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2018-EXAM 1 Review

What are the 4 steps in pharmacokinetics? ADME: Absorption, distribution, metabolism, excretion
Explain Absorption Movement of drug from site of admin to tissues. 1st t pass effect-med may inactive when passes through the liver, the actual amt available to the body can be less than ingested. Bioavailability is the amt of drug available after passing through the liver
Explain Distribution Movement of drug by circulatory system to site of intended action
Explain Metabolism Metabolism: change in drug to more or less potent form more or less potent form, more soluble form, inactive form. Mostly in liver-biotransformation.
Explain Excretion Excretion: elimination of drug or its metabolites
Explain half life Time for drug to decrease by half-may be altered by kidney/liver fn (5 half-lives to clear most drugs)
Explain onset of action Time it takes to demonstrate therapeutic response
What is peak time? Time to demonstrate full therapeutic effect
What is duration of action? Length of time therapeutic effect lasts
What is the difference between side-effects and adverse drug reactions? Side: unintended, common, mild in nature while  Adverse: unintended, unexpected, more severe/life threatening
Explain drug tolerance body’s decreased response to drug over time; increase dose
How does the cumulative effect occur? amt of drug taken is greater than amt excreted; decrease dose
What are some causes of drug toxicity? Excessive dosages, impaired excretion, or small safe/therapeutic window
Name a food that commonly interacts with medications. Grapefruit (removed from many hospital menus)
Describe additive effect drug interaction both drugs act the same 1+1=2
Describe synergistic effect drug interaction Effect of 1 drug is greater when given with another 1+1 >2
Describe antagonistic effect drug interaction Effect of 1 drug is less when given with another 1+1<2
What are the pregnancy risk categories that indicate probable or certain fetal harm? D and X
What is a Black Box Warning? Appears first on drug info-surrounded by black outline. Indicates a very serious life-threatening problem
"Describe the five schedules in the CSA (I-V) that are used to classify drugs and name a medication in each of the 5 schedules. 1-high pot abuse, no medi use, safety-cannabis; 2- high pot abuse, psych or phys dx-morphine, , 3-less abuse pot, low phys dx or high psych dx-Tyl with Cod; 4-low pot for abuse-benzo's Valium; 5-low pot for abuse , sm amt narcotics-Phen with Codeine
žDescribe the enteral administration route —Via the gastrointestinal tract by the oral, rectal, or nasogastric routes
Describe the parenteral administration route —Bypasses the GI tract by using subcutaneous, intramuscular, and intravenous injection
Describe the percutaneous administration route —Absorbed through the skin and mucous membranes (includes inhalation, sublingual, or topical)
What occurs in the first-pass effect? Oral drug is metabolized to an inactive form before it has an opportunity to reach target cells
Define idiosyncratic effect an uncommon response to a drug; unpredictable and often life threatening
Define teratogen Any agent that can disturb the development of an embryo or fetus. Teratogens may cause a birth defect in the child.
Define carcinogen a substance capable of causing cancer in living tissue.
Explain agonist drugs A drug that produces same type of response as endogenous substance, mimics the effect, the better the “fit,” the better the response
Explain antagonist drugs Drugs that attach but do not elicit a response/prevent the endogenous action, block the effect
Explain partial agonists: Drugs that attach and elicit a small response, but also block other responses
What is minimum effective concentration? Amount of a drug required to produce therapeutic effect
What is a toxic concentration? Level of drug that will result in serious adverse effects
What is therapeutic range? Plasma drug concentration between the minimum effective concentration and toxic concentration
Explain drug interactions between protein-bound medications Competitive displacement interactions are ones among protein binding reactions. The competitive protein binding (usually to albumin) drug-drug interactions result in increased the free plasma concentrations of the displaced medications
What does a hypnotic drug do? produces sleep
What does a sedative drug do? relaxes a patient but is not necessarily accompanied by sleep
Name a benzodiazepine used for sleep temazepam (Restoril)
Name a benzodiazepine used for sedation alprazolam (Xanax)
Name a non-benzodiazepine used for sleep zolpidem (Ambien)
What are some standard nursing interventions for sedative-hypnotic therapy? Take immediately before going to bed, May have hypotension on arising, Safety precautions for driving, operating machinery
What Centrally Acting Muscle Relaxant is used to treat spinal cord injury, cerebral palsy, Multiple Sclerosis? baclofen (Lioresal)
Name 3 side effects of centrally acting muscle relaxants Drowsiness, dizziness, weakness, fatigue, nausea, constipation
Differentiate between generalized seizures and partial seizures generalized seizures—affect both brain hemispheres; partial seizures—begin in one hemisphere
Do anticonvulsants increase or decrease seizure threshold increase
Name a benzodiazepine used to treat seizures diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin)
Name a hydantoin used to treat seizures phenytoin (Dilantin)
What unusual possible side effect does phenytoin have? Gingival hyperplasia
What is the preferred drug for absence and partial seizures valproic acid (Depakene)
Name a local anesthetic lidocaine (Xylocaine)
Name a medication often given with general anesthesia or conscious sedation for amnesia effects midazolam (Versed)
What is the reversal agent used for an overdose of benzodiazepines? romazicon (Flumazenil)
What class of drug is fentanyl (Sublimaze) ? Opioid agonist
What is the reversal agent used for an overdose of opioids? naloxone (Narcan)
Name 2 drugs commonly used for ADD or ADHD amphetamine (Adderall), methylphenidate (Ritalin),
Name a drug commonly used for narcolepsy modafinil (Provigil)
Parkinson’s Disease is caused by a deficiency of __________. dopamine
What most likely causes tremors in Parkinson's? excess cholinergic activity (which causes tremors)
What is donepezil (Aricept) for and how does it work? Alzheimers-Prevents acetylcholinesterase from inactivating acetylcholine
How does sumatriptan (Imitrex) work to stop migraine headaches? It is a seratonin agonist that causes vasoconstriction and prevents inflammatory response.
What is the name of the medication that is used for depression and smoking cessation? buproprion (Wellbutrin)
What is the medical consequence of taking MAOI phenelzine (Nardil) with aged cheese? hypertensive crisis
Name 3 therapeutic uses of diazepam. anxiety, status epilepticus, and muscle spasms
Prior to discharge, what patient education would you provide to a patient taking phenytoin (Dilantin)? Take w food. Patients or their carers should be told how to recognize signs of blood or skin disorders, and advised to seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, bruising or bleeding develop.
Name a contraindication for a patient who is ADD and is planning on taking methylphenidate (Ritalin) for treatment. hypersensitive to the drug, in patients with glaucoma, and in patients with motor tics or with a family history or diagnosis of Tourette's syndrome, hypertension, addictive tendencies
A patient taking lithium carbonate is confused, agitated, and has a coarse tremor. What is most likely the cause of this? lithium toxicity
What lab values would you monitor for a patient on valproic acid? LFTs, CBC w/ diff, ammonia
What are the advantages of atypical antipsychotics over first generation antipsychotics? lower risk of extrapyramidal side effects and tardive dyskinesia compared with first-generation antipsychotics (FGAs)
What is a side-effect that you might see in a patient taking Sinemet (carbidopa/levodopa)? anticholinergic type effects such as dizziness, drowsiness, blurred vision, nausea, vomiting, dry mouth, loss of appetite, heartburn,
What is an advantage of Buspar (buspirone) over other anti-anxiety agents? lack problems of habituation and withdrawal, and to be useful in patients with masked comorbid depression
What is a side effect of Prozac? insomnia, strange dreams; headache, dizziness, vision changes; tremors or shaking, feeling anxious or nervous; pain, weakness, yawning, tired feeling; upset stomach, loss of appetite, nausea, vomiting, diarrhea; dry mouth, sweating, hot flashes;
Some children who take ADHD medications are advised to take a drug holiday. What does this mean? a planned period of time that a patient stops taking a medication for a defined period-weekends, summer, etc.
Name 3 different anxiety disorders. Generalized anxiety disorder, Panic disorder, Phobias, Obsessive-compulsive disorder (OCD)
List 2 benzodiazepines used for anxiety disorders lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax)
"Describe the symptoms of depression in more detail around these main categories: Emotional, physical, cognitive, and psychomotor.Emotional symptoms Emotion-Sadness, no enjoyment of usual activities; Physical-Fatigue, sleep disturb, appetite disturb, heart palps; Cognitive-Inability to concentrate, slowed thinking, poor memory, confusion Psychomotor-Slow movements, slow speech, may exhibit agitation
Describe Bipolar symptoms. Episodes of mania (euphoria) and depression, separated by intervals without mood disturbances. Paranoid or grandiose delusions during manic phase.
What medications are used to treat bipolar disorder? Lithium and Anticonvulsant drugs
What are the 3 phases of treatment for bipolar disorder and how long does each take? Acute phase: Med response 10-12 wks, doses adjusted and Psychotherapy initiated; Continuation phase: 4 to 9 mo, Uses pharm & psych therapy, (sx-free for 6 mo); Maint phase-for hx of 3 depressive epis, chron depression, or bipolar disorder,
What are the 2 generations of antidepressants and name medications in each of them. 1st generation: MAOIs phenelzine (Nardil) and TCAs amitriptyline (Elavil); 2nd generation: SSRIs-fluoxetine (Prozac), paroxetine (Paxil) and Serotonin and norepinephrine reuptake inhibitors (SNRIs) venlafaxine (Effexor)
What is another use for the atypical antidepressant, bupropion (Wellbutrin)? smoking cessation
How does bupropion (Wellbutrin) affect the seizure threshhold? LOWERS
What herb is commonly used for depression? St. Johns Wort
What labs must be taken at baseline for patients taking Lithium? Electrolytes, glucose, BUN/creatinine, urinalysis, thyroid function
Name 2 common side effects of Lithium. nausea/vomiting, anorexia, cramps; excessive thirst and urination; fine hand tremor
List 4 signs of Lithium toxicity. Persistent vomiting, profuse diarrhea; Hyperreflexia, lethargy, weakness; Progressive fatigue, weight gain (hypothyroid); Hyperglycemia; Nephrotoxicity
Lithium serum level must be monitored due to a ________therapeutic window. narrow
Name a conventional antipsychotic medication. Phenothizines: chlorpromazine (Thorazine) or chlorpromazine (Thorazine) or haloperidol (Haldol)
List 3 side-effects or adverse drug reactions caused by conventional antipsychotic medications. Anticholinergic effects: dry mouth, constipation; Extrapyramidal symptoms: Akathisia, Acute dystonia, Parkinson-like symptoms, Tardive dyskinesia, Suppressed sexual drive, Neuroleptic Malignant Syndrome
Name a side effect of risperidone (Risperdol), a 2nd generation or atypical antipsychotic. Extrapyramidal symptoms (less than conventional), weight gain, increased cholesterol, diabetes
Created by: mchugh100



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