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Pharm Exam 1 > Drug Action > Flashcards

Drug Action Flashcards

1
Q

Absorption

A

movement of drug particles from the GI tract to the body fluids by passive absorption, active absorption, or pinocytosis

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2
Q

most oral drugs are absorbed…

A

into the surface area of the small intestine through the action of the extensive mucosal villi

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3
Q

What happens to absorption if the villi decreases?

A

Absorption decreases because of disease, drug, effect or the removal of the small intestine

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4
Q

What happens to protein-based drugs in the small intestine?

A

they are destroyed by digestive enzymes

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5
Q

passive absorption

A

-occurs mostly by diffusion -does not require energy to move across the membrane

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6
Q

diffusion

A

movement from high concentration to lower concentration

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7
Q

active absorption

A

-requires a carrier as an enzyme or protein to move the drug against the concentration gradient -energy required

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8
Q

pinocytosis

A

process by which cells carry a drug across the membrane by engulfing the drug particles

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9
Q

GI membrane is composed of…

A

mostly lipid (fat) and protein

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10
Q

Drugs that are __________ pass rapidly through the GI membrane

A

lipid-soluble

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11
Q

________ need a carrier to pass through the membrane

A

water-soluble

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12
Q

Large particles pass through cell membrane if…

A

they are nonionized

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13
Q

nonionized

A

no positive or negative charge

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14
Q

weak acid drugs are..

A

less ionized in the stomach and they pass through the stomach lining easily and rapidly

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15
Q

an infant’s GI secretions are..

A

higher pH (alkaline) than those of adults

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16
Q

drugs that are _____ and _______ are absorbed faster than _______ and ________

A

-lipid-soluble, nonionized -water-soluble, ionized

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17
Q

What can affect drug absorption?

A

-blood flow -pain -stress -hunger -fasting -food -pH

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18
Q

Poor circulation to the stomach…

A

hampers absorption

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19
Q

What could cause poor circulation to the stomach?

A

result of shock, vasoconstrictor drugs, or disease

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20
Q

What could cause slow gastric emptying time?

A

-pain -stress -foods that are solid, hot, or high in fat

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21
Q

What is bad about a slow gastric emptying time when it comes to medication?

A

drug remains in stomach longer

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22
Q

exercise can…..

A

decrease blood flow by causing more blood to flow to the peripheral muscle, thereby decreasing blood circulation to the GI tract

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23
Q

Drugs given IM…

A

are absorbed faster than subQ due to there being more blood vessels in the muscle

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24
Q

Drugs are absorbed faster in the deltoid due to…

A

very vascular

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25
Q

Some drugs do not go directly into the systemic circulation following oral absorption….

A

they pass from the intestinal lumen to the liver via the portal vein

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26
Q

In the liver, what happens to drugs?

A

first-pass effect

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27
Q

first-pass effect

A

process in which the drug passes to the liver first

  1. drug is metabolized to inactive form that may be excreted, thus reducing the amount of active drug
  2. do not undergo any metabolism
  3. drug is metabolized to drug metabolite, which may be equally or more active than the original drug
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28
Q

most drugs given orally are…

A

affected by first-pass metabolism

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29
Q

bioavailability

A

-subcategory of absorption -% of drug administered that reaches the systemic circulation

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30
Q

for oral route, bioavailability…

A

occurs after absorption and first-pass metabolism

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31
Q

The % of bioavailability for the oral route is…

A

always less than 100%

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32
Q

The % of bioavailability for the IV route is…

A

100%

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33
Q

Oral drugs that have a high first-pass metabolism…

A

may have availability of only 20% to 40% on entering systemic circulation

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34
Q

To obtain the best drug effect, oral dose could be…

A

higher than the drug dose for IV use

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35
Q

Factors that alter bioavailability

A
  1. drug form 2. route 3. GI mucosa and motility 4. food and other drugs 5. changes in liver metabolism caused by liver dysfunction or inadequate hepatic blood flow
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36
Q

decreased liver function or decreased hepatic blood flow….

A

leads to increased bioavailability of a drug, but only if the drug is metabolized by the liver -less drug is destroyed by the hepatic metabolism in the presence of liver disorder

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37
Q

With some oral drugs, rapid absorption…

A

increases the bioavailability of the drug and can cause an increase in drug concentration -drug toxicity may result

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38
Q

slow absorption can…

A

limit the bioavailability of the drug, thus causing a decrease in drug serum concentration

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39
Q

Distribution

A

process by which the drug becomes available to body fluids and body tissues

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40
Q

Distribution is influenced by..

A

-blood flow -drug’s affinity to the tissue -protein-binding effect

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41
Q

protein-binding effect

A

as drugs are distributed in the plasma, many are bound to varying degrees with protein

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42
Q

Vd

A

Volume of drug distribution -dependent on drug dose and its concentration in the body

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43
Q

drugs with larger volume of drug distribution….

A

have a longer half-life and stay in the body longer

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44
Q

>89% bound to protein

A

highly protein-bound drugs

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45
Q

61%-89% bound to protein

A

moderately highly protein-bound drugs

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46
Q

30%-60% bound to protein

A

moderately protein-bound drugs

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47
Q

free active drug

A

-drugs not bound to protein -active and can cause a pharmacologic response

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48
Q

the portion of the drug that is bound to protein is…

A

inactive and not available to receptors

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49
Q

as the free active drug decreases over time…

A

more bound drug is released from the protein to maintain the balance of free drug

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50
Q

bound drugs cannot…

A

leave systemic circulation to get to site of action

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51
Q

When two highly protein-bound drugs are given concurrently…

A

they compete for protein-binding sites, thus causing more free drug to be released into circulation

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52
Q

What could result from two highly protein-bound drugs given at the same time?

A

drug accumulation and possible drug toxicity

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53
Q

low serum protein level decreases…

A

the number of protein-binding sites

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54
Q

low number of protein-binding sites can cause…

A

increase in the amount of free drug in the plasma and drug toxicity may result

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55
Q

drug is dosed and prescribed according to…

A

the % in which the drug binds to protein

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56
Q

Who would have low serum albumin levels?

A

-patients with liver or kidney dz -malnourished patients

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57
Q

Who is more likely to have hypoalbuminemia?

A

OAs

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58
Q

with some health conditions that result in low serum protein levels….

A

excess free or unbound drug goes to nonspecific tissue binding sites until needed -excess free drug in the circulation does not occur

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59
Q

To avoid possible drug toxicity, checking the…

A

protein-binding % of all drugs administered to a patient is important

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60
Q

RN should check pt’s plasma protein and albumin levels because…

A

a decrease in plasma protein (albumin) decreases the available protein-binding sites, permitting more free drug in the circulation -could be life threatening based on drug

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61
Q

What hinders drug distribution?

A

-abscesses -exudates -body glands -tumors

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62
Q

_______ do not distribute well at abscess and exudate sites

A

antibiotics

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63
Q

some drugs accumulate in particular tissues such as…

A

-fat -bone -liver -muscle -eye tissues

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64
Q

BBB

A

blood brain barrier -semipermeable membrane in the CNS that protects the brain from foreign substances

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65
Q

____________ drugs are able to cross the BBB

A

highly lipid-soluble

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66
Q

What type are drugs are not able to cross the BBB?

A

-drugs not bound to proteins -drugs that are not lipid-soluble

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67
Q

What is made difficult by drugs not being able to cross the BBB?

A

it is difficult to distribute the drug

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68
Q

During pregnancy, what type of drugs are able to cross the placental barrier?

A

both lipid-soluble and lipid-insoluble drugs -can affect both fetus and mother

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69
Q

What is considered before administering drugs to pregnant mothers?

A

risk-benefit ratio

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70
Q

During lactation, drugs…

A

can be secreted into breast milk -could affect the nursing infant

71
Q

RNs responsibility when it comes to administering meds to breast feeding mother?

A

check which drugs may cross into breast milk

72
Q

Metabolism

A

process by which the body inactivates or biotransforms drugs

73
Q

Drugs can be metabolized….

A

in several organs, but liver is PRIMARY SITE OF METABOLISM

74
Q

Most drugs are ______ by liver enzymes

A

inactivated -then converted or transformed by hepatic enzymes to inactive metabolites or water-soluble substances for excretion

75
Q

Large % of drugs are __________

A

lipid-souble

76
Q

lipid-soluble drugs are metabolized by the liver….

A

into a water-soluble substance for renal excretion

77
Q

Half-Life

A

time it takes for 1/2 of the drug concentration to be elminiated

78
Q

What affects the half-life of a drug?

A

metabolism and elimination

79
Q

liver or kidney dysfunction leads to…

A

prolonged half-life and less drug is metabolized and elminiated

80
Q

Drugs go through…

A

several half lives before more than 90% of the drug is eliminated

81
Q

Longer the half-life…

A

longer to leave the body

82
Q

By knowing the half-life,

A

you can compute the time it takes for a drug to reach a steady state of serum concentration

83
Q

how many half-lives does it take to saturate the biologic system to the extent that the intake of the drug equals the amount metabolized and excreted?

A

3 to 5 half-lives

84
Q

Main route of drug elimination is through…

A

the kidneys/urine

85
Q

other elimination routes are…

A

-bile -feces -lungs -saliva -sweat -breast milk

86
Q

Kidneys filter….

A

free unbound drugs, water-soluble drugs, and drugs that are unchanged

87
Q

Lungs eliminate…

A

volatile drug substances and products metabolized to CO2 and H2O

88
Q

urine pH influences…

A

drug excretion

89
Q

urine pH varies from

A

4.5 to 8

90
Q

acidic urine

A

promotes elimination of weak base drugs

91
Q

alkaline urine

A

promotes elimination of weak acid drugs

92
Q

ASA

A

weak acid -rapidly excreted in alkaline urine

93
Q

With kidney disease that results in decreased GFR or decreased renal tubular secretion….

A

drug excretion is slowed or impaired

94
Q

decreased blood flow to kidneys….

A

alters drug excretion

95
Q

common tests used to determine renal function

A

-CLcr -BUN

96
Q

CLcr

A

compares the level of creatinine in the URINE with the level of creatinine in the BLOOD -varies with age and gender

97
Q

Who is expected to have decreased CLcr values?

A

OA and females because of their decreased muscle mass

98
Q

GFR

A

may be the best test, but very expensive and not so commonly used

99
Q

decreased GFR results in….

A

increase in serum creatinine level and a decreased in CLcr

100
Q

renal dysfunction in OA

A

drug dosage usually needs to be decreased -CLcr needs to be determined to establish appropriate drug dosage

101
Q

creatinine

A

metabolic by-product of muscle that is excreted by the kidneys

102
Q

Pharmacodynamics

A

study of the way drugs affect the body

103
Q

drugs can cause…

A

primary or secondary effect (or both)

104
Q

primary effect

A

desired

105
Q

secondary effect

A

desired or undesired

106
Q

drug response

A

relationship between the minimal vs. maximal amount of drug dose needed to produce the desired drug response

107
Q

all drugs have a….

A

maximum drug effect or maximal efficacy

108
Q

Tramadol vs. Morphine

A

Morphine has a greater maximal efficacy -no matter how much tramadol is given, it will never be as great as Morphine when controlling pain

109
Q

onset of action

A

time it takes to reach the minimum effective concentration (MEC) after a drug is adminitered

110
Q

peak action

A

occurs when the drug reaches its highest blood or plasma concentration

111
Q

duration of action

A

length of time the drug has a pharmacologic effect

112
Q

time-response curve

A

evaluates 3 parameters of drug action: -onset -peak -duration

113
Q

if plasma or serum level decreases below threshold or MEC….

A

adequate drug dosing is not acheived

114
Q

If drug plasma or serum level increases above threshold or MEC…

A

can result in toxicity

115
Q

Receptor theory

A

drugs act through receptors by binding to the receptor to produce (initiate) a response or to block (prevent) a response

116
Q

Activity of many drugs is determined by…

A

the ability of the drug to bind to a specific receptor

117
Q

the better the drug fits into the receptor…

A

the more biologically active the drug is

118
Q

most receptors are….

A

protein in nature and found in cell membranes

119
Q

drug-binding sites are primarily on…

A
  • proteins
  • glycoproteins
  • proteolipids
  • enzymes
120
Q

agonists

A

produce response

121
Q

antagonists

A

block a response

122
Q

Epiniephrine stimulates beta1 and beta2 receptors, so…

A

it is an agonists

123
Q

Atropine blocks histamine receptor, so…

A

it is an antagoinist

124
Q

Effects of an antagonist can be determined by…

A

the inhibitory action of the drug concentration on the receptor site

125
Q

Cholinergic receptors are located…

A
  • bladder
  • heart
  • blood vessels
  • stomach
  • bronchi
  • eyes
126
Q

nonspecific drugs

A

drugs that affect various sites and have nonspecificity properties

-evoke a variety of responses throughout the body

127
Q

nonselective drugs

A

affect various receptors or have properties of nonselectivity

-produce a response but do not act on a receptor may act by stimulating or inhibiting enzyme activity or hormone production

128
Q

categories of drug action

A
  1. stimualtion
  2. replacement
  3. inhibition
  4. irritation
129
Q

Therapeutic Index

A

estimates the margin of safety of a drug through the use of a ratio that measures the effective dose in 50% of people and the lethal dose in 50% of people

-closer to 1, the greater danger of toxicity

TI= LD50/ED50

130
Q

low TI

A

narrow margin of safety, more dangerous

131
Q

high TI

A

wide margin of safety, less dangerous

132
Q

Serum drug levels do not need to be monitored routinely for…

A

drugs with high TI

133
Q

Therapeutic range/window

A

drug concentration in plasma is the level of drug between the minimum effective concentration in the plasma for obtaining desired drug action and the minimum toxic concentration

134
Q

When TR is given…

A

it includes both protein-bound and unbound portions of the drug

135
Q

Increased chance of toxicity…

A

TR monitored

136
Q

loading dose

A

when immediate drug response is desired

-large initial dose is given to achieve a rapid minimum effective concentration in the plasma

137
Q

after loading dose…

A

prescribed daily dosage is ordered

138
Q

Side effects

A

physiologic effect not related to desired drug effects

139
Q

even with correct dose…

A

side effects occur and are predicted

140
Q

side effects results from….

A

drugs that lack specificity

141
Q

Adverse reactions

A
  • more severe than side effects
  • always undesirable
  • must be report and documented
142
Q

Adverse reaction and side effects

A

sometimes used interchangeably but they are different

143
Q

RNs role with side effects

A

teaching patient to report any side effects

144
Q

one of the primary reasons patients stop takinga prescribed medication

A

occurence of side effects

145
Q

toxic effects or toxicity

A

when drug level exceeds the TR, toxic effects are likely to occue from overdosing or drug accumulation

146
Q

For wide therapeutic index…

A

therapuetic ranges are seldom given

147
Q

for narrow therapeutic index…

A

therapeutics ranges are closely monitored

148
Q

Peak and trough

A

indicates the rate of absorption and rate of elimination

149
Q

Peak and trough is requested for

A

drugs that have a narrow therapeutic index and are considered toxic

150
Q

peak drug levels

A
  • indicate the rate of absorption of the drug
  • highest plasma concentration of drug at a specific time
151
Q

trough drug level

A
  • indicate the rate of elimination of the drug
  • lowest plasma concentration of a drug and it measures at the rate at which the drug is eliminated
152
Q

High P&T levels

A

toxicity can occur

153
Q

low peak levels

A

no therapeutic effect

154
Q

when is peak drug level drawn

A

at proposed peak time according to route

155
Q

when is trough drug level drawn

A

immediately before next dose, regardless of route

156
Q

drug interactions

A

different action or effect of a drug as result of an interaction with one or more other drugs

INSIDE THE BODY

157
Q

drug incompatibility

A

chemical or physical reaction that occurs among two or more drugs within a syringe, IV bag, IV tubing

OUTSIDE THE BODY

158
Q

absorption interactions

A

two or more drugs taken at the same time canc ause the absorption rate of one or more of the medications to change

159
Q

distribution interaction

A

two drugs that are highly protein-bound and administered at the same time can result in drug displacement

160
Q

metabolism

A

many drug interactions occur in the livers microsmal system

  • enzyme inhibitors
  • enzyme reducers
161
Q

excretion

A

two or more drugs that undergo the same route of excretion may compete with one antoher for elminiation from the body

162
Q

addictive drug effect

A

two drugs with similar actions administered at the same time

-result is the sum of the effects of the two drugs

163
Q

synergistic drug effect

A

two or more drugs are given together, one can potentiate on another

-clinical effect is substantially greater than the combined effect of the two

164
Q

antagonist drug effect

A

two drugs that have opposite effects are administered together, each drug cancels the effects of the other

-sometimes desired

165
Q

drug-food interactions

A

-food can increase, decrease, or delay drug absorption

166
Q

food can bind…

A

with drugs causing less or slower absorption

167
Q

food may have impact on..

A

absorption of different dosage forms of the same drug

168
Q

classic drug-food interaction

A

occurs when an antidepressant of the monoamine oxidase inhibitor type is taken with tyramine rich foods

169
Q

tyramine rich foods

A
  • cheese
  • wine
  • organ meats
  • beer
  • yogurt
  • sour cream
  • bananas
170
Q

tyramine rich foods have what type of effect?

A

sympathomimetric-like

171
Q

when tyramine rich foods are taken with antidepressants

A

more Norepinephrine is released leading to hypertensice crisis

172
Q

drug-lab interactions

A

abnormal plasma or serum electrolyte concentrations can affect certain drug therapies

173
Q

drug induced photosensitivity

A

two types: photoallergy and phototoxicity

  • skin rxn caused by exposure to sunlight
  • caused by interation of a drug and exposure to UVA light which can cause cellular damage
  • most can be avoided with SPF

Pharm Exam 1 (5 decks)

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