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AE1 > PHARM WEEK 1 INTRO TO MEDS > Flashcards

PHARM WEEK 1 INTRO TO MEDS Flashcards

1
Q

Percocet vs. Percodan

A

Oxycodone (with acetaminophen) vs.
Oxycodone (with aspirin)

[both are pain meds]

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2
Q

Hydroxyzine vs. Hydralazine

A

Antianxiety vs. antihypertensive

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3
Q

Quinidine vs. Quinine

A

Antidysrhythmic vs. antimalarial

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4
Q

Celexa vs. Celebrex

A

SSRI vs. NSAID (anti-inflammatory)

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5
Q

Methods of Drug Distribution
STOCK
- advantages

A

Advantages:

  • Always available
  • Cost Efficiency
  • in your place of work
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6
Q

Methods of Drug Distribution
STOCK
-disadvantages

A 
Disadvantages: 
-More errors 
    - poured by many 
    - more drugs to choose   
      from 
    - may be a multi dose vial which is now discouraged especially liquid meds b/c of some outbreak of hepatitis 
- Drug expiration may be  
   missed
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7
Q

Methods of Drug Distribution
UNIT DOSE
- Advantages

A

Advantages:

  • Fewer errors
  • Saves time
  • Correct dose without calculation
  • Billed for specific # doses
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8
Q

Methods of Drug Distribution
UNIT DOSE
-Disadvantages

A

Disadvantages:

  • time delay to get drug
  • if contaminated or damaged, not readily replaceable
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9
Q

Computer Based Drug Administration (CBDA):

4

A
  1. Computerized Prescription Order System (CPOS)
  2. Bar Code Medication Administration
  3. Medication Administration Record (MAR & eMAR)
  4. Automation of Medication Dispensing Administration
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10
Q

1 teaspoon = __ ml

A

5 ml

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11
Q

1 Tablespoon (T) = __ ml = __ ounce (use a __ __ __ or __)

A

15 ml; 1/2 ounce

med measuring cup
syringe

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12
Q

1 ounce = __ ml = __ T

A

30 ml ; 2T

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13
Q

The art and science of preparing and dispensing drugs and medicines (packaging, pharmacies, oral vs. tablets vs. solution, gastric effects) =

A

pharmaceutics

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14
Q

The quantitative study of how drugs are taken up and biologically transformed (“MOTION”), what the body does to the drug =

A

pharmacokinetics

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15
Q

The quantitative study of drug “ACTION” - what the drug does to the body (how the med works and its chemical action) =

A

pharmacodynamics

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16
Q

What are some contemporary issues in pharmacology? (4)

A
  1. drug approval process
  2. transcultural considerations
  3. drug interactions, OTC drugs, drug abuse
  4. herbal therapies
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17
Q

Food & Drug Administration (FDA) passed which act?

A

1938 Food, Drug, and Cosmetic Act

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18
Q

What does the FDA do?

A

Monitors, regulates, manufactures, and markets drugs

  • testing
  • labels
  • packaging re: adverse effects
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19
Q

1970 Controlled Substances Act: Schedule Categories of drugs (I - V)

A

I. High abuse potential, NO medical use (Heroin, LSD)
II. High abuse potential; ACCEPTED medical use (morphine - epidemic of opioid addiction)
III. Medically accepted;

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20
Q

HIPAA (4)

  1. ___ act set standards for privacy of health information
  2. Limited access to patient info from ___
  3. __ __ __ with pharmacist
  4. All clients __ __ they received copy of privacy practices
A
  1. 2003
  2. pharmacy
  3. Private consult area
  4. sign statement
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21
Q

Nurse practice acts __ __ __

A

vary by state

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22
Q

NY/NJ law prohibits nurse from giving medication without:

A

a valid prescription from HCP

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23
Q

Under the nurse practice acts, there are __ __ and __ __

A

criminal offenses

civil offenses

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24
Q

Nurse practice acts: Civil Offenses include: (3)

A
  1. Misfeasance
  2. Nonfeasance
  3. Malfeasance
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25
Q

Misfeasance

A

negligence (wrong drug/dose) results in death

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26
Q

Nonfeasance

A

omission results in death

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27
Q

Malfeasance

A

correct drug by wrong route causes death

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28
Q

FDA Pregnancy Categories classify __ __ to __ . The categories are: (5)

A

drug risks; fetus

  1. A
  2. B
  3. C
  4. D
  5. X
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29
Q

FDA Pregnancy Categories

- Categories __ and __ are considered safe during pregnancy, especially in the 1st trimester

A

A & B

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30
Q

FDA Pregnancy Category A

A

Studies show no fetal risk

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31
Q

FDA Pregnancy Category B

A

No fetal risk in ANIMAL studies

No risk assumed in humans

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32
Q

FDA Pregnancy Category C

A

Fetal risk in ANIMAL studies

Weigh risk vs. benefit

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33
Q

FDA Pregnancy Category D

A

Established/ Proven FETAL risk

Weigh risk vs. benefit if life-threatening

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34
Q

FDA Pregnancy Category X

A

Established/ Proven FETAL risk
Risk is > benefit
AVOID IN PREGNANCY

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35
Q

Phases of Human Clinical Drug Experimentation

Phase I

A

Determines human drug dose in healthy subjects

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36
Q

Phases of Human Clinical Drug Experimentation

Phase II

A

Demonstrate drug safety & efficacy in subjects with disease

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37
Q

Phases of Human Clinical Drug Experimentation

Phase III & IV

A

Demonstrate drug safety & efficacy in wide client population and collect long term data

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38
Q

Phases of Human Clinical Drug Experimentation

Phase V

A

Adding adverse events to a drug after the drug is widely used
Report any adverse events to the FDA

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39
Q

taking antidepressants can lead to __ because your __ __ increases due to weight gain

A

diabetes

blood sugar

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40
Q

The roles of the nurse in drug research (5 )

A
  1. Client and family advocate
  2. Liaison between client, health care provider, and research nurse responsible for specific protocol
  3. informed consent
  4. risk to benefit ratio
  5. assess for therapeutic effects, side effects, and adverse reactions
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41
Q

Ethnopharmacology = the study of drug responses that may be __ to an individual owing to __, __ and __ phenomena

In other words,
__ + __ = ethnopharmacology

A

unique

social, cultural, biologic

anthropology + pharmacology

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42
Q

Pharmacogenetics = __ of the __ __ to a drug due to genetic factors

A

variations; predicted response

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43
Q

Which classes of antihypertensive agents do African Americans respond poorly to?

A

beta blockers

ACE inhibitors

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44
Q

Asians have a greater sensitivity to which two drug classes ?

A

benzodiazepines

anti-depressants

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45
Q

What 4 things make up transcultural nursing?

A
  1. traditional health practices
  2. complementary health practices
  3. alternative health practices
  4. mainstream health practices
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46
Q

What are traditional health practices?

A

Includes the use of teas, herbs, spices, special foods, and homeopathic remedies

Can produce neutral, beneficial, or deleterious effects

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47
Q

Giger and Davidhizar Transcultural Assessment Model

- Nursing assessment (7)

A
  1. culturally unique individual
  2. communication
  3. space
  4. social organization
  5. time
  6. environmental control
  7. biology variations (pharmacogenomics)
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48
Q

Drug interactions: Additive effects

A

sum of the effects

Two drugs with similar actions sum their effects (e.g., 1+1 =2)

May be desirable or undesirable

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49
Q

Drug interactions: Synergism or Potentiation

A

clinical effect is greater than simply the combined effect of the two
ex: 1 + 1 = 3

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50
Q

Drug interactions:

Drug Interference

A

one drug increases or decreases the metabolism or excretion of another

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51
Q

Drug interactions: Displacement

A

one takes the place of another ; two drugs compete for binding sites on plasma proteins (e.g., albumin)

52
Q

Drug interactions: Antagonism

A

one cancels the effect of the other (1+1 = 0)

Basis for antidotes to toxic effects of another drug or chemical

(e.g., Narcan in an opiates overdose - prevents opiates from binding to CNS receptor sites)

53
Q

Drug interactions: Incompatibility

A

one cannot exist with the other

interaction of 2 drugs interferes w/ action of at least 1 drug

basis for drugs that bind/inactivate another toxic drug in GI tract

54
Q

Examples of additive effects

A

Hydralazine (vasodilator) + Nitroglycerin (vasodilator) = Hypotension
(requires caution and patient knowledge)
Ask q’s like :
1. What is the patient’s bp?
2. What’s their baseline bp?
3. Has patient taken both in the past?

Beta blocker + diuretic =

55
Q

Examples of synergism or potentiation

A

Codeine + ASA = > pain relief

Ampicillin + Sulbactam (enzyme inhibitor which helps ampicillin enter the cell of the bacteria to fight infection) = > therapeutic effect

56
Q

Drug interference examples

A

Cimetidine = med for ulcer, certain enzymes will be inhibited, may not be able to metabolize meds like coumadin = diminished effect of the med

Probenicid given in conjunction with penicillin allows the penicillin to stay in the body longer b/c probenicid slows renal excretion

57
Q

Displacement examples

A

Anticoagulants & anti-inflammatory = > risk bleeding

58
Q

Albumin binds to drugs so that you can carry it around in the body to the intended site. Active form of the medication =

A

when unbound to albumin, this is when the medication is working

you can overdose the patient without actually overdosing them!

59
Q

Incompatibility examples

A

Magnesium in antacids + tetracycline = may impair absorption of tetracycline

Mixing different types of IV meds in the same tubing can cause crystalized drug and line occlusion

laxatives speed up peristalsis by increasing the speed - you have less chance for the drug to be absorbed
- try not give these with other meds

Morphine (opioid) - slows GI mobility - might have a greater effect of the drop, more likely to absorb more without actually giving a greater dose of the drug

60
Q

Drug abuse =

A

drug use inconsistent with medical or social norms

  • nurses and other HCPs at risk b/c
    1. readily available
    2. stress involved on the job
    3. desensitization
61
Q

Drug-Food Interactions

Food __ most drug absorption

62
Q

Drug-food interaction exceptions:

Tyramine foods + ?

A

Tyramine foods beer, wine, cheese, pickled herring, yogurt, liver and yeast extract) + MAO inhibitors = severe HTN

63
Q

Drug-food interaction exceptions:

Vitamin K-rich foods + ?

A

Vitamin K-rich foods (green leafy veggies, broccoli, bananas, fish) + warfarin (Coumadin) = decreased anticoagulation

64
Q

Drug-food interaction exceptions:

Dairy products + ?

A

Dairy products impair absorption of tetracycline

If you drink tetracycline with milk, it will decrease the plasma levels of the drug, therefore inhibiting absorption

65
Q

Drug-food interaction exceptions:

Grapefruit juice + ?

A

Grapefruit juice + calcium channel blockers = decrease bp and possible toxicity.

66
Q

Some meds that must be taken with food:

A

beta blockers
Statin
Aspirin

67
Q

Which med do you want to take on an empty stomach for better absorption?

A

Synthroid - given for hypothyroidism

68
Q

Drug- lab values interactions:
__ __ or __ __ can affect certain drug therapies

Examples:

A

abnormal plasma; serum electrolytes

Examples:
Digoxin & low K+ or Mg++ or high Ca++
- may cause digitalis toxicity (nausea, diarrhea, H/A, blurred vision, bradycardia, ventricular dysrhythmias)

69
Q

What are 7 cautions with use of OTC meds?

A
  1. OTC drugs may cause delay in professional diagnosis and treatment 2. Symptoms may be masked
  2. Be sure to read labels carefully
  3. Consult health care provider before use
  4. Inactive ingredients may cause adverse reactions
  5. Potential for overdose
  6. Risk for drug-drug interactions
70
Q

OTC drugs and herbal therapies (4)

A
  1. need to be aware of usage
  2. may be beneficial
  3. may have serious potential side effects
  4. may interfere with prescription drug therapy
71
Q

Common Herbal Remedies:

Chamomile

A

GI complaints

72
Q

Common Herbal Remedies:

Echinacea

A

immune system enhancer

73
Q

Common Herbal Remedies:

Garlic

A

lower cholesterol and triglycerides,

74
Q

Common Herbal Remedies:

Ginger

A

boost immune system

75
Q

Common Herbal Remedies:

Gingko

A

improve memory

76
Q

Common Herbal Remedies:

Ginseng

A

decreases stress, boost energy, and digestion

77
Q

Common Herbal Remedies:

St. John’s wort

A

antidepressant

78
Q

What are the potential hazards of herbs:

4

A
  1. lack of standards
  2. largely unregulated by FDA
  3. possible interactions with drugs
  4. should NOT be used:
    - if pregnant or nursing
    - by infants or small children
    - with chemotherapy
    - in large quantities
79
Q

Drug Action Phases:

Pharmaceutic Phase

A
  1. Drug becomes a solution so that it can cross the biologic membrane
    * Drugs that are administered by subcutaneous, intramuscular or intravenous routes do not go through a pharmaceutic phase
80
Q

Drug Action Phases:

Pharmacokinetic Phase

A
  1. Absorption
  2. Distribution - protein binding
  3. metabolism or biotransformation
  4. excretion or elimination
81
Q

Pharmacokinetics: Absorption of ORAL MEDS-

First Pass Effect

A

Drug passes through liver before entering systemic circulation;
Chemical and biological barriers in GI environ

82
Q

Pharmacokinetics: Absorption of Oral Meds-

Bioavailability

A

% drug that reaches systemic circulation

In other words, the amount that goes into the bloodstream after being metabolized by the liver

PO drugs always

83
Q

Pharmacokinetics: Distribution =

A

process by which drug becomes available to body fluids and tissues

84
Q

Distribution: Protein Binding

Plasma protein bound drugs

A

Bound drug portion is inactive
Highly bound greater than 89%; less than 30% low protein bound
2 high protein bound drugs together can = toxicity

85
Q

Distribution: Protein Binding

Free (unbound) drugs

A

Only free drugs are active

Hypoalbuminemia = excess free drug & can cause toxicity

86
Q

Be aware of __ __ __ of all drugs taken by client

Check client’s __ __ and __ levels

A

protein binding %

plasma protein & albumin

87
Q

Distribution: Protein Binding

Blood Flow

A

Abscesses, exudates, glands, & tumors decrease distribution

abscesses and exudates don’t have blood flow, no blood vessels

88
Q

Distribution: Protein Binding

Body Tissue Affinity

A

Body Tissue Affinity: Some drugs accumulate in fat, bone, liver, muscle, & eye tissue (e.g., amiodarone (give for a-fib) – can cause lung toxicities)

89
Q

Pharmacokinetics: Metabolism or Biotransformation

What is metabolism?
What is the primary site of drug metabolism?

When metabolism is decreased what happens?

A

Metabolism is the process by which the body inactivates or biotransforms drugs

Liver primary site of drug metabolism
-Liver enzymes convert or transform drugs to inactive metabolites or water-soluble substances for excretion

Liver diseases can affect metabolism (e.g., hepatitis, cirrhosis)

When metabolism is decreased,
-Excess drug accumulation can lead to toxicity

90
Q

Metabolism: Half- life

A

time it takes for 1/2 drug concentration to be eliminated

metabolism affects 1/2 life
Liver dysfunction prolongs 1/2 life

By knowing drug’s half-life, we can estimate time to reach biologic steady state

91
Q

__ to __ half lives saturates biology system

What does saturating the biologic system mean?

A

3-5

the amount of drug taken in is the same amount that is excreted

92
Q

__ are main route of drug excretion

Other routes include: (7)

A

Kidneys

  1. liver
  2. bile
  3. feces
  4. lungs
  5. saliva
  6. sweat
  7. breast milk
93
Q

Kidneys filter __ __ __, __-__ __, and __ __

A
  1. free unbound drugs
  2. water-soluble drugs
  3. unchanged drugs
94
Q

__ __ drugs can not be excreted via the kidneys

A

Protein bound

95
Q

Urine pH

Acid urine excretes __ __ __

A

weak base drugs

96
Q

Urine pH

Alkaline urine excretes __ __ __

A

weak acid drugs

97
Q

We can manipulate the urine pH which is between __ and __ to help patient’s body __ the drug

A

4 and 8

eliminate

98
Q

what is the most accurate renal function test ?

A 
creatinine clearance (Cr Cl)  
this is a 12-24 hour urine collection
99
Q

Creatinine is the

A

metabolic byproduct of muscle tissue that is excreted by kidneys

100
Q

Less muscle mass = __ creatinine values (especially in __ and __)

A

lower;

women; elderly

101
Q

Normal Creatinine Clearance levels are between :

A

85 - 135 ml/ min

102
Q

If CrCl is lower than the normal range, what would you do?

A

may need to decrease drug dose

103
Q

Pharmacodynamic Phase

-Primary physiologic effect

A

desirable

- what drug was approved for

104
Q

Pharmacodynamic Phase

-Secondary physiologic effect

A

May be desirable or undesirable

Example: Diphenhydramine (Benadryl) causes drowsiness

105
Q

Pharmacodynamic Phase

Dose response & maximal efficacy

A

Dose response is relation between minimum vs. max dose needed for desired effect

106
Q

Pharmacodynamics

  • Therapeutic Index
  • Low =
  • High =
A

Low: narrow margin of safety

High: wide margin of safety

107
Q

Pharmacodynamics

Peak levels:

A

Time of highest plasma drug concentration & shows rate of absorption

-Drug peak blood work drawn at prescribed time

108
Q

Pharmacodynamics

Trough levels:

A

Lowest plasma drug concentration & shows rate of excretion.

-Drug trough blood work drawn just before next dose of drug and should be documented

109
Q

Pharmacodynamics

Loading dose:

A

large initial dose

110
Q

Pharmacodynamics

Side effects

A

desirable and undesirable

111
Q

Pharmacodynamics

Adverse reactions

A
  • More severe than side effects
  • Always undesirable
  • Can be mild to severe
  • Example: mild allergic reaction (mild hives) vs. severe such as anaphylaxis (CV collapse)
112
Q

Pharmacodynamics

Toxic effects

A

likely to occur when drug levels exceed therapeutic range

113
Q

Pharmacodynamics

Drug tolerance

A

Can occur due to frequent, repeated drug administration (e.g., opioids)

114
Q

Pharmacodynamics

placebo effect

A

Psychological benefit from a compound without chemical structure of a drug effect

115
Q

Pharmacodynamics: Receptor Theory

A

receptors found on cell membranes

ligand-binding domain is the site on the receptor in which drugs bind

116
Q

Pharmacodynamics: Receptor Theory

What are the four receptor families ?

A
  1. Kinase-linked receptors
  2. Ligand-gated ion channels
  3. G protein-coupled receptor systems
  4. Nuclear receptors
117
Q

Receptor Theory: Families

Kinase-linked receptor

A

ligand binding domain on cell surface

drug activates enzyme inside cell initiating effect

118
Q

Receptor Theory: Families

Ligand-gated ion channels

A

drug spans cell membrane, ion channels (Na and Ca) open initiating effect

119
Q

Receptor Theory: Families

G protein-coupled receptor systems

A

drug activates receptor which activates G-protein which activates effect

120
Q

Receptor Theory: Families

Nuclear receptors

A

effect is achieved through in and through the functions of the cell nucleus by means of a transcription (reading and coding) process. Activation is prolonged in this receptor family.

121
Q

Pharmacodynamics

Agonists

A

drugs that produce a response

122
Q

Pharmacodynamics

Antagonists

A

drugs that block a response

123
Q

Pharmacodynamics

Nonspecific/Nonselective drug effect

A

drugs that affect multiple sites/ receptors

124
Q

Potentially Inappropriate Medications (PIM) in Older Adults

4

A
  1. Beers Criteria
  2. Meds to AVOID in older adults regardless of diseases or conditions
  3. Meds considered potentially inappropriate when used in older adults with certain diseases or syndromes
  4. Meds that should be used with caution
125
Q

1970 Controlled Substances Act:

Schedule Categories of Drugs

A

I. High abuse potential, NO medical use (Heroin, LSD)
II. High abuse potential; ACCEPTED medical use (morphine - epidemic of opioid addiction)
III. Medically accepted;

AE1 (12 decks)

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