Pharm Deck - Exam 1 Flashcards
Chapters 1-8, 33-39
1
Q
What is “therapeutics”
(Pharm Ch 1. pg 4)
A
Therapeutics is concerned with the prevention of disease and treatment of suffering
2
Q
What is “pharmacotherapy”?
(Pharm Ch 1. pg 4)
A
aka “pharmacotherapeutics” is the application of drugs for the purpose of treating diseases and alleviating human suffering.
3
Q
What is a drug?
(Pharm Ch 1. pg 4)
A
a drug is a chemical agent capable of producing biologic responses with in the body.
The responses may be desirable (therapeutic) or undesirable (adverse).
4
Q
What is a biologic?
(Pharm Ch 1. pg 4)
A
biologics are agents naturally produced in animal cells, by microorganisms, or by the body itself.
Biologics are large, complex molecules or mixtures of molecules that may be composed of living material e.g., hormones, monoclonal antibodies, antibodies, nat. blood products & components, interferons, and vaccines.
5
Q
Biosimilar Drugs or Biosimilars
A
chemically synthesized drugs that are closely related to biologic medications having already received FDA approval. Maybe referred to as “reference products.”
Biosimilars are NOT required to undergo rigorous preclinical/clinical trials.
6
Q
Complementary and alternative medicine (CAM) therapies.
A
Natural plant extracts, herbs, vitamins, minerals, dietary supplements. Might include body-based practices i.e., physical therapy, massage, acupuncture, hypnosis, and biofeedback
7
Q
Therapeutic Classification
A
What is the drugs therapeutic USEFULNESS in treating a particular disease? e.g. Cardiac medicine: anticoagulant, antihyperlipidemic, antihyperintensive, etc. Also can be simply written as “drug used for stroke,” or “drug used for shock.” The key is to clearly state what a drug does clinically.
8
Q
Pharmacologic Classification
A
Addresses a drug’s mechanism of action, or how a drug produces a PHYSIOLOGIC effect in the body e.g., a drug that lowers plasma volume is classified as a “diuretic,” a drug that blocks heart calcium channels is classified as a “calcium channel blocker.”
9
Q
Chemical Name
A
Assigned using IUPAC nomenclature. A drug only has ONE chemical name, often COMPLICATED and DIFFICULT to remember or pronounce. Example: diazepam’s chemical name is 7-chloro-1
10
Q
Generic Name
A
Assigned by UANC. Usually less complicated and easier to remember. THERE IS ONLY ONE generic name for each drug.
Example: ibuprofen is the GENERIC name for Advil (trade name).
Keep in mind: Biosimilars (hormones, etc.) are NOT exact copies of original medications so they should not be called generic medications, instead biosimilars use the generic name of the drug FOLLOWED by 4 lowercase letters. Example: infliximab-abda.
11
Q
Trade Name
A
Short, EASY to remember and is assigned by the COMPANY that is MARKETING 💵 the drug. Also can be referred to as proprietary or brand name. Example: Advil, Benadryl , Excedrin.
Remember: A drug developer is given exclusive rights to name and market the drug for 17 years after a new drug application is submitted.
12
Q
Differences between Generic & Trade Named Drugs
A
The answer is unclear and depends. Dosages may be identical, but drug FORMULATIONS are not always the same (I.e., different inactive or filler ingredients)
The key to comparing trade and generic may lie in measuring their bioavailability.
13
Q
Bioavailability
A
the physiologic ability of the drug to reach its TARGET cells and produce its EFFECT.
14
Q
Critical Thinking: what is a prototype drug, and how does it differ from other drugs in the same class?
A
Prototype drugs exhibit typical or essential features of the drugs within a specific class. By learning the characteristics of the prototype drugs, students may better anticipate the actions and adverse effects of other drugs in the same class.
15
Q
Critical Thinking: what are biosimilar drugs? How do they differ from generic drugs?
A
Biosimilar drugs are drugs which are highly similar to biologic medications that have already received FDA approval. They are chemically synthesized and not required to undergo rigorous preclinical/clinical testing.
Because biosimilars are not exact duplicate copies of original medications (reference products) they should NOT be called generic medications.
16
Q
What is a “pharmacopeia”
A
A comprehensive publication of drug standards; medical reference summarizing standards of drug purity, strength, and directions for synthesis.
17
Q
What is the FDA (US Food and Drug Administration)?
A
Established in 1988, exercises control over whether prescription and OTC drugs may be used for therapy.
Mission:
1. facilitating the availability of safe, effective drugs, keeping unsafe products off the market.
2. Provide clear easy to understand drug labels
However… herbal and dietary suppliments can be marketed withOUT prior approval from the FDA.
18
Q
What is a “black box warning”?
A
1997 FDA created to regulate drugs with “special problems.” A black box serves as a primary alert for identifying EXTREME adverse drug reactions i.e., death or serious injury.
19
Q
Phases of Approval for Therapeutic and Biologic Drugs
A
- Preclinical Investigation
- Clinical Investigation (3 phases)
- Review of the New Drug Application
- Post marketing Surveillance
20
Q
Preclinical Investigation
A
extensive laboratory research; testing on human and microbial cells cultured in the lab; Studies are performed in several species of animals; preclinical results are always considered inconclusive.
21
Q
Clinical Investigation
A
Clinical Phases
1: Tests performed on volunteers to determine proper dosage, assess adverse effects
2: large groups of selected patients with the particular disease are then given the medication.
3: Is the drug effective? Did it make things worse? Does it safely interact with other meds?
22
Q
New Drug Application
A
3rd phase of the drug approval process; drug’s trade name is finalized; FDA has 6 months to review drug
23
Q
Postmarketing Surveillance
A
Final phase to survery for harmful drug effects in a larger population;
24
Q
Prescriptive Authority for Nurses
A
ADVANCED practice nurses can prescribe drugs; regulated by state law
25
Dependence
The physiologic or psychologic NEED for a substance.
physical dependence refers to an altered physical condition caused by the adaptation of the nervous system to repeated drug use; when drug is no longer available the individual expresses physical signs of discomfort known as WITHDRAWL.
psychological dependence typically shows few physical signs of discomfort however the individual feels an INTENSE , COMPELLING desire to continue drug use.
26
What is a "controlled substance"?
What is a "scheduled drug"?
A drug that is restricted by the CSA of 1970. This law states that drugs that have a significant potential for ABUSE are placed into 5 categories called schedules.
Scheduled drugs are classified according to their potential for abuse ranked 1-5, 1 having the highest potential for abuse.
27
Can a telephone order be taken by the pharmacy for a controlled substance?
NOPE!!! Also refills are not permitted, a patient must see their doc once a month for a new written script.
28
What is a tetragon?
a substance that has the potential to cause a defect in an unborn child during a mother's pregnancy.
Classifications are: A,B,C,D and X. Category A is the safest group while X poses the most danger to fetus
29
Identify opportunities the nurse has in educating about, administering, and monitoring the proper use of drugs?
The nurse is reponsible for safe administration, monitoring for therapeutic and adverse effects, and providing education.
Learning pharmacology, proper administration, and pt education are all nursing responsibilities.
30
A nurse is preparing to give a patient a med and notes that the drug is a Schedule 3. What info does this tell the nurse about this medicaiton?
A schedule 3 drug has a moderate abuse potential, moderate potential for physical dependency, and high potential for psychologic dependency
31
The nurse's responsibilities when administering drugs:
*hint* it's a lot
Knowledge and Understanding of the following:
1.what drug is ordered
2.Name (generic and trade) AND drug classification
3. Intended or proper use
4. effects on the body
5. Contraindications
6. Special considerations (e.g., how does age/weight/body fat distribution/individual pathophysiologic states affect pharmacotherapeutic response)
7. Side effects
8. Why the med has been prescribed for this particular patient
9.how is the medication supplied by the pharmacy
10. how will med be administered, including dosage ranges
11. what nursing process considerations r/t the medication apply to this patient
32
Some unfavorable effects are not preventable, the nurse must be prepared to recognize and respond to potential harmful effects of medications, such as?
1. adverse event and/or effect
2. side effects
3. allergic reaction
4. anaphylaxis
33
What is an adverse event?
any undesirable experience associated with the use of a medical product in a patient.
AEs are generally described in terms of intensity (e.g., mild, moderate, severe, life threatening)
remember...a serious adverse event SAE is used to define threat of death or immediate risk of death
34
What is an adverse effect?
Can be used interchangeably with adverse event; Most use adverse effect; An AE warrant either lowering the dose or discontinuing use of drug.
don't confuse with "side effect"!
35
What is a side effect?
Describes a nontherapeutic reaction to a drug; may be transient, but not always the case. They may require nursing intervention, but most of the time they are perceived as TOLERABLE e.g., fatigue, mild pain
36
what is an allergic reaction?
an acquired hyper-response of body defenses to a foreign substance (allergen).
Signs may vary: rash, pruritis, edema, runny nose, red eyes.
37
What is the nurse's responsibility when a patient has a known allergy?
1. alert all personnel by DOCUMENTING the allergy in medical record and by appropriately labeling patient records and the medication administration record (MAR).
A bracelet should be placed on the patient.
Communicate with physician and pharmacy
38
What is anaphylaxis?
What are the symptoms?
A severe type of allergic reaction that involves a MASSIVE, SYSTEMIC release of histamine and other chemical mediators of inflammation that can lead to life threatening shock.
Symptoms: acute dyspnea, hypotension, tachycardia.
Requires immediate treatment❗️
39
What is toxic epidermal necrolysis (TEN)
Severe, deadly allergic reaction, widespread epidermal SLOUGHING, occurs when liver fails to properly breakdown drug thus cant be excreted normally
associated with teh use of some anticonvulsants, carbamazepine, sulfamethoxazole, and other drugs, but can occur with any drug
40
What is Stevens-Johnson Syndrome (SJS)?
Often prompted by the same or similar drugs as TEN, usually within 1 to 14 days of pharmacotherapy;
usually signaled by nonspecific upper respiratory infection with CHILLS, FEVER, MALAISE;
generalized BLISTER-LIKE lesions follow within a few days, skin sloughing may occur on 10% of body
41
What are those Five Rights of Drug Administration!
What are some additions?
1. Right patient
2. Right medication
3. Right dose
4. Right route of administration
5. Right time of delivery
additions:
right to refuse medication
right to receive drug education
right preparation
right documentation
42
What action does the nurse take when a patient refuses a medication?
it is the nurse's responsibility to EDUCATE the patient on the benefits and risks, assess for fears and reasons why refusing, the nurse should notify doc and DOCUMENT all of the information.
43
What are the 3 checks of drug administration?
1. Checking the drug with MAR when removing it from the medication drawer
2. Checking the drug when preparing it, pouring it, etc
3. Checking the drug before administering it to a patient
44
The nurse must address essential information that the patient must know in regards to their medication - what are they?
name of drug
why its been ordered
expected drug actions
side effects
potential interactions
45
What is a STAT order? How is an ASAP order different?
a med that is needed immediately and is to be given only once; within 5 minutes; often associated with emergencies
An asap is not considered urgent, it should be administered to patient within 30 minutes of written order.
46
What is a standing order?
*Remember what a single, prn, routine order is :)
written in ADVANCE of a situation that is to be carried out under SPECIFIC circumstances.
Example: set of postoperative prn rx that are written for all patients who have undergone a specific procedure.
"tonsillectomy: "Tylenol elixir 325 mg PO q6h prn sore throat"
standing orders are no longer permitted in some facilities.
47
Why is timing of a medication important?
drug may cause gi issues - take with meal, others shoudn't be taken with food, some may cause sleepiness and should be taken at night, viagra should be taken 30 to 60 minutes before sex.
48
When do nurses document administration of a medication?
AFTER administration! NOT during preparation!
document: drug, dosage, time, any assessments, nurses signature, patient refusal and why.
49
Systems of measurement:
Metric
Apothecary
Household
What specific measurement is no longer used and why?
Metric: most common, vol: liters or milliliters, weight: kg, g, mg, mcg, length: cm
apothecary: old system, joint commission has added to DO NOT USE list
Household: typical household measurements such as tablespoon, cup, etc. know your conversion table
*the cubic centimeter cc is equivalent to 1 mL of fluid, HOWEVER cc can be mistaken for "u" and cause medication errors. No longer used in most facilities
50
How do we identify the patient for safe drug administration?
Ask patient to state full name while checking id band and comparing this info with the MAR and date of birth.
51
After identification, what do we ALWAYS ask a patient?
"Do you have any allergies (known)?"
52
What do we tell the patient about the drug?
name, expected actions, common adverse effects, how it will be administered.
53
Why is properly positioning a patient important?
Avoid possibility of choking/aspiration
54
Routes of Drug Administration:
What is the enteral route?
given orally, nasogastric, or thru gastrostomy tubes
most common, convenient, least costly, safest (in an overdose meds remaining in stomach can be retrieved by inducing vomiting)
55
What are some of the absorptive surfaces via the enteral route?
oral mucosa, stomach, small intestine
56
Why can't we just crush a medication for convience?
Some drugs are inactivated by crushing or opening, others may irritate stomach mucosa and cause nausea or vomiting, they are bitter, may stain teeth.
57
What is an enteric-coated tablet?
Where does it dissolve?
What will happen if an enteric-coated tablet is opened and then taken?
hard, waxy coating that resists acidity; designed to dissolve in the alkaline environment of small intestine; if opened the med would be directly exposed to the stomach environment
58
What is an SR med? What are some other abbreviations?
How does an SR med help the patient adhere to a medication schedule?
“Sustained Release”
adherence to a drug regiment declines as the number of doses per day increases, allows for conviene of once or twice a day dosing
an SR are designed to dissolve slooooowly and med is released over an extended time and results in longer duration of action for the med
XR(extended-release)
LA (long-acting)
59
What are some of the disadvantages of oral route?
pt must be conscious, able to swallow, certain types of drugs are inactivated by digestive enzymes in the stomach and small intestine; gi motility and its ability to absorb can create differences in its bioavailability
VERY important to remember**meds absorbed from stomach and sml intestine first travel to the liver where they may be inactivated before they ever reach their target organs -The First-Pass Effect
60
Enteral Drug Administration:
Explain Sublingual and Buccal Drug Admin
**when multiple drugs are ordered, in what order would you administer sublingual or buccal drugs?
tablet not swallowed but kept in the mouth; mucosa of oral cavity contains rich blood supply for excellent absorbption and meds are not exposed to destructive digestive enzymes and avoid First-pass effect.
sublingual/buccal drugs given after oral medications that need to be swallowed
pg 25 provides specific guide of administration guidelines for enteral route
61
Nasogastric & Gastrostomy Drug administration:
What form does a drug to be administered usually take?
Can crushed meds be given?
liquid form;
Yes..it depends (look at table 3.3 and/or pg 26) "although solid drugs can be crushed or dissolved, they tend to cause clogging within the tube, SR should NOT be administed thru these tubes."
62
what are the different types of Topical Administrations?
1.Dermatologic preparations
2.instillations and irrigantions (drugs applied into body cavities or orifices; ears, rectum, vagina etc)
3. Inhalations
63
Why would a drug be applied topically?
many drugs needed to produce a LOCAL effect e.g., antibiotic for a skin infections, corticosteroids sprayed into nose, etc.
HOWEVER for some drugs it allows for slow release and absorption of the drug in the general circulation. These agents are used for their systemic effects example: nitroglycerin patch is applied not to treat a skin condition but a systemic cond. like coronary artery disease. another example is compazine suppositories are inserted rectally not to treat disease of rectum but to alleviate nausea
64
Tell me about nasal administration
nasal route is used for local AND systemic drug administration; nasal mucosa excellent absorption; advantages: ease of use, avoid first-pass and digestive enzymes;
Disadvantages: potential damage to the cilia and mucosal irritation
65
Nasal Route: with drops or sprays what is an astringent effect?
SHRINKS swollen mucous membranes or LOOSEN secretions and facilitate DRAINAGE
66
What are some different forms a medication may take when used for a vaginal condition?
cream, gel, foam, suppository
*have patient empty bladder prior to administration
67
Tell me about rectal administration
may be used for local and systemic drug administration; safe for comatose patients or those who are nauseous or vomiting; may be a suppository or an enema; avoids first pas effect
68
What is parenteral drug administration?
Is it invasive? How so?
dispensing of meds by routes other than oral or topical; delievers drugs via NEEDLE into skin layers sub q tissue, muscles, or veins;
much more INVASIVE; potential for introducing pathogenic microbes directly into the blood or body tissues, needs ASEPTIC technique.
69
tell me about ID injections. advantages? what are they usually used for? injection sites?
admin into dermis; easy absorbtion; usually used for allergy and disease testing or for local anesthetic; limited to very small volumes of drug (0.1-0.2 mL);
usual sites: non hairy upper back, over scapulae. high upper chest, inner forearm
Example: tuberculosis test
69
What are some of the advantages of intradermal/sub q admin? disadvantages?
advantages: offer a means of admin drugs to patient who can’t swallow them orally, avoid first-pass effect
disadvantages: only small volumes can be administered, pain/irritation at injection site
70
tell me about subcutaneous injections
deeper tissue; insulin, heparin, vitamins, some vaccines are given in this site because they are easily accessible and rapid absorption; sml volume of drug (0.5-1 mL)
sites: upper arm above triceps, anterior thigh, abdomen, etc
71
Tell me about IM injections
muscle tissue has rich supply of blood, med moves quickly into blood vessels more rapid onset of action; larger vol (1-3 mL)
72
Tell me about intravenous IV medications
admin directly to blood stream, immediately available for use by the body; bypasses first pass and digestive enzymes;
73
What are the 3 basic types of IV administration?
1. large-volume infusion
2. intermittent infusion
3. IV bolus (push) administration
74
What is a large-volume infusion?
used for fluid maintenance, replacement, or supplementation.
75
what is intermittent infusion?
small amount of iv solution that is arranged in tandem with or piggybacked to the primary large volume infusion. it is used to instill adjunct meds, such as antibiotics or analgesics, over a short period of time
76
what is IV bolus (push) administration?
this is a CONCENTRATED dose delivered directly to the circulation via syringe to administer single dose meds
77
What makes an IV injection dangerous?
although its the fastest onset of drug action, once injected the med CANNOT be retrieved; possible pathogen introduced to bloodstream and body tissues.
Remember some adverse reactions may take minutes or days, antidotes must always be readily availiable.
78
Why do errors continue to occur despite nurses' following the 5 rights and 3 drug check of administration?
pg 824
79
what strategies can the nurse use to ensure adherence to drug therapy for a patient who is refusing to take his medication?
pg 824
80
compare routes of administration.. which has fastest onset of drug action? which routes avoid first pass effect?
pg 824
81
What is pharmacokinetics
the study of drug movement throughout the body. In practical terms, it describes how the body deals with medications.
82
What are some of the obstacles that drugs face when trying to reach their target cells?
for most meds, the greatest barrier is crossing the many MEMBRANES that separate the drug from its target cells;
Drugs are subject to many physiologic processes: stomach acids, enzymes;
Drugs may also be seen as a foreign body and phagocytes may attempt to remove it;
The kidneys, large intestine, and other organs attempt to excrete medications from body
83
What are the 4 processes of pharmacokinetics?
1. absorption
2. distribution
3. metabolism
4. excretion
84
The passage of drugs through plasma membranes:
1. Explain active transport
2. explain diffusion or passive transport
1. active transport is the movement of a chemical AGAINST a concentration gradient (low to high); requires expenditure of energy on the part of the cell
2. movement of a chemical from an area of higher concentration to an area of lower concentration; no energy expenditure on the part of the cell
85
What makes up a plasma (cell) membrane?
How does this apply to pharmacokinetics?
lipid bilayer, with proteins and other molecules interspersed in the membrane; this LIPOPHILIC it loooooves other fats 💕 membrane is relatively impermeable to large molecules, ions, and polar molecules.
drug molecules that are small, nonionized, and LIPID-soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells.
(However…keep in mind small, WATER-soluble agents, such as urea, alcohol, and water can enter through pores in the plasma membrane.
large molecules, ionized drugs, and water-soluble agents will have more difficulty crossing plasma membranes. They may use other means to gain entry, such as carrier proteins or active transport.
Drugs may not need to enter the cell to produce their effects! Once bound to a receptor some drugs activate second messengers within the cell, which then produce physiologic changes
86
Pharmacokinetics:
Explain Absorption
What is the rate of dissolution?
the process involving the movement of a substance from its site of administration, across body membranes, to circulating fluids. Most drugs must be absorbed to produce an effect.
primary pharmacokinetic factor determining the length of time it takes a drug to produce its effect.
Remember, in order for a drug to be absorbed it must be dissolved. The rate of dissolution determines how quickly the drug disintegrates and disperses to simpler forms; in general, the more rapid the dissolution the faster the drug absorption and the faster the onset of drug action
***however some drugs have shown good clinical response as slowly dissolving drugs e.g., throxine (reverses hypothyroid symptoms)
87
What characteristics of a drug influence how its absorbed?
1. drug formulation - liquid absorbed faster than tablets
2. dose - high dose is generally absorbed more quickly than low dose
3. route of administration - iv drugs are absorbed faster than oral, topical, im routes
4. size of drug molecule - larger drug molecules take longer to be absorbed.
5. surface area of absorptive site- the larger the surface area the faster the drug will be absorbed
6. digestive motility - changes in gi motility may either speed up or slow down absorption
7. blood flow - greater blood flow greater absorption
8. liquid solubility of drug - lipid soluble drugs are absorbed more quickly than water soluble drugs
88
Use aspirin as an example as how a drug's ionization can affect how it is absorbed. (pg 39)
a drug's ability to become ionized depends on the surrounding pH. In the acid environment of the stomach, aspirin is in its NONIONIZED form and thus readily absorbed and distributed by the bloodstream.
As aspirin enters the alkaline environment of the small intestine, however it becomes IONIZED. In its ionized form, aspirin is not likely to be absorbed and distributed to target cells.
Unlike acidic drugs, medications that are weakly basic are in their nonionized form in an alkaline environment.
Therefore, basic drugs are absorbed and distributed better in alkaline environments such as the small intestine.
Basically, acids are absorbed in acids and bases are absorbed in bases
89
What is distribution in pharmacokinetics?
What determines how a drug is distributed?
involves the transport of drugs throughout the body AFTER they have been absorbed or injected.
distribution is determined by the amount of blood flow to body tissues. The heart, liver, kidneys, and the brain receive the most blood supply; skin, bone, and adipose tissue receive a lower blood supply.
90
what is affinity in pharmacokinetics?
Some tissues have the ability to accumulate and store drugs after absorption. The bone marrow, teeth, eyes, and adipose tissue have an especially high affinity or attraction for certain meds.
Example: tetracycline binds to calcium salts and accumulates in the bones and teeth
91
Explain drug-protein complexes
Not all drug molecules in the plasma will reach their target cells, because many drugs bind reversibly to plasma proteins (particularly ALBUMIN*) to form drug-protein complexes.
Drug-protein complexes are too large to cross capillary membranes; thus the drug is not available for distribution to body tissues.
This means that the drug-protein circulates in the plasma until they are released or displaced from the drug-protein complex they have formed.
only unbound (free) drugs can reach their targets cells or be EXCRETED by the kidneys.
Anticoagulant warfarin (Coumadin) is HIGHLY bound, 99% of the drug in the plasma is bound in drug-protein complexes and is unavailable to reach target cells.
Drugs and other chemicals compete with one another for plasma protein-binding sites, and some agents have a greater affinity for these binding sites than other agents.
92
What are the different types of drug-drug interactions?
1. addition
2. synergism
3. antagonism
4. displacement
93
Addition
a drug to drug interaction; the action of drugs taken together as a TOTAL
94
Synergism
a drug to drug interaction; the action of drugs resulting in a POTENTIATED (more than total) effect
95
antagonism
drug to drug interaction; drugs taken together with blocked or opposite effects
96
displacement
drug to drug interaction; when drugs are taken together, one drug may shift another drug at a nonspecific protein-binding site (e.g., plasma albumin), thereby altering the desired effect
97
The fetal-placental barrier
protective function, prevents potentially harmful substances from passing to mother to fetus; however substances such as alcohol, cocaine, caffeine, and certain rx easily cross teh barrier
98
metabolism of medications
metabolism or "biotransformation" is the process of chemically converting a drug to a form that is usually more easily removed from the body.
99
which organ is the primary site of drug metabolism?
the liver, although the kidneys and cells of the intestinal tract also have high metabolic rates
100
what is a conjugate?
meds undergo many types of biochem reactions as they pass through the liver, including hydrolysis, oxidation, and reduction.
during metabolism the addition of side chains known as conjugates makes drugs more water soluble and more easily excreted by the kidneys
101
Okay, explain to me the hepatic microsomal enzyme system aka the P450 system
Okay more details page 41 but essentially...
P450 refers to cytochrome P450 (CY450). There are over 50 types of these enzymes.
CYPS are simply enzymes that metabolize drugs as well as nutrients and other endogenous substances.
CYP enzymes primary actions are to inactivate drugs and accelerate their excretion; however this can produce a chemical alteration that makes the resulting molecule MORE active than the original.
Example: codeine undergoes biotransformation to morphine which has a significantly greater avility to relieve pain
102
what considerations should we make for patients with decreased hepatic metabolism
infants and older patients generally have reduced hepatic enzyme activity therefore they are more sensitive;
patients with cirrohosis will require reductions in drug dosage;
genetic factors must be considered and dosage adjusted accordingly
103
What is the primary organ responsible for excretion?
the kidneys
Remember... free drugs (not bound to a protein), water soluble agents, electrolytes, and small molecules are easily filtered; however proteins, rbcs, and drug-protein complexes are too large to excrete.
104
wow this chapter is dense...okay. What factors affect drug excretion?
liver or kidney impairment
blood flow
degree of ionization of the drug
lipid solubility of the drug
drug-protein complexes (remember warfarin?)
metabolic activity
acidity or alkalinity
respiratory, glandular, or bilary activity
105
minimum effective concentration
the amount of drug required to produce a therapeutic effect.
106
toxic concentration
level of drug that will result in serious adverse effects
107
therapeutic range
the plasma drug concentration between the minimum effective concentration and the toxic range
108
onset of drug action
the amount of time it takes to produce a therapeutic effect after drug administration
109
peak plasma level
when the medication has reached its highest level of concentration in the bloodstream; HOWEVER❗️ depending on the accessibility of meds to their targets, peak drug levels are not necessarily associated with optimal therapeutic effect.
110
duration of drug action
amount of time a drug maintains its therapeutic effect
111
what variables affect the duration of drug action?
drug concentration
dosage
route
drug-food/supplement/herbal/drug interactions
112
plasma half-life
the most common description of a drug's duration of action; the length of time required for a meds plasma concentration to decrease by one-half after administration; the longer a med takes to be excreted the greater the half life.
example: a drug with a half life of 10 hours would take longer to be excreted than a drug with a half life of 5 hours
113
what is a loading dose? why is it important?
a higher amount of drug, often given only once or twice to "prime" the blood stream with a sufficient level of the drug;
loading doses are important for drugs with prolonged half lives and for situations and for situations in which it is critical to raise drug plasma levels quickly e.g., antibiotics for a severe infection
114
median effective dose
the dose required to produce a specific therapeutic response in 50% of a group of patients. "average"
115
potency
a concept to compare drugs with in the same class; A drug that is more potent will produce a therapeutic effect at a LOWER dose, compared with another drug in the same class.
116
efficacy
method to compare drugs; efficacy relates to the magnitude of maximal response that can be produced
remember efficacy is considered more important than potency (the patient most likely wants relief from discomfort and doesnt give a shit about potency)
117
receptor
a cellular macromolecule to which a medicaiton binds in order to initiate its effects. pg 51 explains more indepth
once bound a drug may trigger a series of second messenger events within the cell i.e., a biochemical casacade;
Example:
Drug binds to a receptor thus producing an action.
Drug M + Receptor = Growth of Mustache
118
agonist
a drug that produces the same type of response as a endogeneous substance;
basically it will either copy the body's normal response or ENHANCE the body's normal response
agonists sometimes produce a greater maximal response than the endogenous chemical
119
what is a partial agonist or agonist-antagonist drug
describes a medication that produces a weaker, or less efficacious response than how a full agonist drug would
120
what is an antagonist
a drug will occupy a receptor and PREVENT the endogenous chemical from acting
basically used to reduce or totally eliminate the body's normal response
Good example: opioid and narcan
Patient overdoses on opioid (the opioid is now hogging ALL of the receptor sites. Not good) doc gives narcan an antagonist which BUMPS the opioid OUT of the receptor site which keeps the opioid from producing its effects.
121
Bringing it back to fundamentals: what is the nursing process
a systemic method of problem solving: assessing, diagnosing, planning, implementing, evaluating
pg 59
122
what is a nursing diagnosis?
clinical judgements of a patient's actual or potential health problems; provide a basis for establishing goals and outcomes and evaluating effectivness of care.
nursing diagnosis focus on a patient's response to actual or potential health or life problems
123
when applied to pharmacotherapy, the diagnosis phase of the nursing process addresses three main concerns:
1. promoting therapeutic drug effects
2. minimizing adverse drug effects and toxicity
3. maximizing the patient's ability for safe care
124
What is a medication error?
any PREVENTABLE event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.
125
what factors contribute to medication errors?
- omitting one of the rights of drug administration
- failing to perform an agency system check
- failing to account for patient variables such as age, size, impairment of kidney or liver.
- ALWAYS REVIEW PATIENT LABS PRIOR TO ADMINISTRATION
- giving meds on verbal or phone orders
- giving meds based on an incomplete or illegible order when the rn is unsure of hte correct drug, dosage, or administration method.
- practicing under stressful work conditions
126
What is the most common cause of morbidity and preventable death in hospitals?
med errors
127
What will the nurse document in the patient's record after a med error?
- must include the med error, specific nursing interventions that were implemented following the error to PROTECT pt safety, such as monitoring vital signs and assessing the pt for possible complications
- the rn should also document ALL individuals who were notified of the error.
***failure to report NURSING ACTIONS implies either negligence (i.e., no intervntions were takn) or lack of acknowledgment that the incident occurred.
128
In ADDITION to documentation, what goes into reporting a medication error?
- complete a written report of the error (e.g., "incident report")
- specific details, objective
- this is NOT❗️ put in with the pt's medical records but rather the agency's risk management personnel for quality improvement❗️
- LEGAL STUFF: accurate documentation in the MR and in the incident report verify the patient's SAFETY was protected.
129
What is a sentinel event
an event that results in an unexpected, SERIOUS, or FATAL injury FOLLOWING the administration (or lack of administration ) of a medication
130
what is a patient safety event?
defined as an incident or condition that COULD have resulted or DID result in harm to a patient; this includes actual AS WELL AS potential or near misses❗️
and includes med errors as well as non-medcation related safety events such as a fall.
131
What are some strategies we can use to reduce medicaiton errors?
1. assessment - ask about ALLERGIES, current health conditions, use of OTC/herbal meds/suppliments.
how is the patient's kidney? how is their liver?
2. planning - avoid abbreviations, question unclear orders, do NOT accept verbal orders❗️
3. implementation - ELIMINATE DISTRACTIONS,
- of course positively identify patient...how do you do that? Name & DOB
- use correct technique for administration
4. Double check dose measurements, ask fellow nurse to double check
5. always confirm that a pt has swallowed an oral med. never leave the med bedside unless the order says thats okay
6. and lastly, be alert for drugs whose names look alike and sound alike
-
132
what is poly pharmacy? which patients tend to have poly pharmacy?
many older 👵🏻 patients have multiple chronic illnesses therefore they may have multiple rxs 💊 that have conflicting pharmacologic actions; this is a major challenge
133
what is medicaiton reconciliation? why is it important?
the process of tracking meds as the patient proceeds from one healthcare provider to another
this accurately lists all medications the patient is taking in an attempt to reduce duplication, omissions, dosing errors, or drug interactions this list can be shared with muliple member of the healthcare team
134
a patient states "ive never seen that blue pill before!"👵🏻
what would be the nurses most appropriate action?
VERIFY the order and double check drug label! better to be safe than sorry❗️
135
what is a teratogen
a substance, organism, or physical agent to which an embryo or fetus is exposed that produces a permanent abnormality in structure or function, causes growth retardation, or results in death.
136
Current FDA Pregnancy Category Ratings with Examples
table 8.1 page 80
137
fetal effects caused by tobacco use during pregnancy 🚬
increased chance of miscarriage
low birth weight and growth
risk of premature delivery
rick of SIDS 💀
risk for birth defects, such as cleft lip
138
which age group experiences more adverse effects from drug therapy than any other group
You guessed it! older adults! 👵🏻👴🏻
polypharmacy, degeneration of organ systems, illness, unreliable adherence
139
tell me about inflammation: what is it? what is its purpose? signs?
a body defense mechanism that occurs in response to many different stimuli including physical injury, toxic chem, heat, microorganisms, death of cells.
the central purpose: contain the injury or DESTROY the microorganism 🦠
signs: swelling, pain, warmth, redness
may be classified as acute (infection) or chronic (RA)
140
what does a chemical mediator do? Can you name me some?
the damaged tissue releases a nurmber of chemical mediators that act as ALARMS 🚨 to notify the surrounding area of injury.
chemical mediators include:
- HISTAMINE, leukotrienes, bradykinin, complement, and PROSTAGLANDINS.
*be familiar with histamine and prostaglandin, they come up later
141
tell me about histamine
key chemical mediator of inflammation; stored in mast cells; mast cells detect foreign agents or injury and respond by releasing histamine which initiates the inflammatory response within seconds
histamine DILATES nearby blood vessels, causing capillaries to become more permeable;plasma, complement proteins, and phagocytes can THEN ENTER the area to neutralize foreign agents
142
is inflammation a disease?
no its a nonspecific process that may be caused by a VARIETY of physical and infectious etiologies, it can occur in virtually any tissue or organ system
again, inflammation is a symptom of an underlying disorder; it is natural and usually self limiting
143
what are some common diseases that benefit from anti-inflammatory drugs?
allergic rhinitis, anaphylaxis, ankylosing spondylitits, contact dermititis, crohns disease, glomerulonephritis, hashimotos, peptic ulcer disease, RA, SLE, and ulcerative colitis
144
what are the two primary drug classes used for nonspecific inflammation
1. NSAIDS - preferred for mild to moderate pain, inflammation, and fever
2. corticosteroids - used when inflammation has become more severe or disabling ; due to their serious long term adverse effects, usually used for short term control of acute inflammation
145
Adverse effects of aspirin (NSAID)
stomach pain, heart burn, nausea, vomiting, tinnitus, prolonged bleeding time
***severe gi bleeding, brochospasm, anaphylaxis, hemolytic anemima, reyes syndrome in children, metabolic acidosis.
146
adverse effects of ibuprofen (NSAID)
dyspepsia, dizziness, headache, drowsiness, tinnitus,, rash, pruritus, increased liver enzymes, prolonged bleeding time, edema, nausea, vomiting, occult blood loss
*** peptic ulcer, gi bleeding, anaphylactic reactions with bronchospasm, blood dyscrasias, chronic kidney disease, myocardial infarction, heart failure, hepatotoxicity
147
Tell me about NSAIDS
"nonsteroidal anti-inflammatory drugs"
relatively HIGH safety margin, OTC; treat mild to moderate inflammation; aspirin & ibuprofen; also analgesic and antipyretic
act by inhibiting the synthesis of prostaglandins
148
NSAIDS: what is a salicylate
a chemical family e.g., aspirin is a salicylate
pg 474
149
tell me about corticosteroids (glucocorticoids)
able to suppress SEVERE inflammation; serious side effects, therefore reserved for short term treatment of severe disease
corticosteroids are natural hormones released by the adrenal cortex and have powerful effects on cells
inhibit synthesis of prostaglandins however they affect multiple inflammation mechanisms: suppress histamine release, inhibit phagocytes and lymphocytesj
150
what are some serious adverse effects of corticosteroids?
❗️suppression of NORMAL adrenal gland functions❗️; hyperglycemia, mood changes, cataracts, ulcers, electrolyte imbalances, osteoporosis, suppressing immune response (thus potentional for infections to grow)
***an active infection is usually a contraindication for corticosteroid therapy
151
corticosteroid: tell me about prednisone
synthetic corticosteroid; duration of therapy commonly 4 to 10 days;
pg 477
152
Treating a fever with antipyretics🚫🔥:
tell me about acetaminophen
trade name: tylenol, etc
theraputic class: antipyretic and analgesic
pharmacologic class: cox inhibitors(inhibits pain), hypothalamus (temp)
actions and uses: reduces fever by dilation of peripheral blood vessels which enables sweating, remember acetaminophen has NO anti-inflammatory properties ie it is not effective in treating arthritis or pain caused by tissue swelling
primary therapeutic usefulness is for the treatmet of fever in children and for relief of mild to moderate pain when aspirin is contraindicated
may be combined with opiods
BLACK BOX WARNING: potential to cause severe and eve fatal LIVER INJURY
pg 479
153
what is allergic rhinitis?
inflammation of the nasal mucosa due to expose to allergens
although not life threatening affects millions of patients
symptoms: resemble common cold, tearing, sneezing, nasal congestion, post nasal drip, itching of throat
154
Drugs used to treat allergic rhinitis are grouped into two simple categories. what are they?
1. preventers - used for prophylaxis and include antihistamines, intranasal corticosteroids, leukotriene modifiers, and mast cell stabilizers
2. Relievers - provide immediate though temporary relief for acute allergy symptoms
155
Pharmacology of allergic rhinitis with H1-receptor antagonists and mast cell stabilizers pg 603
antihistamines BLOCK the actions of histamine at the H1 receptor...histamine is a chemical mediator of inflammation that is reponsible for many symptoms of allergic rhinitis....when histamine reaches its receptors it causes itching, mucus secretion, and nasal congestion...the histamine receptors responsible for allergic symptoms are called H1 RECEPTORS....therefore antihistamines are drugs that SELECTIVELY BLOCK histamine from reaching its H1 RECEPTOR thus alleviating allergic symptoms
***H1- receptor ANTAGONIST is therefore a more specific term for antihistamine
156
H1-receptor antagonist: diphenhydramine
trade name: benadryl, etc
actions and uses: first generation h1 receptor antagonist used to treat minor symptoms of allergy adn the common cold
adverse effects: dry mouth, head ache, dizziness, etc pg 603,605
157
pharmacology of nasal congestion with decongestants: what is rebound congestion?
side effect of intranasal prepartations: characterized by hypersecretion of mucus and worsening nasal congestion once the drug wears off
158
Prototype Drug: Fluticasone
trade name: flonase, etc
actions and uses: intranasal corticosteroid used to treat seaonal allergic rhinitis
rare adverse effects
pg 607
159
what is an antitussive?
dampens cough reflex r/t common cold or allergies
159
what is an expectorant?
drugs used to reduce the thickness or viscosity of bronchial secretions, thus increasing mucus flow that can then be removed more easily by coughing
160
what is a mucolytic?
loosens thick, viscous bronchial secretion; breaks down chemical structure of mucus; therefore the mucus becomes thinner and can be easily removed by coughing
161
Pregnancy:
drug therapy is usually postponed until pregnancy is over except under serious conditions such as???
epilepsy
hypertension/gestational hypertension
gestational diabetes
infections
162
How does pregnancy affect pharmacotherapy?
1. absorption of drugs
- hormonal changes, inhaled drugs may be absorbed faster
2. distribution and metabolisim
- changes in cardiac output, plasma volume, and regional blood flow
3. drug excretion
- rate of excretion may increase
163
Recommendations for drug use during lactation?
- administer drug after breast feeding
- drugs with shorter half life are preferable
- drugs with long half life should be avoided
- select drugs with high protein binding ability
- avoid all OTC herbal, dietary supplements
164
what factors affect a drug's distribution in an older patient?
- decreased cardiac output
-increased body fat
-reduced plasma levels
-less body water
-liver produces less albumin:
1. decreased plasma protein-binding ability
2. increased level of free drugs (increases level for drug drug interaction)
165
how does an older patient's reduced meabolism affect how a drug works?
- reduced first pass metabolisim
- decreased production of liver enzymes
- plasma level elevated
- half-life of many drugs increased
-tissue concentrations increased
166
Does a person's older age affect excretion of a drug? how?
- reduced drug excretion for drugs processed by the kidneys due to decrease in kidney function
167
what is substance P?
neurotransmitter
sends pain signal to brain
168
what is an endogenous opioid?
group of neurotransmitters, may modigy sensory information, interuppting pain transmission; eg endorphins
169
what are the 3 opioid receptors?
for pain management mu, kappa, delta
170
how do opioid agonist drugs work?
stimulate mu and kappa receptors
- mechanisim of action: to interact with mu and kappa receptor sites
- primary use: to relieve moderate to sever pain; anesthesia
- examples: oxycontin, percocet
-prototype: morphine
-Adverse effects: respiratory depression, sedation, nausea, vomiting
171
how do opioid antagonist drugs work?
block mu and kappa receptors
-block opioid activity by competing for opioid receptor, reverse symptoms of addiction, toxicity and OVERDOSE
- NARCAN may be used to reverse respiratory depression and other acture symptoms
-prototype drug- narcan
172
treatment for opioid dependence
methadone maintenance; avoids withdrawls symptoms
173
what are some common non-opioid analgesics?
commonly used NSAIDS:
aspirin (bayer)
ibuprofen (motrin, advil)
ketrorolac (Toradol)
naproxen sodium (aleve)
174
what are some adjuvant analgesics?
two primary indications:
1. pain that is refractory to opioids ex intractable cancer pain
2. for neuropathic pain; diabetes, acute trauma, cancer, etc
examples: antidepressants, antiseizure, sedatives, anti-inflammatory
175
Morphine: Opioid Agonist
Trade name: Astramorph PF, Duramorph
theraputic class: opioid analgesic
pharmacologic class: opioid receptor agonist
pharmacokinetics:
onset - less than 60 minutes
peak - PO 60 minutes
IV - 20 minutes
IM - 30 -60 minutes
duration - up to 7 hours
BLACK BOX WARNING - abuse, schedule 2, no alcohol
contraindications: may intensify/mask fallbladder disease; avoid with asthma, gi obstruction, hepatic or renal impairment
treatment of overdose: naloxone
interactions: several drugs: CNS depressants, alcohol, opioids, sedatives, antidepressants, etc
176
Nalaxone: Opioid Antagonist
therapeutic class: drug for treatment of acute opioid overdose and misuse
pharmacologic class: opioid receptor antagonist
pharmacokinetics:
onset:
- iv - 1-2 minutes
-im - 2-5 minutes
-sq - 2-5 minutes
peak: 5-15 minutes
Duration: 45 minutes
actions and uses:
used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected
adverse effects: minimal toxicity, however reversal of the effects of opioids may result in rapid loss of analgesia, increased bp, tremors, hyperventalation, nausea, vomiting
BLACK BOX WARNING:
none; however naltrexone a similar opioid receptor antagonist may cause hepatic injury
177
Aspirin - Salicylates
Prototype Drug - aspirin
therapeutic class - nonopioid analgesic; NSAID (non steroidal anti-inflammatory drug); antipyretic; anticoagulant
pharmacologic class:
salicylate; COX inhibitor
pharmacokinetics:
onset: 1 hour
peak 2-4 hours
duration 24 hours
actions and uses:
Anti inflammatory (inhibits prostaglandin sysnthesis) and produces mild to moderate pain relief; significant anticoagulant activity
administration alerts:
pregnancy category D
contraindications:
increases bleeding time therefore should not be given to patients receiving anticoagulant therapy such as warfarin and heparin
adverse effects:
gastric discomfort and bleeding
lab tests:
may cause prolonged prothrombin time by decreasing prothrombin production. may interfer with pregnancy tests
overdose treatment:
activated charcoal, gastric lavage, laxative
178
Sumatriptin - Imitrex
therapeutic class: antimigraine drug
pharmacologic class: triptan; 5-HT (serotonin) receptor drug; VASOCONSTRICTOR of intracranial arteries
pharmacokinetcs
onset: PO 30 minutes
peak: PO 2 hours
Duration: 24-48 hours
actions adn uses:
antimigraine, vasoconstriction of cranial arteries
administration alerts:
may produce cardiac ischemia, hypertension, dysrhythmias, MI, pregnancy category C
adverse effects: dizzy, drowsy, warming sensation
Serious adverse effects: CORONARY ARTERY VASOSPASM, MI, CARDIAC ARREST
contraindications:
patients with recent MI, hx of angina pectoris, hypertension, diabetes, serious renal impairment, serious hepatic impairment
179
what is a prostaglandin?
lipids found in all tissues that have potent physiological effects, including INFLAMMATION
180
what is a cyclooxygenase COX
a key enzyme in the biosynthesis of prostaglandins
181
NSAIDS Mechanisim of action
acts by inhibiting the systhesis of prostaglandins; it inhibits COX 🍆
Remember… COX (1 and 2) enzymes synthesize prostaglandins which cause…INFLAMMATION
182
what is salicylism
a syndrome from high doses of salicylates that has symptoms including tinnitus, dizziness, headache, excessive sweating
183
Ibuprofen
NSAID
inhibit COX 1 and 2 🍆
treats pain, fever, and INFLAMMATION
low incidence of adverse effects
potential for gastic ulceration and bleeding
184
COX 2 inhibitor
produce analgesic, anti inflammatory, and antipyretic effects without causing risk for bleeding
treatment for moderate to severe inflammation
celebrex only remaining drug in this class
EXPENSIVE 💵💵💵
185
corticosteroids
suppressess severe inflammation
serious adverse effects therefore reserved for short term treatment of severe disease
- suppress normal function of adrenal gland REMEMBER a patient has to taper off for normal function to resume
aka glucocorticoids
186
corticosteroids mechanism of action
act by inhibiting biosynthesis of prostaglandins, supress histamine release, inhibit functions of phagocytes and lymphocytes
llimits inflammation
187
What are some drugs that can CAUSE fever?
anti-infectives, SSRIs, antipsychotics, cytotoxic drugs, immunomodulators
188
Drug Card Slides:
Ibuprofen
therapeutic class: analgesic, anti inflammatory, antipyretic
pharmacologic class: NSAID
Pregnancy Category C
Pharmacokinetics:
onset - PO 30-60 minutes
peak: 1-2 hours
duration: 4-6 hours
actions and uses:
treatment of mild to moderate pain, fever, inflammation
adverse effects:
generally mild includes nausea, heartburn, dizzy. GI ulceration with occult or gross bleeding may occur
BLACK BOX WARNING:
NSAIDS may cause increased risk of serious thrombotic events, MI, stroke which can be fatal;
NSAIDS increase hte risk of serious GI events bleeding, ulceration, perforation of stomach
Drug-drug interaction:
should be avoided when taking anticoagulants
labs:
ibuprofen may increase bleeding time
189
Prednisone
theraputic class: anti inflammatory drug
pharmacologic class: corticosteroid
Pregnancy category c
pharmacokinetcs:
onset: po 1-2 hours
peak: 1-2 hours
duration: 24-36 hours
actions and uses:
synthetic corticosteroid; used for inflammation; limitied use 4 to 10 days
adverse effects:
long term use may result in CUSHINGS syndrome, may cause gastric ulcers
lab tests:
may inhibit antibody resonse to toxoids and vaccines adn may increase blood glucose
contraindications:
patients with active viral, bacterial, fungal, infections
190
Acetaminophen (tylenol)
therapeutic class: antipyretic and analgesic
pharmacologic class: centrally acting COX inhibitor
pregnancy category b
pharmacokinetcs
onset 30-60 min
peak 0.5-2 hours
duration 4-6 hours
actions:
reduces fever, NO anti inflammatory properties, NO effect on platelet aggregation, DOES NOT cause gi bleeding or ulcers (as do the NSAIDS)
adverse effects:
generally safe; not recommended for malnoursihed patiens; high dosage risk for liver damage
BLACK BOX WARNING: liver damage
drug to drug:
inhibits warfarin metabolism causing the anticoagulant to accumulate in toxic levels
lab tests:
may increase hepatic function tests such as bilirubin, AST, ALT
contraindications:
hypersensitivity to acetaminophen and alcoholism
191
Tell me about nociceptive pain
due to injury to tissues
nociceptors
transduction, transmission, modulation, perception
somatic: sharp, localized sensation e.g., step on a nail
visceral: dull, throbbing, aching e.g., kidney stone, stomach ache
192
tell me about neuropathic pain
due to injury to nerves
burning, numbing, shooting
e.g., sciatica, carpal tunnel syndrome
193
what is an endogenous opioid? what does it do?
group of neurotransmitters
may modify sensory information, interrupting transmission
endorphins, dynorphins, enkephalins
194
what is an opioid
natural or synthetic morphine like substances responsible for reducing moderate to severe pain
* all opiates are opioids, but not all opioids are opiates
synthetic: hydrocodone, oxycodone
natural: morphine, codeine
195
NSAIDS - indicated for?
-fever
-inflammation
-mild to moderate pain
196
Corticosteroids - indicated for?
- usually short term control of acute inflammation. then switched to NSAIDS
- severe or disabling inflammation
197
198
explain what a therapeutic classicfication is
based on therapeutic usefulness in treating particular diseases and disorders
199
example of a therapeutic classification
anticoagulant, antihyperlipidemic, antihypertensive, antidysrhythmic, antianginal
200
What is pharmacologic classification and can you give examples
based on the way a drug works at the molecular tissue or body system level;
addresses a drug's mechanism of action
examples: diuretic, calcium channel blocker, vasodilator, adrenergic antagonist
201
what is the key comparison between generic and trade name drugs?
bioavailability
202
what is bioavailability
the physiologic ability of the drug to reach its target cells and produce its effect
203
Ibuprofen trade name?
Advil
204
How do you calculate drip rate?
1. total volume (mL)
2. divided by time (in min)
3. multiplied by the drop factor (gtts/mL)
205
