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Nurs 330 - Test #1

Pharmacology for Nursing

What is pharmacotherapeutics? The use of drugs in prevention and treatment of disease.
What does the controlled substance act govern? Restricts prescriptions and refills Tracks prescriptions, dispensing, purchase of listed substances Organizes drugs based on abuse potential.
High abuse potential, no approved medical use (Heroin, LSD, marijuana) Schedule I
Written prescription required, no automatic refills (opioids like morphine, codeine) Schedule II
May be oral or written Rx, refill up to 5 times, within 6 months of order. (Many opioids, sedatives, stimulants) Schedule III - IV
May be dispensed without Rx by pharmacist to adults with written name and address. (pseudoephedrine) Schedule V
Where are schedule II-IV drugs kept for a nurse to access? In a locked cabinet which nurses must "sign out." If a drug is wasted it must be documented and witnessed.
Term for what the drug does to the body? Pharmacodynamics
Term for what the body does to the drug, as a function of time? Pharmacokinetics
Term for the study of the biochemical and physiologic effects of drugs and their mechanisms of action is? Pharmacodynamics
List factors which determine how the drug interacts with the body otherwise known as pharmacokinetics? Hint: ADME Absorption, distribution, biotransformation (metabolism), excretion of the drugs.
What do the factors of pharmacokinetics determine? The concentration of a drug at the site of action which = intensity of drug.
T/F : All people exhibit the same ADME? False: these variations help account for different drug responses various people exhibit.
ADME all involve the passage of a drug across ____________ ______________? Cellular membranes (may be one layer or many)
Do drugs pass through cells or around them for absorption and activity? Most often the drugs pass through the cell which is why lipid soluble drugs are more usable by the body.
What is the most dominant method of drug transport? Passive diffusion
What is passive diffusion? water and solute move across cell membrane down a concentration gradient until equal concentration of the solute (drug) is achieved on both sides of the membrane.
What is carrier-mediated transport aka facilitated diffusion? Carrier used to carry drug across membrane without the use of ATP. ex: glucose requires K+ and insulin to enter a cell. The carrier speeds up the process of movement.
T/F The body can run out of carriers for facilitated diffusion? True: carriers are selective and saturable.
What is active transport? Moves without regard to concentration gradient, requires ATP. Transport is saturable and selective.
What are some examples of active transport? Many sugars, amino acids, and some electrolytes.
T/F: drugs do not affect drug transport? False: some drugs exert their effects by interfering with the active transport of endogenous substances.
What 8 factors affect drug transport? Molecule size and shape, solubility, degree of ionization, dissolution, concentration of drug at site of absorption, circulation to site of absorption, route of administration, and other drugs and food.
How are small and large molecules transported? Small molecules diffuse freely, large molecules may require carriers, phagocytosis/pinocytosis
Which molecules diffuse better in the body-- water soluble or lipid soluble? Lipid soluble increases rate of diffusion.
< or > nonionized __ lipid solubility ionized __ lipid soluble __ H2O soluble nonionized > lipid solubility ionized < lipid soluble > H2O soluble
Which drug will be quickest acting? A powder or a tablet? Powder
T/F Less concentration of drug means greater absorption? False: Greater concentration leads to great absorption.
Why is a drug administered sublingual? It is a highly vascular tissue. More circulation = greater absorption.
What is the fastest route of drug administration? IV, no absorption necessary.
T/F: Lung tissue is the 2nd fastest route for drug administration? True: very vasucular area. IM, SQ and sublingual follow.
What is the slowest route of drug absorption? Oral: it must pass thru the stomach to small intestine. Some may be destroyed in the stomach and others may suffer from First Pass effect.
What is the First Pass Effect? A drug taken orally enters the blood stream from the small intestine and then must 1st pass thru the liver where it may suffer metabolism and/or inactivation.
Why are doses of drugs given in higher concentrations orally compared to drugs given via IV? To compensate for the 1st pass effect.
What are liposomes, microgel formulations and transfersomes? New vehicles to improve drug transport especially in drugs applied to the skin.
How do foods affect drug absorption? May bind with drug, inactivate it, or may reduce its absorption. This can affect bioavailability!!!
What is distribution of the drug? Once drug reaches the blood stream, must get drug to target tissue. > distribution = > intensity of effect.
Define target tissue? The tissue the drug is intended to affect.
What 2 factors affect distribution? 1. Cardiac Output & regional blood flow 2. Drug storage in body tissue
How does low blood pressure affect distribution? Distribution will be less and slower.
T/F: Drugs distribute throughout the different tissues evenly. F: drugs may have a greater affinity to certain tissues--this will affect where drugs get distributed.
What four areas does the body store drugs in? Plasma proteins, neutral body fat, bone, and rarely misc. others like renal tissue.
Which plasma protein do drugs bind with most often? albumen
Is a drug active when it is bound to a protein? No: free drug is active, bound drug does not act!!!
Can a drug with a greater affinity for a plasma protein knock off a drug with a lower affinity for the plasma protein? Yes, this can lead to great action or toxicity of the drug being knocked off.
What considerations must be made when giving a drug to a person with low serum albumin? There is less albumin to bind with which increases free drug levels. Drug levels may need to be reduced.
What considerations must be made when giving many protein bound drugs at once? Will cause more free drug which increases drug action. Doses may need to be decreased.
T/F: a person with a BMI of 13 has more storage sites than a person with a BMI of 32? False: body fat can act as a storage site.
Which types of drugs are stored in bones? Primarily metals, especially lead. These drugs are tightly bond and difficult to remove.
Body part associated with absorption? GI tract, can bypass with IV
Body part associated with distribution? bloodstream, plasma proteins, fat, bone (not a one step process)
Body part associated with metabolism? kidney, liver
Body part associated with elimination? Kidney, liver
Why does redistribution happen? As plasma concentrations drip, stored drug is released (move down concentration gradient) to maintain equilibrium. This can lead to longer duration of action.
What is the gamma phase? When drug leaves storage sites to be redistributed.
What are two anatomic barriers to drug distribution? Blood-brain and placenta
How effective is the blood-brain barrier? Very, most drugs do not cross BBB.
Which kind of drugs pass the BBB more readily? Lipid, brain tissue is highly lipid.
How effective is the placenta barrier? Not so much... drugs pass easily...usually in about 40 mins.
What are the problems with a fetus receiving drugs intended for mom? Fetus has immature liver... can't metabolize drugs as well. Fetus is much smaller so greater toxicity especially the younger fetus is.
What 3 things happen to a drug during metabolism (biotransformation)? Made less lipid soluble, changed from active form to inactive form or vise versa, some drugs are excreted unchanged.
What happens to drugs that are more water soluble? They are excreted from the body in urine via the kidney.
What happens to drugs that are more lipid soluble when they enter the kidney? They are reabsorbed back into the plasma. These drugs pass through the tubulare membrane more readily.
What are pro-drugs? Drugs that are absorbed and must be transformed into active drug.
Where are the enzymes that metabolize drugs primarily found? The liver, kidney and some in the intestine and plasma.
What is the primary organ of metabolism? LIVER: hepatic microsomal enzymes
How many drugs are hepatic enzymes designed to metabolize? Many, they are very non-specific.
T/F: There are several hepatic enzyme systems? True: each designed to metabolize several substances.
What 4 factors affect metabolism? Age, genetics, disease states, and other drugs.
What considerations must be made for metabolism of infants, children and elderly? Infant: hepatic enzymes not fully developed till 1-2 yrs old Children: more rapid metabolic rates Elderly: aging liver, slowing metabolism
What ethnic group has Slow Acetylators? 50% Caucasians and 21% Native Americans
What is a concern of someone with slow acetylators? Faster buildup of drug in bloodstream... more prone to toxic effects.
What are 4 disease states that affect metabolism? Hepatic disease (hepatitis, cirrhosis), starvation, stress states, and renal disease.
What is the major organ or excretion? Kidney: designed to excrete water soluble substances
What organs besides the kidneys excrete? GI tract, mammary glands, sweat glands, respiratory tract
What condition is treated with antibiotics that are secreted unchanged by the body? UTI
Acid drug + _______ urine = increased excretion; Basic drug + _______ urine = increased excretion basic, acidic
What acidifies urine? vitamin C, ammonia (liver disease, other disease conditions
What alkalinizes urine? Na Bicarbonate
Put in order steps for entero-hepatic recycling: circulates thru liver, reabsorbed from GI tract, absorbed into bloodstream, excreted in bile, into blood stream. drug absorbed into bloodstream, circulates thru liver, excreted into bile, reabsorbed from GI tract, into bloodstream.
Which types of drugs are recycled by the body more readily? Non-ionized and lipid soluble drugs.
In what types of drugs can pulmonary excretion occur? gaseous or volatile drugs: anesthetics, acetone, ETOH
Which neurotransmitters are preganglionic and postganglionic? Pre: Actylcholine Post: Norepinephrine and epinephrine
Why do basic drugs move into breast milk more readily really? breast milk is more acidic than plasma
What 4 factors modify urinary excretion? urinary pH, age (young and old), drug interactions, renal disease or reduced renal function
What is Minimum Effective Concentration (MEC)? The lowest plasma concentration required to cause measurable response.
What is onset of action? when plasma concentration reached MEC (1st response)
What is peak? The highest plasma concentration.
When is the greatest risk for toxic or adverse reactions? Peak plasma concentration.
What is duration of action? Time period when plasma concentration is above MEC
What is the therapeutic index or therapeutic range? the ratio between the toxic dose and the effective dose.
What does a 1 on the therapeutic index indicate? A narrow therapeutic index so the greater risk of toxicity
What is a biological half-life? The time it takes, after absorption, for 50% of the drug to be eliminated.
How many 1/2 lives does it take to eliminate 98% of a drug? 4 to 5
T/F; half-life helps determine Duration of Action? True
What is multiple dosing? Dose approximately every half-life to maintain steady-state blood levels.
How many half-lives does it take to reach a steady state blood level? 4-5
What is a loading dose? giving higher than maintenance doses in order to rapidly reach steady-state blood levels.
Why are peaks and troughs measured? To determine effective drug dosage for drugs with a narrow therapeutic index.
What 5 factors influence pharmacokinetics? Dose, frequency, condition of ADME, drug dissolution (pills, sustained release, etc), route of administration
What is the drug-receptor interaction theory? drugs interact with receptor in lock-and-key fashion; hence, only certain drugs fit certain locks.
What is the rate of interaction theory? The rate of binding determines the type and intensity of response.
Agonist? combines with receptor and produces a response
Antagonist? combines with receptor and inhibits action of agonist.
What is an example of a true antagonist? Narcan: it produces no action of its own.
Competitive Antagonist? has higher affinity for receptor: can displace agonist at receptor, can be overcome by higher concentration gradient.
Noncompetitive antagonist? Cannot be overcome by higher concentrations of agonist.
What is an addition/additive drug interaction? combined effect of 2 similar drugs that act at the same receptor
What is potentiation? Effect of one drug increased by second drug. 1 + 1 = 2
What is synergism? combined effect is greater than each drug given alone. 1 + 1 = 3
What is inhibition? Any decrease in effect, absorption, concentration at receptor or increase in metabolism or excretion.
What is prohibition? A whacked out time in American history leading to increased violence, prostitution and drunkenness.
What is a drug reaction? therapeutic response, desired effect
What is a side effect? Any effect other than the primary therapeutic effect: can be positive or negative.
Adverse drug reaction? Noxious, unwanted or unintended reaction occurring at normal doses.
What is hypersensitivity? any excessive reaction (non-specific term)
What is idiosyncratic effect? uncommon response, may be due to genetics
Define allergy? Histamine-mediated immune response. requires sensitization leading to a state of hypersensitivity.
Define anaphylaxis? abrupt onset, massive histamine release
What are some s/s of anaphylaxis? Edema, anxiety, coughing, sneezing, itching (throat, mouth, palms, feet), wheezing, stridor, and vascular collapse.
Drug treatment for anaphylaxis? Epinephrine 1 mg IV or Endotrachial (0.3 - 0.5 mg IM or SQ for less severe)
What ABCs will you be thinking about if a pt is experiencing anaphylaxis? airway management
What treatment would be used to treat urticaria in a drug induced skin reaction? stop drug, antihistamines, corticosteroids
What type of reaction is serum sickness? Type III Hypersensitivity: skin rash and edema, fever, joint pains/swelling/redness, possible anaphylaxis.
What is the 1st treatment for serum sickness? Corticosteriods
What is angioedema? edema of skin, mucous membranes, or internal organs. It is a histamine mediated reaction with Africa Americans at greatest risk.
What is erythema multiformae? A delayed hypersensitivity reaction with target or bulls-eye lesions.
What is Steven-Johnson syndrome? A more severe form of Erythema Multiformae. Lesions involve MM as well as skin. Lesions erode. Also joint pain, fever, malaise. Death can result from infected lesions.
What is toxic epidermal necrolysis? More severe form of EM where the skin sloughs.
What is photosensitivity? skin reaction caused by some drugs: rash or sunburn easily
What are the most common GI drug reactions? Nausea and vomiting
What is Pseudomembranous Collitis? Overgrowth of Clostridium Dificile in gut. S/s: diarrhea and mucus/bloody stools. Tx: antibiotics.
What s/s of inflammatory reactions can be seen in the GI tract? increase gastric acid and/or affect blood clotting. (ex: NSAIDS, caffine, corticosteriods)
What vitamins does malabsorption syndrom affect most? Fat soluble: A, D, E, K
What is nephrotoxicity? reduced renal function, leads to complete renal failure (acute - chronic)
What tx should be used for nephrotoxicity? Monitor BUN, Creatinine, urine output, hydration, theraputic blood levels, and admin antibiotics.
What is ototoxicity and what are the s/s? Toxicity to the 8th cranial nerve. S/s: tinnitus, vertigo, hearing loss.
What s/s can be expected with encephalopathy? Brain dysfunction: reduced LOC, seizures
What is a paradoxical reaction? opposite of expected therapeutic effect
What is an extrapyramidal reaction? Parkinsonian Symptoms
What are common cardiovascular drug reactions? Arrhythmias, myocardial toxicity, and cardiac vasoconstriction.
What are common hematologic reactions to drugs? Blood dyscrasias, bone marrow depression, hemolytic anemia and severe aplastic anemia.
What are the s/s of toxic hepatitis? Elevated enzymes ALT and AST, jaundice (like viral form).
What is carcinogenicity? The ability to cause cancer--higher dose = higher risk.
What is teratogenicity? Ability to cause birth defects. Most risk in 1st trimester.
Which category of drugs should a pregnant woman avoid? D and X (highest risk) and C or B (smaller risk)
What factors affect adverse drug reactions? Age, gender, race/genetic predisposition, history, current disease state, and drug related factors.
Created by: ewooda05