Pathopharmacology

Final Exam Study Guide

NORMAL LAB VALUES
Kidney
o BUN: 10-20 mg/dL
o Cr: 0.6-1.2 mg/dL

Liver
o ALT: 5-35 IU/L
o AST: 5-40 IU/L

Complete Blood Count (CBC)

o WBC: 5,000-10,000/mm3
o Platelet: 150,000-400,000

APPT: Heparin
o Normal: 30-40 sec
o Therapeutic: ~60-70 sec

PT: 11.0-12.5 sec

INR: Warfarin
o Normal: 0.8-1.1
o Therapeutic: 2-3

H&H
o Hematocrit: 42-52% (male), 37-47% (female)
o Hemoglobin: 14-18 g/dL (male), 12-16 g/dL (female)

Blood Glucose: 70-110 mg/dL

Cholesterol: <200
LDL: <130
HDL: >45
Triglycerides: <150 mg/dL

Calcium: 8.5-10.5 mg/dL

Magnesium: 1.2-2.0 mEq/L

Phosphorous: 3.0-4.5 mg/dL

EXAM 1: M3 IMMUNITY & M4 MOBILITY

E1: IMMUNITY (3-5)
Diseases:
Exaggerated immune response: acute hypersensitive rxn (mild to severe), autoimmune
disorders
o Anaphylaxis
Suppressed immune response immunodeficiency; ex: transplant rejection, neoplasms,
autoimmune disease, viral invasion
Herpes Zoster shingles; inflammation of dorsal root ganglia, usually along dermatomes
Influenza FACTS, pneumonia is common complication
Hepatitis C liver inflammation
HIV human immunodeficiency virus
Epinephrine: nonselective adrenergic agonist
o Pharmacotherapeutics: anaphylactic shock, allergic reactions, possibly asthma
o Pharmacodynamics: stimulates both cells (dilating) & cells
(constricting)
Acts directly on the postsynaptic adrenergic receptors
Alpha usually cardiac = causes vasoconstriction
Effect is increased systolic pressure and decreased diastolic pressure (BP)
Beta 1 & 2 usually respiratory = causes bronchial dilation
Alleviates bronchospasm, wheezing, dyspnea
o Adverse Effects: HTN, anxiety, cardiac arrhythmias (tachycardia), cerebrovascular
disease (cerebral hemorrhage-brain bleed); hyperglycemia; tremors, weakness, ,
sweat, may feel heart palpitations
o Labs to be Monitored: kidney, liver; BG; Vitals (BP, HR, O2); Cardiac: EKG strips
o Patient Teaching: duration 1-4 hours; diabetic BG ; dont take if on BB
(overstimulate beta receptor bc it is being blocked and causes the alpha receptors to
dominate cause high HTN), in labor, anesthesia
Oseltamivir: Neuraminidase (protein or virus) inhibitor
o Pharmacotherapeutics: influenza
o Pharmacodynamics: drug stops the protein on influenza virus from breaking off
and spreading (budding) which is why it works best in the first 48 hours
o Adverse Effects: N/V, bronchitis, pneumonia (side effect of influenza itself),
insomnia, vertigo
o Labs to be Monitored: Kidney (BUN, Cr); urine I&O, color, hydration level; RR,
breathing
o Patient Teaching: diabetic watch BG (fructose content in drug); effective in first 48
hours; caution in pt with airway problems
Acyclovir: purine nucleoside analogues
o Pharmacotherapeutics: all herpes viruses
o Pharmacodynamics: enzyme in virus (viral cell) absorbs, inhibits viral
replication
o Adverse Effects: Tremors, involuntary muscle spasms; Neuro: lightheadedness,
headaches, tremors; lack of appetite, dehydration; GI; NEPHROTOXICITY
Severe: hallucinations, coma
o Labs to be Monitored: Kidney (BUN, Cr); I&O (urine: amber, tea colored)
o Patient Teaching: Watch urine, I&O, drink lots of water (high risk of dehydration),
watch for side effects (neurological and GI), breast feeding moms feed either right
after taking drug or hours after it was taken, regular interval administration;
Valproic acid (seizure): decreases effectiveness
Interferon Alfa-2a: cytokine
o Pharmacotherapeutics: Hepatitis C, Some times of cancer: pro-inflammatory, antiviral, anti-proliferative properties (keeps cancer cells from multiplying)
o Pharmacodynamics: inhibits viral replication DNA synthesis & RNA

Adverse Effects: Neuro: dizziness, confusion, lethargy, depression; GI: anorexia, N/V,
change in taste; Flu-like symptoms: fatigue, malaise; BP problems, cardiac
arrhythmias, Blood effects (bone marrow disorders), low platelet count issue
with clotting
o Labs to be Monitored: kidney, liver; Cardio EKG; CBC - blood toxicity; Psychosocial
things
o Patient Teaching: Monthly blood draw (labs), s/s of kidney/liver failure, no
pregnancy, injection technique; if given at night may be able to sleep through s/s;
needs to be refrigerated; no alcohol; caution in pt on theophylline (asthma) or HIV
HAART therapy: Highly Active Antiretroviral Therapy
o HIV TREATMENT: Combination of drugs to disrupt HIV virus replication
o Drug Classifications:
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs):
incorporate into viral DNA and inhibit reverse transcriptase to stop replication
(work inside cell)
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs): does not
incorporate into viral DNA, inhibits specific site on reverse transcriptase and
prevents RNA to DNA transcription (works inside cell)
Protease Inhibitors (PIs): inhibits protease enzyme and prevents HIV from
maturing and preventing infection of other cells (works inside cell) = Most
potent/adverse effects
Integrase Inhibitors: block enzyme integrase and prevents HIV from entering
host cell nucleus (works inside cell)
Entry Inhibitors: inhibits HIV binding, fusing and entering host cell (works
outside host cell)
o Adverse Effects: GI upset: nausea vomiting; Fever, Chills; Sore throat; Fatigue; Myalgia
= muscle pain; Rash, Itching; Dizziness, HA; Elevated Liver Enzymes
Severe: bone marrow suppression, anemia, neutropenia, black box warning
o Labs to be Monitored: Liver (ALT, AST); CD4 cell count; viral load; resistance
assays; liver, kidney; lipids (cholesterol); electrolytes (dehydration)
o Patient Teaching: adherence to drug therapy lack of can cause mutation
leading to resistance; risk of transmission
o GOAL = increase CD4 count (800-1200 is healthy) & decrease viral load
(<50=undetectable)
o

E1: MOBILITY (2-3)

Diseases:
Muscle spasm: sudden, violent involuntary contraction of a muscle group or group of muscles
Spasticity: certain muscles continuously contracted; may be associated with spinal cord injury
Cerebral Palsy (CP): abnormal muscle tone and coordination
Parkinsons: chronic progressive neurodegenerative disease; slowness in initiation and
execution of movement, increased muscle tone, tremors at rest, gait disturbances
Cyclobenzaprine (Flexeril): centrally acting muscle relaxants
o Pharmacotherapeutics: manages muscle spasms associated with back sprain or
muscle injury
o Pharmacodynamics: relieves muscle spasm through central action... possibly due to
sedative effect
No action at neuromuscular junction = NOT EFFECTIVE ON SPINAL CORD INJURY
o Adverse Effects: drowsiness, dizziness (sedation), hypotension, CNS depression,
Constipation
o Labs to be Monitored: liver, kidney
o Patient Teaching: 1-2 days for full effects; sedation effects; increase fluids; no alcohol,
long-term use may result in independence; orthostatic hypertension; fall risk; interacts
with MAOIs, St. Johns Wort
Baclofen: centrally acting spasmolytics
o Pharmacotherapeutics: relieve some components of spinal spasticity; multiple
sclerosis, CP
o Pharmacodynamics: oral - derivative of GABA, acts at end of spinal cord. Inhibits

transmission of impulses to cause hyperpolarization. As result of this, reduces excessive

reflex activity and allows muscle relaxation
o Adverse Effects: CNS depression, dizziness, drowsiness (sedation); constipation,
hypotension
o Labs to be Monitored: Liver, kidney function, blood glucose levels (drug increases
levels), ROM/pain before and after drug, respiratory status
o Patient Teaching: sedation effects; no alcohol; dont stop abruptly = severe side
effects; interactions with MAOIs & antidepressants; crosses BBB, placenta & into
breast milk
Anti-Parkinsons
Carbidopa-Levodopa: dopaminergic
o Pharmacotherapeutics: treats Parkinsons disease (can take up to 6months for full
effect)
o Pharmacodynamics: combination drug, we want this to cross BBB and turn into
dopamine. We dont have a lot of meds making it to brain, so we combine levodopa with
Carbidopa (doesnt cross BBB) but helps the levodopa cross through
Without Carbidopa, only 2% crosses BBB. With, 10% crosses BBB
Carbidopa prevents levodopa from being metabolized in periphery
o Adverse Effects: BP (orthostatic hypotension), GI upset, pt displays abnormal
mvmts, cardiac arrhythmias
o Labs to be Monitored: Kidney; Vitals: BP
o Patient Teaching: 6 months for full effect; cannot be given with protein/food,
best to give on empty stomach [must space out giving pt protein], timing of medications
want the drug to peak around mealtimes so that the patient doesnt have
trouble swallowing/aspirate. Causes GI upset so give non-protein snack about 30
minutes before administration of drug
Patient usually takes awhile to eat, so space out meals
Keep pt close to nursing station mobility problems
On/Off Syndrome, Freezing
Bromocriptine: dopamine agonist
o Pharmacotherapeutics: Parkinsons disease
o Pharmacodynamics: stimulates dopamine 2 receptor sites (mechanism of action)
o Adverse Effects: has more side effects= causes peripheral vasodilation
hypotension, GI upset, psychiatric disturbances (these disturbances increase with
drug dosage), dizziness, drowsiness
o Labs to be Monitored: Kidney, Liver
o Patient Teaching: can give with food; encourage fluids; On/Off Syndrome eventually
drug may stop working; Freezing pt stops/gets stuck give visual cue
Benztropine: anticholinergic
o Pharmacotherapeutics: Parkinsons Disease tremors and rigidity
o Pharmacodynamics: given with dopamine agonist or dopaminergic if they stop working
[On/Off Syndrome]

EXAM 2: M5 INFLAMMATION & PAIN, M6 CLOTTING, M7 HTN & M8 GAS

EXCHANGE
E2: INFLAMMATION & PAIN (3-5)
Diseases:
Acute pain: increased HR, RR, BP; diaphoretic, pale, anxious, agitated, confused, urine
retention
Chronic Pain: flat affect, decreased physical movement, fatigue, depression, withdrawal
Rheumatoid Arthritis (RA): (+)RF
o Chronic, symmetric inflammation of peripheral joints
o Morning stiffness, tenderness, deformities
o Remission & exacerbations
JIA: (-)RF in 905
o Systemic onset
o Goals: preserve function, prevent deformities, relieve symptoms

Morphine: strong narcotic agonist

o Pharmacotherapeutics: SEVERE acute and chronic pain; anti-anxiety
o Pharmacodynamics: agonist at the mu opioid receptor; reduces release of
neurotransmitters in the presynaptic space and prevents transmission of nociceptive pain
Causes venous system to dilate = decreased blood flow = decreased work load
o Adverse Effects: respiratory depression, orthostatic hypotension, constipation,
CNS sedation, bradycardia; later urinary retention, constipation
o Labs: pancreatic labs: lipase, amylase; kidney, liver
o Patient Teaching: sedative effects; how to manage breakthrough pain; 3-7hr duration
Codeine: mild narcotic agonist
o Pharmacotherapeutics: MILD to MODERATE pain; cough suppressant
o Pharmacodynamics: acts on opioid receptors in CNS (analgesia, euphoria, and
sedation); less respiratory depression than morphine
o Adverse Effects: dry mouth, N/V, constipation
o Labs: Kidney, liver
o Patient Teaching: sedation effects; monitor tolerance, dependence, addiction; can
be combined with NSAID for increased pain control; contraindicated in pt with
asthma/emphysema, other CNS drugs & post-op pt
Naloxone: narcotic antagonist
o Pharmacotherapeutics: morphine overdose, respiratory depression
o Pharmacodynamics: antagonize the effects of narcotics by competing for opioid
binding sites. Used to reverse effects of opiates (analgesic, respiratory depression, OD)
o Adverse Effects: tremors, drowsiness, sweating, tachycardia, hypertension,
relapse into respiratory depression or arrest
o Patient Teaching: IV effective within 2 min; pt may wake up violent & in increased pain
Nonsteroidal Anti-inflammatory Agents (NSAIDs)
Aspirin: Salicylates
o Pharmacotherapeutics: fever and inflammation
HA, neuralgia, dental, dysmenorrhea, pericarditis, RA
o Pharmacodynamics: antipyretic, anti-inflammatory, analgesic, and antiplatelet
o Adverse Effects: GI upset, renal failure, bleeding, false urine testing for glucose in
diabetics; salicylate poisoning (respiratory alterations; fluid, electrolyte, and acidbase imbalances; seizures; high temps; and shock leading to coma or death)
o Labs: CBC (platelets), kidney, liver
o Patient Teaching: OTC drugs, herbal supplements; no more than 4g;
contraindicated in peptic ulcer disease, bleeding disorders, confused pt, children with flulike symptoms (Reyes syndrome); black box warning; interacts with anticoagulants
Acetaminophen: para-aminophenol derivative
o Pharmacotherapeutics: mild or moderate pain, fever hypersensitivity to aspirin
Analgesic, antipyretic
o Pharmacodynamics: primarily centrally acting; inhibits prostaglandin synthesis in CNS
o Adverse Effects: generally well tolerated risk for toxicity; rash, urticaria, nausea;
hypoglycemia
o Labs: CBC, BG, kidney, liver
o Patient Teaching: diabetic- hypoglycemic effects, s/s toxicity, OTC drugs; antidote =
acetylcysteine (mucomyst); contraindicated in liver problems risk of
hepatotoxicity; interacts with activated charcoal, antacids, warfarin
Ibuprofen: non-steroidal anti-inflammatory (NSAIDs) prostaglandin synthetase
inhibitor
o Pharmacotherapeutics: anti-inflammatory, analgesic, antipyretic effects
RA, dysmenorrhea, migraines
o Adverse Effects: NV, diarrhea, constipation, liver/renal toxicity, abdominal pain
o Labs: CBC (platelets), kidney, liver
o Patient Teaching: s/s toxic effects (black, tarry stools; dark urine; rashes; wheezing);
inflammatory effects: few days 2 weeks; black box warning increased risk of
MI, stroke; contraindicated in pt with blood dyscrasia, hemophilia, liver disease,
active GI disease; interacts with salicylates
Disease-Modifying Antirheumatic Drugs (DMARDS)

Methotrexate: [non-biological] disease modifying anti-rheumatic drug (DMARD)

o Pharmacotherapeutics: immunosuppressive effects RA, cirrhosis
o Pharmacodynamics: exerts immunosuppressive effects and results production
of cytokines; may result in folate depression (pt may need folic acid)
o Adverse Effects: stomatitis (inflammation of mouth, lips), alopecia, GI upset, fatigue,
hepatic cirrhosis, intestinal pneumonitis, myelosuppression (suppression of bone
marrow)
o Labs: kidney, liver, CBC; bilirubin, GFR, liver biopsy (later on)
o Patient Teaching: 3-6 weeks for symptom relief; may need folic acid; frequent
labs; photosensitivity; pregnancy X; contraindicated in blood dyscrasias
Etanercept: [biological] tumor necrosis factor inhibitor
o Pharmacotherapeutics: RA s/s; plaque psoriasis
o Pharmacodynamics: RA, T cells release inflammatory mediators (cytokines - TNF);
inflammation of synovial membrane and joint destruction. Drug binds specifically to
circulating TNF, prevents it from binding to TNF receptors on cell membranes, and
prevents the response
o Adverse Effects: injection site reactions, URI, diabetes
o Labs: CBC, liver, kidney, CRP, ESR, chest x-ray, TB skin test
o Patient Teaching: SC WEEKLY; 12 weeks for therapeutic effect; avoid live
vaccinations; produced by recombinant DNA technology; used with methotrexate
for RA treatment

E2: CLOTTING (2-3)

Heparin: anticoagulant
o Pharmacotherapeutics: prevents clot development; DVT prevention of blood clots
No effect on clots already formed
o Pharmacodynamics: Rapidly promotes inactivation of factor X, which prevents
conversion of prothrombin to thrombin; interferes with final steps of clotting cascade
o Adverse Effects: bleeding, thrombocytopenia, bleeding disorders
o Labs: APPT (normal: 30-40sec; therapeutic: ~60-70sec); platelet; baseline
o Patient Teaching: Dur = IV: 2-6hr, SC: 8-12hr; prevent bleeding (soft-bristled
toothbrush); usually sends pt home on warfarin; antagonist = protamine sulfate;
contraindicated in thrombocytopenia, bleeding disorders
Enoxaparin: anticoagulant
o Pharmacotherapeutics: treats DVT; prevents blood clots very predictable
response
o Pharmacodynamics: promotes inactivation of factor X, prevents conversion of
prothrombin to thrombin (same as heparin!); interferes with final stage clotting cascade
o Adverse Effects: bleeding, thrombocytopenia
o Labs: none
o Patient Teaching: prolonged HL = only 1 SC injection/day; s/s bleeding
Warfarin (Coumadin): anticoagulant
o Pharmacotherapeutics: vitamin K antagonist; long-term prevention thrombus
development
o Pharmacodynamics: competitively blocks vitamin K at site of action
o Adverse Effects: bleeding, hemorrhage
o Labs: PT, INR (therapeutic range is 2-3)
o Patient Teaching: interacts with herbal supplements: Ginkgo = increased bleeding risk,
St. Johns Wort = decreased drug effect; 1-2 days for therapeutic effect; s/s
bleeding (bruising, joint stiffness, blood in gums, urine, stool); antidote = vitamin K;
no alcohol; WEEKLY BLOOD DRAWS; take at night; limit green leafy veggies
Clopidogrel: anti-platelet
o Pharmacotherapeutics: reduce atherosclerosis (plaque build-up in arteries); seen in
pt who have had MI or heart stent placements
o Pharmacodynamics: inhibits the binding of ADP to its platelet receptor site. As a
result, inhibits platelet aggregation and prolongs bleeding time. Prevents platelets
from sticking together
o Adverse Effects: NEUTROPENIA, bleeding, GI distress

Labs: WBC (neutrophils fever), platelet count, H&H

Patient Teaching: 3-5 days for therapeutic effects; s/s bleeding; watch for
infection; take with food
Pentoxifylline: hemorheologic
o Pharmacotherapeutics: intermittent claudication for peripheral artery disease
o Pharmacodynamics: increases cAMP levels, decreases platelet aggregations,
promotes vasodilation, decreases blood viscosity
o Adverse Effects: CNS sedation, dizziness, GI upset
o Labs: peripheral pulses
o Patient Teaching: 2-4 weeks to be effective; know sedative effects, assess pedal
pulses/perfusion, stop smoking, take with food; safety not for children
Antihemophillic factor: clotting factor
o Pharmacotherapeutics: deficiency of antihemophillic factor A; comes from
pooled human blood
o Pharmacodynamics: component of blood clotting required for conversion from
prothrombin to thrombin
o Adverse Effects: same as blood transfusion reactions, hypotension, tachycardia,
allergic reaction
o Labs: APPT, H&H
o Patient Teaching: s/s bleeding, storage= refrigeration, only good for 3h after
reconstituted (warmed to room temp), how to draw up concentrate, IV technique;
routine blood levels; HL 12 hours
o
o

E2: HYPERTENSION (2-3)

Diseases:
Hypertension: systolic BP =>140, diastolic BP >=90
Hydrochlorothiazide: diuretic
o Pharmacotherapeutics: HTN (& peripheral edema) in pt with normal renal function
o Pharmacodynamics: Acts on distal convoluted renal tubule to promote Na, Cl
and water excretion by inhibiting reabsorption; also increases excretion of K, bicarb,
and Mg & decreases excretion of Ca
o Adverse Effects: hypokalemia, hypotension, dizziness, lightheadedness
o Labs: electrolytes: K, Na, Cl; BG; kidney, liver
o Patient Teaching: decreases BP by decreasing fluid volume; effective if: no crackling in
lungs, decreased peripheral edema, increased urinary output, decreased BP;
contraindicated if hypersensitive to drug or sulfonamide antibiotics
Metoprolol: beta blocker
o Pharmacotherapeutics: HTN
o Pharmacodynamics: relatively selective beta blocking drug on beta-1 receptors.
Reduces cardiac output by diminishing the SNS response (decreasing HR, contractility,
and renin release)
o Adverse Effects: bradycardia (decreased pulse), hypotension, bronchoconstriction,
nightmares, headache, fatigue, sexual dysfunction, depression, may mask early s/s
hypoglycemia, CNS sedation
o Labs: kidney, liver
o Patient Teaching: interacts with insulin; contraindicated in pt with cardiac problems,
asthma, diabetes; DO NOT abrupt cessation (exacerbation of angina, hypertension,
and arrhythmias); CNS sedation effects; take with food; check pulses, rise slowly;
Verapamil: calcium channel blocker
o Pharmacotherapeutics: HTN
o Pharmacodynamics: prevents movement of extracellular Ca into cell which 1.
Decreases mechanical contraction of the heart, 2. Reduces impulse formation,
and 3. Lessens conduction velocity (the speed with which an electrical impulse can
be transmitted through)
Coronary and peripheral arteries are dilated (decreases PVR) (can cause
reflex tachycardia), myocardial contractility is decreased (DECREASES CO), and
the conduction system is depressed in relation to impulse formation

Adverse Effects: constipation, peripheral (ankle) edema, dizziness, headache,

hypotension
o Patient Teaching: hold if brady-/hypertensive, take with food, watch for reflex
tachycardia; works by blocking calcium = decreased muscle conduction = decreased HR
Captopril: angiotensin-converting enzyme (ACE) inhibitor
o Pharmacotherapeutics: HTN
o Pharmacodynamics: Inhibit angiotensin-converting enzyme, which inhibits
angiotensin I to II conversion, and blocks the release of aldosterone. Blocked
aldosterone promotes Na excretion and K reabsorption.
ACE inhibitors lower PVR = lowers BP
Primary effects are due to ability to reduce BP by decreasing PVR. They do this by
preventing the breakdown of vasodilating substance bradykinin and also
of substance P (potent vasodilator) and preventing the formation of All
(decreased afterload)
o Adverse Effects: DRY cough, hyperkalemia, angioedema, dizziness, fatigue,
headache
o Patient Teaching: give with food, first dose can cause transient hypotension
Losartan: angiotensin II receptor blocker
o Pharmacotherapeutics: HTN
o Pharmacodynamics: blocks binding of angiotensin II to receptors
Blocks the vasoconstriction and aldosterone-secreting effects of angiotensin II
o Adverse Effects: upper respiratory infection, MUSCLE CRAMPS (back, leg pain),
headache, dizziness, angioedema (can occur months, years later)
o Patient Teaching: ARBs stop/block receptor = blocks constriction and aldosterone
release
Eplerenone: aldosterone blocker
o Pharmacotherapeutics: HTN
o Pharmacodynamics: binds selectively to the mineralocorticoid receptors,
thereby blocking aldosterone from binding to these receptors
Inhibits Na and water retention
o Adverse Effects: hyperkalemia, dizziness
o Labs: Electrolytes: K, Na, kidney, liver
o Patient Teaching: 4 weeks to be effective; avoid K-based salt substitutes, avoid K
foods and supplements (bananas, apricots), no grapefruit juice ( drug
availability in blood); interacts with NSAIDs
o

E2: GAS EXCHANGE (3-5)

Diseases:
Upper Respiratory: common cold, allergic or seasonal rhinitis
Lower Respiratory: asthma (inflammation, constriction, mucous production)
Lower Respiratory System
Albuterol: bronchodilator
o Inhaled albuterol = RESCUE DOSE for ASTHMA ATTACK
o Pharmacotherapeutics: quick release for asthma attack; manages asthma
o Pharmacodynamics: selectively stimulates receptors to relax smooth muscles that
cause bronchoconstriction lets airway move in and out much easier
o Adverse Effects: tachycardia, tremors, palpitations, anxiety, headaches,
HYPOKALEMIA
o Labs: BMP/Electrolytes: K level, caffeine intake (sympathomimetic)
o Patient Teaching: 5-15 min for full effect; how/when to use MDI (metered-dose
inhaler); s/s asthma attack, when to go to dr/hospital (if needed more than every
4h), prime device before use to get correct dose (2 sprays), limit caffeine
Fluticasone: inhaled glucocorticoid steroids
o Pharmacotherapeutics: prevention of bronchospasms; long-term treatment for
respiratory disorders [not for sudden symptoms!]
Using a beta-2 agonist (albuterol) first, before fluticasone dilates the
bronchial tree!

Pharmacodynamics: prevents histamine from triggering mast cells; inhibits the

production of leukotriene and prostaglandins through interference with arachiodonic acid
metabolism
o Adverse Effects: thrush (oral fungal infections), sore throat, hoarseness,
coughing, dry mouth, growth stunt
o Patient Teaching: up to 2 weeks for full effects dont stop early!; can stunt
growth/development in kids; rinse mouth after (prevent thrush), take every day
Prednisone: oral glucocorticoids
o Pharmacotherapeutics: get inflammation under control quickly (may use
Prednisone BURST); FOR ACUTE EXACERBATION
o Pharmacodynamics: binds to specific cytoplasmic glucocorticoid receptors;
inhibits leukotrienes to reduce airway inflammation
Short amount of prednisone as a burst to get them under control (for ~7 days)
and they they should go back and take previous two drugs (Fluticasone and
Albuterol)
o Adverse Effects: behavioral changes (aggressiveness, rage, mood swings),
blood sugar or adrenal crisis, mood swings headaches and appetite changes,
sodium and water retention swelling and edema, additive effects
o Labs: BG (blood glucose), kidney, cholesterol (
o Patient Teaching: take daily & early in morning; compliance even with adverse
effects; how to manage hunger small frequent meals; s/s infection; take with milk
to decrease GI upset
Upper Respiratory System
Dextromethorphan: antitussive
o Pharmacotherapeutics: suppresses non-productive cough
o Pharmacodynamics: works in brain on cough reflex center in medulla to prevent
coughing
o Adverse Effects: CNS depression (drowsiness, sedation); GI upset: N/V
o Labs: kidney, liver; mental status, respiratory status
o Patient Teaching: no alcohol; monitor respiratory status; SEROTONIN SYNDROME;
no grapefruit juice; sedation effects; interacts with MAOIs (serotonin syndrome
elevated too high causes hypotension, nausea, excitation, hyperpyrexia [high fever],
coma); contraindicated in pt with asthma, emphysema = we want them to cough!
Fexofenadine (Allegra): antihistamine
o Pharmacotherapeutics: allergies
o Pharmacodynamics: blocks histamine-1 receptors
o Adverse Effects: dry mouth, drowsiness, heartburn, more prone to viral
infections
o Labs: kidney
o Patient Teaching: 2-6 hours for effects; interacts with grapefruit, orange and
apple juice (decreases absorption of drug); take BEFORE s/s; may need to take daily;
encourage fluids, humidifier;
Pseudoephedrine: decongestant
o Pharmacotherapeutics: short term relief of nasal congestion, ear pain
o Pharmacodynamics: causes vasoconstriction in the nasal mucous membranes
which decreases membrane size and promotes drainage and improved airflow
Sympathomimetic = mimics sympathetic nervous system/fight or flight
o Adverse Effects: hypertension restless, tense mood; anxiety, tachycardia,
insomnia
o Labs: GR, BP, blood glucose, alertness
o Patient Teaching: Dur: 4-6hr (reg), 8-12hr (extended); dont end abruptly =
rebound congestion, only take for a week or less, drug may be in combo with other
drugs, monitored and controlled
Guaifenesin: expectorant
o Pharmacotherapeutics: non-productive cough (not nasal congestion)
o Pharmacodynamics: decreases surface tension that decreases viscosity
(liquefies), and you are able to cough up secretions
o Adverse Effects: GI upset: N/V; skin rash; dehydration; headaches, dizziness
o

o
o

Labs: BP (dehydration, smoker), kidney, history of kidney function

Patient Teaching: sedative effects; encourage fluids; no smoking; use humidifier,
take with food, know cause of cough

EXAM 3: M9 GLUCOSE REGULATION, M10 DIGESTION & ELIMINATION, M11

INTRCRANIAL REGULATION & M12 NEOPLASIA
E3: GLUCOSE REGULATION (3-5)
Diseases:
Diabetes Mellitus
o Type 1 = INSULIN DEPENDENT
o Type 2 = INSULIN RESISTANCE IN BODY
o Gestational = during pregnancy
Hyperglycemia: polyuria, polydipsia, polyphagia, dehydration, fatigue, fruity breath, kussmaul
breathing, wt loss, hunger, poor wound healing
Hypoglycemia reduced cognition, tremors, diaphoresis, weakness, hunger, HA, irritability,
seizure
Insulin: glucose decreasing agent (short-acting)
o Pharmacotherapeutics: all types diabetes mellitus, glucose regulation
o Pharmacodynamics: injected insulin mimics effects of endogenous insulin
o Adverse Effects: hypoglycemia (eat appropriately); LIPOATROPHY
o Labs: BG (fasting & Hmg A1C), CBC, electrolytes
o Patient Teaching: count carbs; rotate sites; store open vials at room temp;
special syringe; basal dose (may be necessary); onset 30min-1hr = injection 30-60
min before eating!; interacts with alcohol, beta blockers, thiazide diuretics, MAOIs
Rapid Acting Insulin
Prandial or supplemental/correctional
Onset 10-30 min, peak 30-3 hours, duration 3-5 hours
Give 15 min prior to eating
Short Acting/Regular Insulin
Correctional or an expected rise after eating (prandial
Onset 30min-1hr, peak 2-5 hours, duration 8-12 hours
Adverse Effects: hypoglycemia, Lipodystrophy
PT: avoid alcohol, asceptic technique for administering, disposal of needles,
30-45 min before eating, rotate injection sites, self-monitoring of blood
glucose
Intermediate Acting Insulin (NPH)
Cloudy, used for basal dose, can be mixed with above
Onset 1.5-4 hours, peak 4-12 hours, duration 12-18 hours
Long Acting Insulin
Basal dose, cannot be mixed with any other insulin, and cannot be given
IV/SC pum
Onset 1-4 hours, no peak, duration 24 hours
Glyburide: non-insulin antidiabetic sulfonylureas
o Pharmacotherapeutics: adjunct therapy for DM type 2; hyperglycemia
o Pharmacodynamics: stimulates pancreatic beta cells to produce insulin
o Adverse Effects: hypoglycemia; weight gain; anorexia; metallic taste; dyspepsia
(heartburn)
o Labs: BG (fasting & Hmg A1C); check 2hr after eating = post-prandial
o Patient Teaching: take before 1st meal; drug may stop working 3 Ps = drug
resistance; s/s hypoglycemia eat carbs (quickly absorbed); contraindicated in pt
with hypersensitivity to sulfur
Metformin: non-insulin antidiabetic non-sulfonylureas
o Pharmacotherapeutics: adjunct therapy for DM type 2; overweight pt benefits
First choice for pt with DM type 2

Pharmacodynamics: reduces glucose production by liver; enhances insulin

sensitivity by increasing peripheral glucose uptake
o Adverse Effects: weight loss; anorexia; metallic taste; dyspepsia; LACTIC
ACIDOSIS (hypotension, hyperthermia & respiratory distress); abdominal cramps
o Labs: BG (fasting & Hmg A1C)
o Patient Teaching: take 2x/day (with morning & evening meal); adhere to diet,
exercise; limit alcohol; contraindicated in pt with liver problems, cardiac problems,
surgery & RADIOLOGICAL PROCEDURE; interacts with CONTRAST DYE
Glucagon: glucose elevating agent
o Pharmacotherapeutics: hypoglycemia; insulin OD
o Pharmacodynamics: increases BG - stimulates glycogenolysis in peripheral
tissues
o Adverse Effects: hypotension; respiratory distress; N/V
o Labs: BG (before, during, after)
o Patient Teaching: HL 3-10min; use reconstituted drug ASAP; give supplemental
carb once conscious restore liver glycogen
o

E3: DIGESTION & ELIMINATION (2-3)

Diseases
GERD: heartburn, regurgitation, dysphagia, water brash
H. Pylori: bacteria eats away at mucosal lining; can produce ulcers
PUD: majority have H. pylori; stomach lining red, inflamed; hematemesis; dark/tarry stools; N/V,
weight loss, dyspepsia
Drugs that affect Stomach Acid
Omeprazole: proton-pump inhibitor (PPI)
o Pharmacotherapeutics: GERD (heartburn, regurgitation, dysphasia, water
brash); peptic ulcer disease [stops from getting worse]
o Pharmacodynamics: inhibits the proton pump and parietal cells, decreases the
amount of acid produced and stops secretion
o Adverse Effects: HA; diarrhea; pneumonia; decreased Ca absorption
o Labs: symptoms, CBC (if bloody/tarry stools)
o Patient Teaching: see doctor if heartburn lasts more than a few days; s/s gastric cancer;
take 2 hours before other drugs; take before food (to decrease GERD symptoms);
decreases Ca absorption fall risk, osteoporosis; may take time to work
Ranitidine: H2 receptor antagonist
o Pharmacotherapeutics: GERD; ulcers short period of time or maintenance for
chronic ulcers
o Pharmacodynamics: inhibits ALL day/night BASAL gastric production &
secretion by blocking the histamine-2 receptors in parietal cells
o Adverse Effects: HA; GI upset: constipation, diarrhea, N/V, hepatitis; BLOOD COUNT
CHANGES decreased WBC, platelet & granular site count = infection & bleeding
o Labs: CBC (WBC, platelet, RBC [bleeding risk])
o Patient Teaching: stay away from alcohol, mint; frequent infections; hematemesis
(bloody vomit) can be from ulcer, drug or new ulcer; BLEEDING decreased platelet
count; dizziness, dehydration risk; smoking worsens condition
Aluminum Hydroxide with Magnesium Hydroxide: antacid
o Pharmacotherapeutics: upper respiratory issues heartburn, peptic ulcer
disease
o Pharmacodynamics: neutralize the gastric acid (raise pH) - doesnt STOP
production
o Adverse Effects: constipation (Al), diarrhea (more common) (Mg) [combo balances
these]; HYPOPHOSPHATEMIA = osteoporosis, osteomalacia, softening of bones;
gastric acid rebound; HYPERMAGNESEMIA = if pt has recent GI bleed cardiac
arrest/death;
o Labs: Mg & Phosphate levels, kidney, Ca levels; CMP [complete metabolic panel] or
BMP + Mg & Phosphate levels

Patient Teaching: take 2 hours apart from other drugs; drug interactions; s/s low
phosphate levels (bone issues); tell dr. what other drugs are being taken; GI bleed (s/s
hypermagnesaemia)
Nausea and Vomiting
Metoclopramide: prokinetic
o Pharmacotherapeutics: stimulate peristaltic activity
o Pharmacodynamics: increases motility but not secretions; increases the effect
of acetylcholine on the GI system
Acetylcholine is responsible for normal GI function; increase peristalsis and gastric
emptying
o Adverse Effects: CNS: HA, restlessness, drowsiness; tardive dyskinesia can give
Benadryl to reverse
o Labs: kidney; s/s CNS
o Patient Teaching: risk for tardive dyskinesia (Benadryl to reverse can become
permanent); has CNS effects depression may interfere with mental health and
decision making; suicide risk (depression); dizziness/tremors = fall risk; teach of
interactions (ex: narcotic is interaction and drugs may cancel each other out);
contraindicated in obstruction, seizures, extrapyramidal effects, HI bleed/perforation
sepsis
Ondansetron: antiemetic
o Pharmacotherapeutics: prevent nausea & vomiting
chemo 30 min prior; pregnancy for morning sickness
o Pharmacodynamics: blocks serotonin from stimulating the chemoreceptor
trigger zone
o Adverse Effects: HA; malaise; constipation
IV: cardiac arrhythmias, hypotension, extrapyramidal effects
o Labs: liver (P450), kidney, serotonin (if on SSRI), HR (IV form), dehydration
o Patient Teaching: IV solution can be normal (burning sensation pushed over 2-5
minutes) or diluted (takes away stinging, given over 15 minutes)if pushed too fast
increased risk for IV adverse effects
Magnesium Hydroxide: laxative (saline)
o Pharmacotherapeutics: used to stimulate & promote BM; constipation, bowel
prep
o Pharmacodynamics: salt stimulates water retention = increased pressure in
lumen stimulating a signal that bowel is full & to start peristalsis to have BM
o Adverse Effects: diarrhea (rebound); electrolyte imbalance dehydration
o Labs: BMP, renal, bowel sounds, abdomen extended
o Patient Teaching: know if pt is obstructed or constipated; narcotic could be cause
of constipation; encourage fluids risk for dehydration!; ambulate; take laxative
short term bc intestine can become dependent on drugs stimulation; rebound
constipation if you stop taking it after long-term use; contraindicated in pt with
impaction, elderly & appendicitis
Diphenoxylate HCl with Atropine Sulfate: antidiarrheal
o Pharmacotherapeutics: stops diarrhea
o Pharmacodynamics: stops peristalsis so stool stays in GI longer & water can be
reabsorbed
o Adverse Effects: CNS sedation; abdominal cramping; rebound constipation
o Labs: BMP; stool sample
o Patient Teaching: ATROPINE SULFATE TOXICITY = flushing, dry mouth, hypothermia,
tachycardia, urine retention; abuse; may need probiotic flora; 10 days max;
contraindicated in pt with infection/GI bug
o

E3: INTRACRANIAL REGULATION (3-5)

Diseases:
Cerebral edema increased ICP
Epilepsy: 2 or more unprovoked seizures
Seizures: abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the
brain

Mannitol: osmotic diuretic

o Pharmacotherapeutics: promote water excretion = reduce cerebral edema in
the brain, renal function, high BP
ICP >15 for >10min
o Pharmacodynamics: increases the osmolarity of the blood, thereby drawing water
out of edematous brain tissue and into the vascular system for elimination via the
kidneys
o Adverse Effects: hypotension, dizziness, HYPONEUTREMIA (Na levels diluted
seizures)
o Labs: serum osmolality (275-295), kidney, vitals (BP, HR); hourly urine output (stop
drug if less than 30-50mL/hr)
o Patient Teaching: HEART FAILURE chest pain, difficulty breathing, peripheral
swelling/edema (fluid volume overload); monitor I&O; contraindicated in pt on other
diuretics or MAOIs, low BP, IICP or renal problems (heart failure)
Carbamazepine: antiepileptic hydantoins
o Pharmacotherapeutics: SEIZURES: complex-partial, generalized tonic-clonic or
mixed
o Pharmacodynamics: DECREASES SODIUM INFLUX = binds to Na channels to
decrease frequency of action potentials and decreasing seizures
o Adverse Effects: SUICIDAL, BLOOD DYSCRASIAS [aplastic anemia ( RBC),
thrombocytopenia ( platelets) & agranulocytosis ( WBC)]; MENTAL
SLOWING, CNS sedation
o Labs: CBC (blood dyscrasias)
o Patient Teaching: no grapefruit; titrate upward; dont stop abruptly; FATAL with
MAOIs
Diazepam: antiepileptic benzodiazepines
o Pharmacotherapeutics: status epilepticus (first line rapid-acting anti-seizure med)
o Pharmacodynamics: increases effects of GABA
o Adverse Effects: SUICIDAL, CNS depression, respiratory distress
o Labs: vitals, respiratory, CNS
o Patient Teaching: RAPID ONSET (10-20sec IV); keep emergency resuscitation
equipment & O2 at bedside (no more than 5mg/min); given no more than 5 ep./month
& no more than 1 ep/5 days

E3: NEOPLASIA (2-3)

Bevacizumab: targeted therapy antibodies

o Pharmacotherapeutics: non-small cell lung, kidney & colon cancer
o Pharmacodynamics: INHIBITS ANGIOGENESIS = acts on vasco-endothelial growth
factor to PREVENT the growth of new blood vessels because cancer cannot grow without
that extra blood supply
o Adverse Effects: allergic reactions, often pt are pre-medicated (Benadryl); HTN;
bleeding reason this is not used for CNS cancers; mouth sores, diarrhea, anorexia
common to all chemo; WOUND INHISCENCE (surgery 28 days before use of this drug or
after stopping this drug!)
o Labs: CBC: RBC, WBC; Low blood cell counts = fatigue
o Patient Teaching: 100 DAY DURATION; can cause birth defects use birth control;
pre-medicate pt with Benadryl; monitor vitals closely at beginning of therapy
Vincristine (V): cell cycle specific vinca alkaloids
o Pharmacotherapeutics: leukemia & lymphoma adults and peds
o Pharmacodynamics: inhibits mitosis so cells can no longer divide
o Adverse Effects: Vesicant = extravasation; neurotoxicity; loss of deep tendon
reflexes; can cause paralytic ileus (bowel loses ability to function watch for
constipation); sexual dysfunction
o Labs: CBC
o Patient Teaching: cannot be given intrathecally!; vesicant watch for s/s and when
to report to dr., pt may need stool softner; push fluids & fiber (fruits and veggies)
Cyclophosphamide: cell cycle non-specific alkylating agents

Pharmacotherapeutics: hematologic cancers, solid cancers (breast cancer &

certain small cell lung cancers)
o Pharmacodynamics: attaches to alka-group and then essentially get DNA breakage
o Adverse Effects: drastically REDUCED WBC; STERILE HEMORRHAGIC CYSTITIS;
CARDIOTOXICITY (fluid retention, fatigue, arrhythmias); SECONDARY MALIGNANCIES
o Labs: CBC
o Patient Teaching: dont take past 5PM; push fluids; interacts with general
anesthesia
Doxorubicin (V): cell cycle non-specific anti-tumor antibodies
o Pharmacotherapeutics: blood cancers; solid cancers
o Pharmacodynamics: blocks synthesis of new RNA & DNA
o Adverse Effects: N/V; CARDIOTOXICITY (shows an infinity for myocytes); VESICANT;
RADIATION RECALL: return of redness associated with previous radiation therapy
o Labs: CBC, BNP [brain natriuretic peptide heart failure]
o Patient Teaching: causes RED URINE; watch for EXTRAVASATION; contraindicated in
pt with history of heart failure or cardiomyopathy
Tamoxifen: hormone antagonist
o Pharmacotherapeutics: breast cancer
o Pharmacodynamics: competes with estrogen for binding sites
o Adverse Effects: HOT FLASHES (initially); PRE-MENSTRUAL SYNDROME: weight gain
(fluid retention), lightheadedness, vaginal bleeding; EYE PROBLEMS: decrease in visual
acuity, corneal changes; ENDOMETRIAL PROLIFERATION STIMULATION: can cause
thromboembolic events (clotting)
o Labs: Thyroxin, Calcium
o Patient Teaching: eye exam prior; know fertility goals; HYPERCALCEMIA = urine
retention, malaise, vomiting, constipation
Terms:
o Acute emesis immediately following treatment
o Adjuvant therapy after radiation to destroy residual cells
o Alkylating agent attaches alkyl group to cause DNA breakage cell cant replicate
o Anti-tumor antibiotics interfere w/ DNA-directed RNA synthesis
o Cell cycle growth, development and replication
o Cell cycle non-specific acts throughout all phases of cell cycle
o Cell cycle specific acts on specific part of cell cycle
o Cell kill theory chemo used to reduce # of cancer cells so body can take over
o Chemotherapy cancer treatment
o Combination chemotherapy different types used together
o Consolidation therapy given after remission: increases probability of a cure and
prolong life
o Delayed emesis experienced later after treatment
o First order kinetics certain percentage of cells die based on dosage
o Induction therapy given at beginning to induce remission
o Intensification after remission; inductions drugs given at high doses to improve
chance of cure and a longer remission
o Maintenance therapy low dose, long term
o Neoadjuvant therapy reduce tumor burden
o Palliative therapy manage symptoms and provide comfort
o Salvage therapy last effort
o Tumor burden number of cells that make up a tumor
o

EXAM 4: M13 MOOD & AFFECT, M14 THERMOREGULATION, M15 PERFUSION,

M16 INFECTION
E4: MOOD & AFFECT (5-7)

Lorazepam: benzodiazepine for anxiety

Buspirone: non-benzodiazepine for anxiety

Sertraline: selective serotonin reuptake inhibitors
Haloperidol: typical antipsychotic

E4: THERMOREGULATION (5-7)

Levothyroxine: thyroid hormone

Methimazole: anti-thyroid compound

E4: PERFUSION (12-15)

Lovastatin: antihyperlipidemics statin

Niacin: antihyperlipidemics nicotinic acid
Ezetimibe: antihyperlipidemics cholesterol absorption inhibitor
Nitroglycerin: vasodilator - nitrates

E4: INFECTION (10-13)

Penicillin G: penicillin
Vanomycin: tricyclic glycopeptide antibiotic
Gentamicin: aminoglycosides
Clindamycin: lincosamides
Erythromycin: macrolide antibiotic

Ciprofloxacin: quinolones/fluoroquinolones