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XIO > Pharm ch 1 - 3 > Flashcards

Pharm ch 1 - 3 Flashcards

1
Q

assessment

A

objective (concrete data, test results), subjective (complaints) and human needs statement ( Diaphoresis is the medical term used to describe excessive, abnormal sweating in relation to your environment and activity level)

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2
Q

planning phase

A

outcomes are objective, measurable, and realistic

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3
Q

Outcomes are

A

objective, measurable, and realistic with an established time frame for their achievement.

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4
Q

PO

A

by mouth

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5
Q

redox

A

an addition of H or removal of O

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6
Q

ADE

A

adverse drug event

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7
Q

ADR

A

adverse drug reaction

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8
Q

neonate

A

between birth and 1 month of age

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9
Q

infant

A

between 1 and 12 months

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10
Q

child

A

between 1 and 12 years of age

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11
Q

younger than 38 weeks gestation

A

premature

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12
Q

younger than 1 month

A

neonate

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13
Q

prescribing cascade

A

give potassium to counteract potassium loss from diuretics

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14
Q

Outcomes are

A

objective, measurable, and realistic with an established time frame for their achievement.

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15
Q

The ninth right is that of the right of the patient to

A

refuse

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16
Q

Knowledge of the drug’s indication allows the nurse, prescriber, members of the health care team, patient and/or family members to

A

understand what is being treated.

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17
Q

If there is a medication error

A

complete an incident report with the entire event, surrounding circumstances, therapeutic response, adverse effects, and notification of the prescriber described in detail. However, do not record completion of an incident report in the medical record.

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18
Q

following information needed:

A

following information: date and time of medication administration, name of medication, dose, route, and site of administration

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19
Q

Other factors must be considered in determining the right time, such as

A

multiple-drug therapy, drug-drug or drug-food compatibility, scheduling of diagnostic studies, bioavailability of the drug

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20
Q

Include in your three checks…

A

the frequency of the ordered medication, the time to be administered, and when the last dose of medication was given

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21
Q

Always confirm that the dosage amount is appropriate for the patient’s

A

age and size

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22
Q

Grounded theory was used to identify the

A

essence of medication safety.

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23
Q

If a verbal order is given, the prescriber must

A

sign the order within 24 hours or as per guidelines within a health care setting

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24
Q

Statements of interventions include

A

frequency, specific instructions, and any other relevant information

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25
Q

The study of natural (versus synthetic) drug sources (i.e., plants, animals, minerals) is called

A

pharmacognosy (nature is cognizant)

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26
Q

The study of the adverse effects of drugs and other chemicals on living systems is known as

A

toxicology

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27
Q

Pharmacotherapeutics (also called therapeutics) focuses on the

A

clinical use of drugs to prevent and treat diseases. It defines the principles of drug actions

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28
Q

Pharmacokinetics is the study of what the (kinetic energy is dope)

A

body does to the drug.

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29
Q

Pharmacodynamics involves (dynamic between drug and receptor)

A

drug-receptor relationship

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30
Q

Pharmaceutics is the study of

A

various dosage forms influence the way in which the drug affects the body

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31
Q

Drugs can be classified by their

A

structure (e.g., beta-adrenergic blockers) or by their therapeutic use (e.g., antibiotics, antihypertensives, antidepressants).

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32
Q

Pharmacology includes the following several subspecialty areas:

A

pharmaceutics, pharmacokinetics, pharmacodynamics, pharmacogenomics (pharmacogenetics), pharmacoeconomics, pharmacotherapeutics, pharmacognosy, and toxicology

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33
Q

Oral dosage forms rely on

A

gastric and intestinal enzymes and pH environments to break the medication down into particles that are small enough to be absorbed into the circulation

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34
Q

Topical

A

Aerosols, ointments, creams, pastes, powders, solutions, foams, gels, transdermal patches, inhalers, rectal and vaginal suppositories

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35
Q

Parenteral

A

Injectable forms, solutions, suspensions, emulsions, powders for reconstitution

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36
Q

Enteral

A

Tablets, capsules, oral soluble wafers, pills, timed-release capsules, timed-release tablets, elixirs, suspensions, syrups, emulsions, solutions, lozenges or troches, rectal suppositories, sublingual or buccal tablets

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37
Q

Dosage form determines the

A

rate at which drug dissolution (dissolving of solid dosage forms and their absorption, e.g., from the gastrointestinal [GI] tract) occurs

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38
Q

Metabolism is also referred to as

A

biotransformation. It involves the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite (as in the conversion of an inactive prodrug to its active form), or a less active metabolite

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39
Q

Typically a drug that is highly water-soluble (hydrophilic) will have a smaller volume of

A

distribution and high blood concentrations. In contrast, fat-soluble drugs (lipophilic) have a larger volume of distribution and low blood concentrations

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40
Q

A theoretical volume, called the volume of distribution, is sometimes used to describe the

A

various areas in which drugs may be distributed. These areas, or compartments, may be the blood (intravascular space), total body water, body fat, or other body tissues and organs.

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41
Q

A drug-drug interaction occurs when the

A

presence of one drug decreases or increases the actions of another drug that is administered concurrently (i.e., given at the same time).

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42
Q

Only drug molecules that are not bound to plasma proteins can

A

freely distribute to extravascular tissue (outside the blood vessels) to reach their site of action.

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43
Q

Areas of rapid distribution include the (BLK H)

A

heart, liver, kidneys, and brain

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44
Q

Transdermal drug delivery through adhesive patches is an elaborate topical route of drug administration that is commonly used for (transdermal has a system)

A

systemic drug effects

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45
Q

All topical routes of drug administration avoid

A

first-pass effects of the liver, with the exception of rectal administration.

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46
Q

Muscles have a greater blood supply than does the skin; therefore drugs injected intramuscularly are

A

absorbed faster than drugs injected subcutaneously

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47
Q

Injections into the fatty subcutaneous tissues under the dermal layer of skin are referred to

A

subcutaneous injections

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48
Q

The time until onset of action for the PO form is

A

30 to 60 minutes; for the IV form, this time is 5 minutes.

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49
Q

Intramuscular injections are indicated/used with drugs that are poorly soluble which are often given in

A

“depot” preparation form and are then absorbed over a prolonged period

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50
Q

Medications given by the parenteral route have the advantage of

A

bypassing the first-pass effect of the liver.

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51
Q

Intraarterial, intrathecal, or intraarticular injections are usually given by

A

physicians

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52
Q

The parenteral route is the f

A

fastest route by which a drug can be absorbed, followed by the enteral and topical routes

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53
Q

Drug absorption may be altered in patients who have had

A

portions of the small intestine removed because of disease. This is known as short bowel syndrome

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54
Q

Taking an enteric-coated medication with a large amount of food may cause it to be

A

dissolved by acidic stomach contents and thus reduce intestinal drug absorption and negate the coating’s stomach-protective properties.

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55
Q

Once the drug is in the liver

A

hepatic enzyme systems metabolize it, and the remaining active ingredients are passed into the general circulation.

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56
Q

three basic routes of administration

A

enteral (GI tract), parenteral, and topical.

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57
Q

First-pass effect reduces the bioavailability of the drug to

A

less than 100%.

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58
Q

If a large proportion of a drug is chemically changed into inactive metabolites in the liver, then

A

a much smaller amount of drug will pass into the circulation (i.e., will be bioavailable). Such a drug is said to have a high first-pass effect

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59
Q

Bioavailability is the term used to express the

A

extent of drug absorption

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60
Q

Absorption is the

A

movement of a drug from its site of administration into the bloodstream for distribution to the tissues

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61
Q

Specifically, the combined processes of pharmacokinetics include

A

drug absorption into, distribution and metabolism within, and excretion from the body represent.

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62
Q

Pharmacokinetics is the study of

A

what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body

63
Q

Drugs with nonspecific mechanisms of action do not

A

interact with receptors or enzymes. Instead, their main targets are cell membranes and various cellular processes such as metabolic activities.

64
Q

For a drug to alter a physiologic response in this way

A

it may either inhibit (more common) or enhance (less common) the action of a specific enzyme. This process is called selective interaction

65
Q

Noncompetitive antagonist

A

Drug combines with different parts of the receptor and inactivates it; agonist then has no effect.

66
Q

Competitive antagonist

A

Drug competes with the agonist for binding to the receptor. If it binds, there is no response.

67
Q

Antagonist

A

Drug binds to the receptor; there is no response. Drug prevents binding of agonists.

68
Q

Partial agonist (agonist-antagonist)

A

Drug binds to the receptor; the response is diminished compared with that elicited by an agonist.

69
Q

Agonist

A

Drug binds to the receptor; there is a response.

70
Q

Drugs can exert their actions in three basic ways

A

: through receptors, enzymes, and nonselective interactions.

71
Q

Teratogenic effects of drugs or other chemicals result in

A

structural defects in the fetus.

72
Q

An idiosyncratic reaction is not the result of a

A

known pharmacologic property of a drug or of a patient allergy, but instead occurs unexpectedly in a particular patient

73
Q

Medication errors occur during the

A

prescribing, dispensing, administering, or monitoring of drug therapy. These four phases are collectively known as the medication use process.

74
Q

Toxic drug levels are typically seen when

A

the body’s normal mechanisms for metabolizing and excreting drugs are compromised. This commonly occurs when liver and kidney functions are impaired or when the liver or kidneys

75
Q

drug with a low therapeutic index has a greater likelihood than other drugs of

A

causing an adverse reaction, and therefore requires closer monitoring.

76
Q

The ratio of a drug’s toxic level to the level that provides therapeutic benefits is referred to as

A

the drug’s therapeutic index

77
Q

Empiric therapy is based on

A

]clinical probabilities. It involves drug administration when a certain pathologic condition has a high likelihood of occurrence based on the patient’s initial presenting symptoms.

78
Q

Prophylactic therapy is

A

drug therapy provided to prevent illness or other undesirable outcome during planned events

79
Q

Maintenance therapy does not eradicate preexisting problems the patient may have, but will prevent

A

progression of a disease or condition.

80
Q

Acute therapy often involves

A

more intensive drug treatment and is implemented in the acutely ill (those with rapid onset of illness) or the critically ill

81
Q

The source of all early drugs was

A

nature, and the study of these natural drug sources (plants and animals) is called pharmacognosy.

82
Q

Impairment in either kidney or liver function may result in

A

higher drug levels and/or prolonged drug exposure, and thus increased fetal transfer.

83
Q

During the last trimester, the greatest percentage of

A

maternally absorbed drug gets to the fetus.

84
Q

Drug properties that impact drug transfer to the fetus include

A

the drug’s chemistry, dosage, and concurrently administered drugs

85
Q

Transfer of both drugs and nutrients to the fetus occurs primarily by

A

diffusion across the placenta, although not all drugs cross the placenta

86
Q

The first trimester of pregnancy is generally the period of

A

greatest danger of drug-induced developmental defects

87
Q

older age

A

Skin is thinner and more permeable.• Stomach lacks acid to kill bacteria.• Lungs have weaker mucous barriers.• Body temperature is less well regulated, and dehydration occurs easily.• Liver and kidneys are immature, and therefore drug metabolism and excretion are impaired.

88
Q

Drug therapy in the older adult is more likely to result in

A

adverse effects and toxicity.

89
Q

The simultaneous use of multiple medications is called

A

polypharmacy

90
Q

Kidney function is assessed by measuring

A

serum creatinine and blood urea nitrogen levels. Creatinine is a by-product of muscle metabolism. Because muscle mass declines with age, serum creatinine level may provide a misleading index of renal function.

91
Q

Liver function is assessed by testing the blood for

A

liver enzymes such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT). These laboratory values can help in assessing the ability to metabolize and eliminate medications and can aid in anticipating the risk for toxicity and/or drug accumulation.

92
Q

Therefore the concentrations of highly water-soluble (hydrophilic) drugs may be higher in older adults because

A

they have less body water in which the drugs can be diluted.

93
Q

The transformation of active drugs into inactive metabolites is primarily performed by

A

the liver. The liver loses mass with age and slowly loses its ability to metabolize drugs effectively due to reduced production of microsomal (cytochrome P-450) enzymes

94
Q

Anticoagulants (heparin, warfarin)

A

Major and minor bleeding episodes, many drug interactions, dietary interactions

95
Q

The brown-bag technique requires

A

the patient/caregiver to place all medications used in a bag and bring them to the health care provider.

96
Q

MOA

A

mechanism of action

97
Q

narrow drugs ex

A

digoxin and dilantin

98
Q

Describe the physiochemical processes mediating drug

action.

A

Describe the physiochemical processes mediating drug

action.

99
Q

Explain the client variables that influence the rate
and extent of Absorption, Distribution, Metabolism,
and Elimination

A

Explain the client variables that influence the rate
and extent of Absorption, Distribution, Metabolism,
and Elimination

100
Q

Explain current theories of drug action:

  • drug receptor interaction
  • drug-enzyme interaction
  • nonspecific drug interaction
A

Explain current theories of drug action:

  • drug receptor interaction
  • drug-enzyme interaction
  • nonspecific drug interaction
101
Q

Use Nursing Assessments to identify unusual

and adverse effects of drug therapy

A

Use Nursing Assessments to identify unusual

and adverse effects of drug therapy

102
Q

Drugs do not confer any new functions on a

tissue or organ in the body

A

they only modify

existing functions.

103
Q

● Drugs in general exert multiple actions rather

than a

A

single effect.

104
Q

Drug action results from a

A

physiochemical
interaction between the drug and a
functionally important molecule in the body

105
Q

pharmaceutics - Different drug dosage forms have

A

different
Pharmaceutical (medicinal) properties.
 Dosage form determines the rate of drug
dissolution (dissolving of solid dosage forms and
their absorption from the GI tract).
Enteric-coated tablets
🞑 Extended-release forms

106
Q

4 parts of pharmacokinetics

A

Absorption

  • Distribution
  • Metabolism
  • Excretion
107
Q

pharmacokinetics -  A drug’st ime to

A

Onset of action, time
to Peak effect, and Duration of action
 Study of what happens to a drug from
the time it is put into the body until the
parent drug and all metabolites have left
the body

108
Q

pharmacokinetics absorption

A 
Movement of a drug from its site of
administration into the bloodstream for
distribution to the
🞑 Bioavailability
🞑 First-pass effect
109
Q

routes

A 
A drug’s route of administration affects the rate
and extent of Absorption of that drug
🞑 Enteral (GI tract)
🞑 Parenteral
🞑 Topical
110
Q

enternal route

A

The drug is absorbed into the systemic circulation
through the oral or gastricmucosa or the small
intestine
- Oral
-Sublingual
-Buccal
-Rectal (can also be topical)

111
Q

parenteral route

A 
 Intravenous (fastest delivery into the blood circulation)
 Intramuscular
 Subcutaneous
 Intradermal
 Intraarterial
 Intrathecal
 Intraarticular
112
Q

topical route

A 
 Skin (including transdermal patches)
 Eyes
 Ears
 Nose
 Lungs (inhalation)
 Rectum
 Vagina
113
Q

distribution

A

The transport of a drug by the bloodstream to its
site of action
 Protein-binding
 Water-soluble vs. Fat-soluble
 Blood-brain barrier
 Areas of rapid distribution: Heart, Liver, Kidneys, Brain
 Areas of slow distribution: Muscle, Skin, Fat

114
Q

distribution - a loading dose

A

is administered to reach a
therapeutic response level rapidly. Maintenance
doses are administered at prescribed intervals to
maintain a therapeutic drug response.

115
Q

metabolism/biotransformation

A 
*The biochemical alterationof a drug into aninactive
metabolite, a more soluble compound, a morepotent active
metabolite, or a lessactivemetabolite
 Liver(main organ)
 Skeletal muscle
 Kidneys
 Lungs
 Plasma
 Intestinal mucosa
116
Q

Factors that decrease metabolism

A

Factors that decrease metabolism
 Cardiovascular dysfunction
 Renal insufficiency
 Starvation
 Obstructive jaundiceYellow skin, eyes,, Liver CA, blocked Bile
 Slow acetylatorLiver can’t detoxify becomes toxic
 Ketoconazole therapy- tx for fungus or yeast infections

117
Q

metabolism - Factors that increase metabolism

A

-Fast acetylator
-Barbiturate therapy
CNS depressant, Tx Sz, Anesthesia
- Rifampin therapy- TB
-Phenytoin therapy- Sz

118
Q

excretion

A 
The elimination of drugs from the body
 Kidneys (main organ)
 Liver
 Bowel
🞑 Biliary excretion
🞑 Enterohepatic recirculation
Biliary recycling
119
Q

half life

A

The time it takes for one half of the original
amount of a drug to be removed from the body…
 A measure of the rate at which a drug is
removed from the body
 Most drugs considered to be effectively removed
after about five half-lives
 Steady state- constant drug level- 2, 4, 5X 1/2L

120
Q

bioavailability

A

Refers to the percentage of active drug
substances absorbed and available to reach the
target tissues following drug administration

121
Q

movement through the body - drug actions

A

 The cellular processes involved in the

drug and cell interaction

122
Q

Drug effect

A

Drug effect
 The physiologic reaction of the body to the drug
 Includes onset, peak, and duration of action

123
Q

Onset

A

 The time it takes for the
drug to elicit a therapeutic
response

124
Q

Peak

A

 The time it takes for a drug to reach its maximum

therapeutic response

125
Q

Duration

A

 The time a drug concentration is sufficient to elicit a

therapeutic response

126
Q

therapeutic drug monitoring

A

Peak level = Highest blood level

Trough level = Lowest blood level

127
Q

therapeutic idex

A 
Pharmacotherapeutics / Pharmaceutics
❑ Therapeutic index represents the
ratio between two factors:
▪Lethal dose (LD50)
▪Effective dose (ED50)
TI = LD50/ED50
128
Q

drugs w/ narrow therapeutic index

A
  1. Aminoglycosides (Gentamicin®)
  2. Digoxin (Lanoxin®)
  3. Lithium (Lithobid®)
  4. Phenytoin (Dilantin®)
  5. Valproic Acid (Depakote®)
  6. Warfarin (Coumadin®)
129
Q

pharmacodynamics - mechanisms of action

A

Receptor interactions reactive site on cell surface or inside cell
 Enzyme interactions catalyst most biochemical rx in cell
 Nonselective interaction No Rx with receptors or
enzymes.

130
Q

agonists

A

Mimics action of the receptor
• A drug that has high affinity and intrinsic activity-
(ability of drug to be bound to receptor)
• Affinity -> promotes binding (level of degree
drug attaches or binds with receptor)
• IntrinsicActivity -> allows the
bound agonist to activate the
receptor

131
Q

antagonists

A 
Blocks action of the receptor
• Acts to prevent receptor activation by
endogenous (internal origin) regulatory
molecules and agonist
drugs
• High affinity but no intrinsic activity
132
Q

pharmacotherapeutics - types of therapies

A

 Acute therapy- CC
 Maintenance therapy- Prevent progression of disease, tx;HTN, BC
 Supplemental/replacement therapy-replace substance needed, tx;
Insulin, thyroid
 Palliative therapy- EOL, C/care
 Supportive therapy-recovery post Op or trauma, bldafter surgery
 Prophylactic therapy- prevent illness, vaccines
 Empirictherapy- clinical problem- ex: antibxfor sepsis

133
Q

contraindications

A

 Any characteristic of the patient, especially a
disease state, that makes the use of a given
medication dangerous for the patient
 It is important to assess for contraindications!

134
Q

monitoring

A 
Evaluating the clinical response of the patient to
the treatment
 One must be familiar with the drug’s:
• Intended therapeuticaction(beneficial)
• Unintendedbut potential adverseeffects
(predictable, adverse drug reactions)
135
Q

monitoring 2

A

 Therapeuticindex- ratio TI=LD50/ED50
 Drugconcentration
 Patient’s condition-infection/CV/GI/Stress/ depression/anxiety
 Tolerance and dependence-I
is physiological or psychological response to repeated doses
 Drug interactions (additive effect, synergistic
effect, antagonistic effect, incompatibility)- action
of one drug by another
 Adverse drug events-
( Additive effect= 1+1=2, Synergistic effect= 1+1>2, Antagonis

136
Q

monitoring - adverse drug reactions

A

 Pharmacologic reactions, including adverse effects-
(drug too effective dec BP)
 Hypersensitivity (allergic) reaction
Pt immune sys, histamines cytokines rash- airway
 Idiosyncratic reaction- unexpected rx
 Drug interaction2 or more drugs together in

137
Q

other drug-related effects

A 
Teratogenic
Structural defects to Fetus
 Mutagenic
Permanent change to genetic DNA:
Radiation/virus/chemicals
 Carcinogenic
Cancer causing
138
Q

drug effect

A

Side Effects
• AdverseEffects
• Allergic Effects
• Drug Induced Reactions

139
Q

Side effects are usually

A

predictable secondary
effects such as anorexia, nausea, vomiting,
dizziness, drowsiness, dry mouth, abdominal gas
or distress, constipation, and diarrhea.

140
Q

 Adverse effects are

A

unintended, undesirable, and
often unpredictable drug effects that range from
mild to fatal.

141
Q

drug-induced reactions look up

A 
 Tolerance
 Tachyphylaxis
 Cumulative effect
 Idiosyncrasy
 Drug dependence
 Drug interaction
 Drug antagonism
 Summation
 Synergism
 Potentiation
142
Q

cultural considerations

A

 Influenceof ethnicity on genetics and drugresponse
 Drugpolymorphism-various drug resistance d/t ptage, gender,
size, body composition
 Compliance level with therapy
 Environmental and economic considerations
 Barriers to adequate health care for culturally diverseLanguage, poverty, access, pride, belief in medicine, need for
Cultural Assessment

143
Q

cultural assessment

A 
 Languages spoken
 Health beliefs and practices
 Past uses of medicine
 Herbal treatments, folk remedies, home remedies
 Over-the-counter drugs and treatment
 Usual response to illness
 Responsiveness to medical treatment
 Religious practices and beliefs
 Support from the patient’s cultural community
 Dietary habits
144
Q

legal considerations

A

tate and federal legislation- FDA, DEA, CA Board of Nursing, DPH
 Nurse practice acts
o Scope of nursing practiceo Expanded nursing roles
o Educational requirements
o Standards of care
o Minimally safe nursing practice
o Differencesbetween nursing and medical practice
(Nursing= Caring Medical= Curing)
Only MD, APN, NP, OD, Dentist, Pod

145
Q

legal considerations 2

A

Guidelines from professional nursing groups
 Institutional policies and procedures, state and
federal hospital licensing
 Case law or common law- relies on records of similar
situations/status d/t no official legal code to apply to the
case.
 HIPAA- Privacy Lay for Healthcare records

146
Q

ethical considerations

A 
 American NursesAssociation (ANA) - Codeof
Ethicsfor Nurses- www.nursingworld.org
 International Council of Nurses (ICN) - Code of Ethics
for Nurses
 Duty
 Breach of Duty
 Causation
 Damage
( Book, page 58
147
Q

Tachyphylaxis

A

refers to a quickly developing tolerance that occurs after repeated
administration of a drug. (NTG in chest pain)

148
Q

Cumulative effect occurs when

A

the body cannot metabolize one dose of a drug

before another dose is administered. (1+1 = 1.5)

149
Q

Summation (addition or additive effect) occurs when

A

the combined effect of two
drugs produces a result that equals the sum of the individual effects of each
agent. (1+1 =2)

150
Q

Tolerance refers to a

A

decreased physiologic response that occurs after repeated

administration of a drug or a chemically related substance

151
Q

Drug Dependence is the term preferred over

A

the previous terminology of

“habituation” and “addiction” can be physical or psychological

152
Q

Synergism describes a drug interaction in which the

A

combined effect of drugs is

greater than the sum of each individual agent acting independently. (1+1 =3)

153
Q

Idiosyncrasy is any

A

abnormal of peculiar response to a drug which may manifest by
itself by
1)overresponse or abnormal susceptibility to a drug
2) under response, which demonstrates abnormal tolerance
3) a qualitatively different effect from the one expected, such as excitation after the
administration of a sedative
4) unpredictable and unexplainable symptoms. often from genetic enzymatic
deficiencies.

154
Q

Potentiation refers to the

A

concurrent administration of two drugs in which one drug

increases the effect of the other drug. (PI booster in HIV therapy)

XIO (393 decks)

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