module 1

Question 1

1. Define pharmacology:

2. Name the steps in the approval of drugs in the US:

Answer 1

1. The study of the biological effects of chemicals
2. Preclinical Trials animal testing

Phase 1 (testing on human with the disease)

Phase 2 (tested on humans with the disease and comorbidities)

Phase 3 (drug used in a large clinical market)

Phase 4 (drug goes on market, but is continuously evaluated).

Question 2

1. Brand name drugs begin with ………….case letter, where as generics begin with …………case letter
2. What is the therapeutic index?

Answer 2

1. Upper, lower

2. the margin of safety of the drug and is a ratio between the therapeutic dose and the lethal dose

Question 3

1. • 3. Name the 3 types of adverse reactions/side effects:
2. • 7. Name the types of drug allergies:
3. how does a hypersensitivity differ from an allergic reaction?

Answer 3

1. Primary Actions
   Overdose; extension of the desired effect
2. Secondary Actions
   Undesired effects produced in addition to the pharmacologic effect
3. Hypersensitivity Reactions
   Excessive response to primary or secondary effect of drug
4. Anaphylactic Reaction
   Know Signs and Symptoms of anaphylaxis:
   SOB, Blood pressure changes (may be high initially, then low), rash, itch, tachycardia, severe anxiousness
5. Cytotoxic Reaction:
6. Serum Sickness Reaction:
7. Delayed Allergic Reaction:
8. allergy must involve the immune system - antibody, antigen reaction

Question 4

1. • 6. Name the types of drug induced tissue and organ damage:
2. What happens in poisoning?

Answer 4

1. dermatological reactions: most serious is Steven Johnson’s syndrome
2. Stomatitis: inflammation of mucous membranes, canker sores etc
3. Superinfections: think yeast infections or infections that come as an overgrowth of bad bugs from destruction of normal flora
4. Blood Dyscrasia: bone marrow suppression (most common in chemo and malaria treatment) so blood cells are suppressed.
5. Liver damage: always check lab work. Fever, nausea, jaundice (late sign), change in color of stool or urine, elevated liver enzymes ALT and AST
6. Kidney damage: elevated BUN and creatine, change in urinary pattern.
7. Poisoning occurs when an overdose of a drug damages multiple body systems.
   Damage to multiple systems can lead to a fatal reaction.
   Treatment varies accordingly with drug

Question 5

1. What can happen to patients on corticosteroids?
2. What is hypokalemia or hyperkalemia, and why is this such an important electrolyte to watch?
3. What is target end artery damage?

Answer 5

1. hyperglycemia
2. too little or too much potassium. Affects cardiac rhythm
3. damage of sensory organs, ocular and auditory toxicity (8th cranial nerve has tendency to get damaged and tinnitis or loss of balance is the first clue this is happening).

Question 6

1.- 4. What are some neurological effects and their symptoms:

Answer 6

1, General CNS: altered levels of consciousness

2. Atropine-like (anticholinergic): dry mouth urinary retention, blurred vision.
3. Parkinson-like: muscle tremors and gait changes. Motor symptoms. Discontinue use
4. Neuroleptic Malignant Syndrome: anesthetic reactions. Unexplained high fevers.

Question 7

1. pharmacodynamics:

2. pharmacokinetics and the 4 pharmacokinetic processes:

Answer 7

1. what drugs do to the body

2. what the body does to drugs (absorption, distribution, metabolism, and excretion)

Question 8

1. What is the nursing process?

2. What are the 3 nursing interventions in regard to medications that nurses perform?

Answer 8

1. a framework for making clinical decisions. ADPIE
2. Drug administration
   Provision of comfort measures
   Patient/family education

Question 9

1. what is drug classification?
2. What is drug category?
3. What are the rights of safe drug administration (8)?

Answer 9

1. categorizes drugs by the way they act against diseases or disorders
2. way drugs work at the molecular, tissue, or body system level

3. Right Patient
Right Drug
Right Storage
Right Route
Right Dosage
Right Preparation
Right Timing
Right Documentation

Question 10

1. What are the actions of drugs (4)
2. what is an agonist?
3. What is an antagonist, and describe the 2 types:

Answer 10

1. substitute for missing chemicals

increase/stimulate certain cellular activities

to depress cellular activities

to interfere with the functioning of foreign cells

5. agonists are molecules that activate receptors
6. antagonists prevent receptor activity. Two types: Competitive: compete with agonists at receptor sites, and Noncompetitive: reduce the response by reducing the number of avail receptors

Question 11

1. Name 4 types of drugs that don’t involve receptors.

Answer 11

1. antacids, antiseptics, saline laxatives, and chelating agents

Question 12

1. critical concentration:
2. Therapeutic range:
3. Loading dose:
4. Half-life. How many half lives does it take to clear a drug from the body?
5. Drugs that have shorter half-life requires ……. dosing. Drugs with longer half-life requires ….. ……….. dosing.

Answer 12

1. The correct amount of a drug that is needed to cause a therapeutic effect (not toxic or too weak)
2. quantity of drug in blood to be effective
3. The initial dose being higher to achieve therapeutic level.
4. time required for half of the drug to be excreted. Affected by absorption, distribution, metabolism, and excretion. 5
5. frequent , less frequent

Question 13

1. Dynamic equilibrium:

2. Dynamic equilibrium is affected by the four pharmacokinetic processes::

Answer 13

1. the actual concentration that a drug reaches in the body.
2. Absorption
   Distribution
   Biotransformation
   Excretion

Question 14

1. Absorption is affected by what?
2. What is distribution, and what has an affect on it?
3. Drugs must be ……… soluable to absorb into tissues (deionized, non-charged). Drugs must be ………… soluble to be easily excreted by the kidneys (ionized, charged). Can drugs switch from deionized to ionized?
4. How can drugs pass the blood-brain barrier?
5. Which blood protein is most closely monitored in regard to protein bound drugs?

Answer 14

1. route, food in stomach (for oral meds)
2. The movement of a drug to the body’s tissues. Protein binding
   Ionization/pH
   Perfusion of the reactive tissue
3. lipid, water. Yes, depending on the pH around them
4. must be highly protein-bound
5. albumin

Question 15

1. The ……… is the most important site for biotransformation (metabolism).
2. Describe the first pass effect:
3. What is cytochrome P450? Which are the most commonly used within this class?
4. Why is P450 important?
5. What do elevated ALT and AST enzymes in the blood indicate?

Answer 15

1. liver
2. drugs absorbed in digestion circulate first to the liver which acts as a filter allowing only some of the drug through to the circulation. Drugs vary in the amount the liver metabolizes.
3. a class of enzymes the liver uses to alter the drug and start biotransformation. CYP3A4 and CYP2D6 are most common
4. Genetic variability in these enzymes may influence a patient’s response (beta blockers and antidepressants). Also, can cause drug-drug interactions, and adverse reactions
5. liver damage

Question 16

1. ……….. play the most important role in excretion of medication
2. Where else can drugs be excreted other than urine, feces and skin?
3. What are 3 kidney function tests?

Answer 16

1. Kidneys
2. breast milk
3. BUN 7-20 mg/dL, creatinine < 0.8 -1.4 mg/dL, and GFR > 60 ml/min

Question 17

1. Where in the body do drug-drug interactions take place (5)?
2. Certain foods interact with drugs. Therefore, drugs are best taken on an ……….. stomach

Answer 17

1. Site of absorption
During distribution
During biotransformation
During excretion
At the site of action

2. empty

Question 18

1. what do the feds demand if a drug is to be advertised?
2. Why can herbals advertise whatever they want?
3. what are off-label meds?
4. what is bio-equivalence?

Answer 18

1. Contraindications
   Adverse effects
   Precautions
2. they aren’t FDA approved/regulated. Can be whatever.
3. The use of a drug for an indication not approved by the FDA (remember the Avon cream)
4. the degree to which a generic works the same as brand name drugs.

Question 19

1. what do NSAIDs (including salicylates) block?
2. contraindications to nsaids:
3. Drug to drug interactions:
4. NSAID adverse effects:
5. prototype:

Answer 19

1. Prostaglandin synthesis by inhibiting cox 1 and 2 for mild to mod pain
2. allergy (to nsaid or salicylate), hypertension, peptic ulcer, GI bleeding, pregnancy, lactation, renal or hepatic dysfunction, sulfonamide allergy (celecoxib)
3. decreased diuretic effect of loop diuretics, decreased effect of beta-blockers, lithium toxicity
4. nausea, dyspepsia, GI pain, constipation, diarrhea, GI bleed, platelet inhibition, hypertension, bone marrow depression, somnolence
5. ibuprophen

Question 20

1. What are salicylate effects?
2. What are its pharmacokinetics?
3. contraindications?
4. drug-drug interactions?
5. adverse effects?
6. Prototype salicylate?
7. Patients at risk for salicylates?

Answer 20

1. platelet inhibitory effect, blocks inflammatory response, antipyretic response, analgesic properties ex: aspirin
2. Absorbed from the stomach, peak in 5-30 min., metabolized in the liver, excreted in the urine
3. Known allergy, bleeding abnormalities, impaired renal function
4. Interact with other drugs by interfering with absorption
5. nausea, heartburn, epigastric pain, bleeding, dizziness, ear ringing, vomiting, diarrhea,
6. Aspirin
7. children, renal disease, bleeding disorders,

Question 21

1. what are nsaid effects?

Answer 21

1. Provide strong anti-inflammatory, antipyretic, and analgesic effects

Question 22

1. where are prostaglandins found in high concentration?
2. what is the link w/ gastric damage?
3. what is the only NSAID that blocks only cox 2? What group of people could be sensitive to this?
4. contraindications to NSAIDs:

Answer 22

1. concentration in thegastricmucosa andgastric juice.
2. when we suppress prostaglandins, we suppress the body’s ability to inhibit acid
3. celecoxib. People with sulfonamide allergies.
4. dyspepsia, GI pain and bleed, platelet inhibition
5. can potentiate bleeding if paired w/ another antiplatelet drug and decreased diuretic effects

Question 23

1. Describe pregnancy categories A - X

Answer 23

A. no risk to fetus in any trimester

B. No Adverse effects in animals; no human studies

C. animal studies have adverse effects. Given only after fetal risk considered

D. Definite fetal risk, yet may be given for a life-threatening condition

X. absolute fetal abnormality. Not to be used at all in pregnancy

Question 24

1. What are the characteristics of schedule 1 drugs?

2. What are the characteristics of schedule 2 drugs?

Answer 24

1. High potential for abuse. No medical use
2. High potential for abuse which leads to severe physical /psychological dependence. Has medical use.
3. Less potential for abuse. Has a medical use. Moderate degree of dependence.
4. Lower potential of abuse. Has a medical use. similar level of dependence as schedule 3.
5. Low potential for abuse. Has a medical use. Least level of dependence

Question 25

1. What factors factors influence drug's effect (11)?

Answer 25

1. weight, age, gender, physiologic, pathologic, genetic, immunologic, physchologic, and environmental factors, drug tolerance, and cummulative effect

Question 26

1. What is the purpose of Gold Compounds? 2. Mechanism of action for gold compounds: 3. contraindications:

Answer 26

1. antiarthritis treatment 2. absorbed by macrophages thus inhibiting their action and decreasing tissue damage 3. allergy, diabetes, CHF, renal or hepatic impairment, blood dyscrasias, pregnancy and lactation

Question 27

1. What is the mechanism of action of narcotic (agonist) analgesics? 2. What are the contraindications? 3. With what should the nurse exercise caution? 4. What are the adverse reactions? 5. What is the narcotic agonist analgesic prototype? 6. Name the drug we use to correct overdose? How does it work?

Answer 27

1. act at specific opioid receptor sites in the CNS. Agonists use mu receptors 2. allergy, pregnancy, labor, lactation 3. closely monitor for respiratory dysfunction, GI or GU surgery, ulcerative colitis 4. cardiac arrest from respiratory depression, constipation, urinary retention, orthostatic hypotension, emesis, and intracranial pressure 5. morphine. 6. naloxone (Narcan). It binds the opioid receptor but doesnt stimulate it (antagonist).

Question 28

1. What is the mechanism of action of narcotic Agonist/antagonist? 2. are these safe to use in labor/delivery? 3. prototype? 4. What is the benefit and drawback of this med type? 5. Adverse reactions:

Answer 28

1. agonist/antagonists stimulate kappa receptors and depress mu receptors) 2. yes 3. Buprenorphine or Pentazocine 4. Less analgesia than narcotic agonists and have a lower potential for abuse ``` 5. Headache Dizziness Psychoses Anxiety Hallucinations Ureteral spasm, urinary retention ```

Question 29

1. migraine headaches: 2. cluster headaches 3. tension headaches

Answer 29

1. severe throbbing headache on one side of head caused by vasodilation and inflammation of cranial arteries 2. begin during sleep, sharp, steady eye pain, sweating, flushing, tearing, and nasal congestion 3. brought on by stress. dull band of pain around entire head

Question 30

1. What type of drugs treat migraines? 2. what is the prototype? 3. mechanism of action: 4. contraindications: 5. caution: 6. adverse effects: 7. describe ergotism:

Answer 30

1. Ergot derivatives or triptans 2. Ergotamine 3. blocks alpha-adrenergic and serotonin rec eptors in brain to constrict cranial blood vessels 4. allergy, pregnancy, lactation, CAD, HTN, PVD 5. pruritus, malnutrition 6. nubmness, tingling of fingers/toes, muscle pain in extremities, tachycardia, bradycardia, ergotism 7. nausea vomiting diarrhea caused by too much ergot derivative.

Question 31

1. What is another migraine drug (other than ergot)? 2. Prototype 3. mechanism of action: 4. Adverse effects: 5. contraindications: 6. cautions: 7. drug to drug:

Answer 31

1. Triptans 2. almsumatriptan (Imitrex) 3. Bind to selective serotonin 5-HT 1B/1D receptors sites to cause vasoconstriction of cranial vessels. 4. dizziness, vertigo, weakness, myalgia, BP alterations, tightness of chest 5. allergy, pregnancy, CAD 6. elderly, lactation 7. ergot-containing drugs and MAOI's

Question 32

1. What is the action of acetaminophen? 2. Can this be used prophylactically? 3. contraindications? 4. adverse reactions: 5. drug to drug:

Answer 32

1. acts directly on the hypothalmus (thermaregulatory cells) resulting in CNS analgesia 2. yes, in babies prior to D-tap vaccine 3. allergy, hepatic dysfunction or alcoholism 4. Headache, hemolytic anemia, renal dysfunction, skin rash and fever Hepatotoxicity assoc with chronic use and overdose 5. Oral anticoagulants increase bleeding Hepatotoxicity with barbiturates, carbamazepine, hydantoins, or rifampin

Question 33

1. What is the action of tumor necrosis factor blockers? 2. Name one of the prototypes of this category: 3. What are these drugs used for? 4. how do we administer?

Answer 33

1. decreases local effects of the cytokine, TNF which stimulates proinflammatory activity 2. etanercept (chinese hamster ovary product) 3. used as a first line treatment to progressive arthritis 4. IV and SQ