Midterm Prep Flashcards
Define Pharmacotherapeutics
The use of drugs to prevent, treat and diagnose disease as well as to alter normal functions.
Define Pharmaceutics
The study of how various drug forms influence the way the drug affects the body.
List drug solubility from fastest to slowest acting
liquids, suspension solutions, powders, capsules, tablets, coated tablets, enteric-coated tablets
What is the pharmaceutical phase?
Drug dissolution
What is the pharmacokinetic phase?
Drug movement to achieve drug reaction (what body does to drug)
What is the pharmacodynamic phase?
How the drug changes the body (what drug does to body)
What are pharmacokinetics?
A D M E
Absorption
Distribution
Metabolism
Excretion
What are the routes of drug administration?
Enteral, Parenteral, Topical, Inhalation
What is enteral administration?
Oral, sublingual, rectal (GI tract)
What is Parenteral administration?
Intramuscular injection, subcutaneous injection, intravenous injection, intradermal injection, local injection.
What is topical administration?
Epidemic, instillation, irrigation
What is inhalation administration?
Vaporization, gas inhalation, nebulization
What is the most predictable route of administration?
Parenteral administration (injections)
What is absorption?
The movement of a drug from its site of administration into the bloodstream for distribution into the tissues.
What is bioavailability?
The amount of drug that is available after systemic circulation when it reaches the site of action.
What is bioequivalence?
When two medications have the same bioavailability and concentration of active ingredients. (When a trade name and generic drug are the same drug)
What is first pass effect?
The process that occurs in the liver that affects a drugs bioavailability.
High first pass effect = low drug bioavailability
What is the duration of action?
How long the medication works
What are factors that affect drug absorption enternally?
Food, fluids, blood flow, dosage formulation, GI motility, pH of drugs, molecular size (smaller molecules are more easily absorbed)
What factors affect absorption parenterally?
Solubility (lipid vs water soluble), surface area for absorption (smaller molecule size, easier absorbed.)
What is distribution?
The transport of a drug through the bloodstream to the site of action.
What is a drug-drug interaction?
Occurs when the presence of one drug decreases/increases the action of another drug.
What is the blood brain barrier?
A highly selective semi-permeable membrane made up of endothelial cells. It can make it more difficult for medications to penetrate the brain.
How many half lives does it take for a drug to leave your system? To reach a steady state?
5 half lives for a drug to leave, 5 half lives for drug to reach steady state.
What is steady state?
The even distribution of drug concentration
What is a loading dose?
A larger first time dose to get the patient to a state of therapeutic effect.
What is a maintenance dose?
Dosage that sustains therapeutic effect
How do we measure drug concentration?
We measure drug concentration in the plasma and assume it is the same concentration that is in the tissues.
Describe free drugs
Free drugs are pharmacologically active and cause an effect. They are used for short term effect.
Describe protein bound drugs
Protein bound drugs are not pharmacologically active and are used for slow release and long term effect.
What are concerns with potassium levels?
High potassium levels can cause cardiac arrhythmia or arrest.
What is drug interaction?
The modified action of a drug as a result of interaction to another drug, food, plant, herb or disease.
What is an adverse drug effect?
An undesirable drug effect that can range from mild to lethal.
What is drug incompatibility?
Chemical/physical reaction among two or more drugs in vitro (outside the body)
What is the most common form of drug interaction?
Pharmacokinetic
How do pharmacokinetic interactions affect absorption?
May results in increase/decrease of plasma drug concentration which enhances or reduces the effect of the drug.
How do pharmacokinetic interactions effect distribution?
It can cause increased or decreased drug effect and increased side effects. Free drugs will reach greater amounts of unintended receptors.
What do P450 inducers do?
Induces the P450 enzyme to metabolize the drug, even if it is a drug that was intended for later metabolizing. Inducers speed up metabolism.
What do inducers do?
Inducers cause subtherapeutic effects which means more medication is required to get a therapeutic dose.
What do inhibitors do?
Inhibitors can cause toxicity, a decreased dose would be required.
Is smoking an inhibitor or an inducer?
Smoking is an inducer
How do pharmacokinetic interactions effect excretion?
Any medication that can increase cardiac output or decrease blood flow to the kidneys can also decrease drug excretion (via urine).
What is synergistic effect?
When two drugs are given and one drug increases the effect (potentiates) the effect of the other.
What is antagonistic effect?
When a second drug cancels out or greatly diminishes the effect of the first drug. Example: antidote
What is a side effect?
Secondary drug effect can be undesirable but sometimes desirable. Often predictable, not dose related.
What is an allergic effect?
A non dose dependent effect that often occurs within several hours of contact with an irritant.
What is idiosyncratic effect?
Uncommon drug response. No real explanation for why it occurs and is often misunderstood. Can result from genetic pre-disposition
What is paradoxical effect?
The opposite of the expected effect.
What is an iatrogenic effect?
Disease producing effect. Glucocorticoids medications can increase blood sugar levels, long term use can results in diabetes.
What is toxic effect?
Adverse drug effect- usually caused by excessive dosing whether intentional or not
What is a teratogenic effect?
A birth defect
What is a carcinogenic effect?
Cancer causing agent
What are the types of toxicity?
Neurotoxic, Hepatoxic, Nepgrotoxicity, Immunotoxicity, cardiotoxicity, ototoxic, skeletal muscle toxicity
What is neurotoxicity?
Injury to central nervous system. Can be caused by alcohol, old antipsychotic meds. Can be irreversible.
What is hepatotoxic?
Toxic to liver, leading cause of liver failure is damage from drugs, tylenol, alcohol, jaundice, increased liver enzymes.
What is nepgrotoxicity?
Toxic to kidneys, antimicrobial medications or NSAIDS. Elevated creatinine. Decrease in urine output.
What is immunotoxicity?
Immunosuppression and destruction of the immune system
What is cardiotoxicity?
Toxicity to the heart
What is ototoxicity?
Toxicity to the ear
When is toxicity rare?
When dealing with water soluble medications.
What type of drugs needs to be monitored closely? (A characteristic of the drug)
Drugs that have a narrow therapeutic index
Explain briefly what allergies are
Allergies occur when an antigen enters the body and the immune system perceives it as a threat and creates antibodies to fight it. Allergies account for 10% of adverse reactions. Are usually from a previous sensitizing exposure to the drug.
What are the typical med error causes?
39% prescribing, 38% administration, 12% transcribing, 11% dispensing
What are the causes of fatal med errors?
Overdose 35%, wrong dose 16%, wrong route 9%, causes are 60% human factors
What are nursing measures that can prevent med errors?
Minimize use of verbal and phone orders, avoid abbreviations, never assume, when in doubt check it out, use 10 rights, no trailing 0’s, always leading 0’s for decimals, legible notes.
What is medication reconciliation?
The process of ongoing assessment and updating of patient medication throughout the healthcare process with timely communication.
What are the three steps of medications reconciliation?
Verification, clarification and reconciliation
What characteristics allow drugs to cross the blood brain barrier (BBB)?
Ion charges, lipid solubility and molecule size.
What are concerns with pregnancy and taking medications?
Drug therapy in pregnancy involves risk of the fetus being exposed to to the same substances of the mother through diffusion. This can cause developmental defects.
What is glomeruli filtration rate? (GFR)
How fast the kidneys are filtering waste
How does pregnancy affect albumin?
Albumin levels are decreased during pregnancy which makes more free drug available for protein bound medications.
What are the categories of medication for pregnancy safety?
A- No risk to fetus
B-No risk to animal fetus
C-Adverse effects in animals, potential benefits with risks
D-Possible fetal risk, risk vs reward
X-Fetal abnormalities, should not be used
What are categories of medications for breast feeding mothers?
L1- safest
L2-Safer
L3-Moderately Safe
L4-Hazardous
L5-Contraindicated
What week range is considered a premature/preterm infant
Younger than 38 weeks gestation
What age is considered a neonate/newborn infant?
Younger than 1 month old
What age is considered an infant?
1 month to younger than 1 year
What age is considered a child
1 year to younger than 12 years old
What age is considered an adolescent
13 to 19 years old
What are peds characteristics that affect dosing?
Thinner more permeable skin, stomach lacks acid to kill bacteria, lungs have weaker mucous membranes, body temp less regulated, dehydration occurs regularly. The liver and kidneys are immature.
What are absorption considerations in children and infants?
Gastric pH is less acidic because acid-producing cells in the stomach are underdeveloped until 2 years of age. First pass effect is reduced because of immature liver.
What are the injection sites in children from birth to 12 months
IM - Vastus lateralis
IV - Scalp/foot access
What are the IM IV sites for toddlers 1-3 years
IM - vastus lateralis, deltoid
IV - scalp, avoid foot
What are the IV sites for preschoolers 3-5 years old?
IM - vastus lateralis, ventrogluteal site or deltoid
IV - Peripheral sites
What are the IV sites for 6-12 year olds?
IM - vastus lateralis, ventrogluteal & deltoid
What are the IV sites for 13-16 year olds
IM - same as adults
IV - same as adults
What are strategies for reducing pain from needles?
Apply numbing cream in advance, bring activities or devices for distraction, relaxation techniques, older children sit up, nurse infants during their shots if they are breastfed
What do we need to be cautious of when someone is on beta blockers?
Need to be cautious of blood sugar levels.
What are concerns with alpha blockers in asthmatics
That alpha blockers can cause bronchospasms and dyspnea
What are anticholingeric medications good for?
They are good for treating memory and often treat dementia
What does Beta 1 do?
Effects the heart, increases HR, contraction, conduction through AV node, used for cardiac arrest, heart failure, shock, AV heart block.
Adverse effects: tachycardia, dysrhythmias, angina
What does Beta 2 do?
Lungs and uterus, used for asthma and to delay preterm labour.
Adverse effects: hyperglycemia in diabetics, tremor.
What does isoproterenol do?
Activates beta 1 and beta 2 causing bronchodilation and increased HR.
What does albuterol do?
Albuterol is selective for beta 2, it focuses on bronchodilation
What do alpha blockers do?
Alpha blockers cause vasodilation and reduce blood pressure, usually used to treat benign prostatic, hypertrophy, and peripheral vascular disease.
What do beta blockers do?
Beta blockers decrease heart rate and blood pressure, treat angina, hypertension, dysrhythmias, post MI and heart failure.
What is the primary use of cholinergic medication?
Primarily used for Alzheimer’s and dementia, good for memory.
What is methacholine used for?
Used to test for asthma because it increases respiratory secretions. Asthma meds are then used to see if they decrease the symptoms.
What are Anticholinergics used for?
Anticholinergics act on muscarinic receptors and decrease GI motility, salivation, mydriasis and increase pulse rate. Side effects include dry mouth, blurred vision, tachycardia, constipation and urinary retention.
What are the two main lower respiratory disorders?
Asthma and chronic obstructive pulmonary disease.
What is asthma?
The chronic variable inflammatory disorder of the airways resulting in reversible hyper-responsive inflammation
What is COPD?
Chronic obstructive pulmonary disease is incompletely reversible airflow obstruction that is typically progressive and associated with an abnormal inflammatory response to noxious particles/gases.
What are eosinophils?
A type of WBC that causes swelling and inflammation
What are cytokines?
Messenger proteins that signal cells to trigger inflammatory responses
What are inflammatory mediators?
Leukotrienes, Histamines, and Prostaglandins
What do inflammatory mediators lead to?
Symptoms of inflammation such as swelling, mucus overproduction, vasoconstriction and leaky capillaries.
What are the bronchodilators?
B- Beta 2 Agonist
A-Anticholinergic
M-Methylxanthines
What are anti-inflammatory agents?
S- Steroids
L-Leukotriene Receptor Antagonists
M- Monoclonal antibodies
What is important to remember when administering medication to someone having an asthma attack?
Always give SABA first, this causes bronchodilation and allows for the following meds to be absorbed.
What do bronchodilators do?
Relax bronchial smooth muscle, cause dilation of the bronchi and bronchioles that are narrowed by disease process.
Describe the parasympathetic nervous system
The parasympathetic nervous system is rest and digest and is acetylcholine based.
Describe the sympathetic nervous system.
The sympathetic nervous system is fight or flight and is epinephrine and norepinephrine based.
What are contraindications for B-adrenergic agonists?
Known drug allergy, uncontrolled cardiac dysrhythmias, patients with stroke risk.
What is the rule of twos for B-adregergic agonists?
Treatment is not working if you have asthma symptoms and require use of a quick-relief bronchodilator two or more times a week.
Your asthma wakes you two or more times a month.
You refill your quick-relief bronchodilator two or more times a year.
What are schedule 1 drugs?
Schedule 1 drugs require a prescription for sale and are given by the pharmacist following a diagnosis from a practitioner.
What are schedule 2 drugs?
Schedule 2 drugs are less strictly regulated, but require to be given by the pharmacist and not over the counter from the private area of the pharmacy such as the exam room.
What are schedule 3 drugs?
Schedule 3 drugs are available without a prescription and can be bought from the pharmacy from the pharmacist.
What are unscheduled drugs?
Can be sold without professional supervision, self selected over the counter.
What are the phases of human clinical experimentation?
Phase 1: healthy humans to determine dose range, determines safety.
Phase 2: Efficiency of drug in individuals with disease, small sample
Phase 3:Large sample use, effectiveness over long duration, uncover less frequent adverse effects
Phase 4: Post marketing surveillance, lifetime monitoring
What are the types of research design?
Double blind: provider and subject dont know groups but analyst does
Triple blind: nobody is aware of who is getting what
Single blind: only the subject is unaware
Open label: all parties are aware of treatment groups
