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foundations exam 1
pharmacology basics
| Question | Answer |
|---|---|
| assessment prior to administering meds | a comprehensive medication history awareness of the patient’s allergies patient assessment ongoing assessments of the patient’s response during and after medication administration |
| diagnoses are | developed and problem identification stems from the assessment data |
| patient centered outcomes | are evaluated after implementation of the plan of care are tailored to the patient’s needs |
| drug nomenclature | generic vs trade |
| drug options | Enteral (oral) Topical (suppository, drops) Parenteral (injection, infusion, implantation) administration |
| enteral (oral) drugs | going in through mouth and through GIT |
| Topical (suppository, drops) drugs | on skin, ears, eyes |
| Parenteral (injection, infusion, implantation) administration | inside the body via mechanism |
| drug classification | Pharmaceutical Therapeutic |
| Pharmaceutical | what is it doing in the body? |
| Therapeutic | what is it used for? |
| drug indications | Pharmacotherapeutics Pharmacokinetics Pharmacodynamics |
| Pharmacokinetics | effect body has on the drug |
| Pharmacokinetics: ADME | Absorption Distribution Metabolism Excretion |
| Absorption | process of where med is being moved from site of administration to systemic |
| Distribution | process of moving through the body cells rely on proteins to transport |
| Metabolism | first pass through liver decrease doses in geriatrics because can't metabolize as fast different effects based on status of liver and kidney aka "biotransformation" |
| Excretion | remaining amount leaves body via sweat, urine, feces |
| adverse drug reactions | Side Effect Allergic Effect Drug Tolerance Toxic Effect Idiosyncratic Effect Drug Interactions |
| Side Effect | nausea, constipation |
| Allergic Effect | breaking out in rash, inflammation |
| Drug Tolerance | have chronic pain and take meds constantly, built up tolerance over time |
| Toxic Effect | due to poor metabolism, genetic disposition causing rapid/delayed responses, or could be renal/hepatic |
| Idiosyncratic Effect | unusual reaction, opioids are harder to process through pain |
| Drug Interactions | don't want to give too many/little so ask about OTC, dietary supplements because can interact with many meds |
| factors affecting drug action | Developmental Concerns Body Weight Biological Sex Cultural and Genetic Factors Psychological Factors Pathology Environment Timing |
| Developmental Concerns | during pregnancy or during breast feeding, can pass to fetus |
| Body Weight | higher weight = decreased metabolization lower weight = increased metabolization |
| Biological Sex | more testing for males, except for hormones which have more testing for women |
| Cultural and Genetic Factors | ACEi causes coughing in Asians and edema in african americans |
| Psychological Factors | placebo affect can be affective |
| Pathology | liver or kidney issues |
| Environment | quiet vs noisy for a headache |
| Timing | some are taken with or without food |
| Drug blood level monitoring | Therapeutic range Half-Life |
| half life | amount of time it takes for 50% if concentration of a drug to be eliminated from body, want a steady concentration |
| Pertinent U.S. drug legislation | need prescription in US |
| chemical name | identifies drug’s atomic and molecular structure |
| generic name | assigned by the manufacturer that first develops the drug; derived from the chemical name |
| official name | name by which the drug is identified in official publications (typically generic name) |
| trade name | brand name copyrighted by the company that sells the drug |
| drug classifications | Classified by effect on body system; chemical composition; clinical indication or therapeutic action |
| two primary classifications | Pharmaceutical class Therapeutic class |
| Pharmaceutical class | Refers to the mechanism of action (MOA), physiologic effect (PE), and chemical structure (CS) of the drug |
| Therapeutic class | Refers to the clinical indication for the drug or therapeutic action (e.g., analgesic, antibiotic, or antihypertensive). |
| Factors Affecting Absorption of Medications | Route of administration Lipid solubility pH Blood flow Local conditions at the site of administration Drug dosage |
| Route of administration | IV = quicker and 100% available oral = slower and not 100% available because needs to be broken down |
| pH | blood balance |
| blood flow | if blood flow is limited, slower absorption |
| Local conditions at the site of administration | increased adipose = not absorbed properly |
| drug dosage | would SBAR if increase or decrease |
| when does distribution occur | after a drug has been injected or absorbed into the bloodstream |
| when do metabolism and excretion occur | after distribution |
| distribution depends on | blood circulation protein binding, which affects the drug’s ability to leave the bloodstream or storage areas the selectively permeable BBB that protects the CNS with its capillary wall, but can limit the passage of drugs intended to act on the CNS |
| be careful of pregnancy because | can be passed to fetus across placenta or breast milk |
| metabolism aka biotransformation | the change of an active drug from its original form to an inactivated or new form |
| liver is the primary site for | drug metabolism |
| various processes and enzymes are involved in | metabolism |
| most drugs are inactivated by | the liver and transformed to inactive substances for excretion |
| Physiologic changes | associated with aging, the presence of liver disease, or other factors that impair the functioning of the liver decrease its ability to metabolize drugs |
| GIT, lungs, and kidneys have a role in | drug metabolism |
| drugs given orally | move from the intestinal lumen to the liver by way of the portal vein |
| some drugs are extensively metabolized in | the liver and do not make it to the systemic circulation |
| some drugs are metabolized by the liver to an inactive form which reduces | the amount of active drug left in the body |
| other drugs may be metabolized to an active drug metabolite and | may be more active than the original drug |
| excretion is the process of | removing a drug, or its metabolites (products of metabolism), from the body |
| kidneys excrete most | drugs through the urine |
| lungs are the primary route for the excretion of | gaseous substances, such as inhalation anesthetics |
| skin has minimal | excretory function |
| Some medications may be | contraindicated, or dosages may need to be adjusted |
| if renal excretion is impaired | changes associated with aging, disease, or the presence of other factors that impair the functioning of the kidneys can decrease their ability to excrete drugs |
| Pharmacodynamics is the process by which | drugs alter cell physiology and affect the body |
| Drugs turn on, turn off, promote, or block | responses that are part of the body’s processes |
| Drug–receptor interaction occurs when | the drug interacts with one or more cellular structures to alter cell function |
| Drugs may also combine with | other molecules in the body to achieve their effect |
| Other drugs act on | the cell membrane or alter the cellular environment to achieve their effect |
| adverse drug reactions (ADRs) | Allergic effects: anaphylactic reaction Drug tolerance Toxic effect Idiosyncratic effect Drug interactions: antagonistic and synergistic effects |
| a serious ADE is defined as | an action that is life threatening, requires intervention to prevent death or permanent impairment, and/or leads to death, hospitalization, disability, or congenital anomaly |
| ADE must be | documented |
| an allergic effect is an | immune system response that occurs when the body interprets the administered drug as a foreign substance and forms antibodies against the drug |
| a drug allergy manifests differently depending on | the drug, the allergy, and the pt |
| clinical manifestations of allergic reactions range from | mild to severe |
| the reaction can occur | immediately after the patient receives the medication or be delayed for hours to days |
| symptoms may become | more severe each time the drug is introduced into the body |
| signs and symptoms of a drug allergy | rash, urticaria, fever, diarrhea, nausea, and vomiting |
| Anaphylactic reaction (anaphylaxis) | the most serious allergic effect |
| Anaphylaxis is | life threatening and results in respiratory distress, sudden severe bronchospasm, and cardiovascular collapse |
| Anaphylaxis reaction is treated with | vasopressors, bronchodilators, corticosteroids, oxygen therapy, intravenous fluids, and antihistamines |
| drug tolerance | occurs when the body becomes accustomed to the effects of a particular drug over a period of time |
| Larger doses of the drug must be taken to | produce the desired effect |
| Toxic effects (toxicities) are | specific groups of symptoms related to drug therapy that carry risk for permanent damage or death |
| when can toxicities can occur from | a cumulative effect |
| A mismatch between absorption and excretion means | that each new dose increases the total quantity in the body |
| who is especially at risk for experiencing a cumulative effect | older adults |
| An idiosyncratic effect (sometimes called paradoxical effect) | is any unusual or peculiar response to a drug that may manifest itself by overresponse, under response, or even the opposite of the expected response |
| Idiosyncratic effects are related to | a patient’s unique response to a drug and are thought to be the result of genetic enzyme deficiencies that lead to an abnormal mechanism of drug breakdown |
| This term may become | obsolete as ADR reporting continues and the specific mechanisms of ADRs are discovered |
| Older adults often have | unpredictable or erratic responses to medications |
| when do drug interactions occur when | one drug is affected in some way by another drug, a food, or another substance that is taken at the same time |
| Medications are given together when | their actions are synergistic or when one drug potentiates (increases) the therapeutic effects of another drug, or decreases the therapeutic effect and/or increases the adverse effects |
| Additive effect | drugs with similar pharmacologic actions; results in an increase in the overall effect |
| Synergistic effect | drugs with different sites or MOA; results in greater effects when taken together (one drug potentiates the other) |
| Antagonistic effect | combined drugs alter the overall sum effect or negate each other |
| Antagonistic effect result in | an effect less than that of each drug alone Interference—one drug interferes with the metabolism of another |
| Antagonistic effect leads to the buildup of | a medication (that cannot be metabolized) and can result in toxicity or an ADR Displacement—one drug binds to protein-binding sites and forces another drug to be displaced |
| Factors Affecting Drug Action | Developmental considerations Weight Biologic sex Cultural and genetic factors (ethnopharmacology) Psychological factors Pathology Environment Timing of administration |
| Therapeutic range | concentration of drug in the blood serum that produces the desired effect without causing toxicity |
| peak level | highest plasma concentration of a drug |
| Trough level | the point when the drug is at its lowest concentration, indicating the rate of elimination |
| half life | amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body |
Created by:
leh195