PathoPharm Review - E4 Flashcards
Phases of drug action: pharmaceutic (1)
drug dissolves to be used and absorbed in blood and body (dissolution) all oral drugs and only occurs w/ oral drugs
Phases of drug action: pharmacokinetic (2)
drug moving through the body and what the body does to the drug (4 processes: absorption, distribution, metabolism, excretion)
Phases of drug action: pharmacodynamic
what the drug does to the body (MOA, intended effect, therapeutic action)
what drugs are 100% bioavailable
IV drugs
example of protein binding: warfarin/coumadin
this is a blood thinner that is 97-99% protein bound so if a pt has low albumin a person is at greater risk for bleeding due to higher effect of drug exerted
a drug uses CYP450 system as a substrates
the drug uses the system for metabolism (it initiates the drug)
if a drug uses CYP450 system as an inducer
the system increases the breakdown and elimination of the drug to lower the drugs therapeutic effect
“induce the drug out like a birth, lowering effect b/c drug is no longer in the body”
if a drug uses CYP450 system as an inhibitor
the system decreases the breakdown and elimination of the drug to increase the amount of drug in the body and increase the therapeutic effect risk for toxicity
“inhibits the uptake so the drug stays readily available in the bloodstream”
grapefruit is an example of “” in the CYP450 process
inhibitor
goal of steady state
when intake of a drug is equal to the amount of drug metabolized and excreted (the state when the BP meds will have BP always under control)
takes 4-5 half lives to get to steady state
agonist
a drug that has the ability to initiate a desired therapeutic effect by binding to a receptor
antagonist
a drug that produces its action not be stimulating receptors but by preventing/blocking/inhibiting other natural substances (ligands) from binding and causing a response
drug interactions that increase therapeutic effect: additive effects
2 drugs taken w/ similar MOA (they become stronger together)
drug interactions that increase therapeutic effect: synergism/potentiation
2 drugs w/ different MOA but result in a combined drug effect greater than that of either drug alone (still will become stronger together)
drug interactions that increase therapeutic effect: activation
activation of drug - metabolizing enzymes in the liver which decreases metabolism rate of the drug
drug interactions that increase therapeutic effect: displacement
displacement of one drug from plasma protein binding sties by a second drug which increases effect of displaced drug
what organization approves medications
food and drug administration
Controlled substances: schedule 1
not approved for medical use, there is no reason to ever prescribe it bc they have no therapeutic effects (ex: heroin, LSD)
Controlled substances: schedule 5
low potential for abuse, meds that contain small amounts of certain narcotics or stimulants, usually antitussives (cough suppressants w/ codeine, ephendrine containing meds)
what schedule are narcotics
schedule 2 -> no auto refills watch closely
what is the qualification for a drug to be classified as over the courter and then sold
“consumers must be able to diagnose own condition and monitor effectiveness easily” , meds are low risk for side effects & abuse (no medical background needed to understand med function
teratogens: category A
safe for fetus (ex: acetaminophen)
teratogens: category X
drugs that have known risk that cannot be outweighed by possible benefit, pt usually have to be on bc to take (ex: thalidomine, chemo, istretinoin/retin A aka accutane)
dysplasia
abnormal changes in size/shape/organization of mature cells (often associated w/ neoplastic growths aka cancer cells)
what cell adaptation is most associated with cancer
metaplasia (it can predispose to cancer)
what are the 5 signs of localized inflammation
redness, swelling, heat, pain, loss of function
IgG
most common, 75-80%, protects against bacterial and viral infections produced once an infection has been on going or resolved & can easily leave bloodstream and go into tissues
Ex: pervious infection or vaccine
IgM
10%, activates compliment for cytotoxic functions for early, recent infections, 1st to be produced and signal
IgA
secretory functions, protects against infections found in saliva, tears, GI/GU & breastmilk
IgD
trace amounts in serum, more on B cells, stimulates B cells to multiply and differentiate & secrete other immunoglobulins
IgE
role in immunity against parasites and allergic reactions, signaling of mast cell degranulation
passive immunity
-transfer of plasma containing antibodies from an immunized person to non immunized per
- mother to fetus (IgG cross placenta, IgA in BM so vaccinated mom can pass that)
-injection of antibodies not a vaccine, like actual plasma w/ the antibodies
active immunity
-protected state due to body’s own immune response
-active infections
-vaccines
who cannot receive a attenuated vaccine
people w/ weak immune systems (spec diseases: lung, heart, kidney or metabolic)
what are the live vaccines
MMR
flu mist
varicella
what are the two ways RAAS affects BP
1) Na & H2O retention (fluid volume)
2) Vasoconstrictor & H2O retention (tighter/smaller passage)
how much volume is on board in blood vessels to keep normal BP
HTN crisis: urgency
-no S/s of end stage organ damage
-BP >180/120
-treat w/ oral agents & gradually reduce
-causes: anxiety, pain, abrupt withdrawal
HTN crisis: emergency
-uncontrolled BP that leads to end organ damage
-BP: >180/120
-S/s: headache, blurred vision, stroke, brain hem, chest pain, acute coronary syndrome, heart dysry
-aggressively lower BP in mins to hours w/ IV meds (labetalol)
MOA for all diuretics
-increased urinary output
-decreased circulating volume
-decreased arterial resistance
what is the first line management of HTN
hydrochlorothiazide -> works on distal tubules
what does loop diuretics cause
profound diuresis (so used for HTN & fluid overload)
what pts should not take propranolol & carvedilol
pt’s with lung disease, asthma or COPD bc it is non selective and will block beta 2
when do we hold beta blockers
HR is less than 60 or systolic BP is less than 100
what is the biggest complaint from pts to switch from an ace inhibitor
dry, nonproductive persistent cough
adverse reactions of statins
myopathy (muscle weakness) -> rhabdomyolysis (breakdown of muscle fibers & leads to AK failure)
what statins need to be taken at night
simvastatin and rosuvastatin bc chol is highest at night and these drugs have short half lives
what is the gold standard for hyperlipidemia treatment
statins w/ diet & exercise
metformin MOA
lowers BG by decreasing production of glucose in the liver & enhances glucose uptake & utilization by muscle
(met for my muscles, min glucose in liver)
metformin nursing considerations
-must be held 48 hrs before IV contrast
-do not use in pts w/ elevated ALT levels
gabapentin & pregablin indication
to complement opioid effects and used specifically neuropathic pain
gabapentin & pregablin nursing considerations
can only be partially reversed with naloxone
(the pent up tin man is only partially human)
what NSAID has no anti inflammatory property
acetaminophen
NSAID MOA
anti prostaglandins by blocking key enzyme COX which is crucial for the production of prostaglandins
adult acetaminophen dosage
4g/24 hr
phenytoin causes what special side effects
gingival hyperplasia teeth -> dentist
gold standard for rapid mgt of seizures
if needed (usually stop on their own) IV push benzodiazepines
metabolic syndrome
WC: >40, >35
TAGs: >150 or meds
HDL: <40 (M), <50 (W) or meds
BP: >130 or >85 or meds
FBG: >110 or meds
BMI: >30
a delta
myelinated; pain is sharp, cutting, pinched & localized
c fibers
nonmyelinated; pain is dull, burning, achy & poorly localized
heparin antidote
protamine sulfate (SE: hypotension)
LMWH nursing considerations
do not give w/ heparin
BBW: potential spinal hematoma if pt has epidural catheter
warfarin MOA
vitamin K inhibitor -> prevents the synthesis of factors VII, IX, X & prothrombin
warfarin antidote
vitamin K
apixaban & rivaroxaban antidote
andexxa
aspirin MOA
blocks prostaglandin synthesis through the COX enzyme pathways (+blocks platelet aggregation)
aspirin antidote
desmopressin (DDAVP)
clopidogrel & ticagrelor nursing considerations
BBW (clopid): pt w/ certain genetic abnormalities, who may have higher rate of CV events due to reduced conversion to its active metabolite
BBW (tica): increased bleeding risk w/ aspirin doses over 100mg (so can give w/ baby aspirin)
clopidogrel & ticagrelor antidote
DDAVP or platelet transfusion
long term side effects corticosteroid use
-clouded eyes
-high BS
-increased risk of infections
-thinning bones
-suppressed adrenal gland hormone production
-thin skin, bruising, slow wound healing
lactulose use
liver disease & hepatic encephalopathy
digested in large intestine creating a hyper-osmotic environment which draws water into the colon + reduces blood ammonia levels
polyethylene glycol use
given before diagnostic surgical bowel procedures bowel prep for col
anticholinergic effects
“hot as a hare”
“dry as a bone”
“blind as a bat”
“red as a beet”
“mad as a hatter”
lam & pam MOA
enhance inhibitory effects of GABA in CNS (increasing GABAs relaxing effect, we inhibit anxiety w/ gaba)
benzo antidote
flumazenil
