D116 Unit 8 Study Guide

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Western Governors University

D116 Advanced Pharmacology for the Advanced Practice Nurse

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Unit 8 Study Guide

What are adverse reactions and interactions with muscarinic agonists?

Muscarinic agonists, such as bethanechol, are associated with several adverse effects primarily due to their parasympathetic stimulation. Bethanechol can cause hypotension, which occurs secondary to vasodilation, and bradycardia. Patients may also experience excessive salivation, increased secretion of gastric acid, abdominal cramps, and diarrhea. Additionally, muscarinic agonists can exacerbate asthma symptoms by increasing bronchial secretions and causing bronchoconstriction, which can be dangerous in susceptible individuals.

If patients continue to be re-infected with UTIs, what medication prophylaxis should be given? Differentiate between reinfection and relapse.

Urinary tract infections (UTIs) often involve the lower urinary tract and can be linked to factors such as sexual activity or the use of contraceptive diaphragms. When reinfections occur infrequently—defined as one or two episodes per year—each infection should be treated as a separate incident, typically with a standard antibiotic regimen.

In contrast, when symptoms reappear soon after the completion of treatment, it may indicate a relapse rather than a new infection. Relapse usually points to underlying issues such as structural abnormalities in the urinary tract, renal involvement, or chronic bacterial prostatitis, which is the most frequent cause of recurrent UTIs in males.

Nitrofurantoin is considered the first-line drug for treating uncomplicated cystitis due to its effectiveness and safety profile.

Aspect	Reinfection	Relapse
Cause	New infection, often related to sexual intercourse or contraceptive use	Recurrence shortly after therapy, indicating incomplete eradication or underlying pathology
Treatment Approach	Treat each episode as a separate infection	Investigate structural abnormalities or chronic conditions; may require prolonged therapy
Frequency	Infrequent (1-2 per year)	Symptoms reappear shortly after treatment

Discuss the treatment for a pediatric patient with a UTI.

For pediatric patients, treatment options vary by age group. Methenamine hippurate is approved for children between the ages of 6 and 12 years and can be used as a prophylactic agent against recurrent UTIs. For infants, particularly those younger than six months, a combination of ampicillin and gentamicin is commonly recommended due to their safety and efficacy in this vulnerable population.

Discuss the specific treatment for patients with enterococcal endocarditis.

Enterococcal endocarditis is often difficult to treat due to the bacteria’s resistance patterns. A combination of antibiotics is generally more effective than monotherapy. Specifically, the combination of a penicillin-class antibiotic with an aminoglycoside (such as gentamicin) is used to achieve synergistic antibacterial action, improving treatment outcomes in these patients.

How is gonorrhea treated?

Current guidelines favor the use of cephalosporins as the preferred treatment for gonorrhea due to their broad-spectrum activity and effectiveness against resistant strains of Neisseria gonorrhoeae. This approach is crucial in managing and preventing complications associated with this sexually transmitted infection.

What is epinephrine used for? What is the mechanism of action?

Epinephrine is a powerful adrenergic agonist capable of activating all alpha (α) and beta (β) receptors but does not affect dopamine receptors. It is primarily used in emergency situations, such as allergic reactions and anaphylaxis, due to its ability to rapidly reverse bronchoconstriction, reduce edema, and increase cardiac output through vasoconstriction and increased heart rate.

Which allergy medication is best for children? What are the side effects?

Antihistamines can be safely administered to children when dosed appropriately for their age and weight. The side effect profile in children closely mirrors that seen in adults and commonly includes sedation, dizziness, incoordination, confusion, fatigue, nausea, vomiting, and diarrhea. However, promethazine is contraindicated in children younger than two years due to reported fatalities in this age group and should be avoided.

What should the healthcare provider look for when discontinuing gout medications?

When discontinuing gout medications, clinicians must be vigilant for signs indicating adverse reactions:

Colchicine should be stopped immediately if gastrointestinal symptoms, such as nausea, vomiting, or diarrhea, develop.
Allopurinol must be discontinued at the first sign of rash or fever, as these may indicate severe hypersensitivity reactions.

References

Katzung, B. G., Masters, S. B., & Trevor, A. J. (2022). Basic and Clinical Pharmacology (15th ed.). McGraw-Hill Education.
Brunton, L. L., Hilal-Dandan, R., & Knollmann, B. C. (2018). Goodman & Gilman’s The Pharmacological Basis of Therapeutics (13th ed.). McGraw-Hill Education.
Mandell, G. L., Bennett, J. E., & Dolin, R. (2020). Principles and Practice of Infectious Diseases (9th ed.). Elsevier.