Exam 1 Material Flashcards
1
Q
What are the 3 important qualities of a medication?
A
Effectiveness
Safety
Selectivity
2
Q
Besides the 3 main important qualities of a medication, what other properties do we look for?
A
Predictability
Ease of administration
Cheap
Shelf Stable
Simple generic name
reversibility
3
Q
What are the factors affecting the intensity of drug responses?
A
Administration
Pharmacokinetics
Pharmacodynamics
4
Q
Pharmacokinetics is?
A
What the body does to a drug
Ex: Absorption, distribution, metabolism, excretion
5
Q
Pharmacodynamics is?
A
What the drug does to the body
Ex: Drug-receptor interaction, patient’s functional state, placebo effects
6
Q
What are the 4 things that are involved in a nurse’s role as a patent educator?
A
Dosage and Administration
Minimizing adverse effects
Promoting therapeutic effects
Minimizing adverse interactions
7
Q
What does the food and drug administration do?
A
-supervises development of new drugs
-Approves new drugs
-monitors safety of drugs on the market
8
Q
What are the 3 steps in new drug development?
A
Pre-clinical testing in animals
Clinical testing
Post-market surveillence
9
Q
All drugs have 3 names, what are they?
A
1)chemical
2)generic
3)brand/trade
10
Q
What are the 5 rights of drug administration?
A
The right:
Patient
Medication
Dose
Route
Time
Documentation
11
Q
Purple Mice Do Really Tiny Dances is to help remember?
A
The 5 rights of drug administration.
Patient Medication Dose Route Time Documentation
12
Q
What are the 4 major processes in Pharmacokinetics?
A
Absorption, Distribution, Metabolism, Excretion
13
Q
Both Pharmacokinetics and Pharmacodynamics both have sources of individual variation. What are some of these variables?
A
Physiological variables
Pathological variables
Genetic variables
Drug interactions
14
Q
What are the 3 ways a drug is able to pass through a membrane?
A
Channels or pores
Transport system
Direct penetration of the membrane
15
Q
In Pharmacokinetics, absorption involves the?
A
Movement of a drug from the site of administration INTO the blood
16
Q
What are the factors that effect absorption?
A
Rate of dissolution
Surface Area
Blood Flow
Lipid solubility
17
Q
The ______________ of absorption determines the intensity of effects
A
amount
18
Q
The ________ of absorption determines the onset of effects (this can also be determined by route)
A
rate
19
Q
What are the 3 common cateogories for routes of drug administration?
A
Enteral
Parenteral
Topical
20
Q
Enteral route of drug administration is what? And what are these routes?
A
Enteral (by GI Tract)
PO by mouth
Enteral by feeding tube
SL sublingual
PR per rectum
21
Q
Parenteral routes of drug administration is what? And what are these routes?
A
Parenteral (by injection)
IV intravenous
IM intramuscular
SC/SQ subcutaneous
22
Q
Topical routes of drug adminstration are?
A
Inhalation
Ocular
Otic
transdermal
23
Q
Drug Abbreviations:
AC
A
before meals
24
Q
Drug Abbreviations:
HS
A
hour of sleep
25
Drug Abbreviations:
BID
twice a day
26
Drug Abbreviations:
TID
Three times a day
27
Drug Abbreviations:
STAT
immediatly
28
Drug Abbreviations:
PRN
as needed
29
Drug Abbreviations:
KVO
keep vein open
30
Drug Abbreviations:
NKDA
No known drug allergies
31
In Pharmacokinetics, distribution is?
The movement of a drug from blood INTO the cells
32
Distribution is determined by?
Blood flow to the tissues
Ability of drug to leave vascular system
Ability of drug to enter cells
33
For drugs to cross the BBB, they must be?
lipid soluble
34
What is the carrier protein for drug protein binding?
Albumin
35
Why can albumin not leave the capillaries?
It is too large to exit
36
If a drug is bound to albumin, can it exert it's effects?
No, only 'free' drugs get to leave the capillaries and enter the cells, therefore exerting their effects
37
In Pharmacokinetics, Metabolism is
Biotransformation-the chemical alteration of a drug structure
38
Where does metabolism normally occur?
In the liver
39
Competition for which enzymes or changes in their activity can cause major drug interactions?
Cytochrome P450 System
40
The metabolism of a lipid-soluble to water soluble drug would give which effect?
increase renal drug excretion
41
What is an example of increased therapeutic action?
codeine to morphine
42
What is it called when a drug is inactive until it is metabolized?
activation of "prodrugs"
43
Acetaminophen to a toxic metabolite upon metabolization is an example of?
Increased toxicity
44
What is the first pass effect?
The rapid hepatic inactivation of certain oral drugs.
45
If a drug is known to undergo the first pass effect-how should it be administered?
Parentally
46
Malnutrition can effect drug metabolism, why?
Because many drugs need a number of cofactors to function. In a malnurished patient, these cofactors can be missing
47
If a drug is in enteroheptatic recirculation, what must it have undergone?
Glurcuronidation.
48
In Pharmokinetics, Excretion is?
The removal of drugs from the body
49
What is the main way drugs are excreted?
the kidneys through urine
50
What are some other not as common ways drugs are excreted?
bile, sweat, saliva, breast milk, and expired air
51
What are some of the variables to excretion?
pH dependent ionization
Competition for active tubular transport
age
kidney function
52
What are the 3 plasma drug levels?
Toxic concentration
Therapeutic range
Minimum Effect concentration
53
What is the half-life of a drug
the time required for the drug to decrease by 50%
54
What determines the dosing interval of drugs to maintain therapeutic levels?
The T1/2
(Half life)
55
How does one achieve a therapeutic plateau?
When the amount of drug eliminated between doses equals the dose administered, plateau will be maintained
56
Efficacy is?
the ability of a drug to do it's job; the strongest effect that a drug can produce
57
Potency is?
amount to elicit a desired response; the dosage needed to produce effects
58
What would be an example of a time that a high efficacy wouldn't be the right choice for a patient?
If a patient had a mild headache, morphine would not be the best choice of drug, even though it has a high efficacy. You want to match the intesity of the response with the patients needs.
59
An Agonist is a drug that?
ACTIVATES receptors
60
What is the method of binding for an agonist drug?
The bind to the receptor mimicking the body's own molecules
61
A antagonist is a drug that?
Prevents or blocks a receptor; have no real effect on their own
62
What is tolerance?
When receptors are constantly activated by agonist drugs and become less responsive or desensitized
For long term use of the drug, concentrations will have to be continually increased to produce effects
63
When can receptors become hypersensitive?
When the are constantly blocked by antagonist drugs
64
Rebound hypersecretion can occur when?
Receptors are constantly blocked by antagonist drugs and additional receptors are produced
65
The therapeutic index measures the?
Drug safety.
Therapeutic response vs. death
66
A drug with a narrow therapeutic index would be given?
Under close supervision because it is less safe
67
What are the three possible consequences of a drug drug interaction?
Potentiation (intensify therapeutic effects)
Inhibition (reduce therapeutic effects)
Idiosyncratic reactions (unique response for the individual patient
68
Drug-Drug Interactions:
What is an example of an altered absorption?
a laxative reduces time for another drug to be absorbed
69
Drug-Drug Interactions:
What is an example of a altered distribution?
two drugs that both bind to albumin proteins
70
Drug-Drug Interactions:
What is an example of an altered metabolism?
Drugs that induce or inhibit the activty of CYP enzymes or compete for the same enzymes
71
Drug-Drug Interactions:
What is an example of an altered excretion?
A drug that lowers BP could reduce renal function, thereby decreasing the excretion of the drug
72
What is the definition of an Adverse drug reaction?
Any noxious, unintended and undesired effect that occurs at normal drug doses
73
What type of ADR is independent of drug dosing?
allergic reactions to drugs
74
A Iatrogenic disease is?
A disease produced by drugs
75
What occurs if a drug effects the QT interval?
Some ADR can widen the interval putting the patient at risk of arythmia
76
In regards to drugs/medication errors what does SALAD stand for?
Sounds alike, looks alike
77
What are the 7 classifications of antimicrobial drugs?
Drugs that:
-inhibit bacterial cell wall synthesis
-increase cell membrane permeability
-cause lethal inhibition of bacterial protein synthesis
-cause non-lethal inhibition of protein synthesis
-inhibit bacterial synthesis of DNA and RNA or disrupt DNA function
-Antimetabolites
-supress viral replication
78
Bactericidal means?
the drug is directly lethal to bacteria
79
Bacteriostatic means?
The drug slows bacterial growth but doesn't completely eliminate them. It depends on the host's immune system to do that
80
What are the methods of microbial resistance?
The microbe:
-lowers the drug concentration at the cite of action
-produces new enzymes
-alters the drugs target receptors
-antagonist production
81
What does selection pressure mean?
when an antibiotic kills all bacteria except for the drug resistant bacteria and therefore allowing it to flourish
82
What are the rules for prevention of microbial resistant to antibiotics?
-Prevent infections when possible
-Promote adherence
-Reduce demand for antibiotics in health people and children
-Emphasize adherence
83
Empiric treatment with antibiotics involves?
-A severe infection is present and the antibiotic is given before the sample is tested.
84
What are some of the conditions that would require prophalactic treatment of antibiotics?
-A high infection risk (ex. vascular heart surgeries)
-Neutropenic precautions
-Reoccuring UTIs
-Exposure to STI or other disease
85
The term additive in concern to antibiotics means what?
When two antibiotics is equal to the sum of using 2 drugs alone
86
The term potientiating in concern to antibiotics means what?
Combining two antibiotics to enahce the effect
87
The indicators for combination of antibiotics are?
-initial therapy for empiric infection
-Mixed infection
-Preventing resistance
-Lowers toxcity
-enhanced action
88
What are penicillin and cephalosporin's method of action?
Both are bactericidal drugs that weaken the bacteria's cell wall
89
What type of bacteria is penicillin most effective against?
gram +
90
What are the narrow spectrum penicillins?
What are the broad spectrum ones?
Narrow:
Penicillin V (PO)
Penicillin G (IM, IV)
Broad:
Amoxicillin (PO)
Ampicillin (IV)
Extended spectrum
Piperacillian (IV)
91
What are the microbial resistance methods to penicillin?
-Gram - bacteria are resistant to most penicillin
-Bacteria may change their receptor sites
-Bact. develop enzymes that break the beta-lactam ring
92
What is a bacteria that developed a resistance to methicillin, PCN, and cephalosporins?
MRSA
(methicillin resistant staphylococcus aureus)
93
What enzyme destroys the beta lactam right?
Beta lactamase
94
What is clavulnate?
Given with PCNs, it has no action of it's own, but it coast the PCN so beta lactamase cannot break the ring. It extends the spectrum of what PCN's can do
95
Which antibiotic is characterized into generations?
-hint: The last one can cross the blood brain barrier
Cephalosporins
96
What are some of the characteristics of c.diff?
Gram +
Spore forming
anerobic
97
What is vancomycin's spectrum and method of action?
Narrow spectrum
Weakens the cell wall (bacteriocidal)
98
What is are two resistant diseases that vancomycin treats?
MRSA and C.diff
99
Vancomycin is excreted by which organ?
the kidneys
100
What are the nursing considerations for Vancomycin?
-NTI drug so peak and troughs must be measured
-If an increase of Serum Creatine occurs, lower the dose
-Watch for ototoxicity
101
What are the adverse effects of vancomycin?
-Renal failure
-Ototoxcity (reversible)
-Red man syndrome
-Thrombophlebitis
102
What is 'red man syndrome', and how is it treated?
When vancomycin is admistered too fast through an IV, flushing, red rash, paritis, tachacardia and BP drop can occur.
These clusters of symptoms are called red man syndrome and they can be treated by administering Antihistamines slowly to the IV.
103
What are the antibiotics that are inhibitors of protein synthesis?
Tetracyclines
Macrolides
Amindoclycoside gentamicin
Sulfonamids
sulfamethoxazole, trimethoprim
104
What bacteriostasis antibiotic is a broad spectrum drug that is effective against gram - bacteria and is an alternitive to penicillin?
Tetracyclines
105
What antibiotic binds to calcium?
Tetracyclines
106
What are the adverse effects of a tetracycline?
Gi Upset
Binds to calcium (can discolor teeth)
Photosensitivity
Hepatic and Renal toxcity
107
What are the adverse effects of a macrolide?
CPY inhibitor (could cause toxcity of another drug)
QT Prolongation
GI Upset
108
Which antibiotic must be given parentally and dosed by weight?
Aminoglycoside Gentamicin
109
What are the adverse and not so adverse effects of Aminoglycoside Gentamicin
Adverse:
Nephrotoxicity
Permanent ototoxicity
Not so Adverse Effects:
Beneficial interaction with antibiotics that weaken cell walls
Post Antibiotic Effect
110
What are the nursing considerations for Gentamicin?
Watch for irreversible ototoxicity
Monitor labs for Protein, BUN, Sr, Cr, GFR
Watch peak and trough
111
What is a bacteriostatic antibotic that is broad spectrum and inhibits folic acid?
Sulfonamids
112
What are sulfonamids usually used to treat?
UTIs and topical skin infections
113
What are the adverse reactions for Sulfamethoxazole?
Hypersensitivity reaction
Steven Johnson syndrome (SJS)
Allergy to sulfa common
Possible renal damage if crystals in urine form ******
CYP enzyme inhibitor
114
What are the nursing considerations for Sulfamethoxazole?
Monitor for hypersensitivity reaction
Educate on hypersensitivity
Push oral fluids to reduce risk of crystals
CYP inhibitor (toxic levels of other drug)
115
Which bacteriostatic antibiotic is common to give with sulfanomide, and is normally well tolerated, however hyperkalemia can be an adverse effect?
Trimethoprim
116
Why is it common to give Trimethoprim and Sulfamethoxazole?
Potientiation occurs due to their bacteriostatic qualities
117
Which antibiotic is secreted by the kidneys but therapeutic levels are only present in urine?
Nitrofurantoin (Macrobid, Macrodantin)
118
What is the MOA of Nitrofurantoin?
Damages the bacteria's DNA
Both bacteriostatic and bacteriocidal
119
Which antibiotic gives urine a harmless brown tinge?
Nitrofurantoin
120
What are the adverse effects of Nitrofurantoin?
GI Effects
Avoid in last trimester (hemolytic anemia)
Rare Hypersensitivity reactions (hepatotoxicity/pulmonary rxn, peripheral neuropathy)
121
An woman with alcoholism and and complains about a UTI. Which antibiotic should you not give her?
Nitrofurantoin
Hepatoxcity
122
How is tuberculosis tested for?
In an active infection, by CXR and sputum
In a latent infection by blood test
123
Why is the treatment for TB so complicated?
Treatment doesn't work if:
It's to short or the dosage is too low
contains too few drugs
Adherence is erratic
124
How long is a latent TB infection on Isoniazid?
6-9months
125
What are the Active TB Multidrug combo?
Isoniazid
Rifampin
Ethambutol
Pyrazinamide
126
How long is someone with an Active TB infection on the multidrug combo?
On all 4 drugs for 2 months usually reduce to a isoniazid and riframpin for another 4 months (can be as long as 24)
127
What are the adverse effects of Isoniazid?
M. Tuberculosis can develop a resistance
Peripheral neuropathy
Hepatotoxcitity
128
Which drug is used in TB infection, but also leprosy that disrupts cell RNA synthesis?
Rifampin
129
What are the Adverse effects of Rifampin?
CYP enzyme inducer
Harmless red-orange discoloration of body fluids
Hepatocixity
Peripheral neuropathy
130
What antibiotic is inhibited by dairy?
Fluoroquinolone
131
How long must you avoid dairy when taking the antibiotic Fluroroquinolone?
consume 6 hrs before or 2 hours after med
132
What are the adverse effects of Fluroquinolone?
GI Effects
Photosensitivity effects
Tendonitis/achiles rupture (ankle heel pop)
Monitor other NTI drugs
133
Which antibiotic is commonly used for the treatment of anaerobic bacteria and protozoal infections?
Metronidazole
134
What are the adverse effects of Metronidazole?
N/V/D
Dry mouth with metallic taste
Rxn with alcohol
CYP enzyme inhibitor
135
How long must you avoid alcohol after taking Metronidazole?
Avoid for 3 days after
136
What is the name of the bactericidal broad spectrum drug that is used for fungal infections?
Azol Flucaonazole
137
What are the pharmacokinetics of Fluconazole?
It has a very long half life, therefore it stays in the body for a very long time
138
What are the adverse effects of fluconazole?
Minimal, but it is a CYP inhibtor
139
What would be an example considered an "aggressive factor?"
H. Pylori
140
What are the classes of GI Drugs?
antibiotics
histamine-2 receptors
Proton pump inhibitor
mucosal protectant
antacids
141
What is considered "triple therapy"?
2 antibiotics + H2 blocker or PPi
142
What is considered "quadruple therapy?"
2 antibiotics + H2 blocker or PPi + bismuth
143
What antibiotic is used for an H. Pylori infection?
More than 1
144
Cimetidine is used for?
It selectively blocks histamine 2 receptors in stomach which decrease the volume of acid reducing acid 80%
145
What are the pharmacokinetics of cimetidine
A very short half life
146
What is the very old medication taken before a meal that promotes healing by creating a protective barrier on the stomach lining?
Sucralfate
147
What are the types of antacids and how do they work?
They are aluminum, magnesium, calcium, and sodium and they directly interact with the H+ ions in gastric acid
148
What medicine is a prostaglandin analog used for NSAID induced gastric ulcers that should NOT be used by pregnant women?
Misoprostol
149
What are the groups of laxitives and what makes up their groupings?
Group 1: Produce watery stools in 2-6 hr
Group 2: produce semi-fluid stool in 6-12 hr
Group 3: produce soft stool in 6-12 hrs
150
What is are some examples of a Group 1 laxitive?
Magnesium citrate
Polyethylene Glycol
Castor oil
151
What are some examples of group 2 laxitives?
Stimulant Laxitives like ducolax
152
What is an example of a group 3 laxitive?
Methylcellulose
Psyllium (Metamucil)
153
What does a surfactant laxitive like Lactulose do?
Allows more water into stool to give it more volume and make it softer
