Pharm Exam 1 Flashcards

1
Q

What is the first principle of dosage and administration?

A

1) Read the medication label carefully and compare with MAR at least 3 time.

When removing the drug from the supply drawer/cart

When preparing the drug

Just before administrating the drug to the patient before the container is discarded

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2
Q

What is the second principal of dosage and administration?

A

Look up information on any drug that you are unfamiliar with.

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3
Q

What are the last 5 principles of dosage and administration?

A

3) verify drug calculations

4) label all syringes and IV solutions immediately after preparing the ordered dosage. Keep the vial with the syringe

4) NEVER administer a medication prepared by another person.

5) remain with the patient until all medications have been ingested

6) record the administration of each dose on MAR after it has been given.

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4
Q

What is 6 Rights of Medication administration?

A

Right drug
Right route
Right patient
Right dose
Right time
Right document

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5
Q

What are the pros to oral administration (PO)

A

Simple, convenient, cheap

Despite its drawbacks, this route is generally preferred

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6
Q

What are the cons of oral administration?

A

Exact dose received by patient is unknown due to extensive metabolism by liver

Slow onset of action

Some drugs irritate the GI tract

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7
Q

Pros of intravenous (IV)

A

Rapid drug action

Almost always 100% of dose is received by patient

Large volume of drug can be given via this route

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8
Q

Cons of IV?

A

Rapid drug action

Drug cannot be retrieved once injected

Higher risk of adverse reactions due to rapid drug action

Phlebitis and thrombosis may occur

Sterile technique required

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9
Q

Define pharmacokinetics

A

How drugs move throughout the body

ADME

interactions of body and drug

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10
Q

Define pharmacodynamics

A

What the drug does to the body to cause an effect.

Book***
Effects of the drugs in the body and the mechanisms of their action. As a drug travels through bloodstream, it will exhibit a unique affinity for the drug receptor site.

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11
Q

What is absorption?

A

Occurs from time drug enters body to the time drug enters bloodstream circulation

Affected by many factors: dosage form and bioavailability….. drug potency…… routes of administration

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12
Q

Define bioavailability

A

The ability of a drug to be taken up by the body and made available in the tissue where it is needed.

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13
Q

Define potency

A

The amount of the drug required to produce the desired effect.

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14
Q

Define distribution

A

Once drug is in the bloodstream, it is carried to sites of action. It’s basically the process of how medication is distributed throughout the body.

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15
Q

How does protein binding effect distribution?

A

A certain percentage of almost every drug gets bound to plasma protein albumin when it initially enters the bloodstream. The portion of drug that gets protein bound is inactive while it’s bound

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16
Q

How does bioavailability vary?

A

Dosage form.

IV- practically 100% bioavailable
Oral dosage form- almost always less than 100% bioavailable

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17
Q

What is metabolism

A

Active drug is changed into inactive metabolites

EXCEPTION: prodrugs such as clopidogrel (plavix)

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18
Q

What are pro drugs?

A

When you take them they’re in an inactive form and they have to be metabolized to become active.

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19
Q

How are most drugs metabolized by the liver?

A

First pass effect

Cytochrome P-450 (CYP) enzymes

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20
Q

What is excretion

A

Elimination of drug from the body

Most drugs are excreted by the kidneys and leave the body via urine and we measure this via creatinine clearance (CrCl) or glomerular filtration rate (GFR)

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21
Q

What are CYP enzymes?

A

Most drug metabolism that occurs in the liver is done by the cytochrome P450 (CYP) enzyme family

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22
Q

What are the 3 CYP enzymes specifically responsible for drug metabolism?

A

CYP1– example CYP1A2
CYP2– example CYP2D6
CYP3– example CYP3A4

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23
Q

Which liver enzyme is responsible for most troublesome drug interactions?

A

CYP3A4

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24
Q

How are CYP enzymes inhibited or induced?

A

Other drugs, food, drinks, or even genetics

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25
How do CYP enzymes normally work?
Active drugs are metabolized by enzymes and the are ready to be excreted from the body.
26
What happens when CYP enzymes are inhibited?
The inhibitor inhibits the CYP enzyme from doing what it is supposed to do which is metabolize the drugs. So the drugs start to build up and there is more of it therefore the patient is more at risk of toxicity from the drug.
27
What happens when CYP enzymes are induced?
The CYP enzymes are working faster than they normally would and the drug is being metabolized faster. The patient is at higher risk for the disease state not being treated adequately because there’s not enough drug in circulation.
28
What are important ways we measure renal function?
Creatinine clearance (CrCl) Glomerular filtration rate (GFR)
29
What is creatinine clearance (CrCl)
We are basically measuring the bodies ability to get rid of drug. And how we do that is by measuring the bodies ability to get rid of creatinine which is a waste product of the body. So when we calculate that and assume that that is about how good the body is at getting rid of drug also.
30
What is normal CrCl?
120 mL/min for men 95 mL/min for women CrCl < 30 mL/min is NOT GOOD
31
What is serum drug level?
Lab measurement of exact amount of drug in the blood at a particular time.
32
What is a loading dose?
Dose larger than the regular prescribed daily dosage of a medication, used to attain a therapeutic blood level.
33
What are agonists?
Drugs that produce effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances.
34
What are antagonist?
Drugs that inhibit cell function by occupying receptor sites. Prevent natural substances and/or drugs from reaching receptor sites.
35
What are black box warnings?
Strongest warning the FDA can give consumers
36
What is the type I of the hypersensitivity reactions?
Body reacts to an outside allergen Examples: “seasonal allergies” ; anaphylaxis
37
What is the peak of a drug?
Highest serum drug reached
38
What is a trough of a drug?
Lowest serum drug level
39
What are the 5 steps of nursing process?
Assessment Diagnosis Planning (goals, outcome) Implement (including patient education, rights of medication) Evaluation
40
What is the drug legislation of 1996?
Health insurance portability and accountability act (HIPPA) Requires all health related organizations as well as schools to maintain privacy of protected health information.
41
What is schedule I?
No accepted medical use, high abuse potential ( example. Heroin)
42
What is schedule II?
High potential for abuse. These drugs are considered dangerous. Examples Hydromorphone, methadone, oxycodone, fentanyl, morphine, hydrocodone, codeine
43
What is schedule III?
Moderate to low potential for physical and psychological dependence. Examples Acetaminophen with codeine, ketamine, anabolic steroids
44
What is schedule IV?
Low potential for abuse and low risk of dependence. Examples Lorazepam, diazepam, midazolam
45
What is schedule V?
Guaifenesin with codeine, promethazine with codeine
46
What are nursing safeguards to prevent peer abuse?
Narcotic count Witness for wasted doses Responsibility to report physical dependence of peers to BON
47
What are the types of medication errors?
1) no error, although circumstances or events occurred that could have led to an error. 2) mediation error that causes no harm 3) medication error that causes harm 4) medication error that results in death
48
7 ways to prevent medication errors?
Assessment Two patient identifiers Do not administer if you did not draw up or prepare yourself List indication next to each order Never use trailing zeros Always listen to and honour any concerns expressed by patients Check patient allergies and ID.
49
What is insulin? (Drug)
Functions as a substitute for the endogenous hormone It restores the diabetic patients ability to: Metabolize carbohydrates, fats, and proteins Store glucose in liver Convert glycogen to fat stores
50
Signs of hypoglycemia?
Cold and clammy, need some candy! Shakes/tremors Sweaty/ diaphoretic Tachycardia /palpitations Weakness/ irritability/ headache
51
Define diaphoretic
Sweating a lot!!
52
Signs of hyperglycemia?
Hot and dry, sugar high Polyuria Polydipsia Polyphagia
53
Define polyuria
Produces a large amount of urine
54
Define polydipsia
Extreme thirst
55
Define polyphagia
Extreme hunger
56
Etiology of type 1 diabetes and type 2 diabetes?
Type 1: autoimmune destruction of islet cells Type 2: insulin resistance
57
Incidence of type 1 diabetes and type 2 diabetes as well as age of onset and speed of onset
Type 1: 10% Usually before 35 years old Usually rapid Type 2: 90% Usually after 35 Usually gradual
58
Nutritional state for type 1 and type 2 diabetic and state of endogenous insulin?
Type 1: usually thin Absent (they don’t make insulin.) Type 2: usually overweight Low or high levels of endogenous insulin. Rarely absent.
59
Treatment for type 1 diabetic and type 2 diabetic?
Type 1: exogenous insulin, diet control Type 2: oral agents, diet control, exercise, weight loss
60
What is the generic name, colour, onset, peak, and duration for short duration- rapid acting insulin?
Insulin lispro Clear 15 mins 1-2 hour peak 3-5 hours for therapeutic effects
61
What is the generic name, colour, onset, peak, and duration of short duration- slow acting insulin?
Regular insulin Clear 30-60 mins 2.5 hours peak 6-10 hours of therapeutic effect
62
What is the generic name, colour, onset, peak, and duration of intermediate insulin?
NPH insulin Cloudy 60-120 mins 4-8 hours peak 10-18 hours duration
63
What is the generic name, colour, onset, peak, and duration of long duration insulin?
Insulin glargine Clear 60-120 mins No peak time 24 hour duration
64
Disorder for too much insulin?
Hyperglycemia (diabetes mellitus)
65
Disorder for too little insulin?
Hypoglycemia
66
Disorder for too much growth hormone?
Acromegaly/ gigantism
67
Disorder for too little growth hormone?
Dwarfism
68
Disorder for too much ADH?
Syndrome of inappropriate ADH (SIADH) 😂😂
69
Disorder for too little ADH?
Diabetes insipidus
70
Disorder for too much T3 and T4?
Hyperthyroidism (Graves)
71
Disorder for too little T3 and T4?
Hypothyroidism (myxedema)
72
Disorder for too much parathormone?
Hyperparathyroidism / hypercalcemia
73
Disorder for too little parathormone?
Hypoparathyroidism / hypocalcemia
74
Disorder for too much cortisol?
Cushing’s disease/ syndrome
75
Disorder for too little cortisol?
Addisons disease