Pharm Final Exam Flashcards
What are the four main pharmacokinetic (PK) phase and what occurs during each phase?
🔶 Absorption.
* Movement of the meds into the blood stream via the (veins).
🔶 Distribution.
* Movement of the meds from the blood into the tissue and cells via the (Heart).
🔶 Metabolism
* Change in the drug structure (Liver)
🔶 Excretion
* Movement out of the body (Kidney)
Define pharmacodynamics (PD) and explain how it differs from Pharmacokinetics.
- Pharmacodynamics - “This is how a drug works in the body.”
- Pharmacokinetics - “The movement of drugs.”
How does proteins binding affect the distribution and action of a drug in the body?
- By changing the effective concentration of the drug at its site of action.
- By changing the rate at which the drug is eliminated,
What is the first-pass effect and how does it influence the bioavailability of a drug?
🔶 These are meds that are metabolized in the liver after being absorbed into the portal circulation from the small intestines.
* Levothyroxine
* Esomeprazole
* Diphenhydramine (Benadryl)
What are the key steps in the nursing process when administering medications?
- Assessment
- Analysis (or Nursing Diagnosis)
- Planning
- Implementation
- Evaluation
List at least three patient identifiers that should be used when giving medications to ensure patient safety?
- The patient’s :-
* Name
* Birthday
* Assigned ID number (Medical Record number)
* Telephone number
* Photo ID
When should medication reconciliation be performed?
- Medication reconciliation is done every time a patient is transferred from one level of care to another.
Eg. (ICU to Step down) or (Med surg to ICU) or (Admission and Discharge)
Who does the Medication reconciliation?
- The Doctors do the reconciliation.
(The nurse only makes sure that the doctors have done it.)
What are the common signs and symptoms of Anaphylaxis?
- Rash
- Hives
- Hypotension
- Blocking of the airway
How do we manage Anaphylaxis in an emergency situation?
- Give epinephrine.
- Maintain the airway.
- Monitor the client very closely.
Describe the typical Anticholinergic effects of certain medications?
- Anticholinergic medications interferes with the system making it hard for the body to enter the “Rest and Digest” mode.
- Can’t see
- Can’t spit
- Can’t pee
- Can’t defecate
List the medications that cause Anticholinergic effects.
- Benztropine
- Trihexyphenidyl
- TCA
What are the risk factors for Drug-induced hepatotoxicity and how can it be detected?
- They can be detected through signs and symptoms of Liver failure:- “JAUNDICE”
* Jaundice * Anorexia * Upper abdominal pain * Nausea / Vomiting / Diarrhea * Dark urine * Increased need of sleep * Clay stool (Grayish) * Ecchymosis (Irritated skin) -
- They can be detected through the lab results:-
* AST
* ALT - The risk factors of Hepatotoxicity includes:-
* Liver Disease
* Alcoholism
Explain the signs of CNS depression?
- Bradycardia
- Decreased respirations
- Extreme confusion/ memory loss.
- Nausea and vomiting.
- Poor judgment.
- Blue lips or fingertips.
- Irritability and aggression.
- Clammy or cold skin.
What are the potential consequences of overdosing on CNS depressant drugs?
- Can decrease respirations or even stop the breathing.
- Can increase the risk of falling in older adults
- Decreased heart rate.
- Loss of consciousness
- Can leading to coma or death.
What is Orthostatic Hypotension?
- Its when you move from a horizontal position to a vertical position, and gravity pulls much of the blood to the lower extremities.
How can we manage Orthostatic Hypotension?
- Change positions slowly.
- Drink plenty of water.
- Wear support hose.
Define polypharmacy and explain its potential risks, particularly for elderly patients.
- Polypharmacy - Is when older adults take alot of drugs (more than one).
- Potential risks for polypharmacy include:-
* Toxicity
* drug interaction
How do age-related changes in pharmacokinetics affect drug absorption, distribution, metabolism, and excretion in geriatric and pediatric patients?
🔶 The aging process causes the liver and kidney function to decline.
- Naturally, this usually means dosages should be decreased.
🔶 The pediatric, their organs (Kidneys & livers ) are under developed, that affects the pharmacokinetics process.
Explain the purpose of the Beers Criteria.
🔶 Beers Criteria
- Is a helpful resource that specifies which drugs are most dangerous to older adults and provides a succinct rationale (American Geriatrics Society, 2019).
Describe the basic structure and function of a neuron.
- The neurons sending and receiving neurotransmitters (chemicals that carry information between brain cells.)
Explain the role of synapses in neuronal communication.
- They connect neurons
- They help transmit information from one neuron to the next.
Describe the process of neurotransmitter release, reuptake, and degradation.
🔶 Reuptake.
- This is where the neurotransmitters are sucked back inside the presynaptic terminal where they can be recycles for future use.
🔶 Degradation.
- The brain makes enzymes that break apart neurotransmitters.
Explain the mechanism of action mechanism of action of selective serotonin reuptake inhibitors (SSRIs).
- These drugs, as their name states, are very selective.
- SSRIs only block serotonin reuptake pumps.
- This only increase levels of serotonin in the brain.
What is the typical time frame for antidepressants to start showing their full therapeutic effects?
- 1 - 4 weeks
Discuss the potential increased risk of suicidal thoughts and behaviors associated with using antidepressants, particularly in certain age groups.
- Suicide ideation is most common in children under 18 years.
What precautions should be taken when prescribing and monitoring patients on antidepressant therapy to minimize the risk of suicide?
- Avoid prescribing TCA.
- Make sure you TCA stay out of the hands of those tiny people that like to crawl around and stick everything in their mouth.
Why are TCAs considered to have a higher risk of overdose compared to other classes of antidepressants?
- The most serious problem with TCAs is that they can cause fatal heart dysrhythmias when overdosed.
What are the therapeutic effects of benzodiazepines, and what are their main indications for use?
- Muscle relaxant (for muscle spasms)
- Anticonvulsant (for Seizures)
- Sedative (relaxing) - (for Anxiety)
- Hypnotic (sleep-inducing) - (for insomnia)
- Anxiolytic (anti-anxiety) - (for Anxiety)
Describe the common adverse effects of benzodiazepines.
- CNS depression (Slurred speech, dizziness, Ataxia, Memory difficulties)
- Additive Effects (PT should avoid alcohol)
- Falls and Injuries (Avoid operating heavy machinery)
- Addiction Potential (Highly addictive)
Discuss the risk for addiction and dependence associated with benzodiazepine use, including the factors that may increase this risk.
- Benzodiazepines are highly addictive and withdrawal symptoms are extremely unpleasant.
- Benzodiazepines are meant for short-term use.
- Long-term users should avoid abrupt discontinuation.
Identify common drug interactions involving benzodiazepines and describe their potential consequences.
🔶 The common drug interactions involving benzodiazepines include:-
* Opioids.
* Alcohol.
🔶 Their potential consequences include:-
* Falls and injuries
* CNS depression
Compare and contrast the mechanism of action of benzodiazepines and Z-drugs (e.g., zolpidem, zaleplon, eszopiclone).
🔶 The mechanism of action of benzodiazepines (benzodiazepine1 & 2) incudes :-
* It decrease anxiety.
* Can stop seizure activity.
🔶 The mechanism of action of Z-drugs (benzodiazepine1) incudes:-
* It causes Sedation or sleep.
What are the risk factors for developing lithium toxicity, and how can they be minimized during lithium therapy?
🔶 Risk factors for developing lithium toxicity include:-
* Renal damage/impairment
* Exceeding the recommended dosage
* Low sodium diet
* Drug interaction
* Dehydration
🔶 To minimize dangerous fluctuations in lithium levels, clients should:-
* Maintain consistence amounts of sodium in their diets.
* Avoid excessive exercise (i.e., avoid extreme exercise and hot weather).
* Stay well hydrated (i.e., drink 8-12 cups of fluid per day).
Explain the relationship between sodium levels and lithium levels in the body, and how sodium intake or balance changes can affect the risk of lithium toxicity.
🔶 Kidneys can’t tell the difference between sodium and lithium (both are salts).
* So if a client eats an unusual amount of salt, the kidneys will try to get rid of all that salt. In so doing, they will also get rid of lithium.
🔶 The kidneys will try to hold onto sodium. In so doing, they will also hold onto lithium, causing levels to increase.
* If a client loses a bunch of sodium from dieting or sweating profusely
Describe the common signs and symptoms of lithium toxicity.
- Use the Mnemonic “SCAN”
- Sedation & slurred speech
- Course hand tremors
- Ataxia (incoordination) (being clampsy)
- Nausea, vomiting, diarrhea (persistent)
What is the relationship between clozapine use and the risk of neutropenia, and why is this side effect of particular concern?
- Clozapine causes Agranulocytosis
- The most significant of these is its link to the destruction of WBC.
- This can cause a severe infection that spreads through the bloodstream (septicemia).
Compare and contrast the typical side effect profiles of FGAs and SGAs, including the risks of extrapyramidal symptoms (EPS), metabolic side effects, and tardive dyskinesia.
🔶 FGA (First-Generation Antipsychotics)
* Higher risk of Extrapyramidal Symptoms
* Higher risk Neuroleptic Malignant Syndrome
* Higher risk of Tardive dyskinesia.
🔶 SGA (Second-Generation Antipsychotics)
* Lower risk of Extrapyramidal Symptoms
* Lower risk of Neuroleptic Malignant Syndrome
* Higher risk of Metabolic Syndrome
* Higher risk of Agranulocytosis
Discuss the importance of regular follow-up and growth monitoring in children receiving ADHD medications, including the assessment of height, weight, and overall growth patterns.
- CNS stimulants are strong appetite suppressants.
- This can cause unintended weight loss and growth suppression in children.
- To mitigate this problem, clients can take their medication during or after meals.
- Some prescribers may also recommend taking a break from the medication (drug holiday) on weekends or during the summer.
What strategies can be employed to minimize the risk of insomnia in patients taking ADHD medications?
- CNS stimulants can also cause insomnia.
- The prescriber may reduce the dose if a client is experiencing insomnia.
- It’s also important not to take these medications too late in the day (i.e., after 4 PM).
- They should be taken early in the day.
Explain the relationship between nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of gastrointestinal (GI) bleeding.
- All NSAIDs can cause damage to the stomach’s lining (gastric mucosa).
- Patients taking these drugs should watch for signs of bleeding (e.g Black Tarry stools).
- They should take the medication with food or milk.
- Sometimes we also add medication that will decrease stomach acid production (e.g PPI or histamine-2 blocker).
Explain the importance of limiting the use of ketorolac to a maximum of 5 days.
- To reduce the risk of GI bleeding.
- The providers usually also prescribe a medication to protect the stomach (e.g PPI or histamine-2 blocker).
Describe the precautions and strategies that can be employed to minimize the risk of GI bleeding in patients taking NSAIDs, such as co-administration of gastroprotective agents.
- They should take the medication with food or milk.
- Sometimes we also add medication that will decrease stomach acid production (e.g PPI or histamine-2 blocker).
How can NSAIDs contribute to kidney injury?
- Because NSAIDs inhibit the conversion of arachidonic acid into prostaglandins.
- They do this by inhibiting COX-1, hence decreased kidney blood flow. leading to Nephrotoxicity.
Discuss the importance of increasing fiber intake and maintaining adequate hydration in patients taking opioids.
- Opioid receptors causes the bowel motility to slows down hence causing constipation.
- Constipation can cause a lot of discomfort and problems.
- So we often give medicine to help reduce the risk of constipation (e.g., a stool softener or laxative).
- We also encourage fluids and high-fiber foods (e.g., fruits and vegetables).
Describe the risk factors for phenytoin-induced gingival hyperplasia and the precautions that can be taken to minimize this side effect.
🔶 The risk factors for phenytoin-induced gingival hyperplasia include:-
* The high serum levels of Phenytoin.
🔶 The precautions that can be taken to minimize this side effect of phenytoin-induced gingival hyperplasia include:-
* Encourage clients to practice good dental hygiene.
* Encourage the use of soft toothbrush.
What is the relationship between angiotensin-converting enzyme inhibitors (ACEIs) and the risk of angioedema?
- Angioedema - Is a potentially fatal reaction (swollen face, lips, throat, eyes) that develops in clients with African descent from taking ACE inhibitors the “Pril”.
- Give Epinephrin to reduce the reaction.
- You should avoid and never take the ACE inhibitors the “Pril” after developing Angioedema once.
Describe the proper technique for administering subcutaneous heparin and enoxaparin injections, including site selection.
- Enoxaparin administration (Love handles SubQ)
Compare the onset of action and duration of commonly used insulins.
- Rapid-acting insulin - an onset of 15-30 mins)
Explain the mechanism of action of 5-alpha reductase inhibitors (5-ARIs) in the management of benign prostatic hyperplasia (BPH).
- 5-alpha-reductase inhibitors block the enzyme that converts testosterone into dihydrotestosterone (DHT)—the active form of testosterone.
- Since DHT is what triggers the prostate to grow, this halts the growth of the prostate and even shrinks it.
- Since DHT also plays a role in male-pattern baldness, these drugs also help regrow hair.
Discuss the potential effects of alpha-1 blockers, a class of medications used in the management of BPH and hypertension, on blood pressure.
- It block receptors in the peripheral vasculature, decreasing blood pressure.
- Can cause postural hypotension.
