Pharm Basics SG

Question 1

Pharmacokinetics

Answer 1

All about What the/our body does to the drug
How body processes med

Question 2

Pharmacodynamics

Answer 2

How the med affects the body - what drug do to body; how work to exert effect; part of distribution phase - distributed to diff parts of body to exert an effect

Question 3

Explain the differences between therapeutic and pharmacologic drug classifications.

Answer 3

Therapeutic use: based on usefulness in treating diseases or disorders; how treats disease
Pharmacologic structure: how drug produces physiological effect at molecular/tissue level; how drug works

Question 4

Explain the differences between chemical, generic, and brand/trade names of drugs.

Answer 4

Chemical: speaks to actual chemical structure of drug; not care about this; is chemical components
Generic: original name for common understanding; same affect but diff fillers/binders from brand and generic
Trade (brand) name: assigned by pharmaceutical company; familiar with and ones can say - Fillers/binders differ between brand and generic but they are the same in the end basically -May alter bioavailability - means active part of the drug

Question 5

Preclinical Investigational Studies - Tested on laboratory animals; Have ideas; biochemists figure out how to treat disease on molecular level and test on animals to see if do what do and if any major consequences; Trying to figure out how make drug work way want to without major adverse effects
Phase I Studies - Tested on healthy human volunteers (dose range and pharmacokinetics); How drug works in humans; start looking at dose appropriate to have affect want without too many adverse effects
Phase II Studies - Tested on clients with disease (therapeutic effects, adverse effects); See How works on them
Phase III Studies - Large sample size; placebo and/or blinded studies (effectiveness, safety, dose); Submission of new drug application/approval; approved by FDA and given name; patent 5-7 years; Get drug approval from FDA and given generic and brand name by company and brought to market and drug patented for 5-7 years; patent because costs lot money to make drugs so pharmaceutical company can make money before goes generic and no competition
Phase IV Studies - Post marketing studies (2+ years); new or severe adverse effects; black box or recall; After drug brought to market, cont monitor drug, prescribers prescribing meds to pat report if find anything that might be related to med; some meds taken off the market

Answer 5

Explain the process in which drugs are developed and come to market.

Question 6

Responsible for protecting public health by ensuring safety, efficacy, and security of drugs, biological products and medical devices
Takes sig role that drugs are safe - do all reg for the creation meds, how meds studied, brought to market in US
Ensure safety of nation’s food supply, cosmetics, and products that emit radiation and more…
Drug approval process tightly controlled by FDA

Answer 6

What are the responsibilities of the Food and Drug Administration (FDA)?

Question 7

Controlled Substances Act of 1970 - Responsible for regulating controlled substances; where all fed laws come in - if someone tampers with regulation of drugs get in big trouble with fed govt, go to jail, etc; Regulates manufacturing, distribution, and dispensing of drugs with known abuse potential (controlled substances); Anyone convicted of unlawfully manufacturing, distributing, or dispensing of controlled substances faces severe penalties; Need know how handle meds as nurse; admin opioids to pats - major controlled substance admin to pats regularly regardless where work and need to protect self and admin correctly
Controlled drugs divided into five DEA schedules - Based on potential for abuse/physical and psychological dependence
Physicians and dispensing pharmacists must be registered with DEA

Answer 7

What is the Drug Enforcement Agency (DEA)? What is the function of this organization?

Question 8

Schedule I (heroin, LSD)
Very High abuse potential and no accepted medical use
Street drugs
Schedule II (narcotics/opioids, amphetamines, barbiturates)
High abuse potential with severe dependence liability - someone can become addicted to pain meds; must be carefully prescribed; must handle them correctly as a nurse
Schedule III (nonamphetamines stimulates, nonbarbiturates sedatives)
Less abuse potential and dependence liability than II (moderate)
Schedule IV (antianxiety agents, some sedative)
Less abuse potential and dependence liability than III (moderate)
Schedule V (codeine)
Limited abuse potential - still regulated to some degree

Answer 8

What drugs are placed in a “schedule” designating abuse potential? List the schedule and examples of a type of medication in each level.

Question 9

Cross placental barrier: Potential/actual harm to developing fetus
Many drugs can be this - all drugs assigned pregnancy category
A: adequate studies humans; no evidence of risk; very few drugs are this; not enough pats willing to be that person in study; cannot classify many as this
B: studied in animals who are pregnant; risk unknown for human because never studied in humans - safer end of drugs; no risk to animals
C: studied in animals who are pregnant; reveal adverse effects - studies done found adverse effects to fetus - not resulted in major abnormalities or developmental delays or long-term harmful to developing fetus but have been found; not in place where category D/X
D: studies confirm fetal risk; benefits > risk; see probs in fetus and provider has know condition of mom if more beneficial and those outweigh risk to fetus
X: observation or studies fetal abnormalities - will be fetal abnormalities and pregnant woman should never take this drug

Answer 9

What is a teratogenic drug?

Question 10

Primary Actions/adverse effects
Overdose
Secondary Actions/adverse effect
Undesired effects
Toxicity
Allergic reactions
Adverse effects: EX
Opportunistic infections (fungal):
Blood dyscrasias:
Alterations in blood glucose
Alterations in electrolytes (common electrolyte abnorm: hyper-, hypokalemia; hyper-, hyponatremia)
Auditory damage
Central nervous system depression - not easily aroused, sedated, not aroused to voice, really severe sternal rub to get them awake
Photophobia: sensitivity to light
Photosensitivity: sensitivity to UV rays
Gastrointestinal effects (irritation): Nausea, vomiting, diarrhea (n/v/d)
Headache
QT prolongation increases risk for ventricular arrhythmias (Torsade) - some drugs can cause dysrhythmias that can be potentially fatal
Adverse effects: Toxic effects to organs
Liver
Kidney
Nervous system
Adverse rxns: allergic rxns
Anaphylaxis
Delayed Allergic Reaction
Penicillin allergy
Angioedema
Stevens Johnson Syndrome

Answer 10

Explain the different types of adverse effects and provide examples. What is the nurse’s responsibility regarding adverse effects?

Question 11

Liver disease is a caution/contraindication when administering certain drugs; Monitor liver functions in pat before give drugs to avoid drug toxicity or injury to liver - check liver func tests

Answer 11

What are contraindications in drug therapy?

Question 12

Drug-drug interactions: altered effectiveness
Site of absorption
During distribution/site of action
During metabolism
During excretion
Drug-food interactions
Prevent absorption (with the oral route)
Increase or decrease drug’s effect (any route)

Answer 12

What are drug interactions (food-drug and drug-drug)? Give examples of common drug-food interactions.

Question 13

6 rights part process - but need think about it and think about process
Prevention of med errors: Proper assessment, administration, monitoring, evaluation, and documentation; Question a medication order for any reason when in doubt

Answer 13

Explain the 6 rights of medication administration. Why are they essential to a nursing practice?

Question 14

4 processes: Absorption, distribution, metabolism, excretion
Absorption: getting drug to blood - most in SI, into bloodstream, into portal vein, processed and metabolized by the liver, put out into systemic circ and there distributed to tissues, excreted by kidneys and happens over and over again until all drug been broken down and excreted from body
Distribution: getting drug to tissues
Metabolism: breaking drug down
Excretion: getting drug out of body

Answer 14

List the four phases of pharmacokinetics and explains each phase.

Question 15

Factors affecting absorption via oral route
Molecular weight:
Lipid solubility:
Surface area of gastrointestinal mucosa
Blood flow to gastrointestinal system
Rate of gastric emptying
Oral preparation:
Administration of multiple drugs simultaneously (interaction)
Foods and fluids administered with drugs (binding)

Answer 15

What factors alter the absorption of an oral drug? Explain each factor’s role in altering oral drug absorption.

Question 16

Factors affecting distribution
Lots of these
Blood flow to organs/tissues
Ability to cross blood-brain barrier or fetal/placental barrier -
Drug properties
Protein binding (albumin - protein; most abundant protein in plasma)
Water solubility vs. lipid solubility

Answer 16

What factors alter drug distribution? Explain each factor’s role in altering drug distribution?

Question 17

It is metabolism
Happens mostly with oral routes; some other routes affected by this but not given often
Give drug orally goes into stomach and most drugs absorbed in SI and absorped into portal vein which feeds directly into the liver and goes through first pass effect: heavily metabolized by liver and after drug shoots it into systemic circ - out vein into heart to systemic distribution for absorption - part reason for <100% bioavailability - goes through liver gets to before systemic circ; research studies - how heavily metabolized - if heavily metabolized increase dose for therapeutic effect; not as much might keep with lower dose because not metabolized as much with this effects; other routes beside oral route skipping this because going into gen circ

Answer 17

Explain the “first pass effect”.

Question 18

Liver is the primary site/organ for metabolizing drugs
Hepatic microsomal enzyme system (P-450 system) - specific enzyme sys that does lot work of metabolism - alterations in enzyme sys can result in changes to drug effects
Liver imp for metabolism drug; helps with excretion (done by kidneys) - breaks down and gets ready for excretion by kidneys
Inactivates/breakdown drug for excretion
Changes in hepatic microsomal enzymes can affect drug metabolism

Answer 18

What is the liver’s role in metabolism of drugs?

Question 19

Enzyme induction
Increased activity of enzyme system by presence of first drug
Enzyme inhibited
Some drugs inhibit enzyme system-make less effective
Drug will not be broken down for excretion

Answer 19

What problems may occur if metabolism of drugs is delayed or increased? What factors may cause delayed or increased metabolism?

Question 20

Kidneys are the primary organ/site for excretion of drugs from body - liver breaks it down; circulated into bloodstream, kidneys excrete and it gets out of body
Liver/bowel are secondary site for excretion; Drugs processed by liver, released into bile, eliminated in feces

Answer 20

What organs are primary involved with excretion of drug byproducts?

Question 21

a consequence of a medical treatment of any kind, the results of which are judged to be desirable and beneficial.

Answer 21

Explain therapeutic response.

Question 22

Onset
Time for drug to elicit a therapeutic response
Peak
Time for a drug to reach its maximum therapeutic response
Duration
Time a drug concentration sufficient to elicit therapeutic response

Answer 22

Explain onset, peak, and duration of drugs.

Question 23

Therapeutic window/range/index
Range of med that is deemed safe for a patient and produce some kind of an effect without having toxic effects
Some drugs narrow therapeutic window meaning reach toxic effects easily - get toxic easily with certain drug and with those do blood level monitoring see how much in bloodstream at given time to ensure not already toxic or risk of becoming toxic soon
Potency
an expression of the activity of a drug in terms of the concentration or amount of the drug required to produce a defined effect
Efficacy
the maximum response that can be achieved with a drug

Answer 23

Explain the therapeutic index, potency, and efficacy of drugs.

Question 24

How meds interact with them
Agonists
Drugs interact directly with receptor sites and causes same activity that natural chemicals would
Cause same activity of natural chemicals would cause at that site
Antagonists
Break down into subcategories
blocks/prevents some kind of stimulation/rxn from occurring
Drug–Enzyme Interactions
Drugs that Interferes with enzyme systems that act as catalysts for chemical reactions
One interruption (drug) in cascade can block the normal cell function
Selective Toxicity
Ability of a drug to attack only those systems found in foreign cells
Trying to attack certain types of foreign cells
Receptor theory: ANS
Parasympathetic - major neurotransmitter: AcH; rest and digest; major actions: decreases the HR, constrict bronchioles, increases digestion (GI tract), increases/stimulates urination
Sympathetic - fight/flight: action: increase HR, bronchodilation, increase rate and depth of breathing, slowing of GI tract, decreased urination

Answer 24

Explain the receptor theory. What is an agonist? What is an antagonist?

Question 25

Parasympathetic - major neurotransmitter: AcH; rest and digest; major actions: decreases the HR, constrict bronchioles, increases digestion (GI tract), increases/stimulates urination
Sympathetic - fight/flight: action: increase HR, bronchodilation, increase rate and depth of breathing, slowing of GI tract, decreased urination
Agonist (cholinergic agonist) - cholinergic - parasym NS; mimicking normal actions of parasym NS
Increases saliva production
Slows heart rate
Constricts bronchioles
Stimulates digestive process
Increases urination
SNS branch
Adrenergic agonist - mimic action of SNS
Tachycardia and vasoconstriction
Increases BP
Bronchodilation
Decreased GI motility
Glycogenolysis (increased blood glucose)
Constricts bladder sphincter

Answer 25

Explain the autonomic nervous system. What actions do the sympathetic and parasympathetic nervous system have on the body? What receptors are involved in the sympathetic and parasympathetic nervous systems?

Question 26

What drug is ordered – name and classification
Why medication prescribed
Therapeutic effects on body
Adverse and/or toxic effects possible
Contraindication/special considerations
How medication is supplied by pharmacy
Correct route/dosage
Patient education
Patient monitoring and evaluation

Answer 26

What are a nurse’s responsibilities for safe administration of drugs?

Question 27

Trough
Lowest drug level in bloodstream needed to reach therapeutic range drawn 1 hour prior to start of next infusion
EX: Vancomycin
May wait until get this level back until next infusion if told
Timing matters sig - decisions about dose based on draw
Peak
Highest level of the drug in the bloodstream drawn 1 hour after infusion completed
Timing matters sig - decisions about dose based on draw

Answer 27

Explain peak and trough in drug monitoring. What is the procedure?

Question 28

Part implementenation - educating pat about everything med; education about we need know
How often take it, what taking for, how work, common adverse effects, when call provider if having probs, manage adverse effects if appropriate
Name, dose, action of drug
Timing of administration
How to measure/administer home medications
Special storage and preparation instructions
Specific OTC, herbs, supplements to avoid
Special monitoring (BP checks, lab test, etc.)
Adverse effects and potentials for toxicity
Comfort measure for adverse effects
Warnings about discontinuing drug abruptly
Special considerations (diet, sun exposure, etc.)
Pat edu: teach points to reduce errors
Always keep list of meds, herbals, etc. with you - making sure educate pats keep list of all meds and herbal and OTC meds with you; so many probs arise if not know what taking and what taken today esp if have chronic illness or going to hospital often because big probs can happen and if cannot talk to us then do not have it
Know each drug and why prescribed
Read labels/follow directions
Store drugs in dry place away from children and pets
Speak up to provider about reporting use of herbals, etc.
Never share medications
Measure liquids with appropriate measuring devices
Call provider immediately if problem develops
Pat edu: maintaining compliance
About education is ensuring - compliance - means pat taking meds how prescribed; if not treat prob supposed to and causes lot probs - got to figure out why not compliant and can be multititude of things - not always think about implementation of what want - need think about how carried out
Client has an active role in ensuring compliance
Taking a medication in manner prescribed by health care provider
Factors related to patient deviation from compliance:
Poor education on drug
Cost of drug
Forgetting doses
Annoying adverse effects
Self-adjustment of doses
Fear of dependency
Nurse must be vigilant in verifying patients understand education about medications

Answer 28

What information should be included in patient education?

Question 29

Most common cause of morbidity and preventable death in hospitals
Preventable event!
National Coordinating Council for Medication Error Reporting and Prevention definitions:
1.No error, although circumstances or events occurred that could have led to error
2.Medication error caused no harm
3.Medication error that causes harm
4.Medication error that results in death
Most common med errors
Errors in patient assessment
Errors in prescribing
Errors in administration
Distracting environmental factors and stress
Quite prevalent - cause increased length of stay, deaths
Require lot thinking - one most imp tasks do
6 rights part process - but need think about it and think about process
Sig causes of morbidity and mortality
Adverse effects - unwanted side effects

Answer 29

Explain the difference between a medication error and an adverse drug event.