Ex 2: Pharmacotherapy Flashcards
Pharmacotherapy
Treatment with prescription drugs to achieve a desired therapeutic objective w/minimum of adverse side effects
Prevalence of Prescription drugs
50% of Americans take at least 1 ; 90% of adults age 60 or older take at least one p-medication; 40% of older Americans take five or more p-med/month
During what time period is the risk of non-adherence the highest?
For the first 6 months
Noadherence
1) not taking medication 2) not taking them correctly
What is the most common reason for non-adherence?
Medication side-effects
Drug
Substance that chemically alters biological function
How many people in the U.S die from adverse drug effects?
150,000/year
How long does it take to develop a drug?
Avg - 12 years ( 7-20 years)
SJS
Stevens Johnson Syndrome: Most severe reaction to drug
SJS symptoms
E: fever, headache, sore throat, itchy eyes 24-72 hours: inflammation and blistering of the eyes and mouth, skin,rash, nausea, and vomiting
TEN
Toxic Epidermal necrolysis: similar to SJS but painful blistering of skin and mucous membrane involvement. involves 30% of total body surface area.
Drugs are usually known by what type of name?
Their Brand “aka” trade name
Indications
The reason for administering a medication or performing a treatment
contraindications
A factor that prevents the use of a medication or treatment
Which routes of drug administration are the quickest?
1) IV 2) Oral 3) subcutaneous
Pharmacokinetics
Time course of drug absorption, distribution, metabolism, and excretion
Measure of pharmacokinetics
1) Rate of bioavailability - max concentration in the blood 2) Total exposure of bioavailability- how long drug is active
Acetaminophen
pain and fever; high dosage can cause damage the liver; no alcohol = no problem
NSAIDS
Ibuprofen, naproxen, aspirin = inflammation, pain, and fever; can lead to both kidney and liver damage and cause GI bleeding
pharmacodynamics
The biochemical and physiologic mechanisms of drug action; blood serum levels crucial. Drugs need to be bound to serum albumin. if less than 3.0 g/dL increases drug effect in the body
Explain why patients may have different therapeutic effects among specific generic brands of the same active ingredient.
1) Genetics (different side effects, variation in how drugs are handled, ineffectiveness of a particular drug 2) age, gender, etc 3) different levels of bioavailability.
Therapeutic window
Too little drug has no effect, too much drug has toxicity; (TW = between too much and too little)
Discuss why medication administration is more complicated with pediatric patients and the best mechanism for determining medication dose.
1) higher proportion of water 2) lower plasma proteins 3) immature liver and kidneys
Why are older adults at increased risk for interactions?
1) lower metabolism and excretion 2) multiple medications 3) lack of compliance
Why is medication administration particularly challenging in pregnancy and lactation?
1) increased maternal HR and BV may effect absorption, distribuition and effectiveness 2) Because drugs can cross the placenta, into breast milk, 3) drugs can acts as teratogens
Why is grapefruit juice eliminated from the menus of many hospitals and long-term care facilities?
Exacerbates side effects and toxicity; takes 2-3 days for new enzymes to be produced meaning efefect may persist for 48-72 hours after grapefruite digestion
Why is Vitamin K intake a concern for the patient who is on anticoagulants? What types of food contain Vitamin K?
Involved in the production of blood platelets, antagonizes anti-coagulants; found in cruciferous, leafy vegetables.
Why is natural licorice contraindicated for patients consuming diuretics or other antihypertensive medications?
Antagonizes anti-diuretics and anti-hypertensives; causes NA and H20 retention and K+ excretion; can create hypo kalemia
Why are tyramine containing foods to be avoided for individuals taking MAOIs? What types of foods contain tyramine?
tyramine is a vasoconstrictor which in combinationof MAOIs may cause hypertensive crises; increased BP, HR, Flushing, headache, stoke and death; aged cheeses and meats, soy sauce, sauerkraut, fava beans, all disheses with cheese
St. John’s Wort
Homeopathic; used in depression; diminshes ineffectiveness of drugs used in cancer and HIV/AIDS
Ginkgo or Ginkgo Biloba
homeopathic; inhibits platelet activating factor - leads to excessive bleeding
Glucosamine
homeopathic: linked to increased bleeding
What drug type has the most side effects?
Corticosteroids: increased apetite and weight gain, hyper glycemia, hyperlipidemia, depresessed thyroid, increased risk for osteoporosis
Corticosteroids
antiinflammatory, immunosuppressant ex: prednison cortisone, hydrocortisone; need to take w/food to decrease GI bleeding
Diet concerns w/ corticosteroids
Low sodium, high protein, increased need for vitamins K A CDl increased need for Ca+ and P
