: MAOIs
• Topical Nasal Decongestants: Oxymetazoline (Afrin)
  • Adverse Effects: Rebound congestion, mucosal ulcerations
  • Nursing Interventions: Do not use for more than 5-7 days
• Oral Decongestants: Pseudoephedrine, Phenylephrine
• First-Generation Antihistamines: Diphenhydramine (Benadryl)
  • Adverse Effects: Drowsiness, anticholinergic effects
  • Pediatric Considerations: Test at home before travel
• Second-Generation Antihistamines: Loratadine (Claritin)
  • Adverse Effects: Fewer compared to first-generation
  • Indications: Patients who need to remain alert
• Expectorants: Guaifenesin (Mucinex)
  • Indications: Coughing up secretions
• Mucolytics: Acetylcysteine
  • Indications: Thick secretions, acetaminophen overdose, acute renal failure

Lower Respiratory Tract Medications

Pathophysiology

• Asthma: Bronchoconstriction
• COPD: Chronic bronchitis (mucus production), Emphysema (air space enlargement)
• ARDS: Acute lung injury, alveolar capillary membrane damage

Medications

• Epinephrine: Beta 1 and 2 agonist, rescue inhaler
• Albuterol: Beta 2 agonist, rescue inhaler
  • Adverse Effects: Cardiac arrhythmias, increased heart rate, increased blood pressure
• Anticholinergics: Ipratropium (Atrovent)
  • Adverse Effects: Dry mouth, urinary retention
• Inhaled Glucocorticoids: Budesonide
  • Nursing Interventions: Administer after albuterol, rinse mouth after use
• Leukotriene Receptor Antagonists: Montelukast (Singulair)
  • Adverse Effects: Multiple drug interactions

Review from Exams 1 and 2

Anti-Inflammatories

• Adverse Effects: GI bleeding, liver function monitoring (ALT/AST)
• Acetaminophen: Hypothalamus action for fever reduction, hepatotoxicity
• Ibuprofen: First-line for rheumatoid arthritis
• Auranofin: Second-line for rheumatoid arthritis
  • Adverse Effects: Bone marrow suppression, renal toxicity, GI effects, rhabdomyolysis

Opioids and Narcotics

• Adverse Effects: Respiratory depression, urinary retention
• Antidote for overdose: Naloxone (Narcan)
• Morphine: Primary narcotic agonist
• Sumatriptan: Preferred for migraines over ergotamines

Antivirals

• Medications: Oseltamivir (Tamiflu) for influenza, Remdesivir for COVID-19
• CD4 Count: Higher count indicates effective treatment

Antifungals

• Considerations: Avoid alcohol, monitor ALT/AST

Antihypertensives

• ACE Inhibitors: Prevent conversion of angiotensin I to II
  • Adverse Effects: Angioedema, dry cough, hyperkalemia
• ARBs: Block angiotensin II receptors
• Beta Blockers: Selective (beta-1) and non-selective
• Calcium Channel Blockers: Dihydropyridines (vascular) and non-dihydropyridines (heart rate)

Heart Failure

• Digoxin: Monitor for toxicity (yellow halos), antidote is Digibind
• Anticoagulants: Heparin (PTT), Warfarin (INR), Rivaroxaban
  • Antidotes: Protamine sulfate for heparin, Vitamin K for warfarin

Diuretics

• Loop Diuretics: Furosemide (Lasix), potassium-wasting
  • Adverse Effects: Hypokalemia
• Potassium-Sparing: Spironolactone
  • Adverse Effects: Hyperkalemia
• Thiazide-Like: Hydrochlorothiazide
  • Adverse Effects: Hyperuricemia, elevated blood sugar
• Osmotic: Mannitol
• Carbonic Anhydrase Inhibitors: Used for glaucoma

Anemia

• Iron Supplementation: Ferrous sulfate via straw to prevent staining
  • Adverse Effects: GI upset, dark stools
  • Antidote for overdose: Deferoxamine
• Folic Acid and Vitamin B12: Used for megaloblastic anemia
• Epoetin Alpha: Stimulates RBC production

General Concepts

• Five Rights of Medication: Right dose, time, patient, route, drug
• Pharmacokinetics: Absorption, distribution, metabolism, excretion
• Half-Life: Time for drug concentration to halve
• Lab Values: Glucose (70-110), A1C (>6.5% indicates diabetes), Potassium (3.5-5), Creatinine (>1.3 indicates kidney damage), WBC (5-10 or 4-11), ALT/AST (indicative of liver disease), CD4 count (500-1200), TSH (high in hypothyroidism, low in hyperthyroidism)

Final Tips

• Review study guide thoroughly.
• Practice teaching the material.
• Take practice tests.
• Good luck on the final exam!