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PT 113 > Exam #2 Pharmacology & Evidence Based Research > Flashcards

Exam #2 Pharmacology & Evidence Based Research Flashcards

1
Q

Why do evidence-based research?

A

It provides support for various practice patterns and treatment selection within the profession.

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2
Q

Three topics used for clinical focus are:

A

1) Medical diagnosis, 2) Pharmacological agent, and 3) Therapeutic Procedure

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3
Q

POEM stands for:

A

Patient-Oriented Evidence that Matters - deals with outcomes of importance to patients, such as changes in morbidity, mortality, or quality of life.

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4
Q

DOE stands for:

A

Disease-Oriented Evidence - focuses on specific end points, such as changes in laboratory values or other measures of response based upon patient’s responses to an outcome.

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5
Q

Name the levels of evidence?

A

1) Level A, 2) Level B, and 3) Level C

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6
Q

Level A evidence includes…..

A

Randomized controlled trial/meta-analysis which is described as a high-quality randomized controlled trial (RCT) that considers all important outcomes (strong validity, reliability, and high quality meta-analysis using comprehensive search strategies)

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7
Q

Level B evidence includes…..

A

A well-designed, nonrandomized clinical trial, a non-quantitative systematic review with appropriate search strategies and well-substantiated conclusions (other evidence). Includes lower quality RCT’s, clinical cohort studies, and case-controlled studies with nonbiased selection of study participants and consistent findings.

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8
Q

Level C evidence includes…..

A

Consensus viewpoint or expert opinion. Each rating is applied to a single reference in the article, not to the entire body of evidence that exists on a topic. Each label should include the letter rating (A, B, C), followed by the specific type of study for that reference.

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9
Q

Some descriptors of Level C evidence include:

A

1) Nonrandomized clinical trial, 2) Non-quantitative systematic review, 3) Lower quality RCT, 4) Clinical cohort study, 5) Case-controlled study, 6) Historical uncontrolled study, and 7) Epidemiologic study

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10
Q

The statement, “To improve morbidity and mortality, most patients in congestive heart failure should be treated with an angiotensin-converting enzyme inhibitor” is an example of which level of evidence?

A

Level A evidence RCT

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11
Q

The statement, “The USPSTF recommends that clinicians routinely screen asymptomatic pregnant women 25 years and younger for Chlamydia infection” s an example of which level of evidence?

A

Level B evidence, nonrandomized clinical trial

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12
Q

The statement, “Physical therapy is traditionally prescribed for the treatment of adhesive capsulitis (frozen shoulder), although there are no randomized outcomes studies of this approach” is an example of which level of evidence?

A

Level C evidence

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13
Q

Name the various reasons for Evidence-Based Focus Research?

A

1) Creative processes that challenge the profession, 2) Advances the profession, 3) Clinical research o’s p[art of APTA’s vision, 4) Determines effectiveness or lack of effectiveness of PT intervention, 5) Determines which areas in PT clinical practice that need to be revised, and 6) Evidence / outcomes are used as a guide in clinical practice.

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14
Q

Name the two types of research?

A

1) Experimental and 2) Nonexperimental

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15
Q

Define Experimental Research?

A

One independent variable, single subject design, within subject design, between subject design, and true experimental design with random subject comparison

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16
Q

Define Nonexperimental Research?

A

No manipulation of the independent variables, recording of past history / past phenomena-case studies - historical research, developmental research, qualitative research, and correlation research studies

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17
Q

List some variables in PT research?

A

1) Utrasound parameters, 2) Electrical stimulation parameters, 3) Goniometric measurements - type of measurement tool (stud. goniometer v. angle finders), and 4) Patient’s signs, symptoms (pain scale, pain descriptors (i.e. pain, aching, burning, tingling, weakness, and ROM)

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18
Q

What are the two types of variables in research?

A

1) Independent and 2) Dependent

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19
Q

Characteristics of Independent Variables are:

A

1) Manipulated by the researcher, 2) Defines the focus of the research, 3) Cause of change, and 4) plies to experimental research

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20
Q

Characteristics of Dependent Variables are:

A

1) Provides a measurement of the independent variable, 2) Outcome of research, 3) Changes secondary to the independent variable (i.e. LB pain is a dependent variable)

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21
Q

The type of experimental research used when the control group provides a baseline for interpretation of the results and they do not receive the treatment?

A

Random Control Studies

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22
Q

A ____ _____ generates data that contains in-depth information about an individual, a group or an institution; provides generalized clinical experiences; identifies problem-solving skills; provides future research hypothesis; and establishes fundamental practice guidelines.

A

Case Study

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23
Q

The clinical significance of case studies are:

A

1) Provide information related to clinical intervention, 2) Aides in the development of new hypothesis for new research questions, 3) Identifies problem-solving skills, 4) Helps to develop clinical practice guidelines, 5) Supports & adds to the body of knowledge within the PT profession, 6) Provides information for the development of the GUIDE TO PT PRACTICE, and 7) Provides information/objective data for evidence-based practice.

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24
Q

A research study designed to collect data over time for the purpose of describing developmental changes over time in a particular group of patients is called?

A

A Longitudinal Research Study

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25
A research study based on observations at different ages or developmental groups one point in time and provides information related to trends is called?
A Cross-sectional Non-experimental Research Study
26
A research study that studies the authenticity of the information / data, investigates data / analyzes the data / results, evaluates the data, and uses primary & secondary resources is called?
A Historical Research Study
27
_______ sources consist of original documents, direct recordings, and eye witness accounts.
Primary
28
_________ sources consist of descriptions of events by other individuals, summary of information from textbooks, or newspaper accounts.
Seconday
29
The relationship between variables, or, the formulated educated guess is called....
Hypothesis
30
The idea that the raters must obtain the same rating on multiple occasions or multiple trials is called.....
Reliability
31
_______ is when the instrument or test / measure used in the experiment measures what is supposed to be measured.
Validity
32
The clinical significance of experimental design is.....
1) Controls the manipulating variable, 2) Random control study design, 3) Provides to the body of PT knowledge
33
The clinical significance of non-experimental design is.....
1) Provides to the body of PT knowledge, and 2) Assist in the formation of new research
34
Used to evaluate characteristics of people, behaviors in a group (classification: Nominal, Oedipal, Interval or Ratios)
Scales of Measurement
35
Used to assed balance abilities in the elderly and modified version for pediatric patients
Berg Balance
36
______ scales of measurement classifies variables between two or more mutually exclusive categories based on a common set of characteristics (i.e. gender, nationality, same diagnosis within the same age)
Nominal
37
______ scales of measurement utilizes Linear scale numbers (ranks data in degrees or rank - intervals between ranks can be uneven). Examples include MMT, ROM, Pain scales, Patient's functional status.
Ordinal
38
________ scales of measurement utilizes rankings, percentages, and ratios from predetermined equal intervals (ranks student score between 0 - 100 or Temp. Scales in Fahrenheit or Celsius)
Intervals
39
_____ scales of measurement is based on a true zero value; the most precise level of measurement used in research (i.e. heights, weights, distance, age, time, and Goniometric measurements)
Ratio
40
What is pharmacology?
The study of drugs & the processes on how the drug produces its physiological effects on the body.
41
What is pharmacotherapeutics?
Branch of pharmacology that studies using specific drugs to prevent, treat or diagnose a disease. Analyzes the effect the drug has on the body. Interaction btw body/stems & specific drugs
42
What 2 groups is pharmacotherpeutics divided into?
pharmacokinetics & pharmacodynamics
43
This branch of pharmacotherapeutics describes mathematically how the drug is disposed, absorbed and eliminated overtime in the body?
Pharmacokinetics
44
Pharmacokientics includes the study on how the body deals with the drug in terms of three process, which are?
absorption, distribution and elimination
45
Which branch of pharmacotherapeutics studies the amount of drug concentration in the tissues and blood overtime?
pharmacokientics
46
What is pharmacodynamics described as?
The study of how the drugs effect the body. Studies the mechanics of the drug
47
The study of drug interactions on the cellular components in the body is called?
Molecular Pharmacology
48
Toxicology is described as the study of what?
study of harmful effects of drugs & chemicals on the body. Subdivision of pharmacology.
49
Every medication has what kind of effects?
Adverse
50
Toxicology looks into the toxicity of _______ agents, environmental ___________, toxins and ________.
therapeutic, chemicals, poisons
51
What is the difference btw brand name vs. genetic?
brand names are trademarked and registered and cannot be mimicked till after 17 yrs. Generic names tend to be shorted and are usually cheaper brand name products created after the trademark has expired, with a possible tweak in the effectiveness compared to brand names.
52
Drugs must first be tested on what and approved by who before human trials begin?
animal testing & the FDA must approve human testing
53
What does the first human clinical trial include? How many ppl are selected? What must be obtained b4 testing and what info is given to the subject?
20-80 ppl, informed consent, pharmacology (info ab the drug), pharmacodynamics (effect on the body), toxicology (possible side effects of drug)
54
Phase II of human clinical trials include?
200-300 ppl sample size with specific disease or pathological condition are studied for the effects of the drug on the body. Clinical risk are noted.
55
What does phase III of human trials include?
several hundred ppl are tested, continued study of benefice, effectiveness & safety responses of the drug, more info on adverse effects & toxicity, peak dose response is established
56
Which phase of clinical human testing is the peak does response established aka the max amount of drug needed to reach therapeutic effects?
Phase III
57
What is the difference between a prescription drug and an over the counter drug?
prescription is ordered & dispensed by an authorized practitioner, while over the counter medications can be purchased directly by the consumer & don't need a prescription to obtain the drug.
58
Name 5 routes drugs can be entered into the body?
inhalation, sublingual, rectal, oral, injection, aerosols
59
What route of drug administration is described as placed under the tongue/dissolved by the saliva?
Sublingual
60
Describe what rectal administration of a drug means?
placed into the rectum, suppositories or aqueous solutions placed in the rectum
61
What route of drug administration is described absorbed through the mouth, abdominal region; taken with ease
Oral
62
What are some disadvantages for oral administration of a drug?
It takes longer for the body to absorb the drug into the blood stream b/c it must be broken down by the digestive tract.
63
What are two types of injections that are administered in the muscle belly or subcutaneous?
Intramuscular- injected into the muscle belly (gluteus max or upper arm) Subcutaneous- injected into the subcutaneous layers of the skin/usually upper arm, abdominal region or thigh
64
What route of drug administration is described the drug given through a hollow tubing placed into a body cavity, muscle or vein and underneath the skin?
Injection
65
This injection is described as placement of the needle under the membranes (meninges) surrounding the spinal cord and brain can be used for the treatment of leukemia in the spinal cord and arthritis.
Intrathecal instillation
66
This injection is described as the placement of the drug directly into the vein. What is an advantage of this administration?
Intravenous and the effect of the drug is immediate b/c it's adminstred directly into the blood stream.
67
What route of administration is an example of nitroglycerin tablets being placed underneath the tongue to treat attacks of angina pectorals?
Sublingual
68
What route of drug administration is described vapors or gases taken into the mouth or nose are absorbed into the blood stream through the walls of the air sacs in the lungs?
Inhalation
69
Aerosols are particles of drugs suspend in the air/inhalation and are administered into the lungs. Please name an ex: of a pathology that would require this route of drug transmission?
Asthma/ inhaler
70
What route of drug administration is described applied directly to the mucosal membranes of the mouth or skin?
Topical Application
71
Give some examples of topical application
transdermal patches: nicotine patch (anti-smoking), pain medications, estrogen replacement therapy
72
What route of drug administration is described as applied directly on the skin? Give an example
Direct application , antiseptics (reduction of infection), antipruritics (anti-itching)
73
What is biotranformation?
The body changes the chemical compound into a metabolite (altered compound of a drug that reduced the potency of the drug) for the body to eliminate it.
74
Explain how the body's enzymes alter drugs and eliminate them
Cytochrome p450 enzyme (liver) degrades the drug; the ER of specific cells hydrolyze( breaks compound into parts) and reduction( remove o2 or hydrogen) the drug. Lungs, Kidneys, GI epithelium & skin (sweat glands, breast milk, saliva) metabolize compounds
75
Combination of 2 similar drugs producing an increase effect on the receptors of the organ
Additive Actions
76
Tolerance is described as?
the feature of addiction/ the effects of the drug will be achieved if additional amounts of the drug are given
77
What is a drug addiction?
increase desire & need to have the drug/ psychological dependence & physical need for the drug (ex: morphine, demerol)
78
What are controlled substances?
drugs that produce tolerance & dependence that can cause abuse or additction
79
What are analgesics?
pain reducing agents
80
Examples of analgesics?
narcotics,opiods, ibuprofen, aspirin
81
What is an example of nonsteriodal anti-inflammatory agent?
ibuprofen (motrin & advil), celecoxib (celebrex), aspirin
82
Describe narcotics/opiods
derived from opium, highly addictive, treatment for severe pain, produces stupor- mental & physical impairment, reduced alterness and focusing
83
What are nonsterodial ant-inflammatory agents (NSAIDS) used for?
used for the treatment for acute muscle spasms, & joint pain; reduce fever, migraine headaches.
84
What are some adverse effects of NSAIDS
produces gastrointestinal upset; causes in imbalance of normal flora in the GI region
85
What are analgesics used for?
treatment for acute muscle spasms & joint pain, fever, reduction of pain from arthritis, migraine headaches, myalgias, tootaches
86
What NSAID inhibits thromboxane biosynthesis?
Aspirin
87
What are the benefits of nonsteriodial agents?
does not produce cognitive impairment that can interfere w/ PT as compared to narcotics which can impair
88
What is inontophoresis?
medical administered by electrical charge
89
What type of injuries use inontophoresis to administer medications?
tendonitis (inflammatory)
90
What types of medications are used via inontophoresis & phonophoresis?
dexamethrasone- anti inflammatory/synthetic steriod, hydrocortisone- anti inflammatory
91
What is a bacteriostatic agent?
chemical substance that INHIBITS microorganism development(mold, yeast, bacterium)
92
What is a bactericidal agent?
Chemical substance that KILLS microorganism development (bacteria, fungi, parasites)
93
What are some examples of bactericidal agents?
penicillin, amoxicillin, sulfonamides (sulfa drugs), cephalosporin's (similar to penicillin's)
94
Name some pathologies that bactericidal agents are used to treat?
pneumonia, UTI, streptococcal infections, fungal infections, TB
95
What are antiviral agents to used to treat?
viral infections such as herpes simplex viruses, cytomegallovirus (CMV), HIV
96
What are some examples of bacteriostatic agents?
erthomycins, tetracyclines
97
What must you monitor in someone with an infection either bacterial or viral?
signs of increase or recurrence of inflammation, endurance levels, cardiopulmonary abilities, c/o fatigue, avoid overuse muscle strains gross, teach transfer training & gait training as indicated
98
This organ is located behind the stomach at the L2 & contains specialized cells-islet of langerhans.
Pancreas
99
The pancreas contains beta cells from the islet cells, exocrine & endocrine cells (ducts & glands) that secrete what into the GI tract?
digestive enzymes
100
Two catecholamines secreted from the adrenal medulla are?
norepinephrine (noradrenaline) and epinephrine (adrenaline)
101
Alges/o means?
sensitivity to pain
102
What does norepinephrine (noradrenaline) do?
constricts blood vessels to raise blood pressure (this is wrong but its from her pp, constricts blood going to un needed organs like GI tract)
103
What does epinephrine (adrenaline)
dilates bronchial tubes, releases glucose (sugars) from glycogen, increases HR & BP
104
The beta cells in the pancreas secrete what hormone?
insulin
105
What do Anticoagulants prevent?
reduction of clot formation, degrades clots & prevents clotting, prevents blood from clotting that is going to be used for transfussions
106
What are anticoagulants used in the treatment of and give a few examples of these medications
thrombosis, embolism, ischemic stroke, pulmonary embolism prevention, MI. Ex: heparin, warfin-coumadin
107
PT considerations for pt taking anti-coagulants include?
prevent peripheral artery clots, bed mobility & transfer training (b/c most are bed ridden), avoid cervical manipulation, deep tissue massage, chest percussion, wound care if indicated & care-brusing
108
What are beta-blockers and what do they help lower?
used as a vasodilator which reduces CO, blocks action of epinephrine on the blood vessels of the heart; reduces HTV. Treatment of unstable angina, angina, prevent another MI, cardia arrhythmias
109
Why is an unstable angina bad?
Can cause a sudden rupture of atherosclertic plaques within the coronary arteries; precursor for acute MI
110
What are cholesterol-lowering agents? (statins)
reduces the production of cholesterol in the liver, treats unstable angina- prevents long term coronary occlusion in pts w/ unstable angina. Ex: atrovastatin (lipitor), simvastin sodium (zocor)
111
Beta Blockers are used in the treatment of what?
prevents angina by reducing cardiac workload, and prevents certain cardiac arrhythmias
112
What is the mechanism of action of beta blockers?
blocks beta which are receptors on the myocardium, inhibits norepinephrine & epinephrine activities, peripheral vasodilation, attenuates the sympathetic activity of the disease
113
What are some examples of beta-blockers?
atenolol (tenormin), propanlol (inderal) "lol" at the end of the name of the drug usually a beta-blocker
114
What signs should you monitor in PT for some one taking beta-blockers?
they will have decrease or slow HR, reduced contractile force, monitor for signs of CHR (increased cough, dyspnea, rales, frothy sputum), electrolyte deletion, dehydration, hypotension, bronchosonstriction/ asthma like spasms, depression
115
Describe the symptoms of CHF
peripheral edema; endurance impairments, SOB, left sided heart failure, impaired neurohomronal balance, can be stress induced or pathology/heart disease
116
What medications are use to treat CHF?
digioxon(lanoxin), digtalis
117
Positive inotropic agent helps CHF by?
improves myocardial activation, assist the heart in pumping more forcefully, decreases cardiac workload
118
Mechanism of action for Calcium channel blockers?
blocks calcium into the vascular smooth muscle, prevents vasoconstriction of the blood vessels in the cardiac muscles & body, increases vasodilation of blood vessels, reduces HTN, helps renal function.
119
Calcium channel blockers are used in the treatment of what pathologies.
essential HTN, angina & cardiac arrythmias
120
Example of a calcium channel blocker is?
nefredipine (procardial)
121
Side effects that an impair PT for a pt taking calcium channel blockers?
reduces cardia contraction & HR, monitor for orthostatic hypotension
122
How do Diuretics work ?
increases the elimination of water, sodium from the kidney, reduces blood volume, inhibits sodium re-uptake in the distant tubule of the nephron while increasing osmotic force
123
Examples of diuretics are?
furosemid (Lasix), spironolactone (aldactone), potassium sparing diuretics
124
Diuretics are used in the treatment of what pathologies?
used in treating hypertension; moderate & severe HTN, CHF
125
Side of effects of diuretics on PT?
it increases elimination of water so watch for dehydration, avoid increase in cardiac output/cardiac workload, increase baroreflex, orthostatic hypotension can occur
126
Signs & Symptoms to monitor in PT with pt with diabetes mellitus
monitor progressive ischemia, small blood vessels vasoconstriction, peripheral neuropathy, hyperketoacidosis (too acidic)
127
Anti diabetics are used for what pathology?
diabetes , type I & type II
128
Insulin dependent diabetes mellitus reduces the levels of glucose in the blood by increasing what hormone?
insulin
129
Insulin pumps are given to patients for?
allow the patient to deliver specific amounts of insulin when needed, used for type I diabetes
130
Describe type I diabetes
usually occurs b4 age 30, abrupt onset, little or no insulin production, ketoacidosis often occurs; 3 p's (polyuria, polydipsia, polyphagia)
131
Describe type II diabetes
usually occurs after age30, gradual onset-possible obesity related, insulin is produced but doesn't get into the cells, 3 p's seldom occur
132
How do anti-diabetics help with type I diabetes?
decreases blood glucose, increases carb, protein & lipid metabolism, stimulates the production of insulin (oral anti diabetics)
133
How do anti-diabetics help with type II diabetes?
increases the body's sensitivity to insulin & decreases glucose by the liver, stimulates beta cells in the pancreas to produce insulin
134
What gland is located on bot sides of the trachea and aide in cellular 02 uptake?
thyroid
135
Thyroid secretes thyroid hormones. What are some examples of these hormones?
T3 (thyroxine), T4 (tetraiodothyronine) these hormones are synthesized from iodine.
136
Name the medications used for hypothyroidism and hyperhtryoidism
hypothyroid- synthroid, levothroid hyperthyroid- tapozole
137
Calcitonin is used in the treatment of osteoporosis. What does this hormone do to the body?
increases calcium uptake in the bone especially if blood calcium levels are elevated, prevents weakness in the bone, prevents spontaneous bone fractures
138
What do bronchodilators do?
opens the bronchial tubes of the lungs
139
What are the possible routes of administration for bronchodilators?
injection, aerosal injections
140
examples of medications that are bronchodilators
albuetrol (proventil), epinephrine (primatene)
141
Bronchodilators are used for the treatment of?
ashtma, emphysema, chronic bronchitis, bronchospasm
142
Drugs that have opposite reactions/ cancel each other out-reducing the therapeutic effects of 1 more of the drugs is called?
antagonistic effects
143
Give an example of a antagonistic effect?
albuterol/epinephrine will negated a bronchoconstrictor
144
Synergistic effect is described as?
enhances the pharmacologic effect of the drugs, combinations that have a beneficial effect (HTN, cancer, HIV)
145
Additive adverse effects are considered?
barbiturates & alcohol = 2 CNS depressants can be a lethal combination

PT 113 (2 decks)

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