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RD Polytechnic BScN 2nd Year Semester 1 > 251 Pharma Study Cards - Chap 4 & 7 > Flashcards

251 Pharma Study Cards - Chap 4 & 7 Flashcards

1
Q

Throughout the life spectrum, when is there increased risk of adverse drug effects and toxicity?

A

at both ends of spectrum of life (pediatric and geriatric)

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2
Q

How do drugs primarily cross the placenta?

A

Via diffusion

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3
Q

What are the three factors that affect the safety of using medications during pregnancy?

A

Drug properties
Fetal gestational age
Maternal factors

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4
Q

What is the ‘Pregnancy and Lactation Labelling Rule’?

A

FDA rule that sets standards for how information about using medicines during pregnancy and breastfeeding is presented in the labeling of prescription drugs and biological products. The pregnancy letter categories – A, B, C, D and X will be replaced by a narrative risk summary based on available data.

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5
Q

What are the 3 subsections within the Pregnancy and Lactation summary?

A
  • Pregnancy
  • Lactation
  • Females and Males of Reproductive Potential
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6
Q

True or false: ˜Breast milk is the primary route for maternal drug excretion

A

False. ˜Drug levels in breast milk are usually lower than in maternal circulation˜Exposure depends on volume of consumed milk.

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7
Q

What is the term used for age range of younger than 38 weeks gestation?

A

Premature or preterm infant

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8
Q

What is the term for age range born but younger than 1 month?

A

Neonate or newborn infant

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9
Q

What is the term for the age range 1 month to younger than 1 year?

A

Infant

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10
Q

What is the term for the age range for 1 year to younger than 12 years?

A

child

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11
Q

What considerations are in place for pediatric patients relative to pharmacokinetics and absorption?

A
  • Gastric pH less acidic until 1 to 2 years of age
  • Gastric emptying slowed
  • First-pass elimination reduced
  • Reduced bile salt formation decreases bioavailability
  • Intramuscular absorption faster and irregular
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12
Q

What considerations are in place for pediatric patients relative to pharmacokinetics and distribution?

A
  • Total body water differences result in increased distribution and dilution of water-soluble drugs.
  • Greater total body water means lower fat content.
  • Decreased level of protein binding
  • Immature blood–brain barrier means more drugs enter the brain.
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13
Q

What considerations are in place for pediatric patients relative to pharmacokinetics and metabolism?

A
  • Liver immature; does not produce enough microsomal enzymes
  • Older children may have increased metabolism, requiring higher doses or more frequent administration than infants.
  • Other factors: liver enzyme production, genetic differences, and substances to which the mother may have been exposed during pregnancy
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14
Q

What considerations are in place for pediatric patients relative to pharmacokinetics and excretion?

A
  • Kidney immaturity affects glomerular filtration rate and tubular secretion.
  • Decreased perfusion rate of the kidneys may reduce excretion of drugs.
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15
Q

What factors affect pediatric drug dosage?

A
  • Skin is thin and permeable.˜
  • Stomach lacks acid to kill bacteria.˜
  • Lungs have weaker mucus barriers.˜
  • Body temperatures are less well regulated, and dehydration occurs easily.˜
  • Liver and kidneys are immature, impairing drug metabolism and excretion.
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16
Q

What methods are there for dosage calculation for pediatric patients?

A
  • Body surface area method
    • Uses the West nomogram˜
  • Always use weight in kilograms, not pounds.˜
  • Always use height in centimeters, not inches.˜
  • Body weight dosage calculations
    • Uses mg/kg
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17
Q

What are some considerations for older adult patients?

A
  • Older adults: older than age 65 years˜
  • High use of medications˜
  • Polypharmacy˜
  • Nonadherence˜
  • Increased incidence of chronic illnesses˜
  • Sensory and motor deficits
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18
Q

What physiological changes occur with the cardiovascular system for older adults?

A
  • Decreased cardiac output = decreased absorption and distribution
  • Decreased blood flow = decreased absorption and distribution
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19
Q

What physiological changes occur with the gastrointestinal system for older adults?

A
  • Increased pH (alkaline gastric secretions) = altered absorption
  • Decreased peristalsis = delayed gastric emptying
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20
Q

What physiological changes occur with the liver for older adults?

A
  • Decreased enzyme production = decreased metabolism
  • Decreased blood flow = decreased metabolism
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21
Q

What physiological changes occur with the kidney for older adults?

A
  • Decreased blood flow = decreased metabolism
  • Decreased kidney function = decreased excretion
  • Decreased glomerular filtration rate = decreased excretion
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22
Q

What affects absorption in older adults?

A
  • Gastric pH less acidic
  • Gastric emptying slowed
  • Movement through gastrointestinal (GI) tract slowed because of decreased muscle tone and activity
  • Blood flow to GI tract reduced
  • Absorptive surface of GI tract reduced
23
Q

What affects distribution in older adults?

A
  • Lower total body water percentages
  • Increased fat content
  • Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)
24
Q

What factors affect metabolism in older adults?

A
  • Aging liver produces fewer microsomal enzymes, affecting drug metabolism.
  • Blood flow to the liver is reduced.
  • Leads to a prolonged half-life of many drugs
    • Potential for accumulation if not monitored
25
Q

What factors affect excretion in older adults?

A
  • Decreased glomerular filtration rate
  • Decreased number of intact nephrons
26
Q

What are some common complications of opioids in older adults?

A
  • Confusion
  • constipation
  • urinary retention
  • nausea
  • vomiting
  • respiratory depression
  • falls
27
Q

What are some common complications of NSAIDs in older adults?

A
  • Edema
  • Nausea
  • Gastric ulcerations
  • Bleeding
  • Kidney toxicity
28
Q

What are some common complications of anticholinergics and antihistamines in older adults?

A
  • Blurred vision
  • Dry mouth
  • Constipation
  • Confusion and sedation
  • Urinary retention
  • Tachycardia
29
Q

What are some common complications of anticoagulants (heparin sodium, warfarin sodium) in older adults?

A
  • Major and minor bleeding episodes
  • Many drug interactions
  • Dietary interactions
30
Q

What are some common complications of antidepressants in older adults?

A
  • Sedation and strong anticholinergic adverse side effects
31
Q

What are some common complications of antihypertensives in older adults?

A
  • Nausea
  • Hypotension
  • Diarrhea
  • Bradycardia
  • Heart failure
  • Impotence
32
Q

What are some common complications of cardiac glycosides (digoxin) in older adults?

A
  • Visual disorders
  • Nausea
  • Diarrhea
  • Dysrhythmias
  • Hallucinations
  • Decreased appetite
  • Weight loss
33
Q

What are Beers criteria?

A

˜A listing of drug and drug classes to be avoided in older adults˜

Identified disease states considered to be contraindications for some drugs˜

Three categories:

  • Potentially inappropriate drugs and classes in older adults
  • Potentially inappropriate medications to avoid with certain diseases
  • Medications to be used with caution in older adults
34
Q

What is the fastest growing population in Canada?

A

Indigenous population

35
Q

What is ethnopharmacy?

A

˜Provides an expanding body of knowledge for understanding specific impact of cultural factors on patient drug response

36
Q

Genotype versus phenotype.

A

Genotype versus phenotype. An organism’s genotype is the set of genes that it carries. An organism’s phenotype is all of its observable characteristics — which are influenced both by its genotype and by the environment.

37
Q

What is polymorphism as it relates to medications?

A

Same drug may result in different result in different people. Refers to the effect of a patient’s age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs.

38
Q

What is involved in an ethnocultural assessment?

A
  • Languages˜
  • Health practices and beliefs˜
  • Past uses of medicine˜
  • Use of herbal treatment, folk or home remedies, natural health products˜
  • Use of over-the-counter drugs
  • Usual response to illness˜
  • Responsiveness to medical treatment˜
  • Religious practices and beliefs˜
  • Support for patient’s ethnocultural community˜
  • Dietary habits
39
Q

Which domain of learning is the level at which basic knowledge is learned and stored?

A

Cognitive domain

40
Q

Which domain of learning is the level at which conduct expresses feelings, needs, beliefs, values, and opinions?

A

Affective domain

41
Q

Which domain of learning is the level of learning of a new procedure or skill; often called the doing domain?

A

Psychomotor domain

42
Q

What aspects should be looked at during the assessment phase of patient education?

A
  • Adaptation to any illness˜
  • Age˜
  • Barriers to learning˜
  • Cognitive abilities˜
  • Coping mechanisms˜
  • Cultural background˜
  • Developmental status˜
  • Education, including literacy level˜
  • Emotional status˜
  • Environment at home and work˜
  • Folk medicine, home remedies, and alternative or complementary therapies˜
  • Family relationships˜
  • Financial status˜
  • Health literacy˜
  • Psychosocial growth and development ˜
  • Health beliefs˜
  • Information patient understands about past and present medical conditions˜
  • Language(s) spoken˜
  • Level of knowledge about current medications˜
  • Misinformation about drug therapy˜
  • Mobility and motor skills ˜
  • Current medications, including over-the-counter and herbal medications˜
  • Motivation˜
  • Nutritional status˜
  • Past and present health behaviours˜
  • Past and present experience with drug regimens and other therapies
  • Race and ethnicity
  • Religion or religious beliefs˜
  • Readiness to learn˜
  • Self-care ability˜
  • Sensory status˜
  • Social support
43
Q

Infant (birth to 1 year)

A

Trust vs. Mistrust

44
Q

Toddler 1 -3 years

A

Autonomy versus shame and doubt

45
Q

Preschooler 3 - 6 years

A

Initiative versus guilt

46
Q

School-aged: 6 -12 years

A

Industry versus inferiority

47
Q

Adolescent 12 -18 years

A

Identity versus role confusion

48
Q

Young adult 18 - 45

A

Intimacy versus isolation

49
Q

Middle-aged adult (45 to 64 years old)

A

Generativity versus stagnation

50
Q

Older adult (older than 65 years old)

A

Integrity versus despair

51
Q

Common nursing diagnoses for patient education

A
  • Deficient knowledge˜
  • Readiness for enhanced knowledge˜
  • Falls, risk for˜
  • Ineffective self-health management˜
  • Readiness for enhanced health management˜
  • Impaired memory˜
  • Injury, risk for˜
  • Nonadherence
  • Readiness for enhanced communication˜
  • Readiness for enhanced power˜
  • Readiness for enhanced decision making˜
  • Sleep deprivation
52
Q

At what grade level should written communications be developed?

A

8th grade level

53
Q

What should be documented for patient education?

A
  • Learner assessment˜
  • Outcomes˜
  • Content provided˜
  • Strategies used˜
  • Patient response to the teaching session˜
  • Overall evaluation of learning

RD Polytechnic BScN 2nd Year Semester 1 (9 decks)

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