Module 2 study guide Flashcards
Idiosyncratic reaction
Adverse effects that are completely unexpected and not previously known to be associated with a particular medicine.
Involves abnormal susceptibility to a medication, possibly from genetic trait or dysfunction of a metabolic enzyme.
Medication biotransformation
Occurs in liver
Ability to cause biotransformation
Kidney, skin, lungs, GI tract
Four possible effects on body
Inactive substance can become active - Metabolite
Capable of producing desired or unwanted clinical effects
Inactive medication can be changed into another active medication- active metabolite
Active medication, may be completely or partially inactivated- inactive metabolite
Medication is transformed into a substance that is easier for the body to eliminate- inactive/ active metabolite
Steven johnson syndrome
Severe and possibly Fatal reaction that mimics a burn
May be caused by some antibiotics and anti seizure meds
Lipid soluble vs. water soluble
Lipid or fat soluble meds require higher weight based dose in older adults because of their higher body fat percentage and increased fat distribution
Water soluble requires higher weight based dose for infants because they have a higher percentage of body water
All but the larger lipid soluble medication can easier pass through cell Membranes
Acetylcholinesterase inhibition
Nerve agent toxicity which permits excessive release of ACH which leads to elevated levels in the body
Atropine is treatment
Synergism
Two meds with similar effects combined to produce an effect greater than the sum of the meds effects\
EX: fentanyl and versed acts as a chemical sedative
Potentiation
Definition: effect of one med is greatly enhanced by the presence of another med which does not produce the same effects
EX: promethazine is given to increase the effects of codeine or other antitussives for more improved relief of cough than is achieve by the antitussives alone.
Bioavailability
Definition: percentage of the unchanged med that reaches systemic circulation
Varies significantly from one med to another except when administered by IV
Meds by IV have 100% bioavailability
Irrelevant with meds that are sequestered such as activated charcoal
EX: the reduction in bioavailability due to first pass hepatic metabolism has already been taken into account with oral dosing explaining why the oral doses are significantly higher than IV doses given for the same purpose
Biotransformation
A process with four possible effects on a medication absorbed into the body: (1) an inactive substance can become active, capable of producing desired or unwanted clinical effects. (2) an active medication can be changed into another active medication. (3) an active medication may be completely or partially inactivated. (4) a medication is transformed into a substance (active or inactive) that is easier for the body to eliminate
Acetaminophen contraindications
Hypothermia either related to the toxic affects of the med
Environmental exposure
Known hypersensitivity
Severe active liver disease
Ace inhibitor side effects
Chronic dry cough, life threatening angioedema
Immune mediated medication response
Medications and substances present in the environment can trigger an exaggerated response from the body’s immune system, which is generally described as an allergic reaction. (medication sensitivity, anaphylaxis)
Alpha blocking medications
Alpha adrenergic receptor antagonists
Prevent endogenous catecholamines from reaching alpha receptors, primarily in smooth muscle of blood vessels
Lower BP (particulars diastolic)
Decrease systemic vascular resistance
Pts taking alpha blockers at home are susceptible to orthostatic hypotension and tachycardia.
Prescribed to pts with hypertension, enlarged prostate gland, glaucoma
Renal Failure
More susceptible to the adverse effect of medications than other patients. Renal Failure hinder the capability of the kidneys to eliminate medications properly. (last step in Pharmacokinetics)
Liver Failure
Patients with liver dysfunction are at risk of toxicity from oral medications, even at their conventional dose because the first pass effect is impaired in these individuals
A larger amount of the medication will reach their circulatory system
Alpha-1 Receptors
Adrenergic Receptor, Alpha-1 receptors primarily cause vasoconstriction
Alpha-2 Receptors
Adrenergic Receptor, Alpha-2 receptors generally cause smooth muscle contraction, inhibition of insulin release, induction of glucagon release, and suppression of further norepinephrine release
Lb to kg calculation
Lbs÷2.2 (on calculator)
Lbs÷2 then minus 10% (for freehand)
Osmolarity
The concentration of particles dissolved in a fluid
Hypertonic solution
Has a relatively higher osmotic pressure that does the interstitial( in the brain) fluid
Shifts fluids into vascular space
Can cause excess fluid drain from the tissue into the blood
can decrease swelling in the brain, help stabilize BP increase urine output and reduce edema
Specifically 3% sodium chloride is used as temporary measure to draw out fluids and reduce intracranial pressure
Pulls fluids and electrolytes form intercellular components into intravascular compartments
Because of higher sodium concentration then the cell water is drawn out of cell and may cause cell to collapse from increased extra cellular osmotic pressure
Contraindicated for patients in diabetic ketoacidosis or patients at risk of cellular dehydration
Hypotonic Solution
Lower osmolarity(sodium) than serum, dilutes the serum.
Hydrates the cells and depletes the intravascular space.
Isotonic Solutions
Two Solutions: Normal Saline(Sodium Chloride 0.9%) & Lactated Ringers
Normal Saline- Has similar osmolarity as other body fluids, Ex: blood)
Expands the intravascular space without shifting to other spaces or change of cell shape.
Vasovagal Response
A triggering response
Venous vasculature dialtes, decreases blood pressure, decreases blood flow to the brain; Syncope.
Lactated Ringers
(LR)- used for blood loss, contains lactate which metabolizes in the liver.
NOT for those with liver issues.
Amiodarone
Prolongs the QT interval. Blocks sodium, potassium, and calcium channels: prolongs the action potentials duration and delays depolarization; decreases AV conduction and sinoatrial (SA) node function.
L to mL
Multiply L by 1000 to get mL
mL to L
Divide mL by 1000 to get L
Dopamine Calculations
1600 mcg/mL or 800mcg/500mL
Admin via infusion pump typically in mcg/kg/min (2-10 or 5-20 mcg/kg/min)
Volutrol
Pediatric IV microdrip set (aka Buretrol or Burette) that helps to avoid inadvertent fluid overload. Chamber holds about 100-200mL
Precalibrated drip chamber that only administers preset amount of fluid
Rhonchi
a coarse low pitched respiration
Typically from aspiration of fluid
Indicative of bronchitis/pneumonia
Rales
crackles, wet rattling, bubbling, fluid in small airways
Wheezes
high pitched whistling sound, air forces through narrow airway causing vibration. Asthma,CHF, bronchus obstruction
Tidal Volume
amount of air moved in and out in single breath. Average 500 ml for adults
Minute volume = TV x RR
Neonate Pulse Rate/ bp
Pulse Rate awake: 100-205 asleep: 90-160 BP Systolic 67-84 Diastolic 35-53 MAP 45-60. Pulse should be taken at Brachial Artery for min 30 seconds then multiplied X2.
Pediatric Pulse Rate/bp
Pulse Rate awake 100-180 asleep 90-160 BP Systolic 72-104 Diastolic 37-56 MAP 50-62
70 + (2 x age in years)
Adult Pulse Rate/bp
Pulse 60-100 BP 90-140. Pulse should be palpated at radial artery.
Subdural hematoma
Collection of blood in the subdural space resulting from tearing of a cerebral vein
URI in children
Upper respiratory infection. Children lose “passively acquired immunity” and develop their own immunity called “Acquired immunity.”
Menopause
When a woman reaches the end of child-bearing age, between the ages of 40-50. Menstruation cycles become less frequent. This change can result in loss of bone density and the development of cardiovascular disease
Bruit
Abnormal whooshing sound heard over a main blood vessel that indicates turbulent blood flow within the blood vessel. Often indicates localized atherosclerosis
Pathological Fracture
A fracture that occurs in an area of abnormally weakened bone. When normal forces apply to abnormal bone structures. Often occurs as a result of decreased bone density
Diplopia
double vision
Anisocoria
Condition where pupils are asymmetric (differing in size greater than 1mm)
Found in 30% of the population. It sometimes indicates significant ocular or neurologic pathology, but must be correlated with overall presentation of patient
Ptosis
Sagging or drooping of eyelids.
Can indicate Bell’s Palsy or Stroke
Bounding Pulse
Strong pulse consistent with Circulatory overload and Hypertension
Thready Pulse
Weak, Fast, and difficult to palpate
