Lecture 5 review Flashcards
Over-the-counter drugs
Safe non-prescription drugs. Available to anyone, may safely treat themselves if they follow the instruction (otherwise may cause serious adverse effects)
Schedule I drugs
By prescription only and provided by a pharmacist, includes all prescription drugs
- drugs that require formal diagnosis and monitoring by a prescriber
- controlled drugs/ substances (e.g. narcotics)
Schedule II drugs
available only from a pharmacist; must be in an area with no public access (“behind the counter”). Lower risk, but may require the advice of a pharmacist. (e.g. emergency contraception)
Schedule III drugs
Open access in a pharmacy or pharmacy areas (OTC). Lower risk, package information is sufficient for safe and effective use
Unscheduled drugs
Can be sold in any store without professional supervision (for example, convenience store). Lower risk, may be sold in a limited quantity to promote safety
In a hospital, all drugs ______
All drugs must be “ordered” by a prescriber (usually a physician), including OTC medications and herbals
Controlled substances
They are a special category of prescribed medications that the federal government has categorized as having a higher-than-average potential for abuse or addiction
Each drugs has ____ names
3 names:
the chemical, generic, and brand name
Combination drugs
May have more than one generic drug included, and a new trade name e.g. Tylenol #3
Generic names are usually ____, while trade names are ______
Generic names are usually lower case, while trade names are are capitalized
Bioavailability definition
The amount of drug that is absorbed into the systemic circulation and therefore physiologically available to reach its target cells and produce its effect
Big three
The most important properties of drugs
- effectiveness
- safety
- selectivity
Why is no drug ideal?
The Therapeutic Objective is to provide maximum benefit with minimal harm
What are the factors that determine the intensity of drug responses?
Administration
Pharmacokinetics
Pharmacodynamics
Whaat are the five rights of medication administration?
- right drug
- right patient
- right dose
- right route
- right time/ schedule
What are the expanded rights of medication administration?
- right assessment (before giving drug)
- right documentation (record that drug was given)
- right evaluation (after giving drug)
- right education (patient education)
- right to refuse
What are nurses responsible to know before administering a drug?
- indications
- contraindications
- absolute contradiction
- relative contraindication
Side effect definition
A nearly unavoidable secondary drug effect produced at therapeutic doses
Toxicity definition
The degree of detrimental physiologic effects caused by excessive drug dosing
Allergic reaction definition
An initial exposure to the drug can trigger an abnormal immune response, sensitizing the immune system to the presence of the drug. A second exposure can cause an exaggerated, potentially dangerous immune response. The response may be independent of the dose received
Idiosyncratic effect definition
A uncommon drug response resulting from a genetic predisposition
Paradoxical effect definition
Opposite of the intended drug response
Iatrogenic disease definition
Disease or injury caused by the drug or treatment
Physical dependence definition
A state in which the body has adapted to drug exposure/ presence in such a way that an abstinence syndrome will result if drug use discontinues. Often develops during long-term use/ Abrupt discontinuation may be dangerous and should be warned against
Carcinogenic effect definition
Ability to cause cancer
Teratogenic effect definition
Ability to cause birth defects
Organ-specific toxicity definition
Many drugs are toxic to specific organs - such as the lungs, bone marrow, and the inner ear
Nephrotoxic drugs definition
Injure the kidneys directly by their action or indirectly during filtration of toxic metabolites. Run tests for renal function. Also monitor for signs and symptoms of fluid overload (fluid volume is regulated by the kidney)
Common tests of renal function
- BUN (blood urea nitrogen)
- Creatinine (two waste products that the kidneys should efficiently remove)
- Potassium levels (K) are important electrolyte regulated by the kidneys
Hepatotoxic drugs definition
As some drugs undergo metabolism by the liver, they convert to toxic metabolites that can injure the liver cells - this may occur at higher doses only. Some hepatotoxic drugs, when taken at the same time, can cause liver injury at lower doses (e.g. Tylenol and alcohol).
Liver function tests
Blood tests (AST, ALT enzymes) that are measures as a baseline and compared over time to monitor for liver injury
Signs of liver failure aside from blood tests
- jaudice
- dark urine
- light-coloured stools
- nausea
- vomiting
- malaise
- abdominal discomfort
- loss of appetite
QT interval drugs (cardiac effect) definition
Some drugs can cause a delay in the recovery/ repolarization of the ventricle following contraction (QT segment on the ECG is elongated/ takes more time) - resulting in an improper heartbeat/ fatal arrhythmia
Questions to ask to identify adverse drug reactions
- Did the symptoms appear shortly after the drug was first used?
- Did symptoms stop/ reduce after the drug was stopped?
- Did symptoms reappear if the drug was re-started?
- Could it be another drug or an interaction with a drug?
Ways to minimize adverse drug reactions (ADRs)
Anticipate and monitor for ADRs by knowing your medications well. Monitor specific organ function if there is an increased risk of injury
The First Pass Effect
Occurs when drugs are absorbed from the GI tract and immediately pass through by the liver. This results in significant inactivation of the drug and limiting its therapeutic effect. To bypass this first pass effect, many drugs are given using other routes (IV, sublingually, topically)
6 possible consequences of drug metabolism in GI tract
a. accelerated excretion from the kidneys
b. inactivation of the drug
c. conversion of a “prodrug” to its active form
d. increased therapeutic action
e. increased toxicity
f. decreased toxicity
Ionization helps if ……
We are trying to excrete the drug from the cells and the body. It is not something we want when a drug is being absorbed
When a drug is absorbed in the body, we remember that:
Acidic drugs are best absorbed in acidic environments. Basic drugs are best absorbed in basic environments.
The danger of highly protein bound drugs
- take longer time to develop a therapeutic level
- more likely to become toxic if another drug is introduced that competes with protein binding or if the client has decreased albumin in their body
How are highly protein bound drugs monitored?
With serum blood tests
Which drug will be absorbed across a cell membrane most easily?
A. An ionized drug that is positively charged
B. A water-soluble drug
C. A drug with a neutral charge that is lipid-soluble
D. An ionized drug that is negatively charged
C. A drug with a neutral charge that is lipid-soluble
Requirement for drugs to enter the cell membrane
Must be nonionized. If ionized, will accumulate and be excreted
Enteral route (using the gastro-intestinal tract)
Oral, GI tube, sublingual, rectal
Parenteral route (not using the gastro-intestinal tract)
Intradermal injection, subcutaneous infection, intramuscular injection, intravenous infection, epidural injection
Other routes of administration
Topical, transdermal, inhalation, into body cavity, intrasseous
What is the fastest route for absorption and onset of action?
Inhalation. Anything that bypasses the first pass in GI tract is also fast
What will protein bound drugs bind to?
Albumin. Any part of the drug that doesn’t bind will be bioavailable
A patient states to the nurse “I have been told I have problems with my kidneys”. Based on this, the nurse would anticipate potential issues with drug _______
toxic concentration
A patient with liver cancer is prescribed a drug. The nurse will anticipate the patient may have delayed ____ of the drug
minimum effective concentration
