LSUHSC NURSING LICENSED PERSONNEL Inpatient RN Pharmacology Exam Instructions

The Pharmacology Exam is given on the Tuesday during Nursing Orientation at 3:30 p.m. If you start employment before or after the Nursing Orientation Scheduled Date, then you may take the Pharmacology Exam any weekday Monday through Friday 8:00 a.m. to 3:00 p.m. You will be required to take the Pharmacology Exam within 3 days of employment. You must schedule an appointment by calling 675-5145. You may use a calculator on this test. Location: BG-13 (Ground floor of hospital) Enter through front of Hospital (Kings Hwy. entrance). Go down the hallway behind receptions desk to the first set of elevators. Take the elevators to the Ground floor (G). Take the hallway to the right, come all the way down and make a left and BG-13 will be on the right hand side before you get to the double doors (just past the Credit Union, across from the cafeteria). Testing Time: 8:00 a.m. - 3:00 p.m. You may test during these hours The test usually takes 1-1 hours

YOU MAY NOT GIVE ANY MEDICATIONS UNTIL YOU PASS THE PHARMACOLOGY EXAM.
/var/www/apps/conversion/tmp/scratch_1/138165623.doc Revised: 07/92, 09/98, 6/01, 07/05

RN PHARMACOLOGY TEST STUDY GUIDE

A condition of employment at LSUHSC-S is that you pass a pharmacology test with a score of 80% or higher. There are 60 questions on this multiple-choice test, which tests drug calculations, general medication knowledge, and situational factors. This is a difficult test. We strongly suggest that you use the following information to prepare for this test.

Key items to know are: 1. Routine medical abbreviations. 2. Equivalents (i.e. gramsmilligrams-micrograms). 3. Calculation of IV drip rates using different drop factors (60 gtts=1 cc; 15 gtts=1 cc; 10 gtts=1 cc), different fluid volumes ( 1000 cc, 800 cc, 600 cc, 400 cc, etc.) and different time intervals for infusion of the fluid ( 10 hours, 6 hours, 5 hours, etc.) 4. Computations involving the availability of the drug in a different dosage than what is ordered. 5. Definitions of the following terms: half life, synergistic effect, potentiates, untoward effects, paradoxical effects. 6. Z-track technique. 7. A macrodrip IV set delivers 10 drops of solution per milliliter. 8. A microdrip IV set delivers 60 drops of solution per milliliter. Of each of the following drugs or drug classifications, you will need to know: Uses Lab values
NSAIDS

Actions Route & Dosage

Adverse/Side Effects Patient and Family Education

Premarin Retovir (Zidovudine) Tylenol (Acetaminophen) Fungizone (Amphoterecin B) Cytoxan (Cyclophosphamide) Zofran (Ondansetron) Zyloprim (Allopurinol) Claritin (Loratadine) Aspirin (Acetylsalicylic Acid) Phenobarbital Adriamycin (Doxorubicin Hydrochloride) Atropine Sulfate Bumex (Bumetanide) Xylocaine (Lidocaine Hydrochloride) Rifadin (Rifampin) Cortisol (Hydrocortisone) Intropin (Dopamine Hydrochloride) Sandimmune (Cyclosporine) Ketalar (Ketamine Hydrochloride)

Lupron Mycostatin (Nystatin) TheoDur (Theophylline Anhydrous) Nitrostat (Nitroglycerin) Aerobid (Flunisolide) Proventil (Albuterol) Coumadin (Warfarin sodium) Nolvadex (Tamoxifen citrate) Mucomyst (Acetycysteine) Regular insulin (Humulin R) Carafate (Sucralfate) Potassium Chloride Epogen (Epoetin Alfa) Lopressor (Metoprolol Tartrate) INH (Isoniazid) Vitamin B12 (Cyanocobalamin) Constulase (Lactulose) Penicillin G. Sodium
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Specific Drug Information

Adriamycin (doxorubicin hydrochloride) is used in the treatment of solid tumors, cancer of lungs and bladder, lymphomas and metastatic tumors. It is a vesicant agent and should be administered with extreme caution to avoid extravasation. Patients should be informed that Adriamycin will change the color of urine to red because the drug is red. Tamoxifen citrate (Nolvadex) is indicated in the treatment of advanced breast cancer in post-menopausal women. Adverse/side effects include thrombosis, nausea & vomiting, leukopenia, thrombocytopenia, hair loss, weight gain, shortness of breath photosensitivity, hot flashes, & hypercalcemia. When caring for a client taking tamoxifen citrate you should monitor serum Calcium levels as tamoxifen may produce transient increase in serum calcium. Rifadin (Rifampin) - anti-infective antibiotic, antituberculosis agent. Patient family education instructions would include to caution against abrupt withdrawal because flu-like symptoms occur with the interruption of drug therapy, inform patients that drug may cause a harmless red-orange color to urine, feces, sputum, sweat, and tears. Soft contact lenses may be permanently stained. Ketalar (Ketamine Hydrochloride) a rapid acting general anesthetic. Used for diagnostic & surgical procedures of short duration that do not require skeletal muscle relaxation. Adverse/Side effects include hallucinations, delirium, confusion, excitement, irrational behavior. Ketalar can also cause hypertension, hypotension, tachycardia, bradycardia, and arrhythmias. Recovery from Ketamine anesthesia is frequently prolonged and may be accompanied by hallucinations, vivid imagery, and delirium. Severity of recovery symptoms may be reduced by allowing the patient to awaken quietly with minimal stimulation Lupron (Leuprolide acetate) is prescribed for the palliative treatment of advanced prostatic cancer. Recommended route of administration is 1mg/day subQ or 7.5mg/month IM. Adverse/Side effects include: hot flushes, impotence, decreased libido, nausea, vomiting, increased bone pain, hematuria, dysuria, decreased Hct /Hgb, fatigue, fever, peripheral edema & cardiac arrhythmias.

NOTES: Prior to administering ANY medication, you should always verify that there is an order on the chart. Also, make sure you send a copy all orders to pharmacy via the pneumatic tube system.
Wilson, B.A. and Shannon, M. (1993). Govoni and Hayes: Nurses Drug Guide. Norwalk, CT: Appleton and Lange. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2000). Nurses Drug Guide 2000. Stamford, CT: Appleton & Lange.
Revised: 07/92, 09/98, 6/01, 07/05

AVAILABLE INSULIN
Action
Manufacturer

Type/Brand

Onset

Peak

Duration

Eli Lily NPH*

HUMAN (Humulin) 1-2h 1/2h 1-3h 4-6h 1/2h 1/2h 6/12h 2-4h 6-12h 8-16h 2-4h & 6-12h 2-4h & 6-12h 18-24h 6-8h 18-24h 24-28h 18-24h 18-24h

Regular Lente Ultralente Humulin 70/30 (NPH & Regular)* Humulin 50/50 (NPH & Regular) HUMAN INSULIN ANALOG Humalog (Lispro)* Humalog 75/25 (NPH & Humalog)*s

5 min 5 min 1-2 h

1-2h 1-2h 6-12h

4h 4h & 1-2h 18-20h

Novo Nordisk NPH Regular Lente

HUMAN (Novolin) 1 1/2h-4h 1.2h-2h 2 1/2h-5h 1/2h 4-12h 2 1/2h-5h 7-15h 7-12h 14-24h 5-8h 16-22h 24h

Novolin 70/30 (NPH & Regular)

*Available in Vial and Pen

Revised: 07/92, 09/98, 6/01, 07/05

CALCULATING FLOW CHARTS To calculate the right flow rate for patient, answer these questions: How much solution did the doctor order? How much time is allowed for delivery? Take the amount of solution to be administered and divide it by the delivery time: for example: 1000ml = 125 ml per hour 8 hours Now, decide which type of drip system you're using. If you're delivering a lot of fluid in a short time, use a macrodrip system. The Macrodrip, depending on the manufacturer, takes 10, 15, or 20 drops to deliver 1 ml. If you're delivering a small amount of fluid over a long time, use a microdrip system. The microdrip takes 60 drops to deliver 1 ml. Insert your answers into this formula: Drops per ml 60 minutes Amount of fluid per hour 1 = drops per minute

If you're using a macrodrip system, your equation will look like one of these: 10 60 15 60 20 60 X X X 125 1 125 1 125 1 = = = 125 6 125 4 125 3 = = = 21 drops per minute 31 drops per minute 41 drops per minute

If you're using a microdrip system, your equation will look like this: 60 60 X 125 1 = 125 drops per minute

After you have determined the rate, program the infusion pump to infuse fluids at the specified rate. **As noted in Nursing Policy I49 (Peripheral IV Therapy), an infusion containing additives or an infusion ordered at a specified rate must be administered via an infusion pump.

Revised: 07/92, 09/98, 6/01, 07/05

STUDY GUIDE FOR PHARMACOLOGY TEST

I. EQUIVALENTS: 1,000 mg = 1 gm 1,000mcg = 1mg 1 kilogram = 2.2 pounds 500 ml or cc = 1 pint 1000 ml or cc = 1 liter II. ABBREVIATIONS: (q and SC/SQ are unapproved abbreviations) a.c.- before meals p.c. after meals cap- capsule gm- gram gtt- drops qid- four times a day tab- tablet ml- milliliter III. PRACTICE PROBLEMS 1. 2. 3. 4. What is the smallest amount? A) 0.08cc; B) 0.18cc; C) 0.8cc prn- as often as necessary tid- three times a day h.s.- hour of sleep; at bedtime IM- intramuscular mg- milligram

Order: Regular Insulin 30 units. On hand: Regular Insulin 100 units/ml. How many ml. of insulin would you give? How many KG. Does a 100 lb. man weigh? A) 455 KG;

B) 45.5 KG; C) 4.5 KG?

A patient is to receive 2 mg of a drug for every Kg of body weight. The patient weighs 100lbs. How many milligrams of the drug should he receive? A) 91 mg B) 9 mg C) 910 mg How many milligrams = 0.1 grams? A) 1 mg; B) 1000mg; C) 100 mg?

5.

6. A patient who weighs 198 lbs is to receive Dobutamine HCL (Dobutrex) 5mcg/kg/min. A nurse mixes 250 mg of Dobutamine in 500ml of IV solution. The nurse should set the infusion pump to deliver how many cc/hr? A) 37.5cc B) 13.5cc C) 54cc ANSWERS TO SECTION III:
Revised: 07/92, 09/98, 6/01, 07/05

1. a

2. 0.3ml 3. b

4. a

5. c

6. c

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IV. Dosage and Solution Problems Order: Regular Insulin 30 units. On hand: Regular Insulin 100 Units/ml. How many ml of insulin would you give? 1. Write your known. 100 units 1 ml Write an equal sign. (=)

2. 3.

Write your order. Put the known measure across the same unit of measure. (Put units across from units, ml across from ml, etc.). Write an x for your unknown. 100 units = 30 units 1 ml X Cancel out units of measure that are alike. 100 units = 1 ml 30 units X

4.

5.

Then cross multiply. 100 = 1 ml 30 X

6. 7.

100x = 30 ml X has to stand alone. Therefore, divide each side by 100 to make x stand alone. 100x = 30ml 100 100 Eliminate all 0s that you can.

8. 9.

100x = 30ml 100 100 X = 3ml = 0.3ml 10

Revised: 07/92, 09/98, 6/01, 07/05

V.

HELP If you have difficulty with these problems, you may want to try this approach. To set up your equation: a. Write your equivalent: 1 Kg = 2.2 lbs. In the following manner: 1Kg 2.2 lbs. b. Then write your known across from lbs. If it is lbs; across from Kg if the known is Kg. 1Kg = 2.2 lbs c. d. X 100 lbs.

The other spot (x) is your unknown- the answer youre trying to find. Then cross multiply: Pounds cancel out. 1 Kg = X 2.2 lbs 100 lbs

e.

Then divide each side by 2.2 because X has to stand alone. 100 Kg 2.2 = 2.2X 2.2 ; 45.5 Kg = X

VI.

Help
Dobutamine Order: 5mcg/kg/min Weight: 198 lbs Problem: How many cc/hour? A. First, calculate KG 198 / 2.2 = 90KG B. Then use KG to calculate ordered dose 90KG x 5mcg = 450 mcg/min C. Then calculate how many mcg you want to infuse in an hour 450 mcg x 60 min min hr D. Now, calculate how many mcg you have in your IV solution. First you will need to convert mg to mcg X= 27,000 mcg/hr

250mg 1mg 250mg 1mg

= =

X 1000mcg X 1000mcg

250,000 mcg in the bag Then you will need to determine how many mcg per cc of your 500 cc bag of solution X = 250,000mcg 500cc X = 500mcg/cc E. Now that you know how many mcg per cc from D (500mcg/cc), and how many mcg you want to infuse in a hour from C (27000mcg/hr), you can figure how many mcg to infuse in an hour. 500mcg = 27000mcg 1cc X 500mcg = 27000mcg 1cc X 270cc= 5x 270cc = 5x 5 5 x=54cc
Revised: 07/92, 09/98, 6/01, 07/05

Answer is 54cc/hr

VII.

MORE PROBLEMS 1. How many ccs are indicated by the arrows below? a) 1.3; b) 1.4; c) 1.5

1 Physician Orders 2. 3. 4. 5. 6. Haldol 0.5 mg Lanoxin 0.15 mg Talwin 50mg Tylenol 0.4 grams PO Staphcillin 1gm IM every 6 hours

3 Give ml ml ml tab

Drug on Hand Haldol 2mg/ml Lanoxin 2ml vial with 0.25mg/ml Talwin 10ml vial with 30mg/ml Tylenol 200mg per tablet Staphcillin powder 5gm vial. Directions are to add 8.6 ml sterile water and then each ml will contain 500 mg.

ml

7. Key:

A patient eats at 8:00 a.m., 12 Noon, and 5:00 p.m. The patient receives NPH insulin at 7:00 a.m. NPH insulin peaks at a) hours after administration. When would the patient most likely have problems with low blood glucose? b) 1. 2. 3. 4. b 1.4cc 0.25ml 0.6cc 1.7ml 5. 2 tablets 6. 2ml 7. (a) peaks 6-12 hours (b) mid-afternoon 3pm-5pm

References: Louisiana State University Health Sciences Center Nursing Policy & Procedure I49 Peripheral IV Therapy, I49 1-3. Micromedex- NO Drug- Invision Computer Terminal at Louisiana State University Health Sciences Center-Shreveport. Wilson, B.A. and Shannon, M. (1993). Govoni and Hayes: Nurses Drug Guide. Norwalk, CT: Appleton and Lange.
Revised: 07/92, 09/98, 6/01, 07/05