Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Signs, Symptoms, and Causes of Skin Disorders Introduction Skin disorders comprise a diverse spectrum of conditions that may arise from microbial infections, immune system malfunctions, genetic predispositions, or environmental exposures. Prompt identification of these disorders through their clinical signs and symptoms is essential for accurate diagnosis and appropriate therapeutic intervention. This section examines several common dermatological conditions—including impetigo, psoriasis, herpes simplex virus type 1 (HSV-1), nevi, varicella (chickenpox), zoster (shingles), pemphigus, urticaria, candidiasis, tinea capitis, and skin cancers—detailing their etiology and typical presentations. Common Dermatological Conditions Impetigo Impetigo is a superficial bacterial skin infection that is especially prevalent in children but may also occur in adults with compromised skin integrity. Caused primarily by Staphylococcus aureus—and less frequently by Streptococcus pyogenes—this highly contagious condition is characterized by erythematous sores that rapidly evolve into honey-colored crusts. The lesions often appear on the face, particularly around the mouth and nose, and may spread through direct skin contact or via contaminated objects. Psoriasis Psoriasis is a chronic, immune-mediated skin disorder in which overactive T-cells stimulate excessive production of keratinocytes, resulting in thickened, scaly plaques. These plaques often display a silvery-white appearance and are commonly found on the scalp, elbows, knees, and lower back. While non-infectious, the disease can significantly impact quality of life due to itching, burning sensations, and cosmetic concerns. Genetics, stress, and environmental triggers may contribute to its onset or exacerbation. Herpes Simplex Virus Type 1 (HSV-1) HSV-1 is a viral pathogen that predominantly causes oral herpes, manifesting as painful vesicles or “cold sores” around the lips and mouth. Transmission occurs through direct contact with infected saliva, mucosal surfaces, or contaminated objects. Early symptoms may include localized tingling, burning, or itching before the formation of fluid-filled blisters that eventually crust over. Nevi Nevi, more commonly referred to as moles or birthmarks, are localized accumulations of melanocytes. While typically benign, changes in color, size, or symmetry can indicate malignant transformation into melanoma. Risk factors for atypical nevi include excessive ultraviolet (UV) exposure, genetic predisposition, and immune suppression. Varicella (Chickenpox) Varicella, caused by the varicella-zoster virus (VZV), is a highly contagious disease that primarily affects children but can also occur in unvaccinated adults. It is distinguished by an itchy, vesicular rash that progresses through macular, papular, vesicular, and crusting stages. Accompanying symptoms often include fever, malaise, and loss of appetite. Zoster (Shingles) Shingles is the reactivation of dormant VZV in sensory nerve ganglia, typically occurring decades after a primary varicella infection. The condition produces a unilateral, dermatomal rash with painful vesicles, often located on the trunk or face. Severe cases may lead to postherpetic neuralgia, characterized by prolonged nerve pain after rash resolution. NR 293 Skin and Skin Disorders Pemphigus Pemphigus represents a rare autoimmune blistering disorder in which autoantibodies target desmogleins—proteins critical for cell adhesion in the epidermis. This immune attack results in fragile blisters on the skin and mucous membranes, particularly within the mouth and genital regions. Without appropriate treatment, pemphigus can cause extensive skin loss and secondary infections. Urticaria (Chronic Hives) Chronic urticaria is characterized by recurrent outbreaks of intensely pruritic, erythematous welts. It often arises from type I hypersensitivity reactions to allergens, medications, or other triggers. In some cases, no definitive cause is identified (idiopathic urticaria). Severe reactions may be accompanied by angioedema affecting the lips, eyelids, or throat. Secondary Infections Secondary skin infections occur when primary lesions become colonized by opportunistic pathogens. For example, scratching an eczema lesion can introduce S. aureus, leading to impetiginization, or fungal overgrowth may follow antibiotic use due to disruption of normal microbial flora. Candidiasis Cutaneous or mucosal candidiasis is caused by Candida albicans, a yeast that thrives in moist environments such as skin folds or mucous membranes. It presents with erythema, maceration, intense itching, and sometimes a thick, white exudate. Immunocompromised individuals and those with prolonged antibiotic use are at higher risk. Tinea Capitis Tinea capitis is a dermatophyte fungal infection affecting the scalp and hair shafts, caused by species such as Trichophyton or Microsporum. It manifests as scaly patches, alopecia, inflammation, and itching. Transmission may occur via contaminated combs, hats, or contact with infected pets. Skin Cancers Skin cancers range from benign lesions, such as seborrheic keratoses, to premalignant conditions like actinic keratoses, which can progress to squamous cell carcinoma. Basal cell carcinoma and melanoma represent more serious forms, often linked to prolonged UV exposure, genetic factors, and immune suppression. NR 293 Skin and Skin Disorders – Summary Table Disorder Signs and Symptoms Causes Impetigo Erythematous sores evolving into honey-colored crusts, mainly on the face Staphylococcus aureus or Streptococcus pyogenes Psoriasis Silvery plaques, itching, burning, dry skin patches Autoimmune T-cell activation; accelerated keratinocyte turnover Herpes Simplex Virus (HSV-1) Tingling, burning, fluid-filled blisters near lips Direct contact with infected saliva or mucosa Nevi Pigmented moles or spots; potential malignant transformation Genetic predisposition, UV exposure Varicella Itchy, blister-like rash, fever, malaise Varicella-zoster virus Zoster Painful, dermatomal vesicular rash Reactivation of varicella-zoster virus Pemphigus Fragile blisters, skin shedding, mucosal involvement Autoimmune attack on desmoglein proteins Urticaria Intensely itchy, raised welts, possible angioedema Hypersensitivity to allergens or idiopathic Candidiasis Red, itchy rash with possible white discharge Candida albicans overgrowth Tinea Capitis Scaly patches, hair loss, itching Dermatophyte fungal infection from contact or fomites Skin Cancers Pigmented, scaly patches; nodular lesions UV exposure, genetic mutations Conclusion The wide variety of dermatological disorders underscores the importance of clinical awareness and timely management. While conditions such as impetigo, varicella, and tinea capitis are often treatable with antimicrobial therapies, autoimmune diseases like psoriasis and pemphigus require targeted immunomodulatory approaches. Vigilance in monitoring lesions such as nevi and actinic keratoses is critical to preventing malignant transformation. A thorough understanding of these conditions supports effective patient education, early intervention, and improved treatment outcomes. References Centers for Disease Control and Prevention. (n.d.). Infectious skin diseases. https://www.cdc.gov National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Skin diseases. https://www.niams.nih.gov NR 293 Skin and Skin Disorders Smith, J., & Brown, R. (2020). Dermatological conditions: A guide for clinicians. Clinical Press.

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Gastrointestinal Conditions: Causes, Signs, and Symptoms Hiatal Hernia A hiatal hernia occurs when the upper portion of the stomach moves upward through the diaphragm’s esophageal opening into the chest cavity. This displacement can result from congenital anatomical abnormalities such as a short esophagus, injury to the diaphragm, or progressive weakening of supportive muscles due to aging. In addition to the mechanical factors, increased intra-abdominal pressure from obesity, pregnancy, or chronic coughing may exacerbate the condition.Common clinical manifestations include a burning sensation in the chest (heartburn), regurgitation, excessive belching, and discomfort that often worsens when lying flat. Pain localized behind the breastbone may mimic cardiac discomfort, making proper diagnosis essential. Chronic Gastritis Chronic gastritis is a prolonged inflammation of the stomach’s mucosal lining, often developing gradually and persisting for years if untreated. It is most frequently linked to infection with Helicobacter pylori, but can also result from prolonged nonsteroidal anti-inflammatory drug (NSAID) use, excessive alcohol intake, autoimmune disorders, certain bacterial or viral agents, and allergic reactions.The hallmark symptoms are diminished appetite, persistent nausea, vomiting that may contain traces of blood, and gnawing abdominal pain. Over time, untreated chronic gastritis can lead to mucosal atrophy, impaired nutrient absorption, and increased risk of gastric cancer. Peptic Ulcer Disease Peptic ulcer disease (PUD) is characterized by open sores in the lining of the stomach, lower esophagus, or duodenum. Most cases are attributed to Helicobacter pylori infection or chronic NSAID use, although rare cases may be associated with Zollinger–Ellison syndrome, a condition involving excess gastric acid production from pancreatic or duodenal tumors.Patients may present with epigastric pain that is relieved or worsened by eating, nausea, vomiting, unexplained weight loss, and, in severe cases, gastrointestinal bleeding. Untreated ulcers can lead to perforation or obstruction, making prompt treatment critical. NR 293 Final Exam Concept Review Pathophysiology Condition Primary Causes Common Signs and Symptoms Cirrhosis Chronic alcohol misuse, chronic hepatitis infections Fatigue, anorexia, abdominal swelling (ascites), yellowing of the skin and eyes (jaundice), increased infection risk, and dilated veins in the esophagus (esophageal varices). Esophageal Varices Obstructed portal blood flow from liver disease Often symptom-free initially; later may cause severe bleeding, vomiting of blood, and shock. Potential for liver failure. Hepatic Encephalopathy Advanced liver damage impairing brain function Confusion, forgetfulness, characteristic musty breath odor, involuntary hand flapping (asterixis), slurred speech; diagnosed via blood ammonia levels and clinical evaluation. Inflammatory and Obstructive Conditions Crohn’s Disease Crohn’s disease is a chronic inflammatory bowel disorder that can affect any segment of the gastrointestinal tract, from mouth to anus, though it most often involves the small intestine and the beginning of the large intestine. The disease is characterized by deep ulcerations and patchy areas of inflammation (skip lesions). Symptoms include persistent diarrhea without visible blood, abdominal cramping, poor nutrient absorption, and unintended weight loss. Periods of flare-ups are often followed by remission phases, but complications such as fistulas and strictures are common. Ulcerative Colitis Ulcerative colitis is a chronic inflammatory disease confined to the colon and rectum, typically beginning at the rectum and extending upward in a continuous pattern. The inflammation involves the mucosal and submucosal layers, leading to ulcer formation. Clinical presentation includes cramping abdominal pain, frequent bloody diarrhea, urgency with an incomplete sense of evacuation (tenesmus), and systemic symptoms such as fever and fatigue. Long-standing disease increases colorectal cancer risk, making surveillance colonoscopies important. Appendicitis Appendicitis is the acute inflammation of the appendix, usually resulting from obstruction caused by fecaliths, infection, or lymphoid hyperplasia. Ischemia from impaired blood flow may also play a role. Symptoms often begin with generalized abdominal discomfort that localizes to the right lower quadrant (McBurney’s point), accompanied by tenderness, guarding, and low-grade fever. Nausea and vomiting may be present. This condition requires urgent surgical removal of the appendix to prevent rupture and peritonitis. Intestinal Obstruction An intestinal obstruction refers to a mechanical or functional blockage that prevents the normal passage of contents through the intestines. Mechanical causes include tumors, adhesions from prior surgeries, hernias, and severe constipation, whereas functional obstruction (ileus) can occur after abdominal surgery or with severe illness. Clinical features include cramping abdominal pain, vomiting, bloating, and absence of stool or gas passage. Without prompt management, obstruction can lead to bowel ischemia and perforation. References McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier. NR 293 Final Exam Concept Review Pathophysiology Ignatavicius, D. D., & Workman, M. L. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Medication Teaching Plan Authors: Jaime Weisel and Nnamdi OmeludikeCourse: Pharmacology for Nursing PracticeInstructor: Professor Gloria King-HoffDate: December 2018 Overview of the Project This educational project focuses on Symproic (generic name: Naldemedine), an oral medication classified as an opioid receptor antagonist. Symproic is primarily prescribed for opioid-induced constipation (OIC), a condition that frequently affects patients undergoing long-term opioid therapy for chronic pain. According to Hu and Bridgeman (2018), OIC is characterized by “new or worsening constipation occurring when initiating, changing, or increasing opioid use,” and is considered the most prevalent gastrointestinal complication of opioid treatment (p. 601). The educational material is designed for adult patients with chronic pain—often arising from musculoskeletal disorders, neuropathic pain, or cancer-related pain—who require opioid analgesics for symptom management. At present, there is no established safety or efficacy data for pediatric use, so the focus remains exclusively on the adult population. Purpose of the Educational Brochure The brochure serves as an informative guide to: According to Markham (2017), patients treated with Symproic demonstrated “significantly greater improvements in the frequency of bowel movements per week compared with placebo” in clinical trials (p. 925). These benefits were observed consistently over 12, 24, 36, and 52 weeks, underscoring the medication’s sustained efficacy. Mechanism and Clinical Relevance Symproic works by selectively blocking opioid receptors in the gastrointestinal tract without interfering with the analgesic effects of opioids on the central nervous system. This targeted action reduces constipation while allowing patients to continue receiving necessary pain relief. Unlike laxatives, which address symptoms superficially, Symproic directly counteracts the opioid-driven suppression of bowel motility. NR 293 RUA Medication Teaching Plan Table 1 Summary of Symproic (Naldemedine) for Opioid-Induced Constipation Feature Details Medication Name Symproic (Naldemedine) Indication Management of opioid-induced constipation (OIC) in adults Target Population Adults with chronic pain undergoing opioid therapy Mechanism of Action Peripherally acting µ-opioid receptor antagonist (PAMORA) that restores bowel motility Benefits Increases bowel movement frequency, reduces straining, improves patient comfort Clinical Evidence Statistically significant improvement in bowel movement frequency vs. placebo (Markham, 2017) Dosage Form Oral tablets Common Side Effects Abdominal pain, diarrhea, nausea, flatulence (RxList, n.d.) Contraindications Known hypersensitivity to naldemedine or any tablet component; suspected or known gastrointestinal obstruction Clinical Importance for Nursing Practice For nurses, understanding the appropriate use of Symproic is essential for effective patient education and care planning. Patient teaching should include: Through proper counseling, nurses can empower patients to manage OIC effectively without compromising pain control. References Constipation too? Ready to make a move? (n.d.). Retrieved from https://www.symproic.com/ Hu, K., & Bridgeman, M. B. (2018). Naldemedine (Symproic) for the treatment of opioid-induced constipation. P&T: A Peer-Reviewed Journal for Managed Care & Formulary Management, 43(10), 601–627. NR 293 RUA Medication Teaching Plan Kaufman, M. B. (2017). Pharmaceutical approval update. P&T: A Peer-Reviewed Journal for Managed Care & Formulary Management, 42(8), 502–504. Markham, A. (2017). Naldemedine: First global approval. Drugs, 77(8), 923–927. http://dx.doi.org.chamberlainuniversity.idm.oclc.org New drug approvals. (2017). P&T: A Peer-Reviewed Journal for Managed Care & Formulary Management, 42(5), 296–297. Symproic (Naldemedine Tablets): Side effects, interactions, warnings, dosage & uses. (n.d.). Retrieved from https://www.rxlist.com/symproic-drug.htm

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Medication Teaching Plan Overview of Xtampza ER (Oxycodone) Xtampza ER is an extended-release formulation of oxycodone, a potent opioid analgesic classified as a Schedule II controlled substance under the United States Controlled Substances Act. Oxycodone belongs to the narcotic (opioid) drug class and is primarily indicated for managing moderate to severe pain that requires continuous, around-the-clock opioid therapy when alternative treatment options are inadequate. The drug exerts its effects by binding to mu-opioid receptors within the central nervous system (CNS), altering the perception of pain and producing generalized CNS depression (Vallerand, Sanoski, & Quiring, 2019). This mechanism not only reduces pain intensity but may also influence emotional responses to pain. Target Audience This educational brochure is designed for patients prescribed Xtampza ER, as well as their caregivers. While most patients are adults experiencing chronic pain, pediatric patients may also receive oxycodone at carefully adjusted doses — typically 0.05–0.15 mg/kg every 4–6 hours as needed — under strict medical supervision (Vallerand et al., 2019). The brochure serves as a comprehensive, patient-friendly resource containing key information such as: Special Considerations Xtampza ER carries significant risks due to its high abuse potential. Misuse can lead to addiction, overdose, and potentially fatal respiratory depression. Patients must be informed about safe storage, theft prevention, and the dangers of sharing their medication. The medication should be kept out of sight and reach of children and stored in a secure, inaccessible location. In addition, oxycodone use during pregnancy may result in neonatal opioid withdrawal syndrome and can cause fetal harm. Pregnant patients should avoid this medication unless absolutely necessary, and prescribers should discuss safer alternatives (Collegium Pharmaceutical, 2023). Patient Teaching Considerations Proper patient education plays a critical role in promoting safe and effective use of Xtampza ER. Healthcare providers should ensure patients understand: NR 293 RUA Teaching Point Key Information Dosage & Timing Take exactly as prescribed, at the same times each day. Do not crush or chew capsules, as this can cause rapid release and absorption of a potentially fatal dose. Route of Administration Oral; swallow capsules whole or sprinkle contents on soft food if necessary, following specific instructions. Missed Dose Take the missed dose as soon as remembered unless it is near the time for the next scheduled dose. Do not double doses. Storage Keep in a locked location, away from children and unauthorized individuals. Signs of Overdose Recognize symptoms such as extreme sleepiness, slowed breathing, or loss of consciousness; seek emergency medical help immediately. Abuse Prevention Never share with others. Dispose of unused medication via take-back programs. Pregnancy Warning Avoid during pregnancy due to potential harm to the fetus. Drug Interactions Avoid alcohol, sedatives, and other CNS depressants unless approved by a healthcare provider. Mechanism of Action and Effects Oxycodone works by binding to opioid receptors in the CNS, particularly mu-receptors, thereby reducing the brain’s perception of pain and altering the emotional response to discomfort. While effective, this mechanism also causes CNS depression, which can manifest as sedation, slowed breathing, and, in severe cases, coma or death. Therapeutically, the primary goal is to achieve effective pain control while minimizing the risk of adverse events. Key Safety Messages for Patients References Collegium Pharmaceutical, Inc. (2023). Xtampza ER (oxycodone) extended-release capsules [Prescribing information]. U.S. Food and Drug Administration. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=b0a5ded2-8ee2-49ca-a86c-2b28ae40f60c NR 293 RUA Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis’s drug guide for nurses (17th ed.). F. A. Davis Company.

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date NR 293 Exam 2 Comprehensive Study Guide Overview of Medication Safety, Indications, and Patient Education This study guide is designed to assist nursing students in preparing for the NR 293 Exam 2. It emphasizes the clinical understanding of various drug classes, focusing on their therapeutic purposes, contraindications, potential adverse reactions, drug interactions, and patient teaching considerations. By reviewing these core concepts, students can enhance patient safety, improve therapeutic outcomes, and minimize risks associated with pharmacological therapy. When studying each medication or drug class, it is essential to: Analgesics and Related Medications Opioid Analgesics — Morphine (Class II Narcotic) Category Details Indications Relief of moderate to severe pain, including post-surgical pain, cancer-related pain, and injury-related pain. Contraindications Known hypersensitivity to morphine; conditions such as severe respiratory depression, acute or severe bronchial asthma, paralytic ileus; caution in patients with epilepsy, heart disease, liver or kidney impairment, or during pregnancy/lactation. Adverse Effects Respiratory depression, constipation, sedation, nausea/vomiting, hypotension, pruritus (itching), urinary retention, and potential for dependence. Interactions Should not be taken with MAOIs within 14 days; avoid alcohol and other CNS depressants; monitor for interactions with certain herbal supplements and vitamins. Safety/Patient Teaching Educate on high risk for addiction; advise against driving or operating heavy machinery until response is known; stress bowel regimen to prevent constipation; avoid alcohol; monitor for signs of overdose (extreme sleepiness, slow breathing). Non-Opioid Analgesics — Acetaminophen Category Details Indications Management of fever and mild to moderate pain; preferred in patients who cannot take NSAIDs due to gastrointestinal risks. Contraindications Severe liver disease, known hypersensitivity; avoid in chronic alcohol use due to hepatotoxicity risk. Adverse Effects Rare at therapeutic doses; hepatotoxicity in overdose; allergic reactions; rare cases of blood dyscrasias. Interactions May increase bleeding risk when taken with warfarin; monitor INR closely; avoid excessive alcohol. Safety/Patient Teaching Do not exceed 3,000 mg/day for adults and 2,000 mg/day for elderly or those with liver disease; will not treat inflammation; read labels to avoid accidental overdose from combination products. Benzodiazepines — Diazepam (Class IV Controlled Substance) Category Details Indications Anxiety disorders, muscle spasms, status epilepticus, and alcohol withdrawal symptoms. Contraindications Narrow-angle or untreated open-angle glaucoma, severe respiratory insufficiency, severe liver disease, myasthenia gravis, sleep apnea; pregnancy and breastfeeding. Adverse Effects Sedation, dizziness, confusion, fatigue, ataxia, risk of dependence and withdrawal symptoms. Interactions Avoid with MAOIs, theophylline, certain antidepressants, seizure medications, and phenothiazines. Safety/Patient Teaching Warn about risk of dependence; avoid alcohol; do not stop suddenly to prevent withdrawal; caution when operating machinery; avoid use in pregnancy/breastfeeding unless benefits outweigh risks. Barbiturates — Phenobarbital Category Details Indications Management of seizures, sedation, and prevention of withdrawal symptoms in barbiturate dependence. Contraindications Acute intermittent porphyria, severe liver or respiratory disease, previous barbiturate hypersensitivity, concurrent sodium oxybate use. Adverse Effects Drowsiness, dizziness, headache, agitation, nausea/vomiting, loss of appetite, dependency potential. Interactions Potentiates CNS depressants; interacts with phenytoin, valproate, sodium oxybate, and various respiratory/pain medications. Safety/Patient Teaching Avoid alcohol; warn about sedation; do not discontinue abruptly; monitor mood for signs of depression or suicidal ideation. Lipase Inhibitors — Orlistat Category Details Indications Long-term weight management in combination with reduced-calorie diet; suitable for patients with BMI ≥30 or ≥27 with comorbidities. Contraindications Pregnancy, chronic malabsorption syndrome, cholestasis, hypersensitivity to orlistat. Adverse Effects Oily stools, flatulence with discharge, fecal urgency, abdominal pain, possible liver injury, kidney stones. Interactions May reduce absorption of fat-soluble vitamins; interacts with cyclosporine, levothyroxine, anticoagulants, antidiabetics. Safety/Patient Teaching Take multivitamins 2 hours before or after orlistat; follow a low-fat diet to reduce GI side effects; report signs of liver injury (jaundice, dark urine). CNS Stimulants — Methylphenidate Hydrochloride Category Details Indications Attention Deficit Hyperactivity Disorder (ADHD), narcolepsy. Contraindications Glaucoma, severe anxiety, tics or Tourette’s syndrome, hyperthyroidism, severe cardiovascular conditions. Adverse Effects Insomnia, decreased appetite, abdominal pain, tachycardia, hypertension, nervousness. Interactions Avoid with MAOIs, antihypertensives, anticoagulants, seizure medications, alcohol. Safety/Patient Teaching Risk of dependence; monitor blood pressure and heart rate; avoid late-day dosing to prevent insomnia; report chest pain, vision changes, or mood changes. Neurologic and Psychiatric Medications Ergot Alkaloids Category Details Indications Management of acute migraine headaches and cluster headaches; sometimes used postpartum to control bleeding. Contraindications Pregnancy, breastfeeding, peripheral vascular disease, coronary artery disease, uncontrolled hypertension, sepsis. Adverse Effects Nausea, vomiting, muscle pain, paresthesia, chest pain, elevated blood pressure. Interactions Avoid concurrent use with macrolide antibiotics, protease inhibitors, triptans, and potent CYP3A4 inhibitors due to risk of vasospasm and ischemia. Safety/Patient Teaching Do not exceed recommended dose; avoid during pregnancy; report severe chest pain or weakness; avoid smoking due to vasoconstrictive effects. Phenytoin Category Details Indications Prevention and control of seizures; sometimes used for certain cardiac arrhythmias. Contraindications Sinus bradycardia, SA block, second/third-degree heart block, Adams-Stokes syndrome, hypersensitivity to hydantoins. Adverse Effects Gingival hyperplasia, nystagmus, ataxia, rash, hepatotoxicity, blood dyscrasias. Interactions Reduces effectiveness of oral contraceptives, warfarin, and corticosteroids; interacts with alcohol, cimetidine, isoniazid, and certain antibiotics. Safety/Patient Teaching Maintain consistent dosing; do not stop abruptly; maintain good oral hygiene to prevent gum overgrowth; monitor serum levels. Levodopa-Carbidopa NR 293 Exam 2 Category Details Indications Treatment of Parkinson’s disease and Parkinson-like symptoms. Contraindications Narrow-angle glaucoma, history of melanoma, MAOI use within 14 days, severe cardiovascular or pulmonary disease. Adverse Effects Nausea, dyskinesia, orthostatic hypotension, compulsive behaviors, hallucinations. Interactions MAOIs, antipsychotics, isoniazid, high-protein meals (reduce absorption). Safety/Patient Teaching Take at regular intervals; do not stop abruptly; avoid high-protein meals near dosing; report uncontrolled movements or mood changes. Benztropine Category Details Indications Adjunct therapy in Parkinson’s disease; management of extrapyramidal symptoms from antipsychotic drugs. Contraindications Glaucoma, myasthenia gravis, obstructive bowel disease, urinary retention. Adverse Effects Dry mouth, blurred vision, constipation, urinary retention, confusion, decreased sweating. Interactions Other anticholinergics, phenothiazines, tricyclic antidepressants. Safety/Patient Teaching Avoid overheating; maintain hydration; monitor for confusion or hallucinations; avoid alcohol. Amantadine (Viral M2 Channel Inhibitor/Dopamine Agonist) Category Details Indications Prevention and treatment of influenza A; management of Parkinson’s disease and drug-induced extrapyramidal symptoms. Contraindications Untreated narrow-angle glaucoma, severe heart, kidney, or liver disease, epilepsy. Adverse Effects Dizziness, insomnia, nausea,

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Week 3: Gas Exchange and Bronchodilators Introduction to Bronchodilators Optimal gas exchange begins with a thorough respiratory assessment, enabling the nurse to prioritize interventions appropriately. Bronchodilators play a central role in pharmacotherapeutic strategies for respiratory conditions. These medications enhance breathing by widening the airways, easing mucus clearance, and minimizing inflammation. Depending on the formulation, they may act as single agents or as part of combination therapies with synergistic effects. Administration order is also significant—some drugs are taken first to open airways, improving the effectiveness of subsequent medications. Conditions Managed with Respiratory Medications Respiratory medications are prescribed to address a range of acute and chronic conditions, such as: These medications can target inflammation, relax smooth muscles, reduce secretions, and control allergic responses. Rescue Inhalers and Drug Classifications Short-acting inhaled beta2-adrenergic agonists are recommended as “rescue” inhalers to relieve sudden episodes of breathlessness rather than for daily maintenance. In clinical practice, respiratory drugs are categorized according to their primary therapeutic effect. Classification Examples Primary Uses Bronchodilators Albuterol, Levalbuterol Relief of asthma and COPD symptoms Antihistamines Loratadine, Fexofenadine Management of allergic rhinitis, anaphylaxis Expectorants Guaifenesin Loosening and clearance of mucus Antitussives Codeine, Dextromethorphan Suppressing persistent cough Decongestants Fluticasone, Triamcinolone Reducing nasal congestion Use of Respiratory Medications Respiratory medications are essential in controlling airway inflammation, alleviating bronchospasm, and improving ventilation. In emergency situations, adrenergic agents may be administered to stimulate cardiac output and rapidly dilate airways, enhancing oxygenation. Types of Bronchodilators Antihistamines These medications block histamine activity, constrict smooth muscle in nasal passages, decrease secretions, and reduce capillary permeability. They are highly effective in allergic rhinitis and anaphylaxis. Decongestants Decongestants may be adrenergic, anticholinergic, or corticosteroid-based. They shrink swollen nasal tissues, improving airflow and easing congestion. Antitussives These agents suppress cough by acting on the brain’s cough center, reducing the urge to cough. Expectorants Expectorants help thin mucus, making it easier to expel from the respiratory tract. Short-Acting Beta-Adrenergic Agonists (SABA) SABAs, such as albuterol, are essential in acute asthma management, providing rapid relief by relaxing bronchial smooth muscle. For example, Valine, a 24-year-old nursing student with newly diagnosed asthma, experiences post-exertional shortness of breath and chest tightness; in such cases, an inhaled SABA offers quick symptom relief. Long-Acting Beta2 Agonists (LABA) LABAs, including salmeterol and formoterol, are intended for long-term symptom control in asthma and COPD, not for acute episodes. They are commonly combined with inhaled corticosteroids and typically administered twice daily. Anticholinergics Ipratropium is the most commonly used anticholinergic bronchodilator. By blocking acetylcholine in airway smooth muscle, it prevents bronchoconstriction and facilitates airflow, particularly in COPD, chronic bronchitis, and emphysema. Contraindications for Ipratropium: Condition Reason for Avoidance Glaucoma May worsen intraocular pressure Enlarged prostate Can aggravate urinary retention Urinary retention disorders May exacerbate symptoms Adverse Effects: Cough, nervousness, nausea, xerostomia, headache, and, rarely, paradoxical bronchospasm or anaphylaxis. Drug Interactions with Ipratropium Only one direct drug contraindication exists—revefenacin. Caution is required when combined with other anticholinergics or drugs metabolized by the CYP450 system. Condition Potential Interacting Medications Depression, anxiety Antidepressants, anxiolytics Seasonal allergies Antihistamines Parkinson’s disease Anticholinergics Gastrointestinal issues Antacids, GI medications Overactive bladder Anticholinergics Use of other bronchodilators Additional respiratory agents Dosage Information for Ipratropium Parameter Details Typical dosage 0.25–0.5 mg per 2.5 mL Renal/Hepatic adjustment Not required Use in asthma For exacerbations only, not as rescue therapy Compatibility Can be nebulized with albuterol or levalbuterol within 1 hour of mixing NR 293 Edapt Key Patient Education Points: Albuterol: A Beta Agonist Mechanism of Action: Stimulates beta-2 adrenergic receptors in bronchial smooth muscle, causing relaxation and bronchodilation. Body System Effect Respiratory Bronchodilation Cardiovascular Mild vasoconstriction, possible increased heart rate Contraindications: Allergy to albuterol, uncontrolled cardiovascular disease.Adverse Effects: Tachycardia, chest discomfort, dizziness, nervousness, headache. Dosage Form Max Daily Dose (Adults) Max Daily Dose (Pediatrics) Inhalation/Oral 32 mg 12 mg Patient Education: Theophylline: Overview Acts as a CNS stimulant and bronchodilator, metabolizing into caffeine. Increases respiratory rate and enhances cardiac output, but requires careful dosing due to a narrow therapeutic range. Therapeutic Range mcg/mL Standard 10–20 Preferred by clinicians 5–15 Toxicity likely >20 Key Caution: Smoking accelerates metabolism, lowering drug levels. Dose adjustments may be needed for smokers or those who recently quit. Preventive Asthma Medications Used for long-term control, not acute relief. May include monoclonal antibodies (e.g., omalizumab, mepolizumab) and inhaled corticosteroids (e.g., fluticasone). Medication Action Omalizumab Binds IgE Mepolizumab Blocks IL-5 receptor (6+ years) Benralizumab Blocks IL-5 receptor (12+ years) Inhaled Corticosteroids: Montelukast (LTRA) Blocks leukotrienes, reducing airway inflammation. Not for acute asthma attacks. Indication Adult Dose Asthma/Allergic Rhinitis 10 mg daily Exercise-Induced Bronchospasm 10 mg at least 2 hrs before exercise Monitoring: Check liver enzymes (ALT, AST) during therapy. Nursing Interventions Intervention Key Details Inhaler technique Demonstrate and observe patient return-demonstration Dose adherence Prevent under- or overdosing MDI coordination Wait 1–2 min between puffs of same drug; 2–5 min between different inhalers Spacer use Improves delivery efficiency Evaluation of Medication Effectiveness Documentation Guidelines Antihistamines Overview Block H1 receptors to reduce allergic responses. Effective for rhinitis, urticaria, and anaphylaxis. Adverse Effects: Drowsiness, dry mouth, constipation, urinary retention. Conclusion A comprehensive understanding of bronchodilators, corticosteroids, LTRAs, and adjunct therapies enables healthcare providers to tailor treatment to each patient’s needs. Effective education, proper inhaler technique, and close monitoring ensure safety and optimize respiratory health. References American Thoracic Society. (2021). Guidelines for the management of asthma. https://www.thoracic.org Dhingra, N. (2020). Pharmacotherapy for respiratory disorders. Journal of Clinical Pharmacy, 45(2), 150–162. NR 293 Edapt MedlinePlus. (2022). Antihistamines. https://medlineplus.gov National Heart, Lung, and Blood Institute. (2023). Asthma medications. https://www.nhlbi.nih.gov U.S. Food and Drug Administration. (2021). Ipratropium bromide inhalation solution. https://www.fda.gov U.S. National Library of Medicine. (2022). Albuterol. https://medlineplus.go

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Week 3: Gas Exchange and Bronchodilators Introduction to Bronchodilators Optimal gas exchange begins with a thorough respiratory assessment, enabling the nurse to prioritize interventions appropriately. Bronchodilators play a central role in pharmacotherapeutic strategies for respiratory conditions. These medications enhance breathing by widening the airways, easing mucus clearance, and minimizing inflammation. Depending on the formulation, they may act as single agents or as part of combination therapies with synergistic effects. Administration order is also significant—some drugs are taken first to open airways, improving the effectiveness of subsequent medications. Conditions Managed with Respiratory Medications Respiratory medications are prescribed to address a range of acute and chronic conditions, such as: These medications can target inflammation, relax smooth muscles, reduce secretions, and control allergic responses. Rescue Inhalers and Drug Classifications Short-acting inhaled beta2-adrenergic agonists are recommended as “rescue” inhalers to relieve sudden episodes of breathlessness rather than for daily maintenance. In clinical practice, respiratory drugs are categorized according to their primary therapeutic effect. Classification Examples Primary Uses Bronchodilators Albuterol, Levalbuterol Relief of asthma and COPD symptoms Antihistamines Loratadine, Fexofenadine Management of allergic rhinitis, anaphylaxis Expectorants Guaifenesin Loosening and clearance of mucus Antitussives Codeine, Dextromethorphan Suppressing persistent cough Decongestants Fluticasone, Triamcinolone Reducing nasal congestion Use of Respiratory Medications Respiratory medications are essential in controlling airway inflammation, alleviating bronchospasm, and improving ventilation. In emergency situations, adrenergic agents may be administered to stimulate cardiac output and rapidly dilate airways, enhancing oxygenation. Types of Bronchodilators Antihistamines These medications block histamine activity, constrict smooth muscle in nasal passages, decrease secretions, and reduce capillary permeability. They are highly effective in allergic rhinitis and anaphylaxis. Decongestants Decongestants may be adrenergic, anticholinergic, or corticosteroid-based. They shrink swollen nasal tissues, improving airflow and easing congestion. Antitussives These agents suppress cough by acting on the brain’s cough center, reducing the urge to cough. Expectorants Expectorants help thin mucus, making it easier to expel from the respiratory tract. Short-Acting Beta-Adrenergic Agonists (SABA) SABAs, such as albuterol, are essential in acute asthma management, providing rapid relief by relaxing bronchial smooth muscle. For example, Valine, a 24-year-old nursing student with newly diagnosed asthma, experiences post-exertional shortness of breath and chest tightness; in such cases, an inhaled SABA offers quick symptom relief. Long-Acting Beta2 Agonists (LABA) LABAs, including salmeterol and formoterol, are intended for long-term symptom control in asthma and COPD, not for acute episodes. They are commonly combined with inhaled corticosteroids and typically administered twice daily. Anticholinergics Ipratropium is the most commonly used anticholinergic bronchodilator. By blocking acetylcholine in airway smooth muscle, it prevents bronchoconstriction and facilitates airflow, particularly in COPD, chronic bronchitis, and emphysema. Contraindications for Ipratropium: Condition Reason for Avoidance Glaucoma May worsen intraocular pressure Enlarged prostate Can aggravate urinary retention Urinary retention disorders May exacerbate symptoms Adverse Effects: Cough, nervousness, nausea, xerostomia, headache, and, rarely, paradoxical bronchospasm or anaphylaxis. Drug Interactions with Ipratropium Only one direct drug contraindication exists—revefenacin. Caution is required when combined with other anticholinergics or drugs metabolized by the CYP450 system. Condition Potential Interacting Medications Depression, anxiety Antidepressants, anxiolytics Seasonal allergies Antihistamines Parkinson’s disease Anticholinergics Gastrointestinal issues Antacids, GI medications Overactive bladder Anticholinergics Use of other bronchodilators Additional respiratory agents Dosage Information for Ipratropium Parameter Details Typical dosage 0.25–0.5 mg per 2.5 mL Renal/Hepatic adjustment Not required Use in asthma For exacerbations only, not as rescue therapy Compatibility Can be nebulized with albuterol or levalbuterol within 1 hour of mixing NR 293 Edapt Key Patient Education Points: Albuterol: A Beta Agonist Mechanism of Action: Stimulates beta-2 adrenergic receptors in bronchial smooth muscle, causing relaxation and bronchodilation. Body System Effect Respiratory Bronchodilation Cardiovascular Mild vasoconstriction, possible increased heart rate Contraindications: Allergy to albuterol, uncontrolled cardiovascular disease.Adverse Effects: Tachycardia, chest discomfort, dizziness, nervousness, headache. Dosage Form Max Daily Dose (Adults) Max Daily Dose (Pediatrics) Inhalation/Oral 32 mg 12 mg Patient Education: Theophylline: Overview Acts as a CNS stimulant and bronchodilator, metabolizing into caffeine. Increases respiratory rate and enhances cardiac output, but requires careful dosing due to a narrow therapeutic range. Therapeutic Range mcg/mL Standard 10–20 Preferred by clinicians 5–15 Toxicity likely >20 Key Caution: Smoking accelerates metabolism, lowering drug levels. Dose adjustments may be needed for smokers or those who recently quit. Preventive Asthma Medications Used for long-term control, not acute relief. May include monoclonal antibodies (e.g., omalizumab, mepolizumab) and inhaled corticosteroids (e.g., fluticasone). Medication Action Omalizumab Binds IgE Mepolizumab Blocks IL-5 receptor (6+ years) Benralizumab Blocks IL-5 receptor (12+ years) Inhaled Corticosteroids: Montelukast (LTRA) Blocks leukotrienes, reducing airway inflammation. Not for acute asthma attacks. Indication Adult Dose Asthma/Allergic Rhinitis 10 mg daily Exercise-Induced Bronchospasm 10 mg at least 2 hrs before exercise Monitoring: Check liver enzymes (ALT, AST) during therapy. Nursing Interventions Intervention Key Details Inhaler technique Demonstrate and observe patient return-demonstration Dose adherence Prevent under- or overdosing MDI coordination Wait 1–2 min between puffs of same drug; 2–5 min between different inhalers Spacer use Improves delivery efficiency Evaluation of Medication Effectiveness Documentation Guidelines Antihistamines Overview Block H1 receptors to reduce allergic responses. Effective for rhinitis, urticaria, and anaphylaxis. Adverse Effects: Drowsiness, dry mouth, constipation, urinary retention. Conclusion A comprehensive understanding of bronchodilators, corticosteroids, LTRAs, and adjunct therapies enables healthcare providers to tailor treatment to each patient’s needs. Effective education, proper inhaler technique, and close monitoring ensure safety and optimize respiratory health. References American Thoracic Society. (2021). Guidelines for the management of asthma. https://www.thoracic.org Dhingra, N. (2020). Pharmacotherapy for respiratory disorders. Journal of Clinical Pharmacy, 45(2), 150–162. NR 293 Edapt MedlinePlus. (2022). Antihistamines. https://medlineplus.gov National Heart, Lung, and Blood Institute. (2023). Asthma medications. https://www.nhlbi.nih.gov U.S. Food and Drug Administration. (2021). Ipratropium bromide inhalation solution. https://www.fda.gov U.S. National Library of Medicine. (2022). Albuterol. https://medlineplus.go

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Quiz 3 Pharmacology Review 1. Three days after beginning therapy with oral iron tablets, a patient calls the office, saying, “I’m very worried because my bowel movements are black!” What will the nurse do? Correct Answer: d. Explain to the patient that this is an expected effect of the medication. Explanation:Black or dark-colored stools are a common and harmless side effect of oral iron therapy. This occurs because unabsorbed iron is oxidized in the gastrointestinal tract. The nurse should reassure the patient that this is normal and does not indicate internal bleeding unless accompanied by symptoms such as abdominal pain or bloody stools. 2. Connie, age 58 years, is in the hospital because of extreme weakness. She has a history of chronic renal failure, and there is a new order for epoetin alfa (Epogen). What laboratory results are monitored during epoetin therapy, and why? Answer:The nurse should regularly monitor hemoglobin levels and hematocrit during epoetin therapy. If hemoglobin levels rise too quickly or exceed 12 g/dL, the patient may be at increased risk for hypertension or seizures. This monitoring ensures safe therapeutic effects without triggering adverse cardiovascular events. 3. When administering angiotensin-converting enzyme (ACE) inhibitors, the nurse keeps in mind that which are possible adverse effects? (Select all that apply.) Correct Answers: b. Fatigue, d. Headaches, e. A dry cough Explanation:ACE inhibitors may cause fatigue, headaches, and a persistent dry cough due to bradykinin accumulation. Other potential adverse effects include dizziness, hyperkalemia, and angioedema. 4. A patient is being treated for a hypertensive emergency. The nurse expects which drug to be used? Correct Answer: a. Sodium nitroprusside (Nitropress) Explanation:Sodium nitroprusside is the drug of choice for hypertensive emergencies because it acts rapidly as a potent vasodilator to immediately lower blood pressure. 5. A beta1 blocker is prescribed for a patient with heart failure and hypertension. Which adverse effects, if present, may indicate a serious problem is developing while the patient is taking this medication? (Select all that apply.) Correct Answers: a. Edema, c. Shortness of breath Explanation:Edema and shortness of breath can indicate worsening heart failure or pulmonary congestion, requiring immediate evaluation and possible adjustment of therapy. 6. Given the nurse’s knowledge of the side effects of alpha blockers, which instruction should the nurse provide to the patient with a new order for an alpha blocker to treat hypertension? Correct Answer: c. Change positions slowly. Explanation:Alpha blockers can cause orthostatic hypotension, leading to dizziness or fainting when standing suddenly. Patients should be instructed to change positions gradually to reduce the risk of falls. 7. Indicate which ACE inhibitor would be best for the following patients. Explain your answers. Patient Best ACE Inhibitor Reason Irene (liver dysfunction, high BP, critically ill) Captopril Not a prodrug, so it does not require liver metabolism for activation. Kory (poor adherence history) Lisinopril or Benazepril Long half-life allows once-daily dosing, improving adherence. 8. White and African-American patients are known to respond differently to antihypertensive agents. Which antihypertensives are considered more effective in African-American patients than in white patients? Answer:Calcium channel blockers and diuretics have been shown to be more effective in African-American patients compared to ACE inhibitors or beta blockers for initial hypertension management. 9. What is the purpose of antianginal drug therapy? Correct Answer: c. To increase blood flow to ischemic cardiac muscle Explanation:Antianginal medications improve myocardial oxygen supply-demand balance by increasing blood flow to oxygen-deprived cardiac tissue, reducing chest pain and preventing ischemia. 10. A patient with coronary artery spasms will be most effectively treated with which type of antianginal medication? Correct Answer: b. Calcium channel blockers Explanation:Calcium channel blockers relax smooth muscle in coronary arteries, preventing and relieving vasospasms. 11. During his morning walk, a man begins to experience chest pain. He sits down and takes one nitroglycerin sublingual tablet. After 5 minutes, the chest pain is worsening. What action would be the priority in this situation? Correct Answer: a. Call 911 (emergency medical services) Explanation:Worsening chest pain after nitroglycerin could indicate a myocardial infarction. Immediate emergency assistance is critical. 12. As part of treatment for early heart failure, a patient is started on an ACE inhibitor. The nurse will monitor the patient’s laboratory work for which potential effect? Correct Answer: c. Hyperkalemia Explanation:ACE inhibitors reduce aldosterone secretion, leading to potassium retention, which can cause dangerous hyperkalemia. 13. Before giving oral digoxin (Lanoxin), the nurse discovers that the patient’s radial pulse is 52 beats/min. What will be the nurse’s next action? Correct Answer: c. Hold the dose and notify the physician. Explanation:A pulse below 60 bpm may indicate digoxin toxicity or bradycardia, requiring medical evaluation before administration. 14. Which statement regarding digoxin therapy and potassium levels is correct? Correct Answer: a. Low potassium levels increase the chance of digoxin toxicity. Explanation:Hypokalemia enhances digoxin binding to cardiac tissue, increasing toxicity risk. 15. While monitoring Mr. F. after oral digoxin (Lanoxin) administration, the nurse notes increased urinary output, decreased dyspnea and fatigue, and constipation. Mr. F. complains that if he were allowed to eat bran as often as he used to, he wouldn’t be constipated. What do the nurse’s findings indicate? How will the nurse respond to Mr. F.? Answer:The increased urinary output and reduction in dyspnea and fatigue indicate that digoxin is having its desired therapeutic effect in improving cardiac function. However, constipation is an undesired side effect. The nurse should advise Mr. F. to avoid bran because it can interfere with digoxin absorption, and instead suggest other constipation remedies such as increased fluid intake, dietary fiber from non-bran sources, and possibly stool softeners. 16. Before giving oral digoxin (Lanoxin), the nurse discovers that the patient’s radial pulse is 52 beats/min. What will be the nurse’s next action? Correct Answer: c. Hold the dose and notify the physician. Explanation:A radial pulse below 60 bpm requires withholding digoxin and contacting the healthcare provider to avoid potential toxicity or severe bradycardia. 17. Mr. K., who has been diagnosed with hypertension, is hospitalized after a myocardial infarction (MI). a.

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Quiz 2 This quiz assesses knowledge of pharmacology, pain management, anesthesia, psychiatric disorders, and nursing interventions. The questions below are presented in their original form, but the answers have been carefully rephrased and expanded for clarity, with correct responses highlighted in yellow. A table format has been used for clarity where appropriate. Questions and Answers No. Question Options Correct Answer 1 Several patients have orders for acetaminophen as needed for pain. The nurse discovers one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication? A. A patient with a fever of 103.4°F B. A patient admitted with a blood clot C. A patient admitted with severe hepatitis D. A patient who had abdominal surgery a week ago C. A patient admitted with severe hepatitis 2 Pain occurring in the area of a body part that has been removed surgically or traumatically is what type of pain? A. Visceral Pain B. Neuropathic Pain C. Superficial Pain D. Phantom Pain D. Phantom Pain 3 A patient is recovering from general anesthesia. What is the nurse’s main concern during the immediate postoperative period? A. Pupillary Reflexes B. Airway C. Level of consciousness D. Return of sensations B. Airway 4 What is Nitrous oxide also known as? A. Tickling gas B. Laughing gas C. Painful gas D. Numbing gas B. Laughing gas 5 Diazepam (Valium) is used for which of the following? A. Anxiety B. Sleep disorders C. Pain D. Hypertension A. Anxiety 6 Muscle relaxants are used for which of the following conditions? A. Seizures B. Insomnia C. Hypertension D. Muscle Spasms D. Muscle Spasms 7 Which of the following is the most common psychiatric disorder in children? A. Seizures B. Attention Deficit/Hyperactivity Disorder (ADHD) C. Obesity D. Hypertension B. Attention Deficit/Hyperactivity Disorder (ADHD) 8 The nurse is given an order for 40 mg tablets of Lasix by mouth, one-time dose. The nurse has 20 mg tablets available. How many tablets should the nurse administer? A. 1 B. 2 C. 3 D. 4 B. 2 9 True or False? Anorexiants stimulate an appetite. False False 10 A hospitalized patient is having trouble sleeping. Which action will the nurse take first to address this problem? A. Administer a sedative hypnotic drug B. Offer tea C. Encourage the patient to walk the halls of the medical unit D. Provide an environment that is restful, and reduce loud noises D. Provide an environment that is restful, and reduce loud noises Explanation of Key Concepts Acetaminophen is widely used for pain and fever management; however, it poses significant risks for patients with liver disease, such as hepatitis, due to its hepatotoxic effects (Dart et al., 2022). Phantom pain is a form of neuropathic pain perceived in a body part that is no longer present, often requiring specialized pain management techniques. Airway maintenance remains the top priority in the immediate postoperative period following general anesthesia, as airway compromise is a leading cause of postoperative complications (Miller et al., 2020). Nitrous oxide, commonly referred to as “laughing gas,” is used for analgesia and sedation in dentistry and surgery. Diazepam is a benzodiazepine used primarily for anxiety, muscle spasms, and certain seizure disorders. Muscle relaxants target muscle spasms caused by neurological or musculoskeletal conditions. ADHD is the most prevalent psychiatric disorder in children, affecting academic and social functioning. NR 293 Quiz 2 For medication dosage, correct calculation is essential—two 20 mg Lasix tablets equal the prescribed 40 mg dose. Anorexiants suppress appetite rather than stimulate it. Lastly, sleep hygiene should be addressed before pharmacologic interventions to promote restful sleep in hospitalized patients. References Dart, R. C., Bailey, E., & Buckley, N. A. (2022). Acetaminophen poisoning: An evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology, 60(5), 546–562. https://doi.org/10.1080/15563650.2022.2031782 NR 293 Quiz 2 Miller, R. D., Pardo, M. C., & Butterworth, J. F. (2020). Miller’s anesthesia (9th ed.). Elsevier.

Student Name Chamberlain University NR-293: Pharmacology for Nursing Practice Prof. Name Date Quiz One Rights of Medication Administration The rights of medication administration serve as essential safety measures to ensure patient well-being and minimize errors. These include the right patient, right dose, right route, and the right to refuse. Nurses are expected to perform the final verification of medications at the patient’s bedside, rather than at the nurse’s station. This direct verification helps prevent administration errors by confirming the medication against the patient’s identification and the provider’s order in real time. First Pass Effect The first-pass effect refers to the initial metabolism of a drug within the liver before it enters systemic circulation. This process significantly reduces the bioavailability of some medications, particularly when taken orally. As a result, higher oral doses may be prescribed to ensure adequate therapeutic effects. For instance, oral morphine often requires a higher dose than parenteral morphine due to this effect. Understanding the first-pass effect is crucial for correct dosing and ensuring that the patient receives an effective drug concentration. Nursing Considerations When Administering Medications Nurses must adopt multiple precautionary measures when administering medications. These include verifying the patient’s identity through two identifiers, avoiding leaving medications at the bedside, disposing of unused or refused doses appropriately, documenting refusals, ensuring the patient fully ingests the medication, and administering medications with water (as certain beverages, such as milk, can interfere with absorption). Nursing Considerations Details Patient identity verification Use at least two identifiers (e.g., name and date of birth) Unused medications Do not leave at bedside; dispose of according to protocol Refusal handling Document refusal and discard medication safely Supervised administration Stay with the patient until the medication is swallowed Fluid for administration Preferably water; avoid liquids that may alter absorption Routes of Medication Administration Medications may be given orally, subcutaneously, intravenously, or via other routes as prescribed. Orders from providers sometimes list multiple possible routes; in such cases, nurses must confirm the intended route and discontinue unused routes to avoid confusion. Ethics in Medication Administration Patients have the right to refuse medication, and nurses must respect this while also balancing ethical obligations. For example, in cases of pain management, nurses should advocate for patient comfort within the boundaries of safe and lawful medication administration. STAT and PRN Medications Oral Medication Types and Considerations Medication Type Key Information Special Instructions Capsules Coating dissolves to release medication Swallow whole Enteric-coated tablets Prevent breakdown in the stomach; reduce GI irritation Do not crush or chew Extended-release tablets Release medication slowly Do not crush; may cut only if scored Liquid solutions & suspensions Absorbed faster than tablets/capsules Shake suspensions before use Pregnancy Medication Categories Category Description Example A No risk to fetus/mother based on human studies Safe vitamins B No risk in animal studies; no human data Acetaminophen C Animal studies show adverse effects; no human studies Certain antidepressants D Evidence of human fetal risk ACE inhibitors X Risks outweigh benefits Isotretinoin Administration in Adults vs. Children Infants have a higher body water content than adults, which influences medication distribution and dosing considerations. Quiz Two Antidote for Opioids Naloxone is the primary antidote used in opioid overdose or withdrawal situations, rapidly reversing respiratory depression. Vasopressin for Diabetes Insipidus Diabetes insipidus presents with polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (increased hunger). Vasopressin helps reduce urine output and restore fluid balance. Patient Teaching: Levothyroxine Levothyroxine, prescribed for hypothyroidism, should be taken on an empty stomach with water, at least 30–60 minutes before breakfast. Capsules should be swallowed whole and kept in their packaging until use. Common side effects include heat intolerance, tachycardia, and diarrhea, while serious effects may involve tremors and mood changes. Propylthiouracil (PTU) Considerations PTU, used for hyperthyroidism, can cause severe liver damage. Adverse effects may include hair loss, altered taste, numbness, joint pain, dizziness, and neck swelling. Metformin for Diabetes Metformin should be taken with meals to minimize gastrointestinal discomfort. It must be discontinued during contrast dye procedures and withheld for at least 48 hours afterward due to the risk of lactic acidosis. Regular Insulin Timing Regular insulin should be taken 30–60 minutes before meals to align peak action with food absorption. Exercising too soon after insulin administration can cause hypoglycemia. Prednisone and Nutrient Considerations Prednisone may cause weight gain, mood changes, and decreased immunity. Patients should increase dietary calcium and vitamin D to counteract bone loss. NR 293 Quiz 1 Nutrient Food Sources Calcium Dairy, sardines, salmon, kale Vitamin D Salmon, tuna, egg yolks, sunlight Glaucoma Medication Administration Timolol should be applied by placing one drop in the conjunctival sac and applying gentle pressure to the inner corner of the eye for 1–2 minutes. Pilocarpine requires pulling the lower eyelid to create a pocket for the drop. Combination therapies like timolol/latanoprost are generally preferred for intraocular pressure reduction. Quiz Three Antihistamines Used to relieve allergic symptoms, antihistamines may cause blurred vision, dizziness, and drowsiness due to their anticholinergic properties. Respiratory Medications Antitussives vs. Expectorants Type Purpose Antitussives Suppress cough reflex Expectorants Thin mucus for easier clearance Albuterol Commonly causes shakiness, headache, throat irritation, and muscle aches; these effects are generally mild and temporary. Inhaled Steroids May lead to oral thrush; patients should rinse their mouth after use. Decongestants Effectiveness is indicated by improved breathing and reduced congestion. Theophylline Prescribed for COPD; side effects may include palpitations and tachycardia. References U.S. Food & Drug Administration. (2023). Pregnancy and lactation labeling. https://www.fda.gov Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2021). Fundamentals of nursing (10th ed.). Elsevier Health Sciences. NR 293 Quiz 1 Lilley, L. L., Collins, S. R., & Snyder, J. S. (2020). Pharmacology and the nursing process (9th ed.). Elsevier.