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pharm 305 > pharm test 1 > Flashcards

pharm test 1 Flashcards

1
Q

effectiveness

A

does what it is intended to do

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2
Q

safe

A

safety cannot be assured

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3
Q

selectivity

A

would do only what it is intended to do

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4
Q

therapeutic objective

A

max benefit
min harm

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5
Q

agonist

A

activates receptor sites by binding w/ them

binds & creates change (mimics something in body)

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6
Q

agonist examples

A

dobutamine MIMICS nor-epi

insulin

morphine (opioid)

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7
Q

antagonist

A
  • prevent receptor activation (prevents event)
  • inhibit action of endogenous substances & drugs (inhibits action)
  • have no effects of their own on receptors (don’t cause response)
  • prevent agonist from doing job (prevent effects of drug)
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8
Q

non-receptor drugs

A

chemically neutralize

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9
Q

non-receptor drug examples

A

antacid (neutralize acid)

magnesium sulfate (laxative)
-pulls water out=stool

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10
Q

pharmacokinetics

A

what body does to drug?

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11
Q

ADME (pharmacokinetics)

A

Absorption
Distribution
Metabolism
Excretion

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12
Q

absorption

A

enters body –> reaches blood stream

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13
Q

factors affecting absorption

A

route
-IV, IM, subQ, PO

form
-liquid&raquo_space; tablet

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14
Q

distribution

A

drug carried throughout body (transport)

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15
Q

factors affecting distribution

A

protein binding

blood-brain barrier

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16
Q

phenytoin

A

protein bound drug

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17
Q

metabolism

A

drug absorbed into body

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18
Q

where does metabolism usually take place

A

liver

fat –> water soluble = renal secretion

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19
Q

hepatic microsomal enzyme system

A

cytochrome P450 system

-system that metabolizes

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20
Q

therapeutic consequences of metabolism

A
  • faster renal excretion
  • drug inactivation
  • increased therapeutic action
  • activation of prodrug (cover to help get to intestines)
  • increase/decrease of toxicity
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21
Q

first pass effect

A

oral med pass first through liver –> mostly metabolized = small portion available

-given sublingual instead

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22
Q

nitroglycerin

A

given sublingual (absorbed through mouth)

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23
Q

excretion

A

getting drug out of body

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24
Q

where does excretion take place

A

mostly through kidneys

could be:
-bowel
-lungs
-skin

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25
Q

how would you check pt’s renal status

A

BUN, GFR

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26
Q

serum half life

A

time for the blood level of a med/drug to decrease by 50%

4-5 half-life cycles before steady state

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27
Q

half-life example:

   half-life = 3 hr
   how long until steady state
A

12 hours

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28
Q

lethal dose

A

does that will kill

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29
Q

effective dose

A

dose that produces a predefined response

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30
Q

therapeutic indec

A

measure drug safety

ratio of LD - ED

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31
Q

large index

A

LD & ED are far apart

safe

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32
Q

small index

A

LD & ED are close

dangerous

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33
Q

drug prototype

A

chemical name (long name)

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34
Q

generic name

A

usually class specific

professional name

(need to know generic)

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35
Q

trade name

A

branded or trademark name
(pt usually knows)

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36
Q

pharmacodynamics

A

how drug influences target cells & subsequent changes in body’s biochemical reactions

-what drug does to body

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37
Q

interference

A

one drug inhibits/induces metabolism or excretion of another

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38
Q

displacement

A

two drugs compete for binding site on albumin

-2 protien bound = 1 kicked off

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39
Q

antagonism

A

effects of two drugs cancel each other out

-key hole

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40
Q

incompatibility

A

physical interaction of two drugs interfere with effect of at least one

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41
Q

food interactions

A
  • dairy products
  • certain antibiotics
  • foods containing vitamin k
  • grapefruit juice
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42
Q

drug + empty stomach

A

1 hour before

2 hours after

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43
Q

side effects depend on:

A
  • dose
  • therapeutic index
  • age
  • medical history
  • drug-drug interactions
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44
Q

allergic reaction

A

penicillin
NSAIDs
sulfa drugs

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45
Q

idiosyncratic reaction

A

bad response to med

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46
Q

iatrogenic

A

medication causes disease

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47
Q

teratogenic effects

A

drug induced birth defect

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48
Q

toxicity

A

nausea/vomiting
anemia/abnormal bleeding
damage to liver
damage to kidneys

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49
Q

reporting medication errors

A

assessment
determine interventions
complete incident report
notify person in charge
follow protocol

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50
Q

schedule I substances

A

not approved for medical use

high risk for abuse

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51
Q

schedule I examples

A

heroin
LSD
marijuana*

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52
Q

schedule II

A

medical use
high risk for abuse

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53
Q

schedule II examples

A

opioids (morphine, codeine)

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54
Q

schedule III

A

combination drugs
lower risk for abuse

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55
Q

schedule III examples

A

tylenol #3= tylenol + codeine

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56
Q

schedule IV

A

medically indicated
mild physical/psychological dependence

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57
Q

schedule IV examples

A

benzodiazepines (diazepam)
choral hydrate
phenobarbital

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58
Q

schedule V

A

medically accepted
limited dependency

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59
Q

schedule V examples

A

lomotil
cough syrup w/ codiene

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60
Q

schedule # drugs

A

lower # = higher risk for abuse

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61
Q

Before administering a medication, what does the nurse need to know to evaluate how individual pt variability might affect the pt’s response to the med? (Select all that apply)

a. chemical stability of med
b. family medical history
c. pt’s age
d. ease of administration
e. pt’s diagnosis

A

b. family medical history
c. pt’s age
e. pt’s diagnosis

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62
Q

which patient’s are @ increased risk for adverse drug events? (Select all that apply)

a. 2-month-old infant taking med for gastroesophageal reflux disease
b. 7-year-old female receiving insulin for diabetes
c. 23-year-old female taking antibiotic for first time
d. 40-year-old male who is intubated in the ICU & taking antibiotics & cardiac meds
e. 80-year-old male taking meds for COPD

A

a. under 1
d. more drugs
e. over 70

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63
Q

pt who has cancer reports pain as “burning” & “shooting” alternating w/ feelings of numbness & coldness. what med will be given

A

duloxetine (cymbalta)

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64
Q

what is preferred for pt w/ persistent pain

A

scheduled dosing around the clock

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65
Q

opioids shouldn’t be used

A

chronic pain

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66
Q

pain threshold

A

point where it becomes painful

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67
Q

pain tolerance

A

point when pain becomes too much

(finally take/do something)

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68
Q

pain tolerance is decreased by:

A

repeated exposure to pain
fatigue
anger
fear
sleep deprivation

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69
Q

physical dependence

A

body’s reaction

ex: no coffee –> headache

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70
Q

addiction

A

behavior pattern

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71
Q

initial reaction of physical dependence

A

about 10 hours after last dose

yawning, rhinorrhea, sweating

72
Q

later reaction of physical dependence

A

violent sneezing
weakness
nausea/vomiting
diarrhea
abdominal cramping
bone & muscle pain
muscle spasm & kicking movements

73
Q

how long does physical dependence last if untreated

A

7-10 days

74
Q

what moderates pain

A

nor-epi & seratonin

75
Q

where do nor-epi & seratonin moderate pain

A

medulla & pons

76
Q

acute pain

A

less than 6 months

somatic, visceral, referred

77
Q

acute somatic pain

A

connective tissue, muscle, bone, & skin

78
Q

acute visceral pain

A

internal organs & abdomen

79
Q

referred pain

A

present in area removed or distant from point of origin

80
Q

somatic pain feeling

A

sharp & localized or dull & non-localized

81
Q

acute somatic pain responds best to

A

TYLENOL & OPIOIDS

acetaminophen
corticosteroids
NSAIDs
opiates
local anesthetics
ice
massage

82
Q

visceral pain responds to

A

OPIOIDS

corticosteroids
NSAIDs

83
Q

analgesics

A

relieve pain w/out causing loss of consciousness

84
Q

opioids

A

most effective pain relievers available

85
Q

drugs for acute pain

A

morphine & other opioid agonists

acetaminophen

86
Q

morphine & opioids

A

moderate –> severe pain

oral, IV, transdermal

87
Q

morphine & opioids for - moderate pain

A

codeine or codeine/acetaminophen

hydrocodone or hydrocodone/acetaminophen

88
Q

morphine & opioids - severe pain

A

morphine

oxycodone

89
Q

chronic pain

A

over 6 months

significant behavior & psychological changes

90
Q

types of chronic pain

A

central
non-neuropathic
neuropathic
psychogenic

91
Q

central chronic pain

A

CNS lesion or dysfunction

migraine (headache)

92
Q

central pain treatment

A

treat cause

medications

93
Q

non-neuropathic pain

A

myofascial (chronic) pain syndromes

fibromyalgia (muscle pain)
myositis (inflammed muscles)
myalgia (sore muscles)
muscle strain

94
Q

non-neuropathic drug choices

A

NSAIDs
TCAs
serotonin reuptake inhibitors

95
Q

neuropathic pain feeling

A

burning & tingling sensation

96
Q

neuropathic pain

A

trauma or disease to nerves

diabetic neuropathy (nerve damage due to diabetes)
post-herpetic neuralgia (lasting pain from shingles)
deafferentation pain (pain loss due to sensory input)

97
Q

management strategy (ABCDE)

A

Ask about pain regularly
Believe pt/family in reports of pain
Choose pain control appropriate for pt
Deliver interventions in timely, logical, coordinated fashion
Empower pts/families (allow pts to control treatment)

98
Q

drugs for neuropathic pain

A

anti-epileptics:
- pregabalin
- gabapentin

antidepressant:
- TCAs
- duloxetine (cymbalta)

99
Q

three families of peptides

A

enkephalins
endorphins
dynorphins

100
Q

peptides severe

A

neurotransmitters
neurohormones
neuromodulators

101
Q

pure opioid agonists

A

agonist: MU & KAPPA

morphine
codeine
meperidine

102
Q

MU antagonist & KAPPA agonist

A

pentazocine
nalbuphine
butorphanol

103
Q

MU agonist & KAPPA antagonist

A

buprenorphine

104
Q

pure opioid antagonists

A

MU & KAPPA

naloxone
naltrexone

105
Q

morphine

A

moderate to severe pain
(not used to treat anxiety)

binds to MU

106
Q

morphine adverse effects

A

respiratory distress
constipation (need laxative)
orthostatic hypotension
urinary retention
euphoria/dysphoria
sedation
miosis (pinpoint pupils)
intracranial pressure (ICP)
birth defects

107
Q

morphine shouldn’t be given to…

A

pt w/ head trauma (ICP)
pregnant women (birth defect)
pt w/ impaired pulmonary function (asthma, emphysema, kyphoscoliosis, chronic cor pulmonale)

108
Q

pharmacokinetics of morphine

A

not very lipid-soluble

doesn’t cross blood-brain barrier easily

small fraction of dose reaches site of analgesic action

109
Q

what schedule is morphine

A

schedule 2

110
Q

precautions of morphine

A

decreased respiratory reserve (COPD), head injury, pregnant, labor & delivery

111
Q

morphine toxicity

A

classic triad

  • coma
  • RD
  • miosis
112
Q

morphine toxicity treatment

A

ventilatory support
naloxone (narcan) –> blocks receptors

113
Q

mild to moderate pain

A

codeine (generic)
hydrocodone (vicodin)
oxycodone (oxycontin)
meperidine (demerol)

114
Q

moderate to severe pain

A

morphine
hydromorphone
oxymorphone
levorphanol
fentanyl
methadone

115
Q

codeine dose

A

parenteral:
- 120

oral:
- 200

116
Q

hydrocodone dose

A

oral:
- 30

117
Q

oxycodone dose

A

oral:
- 20

118
Q

meperidine dose

A

parenteral:
- 100

oral:
- 400

119
Q

morphine dose

A

parenteral:
- 10

oral:
- 30

120
Q

hydromorphone dose

A

parenteral:
- 1.5

oral:
- 7.5

121
Q

oxymorphone dose

A

parental:
- 1

122
Q

levorphanol dose

A

parenteral:
- 2

oral:
- 4

123
Q

fentanyl dose

A

parental:
0.1-0.2

124
Q

methadone dose

A

parenteral:
10^b

oral:
3-5^b

125
Q

fentanyl

A

100x potency of morphine

chronic pain

126
Q

five formulations in three routes

A

parenteral (sublimaze)

transdermal (duragesic)

transmucosal

127
Q

parenteral

A

sublimaze

surgical anesthesia

128
Q

transdermal

A

duragesic

  • patch
  • iontophoretic system
129
Q

transmucosal

A

lozenge on stick (Actiq)
buccal film (onsolis)
buccal tablets (fentora)
sublingual tablets (abstrail)

130
Q

alfentanil & sufentanil

A

1000x more

131
Q

remifentanil

A

10,000x more

animal tranq.

132
Q

meperidine

A

short half-life

can’t use for longer than 48 hours

133
Q

methadone

A

long half-life

treatment for pain & opioid addicts

134
Q

hydromorphone (dilaudid)

A

10x more patent than morphine

less nausea than morphine

135
Q

1.5 mg of hydromorphone IV = ??? morphine IV

A

10 mg

136
Q

codeine

A

schedule 2

pain & cough suppression

137
Q

what precent of codeine converts to morphine in liver

A

10%

138
Q

when can’t pt convert codeine to morphine in liver

A

lack 2D6 pathway

139
Q

oxycodone

A

long-acting analgesic

140
Q

hydrocodone

A

no max dose unless combined w/ tylenol or ibuprofen

141
Q

dosing guidelines

A
  • pain assessment
  • dosage determination
  • dosing schedule
  • avoiding withdrawal
142
Q

pure opioids max dose?

A

no ceiling dose

143
Q

when should opioids be administered

A

on fixed schedule

144
Q

patient-controlled analgesia

A

PRN

pt gives own dose

145
Q

opioid antagonists

A

block effects of opioid agonists

146
Q

uses of opioid antagonists

A

opioid overdose (opioid- induced constipation)
reverse post-operative opioid effects
manage opioid addiction

147
Q

pure opioid antagonist meds

A

naloxone (narcan)
methylnatrexone (re listor)
alvimopan (entereg)
naltrexone (revia, vivitrol)

148
Q

naloxone (narcan)

A

reverse opioid overdose (titrated cautiously)

reverse post-operative opioid effects

reversal of neonatal RD (labor & delivery)

149
Q

methylnatrexone

A

treat opioid-induced constipation

(laxative isn’t working)

150
Q

non-opioid centrally acting analgesics

A

tramadol (ultram): suicide risk
clonidine (duraclon)
ziconotide (prialt)
dexmedetomidine (precedex)

151
Q

tramadol

A

schedule 4

increase nor-epi & serotonin in brain (blocks uptake)

used for suicide

152
Q

clonidine

A

neuropathic pain

hypotension
rebound hypertension
bradycardia

153
Q

after surgery, a pt has morphine prescribed for postoperative pain. it is most important for the nurse to make which assessment?

a. RR
b. HR
c. pain level
d. constipation

A

a. RR

154
Q

a post-operative pt who has an IV infusion of morphine has a RR of 8 breaths/min & is lethargic. which as-needed (PRN) medication should the nurse administer to pt?

a. methadone (dolophine)
b. nalbuphine (nubain)
c. tramadol (ultram)
d. naloxone (narcan)

A

d. naloxone (narcan)

155
Q

nociceptive pain patho

A

injury to tissues

somatic & visceral

156
Q

neuropathic pain patho

A

injury to peripheral nerves

responds poorly to opioids

157
Q

ongoing evaluation

A

reassess frequently

evaluate after sufficient time

be alert to new pain

158
Q

barriers to assessment

A

inaccurate reporting by pt

under-reporting by pt

language & cultural barriers

159
Q

drug therapy

A

non-opioid analgesics

opioid analgesics

adjuvant analgesics

160
Q

step 1: analgesic ladder

A

mild to moderate
- non-opioid
- NSAID & acetaminophen

161
Q

step 2: analgesic ladder

A

more severe pain
- opioid analgesic
- oxycodone
- hydrocodone

162
Q

step 3: analgesic ladder

A

severe pain
- morphine
- fentanyl

163
Q

cancer pts avoid

A

meperidine (demerol)

164
Q

routes of administration

A

oral
rectal
transdermal
IV or sub Q
IM
intraspinal
intraventricular
PCA

165
Q

breakthrough pain

A

transient episodes of pain

give PRN

166
Q

adjuvant analgesics

A

complement effects of opioids

amitriptyline (elavil)

give w/ opioid

167
Q

types of adjuvant analgesics

A

antihistamines
- hydroxyzine (vistaril)

glucocorticoids

bisphosphonates

168
Q

physical interventions

A

heat
cold
massage
exercise
TENS

169
Q

psychosocial interventions

A

relaxation & imagery

cognitive distraction

peer support groups

170
Q

older adults

A

heightened drug sensitivity

under-treated: believed to…
- insensitive to pain
- tolerate pain well
- highly sensitive to opioid side effects

171
Q

young children

A

asses & treat verbal/non-verbal

172
Q

a pt w/ cancer complains of bone pain rates 8/10. which medication should the nurse administer?

a. ibuprofen (motrin)
b. acetaminophen (tylenol)
c. hydromorphone (dilaudid)
d. meperidine (demerol)

A

c. hydromorphone (dilaudid)

173
Q

which is the priority of care in the pt w/ moderate to severe pain from cancer?

a. prevention of addiction & physical dependence
b. adequate pain relief w/ opioid medication
c. avoid constipation by increasing dietary intake
d. using TENS or massage to treat cancer pain

A

b. adequate pain relief w/ opioid meds

174
Q

the nurse instructs a pt w/ cancer pain about taking opioids. which statement, if made by pt, indicates understanding about instructions?

a. i can expect drug to cause serious side effects
b. i will develop an addiction to pain medication
c. if the drug no longer works, the dose can be increased
d. i should not take medication until pain is severe

A

c. if drug no longer works, dose can be increased

175
Q

a pt who is an opioid abuser is diagnosed w/ bone cancer. if the pt complains of severe bone pain, it is most important for the nurse to administer which medication?

a. potent non-steroidal anti-inflammatory drugs
b. adequate doses of opioids
c. frequent doses of non-opioids
d. regular doses of an opioid agonist-antagonist

A

b. adequate doses of opioids

pharm 305 (1 decks)

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