NUR 1140 Nursing Pharmacology

Test #3 Review

This is a general review for the test. It is not all inclusive. There may be other items included on
the test.

1. Regulation of calcium by the body; parathyroid, parathyroid hormone, kidneys, calcitonin

2. Hypothalamus and pituitary – know function of each
Hypothalamus is coordinating center “master gland” of nervous system and endocrine system. It
maintains homeostasis by analyzing input from periphery and CNS, and coordinating responses
through ANS, endocrine and nervous system. It controls body temperature, thirst, hunger, water
retention, BP, respiration, reproduction and emotional reactions.
Pituitary controls hormone functions such as our thyroid activity, growth during childhood, urine
production, testosterone production in males and ovulation and estrogen production in females,
lactations, hair growth. It produces hormones, endorphins and enkephalins and stores two
hypothalamic hormones.

3. Characteristics of hormones:
- produced in small amounts
- secreted to bloodstream
- travel to and react with specific receptors within the body
- increase or decrease normal metabolic processes in the cells
- immediately broken down

4. How do hormones act?

a. Some hormones react with specific receptor sites on a cell membrane to stimulate the
nucleotide cAMP, they react quickly, i.e. insulin.
b. By entering the cell and reacting with receptor sites inside the cell to chamge mRNA,
which enters cell nucleus, affects cell’s DNA and in long term affects the function of the cell, i.e.
estrogen.
5. Where are hormones produced and what are the hormones? i.e. parathyroid –
parathormone, thyroid – calcitonin
Hormones are chemical messengers working within the endocrine system to communicate within
the body.
Pituitary
Ovaries – estrogen, progesterone
Testes - testosterone
Adrenal – cortisol, aldosterone
Thyroid – thyroid hormone, calcitonin
Parathyroid - Parathormone
Pancreas – insulin, glucagon, somatostatin
Pineal gland - melatonin
Intestines- secretin, cholecystekinin
Kidney –erythropietin, rennin
Stomach - gastrin

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6. 3 lobes of the pituitary gland and hormones produced and/or stored in each lobe
Anterior – TSH , PRL, GH, ACTH, LH, FSH and MSH (melanocyte-stimulating h.)
Intermediate lobe - endorphins and enkephalins
Posterior – oxytocin and vasopressin (ADH)
ADH –stimulates kidneys to conserve water
- increases BP by vasoconstriction
7. What is the negative feedback system?
Hypothalamic-pituitary axis works by supply and demand. Increasing levels of hormone lead to
decreases level of releasing and stimulating hormones, leading to decreased hormones level, which
stimulates the release of releasing and stimulating hormones; allows tight control of the endocrine
system.
8. What are the functions of the renal system
RS consists of kidneys, ureters, urinary bladder, and urethra. 4 major functions:
a. maintain volume and composition of body fluids, including clearing nitrogenous waste
from protein metabolism, maintain acid-base balance, electrolyte levels, excreting drugs
b. regulate vitamin D activation, which regulates calcium levels
c. regulating BP trough rennin-angiontensin- aldosterone system
d. regulating RBC production by secreting erythropoietin
9. Know how each class of diuretics act on the renal system
a. Loop diuretics – act by preventing reabsorption of Na+& Cl- in loop of Henle
b. Thiazide diuretics – act by blocking Na+ and Cl- in distal tubule, increase K+ and H2O
secretion, blocking chloride pump, vasodilators.
c. Potassium-sparing diuretics – loss of Na+, retention of K+, block aldosterone actions in distal
tubule; minimal effect of K+ secretion.
d. Miscellaneous diuretics – CAI and osmotic diuretics
10. Loop diuretics, thiazides, potassium sparing, osmotic, carbonic anhydrase inhibitors
Loop diuretics – most effective; used for edema with CHF, hepatic cirrhosis, chronic renal failure,
HTN; Lasix; caution –gout and diabetes mellitus, digoxin, and ototoxic drugs; side effects:
hypokalemia, dehydration, alkalosis, hypocalcemia, tetany, hypotension, diziness.
Thiazide diuretics – most frequently used, hydrochlorothiazide, treat HTN, edema in HF, liver
failure, renal failure, ineffective in severe renal failure; adverse effects: dehydration, loss of Na, K
and Cl, hypokalemia, diabetic patients – raised sugar
Potassium-sparing diuretics – loss of Na+, retention of K+, block aldosterone actions in distal
tubule; indicated for hyperaldosteronism, hypokalemic patients, adjuctive therapy with thiazides,
or loop diuretics; adverse effects: hyperkalemia, gynecomastia, dizziness, headache, drowsiness,
impotence, menstrual irregularities, hirsutism, spironolactone.
Carbonic anhydrase inhibitors – Diamox, blocks the enzyme carbonic anhydrase, which forms
carbonic acid, slows hydrogen ions, loss of Na+ and bicarbonate in urine. Indications: adjunctive
to other diuretics, motion sickness, mountain sickness, anticonvulsant, open-angle glaucoma, not
used as diuretic, because it’s weak and may cause acidosis.
Osmotic diuretics – pull water into the renal tubule without loss of Na+; maintain urine flow in
acute renal failure, prolonged surgery, lower IOP in glaucoma, increased cranial pressure in shock,
drug overdose, does not draw fluids out of tissues and, can worsen edema; Mannitol.

11. What are the nursing implications of each of these diuretics i.e. major contraindications
of each class

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- take diuretic early in day with food to prevent GI upset
- potassium-rich or potassium-low diet, monitor edema, BP, hyperglycemia
- daily weights, intake & output, electrolytes, liver function tests
- adequate fluid intake to prevent fluid rebound
Contraindications:
Thiazides: allergy to thiazides and sulfonamides, fluid electrolyte imbalances, severe renal
disease, SLE – lupus, DM, gout, liver disease, hyperparathyroidism, bipolar disorder, pregnant or
lactating women.
Loop diuretics: allergy to loop d, electrolyte depletion, anuria –severe renal failure, hepatic coma,
pregnancy, SLE – lupus, DM, gout.
Potassium-sparing diuretics: allergy, hyperkalemia, renal disease, anuria, pregnancy.
Carbonic anhydrase inhibitors: allergy to drug, sulfonamides, or thiazides; chronic
noncongestive angle-closure glaucoma, pregnancy, fluid or electrolyte imbalance, renal or hepatic
disease, adrenocortical insufficiency, COPD.
Osmotic diuretics: severe renal disease, anuria, pulmonary congestion, intercranial bleeding,
dehydration, HF, pregnancy.

12. What is a contraindication for giving thiazide diuretics?

Allergies – to sulfa medications, sunlight – photosensitivity, Digoxin and antidiabetic agents. Fluid
electrolyte imbalances, severe renal disease, SLE – lupus, DM, gout, liver disease,
hyperparathyroidism, bipolar disorder, pregnant or lactating women.
13. Know definition of hemoglobin and hematocrit

14. Signs of hypokalemia and hyperkalemia

Hypokalemia – weakness, muscle cramps, trembling, nausea, vomiting, diarrhea, arrythmias.
Hyperkalemia – nausea, vomiting, muscle weakness, fatigue, bradycardia, weak pulse, cardiac
standstill, dysrhythmias, difficulty breathing, paralysis, numbness, tingling sensations.

15. What are the normal ranges for Ca, K, Na

Na 135-145 mEq/L
K 3.5 – 5.0 milliequivalents per liter (mEq/L)
Ca 8.5 to 10.2 mg/dL
16. Damage to the glomerulus allows larger particles to be filtered and enter Bowman’s
capsule. What might you see in the urine (not normally present) in this case?

17. Know the prototype potassium sparing, loop, and thiazide diuretic names (the test will
have both generic and brand names)
Potassium sparing – spironolactone
Thiazide – hydrochlorothiazide
Loop diuretics - Lasix
18. What are some of the causes of chronic renal failure?
Diabetes mellitus, hypertension
19. What are signs and symptoms of a UTI?
Urinary frequency, urgency, burning during voiding, chills, fever, flank pain, and tenderness. In
older people S&S are: altered mental status, anorexia, nausea, vomiting, abdominal pain.
20. Patient teaching for a female to prevent UTIs

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Wipe from front to back. Void after sex. Avoid douching. Drink plenty of fluids, and cranberry
juice. Use proper hygiene and diet.
21. Patient teaching for a patient on pyridium
Causes GI upset, headache, rash, reddish-brown (dye) urine color, yellow skin. Take drug with
food, d/c if skin and sclera become yellowish, prevention of UTIs, patient teaching – drug name,
dosage, adverse effects, and measures to avoid them.
Antibiotic and pyridium can’t be taken together for more than 2 days due to toxicity.
22. Adrenal cortex produces 3 types of corticosteroids. What are they and what does each
do.
Androgens – sex hormones similar to testosterone
Glucocorticoids – increase glucose levels for energy
Mineralocorticoids – affect electrolyte levels and homeostasis
23. What is diurnal rhythm?
It’s response of hypothalamus and then pituitary and adrenals to wakefulness and sleeping.
24. Causes of adrenal insufficiency; what happens with long term use
a. insufficient production ACTH
b. adrenal glands do not respond to ACTH
c. adrenal glands are damaged
d. surgical removal of adrenals
e. prolonged use of corticosteroids
25. Adverse effects of steroids – i.e. what do they do to the immune system
Block the immune system, and inflammatory reactions
26. Thyroid control of hormone levels (see negative feedback diagram)
Low TH in blood: Hypothalamus responses -> TRH release-> Anterior pituitary -> TSH release ->
Thyroid response -> release of T3 and T4
27. Functions of thyroid hormones and signs and symptoms of hypothyroidism and
hyperthyroidism:
Calcitonin – responds to high calcium levels and balances PTH that does opposite
Thyroxine T4 - tetraiodothyronine (levothyroxine)
T3 – triiodothyronine, (liothyronine)
TH – regulate metabolism, growth and development, heat production, body temperature, oxygen
consumption, cardiac output, blood volume, enzyme system activity, metabolism of fats, carbs and
proteins.
Hypothyroidsm S&S: cretinism, hypothyroidism - myxedema, obesity, fatigue, hair loss,
bradycardia; due to Hashimoto’s disease.
Hypertyroidsm S&S: intolerance to heat, high BMR, excessive sweating, irritability, tachycardia,
thin skin, palpitations, HTN, flushing, amenorrhea, weight loss and goiter; caused by Grave’s
disease.
28. What are the actions/function of PTH?
a. PTH stimulates osteoclasts to release calcium from bones.
b. Increases intestinal absorption of calcium.
c. increases calcium resorption from kidneys.
d. stimulates kidneys to produce calcitriol D3 – which improves calcium transport from GI to
blood
29. Why does the body need iodine?
Thyroid gland needs iodine to produce thyroid hormones.

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30. What is insulin? What does it do in the body?
Insulin is hormone produced by beta cells of pancreas. It is released into circulation when the
levels of glucose rise, stimulating the synthesis of glycogen, converts lipid into fats, synthesis of
proteins from aminoacids. Promotes the storage of fuels.
31. Signs and symptoms of hyperglycemia and hypoglycemia; know the definition of diabetic
ketoacidosis
Hyperglycemia – fatigue, lethargy, irritability, polydipsia, polyphasia, glycosuria, itchy skin,
fruity breath, acetone like smell, dehydration, slow deep respirations-Kussmaul’s respirations,
loss of orientation, coma.
Hypoglycemia – blood sugar < 40 mg/dL, breakdown of fat and glycogen for energy, headache,
blurred vision, diplopia, tatxia, drowsiness, coma, hyperactive reflexes, weakness, muscle spasms,
paresthesia, tachycardia, palpitations, high BP, seizures, hunger, diaphoresis, cool and clammy
skin, anxiety.
Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces
very high levels of blood acids called ketones. Without enough insulin, body begins to breaks
down fat as an alternate fuel. In turn, this process produces toxic acids in the bloodstream called
ketones, eventually leading to diabetic ketoacidosis if untreated.

32. What is the purpose of glycosylated hemoglobin (HbA1c) levels?

Glycosylated hemoglobin levels provide 3-month average of glucose levels.
RBC life – 120 days, RBCs are freely permeable to glucose.
>6% pre-diabetic state
Goal of therapy for diabetic patient is <7%.
33. When would glucagon be used? Produced by alpha cells in pancreas, it decreases insulin
release, accelerates breakdown of glycogen in the liver to release glucose. Taken orally at home to
increase blood sugar when patient develops hypoglycemia.
34. Disorders associated with diabetes:
Atherosclerosis -> heart attack, stroke
Retinopathy -> loss of vision
Neuropathies -> sensory & motor changes in legs and feet due to O2 cut off
Nephropathy -> renal dysfunction, changes in basement membrane of glomerulus
35. Drug to drug interactions with insulin
Beta blockers, anything that decreases blood glucose levels.
36. Difference between Type 1 and Type 2 diabetes
DM1 – rapid onset in younger people, associated with viral destruction of beta cells, requires
insulin replacement because beta cells are not functioning.
DM2 - insufficient production of insulin , leads to increased glucose , caused by bad diet and lack
of exercise
37. Characteristics of the GI system
One long tube consisting of: mouth, esophagus, stomach, small intestine, large intestine, anus.
Pancreas, liver and gallbladder are accessory organs.
4 layers: mucosa, muscularis mucosa, nerve plexus, adventitia.
38. How do the SNS and PNS effect the GI system?
SNS slows GI tract, decreases muscle tone, secretions, and contractions, increases sphincter tone.
PNS stimulates GI tract, increases secretions, and stimulates digestion.
39. What is the purpose of bile?

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Bile contains detergent-like substance that breaks apart fat molecules so that they can be processed
and absorbed.
40. Nursing interventions for someone with difficulty swallowing
Icing the tongue, sucking on an ice pop or an ice cube blocks the external impulses, and allows the
more basic reflex to respond. Keeping the head straight, and using different textured foods.
41. Major activities of the GI system and definition of each
Secretion – enzymes, acid, bicarbonate, mucus
Absorption – active process of removing water and essential nutrients from GI tract -> blood
Digestion – process of breaking food into absorbable and usable components (mouth, stomach,
small intestine)
Motility – movement of food and secretions through the system
42. Know definitions of peristalsis, churning, segmentation, and mass movement. Where does
each occur?
Peristalsis – the basic movement in esophagus, constant wave of contraction that moves food
Churning – stomach use three layers of muscles to produce churning action
Segmentation – an occasional peristaltic wave to clear the segment used by small intestine
Mass movement – large intestine
43. Antacids – problems with OTC use and patient education needed i.e. administration
Rebound acidity, GI obstruction, constipation or diarrhea, affect electrolytes, alkalosis,
hypercalcemia, hypophosphatemia, hypokalemia, muscle weakness. Worsen absorption of other
drugs.
44. What drugs are used in the treatment of ulcers and what does each do
Histamine-2 antagonists – block the release of HCl in response to gastrin
Antacids – inorganic chemicals (chalk) that neutralize HCl
Proton pump inhibitors – suppress the secretion of HCl into the lumen of stomach
45. Peptic ulcers – definition, symptoms, and cause
Definition: PU are erosions in the lining of stomach, and adjacent areas of the GI tract.
S&S: gnawing, burning pain, occurring after meals.
Causes: Helicobacter pylori
46. Indications and contraindications for laxatives
Indications: emptying bowels before surgery, to avoid straining, treat constipation, after rectal
surgery, hemorrhoids, MI, obstetrical delivery,
CI: pregnancy, colitis, diverticulitis, appendicitis, CAD, debility, heart block, seizures.
47. Antiemetics – know the prototype drug in each class and when it is used
a. Phenothiazines – prochloperazine –severe nausea and vomiting after anesthesia
b. Nonphenothiazines – metoclopramide – N&V during chemotherapy, post-op N&V
c. Anticholinergics/antihistamines – meclizine – motion sickness in patients over 12 years
d. 5HT3 receptor blockers – ondasetron – N&V during cancer treatment, pos-op N&V
e. Substance P/neurokinin 1 receptor antagonist – aprepitant – cancer chemotherapy
48. What are some non-pharmacologic nursing interventions for someone with nausea and
vomiting?
Provide mouth care, access to bathroom, assistance with ambulation, orientation, ice chips to suck,
protection from sun, treat dehydration, quite environment, carbonated drinks, deep breathing,
adequate ventilation, fluid and intake.