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Nurs 330 - Test #1
Pharmacology for Nursing
| Question | Answer |
|---|---|
| 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
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