Core Concepts (3/19/15) Flashcards
The study of medicine and the effects of chemicals/drugs on the human body and animals is called?
Pharmacology
Pharmakon = medicine drug
Logos = study
A chemical must have ______ value without damaging properties to become a useful drug.
Therapeutic
The ______ must outweight the ______ when using a drug.
Benefits; risks
All ____ are drugs but not all drugs are _____.
medications;medications
The nurses responsibilities in medication administration include:
- Assessing for adverse effects
- Intervening to make the regimen more tolerable
- Educating about the drug and drug regimen
- Monitoring
- Prevention of drug error
The branch of pharmacology that uses drugs to treat, prevent, and diagnose disease. It focuses on the drug’s effect on the body and the body’s response.
pharmacotherapeutics
Drug effects can be either ______ or ______.
therapeutic or adverse
There are four different types of drug therapy: acute, ______, ______, and palliative (for pain-like morphine).
- maintenance (Blood pressure med taken to maintain BP)
- supplement/replacement (hormone replacement/insulin is an example)
Before taking Beta blockers, you were nervous and dreading giving a speech. BUt after taking it, you were relaxed and laughing. What is the beta blocker suffix?
LOL
Just remember you were able to laugh out loud at how nervous you were before taking the drug
Drugs can come from natural or lab sources. Natural sources are plants, animals, minerals. Lab source are _____ or _____ compounds. Sometimes drugs are a combination of btoh natural and lab sources.
inorganic or synthetic.
How many stages of approval are there for therapeutic and biologic drugs?
4
During the ______ phase, extensive laboratory research is done. Chemicals are tested on animals and cells cultured in the lab.
pre-clinical
During phase ____, chemicals are tested on “healthy” human volunteers. This is when proper dosage is determined and adverse effects are assessed (keep in mind LT effects will not show at this time).
I (One)
During phase ____, drugs are tried on informed clients and clients with the particular disease.
II (Two)
During phase ____, drugs are now used on the clinical market. They remain under review.
III (Three)
Memorization trick - tried on 3 groups so far: animals, humans, public.
During phase ____, the drug is continued to be evaluated but is approved.
IV (Four)
T or F: There is a governing agency that oversees supplements.
False. It false between drugs and food.
What is the name of the governing agency that regulates testing and confirmation of safety and efficacy of food, drugs and cosmetics?
FDA (Food and Drug Administration)
What is the name of the governing agency that regulates the categorization, manufacture, distribution and dispensing of drugs and narcotics?
DEA (Drug Enforcement Agency)
Controlled substances are categorized into schedules from I to V. Which class has the highest abuse potential and no accepted medical use?
I - One
Includes LSD, heroin
Which class has the lowest potential for abuse?
V - Five
Which class has high abuse potential with severe dependency liability?
II - Two (Marijuana, narcotics, amphetamines and barbiturates are in this group.)
Can drugs change which schedule they belong to?
Yes. Vicodin is an example.
What is the general rules for administering medication to pregnant women?
- generally you do not give it; however,
2. if the benefits outweight the risks, you can
Pregnancy categories range from A to X. Is the beginning of the alphabet higher or lower risk than X?
Lower. X is the worst. Think X this one off your list.
Medications have three names, what are they?
Chemical, generic, and trade
The _____ name is the one we need to know. It is assigned by the US Adopted Names council and to a particular category of chemicals that have a particular effect.
generic
The patented/proprietary name is called the _____ name and belongs to the developing company. No one can make the drug until its patent has run out.
Trade
What is the difference between trade named drugs and the generic versions?
Fillers/binders
Generic brands don’t always work because they don’t have the correct binders
There are three types of drugs - OTC, prescription and _____ drugs.
orphan drugs - not available for use by those who could benefit from them, usually because they are not financially profitable - such as HGH
A _______ is used to compare drugs within the same classification.
Prototype
What are some concerns with OTC medications?
- can mask the signs and symptoms of underlying disease
- can result in drug interaction if taken with prescription medication.
- Could result in overdose (remember the story of the daughters who gave their mom three meds with acetaminophen because they did not pay attention to labels)
What is the safe standard for acetaminophen?
2500mg/ day
__________ is the science of dealing with the interactions between living organisms and foreign chemicals; the branch of pharmacology concerned with the effects of drugs and the mechanism of their action.
pharmacodynamics
Drug clings to a target cell receptor which allows the drug to be _______.
selective/selectively toxic (kills bacteria but not human)
T or F: The better the fit between receptor site and chemical, the more pronounced the reaction.
True
_______ within the body are needed to break down the chemical to open up the receptor sites.
enzymes
Ideally drugs will act only on the enzymes essential for a pathogen.
What are four drugs actions?
- replace or act as substitutes for missing chemicals (insulin)
- Increase of stimulate certain cellular activities (ex.epinephrine - speeds up everything)
- depress or slow certain cellular activities. (BP med)
- To interfere with the functioning of foreign cells (chemotherapeutics - penicillin)
T or F: the goal for using medication is to have therapeutic effect without harming the host.
True.
What are the four main components of pharmacokinetics?
- absorption
- Distribution
- biotransformation (metabolism)
- excretion
Why would you take medication on a full stomach?
Empty stomach?
Avoid stomach upset;
For faster absorption (pH dissolves quicker)
When you eat something it goes from your stomach, then to your small intestine, and then into the liver through the _____ _____ ____ . The liver cleans the blood.
Hepatic Portal Vein
A higher dose than usually used for treatment, given up front, allowing drug to reach critical concentration quickly (inducing a therapeutic response)…
loading dose
The actual concentration that a drug reaches in the body (maintaining an amount)…
dynamic equillibrium
DE is effected by absorption, distribution, biotransformation (metabolism) and excretion.
The amount of drug needed to cause a therapeutic effect…
critical concentration
_______ is the movement of the drug from the site of administration into the blood.
Absorption
Absorption is affected by …. List some factors
- Route of administration (IV is faster than IM, IM faster than oral)
- blood flow to the area being treated
- food in the gut
- interactions with other drugs (the other drugs may use same receptor sites…)
- Surface area (how fat is the pt?)
- Lipid solubility
- pH Partitioning (acid ionizes in base and vice versa)
Due to the _____ ______ ______ , oral medication are reduced in strength, so you have to take more orally.
(Liver generally renders a portion inactive by binding part of that drug with soluble compounds)
First Pass Effect - cleans/reduces the drug to an appropriate amount.
.
Definition of first pass effect - “Hepatic inactivation of certain oral drugs.”
T or F: If the drug is lipid base the absorption is faster than if the drug is protein binding.
True
T or F: The blood brain barrier will only allow water soluble drugs to pass through?
False! Lipid soluble would make the statement true.
The process by which a drug is delivered to the tissues and body fluids is called _______
distribution
The main factors determining distribution are …..
- Blood flow
- cardiac output
- body composition
- vasoconstriction/vasodilation
Where is the site of biotransformation (metabolism) of drugs?
liver
WHat factors influence metabolism?
- liver function
- genetics
- stress
- age
(may be missing enzymes, or have decreased liver function)
The most important organ for excretion is the ______
kidney
some drugs are eliminated through lungs, sweat, tears, mammary glands and biliary system (bile related ducts/organs)
_____ ______ is the time it takes for the amount of drug int he body to decrease to one half.
half life
TO maintain a level of drugs in the body, for every half life you lose, you have to add back. This is how dosage is determined.
How half life works…
You take a pill and in 12 hours, 50mg becomes 25, in another 12 hours it is 12.5 and in another 12 its 6.25 and so on
If the half life is 6 hours, how often would you take the med?
every 4-6 hours
general rule:if the half life is 30-36 hours long, we give the pill once a day
If a patient has a decreased response to a drug over time, that person is experiencing ______ to a drug.
tolerance
If this happens, dosage will need to be increased
Physical dependence produces _______ symptoms when the drug is stopped.
withdrawal
Drugs can interact with ____ and other ______.
food; drugs
Drug Drug interactions can do one of the following:
- additive (1+1=2)
- enhance each other (potentiation 1+1=3)
- ________
antagonistic (1+1=0)
A ______ dose is given to keep plasma concentration in the therapeutic range.
maintanence
A ____ dose results in serious adverse effects
toxic
A _____ dose gives us the desired effect and lies between the minimum effective level and the toxic level
therapeutic
______ is given by mouth, _______ is given elsewhere
enteral;parenteral
List ROUTES of administration….
enteral (GI tube is considered enteral)
parententeral - IV, TPN - total parenteral nutrition thru blood
percutaneous - injection
transdermal/topical - patches or creams
Why is it important to obtain a patient history before administering drugs?
History reveals:
- allergies, level of understanding (speak on their level - majority read at grade 6 level), disease (kidney or liver problems?), financial (can they afford med), issues swallowing (if so, may need diff method)
Helps you plan accordingly
What are the 8 rights?
First five are standard
- Patient
- Medication
- Dosage
- Time
- Route
- reason
- approach
- documentation
T or F: Nurses are required to adhere to “Informed consent” before administering medication.
True. Share the side effects, dosage, what the med is for, etc. Make sure patient understands what it does before they take it.
If pt refuses, document!
The nurse is responsible for observing and monitoring _________ after administering a drug.
therapeutic effects to make sure the med is doing what we want it to.
side/adverse effects (offer pt crackers for stomach upset, report any sever unexpected adverse effects)
vitals signs
lab values/serum levels
drug interactions
Don’t forget to keep teaching!!
Effects of medication include: therapeutic, adverse, side, systemic, regional/local effects. What is the effect that is unexpected and rare?
Idiosyncratic effect - drug reactions may be defined as adverse effects that cannot be explained by the known mechanisms of action of the offending agent, do not occur at any dose in most patients, and develop mostly unpredictably in susceptible individuals only.
Memorization - Or as Dr. Tong said “You are an idiot because you don’t know what it’s doing.”
What is the desired effect?
therapeutic
What effect is harmful and undesirable?
adverse effect which can lead to an adverse drug reaction
A mild and possibly expected occurrence is?
a side effect
What are the reasons an adverse drug reaction may occur?
drug may have other effects on the body besides therapeutic effect
pt. is sensitive to the drug
drug’s action on the body causes other responses
pt. is taking up too much or too little of the drug
What are the types of adverse reactions?
primary action
secondary action
hypersensitivity reaction
A _______ is an overdose: extension of the desired effect
primary action
A _______ is an undesired effect produced in addition to the pharmacologic effect
secondary action
A _______ is an excessive response to the primary or secondary effect of the drug
hypersensitivity reaction
side effect vs. adverse reaction
a side effect is a common unintended effect of a drug while an adverse reaction is a negative effect that is rare and can be life threatening
What are the types of drug allergies?
anaphylactic reaction - (body reacts by forming antibodies and producing histamine; usually throat closing; epinephrine used to counter)
cytotoxic reaction - (produces antibodies that attacj to the drug on cell cites; cyto = cell; damages liver and kidney )
serum sickness reaction (antibodies damage tissues, manifests rash, fever/swollen joints and lymph nodes)
delayed allergic reaction (antibodies bind to WBCs, hives)
The body reacts strongly to a med by forming antibodies and immediately producing histamine. The histamine results in hives, closing of the throat, rash, and breathing difficulties. The nursing intervention is Epinephrine. This is which type of allergic reaction?
Anaphylactic reaction
The body produces antibodies that circulate in the blood and attach the antigens (the drug) on cell sites. There is a delayed reaction resulting in damage to the liver and kidneys. The nursing intervention is to discontinue meds. This is what type of allergic reaction?
cytotoxic reaction
A delayed allergic reaction in which antibodies circulate and damage various tissues. Resulting in rash, fever, swollen joints and lymph nodes. Nursing intervention is to discontinue meds and provide comfort measures. This is _____ ______ ______.
serum sickness reaction
________ allergic reaction is several hours after exposure. Antibodies bind to white blood cells resulting in rash or hives. Nursing intervention is to discontinue drug and provide skin care and comfort measures.
Delayed
what are the dermatologic reactions?
rash/hives: skin abnormalities, redness or blisters. discontinue meds
stomatitis: inflammation of mucous membranes, bleeding or blisters. frequent mouth care
_____________ is destruction of the body’s normal flora
superinfections
assess for fever, diarrhea and vaginal discharge. provide supportive care and give anti-fungal meds. stop the drug responsible for infection
_______ ________ is bone marrow suppression
blood dyscrasia
assess for fever, chills and weakness. monitor blood counts and protective isolation
Which two organs are play a role in toxicity?
liver: assess fever nausea, jaundice, change in urine or stool, elevated liver enzymes. discontinue meds
kidneys: assess change in urinary pattern or elevated BUN and creatinine. notify physician, stop meds, or decrease dose
CBC
complete blood count
_____ and ______ determine measurement of kidney function
BUN and creatinine
Backstory ….
BUN = A blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of your body in the urine. A BUN test is done to see how well your kidneys are working.
Creatinine = If your kidneys aren’t functioning properly, an increased level of creatinine may accumulate in your blood. A serum creatinine test measures the level of creatinine in your blood and gives you an estimate of how well your kidneys filter (glomerular filtration rate).
________ is what the muscles put out and the body breaks down
creatinine
Def: a compound that is produced by metabolism of creatine and excreted in the urine.
_________ occurs when an overdose of a drug damages multiple body systems and can lead to a fatal reaction
poisoning
If someone has ________, the assessment will show low serum blood glucose level. If they are awake and alert, feed them asap. If they are unconscious but have an IV access, give them ____.
hypoglycemia;
D50 (without an IV give glucagon)
intervention: restore glucose to the body (D50)- IV push
If someone has _________, the assessment will show high serum glucose level
hyperglycemia
intervention: administer insulin to decrease glucose level. The insulin gets the sugar from the blood and into the cells.
What is a normal glucose level ?
70-110mg/dl
indications of electrolyte imbalances:
hypokalemia (low potassium - will show on ECG)
hyperkalemia (high potassium)
_________ is a decrease in serum potassium level.
ALWAYS CHECK LEVELS BEFORE ADMINISTERING
hypokalemia
intervention: replace serum potassium (IV or oral) and monitor serum level of potassium
_________ is a increase in serum potassium level
ALWAYS CHECK LEVELS BEFORE ADMINISTERING
hyperkalemia
interventions: decrease the serum potassium concentration, monitor serum level of potassium, monitor cardiac rhythm
________ ________ results in visual changes. If a med is known to cause this you must monitor for it.
ocular toxicity
monitor for visual changes when giving meds known to cause ocular damage and discontinue meds after notifying a physician
_________ _________ results in damage to the eighth cranial nerve. Monitor for hearing loss. Discontinue the med after notifying the physician.
auditory damage
monitor for hearing loss, discontinue meds after notifying physician
Some medication can have effects on the CNS (neurologic effects)… What is a GENERAL effect we may see from taking an antihistamine such as Benadryl?
assess: altered level of consciousness (drowsiness)
common with antihistamines (Benadryl)
intervention: prevent injury
Atropine-like / Anticholinergic effects (neurologic effect)
assess: dry mouth, urinary retention, blurred vision
(Anticholinergic means against the parasympathetic nervous system aka against rest and digest. Dries saliva, closes down gastrointestinal tract and prevents urination)
intervention: sugarless lozenges to keep mouth moist, advise pt. to void before administration of meds
Antidepressants work by blocking dopamine, and can cause ______-____ _________; tremors and changes in gait are side effects.
Parkinson-like syndrome
intervention: discontinue meds (change which antidepressant)
Neuroleptic malignant syndrome can be caused by antidepressants (which block dopamine). Signs of this are?
extrapyramidal symptoms ( drug induced movement disorders )
Can also cause an extremely high fever.
intervention: discontinue meds
Which drug categories are safe for pregnancy?
A and B are relatively safe
_______________ drugs may harm the developing fetus or embryo
teratogenic
How do you prevent teratogenicity?
Through teaching!
let pregnant women know that any med can affect the baby
weigh actual benefits against potential risk
advise pregnant women to not take meds without checking with their health care provider
Dosing considerations:
sex weight (standard weight is 150lbs) age (for children use BSA) physical condition other drugs pt. is taking
Difference between drugs when dealing with children and adults
children absorb, distribute, metabolize, and excrete drugs differently than adults
children organs are not as developed as adults
Dosage for children is based on __________ _________ and ________ for adults.
surface area, weight
Especially used for kids and chemo patients
What is accurate dosing dependent on?
the prescriber who orders the drug
the pharmacist who dispenses the drug
the nurse who administers the drug
NURSES will always be responsible for any errors because we are suppose to check multiple times.
What are the 4 measuring systems used?
metric
apothecary
household
avoirdupois
Changes to health care in the 21st century
access to medical and pharmacologic info is available from many sources (TV, internet, etc.)
consumers are demanding specific treatments and considerations (I want that drug!)
alternative therapies are being offered and advertised (remember the story about the lady with her “special tea” that turned out to be why her platelets were low? It was supposed to be topical!!!!)
financial pressures are leading to early discharge (send the guy home in a shock vest?!)
patient teaching and home care provisions are vital
pharmacogenetics
Advertisement of drugs must include ___________, _____ _______, and ____________.
contraindications, adverse effects, precautions
What internet sources have drug info?
pharmaceutical company info sites
chatrooms w/ others taking the drug
online pharmacies
lists of government regulations
research reports about the drug and its effectiveness
What is your responsibility as a nurse if a patient comes to you with drug information from the internet?
explain the info to the patient and guide the patient to good reference material about the drug
When determining which internet site to use for drug info what factors should you take into consideration?
navigation( is the site easy to use), contributer (who prepared the site), (accuracy/reliability/updated
After two weeks of self treatment (drugs, herbals, etc.) the patient does not see any health improvements what should they do?
GO SEE THE DOCTOR!
Problems with OTC meds
can mask the signs and symptoms of disease
can interact with prescription drugs
can be taken in greater than the recommended dose leading to toxicity
_____ _____ _____ drugs are drugs that were “grandfathered” in, former prescription drugs that have been tested and found to be safe for the general public if used as directed
Over the Counter (OTC)
________ ________ can cause drawbacks. The active ingredient has not been tested by FDA, incidental ingredients are unknown, pts. do not always mention therapies to their health care provider. interactions may occur
alternative therapy
example: St. JOhn’s wort. If you take it with oral BC, it will counteract the drug. Ginseng can cause hypoglycemia.
_______ _________ and _________ _________ are NOT controlled or tested by the FDA. Advertisement is not restricted because they are considered dietary supplements.
herbal medications, alternative therapies
________ __________ medication are used for an indication that is not approved by the FDA.
Off-label medications
Example: Viagra - was made for pulmonary HTN… :-P
What is the occurrence of off label medications?
commonly takes place in groups of pts. for whom there is little premarketing testing
used w/ pediatric and geriatric population
What are some factors leading to health care crisis?
high cost of care and drugs
huge research and equipment requirements to meet consumer demands
rising cost of health insurance
earlier discharge from hospitals
Measures to protect the public from bioterrorism
emergency preparedness at all levels of the government
Education of health care providers and public concerning recognition and treatment of infections causes by bioterrorism
____________ ________ is a substance that blocks the neurotransmitter acetylcholine in the CNS and PNS. The side effect is a dry mouth.
Anticholinergic agent
