Chapters 6-11 Flashcards
Potentiative
Increase activity of drug
1 +1 =2
Inhibitory
Decrease the effect of the drug
1 + 1 =0
Change
Changes the drug activity/effectiveness completely
1 + 1 =orange
What all can drug interactions mess up?
Absorption, distribution, metabolism, and/or excretion
What happens when you mix the drug tetracyclines with calcium?
Tetracycline when taken with calcium will render the tetracycline inactive
Teeth and bones become grey
What happens when you mix the drug digoxin with fiber?
The fiber and digoxin bind causing the digoxin not to work. This can kill a patient
What happens when you mix the drugs with aluminum in them with citrus?
The body will start to absorb the aluminum when it normally would not
S.A.S.H
Why do you do S.A.S.H?
Saline flush
Administer medication
Saline flush
Heparin lock
Because you are adding an IV to the main IV line and you need to make sure the drug won’t mix and have adverse effects with the other drug. More precautionary than anything. You do this just in case the previous nurse didn’t do the saline flushes
Cytochrome P450 (CYP)
Messes stuff up to drugs (Knappiers words)
Substrate
Drug metabolized by CYP
Inducer
Speeds up a drug
Inhibitor
Slows down a drug
Anti-depresent Paroxetine is an inhibitor. What would happen if a patient was taking both paroxetine and metoprolol (metoprolol is a substrate-aka a drug metabolized by CYP)
So the anti-depressent would inhibit CYP to metabolize the drug metoprolol (a beta blocker–beta blockers reduce HR). Therefore, the metoprolol is not “sawed up” (metabolized) so your HR would not be lowered as effectively
What is the 4th leading cause of death in America?
Adverse drug reactions
Adverse drug reaction
An undesired effect that occurs at a normal dose
Side effect
An ADR that is very mild, expected, predictable, and tolerable
Do we ever give some medications for the side effects they produce?
Yes
Toxicity
Severe ADR that occur with an overdose (technical term)
Severe ADR regardless of the dose (what most people mean)
Allergic reaction
- Some fairly minor others can be deadly
- The result of an immune response
Allergy
Previous exposure
Many drugs have the potential to be toxic to the ____ and ___.
Liver and heart
What are the two main reasons a drug causes damage to the liver
Excessive dosing Normal dosing (idiosyncratic)
Idiosyncratic
A normal dose be fine to one patient but causes damage in another
What are the 8 signs of liver damage?
J.A.U.N.D.I.C.E J-jaundice A-anorexia U-Upper abdominal pain N-Nausea, vomiting D-Dark urine I-Increased need for sleep C-Clay colored stool E-Encephalopathy (brain disease) & ecchymosis (bruising)
If a patients QT interval is abnormally long/prolonged, they may be at risk for developing dangerous heart rhythms, specifically _______.
Torsades de pointes–> leads to ventricular fibrillation
If a drug lists prolonged QT interval as a risk, who are some people that are at an even higher risk for this developing?
- Patients who are on multiple QT drugs
- Women
- Elderly patients who have bradycardia
- Patients with decreased K and decreased Mg
- Patients with heart failure
Why are women who take a drug that has a risk of prolonged QT more at risk than men?
Women tend to have slower QT intervals..so taking a drug with a prolonged QT makes their intervals even slower
What are the three main problems that can occur with genetic variations?
Metabolism (most common)
Receptors
Immune responses
Pharmacogenomics
The future of medicine using genetic testing for drugs
What are the three types of tolerances to drugs we have and define them
Pharmacodynamic: When our bodies develop tolerance to a drug, requiring us to take larger and larger quantities
Metabolic tolerance: Inducers (alcohol is an inducer–taking a drug with alcohol causes the liver to metabolize quicker–more drug needed to produce therapeutic effects)
Tachyphylaxis: fast protection; the body notices a large level of a drug and quickly develops the ability to resists its effects
Teratogenesis
Any drug that harms the normal cellular development of an embryo or fetus
What 3 problems does teratogenesis cause?
Major structural: 1-3%, may require surgery
Minor structural: Does not necessarily require surgery
Functional: Everything looks normal, but an organ may not function correctly
If a teratogen is exposed to the zygote during the first couple weeks after conception, what will happen?
Completely unharmed or it will die–basically all or nothing
What is the period during pregnancy when major structural defects can occur?
during 3-8 weeks of the embryonic period–>these could lead to death or require surgical intervention
What is the period during pregnancy when minor structural defects occur?
Fetal period (weeks 9-38)
If you look at a drug guide and it has pregnancy risk categories, what category represents the least amount of risk or the safest? What category represents the off limits to taking that drug–as in the risk outweighs the benefits?
A=remote risk/safest B= not given in PPT C= not given in PPT D=Proven risk X= Risks outweigh benefits
What kind of drugs pass into breast milk the easiest?
Lipid soluble, but practically all drugs can cross into the breast milk
What is the most vulnerable age group when it comes to medications and pediatrics? Why?
Neonates and infants; their various organs are immature and may not be prepared to handle meds
When do infants organ systems mature and operate fairy similarly to adults?
By age one
What are the unique features of infants that cause them to be more sensitive to drugs and ADR?
- Irregular gastric emptying
- Changes in gastric pH
- Lower levels of albumin
- Slow metabolizers of medication
- Don’t excrete drugs through the kidneys well
[GASK: Gastric (emptying/pH, albumin (levels), Slow (metabolizers), Kidneys (don’t excrete as well)]
Why is absorption slow when giving a NEONATE an IM injection?
They have poor blood flow to their muscles
Why is absorption quicker (including being quicker in adults) when giving an INFANT an IM medication?
An infant has greater absorption since they have less fat
What is the test to most accurately assess kidney function in the elderly?
Creatinine clearance
Creatinine clearance
Drawing blood and collecting urine to assess kidney function
