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Krystan: Semester Two Nursing School > 2820 Pharmacology Exam One > Flashcards

2820 Pharmacology Exam One Flashcards

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1
Q

Pharmacokinetics

A

How medications travel through the body

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2
Q

Absorption

A

Transmission of medication from location of administration to the bloodstream

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3
Q

What does the rate of absorption determine?

A

How soon the medication will take effect

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4
Q

What does the amount of absorption determine?

A

Intensity of medication effects

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5
Q

What does the route of medication administration affect?

A

Rate and amount of absorption

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6
Q

What is the slowest absorption route for med administration?

A

Oral (usually takes at least 30 minutes)

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7
Q

What are the fastest routes of med administration?

A

IV and sublingual

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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

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9
Q

What is meant by medication distribution?

A

Transportation of medications to sites of action by body fluids

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10
Q

What factors influence medication distribution in the body?

A

Circulation
Permeability of cell membrane
Plasma protein binding ability

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11
Q

What are some diseases that could affect circulation and med distribution?

A

Diabetes

Cardiovascular diseases

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12
Q

Another word for metabolism (for medications) is

A

Biotransformation

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13
Q

What is meant by metabolism of a medication?

A

The changing of medications into inactive forms by enzyme action

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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
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15
Q

What influence does aging have on metabolism of medication?

A

Hepatic medication metabolism decreases

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16
Q

What two populations might need adjusted/smaller doses?

A

Infants/children

Older adults

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17
Q

Lower doses of medications in elderly patients helps prevent…

A

Medication accumulation in the body

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18
Q

If a patient has increased medication metabolizing enzymes, they may require..

A

Increased doses

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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

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20
Q

What would be required for medications affected by first pass effect?

A

Non-enteral administration route (usually IV)

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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

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22
Q

How can nutrition status impact medication metabolism?

A

A malnourished patient may have decreased production of medication metabolizing enzymes

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23
Q

What is the primary route of medication excretion?

A

Kidneys

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24
Q

How else can medications be excreted?

A

Liver
Lungs
Intestines
Exocrine glands (including into breast milk)

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25
Q

What is the impact of kidney dysfunction on medication excretion?

A

Increase in duration and intensity of a medication’s response

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26
Q

What is meant by therapeutic index?

A

The range of medication concentration in the bloodstream where medication is effective and not harmful

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27
Q

What is the difference between a medication with a high therapeutic index versus low in terms of safety?

A

High has a wide safety margin, while low has a small safety margin and requires close monitoring

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28
Q

Half life

A

Time needed for medication level in the body to decrease by 50%

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29
Q

Describe the difference between medications with a short half life versus a long half life?

A

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

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30
Q

Pharmacodynamics

A

Interactions between medications and target cells, body systems, and organs to produce effects

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31
Q

Agonists

A

Bind to or mimic receptor activity that endogenous compounds normally regulate

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32
Q

Antagonists

A

Block usual receptor activity for endogenous compounds or block receptor activity of other medications

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33
Q

Partial agonists

A

Act as both agonists and antagonists (have limited affinity to receptor sites)

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34
Q

Pharmacotherapeutics

A

The study of the therapeutic uses and effects of drugs

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35
Q

What knowledge are nurses responsible for in terms of medication administration?

A

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?)

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36
Q

What information should nurses include in their knowledge base of medications?

A 
Uses
Mechanisms of action
Routes
Safe dosage range
Adverse effects
Precautions
Contraindications 
Interactions
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37
Q

What steps should a nurse take to reduce medication errors?

A 
Verify prescription 
Report errors promptly 
Safeguard and store meds properly 
Calculate accurately
Know and follow controlled substance laws
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38
Q

Why should the nurse know the roes of other healthcare team members regarding medications?

A

So they know what resources they have available, who to ask questions to, and what their own scope of practice is

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39
Q

Pharmacogenomics

A

The study of how a person metabolizes medication based on his or her genetic makeup

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40
Q

What should the nurse assess about medical diagnoses and conditions before administering medications?

A

Allergies
Swallowing ability
Heart/liver/kidney disorders
Anything that could cause a problem with the specific medications

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41
Q

What is included in pre-administration data?

A

Heart rate
Blood pressure
Medication blood level

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42
Q

What is meant by ‘high risk’ medications?

A

Meds with a high risk of causing serious harm if administered accidentally

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43
Q

What are some strategies to prevent errors related to high alert medications?

A

Limit access to them
Use auxiliary labels and automated alerts
Standardized prescriptions, preparation, and administration methods
Double check systems in place

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44
Q

Why is it important to identify patient outcomes with med administration?

A

Because the nurse wants to know if the med has been effective in correcting the patient problem

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45
Q

What are some priorities when planning med administration?

A

Pain
Breathing or cardiac problems
Time sensitive or treatment specific medications

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46
Q

Who is responsible for assessing medication effectiveness and monitoring for adverse effects?

A

The nurse

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47
Q

What is the most important thing a nurse should do if a medication error occurs?

A

ASSESS the patient

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48
Q

What else should the nurse do in the case of a med error?

A

Implement corrective measures
Notify the provider
Complete incident report within 24 hours

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49
Q

An incident report should include:

A 
Client name
Med name/dose/route/time
Account of incident
All actions taken and people notified
Signature of nurse
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50
Q

How should a med error be documented? What should not be included?

A

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!

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51
Q

How are pediatric medication doses prescribed?

A

By body weight or body surface area. Usually mg/kg

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52
Q

What are some pharmacokinetic factors to consider when dealing with pediatric doses?

A

Less gastric acid production in children
Slower gastric emptying
Decreased first pass effect
Lower blood pressure

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53
Q

What are some nursing considerations when administering pediatric medications?

A

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

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54
Q

Pregnancy risk category A

A

Know evidence of risk to human fetus with lots of evidence to support that

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55
Q

Pregnancy risk category B

A

No evidence of risk to animal fetus, but no well-controlled human studies

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56
Q

Pregnancy risk category C

A

Adverse effects known in animal fetuses, can be given if benefits outweigh risks

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57
Q

Pregnancy risk category D

A

Adverse effects known in human and animal fetuses, can be used in pregnancy if benefits outweigh risks

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58
Q

What are some examples of medications that could be given in pregnancy where benefits would outweigh the risks?

A

Psychotropic or antiseizure medications

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59
Q

Pregnancy risk category X

A

Adverse effects in human and animal fetuses, risks outweigh benefits, use is contraindicated in pregnancy

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60
Q

Before prescribing medications in pregnancy, what must the provider consider?

A

Risk category
Physiological changes that occur in pregnancy
Live virus vaccines contraindicated

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61
Q

What are some common meds prescribed during pregnancy?

A

Nutritional supplements

Meds to treat nausea/vomiting/gastric acid

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62
Q

What changes physiologically in pregnancy that could alter medication dosage?

A

Kidney, liver, and GI systems

63
Q

What types of medications should be avoided by breastfeeding women?

A

Those with a long half life, sustained release meds, or meds harmful to infants

64
Q

If a breastfeeding woman must take a medication, when should she take it?

A

Right after breastfeeding, allowing the most time for it to be metabolized before the next feeding

65
Q

What are some nursing considerations/actions when administering medications to the elderly population?

A

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
Q

What are some physiological changes that affect pharmacokinetics in older adults?

A

Increased gastric pH
Decreased hepatic enzyme function
Less protein binding sites

67
Q

Polypharmacy

A

Taking several medications simultaneously

68
Q

How should individuals dispose of unused medications?

A

Drug buy back programs
Drop boxes for unused medications
Putting in a plastic bag and disposing of with undesirable substances

69
Q

What are some social justice and economic factors that impact adherence to medication regimens?

A

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
Q

Black cohosh: uses

A

Estrogen replacement used for menopause treatment

71
Q

Black cohosh: adverse effects and precautions

A

Do not use in pregnancy

Can cause GI distress, headache, rash, lightheaded ness, weight gain

72
Q

Black cohosh: interactions

A

Increases effects of antihypertensives and estrogen replacements
Increases hypoglycemic effects of diabetic meds

73
Q

Feverfew: uses

A

Blocks platelet aggregation and a factor that causes migraines

74
Q

Feverfew: adverse effects and precautions

A

Can cause:
GI Issues
Post feverfew syndrome (discontinue slowly)
Allergic reaction in those allergic to ragweed

75
Q

Feverfew: interactions

A

Increased bleeding risk for those on blood thinners or NSAIDS

76
Q

Feverfew: nursing administration

A

Discontinue two weeks before surgery

Question about blood thinners or NSAIDs

77
Q

Ginger root: uses

A

Relieves nausea
Relieves vertigo
Increased GI motility
Anti-inflammatory

78
Q

Ginger root: adverse effects and precautions

A

High doses in pregnancy can cause uterine contractions

Potential CNS depression and cardiac dysrhythmias if taken in large doses

79
Q

Ginger root: interactions

A

Interferes with NSAIDs and anticoagulants

Can increase hypoglycemic effects of antidiabetic meds

80
Q

Kava: uses

A

Promotes sleep
Decreases anxiety
Muscle relaxation

81
Q

Kava: adverse effects and precautions

A

Can cause liver injury, dry skin, and jaundice

82
Q

Kava: interactions

A

Sedation when taken with CNS depressants

83
Q

Saw palmetto: uses

A

Decreases manifestations/progression of benign prostatic hyperplasia

84
Q

Saw palmetto: adverse effects and precautions

A

Pregnancy risk category X

Can cause mild GI issues

85
Q

Saw palmetto: interactions

A

Can interact with antiplatelets and anticoagulants

Possible additive effects with finasteride

86
Q

Ferrous sulfate: uses

A

Iron deficient anemia

87
Q

Ferrous sulfate: adverse effects and precautions

A

Seizures
Hypotension
Nausea
Constipation

88
Q

Ferrous sulfate: interactions

A

Decreased absorption of tetracyclines, biphosphonates, levothyroxine

89
Q

DMARD

A

Disease modifying anti-rheumatic drugs

90
Q

What chronic illness do DMARDs treat?

A

Rheumatoid arthritis

91
Q

What are desired patient outcomes when taking a DMARD?

A 
Controlled inflammation
Reduced pain
Reduced mortality
Higher quality of life
Minimized disability
92
Q

Which DMARD is often prescribed a a first line RA treatment?

A

Methotrexate

93
Q

Methotrexate: pharmacological action

A

Immunosuppressive

Interference with folic acid metabolism to inhibit DNA synthesis and cell reproduction in rapidly replicating cells

94
Q

Methotrexate: evaluation of effectiveness

A

Decreased in joint pain and swelling in RA
Improved mobility
Maintenance of joint function

95
Q

Define gout

A

Form of acute arthritis caused by accumulation of uric acid crystals in the joints, causing inflammation

96
Q

Which medication classes are preferred for gout treatment?

A

NSAIDs and corticosteroids

97
Q

Colchicine: drug class

A

Anti gout

98
Q

Why has use of colchicine decreased?

A

Very narrow therapeutic index and adverse GI effects in the majority of patients

99
Q

Colchicine: pharmacological action

A

Interferes with function of WBCs in starting and continuing inflammatory response to monosodium urate crystals

100
Q

Colchicine: therapeutic use

A

Prophylaxis and treatment of acute gouty arthritis

101
Q

Colchicine: measures of effectiveness

A

Decreased joint pain and swelling
Symptom relief
Prevention of acute gout attacks

102
Q

What are some common causes of hypocalcemia?

A 
Lack of dietary calcium or vitamin D
Excessive vomiting
Malabsorption 
CKD
Decreased PTH secretion
103
Q

What are some signs and symptoms of hypocalcemia?

A 
Nerve and muscle excitability 
Cramping
Hyperactive bowel sounds
Twitching
Tremors
Seizures
Confusion
104
Q

What is the first line of treatment for hypocalcemia if not severe?

A

Nutritional adjustments

105
Q

Calcium carbonate: category/class

A

Mineral/electrolyte replacement

106
Q

Calcium carbonate: pharmacological action

A

Bone formation and blood coagulation

Calcium replacement in calcium deficiency

107
Q

Calcium carbonate: therapeutic use

A

Treatment or prevention of hypocalcemia

Prevention of post-menopausal osteoporosis

108
Q

Calcium carbonate: evaluation of effectiveness

A

Increased serum calcium
Prevention of post-menopausal osteoporosis
Decreased s/s of hypocalcemia
Increased bone density

109
Q

What is the defining characteristic of osteoporosis?

A

Bone being resorbed faster than it is being deposited

110
Q

Which group is most commonly affected by osteoporosis?

A

Post-menopausal women

111
Q

What are other risk factors for osteoporosis?

A 
Menopause
Increased age
Personal or family history
Caucasian/Asian race 
Limited activity 
Low dietary calcium and vitamin D
112
Q

Alendronate: class

A

Biphosphonate

113
Q

Alendronate: pharmacological action

A

Inhibits resorption of bone by inhibiting osteoclasts activity

114
Q

Alendronate: therapeutic uses

A

Reversal of osteoporosis progression with decreased fractures

115
Q

Alendronate: evaluation of effectiveness

A

Decreased fractures

116
Q

How do biphosphonates inhibit bone resorption?

A

They structurally resemble pyrophosphate, a natural substance that inhibits bone breakdown in the body

117
Q

When do the beneficial effects of biphosphonates plateau?

A

After 2-3 years. Bone density will remain increased for up to a year after discontinuing

118
Q

How often are biphosphonates administered?

A

Once weekly

119
Q

Raloxifene: class

A

Selective estrogen receptor modulator

120
Q

Raloxifene: pharmacological action

A

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
Q

Raloxifene: therapeutic use

A

Osteoporosis treatment in post-menopausal women

Reduction of breast cancer risk

122
Q

Raloxifene: evaluation of effectiveness

A

Prevention of osteoporosis
Reduced breast cancer risk
Reduced pain and swelling

123
Q

Is raloxifene an agonist or antagonist?

A

It is both, depending on where it is binding

124
Q

Calcitonin salmon: class

A

Hypocalcemic

125
Q

Calcitonin-salmon: pharmacological action

A

Inhibits osteoclast bone resorption, decreases bone turnover, and lowers serum calcium

126
Q

Calcitonin-salmon: therapeutic use

A

Hypercalcemia

Management of post-menopausal osteoporosis

127
Q

Calcitonin-salmon: evaluation of effectiveness

A

Lowered serum calcium
Decreased bone pain
Slowed progression of postmenopausal osteoporosis

128
Q

What is the role of calcitonin (naturally in the body) in calcium regulation?

A

Acting in opposition to PTH and vitamin D to lower calcium

129
Q

Succinylcholine: class

A

Paralytic

130
Q

Succinylcholine : pharmacological action

A

Minimizing ACH binding at cholinergic receptors of neuromuscular junction, leading to muscle paralysis

131
Q

Succinylcholine: therapeutic use

A

Skeletal muscle relaxation as an adjunct to anasthesia for surgery and to facilitate intubation
Control of spontaneous breathing on mechanically ventilated patients

132
Q

Succinylcholine: evaluation of effectiveness

A

Muscle relaxation during surgery
No spontaneous respiration in ventilated patients
Successful intubation

133
Q

Are neuromuscular blocking agents agonists or antagonists?

A

Antagonists

134
Q

What are the two classifications of neuromuscular blocking agents?

A

Depolarizing and non-depolarizing

135
Q

What is a potential complication of succinylcholine?

A

Malignant hyperthermia (characterized by muscle rigidity and temp as high as 109 degrees)

136
Q

Baclofen: class

A

Antispasticity agent, skeletal muscle relaxant

137
Q

Baclofen: pharmacological action

A

Inhibition of reflexes at spinal level

138
Q

Baclofen: therapeutic use

A

Treatment of reversible spasticity due to MS or spinal cord lesions
Severe spasticity of cerebral or spinal origin

139
Q

Baclofen: evaluation of effectiveness

A

Decreased muscle spasticity and musculoskeletal pain

Increased ability to do ADLs

140
Q

What are signs and symptoms of muscle spasm?

A

Tightened/fixed muscles

Intense pain lasting for a few minutes and then abating

141
Q

What are risk factors for muscle spasms?

A 
Dehydration
Hypocalcemia 
Epilepsy
Excessive use
Neurological disorder
Hypocalcemia
142
Q

What are signs and symptoms of muscle spasticity?

A

Continuous involuntary muscle contraction
Stiff muscles with increased muscle tone
Exaggerated deep tendon reflexes
Scissoring

143
Q

What are some common causes of spasticity?

A

Damage to motor area of cerebral cortex that controls muscle movement, in things like cerebral palsy, head or spinal cord injury, stroke

144
Q

What are two direct acting anti-spasmodic drugs?

A

Dantrolene

Abotulinumtoxin A

145
Q

Bethanechol: class

A

Muscarinic agonist

146
Q

Bethanechol: pharmacological action

A

Stimulation of muscarinic receptors to produce parasympathetic effects in the body

147
Q

Bethanechol: therapeutic uses

A

Alleviation of dry mouth
Treatment of non-obstructive urinary retention
Improve GI motility

148
Q

Bethanechol: evaluation of effectiveness

A

Relief of urinary retention

Increase in normal parasympathetic activity

149
Q

Oxybutynin: class

A

Anticholinergics

150
Q

Oxybutynin: pharmacological action

A

Inhibit/antagonize muscarinic receptors to produce anticholinergic effects in the body

151
Q

Oxybutynin: therapeutic use

A

Treatment of neurogenic bladder: frequency, urgency, nocturia, urge incontinence
Treatment of overactive bladder

152
Q

Oxybutynin: evaluation of effectiveness

A

Relief of bladder spasm and associated symptoms in patients with overactive or neurogenic bladder

153
Q

What are possible complications of muscarinic antagonists?

A 
Anticholinergic effects
Hallucinations
Confusion
Insomnia
Nervousness

Krystan: Semester Two Nursing School (13 decks)

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