Midterm Flashcards
Gender differences in relation to pharmacokinetics and medication compliance
• Can affect success of medication tx
• Seeking medical attention, compliance with medications, elimination rates differ
• Side effects of meds can be gender specific and affect compliance
o Anti-hypertensives can cause male impotence problems
o FDA mandates that drugs are tested on both genders
o Insurance coverage differences (ie. OCP and females)
5 rights
- Right Patient
- Right Drug
- Right Dose
- Right Route
- Right Time
Pharmacokinetic principles
- How drugs move through the body.
- Absorption, Distribution, Metabolism, Excretion
- Factors affecting drug absorption: route of administration, drug formulation, drug dosage, digestive motility, digestive tract enzymes, blood flow at administration site, degree of ionization of drug (acidic or alkaline), pH surrounding environment, drug-drug/drug-food interactions, dietary supplement/herbal product-drug interactions
Buccal
tablet or capsule is placed in the oral cavity between the gum and the cheek. This route is preferred over the sublingual route for sustained-release delivery because of the greater mucosal surface area
Sublingual
medication is placed under the tongue and is allowed to dissolve slowly. This route results in a more rapid onset of action because of the rich blood supply
Sustained Release (SR)
tablets or capsules are designed to dissolve very slowly. This releases the medication over an extended time and results in a longer duration of action for the medication
Extended-release (XR) or long-acting (LA)
allow for the convenience of once or twice day dosing. Must not be crushed or opened
Topical drugs
applied locally to the skin or the membranous lining of the eye, ear, nose, respiratory tract, vagina, and rectum
o Applications include:
• Dermatological preparations- drugs applied to the skin, the topical route most commonly used. Formulations include creams, lotions, gels, powders, and sprays.
• Instillations and irrigations- drugs applied into the body cavities or orifices. These routes may include the eyes, ears, nose, urinary bladder, rectum, and vagina
• Inhalations- drugs applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing apparatuses
Intra-dermal (ID)
injection is administered into the dermis layer of the skin. This layer contains more blood vessels than the deeper subQ layer allowing for drugs to be more easily absorbed. Limited to small volumes of drug
Pharmacokinetics (absorption) during pregnancy trimesters
- Abdominal/gastric changes affect absorption
- Inhaled drugs may be absorbed faster
- Changes in cardiac output, plasma volume, and regional blood flow change distribution and metabolism
- Drug excretion rates may increase
- Pre-implantation period: 1-2 weeks of 1st trimester, teratogen either causes death of the embryo or has no effect
- Embryonic period: 3-8 weeks, period of maximum sensitivity to teratogens
- Fetal period: 9-40 weeks or until birth, medications have prolonged duration of action
- Pregnancy categories: A,B,C,D,X (X is the worst)
ADRs Adrenergic agents (Sympathomimetics) (phenylephrine (neo-synephrine))
tachycardia, hypertension, dysrhythmias, CNS excitation and seizures, dry mouth, nausea and vomiting, anorexia
ADRs Anticholinergic agents (benzotropine mesylate (Cogentin))
dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, glaucoma
ADRs Cholinergic agents (Parasypathomimetic)(miniopress))
profuse salivation, sweating, increased muscle tone, urinary frequency, bradycardia
ADRs
Salicylates (Aspirin)
with high doses may cause GI distress and bleeding, may increase action of oral hypoglycemic agents
ADRs
Vancomycin
nephron/ototoxicity, peak/trough with the 3rd dose, Red Man Syndrome
ADRs Hydantoins phenytoin (Dilantin)
CNS depression, gingival hyperplasia (soft bristle tooth brush), skin rash, cardiac dysrhythmias, hypotension
ADRs
Succinylcholine
malignant hyperthermia (fast rise in temp. and severe muscle contractions), (Dantrolene Sodium is the preferred tx)
ADRs
Glucocorticoids (Corticosteroids) (Prednizone)
adrenal gland suppression, hyperglycemia, mood changes, cataracts, peptic ulcer disease, osteoporosis and “masking infections”, Cushing’s Syndrome as a result from long term therapy
ADRs
Aminoglycosides (Gentamicin)
ototoxicity, nephrotoxicity
ADRs
Fluoroquinolones (Cipro)
may cause tendon inflammation/irritation/rupture
ADRs
Rifampin
can turn body fluids orange
Penicillin injections
highest allergy incidence, observe pt for 30 minutes after dose, given IM because it has a poor oral absorption rate
Dilantin
given IV deserves caution because it can cause tissue damage, do not use hand veins, it may also cause a severe rash
Tylenol
liver damage with high doses
Epoetin alfa
gental rotation of vial, subQ route, given for side effects and not for the cancer itself
KCI
always give medication while pt is upright to prevent esophagitis, do not crush tablets or allow pt to chew, dilute liquid forms before giving orally or through NG tube, never administer IV push or in concentrated amounts, be careful to avoid extravasation and infiltration
Food/drug interactions
Metronidazole
Disulfiram like effects with alcohol
Food/drug interactions
PCNs
decrease the effectiveness of OCPs, aminoglycoside antibiotics
Food/drug interactions Valporic acid (Depakote)
alcohol, phenobarbital and phenytoin
Food/drug interactions
Tetracyclines
OCPs, dairy products interfere with absorption
Food/drug interactions
Spironolactone (Aldactone)
hawthorne, ammonium chloride, aspirin, digoxin, potassium supplements, ACE inhibitors, angiotensin-receptor blockers (ARBs), antihypertensives
Anticholinergics
Inhibit parasympathetic impulses. Suppressing the parasympathetic division induces symptoms of flight-or-fight response
Naloxone (Narcan)
pure opioid antagonist, blocking both mu and kappa receptors. Used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected
Antibiotics
encourage compliance to prevent possibility of antibiotic resistance, monitor for allergies because of the high allergenicity, clients who are allergic to one have a high chance of being allergic to others (PCNs)
Acetaminophen
avoid alcohol because of the possibility of liver toxicity with high doses
Spirituality
Incorporates the capacity of love, to convey compassion and empathy, to give and forgive, to enjoy life, and to find peace and fulfillment in living. The spiritual life overlaps with components of the emotional, mental, physical, and social aspects of living
Potassium rich foods
Bananas, white beans, dark leafy greens, yogurt, fish, avocado
Who is the father of Pharmacology
John Jacob Abel
What are the 3 types of drugs
Synthetic
Biologic
Herbal
Why is it important to ask patients if they are taking Herbal medication
Because you can never be sure how much they are taking
Who regulates medications in the US
FDA
How long and how many phases are there in the approval process of a drug
4 phases: Preclinical (1-3 yrs) Clinical (2-10 yrs) Review of new drug Postmarking
What is an ADR
Allergic: non-life threatening
Anaphylactic: life threatening
Name 2 ways drugs are categorized
Therapeutic
mechanism of action
What is a prototype drug
A model drug that is well understood, has known action and adverse effects
Which class of controlled substances are considered highest risk of abuse potential
Class 1
What age groups commonly require further caution when administering drugs
Pregnant and breastfeeding
young and elders
any age with chronic health issues
Which pharmacokinetic elements change during pregnancy
Metabolic rates
Which period of pregnancy is considered at highest risk for teratogenic exposure/consequence
Embryonic period: 3-8 weeks
Which FDA category of drug poses the lowest risk when consumed by a pregnant woman
Cat A
How are medication doses commonly calculated
by weight in kg/mg
Where is a consistent area to inject medications in the pediatric population
vastus lateralis in the thigh
Which age group is known for polypharmacy
older adults
Describe some important nursing teaching interventions for the older adult group
Making sure that they understand how to take medications
What are 2 types of immune modulators
stimulator
suppressor
Which vaccine type deserves extra caution when administering
Live vaccinations
What are 2 types of biologically developed cytokines
Interferons
Interleukins
Why are immunosuppressants given
To suppress the immune system so that it doesn’t attack a foreign substance (organ transplant, autoimmune disorder, various inflammatory disorders)
When taking Cyclosporines, what specific nursing advice should be given
Don’t drink grapefruit juice
What is inflammation
Non-specific defense with a goal of containing injury or destroying invading pathogen
Name 2 classes of anti-inflammatory drugs
NSAIDs
Glucocorticoids
What is the common mechanism of action for anti-inflammatory drugs
prevent prostaglandins (pain messages)
What is the FDA black box warning for IBU
Contraindicated in use for tx of preoperative pain in the setting of coronary artery bypass graft surgery due to potential for stroke or MI
Which NSAID can cause Reye’s syndrome in the pediatric population
Aspirin
Is Tylenol considered a NSAID
No, it is used for tx of fever and pain but it is not an anti-inflammatory
What are causes for bacterial mutation
- Not taking medications as prescribed
- Taking medications for the wrong infection
- Partial tx
- Nonsocomial infections
Which class of drugs is commonly associated with ototoxicity
Aminoglycosides
Why are patients often non-compliant with tx of TB
pts often times don’t experience symptoms till the TB becomes active and with the medications they have a lot of symptoms
Cyclosporine (Neoral, Sandiummune)
- Immunosuppressant-inhibits helper T cells
-Tx of: organ transplants, Crohns disease, ulcerative colitis
ADRs: Oliguria, HTN, tremors, gingival hyperplasia
-Interactions: phenytoin, phenobar, carbamazepine, rifampin, azoles, ACE inhibitors, NSAIDs, macrolides, GRAPEFRUIT JUICE
ADRs of vaccinations
site tenderness
low grade fever
fatigue
dizziness
Interferon alfa-2b (Intron A)
- Immunostimulant- normal cell protectors, WBC enhancement-better defense
- Tx: Cancers and viral infections
- ADRs: flu-like symptoms, depression/suicidal ideation, hepato/neurotoxicity
- Interactions: Zidovudine (hematologic toxicity)
PCNs
- Tx: G+ cell wall inhibitors
- cillin in the name
- high allergenicity profile
- Interacts with OCP
Cephalosporins
- Tx: G+ (1st gen.), G- (3rd gen), cell wall inhibitors
- cef, kef
- Caution in PCN allergic pts
- Disulfiram-like effect with ethos
- Interacts with cumadin
Tetracylines
-Tx: G+/-, ribosome function inhibition
-cycline
-Teratogenic
-bone growth stunting, tooth staining
-binds with minerals
do not give with dairy
Macrolides
- Tx: G+/-, ribosome function inhibitor
- mycin
- drug interactions: cyclosporin, anticonvulsants, cumin
- oral table dissolves with acid, NO JUICE!
Aminoglycosides
- Tx: G+/-, protein synthesis inhibitors
- micin, mycin
- ototoxic/nephrotoxic
- serum levels of drug often drawn for therapeutic benefit/toxicity
- interacts with many drugs (ampho B)
- peak/trough levels with 3rd dose
Fluoroquinolones
- Tx:G+/-, bacterial DNA enzyme inhibitor
- oxacin
- no use in pediatric puts
- binds with minerals (no dairy/multivitamins
- FDA black box warning: tendon inflammation
Sulfonamides
- Tx: G+/-, folic acid inhibitors
- sulfa
- drug interactions: coumadin, phenytoin
- causes urine crystals
- caution in: megablastic anemic pts, hx of kidney diseases due to crystals
Metronidazole
- Tx: anaerobic/non-malarial protozoans
- Flagyl
- Disulfiram-like effects with alcohol consumption
- common metallic taste in mouth
Clindamycin-not an amino glycoside or macrolide
- Tx: G+/-, bacterial protein synthesis inhibitor
- cleocin
- Associated with Antibiotic Associated Pseudo-membranous Cellulitis (AAPMC)
Linezolid
- Tx: MRSA (G+)
- Zyvox
- Causes thrombocytopenia
- caution in pots taking SSRIs- HTN crisis!
Quinupristin Dalfopristin
- Tx: VRE
- Synercid
- Risk for hepatotoxicity and pseudo-membranous colitis
Vancomycin
- Tx: G+
- big gun, use in sepsis, severe infection or resistance concerns
- Vancocin
- Ototoxicity/Nephrotoxicity
- Red Man Syndrome- decrease rate of infusion
What are the 4 drugs for the tx of TB
- Isoniazid (INH)
- Rifampin
- Pyrazinamide
- Ethambutol
What drugs are used for malaria
chloroquine
primaquine
Is tx for HIV a single or multi drug regime
multi
What is the goal of HIV tx
Reduce HIV RNA copies in the blood
- Increase lifespan
- Higher quality of life
- Decreased risk of transmission from mother to child
What are common labs to measure HIV status
-CD4 count
-HIV RNA assays
-amylase (assess for pancreatitis)
-CBCs
-lipid levels
LFT (liver function test)
What is the function of interferon therapy when treating a viral infection
Reprogram infected cells to inhibit replication
Which antineoplastic drugs have the risk of secondary malignancy following tx
Alkylating agents and Antitumor Antibiotics
What is a unique ADR to the alkylating agents
secondary malignancy
When taking hormone/hormone antagonist drugs, what type of side effects can the patient expect
menopausal symptoms for both men and women
What are some ADRs of diphenhydramine
- drowsiness, occasionally paradoxical
- CNS stimulation and excitability
- Anticholinergic effects: dry mouth, tachycardia, mild hypertension, photosensitivity
When using steroid inhalers, how long does it take to observe positive effects
2-3 weeks
What is a hallmark ADR of cyclophosphamide (cytoxan)
hemorrhagic cystitis
What beverage should a pt taking theophylline, a xanthine bronchodilator avoid
caffine
Name 2 LABA drugs
Salmeterol
Arfomoterol
Name 2 SABA drugs
Albuterol
Xopenex
What device is used to administer MDIs
a spacer
When comparing drowsiness effects with antihistamines, which generation has the highest drowsiness
1st generation
What is the antidote for benzos
Flumazinone
How long does a patient need to wait before starting Buspar when discontinuing an MAOI
14 days because hypertensive crisis may result
What time of day should an SSRI be taken and why
take in the morning because can cause sleep disturbances
How do SSRIs work
Selectively inhibit serotonin reputake, allowing more serotonin to stay at the junction of the neurons
4 common effects from SSRIs
weight gain GI bleeding sexual dysfunction diaphoresis tremor nausea fatigue
when taking an SSRI when should a patient expect therapeutic results
up to 4 weeks
What is the enzyme required for HIV to replicate itself
Protease
Which drugs are used to treat influenza and when are they used
- Tamiflu, Relenza
- Must be used within the 1st 48 hours and only for high risk groups
