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Pharm 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Controlled Substance Act

A

1970
Designed to fix drug abuse by:
-Promoting drug education and research
-Strengthening the enforcement authority
-Establishment of treatment and rehab facilities
-Designation of categories of controlled substances according to abuse

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2
Q

Food and drug administration modernization act

A

1997
Regulated foods, drugs, devices, and biological products

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3
Q

HIPAA

A

Protects patient information

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4
Q

First federal pure foods and drugs act

A

1906
-Protected the public from adulterated or mislabeled drugs
-Required companies to label dangerous and possibly addicting drugs
-Established FDA

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5
Q

Shirley amendment

A

1912
-Prohibited false therapeutic claims
Teething syrup contained morphine

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6
Q

Durham humphrey amendment

A

1951
-you need a prescription for legend drugs
-needs to be refilled with physician authorization
-doctors can call pharmacy telling them to refill, but not all pharmacies allow this
-You don’t need a prescription for OTC

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7
Q

C-I, C-II, C-III, C-IV, C-V

A

C-I: high abuse potential, severe dependence, no accepted medical use; restricted to research
C-II: high abuse potential, severe dependence, requires specific type of rx, phone orders not accepted, refills require new rx
C-III: Moderate potential and dependence, written or phone rx allowed. May be refilled 5 times within 6 months from date of issuance
C-IV: Low abuse potential, limited dependence, same as C-III
C-V: Limited abuse potential, lowest dependence, OTC

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8
Q

Medications for pregnancy (categories A, B, C, D, X)

A

A: Well-controlled studies show no fetal risk
B: No well controlled studies on humans; animal studies show no fetal risk
C: No well control studies on humans; animal studies show adverse effect on fetus
D: Evidence of human risk to the fetus exists; benefits outweigh risks in certain studies
X: Controlled studies in animals or humans demonstrate fetal abnormalities; not worth it

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9
Q

Protein binding

A

When drugs are distributed in the plasma, many bind with plasma proteins
bound part of drug is inactive because it can’t interact with tissue receptors (think of a locked up student, can’t leave and study)
free drug does stuff
when free drug decreases, bound drug leaves to have balance

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10
Q

Bioavailability

A

How much drug gets used by the body

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11
Q

Study designs (Open label, single, double, triple blind)

A

Open label: everyone knows
Single blind: participants dont know
double blind: HCP and participants dont know
Triple blind: HCP and collects data and doesnt know, removing biases

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12
Q

DAW

A

Can’t substitute for generic drug

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13
Q

Dietary supplement health and education act

A

1994
All labels must contain:
-name of supplement
-amount
-nutrition labeling
-ingredient list
-name and place of manufacturer

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14
Q

1992 (related to CAMS)
what was developed to support studies of CAMS

A

office of alternative medicine

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15
Q

Can CAMS be patented?

A

no

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16
Q

When not to take CAMS?

A

If pregnant, taking rx meds, not for infants

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17
Q

ADME

A

absorption
distribution
metabolism
excretion

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18
Q

Absorption

A

Drugs dissolve better in acid
enteric coated drugs r better in alkaline small intestine (aspirin)

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19
Q

Passive transport

A

Diffusion (high to low), no energy required
You want to PASS your test so your LOW CONCENTRATION brain sleeps on a HIGH CONCENTRATION textbook (HIGH TO LOW) and it doesnt take energy

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20
Q

Active transport

A

Requires a carrier, like an enzyme or a protein to move the drug along the concentration gradient. Energy required to be ACTIVE

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21
Q

Lipid soluble drugs pass rapidly or slowly?

A

Rapidly through the GI membrane bc it’s made of lipid

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22
Q

Water soluble drugs

A

Need a carrier, enzyme or protein, to pass membrane

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23
Q

Between ionized and nonionized, what passes faster?

A

Nonionized. Even larger particles pass quicker if they are nonionized

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24
Q

Are IM drugs absorbed faster in deltoid or gluteals?

A

deltoid bc more blood vessels

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25
Q

IO, IM, IV, and SC, fast to slow?

A

IV and IO, IM, SC

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26
Q

First pass effect

A

Some drugs don’t go directly into circulation. Some pass intestinal lumen to get to the liver via the portal vein

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27
Q

Metabolism in the liver

A

Some drugs get turned inactive and excreted, some are metabolized into metabolite, an equal or stronger form of the drug

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28
Q

How much more should oral dose be compared to IV

A

3-5x more

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29
Q

What factors effect bioavailability (there are 5)

A

Drug form
route
GI mucosa and motility
presence of food and other drugs
changes in liver’s metabolism or inadequate hepatic blood flow

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30
Q

If the liver metabolizes a certain drug but the liver isn’t working, what happens to the drug?

A

More bioavailability

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31
Q

rapid vs slow absorption

A

Rapid: increases bioavailability, may be toxic
Slow: limits bioavailability, decrease in drug serum concentration

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32
Q

Protein binding

A

Some part of the drug binds with proteins and can’t interact with receptors, making them useless. Free drug helps. Once the body starts running out of free drug, bound drugs break free and become useful

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33
Q

how do low plasma protein levels affect protein binding?

A

low plasma protein levels=fewer proteins to bind with=more free drug=toxicity

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34
Q

BBB

A

Blood brain barrier
Protects the brain from foreign substances
Endothelial lining

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35
Q

Risk of drug crossing the placenta

A

First trimester: risk of spontaneous abortion
Second: risk of spontaneous abortion, teratogenesis, or subtler defects
Third: altered growth and dev

36
Q

Metabolism

A

How the body chemically changes drugs into a form that can be excreted

37
Q

Where can drugs be metabolized? (and where is primary site?)

A

Liver (primary) and GI tract

38
Q

Metabolism of drugs in the liver

A

Inactivated by liver enzyme (CYP450) and converted by hepatic enzymes to inactive metabolites or water soluble substances

39
Q

in ADME, which two effect half life?

A

metabolism and excretion

40
Q

Steady state

A

Drug administered=drug being eliminated

41
Q

Loading dose

A

Large initial dose, used when half life is too long to wait for
After this, a daily order is prescribed, less than loading dose

42
Q

What is the main route of elimination

A

The kidneys (urine)

43
Q

Routes of elimination (not the main one), there are 6

A

Bile, feces, lungs, saliva, sweat, and breast milk

44
Q

What kind of drugs can the kidneys filter?

A

Free, unbound drugs, unchanged, water soluble (NOT PROTEIN SOLUBLE)

45
Q

What do creatinine clearance and BUN test?

A

Renal function

46
Q

What is creatinine

A

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

47
Q

CLcr

A

Compares the level of creatinine in the urine with amount in the blood
varies with age and gender (lower values in women and older ppl bc less muscle mass)
Decrease in renal function=increase in serum creatinine level and decrease in urine CLcr
Normal is 85-135mL/min

48
Q

Blood urea nitrogen (BUN)

A

A metabolic breakdown product of protein metabolism

49
Q

Affinity

A

The amount or attraction between med and site

50
Q

Dose-response relationship

A

The body’s physiological response to changes in drug concentration at a site of action

51
Q

Therapeutic range

A

Between MEC and minimum toxic concentration

52
Q

therapeutic index

A

Margin of safety of a drug (divide minimum toxic concentration by MEC, close to 1 is bad)

53
Q

peak and trough levels are requested when?

A

When the TI is very narrow. If peak and trough levels are too high, toxicity can occur. If trough is too low, no therapeutic effect

54
Q

Peak

A

Blood sample should be taken
Indicates drug’s rate of absorption
Average peak is 2-3 hours if oral
2-4 hours if IM
30-60 min if IV

55
Q

Trough

A

Blood sample should be taken right before next dose
Indicates drug’s rate of eliminiation

56
Q

Receptor theory

A

Drugs act by binding to receptors. this may activate/inactivate a receptor, or produce a response
The better the drug fits the receptor, the more active the drug is (lock and key)

57
Q

Four receptor families

A

Cell membrane-imbedded enzymes
Ligand-gated ion channels
G protein- coupled receptor systems
Transcription factors

58
Q

Agonist

A

Drugs that activate receptors and produce a desired response

59
Q

Antagonist

A

Drugs that prevent receptor activation and block a response

60
Q

Additive effect

A

2 or more like drugs combined to enhance effect

61
Q

Synergistic effect

A

2 or more unlike drugs combine for a greater (poor) effect

62
Q

Potentiation

A

2 drugs combined and only one enhanced

63
Q

Antagonistic effect

A

one drug cancels out another (drug and antidote)

64
Q

Enzyme induction

A

One med will speed up metabolism of another, making it less effective

65
Q

Enzyme inhibition

A

One med inhibits hepatic enzymes, increasing levels of the other med

66
Q

Considerations in toddlers

A

Be firm, use imagination, and simple explanation

67
Q

Considerations in school age children

A

May be scared of body injury, permit some control, involvement and education

68
Q

Considerations in older school age people

A

fear of pain, changes in body image, and injury. Establish a positive relationship, privacy, and collaboration

69
Q

Wong’s principle of atraumatic care

A

Minimize distress to patient and family

70
Q

What age group uses an oral syringe

A

Children under 6

71
Q

absorption in geriatrics

A

GI changes, swallowing difficulties, poor nutrition, feedig tubes

72
Q

distribution in geriatrics

A

decline in muscle, increase in fat. Lipid soluble drugs can be stored longer with prolonged action. Reduced albumin, decreased protein binding=increase in free drug (toxicity)

73
Q

Metabolism in geriatrics

A

decreased hepatic blood flow and enzyme activity. Prolonged half life

74
Q

excretion in geriatrics

A

renal function decreases, prolonged half life=increased drug levels

75
Q

Pharmacodynamics in geriatrics

A

Effects most seen in cardiovascular system and CNS
Reduction in receptors
Reduced blood flow to brain, more permeable BBB

76
Q

SC

A

Slower than IM because no blood flow, just fat
Insulin, heparin, lovenox, arixtra, epi, growth hormones
1ml max

77
Q

SC sites (5)

A

Outer upper arm, abdomen 2 in away from belly button, upper anterior thighs, upper back, upper ventral gluteal area

78
Q

SC needle and syringe

A

0.5ml-2ml syringe
needle gauge 25-30
needle size 1/2-5/8”
short needle at 90 degrees, long at 45
pinch skin
light pressure, no rub, press, or massage

79
Q

Insulin needle and syringe

A

In units
U-30 or 50 but usually 100
Total volume 0.5 or 1ml
usually has small, short needle

80
Q

IM

A

Injected in muscle
Begins in 5 min, peaks at 30-60
systemic and faster than SC
irritating bc deeper
1ml max for small muscle, 3ml for big
Pressure or massage after

81
Q

IM sites (4)

A

ventrogluteal (3ml and good for ztrak), deltoid (1ml and not for kids), vastus lateralis (3ml and for infants under 12), rectus femoris
NOT dorsal gluteal bc of sciatic nerve damage

82
Q

Ztrak

A

Pull skin back, inject and let go
seals everything in

83
Q

Tuberculin

A

max 1ml
Short, small gauge needle
Large gauge=thin needle
Needle is 1-3” long

84
Q

Medication order (9)

A

Client name, date, time, drug name,dosage, route, frequency, special instructions, signature
Parameters if cardiac!!

85
Q

What types of medications shouldn’t be crushed

A

Coated
Sustained
long-acting

Pharm 1 (4 decks)

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