Instructions:The contents on this guide are intended to help you organize your
preparation for the Evolve Specialty Exam (ESE) for NR292. This is NOT intended
to serve as a direct reflection of the exact questions which will be presented in
the exam. As you review the topics listed below, be sur...
Hesi
Instructions:The contents on this guide are intended to help you organize your
preparation for the Evolve Specialty Exam (ESE) for NR292. This is NOT intended
to serve as a direct reflection of the exact questions which will be presented in
the exam. As you review the topics listed below, be sure that you can
1. Apply Pharmacological Concepts (to the drugs/drug classes listed below)
• Pharmacokinetics, Pharmacodynamics, Pharmacotherapeutics
• Indications and Contraindications
• Adverse effects
• Patient variables: Pediatric, Gerontology, Pregnancy/Breast-feeding,
Gender, and Cultural/Ethnic variations
2. Apply Nursing Considerations (to the drugs/drug classes listed below)
• Assessments to include vital signs, physical assessment, labs, &
diagnostics
• Drug administration: safety, route considerations, med orders
• Drug toxicity (signs/symptoms) and antidote if applicable
• Patient teaching
3. Perform medication calculation:
• Oral, suspension, injectable, IV (ml/hr and gtt/min)
• Metric and household conversions
Pharmacokinetics – A drugs time to onset of action time to peak effect and duration of
action are all characteristics defined by pharmacokinetics. It is the study of what happens to
a drug from the time it is put into the body until the parent drug and all metabolites have
left the body. Absorption into, distribution and metabolism within and excretion from the
body are combined focus of pharmacokinetics.
Pharmodynamics- what a drug does to the body, ( done after phase 11 pharmacokinetic
phase – absorption, distribution, metabolism and excretion) involves drug receptor
interactions
Pharmacotherapeutics (mechanism of action) – focuses on the clinical use of drugs to
prevent and treat diseases – It defines the principles of drug action – the cellular processes
that change in response to the presence of drug molecules. Some drug mechanisms of
action are more clearly understood than others.
Pharmacologic Concepts:
• Synergistic effects – 1+1= 2 combination of drugs with similar action is greater
than the sum of the individual effects of the same drugs given alone.
• Agonistic – works together with. A drug that binds to and stimulates the activity of
one or more receptors in the body.
• Antagonistic effects – Inhibit – a drug that binds to and inhibits the activity of one
or more receptors in the body.
• Tolerance – reduced response to a drug after prolonged use
• Addiction – dependence physiologic or psychologic need for a drug – physical
dependence is the physiologic need for a drug to avoid the withdrawal symptoms
(diaphoresis and tachycardia)
• Anaphylaxis – severe allergic reaction – closing of the throat and cutting airway off
• Adverse effects – undesirable effects of one or more drugs
• Side effects - is an effect, whether therapeutic or adverse, that is secondary to the
one intended; although the term is predominantly employed to describe adverse
, ESE Study Guide
effects, it can also apply to beneficial, but unintended, consequences of the use of a
drug.
DRUG Categories:
CNS drugs
• Opioids/Pain Management:
• Oxycodone (Percocet) – scheduled II drug – Indication –used to control
postoperative and other types of pain (strong opioid) Contraindicated for people with
drug allergy or severe asthma. Opioids release histamine which causes the itching,
vein and arteries to dilate which then leads to flushing and orthostatic hypotension.
Adverse effects – respiratory depression, hypotension, flushing disorientation,
bradycardia, N/V, constipation, urinary retention and pruritus. Antidote – naloxone
(narcan)
• Acetaminophen (Tylenol)- nonopioid analgesic Indication – mild to moderate pain
and reduce fever. Mechanism of action – blocks peripheral pain impulses by inhibition
of prostaglandin syntheses. Contraindications – drug allergy, severe liver/ kidney
disease and genetic disease. Adverse effects- rash, nausea and vomiting or severe
effects of the blood are anemias and nephrotoxicity’s and hepatotoxicity Antidote –
acetylcysteine – maximum dose is 4000mg however 2000mg or less may be
necessary for patients with risk factors such as advanced age or liver dysfunction.
Liver dysfunction can occur if taking acetaminophen with alcohol in access.
• Fentanyl (Duragesic)- synthetic opioid schedule II – Indication (cancer induced
pain med) – moderate to severe pain – has a high abuse potential. Available in
parenteral injections transdermal patches buccal lozenges and buccal lozenges on a
stick “lollipop “or IV – giving fentanyl patch to a non-opioid tolerant patient may
result in severe respiratory depression. To be considered for opioid patch the patient
should have been taking for a week or longer morphine daily oxycodone or
hydromorphone. Patients should not use heating pads because it can increase
circulation that results in increased absorption causing overdose. Patches should be
folded with sticky sides together and flushed down the toilet. New patches can be
applied after 72 hours . Know that it will take 6 to 12 hours to reach steady state pain
control again. Contraindicated for people with drug allergy or severe asthma. Opioids
release histamine which causes the itching, vein and arteries to dilate which then
leads to flushing and orthostatic hypotension. Adverse effects – respiratory
depression, hypotension, flushing disorientation, bradycardia, N/V, constipation,
urinary retention and pruritus. Antidote – naloxone (narcan)
• Aspirin (do not give to children with flulike symptoms because it can cause
ryes syndrome). It is given as prophylactic therapy for risk factors of coronary
artery disease or stroke and given as 81mg or 325mg dose. Mechanism of action –
inhibit platelet aggregation known as antiplatelet activity. There used as a
prophylactic for acute myocardial infarction and many other thromboembolic
disorders. Other NSAIDS generally lack these antiplatelet. Contraindications – patient
at risk for bleeding, vitamin K deficiency and peptic ulcer disease and patient with
aspirin drug allergy. NSAIDs can be given the first 2 trimesters but is contraindicated
in the 3rd trimester and is not recommended for nursing mothers. NSAIDs should also
be discontinued one week before any surgical procedures due to risk of bleeding.
Adverse effects – GI symptoms such as heartburn and gastrointestinal bleeding,
noncardiogenic pulmonary edema. Symptoms of alicylate intoxication: Increased
HR, tinnitus, hearing loss, dimness of vision, headache dizziness, mental confusion,
Nausea and vomiting sweating thirst hyperventilation hypo/hyperglycemia. Antidote
for toxicity- no antidote medication – goals is to remove salicylate from the GI and or
preventing its further absorption correcting fluid electrolyte and preventing its further
absorption, and acid base disturbances and implement measure to enhance
salicylate elimination including hemodialysis. NSAIDs are contraindicated for
patients with cardiovascular disease due to the increased risk of
, ESE Study Guide
thrombotic events MI and stroke. (Not for aspirin because aspirin as the
antiplatelet effect as other NSAIDs do not. In patients with GI upset they can be
given cytotec to prevent gastric ulcers and gastrointestinal bleeding that can occur in
patients receiving NSAIDs. Ketorolac (Toradol) – powerful analgesic effect and has
an anti-inflammatory effect. Ketorolac lacks the addictive properties like opioids. Its
indicated for orthopedic injuries or surgery. Can be given orally or injection. It is a
short tem treatment not for minor or chronic pain. Adverse effects – renal
impairment, edema GI pain dyspepsia and nausea- this drug can only be used for 5
days because of its potential adverse effects.
• Muscle Relaxants: Baclofen – Indications – trauma inflammation anxiety and pain
associate with acute muscle spasms. Mechanism of action – depresses nerve
transmission in the spinal cord. Contraindicated in patients with renal failure. Adverse
effects – euphoria, lightheadedness, dizziness, drowsiness, and fatigue and muscle
weakness – experienced early in treatment, generally short lived after growing
tolerant to them over time. Toxicity and antidote - No specific antidote or reversal
drug. Gastric lavage and close observation of the patient is recommended. Adequate
airway should be maintained and electrocardiographic monitor should be instituted
and large quantities of IV fluids to avoid crystalluria.
• Neuromuscular blockers/Anesthetics: Nalbuphine (Nubain) – synthetic
narcotic analgesic Indications – relief of moderate to severe pain also preoperative
sedation analgesia as a supplement to surgical anesthesia. Contraindicated – drug
allergy or pregnancy. Caution use in patient with emotional instability or drug abuse
head injury increased ICP cardiac disease impaired respirations, COPD GI disorders
impaired kidney or liver function MI and lactation. Nursing implications – Withhold
this drug if respiratory rate is below 12 – watch for respiratory depression of newborn
if given during labor and delivery – avoid abrupt termination of drug following
prolonged use may result in withdrawal symptoms.
• Cholinergics: Tensilon – evaluation of treatment requirements of
myasthenia gravis. Diagnose cholinergic crisis - Negative Tensilon test - makes
client worse - Positive Tensilon test - client improves. Tensilon is injected
intravenously, atropine sulfate is antidote for overdose, in order to diagnose MG -
most clients will see improvement in 30-60sec/lasts 4-5 min
• Antiepileptics: Depakote – valproic acid unspecified antiepileptic –
Indications – treatment for generalized seizures (absence, myoclonic and tonic
clonic)also effective in partial seizures. Contraindicated in patients with liver
impairment and urea cycle disorders. Adverse reactions – drowsiness, nausea and
vomiting along with other GI disturbances, tremor weight gain and hair loss. This
drug has interactions to the following drugs: aspirin, cholestyramine, diazepain and
warfarin, rifampin, tricyclic antidepressants and antimalarial medications. Advice
patients to avoid alcohol, herbal products and to notify health care provider if any
thoughts or suicide or dying /anxiety irritability or panic attacks.
CNS/Psychotherapeutic Drugs:
• Stimulants: Amphetamine (Adderall) – releases norepinephrine from nerve
endings to increase motor activity mental alertness and decreased fatigue
in narcoleptic patients and ADHD patients Indications ADHD and narcolepsy
Contraindicated in patients with hyperthyroidism, psychotic personalities suicidal or
homicidal tendencies chemical dependence glaucoma or pregnant. Adverse
effects/side effects – hyperactivity insomnia restlessness tremor palpitations
tachycardia anorexia erectile dysfunction growth inhibition and psychological
dependence Interactions : MAOI will cause hypertensive crisis, beta blockers, digoxin
or antidepressants Nursing implementations – advise patients to take at least 6 hours
before bed to prevent insomnia, monitor children’s height and weight frequently,
teach the parents how to take summer vacations from the meds.
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