NR 293 Exam 2

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Chamberlain University

NR-293: Pharmacology for Nursing Practice

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Date

NR 293 Exam 2 Study Guide

This study guide provides an in-depth overview of pharmacological concepts crucial for NR 293 Exam 2. It focuses on the clinical application of medications, including their indications, contraindications, adverse effects, drug interactions, and patient safety/education considerations. Exemplars from each drug class are included to strengthen understanding of therapeutic uses and clinical precautions.

Morphine

Indications
Morphine is primarily used to manage moderate to severe pain, particularly in cases where other analgesics are insufficient. It is often prescribed for post-operative pain, cancer-related pain, and chronic pain syndromes.

Contraindications
Morphine is contraindicated in patients with epilepsy, heart disease, significant liver or kidney dysfunction, and hypersensitivity to opioids. It should also be avoided in individuals with respiratory depression or paralytic ileus.

Adverse Effects
Potential adverse effects include allergic reactions (rash, itching, swelling), respiratory depression, constipation, peripheral edema, and sedation. Long-term use increases the risk of dependence.

Interactions
Patients should avoid taking morphine with Monoamine Oxidase Inhibitors (MAOIs) within 14 days. It may interact with alcohol, herbal supplements, benzodiazepines, and vitamins, increasing CNS depression.

Safety and Patient Teaching
Morphine has a high risk of dependence and should be used under close supervision. Patients should be instructed not to drive or operate heavy machinery while on the drug. Pregnant or breastfeeding individuals must consult a healthcare provider due to potential risks for the fetus or infant.

Acetaminophen

Indications
Acetaminophen is widely used for reducing fever and alleviating mild to moderate pain such as headaches, musculoskeletal pain, or osteoarthritis discomfort.

Contraindications
Patients with liver disease, alcoholism, or known hypersensitivity should avoid this medication due to the risk of hepatotoxicity.

Adverse Effects
Adverse reactions may include allergic responses, black or tarry stools, fatigue, excessive sweating, and, in severe cases, liver failure.

Interactions
In patients taking anticoagulants, Prothrombin Time (PT)/International Normalized Ratio (INR) must be monitored closely to prevent bleeding risks.

Safety and Patient Teaching
Patients should not exceed 3000 mg/day in adults or 2000 mg/day in elderly and children. Importantly, acetaminophen does not possess anti-inflammatory properties, and patients should be educated about differentiating it from NSAIDs.

Diazepam

Indications
Diazepam is a benzodiazepine prescribed for anxiety disorders, muscle spasms, seizures, and alcohol withdrawal symptoms.

Contraindications
It is contraindicated in patients with narrow-angle glaucoma, myasthenia gravis, severe hepatic impairment, or sleep apnea.

Adverse Effects
Patients may experience seizures, confusion, dizziness, nausea, lethargy, and allergic reactions. Respiratory depression is a serious risk with high doses.

Interactions
Diazepam should not be combined with MAOIs, theophylline, or other sedatives due to increased CNS depression and toxicity risk.

Safety and Patient Teaching
Diazepam is habit-forming and may cause dependency. Overdose can be fatal. Patients should avoid alcohol, and caution should be taken in those with renal/hepatic impairment. Pregnant or breastfeeding women should not use diazepam due to teratogenic effects.

Phenobarbital

Indications
Phenobarbital is a barbiturate used to control seizures and prevent withdrawal symptoms in individuals dependent on barbiturate medications.

Contraindications
This drug is contraindicated in patients with acute intermittent porphyria, liver dysfunction, or respiratory illness.

Adverse Effects
Patients may experience dizziness, nausea, vomiting, sedation, and drowsiness. Long-term use may contribute to dependency.

Interactions
Phenobarbital interacts with medications for anxiety, depression, and seizures, as well as with sodium oxybate (GHB).

Safety and Patient Teaching
Patients should avoid pregnancy and breastfeeding while taking phenobarbital due to teratogenic effects. Those with a history of suicidal ideation or depression should use with caution.

Drug Class Overview

The following table summarizes essential pharmacological details for selected drug classes:

Anticoagulants and Related Medications

Therapeutic Monitoring and Drug Interactions

Patients on anticoagulants require regular laboratory monitoring, particularly for PT and INR levels, with a therapeutic range of 2–3. Thrombolytic medications are crucial for breaking down clots by converting plasminogen into plasmin, and they are used in conditions such as MI, DVT, pulmonary embolism, catheter occlusion, and ischemic stroke.

Contraindications and Adverse Effects

Thrombolytics carry significant risks, including internal, intracranial, and superficial bleeding. Other adverse effects include hypotension, dysrhythmias, hypersensitivity reactions, nausea, and vomiting. Co-administration with other anticoagulants or antiplatelets increases bleeding risk. Patients must be counseled to avoid alcohol when taking medications like disulfiram, as it can cause severe adverse reactions.

Anticoagulant and Related Drugs Table

Medication-Specific Considerations

Bronchodilators
Drugs like albuterol and salmeterol are prescribed for asthma and COPD. They prevent bronchospasm and improve airway function. Patients must be cautioned about paradoxical bronchospasm and should not rely solely on these medications for acute relief—rescue inhalers are essential.

Uric Acid Reducers
Allopurinol is used to manage gout and prevent kidney stones. Contraindicated in patients with severe renal impairment, it can cause GI upset, rash, and drowsiness. Patients should be advised about possible drug interactions and the importance of hydration.

Patient Education and Monitoring

Patient education ensures safe and effective therapy. For example, anticoagulant users must understand the importance of INR monitoring and recognize bleeding signs. Patients on disulfiram require strict avoidance of alcohol. Similarly, patients using bronchodilators should be educated on the difference between rescue and maintenance inhalers.

Conclusion

Effective management of conditions with pharmacological agents requires a balance between therapeutic benefits and adverse effects. Close monitoring, patient education, and careful assessment of drug interactions are key to improving patient outcomes while minimizing risks.

References

American Heart Association. (n.d.). Anticoagulants: Facts about blood thinners. https://www.heart.org

NR 293 Exam 2

National Heart, Lung, and Blood Institute. (n.d.). Thrombolytics: Use and risks. https://www.nhlbi.nih.gov

U.S. National Library of Medicine. (n.d.). Disulfiram. https://medlineplus.gov