Pharm Exam 1 Flashcards
Pharmacology
The study of drugs and their interaction with living systems
Properties of an ideal drug
effectiveness and selectivity
Effectiveness
a drug that elicits the response it was meant to
Selectivity
a drug that elicits only one response for which it was given
Therapeutic classification
what the drug does
Examples:
antihypertensives = lower blood pressure
anticoagulants = influence blood clotting
antihyperlipidemics = lower blood cholesterol
antidysrhythmics = restore normal cardiac rhythm
antianginals = treat anginas
Tachyphylaxis
quick and rapid decrease in drug responsiveness regardless of time
Tolerance
decreased drug responsiveness over time
Drug naming conventions
chemical, generic, and brand naming
Chemical naming
used by chemists and manufacturers
Generic naming
used by healthcare providers and written in lowercase
Ex: ibuprofen
Brand naming
assigned by drug manufacturers and start with CAPITAL letter
Also proprietary and trade name
Ex: Advil
Non-prescription medication
Over-the-counter medication (OTC meds)
First line of defense medications
Over-the-counter meds
Do OTC meds requires a prescription?
No
Where can you purchase OTC meds?
drug stores (CVS, Walgreens) and grocery stores (Publix)
FDA regulation that states these meds are relatively safe to take without supervision
OTC meds
OTC med examples
diphenhydramine (Benadryl)
acetaminophen (Tylenol)
ibuprofen (Advil)
Medications that are considered potentially harmful if there is no supervision over administration. Prescribed by a licensed healthcare professional.
Prescription medications
Prescription med examples
antibiotics (ceftriaxone)
antihypertensives (lisinopril)
narcotics (fentanyl)
Types of PO meds
tablet, capsules, powder, liquid
Medication release time is dependent on
the type of PO medication
Enteric-coated drugs (EC)
barrier to prevent GI upset
Extended-release drugs (ER)
last longer in the body
Extended-length drugs (EL)
release slowly over 24-48 hours
Sustained release drugs
lasts longer in the body
Can you crush or chew enteric-coated tablets?
No- can cause drug toxicity and lead to fatal OD or oropharyngeal irritation
A nurse is caring for a client who is having difficulty remembering to take their prescribed drug three times a day. The nurse should identify that which of the following alternate forms of the drug can help promote adherence to the prescribed dosage?
A. Immediate-release capsule
B. Extended-release tablet
C. Liquid suspension
D. Powder form
B. Extended-release tablet
A nurse is teaching a client about naproxen enteric-coated tablets. Which of the following statements should the nurse include in teaching?
A. “You should allow the tablet to dissolve in your mouth”
B. “Drug absorption occurs in the stomach
C. “Do not crush or chew the tablet”
D. “You should expect immediate absorption of the medication”
C. “Do not crush or chew the tablet”
Six Rights of Safe Medication Administration
- Right drug
- Right patient
- Right dose
- Right route
- Right time
- Right documentation
Additional guidelines to Safe Medication Administration
● Check expirations dates
● NEVER leave medication unattended
● Two patient identifiers
● Stay with the patient until medication is fully administered
● Record results and effectiveness
● Only administer drugs that you prepared
What is a medication error?
Any avoidable event that may cause/lead to incorrect medication use or patient harm
Nurses Rights to Safety & Quality for Med Administration
● Complete or clear orders
● Six rights
● Access to information
● Policies to guide safe administration
● Administer medications safely and to identify system problems
● Stop, think, and be vigilant when administering medication
Common routes of med administration
Oral/enteral, intravenous, intramuscular, subcutaneous, topical, transdermal, inhaled, rectal, ocular, aural, vaginal
Drug-Drug Interactions
-Intensified effectiveness
-Reduction in effectiveness
-Unique response
Drug-Food Interactions
● Increase or decrease the absorption
● Increase the risk of toxicity
● Impact drug action
● Alter metabolism
What is the grapefruit juice effect?
“Only pervs eat grapefruit” -Oleg
Instead of the drug being metabolized in the body, more drug enters the bloodstream, resulting in too much drug in the body
The use of medication to prevent, mitigate, or cure disease
Pharmacotherapeutics
The intended response of the drug
Therapeutic effect
Physiological effects not related to the desired effect
Side effect
More severe reaction, than a side effect
Adverse effect
Types of adverse effects
Allergic reactions, idiosyncratic effect, latrogenic disease, physical dependence, carcinogenic effect, teratogenic effect
Pharmacokinetics
the process of drug movement throughout the body necessary to achieve drug action
What the BODY does to the drug
Absorption
movement of the drug outside of the body to the bloodstream
Distribution
the journey of the drug through the bloodstream to various tissues of the body
Metabolism
how the drug is broken down; biotransformation
Where does metabolism primarily take place?
liver
Excretion
how the drug leaves the body; elimination
Routes of excretion/elimination
urine, breastmilk, saliva, hair, sweat
Where does excretion primarily take place?
kidneys
First pass effect
Oral medications from the GI tract pass the intestinal lumen via the portal vein. The liver then metabolizes some of the drug that in turn reduces the concentration of active drug.
Minimum effective concentration (MEC)
The lowest level of concentration of drug in the bloodstream,
needed for the intended therapeutic effect
DNA testing to predict the likely drug response to assist with medication selection
Pharmacogenetics
Pharmacodynamics
what drugs do to the body and how they do it
The start of the desired effect of drug
onset
Point of maximum strength of drug
peak
How long it works
duration
Half life
time required for amount of drug to decrease by 50%
Therapeutic index
the relationship between the therapeutic dose and the toxic dose
Activates the desired response
agonist
Less effect than a full agonist
partial agonists
Blocks a response
antagonist
When two or more drugs are given together to have a greater therapeutic effect
synergistic effect
Two drugs combined causes an equal therapeutic effect
additive effect
A nurse is teaching a client who has a prescription for a drug that has a receptor agonist effect. Which of the following information should the nurse include in the teaching?
A. “This will increase the effects of normal cellular function”
B. “This minimizes the risk of that the medications you take will become toxic”
C. “This prevents cells in your body from performing certain actions”
D. “This prevents hormones in your body from attaching to cell receptor sites”
A. “This will increase the effects of normal cellular function”
Drug toxicity
drug level exceeds the therapeutic range
The health of the fetus is dependent on
the health of the mother
The process by which congenital malformations are produced in embryo or fetus
Teratogenesis
Which trimester is the fetus most vulnerable?
first trimester
Drug therapy considerations during pregnancy
● Placental transfer
● Adverse reactions
● Physiological changes related to pregnancy
● Breastfeeding consideration
Teratogenic med categories
● Category A: fails to show risk to fetus
● Category B: animal studies shows no risk to fetus
● Category C: studies in animals have shown adverse effects to fetus
● Category D: confirmed human fetal risk (risk v. benefit)
● Category X: animal and human studies have shown fetal risk (contraindicated)
Why is pharmacology research limited re: children?
Limited research due to the risk
More specific dosage calc for children because
children are less developed than adults
Pharmacology consideration for older adults
more vulnerable due to the aging process
Polypharmacy
occurs when a person is taking many different medications at the same time
Increased number of drugs leads to an
increased risk of adverse side effects
A nurse is providing teaching to a pregnant client who is taking captopril, an ACE inhibitor, to treat hypertension. The nurse informs the client that captopril is a teratogenic drug. The nurse should explain that teratogenic drugs can cause which of the following?
A. Maternal bleeding
B. Maternal blood clots
C. Fetal malformation
D. Gestational diabetes mellitus
C. Fetal malformation
Adherence concerns in older adults
- Patient may not fully understand drug regimen.
- Nonadherence may cause underdosing.
- Nonadherence may cause overdosing.
- Barriers to effective drug use by the older adult
- Medication education extremely important
Rate of absorption by type of PO drug type – fast to slow
liquid, suspension, powder, capsule, tablet, coated tablet, enteric-coated tablet
What is complementary and alternative medicine (CAM)?
Medical therapies used instead of or in addition
to pharmacotherapies
Does CAM have positive or negative effects?
both
Types of CAM
● Herbal supplements
● Botanicals
● Nutritional products
Drug-herb interactions: St. John’s Wort taken in addition to SSRIs can lead to
serotonin syndrome
St. John’s Wort interacts w/
cyclosporine, indinavir, oral contraceptives, warfarin, digoxin, benzodiazepines (and other drugs)
General guidelines for CAM
● Natural therapies do not mean SAFE therapies
● Speak with your provider before taking supplements
● Do not take if you are pregnant or breastfeeding
● Do not give to children
● Follow instructions
● If you experience side effect, stop the supplement and contact your provider
● Not all ingredients may be listed
Organic substances necessary for tissue growth and healing; made by plants and animals; obtained through diet
vitamins
Elements that come from soil and water that is then absorbed by the plants and animals we consume
minerals
Ex: Potassium, Sodium, Calcium, Chloride, Magnesium, Iron
Instances for increasing vitamin intake
● Pregnancy/breastfeeding
● Illness
● Malabsorption diseases
● Malnourishment
● Inadequate diet
Megadoses of vitamins
condition specific; generally not toxic, but must be monitored for toxicity
Fat soluble vitamins
Fat-soluble vitamins (vitamin A, vitamin D, vitamin E, and vitamin K) dissolve in fat and tend to accumulate in the body.
Water soluble vitamins
Water-soluble vitamins (vitamin C and the B-complex vitamins, such as vitamin B6, vitamin B12, and folate) must dissolve in water before they can be absorbed by the body, and therefore cannot be stored. Any water-soluble vitamins unused by the body is primarily lost through urine.
Can you overdose on fat soluble or water soluble vitamins?
fat soluble vitamins
Why would someone need nutritional support?
Unable to receive enough nutrition by simply eating or drinking
Types of nutritional support
oral feeding, parenteral nutrition, enteral nutrition
When is oral feeding used?
when the pt can swallow and has a working GI tract
Nutritional supplements are used to
increase calories or nutritional intake
The administration of nutrition to the bloodstream, not the GI tract directly (IV nutrition)
parenteral nutrition
Tube that delivers nutritional intake directly to the GI tract
enteral nutrition
Complications of enteral nutirtion
rate, temperature, placement, NVD, aspiration, and r/o dehydration
Complications of parenteral nutrition
pneumothorax/hemothorax during insertion, air embolism, infection, blood sugar
Types of enteral nutritional support
a. nasogastric (delivers food directly to stomach)
b. nasoduodenal/ nasojejunal (after the stomach or below the pyloric sphincter)
c. gastrostomy (directly to stomach)
d. jejunostomy (after the stomach or below the pyloric sphincter)
If after stomach, used for pt at risk for aspiration
Reason for short term use of enteral nutrition
pt who cant swallow or has no appetite
Reason for long term use of enteral nutrition
malabsorption disorders or increase catabolism (fast metabolism)
Why is enteral nutrition preferred over parenteral nutrition?
enteral is more natural
Central nervous system includes the
brain and spinal cord; the master
Peripheral nervous system includes the
autonomic and somatic nervous systems
The Autonomic nervous system includes the
sympathetic and parasympathetic nervous systems
Fight or Flight
sympathetic
PNS regulates
HR, BP, and vascular constriction
Rest and digest
parasympathetic
Adrenergics impact the __________ nervous system
sympathetic
Norepinephrine is the
adrenaline hormone
What neurotransmitter is used by the SNS?
norepinephrine
Four receptor types that norepi binds to?
alpha1, alpha2, beta 1, and beta2
Where are alpha receptors located?
smooth muscles (blood vessels, eyes, bladder, prostate)
vasoCONSTRICT (stimulatory)
Alpha1
Alpha1 constrict the blood vessels and cause
Increased peripheral resistance, arteries constrict –> INCREASED BP
vasoDILATE (inhibitory)
Alpha2
Alpha2 inhibit norepi release causing the
arteries to dilate –> DECREASED BP
more space for the blood to move
Alpha2 also inhibits
insulin
Impacts the heart and juxtaglomerular cells
Beta1
Beta1 increases myocardial contractility and HR, stimulates RAAS leading to
increased BP and HR
Impacts bronchioles, eyes, uterine muscle, GI tract, arteries of skeletal muscles
Beta2
Beta2 causes
Relaxation of smooth muscles of lungs (BRONCHODILATION), decrease in GI tone and motility, uterine relaxation (decrease in uterine contraction)
Agonists that stimulate the SNS are also called
adrenergics or sympathomimetics
Adrenergics that increase HR and BP
Epinepherine, Norepinephrine, Dopamine
Adrenergic med that dilate bronchi
Albuterol
Antagonists that block the SNS are also called
adrenergic blockers or sympatholytics
Meds ending in -olol are
beta blockers
Adrenergic blocker med that lowers blood pressure
Atenolol
What causes side effects when using adrenergic agonists?
Side effects frequently result when adrenergic drug dosage is increased or when the drug is nonselective
Adverse effects of adrenergic agonists
tachycardia, hypertension, palpitations, restlessness, dysrhythmias, CNS excitation and seizures, dry mouth, nausea and vomiting, anorexia
How many adrenergic receptors does epinephrine stimulate?
more than one; so it is non-selective
Epinephrine responses include
CNS stimulation
increase in BP, pupil dilation, increase in HR, bronchodilation
When is epinephrine used?
Used in anaphylactic shock to increase BP, HR, and airflow through lungs
Onset of action and peak concentration time of epinephrine is __________.
rapid
Primary use of adrenergic antagonists
Treat hypertension, dysrhythmias, angina, heart failure, benign prostatic hypertrophy, narrow-angle glaucoma
Adverse effects of adrenergic antagonists
dizziness, drowsiness, headache, loss of energy and strength, palpitations, dry mouth
Promote vasodilation, causing a decrease in BP
alpha antagonists
Cause decrease in HR, followed by decrease in BP
Beta-adrenergic antagonists (beta blockers)
Other therapeutic applications of beta-adrenergic antagonists (beta blockers)
Angina pectoris, Migraines, Heart failure
A cardioselective beta1 blocker that decreases sympathetic outflow to periphery and suppresses RAAS response (which will DECREASES BP)
Atenolol
Atenolol is used to treat
HTN, angina, prophylaxis and treatment of acute MI
Side effects of Atenolol
bradycardia, hypotension, headache, dizziness, bronchospasm
Before administering Atenolol, you should always check the pt’s HR & BP. If HR is below 50 you should
hold meds and notify provider
Cholinergics impact the
Parasympathetic nervous system
Receptors of PNS are either
nicotinic or muscarinic
Nicotinic
stimulate smooth muscle & slow HR
Muscarinic
affects skeletal muscles
What neurotransmitter is used by the PNS?
acetylcholine
Cholinergic agonist __________ the PNS
stimulate
Cholinergic agonists are also called
Parasympathomimetics
Cholinergic agonists are used to treat
glaucoma, urinary retention, myasthenia gravis, Alzheimer’s disease
Adverse effects of cholinergic agonists
○ Profuse salivation
○ Sweating
○ Increased muscle tone
○ Urinary frequency
○ Bradycardia
Wet side effects
cholinergic agonists
Bethanechol Chloride is a
direct acting cholinergic agonist
Bethanechol Chloride is the treatment for? Causes?
Urinary Retention & Neurogenic Bladder
Acts on detrusor muscle to contract bladder → Increases urination
Side effects and adverse reactions of Bethanechol Chloride
hypotension, increased gastric acid secretion, abdominal cramps, diarrhea, bronchospasm
Cholinergic antagonist _________ the PNS
inhibit/block
Cholinergic antagonists are also called
parasympatholytics
Primary uses of cholinergic antagonists
peptic ulcers, irritable bowel syndrome, mydriasis and cycloplegia during eye examination, bradycardia, preanesthetic, asthma
Adverse effects of cholinergic antagonists
tachycardia, CNS stimulation, urinary retention, dry mouth, dry eyes, decreased sweating, photophobia
Dry side effects
cholinergic antagonists
Atropine is a
cholinergic antagonist
Atropine is used as a __________ med to reduce respiratory & salivary secretions
pre-op
Side effects and adverse reactions of atropine
xerostomia (dry mouth), nasal dryness, blurred vision, tachycardia, constipation, urinary retention
These drugs stimulate the CNS and are typically prescribed to treat ADHD,
narcolepsy and to reverse respiratory depression.
Include amphetamines, analeptics, and anorexiants
stimulants
Side effects of stimulants
tachycardia, headache, restlessness, insomnia, pruritus (itching)
What type of stimulant has a high abuse potential?
anorexiants
What is the primary use of an analeptic?
stimulate respiration
These drugs cause varying levels of CNS depression based on the amount of the drug taken. Sedative hypnotics are typically ordered to treat sleep disorders.
Include phenobarbital, benzodiazepines, and anesthetics
depressants
Side effects of depressants
slurred speech, confusion, headache, dizziness, dry mouth
Why are barbiturates less commonly prescribed?
Dangerous, respiratory depression, and potential dependency
Can you stop depressants abruptly?
no!
Anesthetics are used to cause complete or partial loss of sensation. What is the difference between general, regional, and local anesthetics?
general- affects the whole body
regional- affects larger areas of the body
local- affects small part of the body
Antiseizure drugs act in three ways:
Increase action of GABA (GABA will calm the brain down), suppress sodium influx, or suppress calcium influx
Phenytoin is a(n)
antiseizure medication that inhibits sodium influx
Side effects & adverse effects of Phenytoin
S/E: chest pain, diaphoresis, N/V, constipation, drowsiness, depression, &suicidal ideation
A/E: gingival hyperplasia, Stevens-Johnson syndrome
What is the therapeutic serum level for Phenytoin?
10-20 mcg/mL
Valproate is a(n)
antiseizure medication that decreases calcium influx
Use: absence, tonic clonic, and partial seizures
Side effects of Valproate
hepatotoxicity, N/V, diarrhea, tremors, headache, weight gain, &stomatitis
Do not give Valproate to children under 2
true
Phenobarbital is a(n)
antiseizure medication that enhances GABA activity; barbiturate
Use: myoclonic, tonic clonic and partial seizures, and status epilepticus
Side effects of Phenobarbital
hepatotoxicity, agitation, confusion, ataxia, dizziness, insomnia, hypotension, bradycardia, syncope
Do not give Phenobarbital to children under 2
true
Diazepam is a(n)
antiseizure medication that enhances GABA activity; benzo
Use: status epilepticus
Side effects of Diazepam
drowsiness, confusion, sedation, respiratory depression
A nurse is monitoring a client who is receiving phenytoin IV for the treatment of status epilepticus. Which of the following findings should the nurse identify as an adverse effect of the medication?
a. Hypertension
b. Cardiac dysrhythmias
c. Gastric discomfort
d. Tachycardia
b. Cardiac dysrhythmias
A nurse is caring for a child who has epilepsy and is scheduled to receive a dose of phenytoin. The nurse notes the child’s serum phenytoin level is 14 mcg/mL. Which of the following actions should the nurse take?
a. Administer the dose
b. Administer half the dose
c. Hold the dose
d. Clarify the dose with the provider
a. Administer the dose
A nurse is providing teaching to a client who has a new prescription for diazepam. Which of the following instructions should the nurse include in the teaching?
a. Expect this medication to make you feel anxious
b. This medication can be habit-forming
c. Take this medication on an empty stomach
d. This medication needs to be taken for 2 to 3 weeks to reach the full therapeutic effect
b. This medication can be habit-forming
A nurse is assessing a client who has ADHD and reports abruptly discontinuing his amphetamine treatment. Which of the following assessments indicates that the client is physically dependent on the amphetamines?
a. The client exhibits paranoia
b. The client reports having insomnia
c. The client reports eating excessively
d. The client has an increased heart rate
c. The client reports eating excessively
Rivastigmine is used to treat
mild to moderate Alzheimer’s Disease
Goal: slow disease process, decrease S/Sx, & improve cognitive function/ADL’s
Action of Rivastigmine
Rivastigmine is an acetylcholinesterase inhibitors. Acetylcholinesterase is an enzyme that digests ACh. This drug will block the enzyme from digesting ACh which leads to an
increase of ACh at synapses
Side effects and adverse reactions of Rivastigmine
S/E: GI Sx, dizziness, orthostatic hypotension, HA, nystagmus
(repetitive eye movements), dehydration
A/R: hepatotoxicity, bradycardia, dysrhythmias, heart failure,
seizures, suicidal ideation
Directly observed therapy for Alzheimer’s Disease
watch pt take medication
Alzheimer’s Meds - Patient Teaching
- Take as prescribed
- Do not crush extended-release tablets
- Report S/E or A/R to provider
- Take w food or milk to avoid GI distress
- S/sx of OD: NV, sweating, hypotension, excess salivation, bradycardia, seizures, muscle weakness
In Parkinson’s disease, dopamine is __________ and acetylcholine is __________.
low, high
Benztropine is used to treat
Parkinson’s disease
Benztropine is a(n)
anticholinergic that blocks the release of ACh
Benztropine is contraindicated for pts w/
glaucoma
Side effects of Benztropine
dry mouth, constipation, urinary retention, N/V, restlessness/anxiety,
tachycardia, blurred vision, confusion
Can you abruptly stop Benztropine
no! could increase S/Sx
Carbidopa-levodopa is used to treat
Parkinson’s disease
Carbidopa-levodopa is a
dopaminergic
Levodopa is converted to __________ in the brain. Carbidopa helps Levodopa cross the blood brain barrier.
dopamine
Side effects of Carbidopa-levodopa
dizziness, fatigue, N/V/C, orthostatic hypotension, dystonia,
dyskinesia, psychosis, depression, sleep disturbances
Carbidopa-levodopa patient teaching
- Take as prescribed & don’t crush extended-release tablets
- Do not take w/ high protein foods, Vit B6, or alcohol
- Don’t stop abruptly
- May cause urine & sweat to turn brown
- Assess Sx status & “on-off” phenomenon (drug holiday)
Rasagiline is used to treat
Parkinson’s disease
Rasagiline is a
monoamine oxidase-B inhibitor
Increases dopamine by inhibiting MAO-B & delays wearing off of Levodopa
Rasagiline
When taking rasagiline, food w/ _________ should be avoided. Can cause hypertensive crisis.
tyramine
Foods: aged cheese, red wine, bananas, smoked meats, chocolate
A nurse is administering rivastigmine (Exelon) to a client with Alzheimer’s disease. As the nurse prepares the medication, the client says, “I know how to take my pill, why do you have to watch me take it?” Which of the following is the best response by the nurse?
a. I will watch to make sure you do not choke on the medication.
b. Please don’t make this difficult, just take the pill.
c. I will ensure your medication is taken appropriately so it is effective.
d. You are always confused, so I will make sure you know how to take your medication properly.
c. I will ensure your medication is taken appropriately so it is effective.
A client with Parkinson’s disease is taking rasagiline (Azilect) to treat their
Parkinson’s disease. After taking their medication, they prepare to order their dinner. Which of the following indicates the client needs further teaching?
a. Grilled chicken with green beans and mashed potatoes
b. Smoked sausage with broccoli and a chocolate milkshake
c. Steak with brown rice and carrots
d. Lasagna and apple pie
b. Smoked sausage with broccoli and a chocolate milkshake
The nurse is teaching a client with a new prescription for carbidopa-levodopa (Sinemet) for Parkinson’s disease. Which of the following instructions should the nurse include?
a. Increase intake of protein-rich foods.
b. Expect muscle twitching to occur.
c. Take this medication with food.
d. Anticipate relief of symptoms in 24 hours.
c. Take this medication with food.
Pyridostigmine is used to treat
Myasthenia gravis
Pyridostigmine is a(n)
acetylcholinesterase inhibitor that increases muscle strength by preventing destruction of ACh
Side effects of Pyridostigmine
NVD, abdominal cramping, miosis (pupil constriction),
increased salivation & tear production, blurred vision, bradycardia,
hypotension
- “Wet” symptoms
OD of Pyridostigmine can cause
cholinergic crisis
- Muscle weakness can → respiratory paralysis & arrest
Interferon beta 1a is used to treat
Multiple Sclerosis
Interferon beta 1a is a(n)
immunomodulator that slows disease progression and prevents relapses
Can cause flu-like sx
Interferon beta 1a
What is the biggest risk associated w/ immunomodulators?
infection
Relieve muscle spasticity and pain in pts w/ MS, stroke, cerebral palsy, head & spinal cord injuries
skeletal muscle relaxants
Side effects of muscle relaxants
drowsiness (CNS depression), dizziness, headaches, GI upset
Drugs that improve spasticity
baclofen, dantrolene, tizanidine
Drugs that improve muscle spasms
metaxalone, cyclobenzaprine, chloroxazone
Why are barbiturates less commonly prescribed?
Dangerous, respiratory depression, and potential dependency