Exam 1 Flashcards
What is pharmacotherapeutics?
The use of drugs for the purpose of disease prevention, diagnosis and treatment
What are therapeutic effects?
The beneficial responses to medication treatment
What are adverse effects?
The serious side effects resulting from taking a medication
What are teratogens?
Drugs that cause birth defects
What is the minimal effective concentration definition?
The amount of drug required to produce a therapeutic effect
What is a toxic concentration?
The amount of drug that results in serious adverse effects
T/F Preclinical trials are not regulated by the FDA.
True
T/F Preclinical trials are tested on animals or human microbial cells.
True
When do FDA regulations begin on drug approval?
When humans become involved as test subjects
What happens in Phase I of clinical trials?
The volunteers are all healthy.
What happens in Phase II of clinical trials?
There is a larger number of volunteers who have the specific disease for the drug being tested.
What happens in Phase III of clinical trials?
The trials are wide scale, patient’s have multiple issues and they monitor drug interactions.
What happens in Phase IV of clinical trials?
The drug is in the public and adverse effects are reported.
How long does it take for a drug to get approved for use?
12 years
What is Category X?
a drug that has demonstrated fetal abnormalities or adverse responses
What is pharmacokinetics?
How the body responds to a drug
What are the four phases of pharmacokinetics?
Absorption, distribution, metabolism, excretion
What happens in the absorption phase?
The drug is absorbed and starts going places
What happens in the distribution phase?
The drug travels to where it needs to go in the body
What is the metabolism phase?
the speed at which your body breaks down and excretes a drug
What happens in the excretion phase?
The speed at which your body rids the drug from your system
What happens in the excretion phase?
The speed at which your body rids the drug from your system
What is the primary factor that determines the onset and intensity of drug action?
Absorption
Which routes do not go through the 1st pass effect?
Sublingual and buccal
What is the 1st pass effect?
Where the drug concentration is greatly reduced before reaching systemic circulation
What kind of tablet takes longer to absorb?
enteric coated
What needs to be monitored in order to make sure the body can metabolize drugs?
liver function
Where is the primary site of excretion in the body?
the neys
What are some considerations for a drug with a narrow therapeutic index?
Mo
What are some considerations for a drug with a narrow therapeutic index?
Monitor via labs, random serum drug levels, peak and trough
What is a peak?
When the drug is highest in the body
What is a trough?
The point where the drug serum level is lowest in the body
What are factors influencing drug effects?
Weight, age, biological sex, pathologic, genetic, psychological, immunological factors and physiological factors
What weight are drug recommended doses based off of?
150 lbs
How can age affect drug effects?
Children metabolize drugs differently; metabolism can be faster or slower. Older adults may take longer to metabolize and have more CNS effects
How can biological sex affect drug effects?
Men have more vascular muscle and women have more fat cells
What are 3 common drug classes that cause adverse effects?
Opioids, diuretics and anticoagulants
Where is the site of drug metabolism?
The liver
T/F Drugs with a narrow therapeutic index are more likely to cause serious consequences.
True
T/F Dietary supplements are controlled and tested by the FDA.
False
The Dietary Supplement Health and Education Act of 94 states that
Medical claims cannot be on bottle however symptoms can.
What are DMARDS?
Disease Modifying Antirheumatic Drugs
T/F Early start of DMARDS reduces chances of long term complications.
True
T/F DMARDS take several months to reach max therapeutic effects; patients will take an NSAID with DMARD.
True
What are the prototypes of DMARDS I?
Methotrexate and hydroxychloroquine
DMARDS are antimetabolite drugs, which means _____
they interfere with folic acid
An adverse effect of DMARDS I is putting you at risk for ___ blood cells
low
DMARDS I are contraindicated in those with visual field damage (methotrexate) because
they can cause more field damage.
T/F A woman of childbearing age needs to be on contraception when taking DMARDS I because it is a category X medication.
True
T/F You cannot take DMARDS I & II together.
False; you can take these together.
What is the MOA of DMARDS II?
The primary action for RA is immunosuppression
T/F DMARDS II are tumor necrosis factor antagonists.
True
T/F Discontinue DMARDS II if a rash appears, this could be Steven Johnson’s syndrome.
True
What are the major reactions of DMARDS II?
Increased risk of infection, injection site reactions, severe skin reactions.
What is the DMARDS II prototype?
etanercepts
What is the black box warning of etanercept?
It can reactivate latent TB and increase risk of fatal infections
T/F DMARDS II can completely wipe out the immune system if taken with chemo.
True
DMARDS III include ____ compounds and are very toxic.
gold
SERMS have a black box warning because of the risk of _____________
thromboembolisms
SERMS are used for osteoporosis and activate _______ receptors in endometrial tissue and bones.
estrogen
When taking Biphosphonates (alendronate) for osteoporosis, the black box warning states that _______
You need to remain upright for 30 minutes after taking the medication and avoid drinking/eating anything other than water
What does remaining upright for 30 minutes after taking biphosphonates (alendronate) prevent?
Esophagitis and erosion
What does a nurse need to monitor for when giving biphosphonates (alendronate)?
esophagitis & GI effects
What neurotransmitters are involved in PD?
dopamine and acetylcholine
How do dopaminergic agents work?
They mimic dopamine by increasing dopamine levels
How do anticholinergic agents work?
They blcok Ach to stop tremors
PD dopaminergics only work when there are enough intact neurons; decline will happen when ________
dopamine levels decrease with age.
What is the most effective prototype for dopaminergic agents?
levodopa/carbidopa
levodopa works by ______
crossing the BBB & converts to dopamine
Carbidopa works by ______
helping levodopa get into the CNS at a greater amount.
What are the anticholinergic effects?
dry mouth, urinary retention, constipation and blurred vision
T/F If adding carbidopa to levodopa, you must wait 12 hours or else levodopa will reach toxic effects.
True
How long does it take for levidopa/carbidopa to start working?
2-3 weeks
What medication helps with involuntary movements, tremors and twitching in the case of PD?
amantadine
What foods should be avoided with levodopa?
High protein, fortified cereal or multivitamins
What effect does Vitamin B6 and high protein meals have on levodopa?
They lower the effects
What is the on/off syndrome?
the loss of drug effect in long term use that eventually maxes out
What is the function of anticholinergic agents?
lowering the effects of acetylcholine
What is the prototype for antocholinergics?
Benztropine
What does benztropine provide the most benefit for?
tremors; less effective than levodopa
How do anticholinergics (benztropine) work in the body?
They block ach receptors in the brain?
What is a serious GI effect caused by benztropine?
Paralytic ileus, which is the lack of movement in digestive system
What are contraindications for benztropine?
allergies, urinary obstruction and children under 3
How long does it take for the anticholinergic (benztropine) to decrease symptoms associated with PD?
2-3 days
What is the goal of immune modulators?
To modify the progression of MS
What is the goal of high dose corticosteroid therapy?
To treat acute exacerbations of MS
What are the goals of antianxiety, antidepressants and analgesics in MS?
To manage symptoms
What drug offers a cure for MS?
There is no cure
What is the prototype for immunomodulators?
Interferon Beta 1B
What side effects are associated with Interferon 1B?
Flu like symptoms, bone marrow suppression & suicidal ideation
What can prevent flu like symptoms with Interferon Beta 1B?
Pre-treatment with an NSAID or acetaminophen
What is Interferon Beta 1B meant to treat?
relapsing forms of MS
How does Interferon Beta 1B work?
It keeps leukocytes from crossing the BBB, which protects the myelin sheath from demyelinization
What are other adverse effects related to Interferon Beta 1B?
Bone marrow suppression, injection site reactions and increased liver enzymes and liver toxicity
What is an adjuvant analgesic?
A medication that is NOT a pain med and that is used for neuropathic pain
What are the two indications for adjuvant analgesics?
Pain that is intractable and neuropathic pain
What are analgesics?
Drugs that relieve pain without LOC
What are corticosteroids used for?
severe or disabling inflammation
What are NSAIDS used for?
mild to moderate pain, inflammation and fever
What drugs are in the first major category of NSAIDS?
salicylates (aspirin) and ibuprofen
What drug is in the second major category of NSAIDS?
Cyclooxygenase-2 (COX) inhibitors
Which drug inhibits platelet aggregation?
ASA
Which COX is responsible for the mediation of inflammation, pain and fever?
Cox 2
Which COX is responsible for protecting gastric mucosa, promoting renal function and blood clotting?
Cox 1
What happens when you block COX 2?
There is improvement in inflammation, pain and fever
What happens if you block COX 1?
There is decreased renal fx, no protection of gastric mucosa and risk of bleeding
What is the MOA of ASA?
Inhibiting COX-1 & 2
What happens if you take ASA before vaccines?
the immune response is prohibited, which makes the vaccine less effective
How does ASA affect the clotting system?
There is a risk of bleeding
What are GI affects associated with ASA?
nausea, dyspepsia, heartburn and epigastric discomfort
How does ASA affect platelets?
It affects platelets for the life of that platelet
What are symptoms of salicylism?
levels of salicylate 200 mcg or above; tinnitus, confusion
What is the antidote to salicylism?
stopping the medications
What is the effect of Reye’s Syndrome?
Liver & brain damage in children 19 or younger if ASA is taken when the flu or chicken pox is present
What is the prototype for 2nd generation NSAIDS?
Celecoxib
T/F There is double the risk of MI or stroke with use of celecoxib.
True
What is the only antidote for acute acetaminophen poisoning?
acetylcysteine
opioid agonists activate _________
both mu and kappa receptors
mixed opioid agonist-antagonists __________
are less potent, block one receptor and activate the other
An example of an opioid antagonist is _______
naloxone
What is the max dose of acetaminophen for adults?
4g for healthy adults, 3g for undernourished and 2g for alcoholics
When should you hold opioids from being administered?
When respirations are less than 12
When should you administer naloxone?
When respirations are less than 10
What is the opioid agonist prototype?
Morphine
When is morphine contraindicated?
In premature deliveries because preemies lungs aren’t fully developed
What is the abstinence syndrome reaction for opioids?
yawning, runny nose, sweating, violent sneezing, weakness, GI issues, bone and muscle pain, spasms and kicking movements
abstinence syndrome means
physical withdrawal
What are the classic triad of symptoms from Morphine overdose?
pinpoint pupils, respiratory depression, unconsciousness
What is the mixed agonist-antagonist medication for opioids?
pentazocine
Why is pentazocine important?
It produces less respiratory depression
what is the therapeutic use of pentazocine?
moderate to severe pain, anesthesia adjunct, and pain relief during labor/delivery
T/F You cannot abruptly stop taking corticosteroids.
True; this will affect adrenal function and secretion.
A person with osteoporosis should consume ____ and ____
Calcium and vitamin D
Pay attention to behavioral changes with costicosteroids, especially _____
Nervousness
What is the corticosteroid prototype?
Prednisone
What makes up a corticosteroid?
Glucocorticoid and mineral corticoid
T/F Keep corticosteroid amount low for maximum effects.
True
