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NURS 216A
Spetember 19
| Question | Answer |
|---|---|
| What are the toxidromes for acetylsalicylic acid? | - Confusion - Tachycardia - Hyperthermia - Diaphoresis - Vomiting |
| What happens when there is an injury? | 1. Release of chemical signals (mediators) - Potassium ion - Bradykinin - Pyrogens 2. Synthesis of prostaglandins from Arachidonic acid precursor => inflammatory sequelae - Uses an enzyme called COX |
| What is the half life of a drug? | - T1/2 - The time required for a drug plasma concentration to decrease by 50% - Circulating drug is continuously biotransformed for excretion - Broad guideline to estimate frequency of administration - 4 X t1/2 = 90% of drug excreted |
| What do anti-infective drugs bind to? | Directly to bacteria or viruses |
| What is receptor affinity? | - Strength of binding or length of binding - Saturable, specific, and reversible |
| What is potency? | - Amount, how much of the drug is required Drug A is 20mg, Drug B is 10mg, therefore Drug B has a higher potency |
| What is an agonist? | - Drug mimics the endogenous substance - Binds to receptor readily and produces very good effects - Primary or full agonist: extensively and successfully binds to existing receptor |
| What is a partial agonist? | - The maximum response is smaller even if all receptors are occupied - Lower efficacy - In the presence of full agonists, a partial agonist acts like an antagonist |
| What is an inverse agonist? | - It binds to receptors - Induces the OPPOSITE effect of the naturally binding substance |
| What is an antagonist? | - Drug that blocks the receptor site to prevent endogenous or endogenous like substances from binding - NO effect other than blocking others from binding (naloxone, no efficacy at a cellular level other than to block receptors) |
| What is tolerance? | - Down regulation, most common - Receptor de-sensitization or decreased number of viable receptors to a substance - More drug is required for the same response |
| What is resistance? | - Many variations of kinetic alterations - Increased drug metabolism due to increased demand for it => drug metabolized too fast and not effective |
| What are three common nursing errors? | 1. Dose 2. Crushing of enteric coated tablets 3. Crushing of sustained release tablets |
| What is a toxidrome? | Signs and symptoms associated with an overdose of a drug |
| What are the toxidromes for opioids? | - Bradypnea/apnea - Bradycardia - Somnolence/coma - Constricted pupils |
| What are the toxidromes for cocaine and other brain stimulants? | - Agitation, tremors - Tachycardia - Tachypnea - Hyperthermia - Diaphoresis - Dilated pupils |
| What are the steps to treating an overdose? | - Adsorption - Increase metabolism - Increase elimination |
| What is adsorption? | - "Binding of drug, to decrease its absorption" - Activated charcoal binds drug to the surface carbon atoms - Used for Tylenol poisoning, ASA, benzodiazepines |
| How do we induce metabolism? | - NAC (N-acetylcysteine) - Increases glutathione liver enzyme |
| How do we increase elimination? | GI tract: - Activated charcoal, intestinal elimination of bound drug Renal: - Urinary alkalization, charged molecules excreted - Hemodialysis (active removal/cleaning of blood with a machine) |
| What is pain? | A warning mechanism that causes the patient sympathetic NS simulation (fight or flight response), which increases the heart rate and blood pressure, which also vasoconstricts blood away from non-essential organs. |
| How can chronic pain form? | From acute pain that is not dealt with properly or timely |
| How do we assess pain as a symptom? | 1. LATERSNAPS 2. Severity - Scale of 0-10 - Pediatrics face tool |
| How does sensory information go from the PNS to the CNS? | - Starts at the sensory receptors in a specific body part - Ends in the CNS's somatosensory cortex - The sensory impulse needs to be strong enough to reach threshold for action potential - Nociceptor => 1st order neuron in the PNS => spinal cord |
| How do nociceptors transmit pain information to the brain? | Nociceptors>1st order>spinal nerve>dorsal root/ganglion > posterior horn synapse (substance P)>2nd order>ascends spinal cord via spinothalamic tract > thalamus > synapse with 3rd order>somatosensory cortex>localizes in the sensory homunculus>awareness |
| What does a large stimulus trigger? | - Pressure receptors - Nociceptors - Temperature (if arterial blood present) - Mechanoreceptors (tears, stretches) More receptors = bigger sensation of pain |
| How does the pain gate theory work? | Interneurons intercept the pain signal from the nociceptor to the brain and send a sensation of rubbing instead of pain. |
| What is the endogenous response to pain? | - Endogenous opioid peptides are neuromodulators: endorphins, enkephalins, dynorphin - Released from the hypothalamus, limbic system, reticular formation - Bind to receptors and inhibit the release of substance P when bound |
| How do opioids work? | - Centrally acting analgesic - Agonist for receptors, inhibiting the release of substance P |
| What is a psychological dependence? | When someone alters their normal behaviour to seek out a dopamine release |
| What is a physical addiction? | When receptors down regulate, then we do weaning protocols |
| How do we treat an opioid OD? | Opioid receptor antagonist - Naloxone, onset of 2 minutes and lasts 45 minutes |
| What is the connection between COX and NSAIDs? | Since NSAIDs aren't specific, they inhibit both COX-1 and COX-2. The target is COX-2 (inflammatory), but both are the target, and COX-1 becomes the side effect (gastric bleeds and kidney failure) |
| How is inflammation triggered? | - Histamine - Stored in mast cells, released upon mast cell contact with allergen, binds to H1 receptors (G protein) - Non desirable histamine effects: capillary vasodilation and permeability, itching, urticaria, pain, increased HR, bronchoconstriction |
| How is cough and congestion treated? | 1. Cough - Antitussives - CNS depression of cough reflex 2. Congestion - Sympathomimetics - SNS stimulation => decreased nasal secretion |
| What are the factors of drug receptor binding? | 1. Saturable 2. Increases or suppresses existing processes 3. Only block the receptors |
| What are the 6 major types of receptors? | 1. G protein (GCPR) 2. Ion channels 3. Nuclear receptors 4 & 5. Enzyme types 6. Non enzyme (JAK-STAT) |
| What is drug efficacy? | - Effectiveness - Degree to which a drug induces maximum therapeutic effect - Note: antagonists have no efficacy (only block receptors) |
| What are the ABCD's of clinical procedure? | A: airway - patency B: breathing - oxygen and ventilation (RR) C: circulation - organ perfusion (BP) D: disability - assess for dysfunction and treat as needed - CNS: agitation, coma, PERLA, temperature - Cardiac: ECG for arrhythmias |
| What are the toxidromes for acetaminophen? | - Abdominal pain - Loss of appetite - Nausea/vomiting - Diaphoresis - Somnolence |
| What are dermatomes? | - Cutaneous segments serviced by the same spinal nerve, clinically assessed to determine sensory input |
| How does the pain treatment of analgesia work? | 1. At CNS level - Non opioid centrally acting agents - Acetaminophen and opioids 2. At peripheral level - NSAIDS - If inflammation: high efficacy |
| What are the three levels of pain ratings and the medication used in each of them? | 1. <4/10 - Non opioid, PO 2. 4-6/10 - Opioids, PO 3. >6/10 - Higher potency opioids, IV |
| How does acetaminophen work? | Centrally acting analgesic - NOT anti inflammatory, PO Antipyretic - Highest efficacy, peripheral vasodilation causes cooling |
| What is the location and functions of COX-1? | - Present in all tissues - Protects gastric mucosa, supports kidney function, and promotes platelet aggregation - Undesirable affects if inhibited by medications: increased risk of gastric bleeds and kidney failure |
| What is the location of functions of COX-2? | - Present at sites of tissue injury - Mediates inflammation, sensitizes pain receptors, mediates fever in the brain - Desirable effects if inhibited by medication: suppression of inflammation |
| What are glucocorticoids? | Endogenous hormones produced and secreted by adrenal gland - For survival during fasting: stimulates gluconeogenesis and protein degradation, and facilitates lipolysis - Suppresses phagocytes and lymphocytes |
| What is the medication suffix for glucocorticoids? | -one - Hydrocortisone, cortisone - Prednisone, prednisolone - Methylprednisolone - Dexamethasone |
| What is the ADME factors of glucocorticoids? | - Lipophilic - Highly PPB |
| What are the specific uses of glucocorticoids? | 1. Systemic inflammation - Autoimmune - Anaphylaxis 2. Local: intranasal - Allergic rhinitis 3. Asthma: inhalation 4. Local: joint injections |
| What are the two types of histamine receptor antagonists? | 1. First generation - Block histamine receptors - Crosses BBB = CNS effects 2. Second generation - Block H1 histamine receptors - Decreased CNS distribution |
| What is an analgesic? | Drugs that relieve pain |
| What is an opioid? | Drug that relieves pain by the same mechanism as endogenous opioids. |
| What is a narctoic? | Dugs which are taken to alter mood & behaviour, usually acquired illegally (this includes opioids, but also other substances) |
| What is naloxone? | Opiate antagonists, gas a higher affinity to the receptors in the brain that the opiate is attached to. Therefore replaces the drug and stops the overdose. |
| What drugs are in the classification of oipoid? | Fentanyl, hydromorphone, demerol, morphine, hydrocodone, oxycodone, oxycodin, tramadol, codeine, percocet, percodan, Vicodin, tramacet |
| What type of drugs are depressant drugs, and which drugs are they? | Benzodiazepines, xanax, ativan, valium |
| What type of drugs are stimulant drugs? | Cocaine |
| What drugs increase the pH of the stomach? | Antacids - tums, rolaids |
| What is the suffix for corticosteroids? | -ONE, reduce inflammation and suppress the immune system |
| What is the function and drugs in the NSAID class? | - Reduce inflammation, analgesics, and antipyretic properties - Aspirin, ibuprofen, robax, diclofenac, naproxen, ketorolac, indomethacin, celecoxib |
| What drug is in the anticonvulsant class? | Phenytoin (Dilantin) |
| What type of drug is acetaminophen? | Analgesic and antipyretic |
| What type of drug is cocaine? | Stimulant |
| What types of drugs are in the bronchodilator class? | B2 adrenergic agonists (Salbutamol) Anticholinergics (Atrovent) Epinephrine |
| What type of drugs are in the antihistamine class? | First generation (diphenhydramine, chlorpheniramine) Second generation(fexofenadine, loratadine, cetirizine, desloratadine) |
| What is the suffix and function of drugs in sympathomimetics? | -DRINE, SNS stimulation which decreases nasal secretions |
| What is the function of antitussives? | CNS depression of the cough reflex |
| Which three drugs are absorbed directly across the stomach mucosa? | ASA Phenytoin (dilantin) ETOH - alcohol |
Created by:
aschelle
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