Pharm Test #1 Flashcards
1
Q
what is the study of biological effects of chemicals
A
pharmacology
2
Q
what are chemicals that are introduced into the body to cause some sort of change
A
drugs
3
Q
what kind of pharmacology do nurses deal with
A
pharmacotherapeutics or clinical pharmacology
4
Q
who focuses on how chemicals act on living organisms
A
healthcare providers
5
Q
what is the nurse’s responsibility
A
administering drug
assessing drug effects
intervening to make drug regimen more tolerable
providing patient teachings about drugs and the drug regimen
monitoring overall pt care plan to prevent medication errors
***know
6
Q
what does a nurse always do after giving a pt medications
A
reassess the pt
7
Q
what category of drugs is risk to fetus in the first trimester, but no evidence of risk in later trimesters
A
category A
8
Q
chemicals produced by companies involved solely in manufacturing of drugs
A
generic drugs
**know
9
Q
bioavailabilty of drug may be different than brand name
A
generic drug
10
Q
these are dispensed as written
A
generic drugs
11
Q
taking these drugs w/ prescription medicatons could result in drug interactions and interfere w/ drug therapy
A
OTC
12
Q
these products are available without prescriptons
A
OTC
13
Q
these are high abuse protentional, no accepted medical use
what types of drugs are included in this
A
Level I drug on DEA schedule of controlled substance
heroin, marijuana, lsd
14
Q
control over coding of drugs and the enforcement of these codes
A
FDA and the DEA
15
Q
this agency deals with the prescription, distribution, storage and use of drugs
A
FDA
16
Q
study of the interactions btwn the chemical components of living systems and foreign chemicals that enter those systems
A
pharmacodynamics
17
Q
this is how the drug acts on the body
A
pharmacodynamics
18
Q
drugs act in what four ways
A
- replace or act as a substitute for missing chemicals
- increase or stimulate certain cellular activities
- depress or slow cellular activities
- interfere with the functioning of foreign cells
19
Q
these react to certain chemicals to cause an effect within the cell
A
receptor sites
20
Q
this produces an effect
A
agonists
21
Q
these block the receptor sites
A
competitive antagonists
noncompetitive antagonists
22
Q
these distrupt cell function
A
drug enzyme interactions
23
Q
this targets only foreign cells
A
selective toxicity
24
Q
the study of absorption, distribution, metabolism, and excretion of drugs
A
pharmacokinetics
25
distribution means
moving into another body system
26
excretion means
how the drug leaves the body
27
this means how the body detoxifies chemicals to make them friendly throughout body
metabolism
28
this means when the drug has effects - not always instant unless its via IV
onset of drug action
29
time it takes drug to peak
drug half life
30
time for max effect of drug
timing of the peak effect
31
how long the drug stays in the system
duration of drug effects
32
the reaction before excretion of drgu
metabolism/biotransformation of drug
33
another word for metabolism
biotransformation
34
where the drug is eliminated from body
site of excretion
35
amount of drug that is needed to cause a theraputic effect
critical concentraion
36
a higher dose than usually used for treatment
loading dose
37
what is the action of a drug
to depress or slow cellular activities
38
most common route of taking drugs
via oral
39
this is what happens to a drug from time it is introduced to the body until it reaches circulating fluids and tissues
absorption
40
movement of a drug to the body's tissues affected by lipid solubility, ionization, perfusion of reactive tissue
distribution
41
3 types of distribution
protein binding
blood brain barrier
placenta and breast milk
42
factors affecting absorption intravenously
none
43
factors affecting absorption via intramuscular
1. perfusion or blood flow to muscle
2. fat content of muscle
3. temp of muscle
44
factors affecting absorption subcutaneous
1. perfusion or blood flow to tissue
2. fat content of tissue
3. temp of tissue
45
factors affecting absorption PO (oral)
1. acidity of stomach
2. length of time in stomach
3. blood flow to gi tract
4. presence of interacting foods or drugs
46
factors affecting absorption PR (rectal)
perfusion or blood flow to rectum
lesions in rectum
length of time retained for absorption
47
factors affecting absorption muscuos membranes (sublingual buccal)
perfusion or blood flow to area
integrity of mucous membranes
presence of food or smoking
length of time retained in area
48
factors affecting absorption topical (skin)
perfusion or blood flow to area
integrity of skin
49
factors affecting absorption inhalation
perfusion or blood to low to area
integrity of lung lining
ability to administer drug properly
50
what is the single most important site for biotransformation (metabolism)
liver
51
this is the first pass effect
hepatic enzyme system
metabolism (biofransformation)
52
if this doesn't work it will cause toxicity within body
liver
53
this is the removal of drugs from body
excretion
54
what is the most important role in excretion of medication
kidneys
55
nephrotoxicity is where
kidneys
56
normal BUN numbers
8-20
57
factors influencing drug effect
1. weight
2. age
3. gender
4. physiological & pathological factors
5. genetic factors
6. immunological & psychological factors
7. environmental factors
8. tolerance, accumulation, interactions
58
what is accumulation in regards to influencing drug effect
time drug takes to get into body and take too much it turns toxic
59
what is the half life of drug
time it takes for amount of drug in body to decrease to one half the peak level
60
half life is affected by what four things
absorption, distribution, metabolism, excretion
61
what impacts absorption and is important that may interact with drugs
food
62
this can occur any time two or more drugs are taken together
drug to drug interaction
63
what is tydrating
slowly coming down from medication
64
excessive response to primary or secondary effect of drug
hypersensitivity
65
body forms antibodies to a drug, causing immune response when reexposed
drug allergy
66
a reason adverse effect of drug occurs
pt is sensitive to drug being given
pt is taking too much or too little of drug
67
what is the inflammation of mucous membranes
stomatitis
68
what types of infections are hardest to treat
fungal
69
destruction of the bodys normal flora
superinfections
70
bone marrow suppression caused by drug effects
blood dyscrasia
71
toxicity =
poison
72
what interventions would you do for liver injury toxicity
small frequ meals, good skin care, vital signs, let pt rest since they'll be fatigue
73
what interventions would you do for renal injury toxicity
renal diet, fluid restriction, discontinue meds, treat electrolyte balance
74
what intervention would you do for hypoglycemia
get blood sugar level up --- use juice or dextrose IV
75
what intervention would you do for hyperglycemia
admin insulin, reassess
76
what intervention would you do for hypokalemia
EKG to check cardiac rhythm and function
77
what intervention would you do for hyperkalemia
1. kayexalate - orally or enema
2. do cleansing enema
3. give insulin bc binds with potassium and give dextrose
78
what assessment would take place for ocular damage
visual changes (blurred vision, corneal changes, blindness)
79
what assessment would take place for auditory damage
dizziness, ringing in ears, loss of balance, loss of hearing
80
what is the assessment for atropine-like effects (anticholinergic)
dry mouth, urinary retention, constipation, blurred vision, nasal congestion, skin dryness
81
what are the interventions for atropine-like effects
sugarless lozenges to keep mouth moist
prevent dehydration
have pt void before admin of medication
82
in regards to neurological effects - waht is the most important to know for the CNS
know pts base line
83
any drug causes harm to developing fetus or embryo
teratogenicity
84
when teaching to prevent teratogenicity - waht is the most important thing
advise pregnant woman any medication may have possible effects on baby
85
this is a progressive chronic neurological disorder; may develop in ppl of any age
parkinsons disease
86
what are signs of progression of parkinsons disease
1. lack of coordination
2. rhythmic tremors
3. bradykinsea
4. problems with urinary retention, mostly men
5. mask like expressions
6. rigidity/weakness
87
mgmnt of care for pt's with parkinson's disease
1. encourage pt's to: be active, perform exercises, maintain independent ADL, follow drug protocol
2. caregivers should: monitor adverse effects; provide support
88
what two drugs for parkinson's disease
levodopa (generic)
carbidopa-levodopa (sinemet)
**these must be taken with food
89
parkinson's disease meds are what type
dopaminergics
90
what are the pharmacokinetics for dopaminergics (4)
1. well absorbed from GI tract and widely distributed in body
2. metabolized in liver and peripheral cells
3. excreted in urine
4. crosses placenta
91
what actions do dopaminergics do
1. increase levels of dopamine in substantia nigra
2. directly simulating dopamine receptors in area
3. helping to restore balance btwn inhibitory and stimulating neurons
92
contraindiction of dopaminergics
angle closure glaucoma
93
what cautions for dopa minergics
cv disease
bronchial asthma
h/o petic ulcer
**these can aggravate condition
94
adverse effects of dopaminergics
anxiety
headache/blurred vision
arrhythmia
neutropenia
bowel movement probs
95
what drug to drug interactions occur with dopaminergics
vitamin b6
st johns wart
**decrease theraputic effect of med
96
what are the RN interventions for parkinson's disease
baseline vitals and neurologic assessment
check for dyskinesia, rigidity, tremors, gait disturbances
assess ability to swallow
do not crush extended release pills
drugs are admin by transdermal patch. -- use fatty or muscle areas
97
this is the mainstay treatment of parkinsons
precursor of dopamine that crosses blood/brain barrier
almost always given in combo with carbidopa
levodopa
98
what is another name for sinemet
levodopa carbidopa
99
what are the anticholinergic contraindictions
1. allergy, glaucoma, prostatic hypertrophy, tachycardia, hepatic dysfunction
100
adverse effects of anticholinergic agents
cns effects & peripheral anticholinergic effects
101
drug to drug interactions of anticholinergics
other anticholinergics, antipsychotics
102
this is used with drug to enhance effects of drug
adjunctive agents
103
this is used to restimulate the carbidopa levodopa after pts show signs of deteriorating response to treatment
selegiline
104
this is used with carbidopa levodopa to increase the plasma concentration and duration of action of levodopa
entacapone
105
what are the 8 rights for nurse's role
1. right pt
2. right drug
3. right storage
4. right route
5. right dose
6. right preparation
7. right time
8. right recording
106
during assessment what do we need to know
history: chronic conditions; drug use; allergies, level of educ; social supports; finl supports; pattern of healthcare
phy exam: weight, age, physical parameters related to disease
107
what are the steps to the nursing process
assessment
planning
implementation
evaluation
108
nursing interventions are aimed at what
achieving outcome goals determined in planning phase
109
all medication issues are reported to who
national level and institutional level
110
this is part of the continuing process of pt care
leads to changes in assessment, diagnosis & intervention
evaluation & re evaluation
111
**may not need to take pt off med... may just need to
reduce the medication dosage
112
what are signs of depression
low energy level
sleep disturbances
overwhelming saddness, hopelessness
113
what is an example of a tricyclic antidepressant
amitriptyline ***know
114
how choose the right tricyclic antidepressants
choice depends on individual response to drug and tolerance of adverse effects
115
what are indications of tricyclic depressants are working
relief of symptoms of depression
116
what cautions are associated with tricylic antidepressants
cardiovascular disease. dont put pt on if cv history - can cause reinfarction, palpitations
117
what are adverse effects of tricyclic antidepressants
fatigue, dry mouth, sleep disturbances,
can't go cold turkey or will cause withdrawal symptoms
-must check liver functions due to concentration of drug in liver
118
MAOIs stand for waht
monoamine oxidase inhibitors
119
what is the indications for MAOIs
treatment of pts with depression who are unresponsive to or unable to take other antidepression agents ***** know
120
what are the pharmacokinetics of MAOIs
*metabolize in liver, excreted in urine --- watch liver functions
*cross placenta and enter breast milk
*can't have food w/ tyramine --- beer, cheese, soy, smoked meats, etc
121
what drug can you not put pt on if on MAOIs
SSRI - causes serotinin syndrome
122
what drugs do MAOIs have interactions with
*other anti depressants - hypertensive crisis, coma
*methyldopa - sympathomimetic effects increase
*insulin - additive hypoglycemia
123
what food does MAOIs interact negatively with
tyramine - increases blood pressure
124
can you take MAOIs if you have liver or kidney issues
no
125
Can MAOIs cause suicidal ideations
yes
126
what does SSRI stand for
selective serotonin reuptake inhibitors
127
waht do SSRIs do
block reuptake of 5Ht, with little to no known effects on NE
128
how many adverse effects do SSRIs have associated with TCAs and MAOIs
not many. safest meds. fewest side effects
129
What are 3 examples of SSRIs
*citalopram (celexa)
*escitalopram (lexapro)
*sertraline (zoloft)
130
waht SSRI doesn't cross placental barrier
lexapro
131
what are the pharmacokinetics of SSRIs
absorbed in GI tract
metabolized in liver
associated with congenital abnormalities
132
what contraindications do SSRIs have
known allergy, pregnancy, lactation, impaired renal function, hepatic function
133
can you crush or chew your SSRIs
no
134
what herb decreases concentration of meds
st johns wort
135
how many days does a pt need to be off medications before switching to a different class of antidepressant
10 days
136
what is adverse effect of SSRI
headache, drowsiness, dizziness, hypertension
137
how do you know if SSRI is working
improving pts depression
138
waht drug interactions do SSRI have
MAOI, TCA
139
What does SNRI stand for
serotonin norepinephrine inhibitors
140
what actions do SNRI take
decrease neuronal reuptake of both serotonin and norepinephrine and more weakly inhibit dopamine **** know
141
when do you take you SSRI
in the AM for max effect
142
what are the pharmacokinetics of SNRI
absorbed from GI tract
metabolize din liver
excreted in urine
143
waht are the contraindications of SNRI
allergy, MAOI use ***** know
144
what two drugs are SNRI taht you'll see in hospital
duloxetine (cymbalta)
venlafaxine (effexor)
145
what are some mental disorders for psychotherapeutic agents
schizophrenia
bipolar
narcolepsy
ADD
146
what are psychotherapeutic agents for
used to treat psychoses -- preceptual and behavioral disorders
147
do psychotherapeutic drugs cure the disorders
no. they help pts function with ADL. helps with symptoms
148
3 psychotherapeutic drugs that cause paramedial effects
*chlorpromazine (thorazine)
*haloperidol (haldol)
*risperidone (risperdal)
149
this person has hallucinations, paranoia, delusions
schizophrenia
150
what are the causes of schizophrenia
strong genetic association
may reflect fundamental biochem abnormality
151
antipsychotic neuroleptic drugs are used for what disorder
schizophrenia
152
this is extreme depression followed by hyperactivity and excitement
biopolar
153
this is daytime sleepiness and sudden periods of loss of wakefulness
narcolepsy
154
this is the inability to concentrate on one activity longer than a few mins.
is usually diagnosed in school age kids
ADD - attention deficit disorder
155
who's involvement is needed to fill out APPIE for ADD pts
parents
156
what are these interventions for
1. ID factors that aggravate/alleviate pt's performance
2. provide distraction free environment
3. use simple language, talk slowly
4. state expectations of tasks
nursing interventions for ADHD
157
waht is the most important nursing intervention for ADHD pts
provide positive feedback for completion of each step of task
158
WHAT kind of medications are used to treat ADHD
stimulants
159
what are contraindications of antipsychotic and neuroleptic drug
parkinsons disease
coronary disease
prolonged QT interval - cardiac rhythm
160
what are drug to drug interactions for antipsychotic/neruoleptic drugd
alcohol
anticholinergics
ziprasidone
161
these have the signs and symptoms of anticholinergics
antipsychotic / neuroleptic drugs
162
these are muscle tremors, cogwheel rigidity, drooling, shuffling gait
extrapyramidal effect
pseudoparkinsonism
163
extrapyramidal effect
spasms of tongue, neck, back, legs which can cause unnatural posturing
dystonia
164
extrapyramidal effect
continuous restlessness, inability to sit still (foot tapping, hand movements)
akathisia
165
extrapyramidal effect
abnormal muscle movements, lip smacking, tongue rolling, chewing, leg/arm movements
**** know this
tardive dyskinesia
166
what drug is used for bipolar
***know this
lithium (lithobid)
167
-this alters sodium transport in nerve and muscle cells
-inhibits release of norepinephrine and dopamine from stimulated neurons
lithium
168
what does lithium cross that's associated with creating congenital abnormalities
placenta barrier
169
what are the adverse effects of lithium
lithium toxicity
170
what #s are the therapeutic lithium level
0.5-1.0 mEq/L
*must know
171
this lithium level creates lethargy, slurred speech, muscle weakness,, nausea ****** know this
1.1 -1.5
172
what is a lithium drug
haloperidol
173
what is important for nursing considerations for antimanic drugs
any known allergies to lithium
sodium depletion
use of diuretics
urinary output, liver and renal function tests
174
this is most prevalent of neurological disorders
epilepsy
175
this disorder is frightening to pts
epilepsy
176
two types of generalized seizures
absence and status epilepticus
177
this seizure lasts 3-5 secs, can lose consciousness, mostly in children, disappears once hit puberty
absence
178
this seizure is a medical emergency, most dangerous bc no recovery in btwn seizures
status epilepticus
179
2 categories of seizures
1. grand mal
2. petit mal (absence)
*** these are now called generalized or partial seizures
180
what do generalized seizure drugs treat
they stabilize nerve membranes by blocking channels in cell membrane or altering receptor sites.
work generally on central nervous system
181
what hydantoins drug is used for seizures
phenytoin **** know
182
why is phenytoin used
*generally less sedating
*may be drug of choice for pts unable to tolerate sedation and drowsiness
183
waht is the pharmacokinetics of hydantoins
therapeutic serum phenytoin levels 10-20 mcg/mL
184
can you give hydantoins with dextrose
no. only normal saline. give IV or orally
185
waht are adverse effects of hydantoins
***** know
depression, confusion, severe liver toxicity, bone marrow suppression, decrease appetite
186
*** know these
what are the nursing considerations for hydantoins .... phenytoin (7)
1. thorough neuro assessment
2. gingival hyperplasia (overgrowth of gum tissue)
3. PO or IV (vesicant -- harmful to vein)
4. take 2-3 hours before or after antiacid
5. no grapefruit
6. therapeutic drug levels drawn as prescribed
7. photosensitivity
187
what benzodiazepines are used for anti seizure
diazepam (valium) **
188
what are the RN considerations for benzodiazepines for antiseziures
-addictive drugs
-CNS assessment to know level or orientation
189
what are adverse effects of benzodiazepines
depression, confusion, drowsiness, cardiac arrhythmias, urinary retention, phys dependence, withdrawal
190
adverse effects for treating absence seizures
liver toxicity and CNS suppression
191
RN considerations for treating absence seizures
N/V, anorexia, drowsiness/dizziness, photosensitivity, bleeding
