2820 Pharmacology Exam One Flashcards
1
Q
Pharmacokinetics
A
How medications travel through the body
2
Q
Absorption
A
Transmission of medication from location of administration to the bloodstream
3
Q
What does the rate of absorption determine?
A
How soon the medication will take effect
4
Q
What does the amount of absorption determine?
A
Intensity of medication effects
5
Q
What does the route of medication administration affect?
A
Rate and amount of absorption
6
Q
What is the slowest absorption route for med administration?
A
Oral (usually takes at least 30 minutes)
7
Q
What are the fastest routes of med administration?
A
IV and sublingual
8
Q
What are the two methods of IV administration?
A
Piggyback: smaller bag given over longer period of time
IV push: med pushed in through IV port rapidly over a few seconds or minutes
9
Q
What is meant by medication distribution?
A
Transportation of medications to sites of action by body fluids
10
Q
What factors influence medication distribution in the body?
A
Circulation
Permeability of cell membrane
Plasma protein binding ability
11
Q
What are some diseases that could affect circulation and med distribution?
A
Diabetes
Cardiovascular diseases
12
Q
Another word for metabolism (for medications) is
A
Biotransformation
13
Q
What is meant by metabolism of a medication?
A
The changing of medications into inactive forms by enzyme action
14
Q
What are the factors that influence the rate of medication metabolism?
A
Age Increased medication metabolizing enzymes First pass effect Similar metabolic pathways Nutritional status
15
Q
What influence does aging have on metabolism of medication?
A
Hepatic medication metabolism decreases
16
Q
What two populations might need adjusted/smaller doses?
A
Infants/children
Older adults
17
Q
Lower doses of medications in elderly patients helps prevent…
A
Medication accumulation in the body
18
Q
If a patient has increased medication metabolizing enzymes, they may require..
A
Increased doses
19
Q
First pass effect
A
Liver inactivation of oral medications on their first pass through the liver, meaning they don’t get to the bloodstream
20
Q
What would be required for medications affected by first pass effect?
A
Non-enteral administration route (usually IV)
21
Q
What occurs when the same pathway metabolizes two medications? What can it cause
A
Altered metabolism of one or both medications, which can lead to accumulation for one or both meds
22
Q
How can nutrition status impact medication metabolism?
A
A malnourished patient may have decreased production of medication metabolizing enzymes
23
Q
What is the primary route of medication excretion?
A
Kidneys
24
Q
How else can medications be excreted?
A
Liver
Lungs
Intestines
Exocrine glands (including into breast milk)
25
What is the impact of kidney dysfunction on medication excretion?
Increase in duration and intensity of a medication’s response
26
What is meant by therapeutic index?
The range of medication concentration in the bloodstream where medication is effective and not harmful
27
What is the difference between a medication with a high therapeutic index versus low in terms of safety?
High has a wide safety margin, while low has a small safety margin and requires close monitoring
28
Half life
Time needed for medication level in the body to decrease by 50%
29
Describe the difference between medications with a short half life versus a long half life?
Short: leaves body quickly, usually within 4-8 hours and requires more frequent dosing
Long: leaves body more slowly, often over more than 24 hours. Requires less frequent dosing, takes longer to reach therapeutic levels, and has higher accumulation risk
30
Pharmacodynamics
Interactions between medications and target cells, body systems, and organs to produce effects
31
Agonists
Bind to or mimic receptor activity that endogenous compounds normally regulate
32
Antagonists
Block usual receptor activity for endogenous compounds or block receptor activity of other medications
33
Partial agonists
Act as both agonists and antagonists (have limited affinity to receptor sites)
34
Pharmacotherapeutics
The study of the therapeutic uses and effects of drugs
35
What knowledge are nurses responsible for in terms of medication administration?
Federal/state/local laws
Facility policy for preparing, administering, and evaluating medications and effects
How to evaluate patient response (what are the therapeutic effects, as well as adverse and side effects?)
36
What information should nurses include in their knowledge base of medications?
```
Uses
Mechanisms of action
Routes
Safe dosage range
Adverse effects
Precautions
Contraindications
Interactions
```
37
What steps should a nurse take to reduce medication errors?
```
Verify prescription
Report errors promptly
Safeguard and store meds properly
Calculate accurately
Know and follow controlled substance laws
```
38
Why should the nurse know the roes of other healthcare team members regarding medications?
So they know what resources they have available, who to ask questions to, and what their own scope of practice is
39
Pharmacogenomics
The study of how a person metabolizes medication based on his or her genetic makeup
40
What should the nurse assess about medical diagnoses and conditions before administering medications?
Allergies
Swallowing ability
Heart/liver/kidney disorders
Anything that could cause a problem with the specific medications
41
What is included in pre-administration data?
Heart rate
Blood pressure
Medication blood level
42
What is meant by ‘high risk’ medications?
Meds with a high risk of causing serious harm if administered accidentally
43
What are some strategies to prevent errors related to high alert medications?
Limit access to them
Use auxiliary labels and automated alerts
Standardized prescriptions, preparation, and administration methods
Double check systems in place
44
Why is it important to identify patient outcomes with med administration?
Because the nurse wants to know if the med has been effective in correcting the patient problem
45
What are some priorities when planning med administration?
Pain
Breathing or cardiac problems
Time sensitive or treatment specific medications
46
Who is responsible for assessing medication effectiveness and monitoring for adverse effects?
The nurse
47
What is the most important thing a nurse should do if a medication error occurs?
ASSESS the patient
48
What else should the nurse do in the case of a med error?
Implement corrective measures
Notify the provider
Complete incident report within 24 hours
49
An incident report should include:
```
Client name
Med name/dose/route/time
Account of incident
All actions taken and people notified
Signature of nurse
```
50
How should a med error be documented? What should not be included?
A full report of what happened and the assessment of the patient should be included
Do not put in chart that an incident report was filled out!
51
How are pediatric medication doses prescribed?
By body weight or body surface area. Usually mg/kg
52
What are some pharmacokinetic factors to consider when dealing with pediatric doses?
Less gastric acid production in children
Slower gastric emptying
Decreased first pass effect
Lower blood pressure
53
What are some nursing considerations when administering pediatric medications?
Check dosages
Always do the math when a new med is ordered
Know that most medications are not tested on kids
Know that initial doses are usually an approximation
54
Pregnancy risk category A
Know evidence of risk to human fetus with lots of evidence to support that
55
Pregnancy risk category B
No evidence of risk to animal fetus, but no well-controlled human studies
56
Pregnancy risk category C
Adverse effects known in animal fetuses, can be given if benefits outweigh risks
57
Pregnancy risk category D
Adverse effects known in human and animal fetuses, can be used in pregnancy if benefits outweigh risks
58
What are some examples of medications that could be given in pregnancy where benefits would outweigh the risks?
Psychotropic or antiseizure medications
59
Pregnancy risk category X
Adverse effects in human and animal fetuses, risks outweigh benefits, use is contraindicated in pregnancy
60
Before prescribing medications in pregnancy, what must the provider consider?
Risk category
Physiological changes that occur in pregnancy
Live virus vaccines contraindicated
61
What are some common meds prescribed during pregnancy?
Nutritional supplements
| Meds to treat nausea/vomiting/gastric acid
62
What changes physiologically in pregnancy that could alter medication dosage?
Kidney, liver, and GI systems
63
What types of medications should be avoided by breastfeeding women?
Those with a long half life, sustained release meds, or meds harmful to infants
64
If a breastfeeding woman must take a medication, when should she take it?
Right after breastfeeding, allowing the most time for it to be metabolized before the next feeding
65
What are some nursing considerations/actions when administering medications to the elderly population?
Obtain complete medication history, including OTC and herbal supplements
Assess and monitor for therapeutic and adverse effects
Observe for interactions between meds
Start at lowest possible dose
Monitor plasma med levels
66
What are some physiological changes that affect pharmacokinetics in older adults?
Increased gastric pH
Decreased hepatic enzyme function
Less protein binding sites
67
Polypharmacy
Taking several medications simultaneously
68
How should individuals dispose of unused medications?
Drug buy back programs
Drop boxes for unused medications
Putting in a plastic bag and disposing of with undesirable substances
69
What are some social justice and economic factors that impact adherence to medication regimens?
Insulin price/insulin rationing
Lack of accessibility of healthcare facilities and pharmacies
Cost of epi-pens
Accessibility/coverage for mental health treatments and medications
70
Black cohosh: uses
Estrogen replacement used for menopause treatment
71
Black cohosh: adverse effects and precautions
Do not use in pregnancy
| Can cause GI distress, headache, rash, lightheaded ness, weight gain
72
Black cohosh: interactions
Increases effects of antihypertensives and estrogen replacements
Increases hypoglycemic effects of diabetic meds
73
Feverfew: uses
Blocks platelet aggregation and a factor that causes migraines
74
Feverfew: adverse effects and precautions
Can cause:
GI Issues
Post feverfew syndrome (discontinue slowly)
Allergic reaction in those allergic to ragweed
75
Feverfew: interactions
Increased bleeding risk for those on blood thinners or NSAIDS
76
Feverfew: nursing administration
Discontinue two weeks before surgery
| Question about blood thinners or NSAIDs
77
Ginger root: uses
Relieves nausea
Relieves vertigo
Increased GI motility
Anti-inflammatory
78
Ginger root: adverse effects and precautions
High doses in pregnancy can cause uterine contractions
| Potential CNS depression and cardiac dysrhythmias if taken in large doses
79
Ginger root: interactions
Interferes with NSAIDs and anticoagulants
| Can increase hypoglycemic effects of antidiabetic meds
80
Kava: uses
Promotes sleep
Decreases anxiety
Muscle relaxation
81
Kava: adverse effects and precautions
Can cause liver injury, dry skin, and jaundice
82
Kava: interactions
Sedation when taken with CNS depressants
83
Saw palmetto: uses
Decreases manifestations/progression of benign prostatic hyperplasia
84
Saw palmetto: adverse effects and precautions
Pregnancy risk category X
| Can cause mild GI issues
85
Saw palmetto: interactions
Can interact with antiplatelets and anticoagulants
| Possible additive effects with finasteride
86
Ferrous sulfate: uses
Iron deficient anemia
87
Ferrous sulfate: adverse effects and precautions
Seizures
Hypotension
Nausea
Constipation
88
Ferrous sulfate: interactions
Decreased absorption of tetracyclines, biphosphonates, levothyroxine
89
DMARD
Disease modifying anti-rheumatic drugs
90
What chronic illness do DMARDs treat?
Rheumatoid arthritis
91
What are desired patient outcomes when taking a DMARD?
```
Controlled inflammation
Reduced pain
Reduced mortality
Higher quality of life
Minimized disability
```
92
Which DMARD is often prescribed a a first line RA treatment?
Methotrexate
93
Methotrexate: pharmacological action
Immunosuppressive
| Interference with folic acid metabolism to inhibit DNA synthesis and cell reproduction in rapidly replicating cells
94
Methotrexate: evaluation of effectiveness
Decreased in joint pain and swelling in RA
Improved mobility
Maintenance of joint function
95
Define gout
Form of acute arthritis caused by accumulation of uric acid crystals in the joints, causing inflammation
96
Which medication classes are preferred for gout treatment?
NSAIDs and corticosteroids
97
Colchicine: drug class
Anti gout
98
Why has use of colchicine decreased?
Very narrow therapeutic index and adverse GI effects in the majority of patients
99
Colchicine: pharmacological action
Interferes with function of WBCs in starting and continuing inflammatory response to monosodium urate crystals
100
Colchicine: therapeutic use
Prophylaxis and treatment of acute gouty arthritis
101
Colchicine: measures of effectiveness
Decreased joint pain and swelling
Symptom relief
Prevention of acute gout attacks
102
What are some common causes of hypocalcemia?
```
Lack of dietary calcium or vitamin D
Excessive vomiting
Malabsorption
CKD
Decreased PTH secretion
```
103
What are some signs and symptoms of hypocalcemia?
```
Nerve and muscle excitability
Cramping
Hyperactive bowel sounds
Twitching
Tremors
Seizures
Confusion
```
104
What is the first line of treatment for hypocalcemia if not severe?
Nutritional adjustments
105
Calcium carbonate: category/class
Mineral/electrolyte replacement
106
Calcium carbonate: pharmacological action
Bone formation and blood coagulation
| Calcium replacement in calcium deficiency
107
Calcium carbonate: therapeutic use
Treatment or prevention of hypocalcemia
| Prevention of post-menopausal osteoporosis
108
Calcium carbonate: evaluation of effectiveness
Increased serum calcium
Prevention of post-menopausal osteoporosis
Decreased s/s of hypocalcemia
Increased bone density
109
What is the defining characteristic of osteoporosis?
Bone being resorbed faster than it is being deposited
110
Which group is most commonly affected by osteoporosis?
Post-menopausal women
111
What are other risk factors for osteoporosis?
```
Menopause
Increased age
Personal or family history
Caucasian/Asian race
Limited activity
Low dietary calcium and vitamin D
```
112
Alendronate: class
Biphosphonate
113
Alendronate: pharmacological action
Inhibits resorption of bone by inhibiting osteoclasts activity
114
Alendronate: therapeutic uses
Reversal of osteoporosis progression with decreased fractures
115
Alendronate: evaluation of effectiveness
Decreased fractures
116
How do biphosphonates inhibit bone resorption?
They structurally resemble pyrophosphate, a natural substance that inhibits bone breakdown in the body
117
When do the beneficial effects of biphosphonates plateau?
After 2-3 years. Bone density will remain increased for up to a year after discontinuing
118
How often are biphosphonates administered?
Once weekly
119
Raloxifene: class
Selective estrogen receptor modulator
120
Raloxifene: pharmacological action
Binds to estrogen receptors to produce estrogen-like effects on bone, resulting in reduced bone resorption and turnover
Binds to estrogen receptors in uterus and breasts to block proliferative effects of actual estrogen on these tissues to reduce cancer risk
121
Raloxifene: therapeutic use
Osteoporosis treatment in post-menopausal women
| Reduction of breast cancer risk
122
Raloxifene: evaluation of effectiveness
Prevention of osteoporosis
Reduced breast cancer risk
Reduced pain and swelling
123
Is raloxifene an agonist or antagonist?
It is both, depending on where it is binding
124
Calcitonin salmon: class
Hypocalcemic
125
Calcitonin-salmon: pharmacological action
Inhibits osteoclast bone resorption, decreases bone turnover, and lowers serum calcium
126
Calcitonin-salmon: therapeutic use
Hypercalcemia
| Management of post-menopausal osteoporosis
127
Calcitonin-salmon: evaluation of effectiveness
Lowered serum calcium
Decreased bone pain
Slowed progression of postmenopausal osteoporosis
128
What is the role of calcitonin (naturally in the body) in calcium regulation?
Acting in opposition to PTH and vitamin D to lower calcium
129
Succinylcholine: class
Paralytic
130
Succinylcholine : pharmacological action
Minimizing ACH binding at cholinergic receptors of neuromuscular junction, leading to muscle paralysis
131
Succinylcholine: therapeutic use
Skeletal muscle relaxation as an adjunct to anasthesia for surgery and to facilitate intubation
Control of spontaneous breathing on mechanically ventilated patients
132
Succinylcholine: evaluation of effectiveness
Muscle relaxation during surgery
No spontaneous respiration in ventilated patients
Successful intubation
133
Are neuromuscular blocking agents agonists or antagonists?
Antagonists
134
What are the two classifications of neuromuscular blocking agents?
Depolarizing and non-depolarizing
135
What is a potential complication of succinylcholine?
Malignant hyperthermia (characterized by muscle rigidity and temp as high as 109 degrees)
136
Baclofen: class
Antispasticity agent, skeletal muscle relaxant
137
Baclofen: pharmacological action
Inhibition of reflexes at spinal level
138
Baclofen: therapeutic use
Treatment of reversible spasticity due to MS or spinal cord lesions
Severe spasticity of cerebral or spinal origin
139
Baclofen: evaluation of effectiveness
Decreased muscle spasticity and musculoskeletal pain
| Increased ability to do ADLs
140
What are signs and symptoms of muscle spasm?
Tightened/fixed muscles
| Intense pain lasting for a few minutes and then abating
141
What are risk factors for muscle spasms?
```
Dehydration
Hypocalcemia
Epilepsy
Excessive use
Neurological disorder
Hypocalcemia
```
142
What are signs and symptoms of muscle spasticity?
Continuous involuntary muscle contraction
Stiff muscles with increased muscle tone
Exaggerated deep tendon reflexes
Scissoring
143
What are some common causes of spasticity?
Damage to motor area of cerebral cortex that controls muscle movement, in things like cerebral palsy, head or spinal cord injury, stroke
144
What are two direct acting anti-spasmodic drugs?
Dantrolene
| Abotulinumtoxin A
145
Bethanechol: class
Muscarinic agonist
146
Bethanechol: pharmacological action
Stimulation of muscarinic receptors to produce parasympathetic effects in the body
147
Bethanechol: therapeutic uses
Alleviation of dry mouth
Treatment of non-obstructive urinary retention
Improve GI motility
148
Bethanechol: evaluation of effectiveness
Relief of urinary retention
| Increase in normal parasympathetic activity
149
Oxybutynin: class
Anticholinergics
150
Oxybutynin: pharmacological action
Inhibit/antagonize muscarinic receptors to produce anticholinergic effects in the body
151
Oxybutynin: therapeutic use
Treatment of neurogenic bladder: frequency, urgency, nocturia, urge incontinence
Treatment of overactive bladder
152
Oxybutynin: evaluation of effectiveness
Relief of bladder spasm and associated symptoms in patients with overactive or neurogenic bladder
153
What are possible complications of muscarinic antagonists?
```
Anticholinergic effects
Hallucinations
Confusion
Insomnia
Nervousness
```
