MIDTERM DECK - B Flashcards
The strength of the attraction between a drug and its receptor.
Affinity
T or F: Drugs with high affinity (attraction to receptors) can bind when present in low concentrations. This means drugs with high affinity are potent.
True. This means the drugs will go straight to receptors due to attraction versus floating around waiting to get picked up.
This term refers to the ability of a drug to activate a receptor upon binding. The higher this activity, the more intensely a receptor is activated.
intrinsic activity
Affinity is to potency as Intrinsic activity is to ______ _____. Drugs with high intrinsic activity cause intense receptor activation, therefore intense responses.
maximal efficacy
T or F: Agonists are molecules that activate receptors. These molecules include neurotransmitters, hormones, other endogenous regulators as well as drugs that mimic them.
TRUE
__________ produce their effects by preventing receptor activation by endogenous regulatory molecules and drugs.
antagonists
Affinity allows the agonist to bind to receptors. What does intrinsic activity allow?
Allows the bound agonist to activate or turn on the receptor function. p.54
T or F: If there is no agonist present, antagonist will still have an effect.
False. antagonist prevents agonist from activating receptor. If there is no activation, antagonist cannot deactivate. Administration of an antagonist has no observable effect; the drug binds to its receptors, but nothing happens.
Antagonist can be competitive or non-competitive. Non-competitive bind (irreversibly or reversibly?) to receptors. Competitive bind (irreversibly or reversibly)?
Side note: Most are competitive
- Noncompetitive antagonists bind irreversibly to receptors. Because irreversible they are rarely used therapeutically.
- Competitive antagonists bind reversibly to receptors.
______ _______ have only moderate intrinsic activity; therefore, their maximal efficacy is lower than that of full agonists.
partial agonist
What causes down-regulation? Hint: Down-regulation is also referred to as desensitized or refractory.
When receptors of a cell are continually exposed to an agonist, the cell usually becomes less responsive.
Does-response curves demonstrate efficacy and potency. There are three phases:
Phase 1 - does is too low to elicit a response (curve relatively flat)Phase
2 - bigger dose elicits a bigger response (curve climbs upward)Phase
3 - ______________ (curve levels off)
Phase 3 - bigger doses are unable to elicit a further increase in response.
What are the seven rights of medication administration?
Right Patient, Drug, Dose, Time, Route, Technique, Documentation.PRTTDDD
How can you ensure you have the right patient?
Ask the patient for his or her name and birthdate. Double check ID bracelet.
How can you double check that you have the correct drug?
CHECK LABEL!!!!
- Check before taking from shelf.
- Check before pouring the drug out.
- Check before putting bottle back on shelf.
If you suspect that a doctor prescribe an incorrect dose, what do you do?
Double check before administering.
Does the condition of the liver matter in dosing?
Yes, if the liver does not function properly, a toxic amount of medication could build up.
T or F: Drug administration takes place in the hospital at times the patient chooses?
False. Drugs such as antibiotics have regular intervals at which drugs must be given to be effective.
Can you rely on the pharmacy to send the correct form of a medication or must you alert them as to your patient needs.
We must alert. Where the medication will be given depends on the patient and his/her condition. If they cannot swallow, we may need an IV or GI version.
If you are unsure of where or how to administer a medication, what can you do?
Access written procedure manuals available in the workplace.
When you are documenting (charting), what info must be included about drugs you administered?
Drug,Dose,Route, lot#, expiration date.
What are some important physical factors to consider before administering drugs?
Age, weight, nutrition, gender, culture, environment, pregnancy and organ function.
Where can I find a list of commonly confused drug names?
http://www.ismp.org/tools/confuseddrugnames.pdf
What do abbreviations tell us? examples: ID, qid, IM
When a med may be taken, how often it can be take, where it should be administered.
The sinister hand is the left, with which many countries use for “dirty” deeds such as toileting. Remeber S is for left. So what is D?
Dextrous - Right
If someone writes a.s., what location on the body are they referring to?
Hint: The letter “a” looks like an ear. a = ear s = sinister leftLeft Ear
The abbreviation “U” means what?
“Both”Remeber: U for union…
What does “bid” abbreviation mean?
bid = bi daily = twice daily
What does the abbreviation o.d. mean?
right eyeRemeber: “o” looks like an eye
NPO?
nothing per oral
IV
intravenously
IM
intramuscularly
ID
intradermallyDef:1. within the dermis.2. intracutaneous.
What does the abbreviation of “C” w /line over the top of it mean?
with (c with a line)
qid?
4x a dayquattro times a day (cuatro - espanol)
s with a line
without
SC
subcutaneously (into fat)
tid
three times perday
If a diabetic patient is NPO, should you administer insulin?
no, there is no food to interact with.
Where can I find a sample med schedule for patients to use at home?
page 30 - watkins
Why is nutrition an important factor when administering medication?
Some nutrients may be needed for absorption of med. Some nutrients may block absorption.
Although there are normal doses for some medications, may that does change if the patient is an amputee or obese?
Yes.
How does age effect medication administration?
Geriatric patients (over 55) may have decreased muscle mass and function of organs. Examples: Liver - decrease in metabolism / Kidney - decrease in filtration
What is polypharmacy? What is the issue with polypharmacy?
pol·y·phar·ma·cy
ˌpälēˈfärməsē/
noun
the simultaneous use of multiple drugs to treat a single ailment or condition.
the simultaneous use of multiple drugs by a single patient, for one or more conditions;
it increases risk of side effects and interactions.
What do you need to do if you think a child may be having an adverse reaction to a medication you administered?
Fill out a MedWatch form.
Why does gender matter in drug administration?
Men have more muscle to fat compared to women. Medication is absorbed and distributed more quickly in men.
A ________ drug causes deformities when it crosses the placenta.
Teratogenic
Which organs are most affected by SYSTEMIC drug accumulation?
Kidneys, liver, heart
Liver produces ____ ______. A decrease in these levels, can alter the capacity of a drug to bond.
serum protein
Why is it important to educate patients in their own language?
Misunderstanding can lead to injury, overdose, or subtherapeutic treatment (not producing a therapeutic effect).You must tell them the risks of taking too much.
Patients can refuse medication. What can you do to help them feel better about taking it? (patient consent p.35)
Educate them on what it is for, how to take it, etc. If they still refuse, let them know risks of not taking the treatment. Do not force them . Technically forcing med on someone is considered assault and battery. It is there choice. Inform the dr and chart that they refused treatment.
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
______ allows patient control over their medical record include access and how it is shared with other.
HIPAA
Before administering medication (including emergencies), what should you ask the patient?
Are you allergic to any medications?
Why is important to observe a patient for 15 minutes following an injection antibiotic or allergy shot?
To watch for allergic reaction. Document this in your charts!
If a patient has swelling in the neck, difficulty breathing, itching, wheezing, anxiety and light-headedness, they may experiencing __________.
Anaphylaxis - a sever allergic reaction
T or F: Some drug interactions are desired.
True.
When drugs interact, there are three possible outcomes. List them.
- One drug may intensify the effects of the other
- one drug may reduce the effects of the other
- the combo can produce a new response not seen with each drug individually.
What is the term used for the type of interaction where one drug intensifies the other?
potentiative (poh ten she uh tiv); may be beneficial or detrimental.
Drug interactions can occurs when combined in an IV solution. They may form a precipitate. What should you do if a precipitate forms? Should you rely on a precipitate to form to know whether or not an interaction has taken place?
If you see a precipitate in an IV, the IV must be discarded.You cannot rely on the precipitate because it does not ALWAYS happen. You must NEVER combine two drugs in one IV unless it has been established that a direct interaction will not occur.
if the pH increases does it become more basic or acidic?
Basic
if a drug were to increase extracellular pH, would it increase the ionization of a acidic drugs?
Yes.
How do drugs increase the metabolism?
- Drugs that increase the metabolism of other drugs do so by inducing synthesis of hepatic drug-metabolizing enzymes. Drugs that decrease the metabolism of other drugs do so by inhibiting those enzymes.
- Drugs that stimulate the synthesis of cytochrome P450 isoenzymes are referred to as inducing agents.
How does a drug causing reduction in cardiac output decrease drug filtration?
Glomerular filtration is decreased by drugs that decrease cardiac output.
What are a some simple things we can do to minimize drug-drug interactions?
- Take a thorough drug history
- Encourage patients to share any “street drugs,” supplements and OTC drugs they are taking.
- Monitor for early signs of toxicity.
How does grapefruit juice raise drug levels in the blood?
By inhibiting metabolism. The drug becomes built up in the system.
• Although inhibition of drug metabolism can be beneficial, as a rule inhibition has undesirable results. In most cases, when an inhibitor increases the level of another drug, the outcome is toxicity. • Grapefruit juice can inhibit the metabolism of certain drugs, thereby raising their blood levels
When a medication order says to administer a drug “with food”, when should the medication be given?
With the meal or right after eating.
Why do some medications require to be taken with food?
It may increase absorption or it could help prevent stomach upset.
To administer a drug on an empty stomach, you should give the medication either ____ before a meal or ____ after.
1 hour before or 2 hours after.
If medical orders do not dictate with or without food, what should you do?
Ask the prescriber to confirm whether or not the patient should eat.
T or F: ADR (Adverse Drug Reactions) are any noxious, unintended, undesired effect that occurs at normal doses.
True
What is neutropenia?
presence of abnormally few neutrophils in the blood, leading to increased susceptibility to infection. It is an undesirable side effect of some cancer treatments.
neutro = neutrophils penia = lack of
What do neutropenia, hepatocellular injury, cardiac dysrhythmias, anaphylaxis and hemorrhage have in common?
They are all severe drug reactions.
A _______ _______ is a nearly unavoidable secondary drug effect produced at therapeutic dose. Ex. drowsiness, stomach upset, nausea, constipation and sensitivity to light.
Side Effect
___________ is an adverse drug reaction caused by excessive dosing. Can cause coma, hypoglycemia, neutropenia.
Toxicity is overdose induced
An _____ ______ is an immune response. In order for this to take place, prior exposure/sensitization must have taken place. Can range from itching to rash or even anaphylaxis.
Allergic Reaction
_______ is a life threatening response characterized by bronchospasm, laryngeal edema, and a precipitous drop in BP.
anaphylaxis
T or F: Intensity of allergic reactions is independent of dosage.
True.
_________ __________ is an uncommon/unique drug reaction. Results from a genetic predisposition. One example is succinylcholine. The effects may last longer because the person produces the enzymes that inactivate the drug slower than normal.
Idiosyncratic EffectThe effect may not have appeared in clinical trials, but must be managed. If serious, report through MedWatch.
“Disease produced bye a physician/drug.”
Iatrogenic Disease
Iatro= relating to physician or medical treatment
Physical dependence develops during long-term use of certain drugs. If this occurs, an abstinence syndrome will result when the drug is discontinued. Is it a good or bad idea to stop “cold turkey?”
Patients should be warned against abrupt discontinuation of any med without consulting a health professional.p.68
__________ __________ refers to the ability of certain medications and environmental chemicals to cause cancer.
Carcinogenic Effect
_________ _______ is a drug-induced birth defect.
Teratogenic Effect (TUR RAT OH JEN ICK)
How can drugs that are not supposed to cause liver damage, end up causing liver damage?
When they are mixed with other substances. An example is tylenol + alcohol. Therapeutic dose of tylenol is not toxic. 2-3 drinks combined with it can cause severe liver injury.
What are some signs/symptoms of liver damage?
Jaundice, dark urine, light-colored stools, nausea, vomiting malaise, abdominal discomfort, loss of appetite.
What is a QT interval?
Measure of time required for ventricles to repolarize after each contraction.
What are QT drugs?
Drugs that prolong the qt interval.
What happens when the QT interval is prolonged?
patients can develop dysrhythmias (abnormal rhythm known as torsades de pointes) which can lead to fatal ventricular fibrillaton.
How can we identify if a drug administered is causing the symptoms we see (what questions can we ask):
- Did symptoms appear shortly after the drug was first used?
- Did symptoms abate when the drug was discontinued?3. If drug was reinstituted, did symptoms reappear?
- Is the illness itself sufficient to explain the event?
- Are other drugs in the regimen sufficient to explain the event?p.69
If you suspect a brand new drug is causing an unknown adverse effect, what should you do?
Report it to MEDWATCH FDA Medical Products Reporting Program.
How can you effectively assist your patient in watching for ADRs?
Inform them of what possible side effects there are with the med being given. This way if something happens, they can report it before it’s too late to treat.
A ________ ________ is a preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.
Medication Error
What are some causes of medication errors?>
Such events may be related to professional practice, healthcare products, procedures, and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.
What are some preventative measure we can take to prevent med errors?
Clarify order
No abbreviations/clarify abbreviations
Only accept metric system measurements
Pay attention to decimal unitsIf multiple drug units clarifyRead back order when verbal
Clarify order with metric weight, frequency and route
Check orders when transcribed
Don’t borrow medications
Check patient by name verbally and by wrist band
Use standard administration timesUnderstand infusion devices
These are all considered what?
Allergic Reaction, Idiosyncratic effect, Iatrogenic Disease, Physical Dependence, Carcinogenic effect, Teratogenic effect, and Toxicity
side effects
Toxicity is: an ADVERSE REACTION caused by excessive dosing.
What does contraindication mean?
A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the patient.
