Pharm Week 2 Flashcards
Describe the three phases of drug activity: (think pharmaceuticals)
- Pharmaceutical
- Pharmacokinetic
- Pharmacodynamics
Describe the physiochemical processes mediating drug
action.
Describe the physiochemical processes mediating drug
action.
Explain the client variables that influence the rate and extent of Absorption, Distribution, Metabolism,
and Elimination.
Absorption, Distribution, Metabolism,
and Elimination.
Definitions! Chemical/Generic/Trade name
Definitions! Chemical/Generic/Trade name
drug actions: (recept the enzyme or be nonspecific)
- drug receptor interaction
- drug-enzyme interaction
- nonspecific drug interaction
drug-enzyme interaction
drug-enzyme interaction
nonspecific drug interaction
nonspecific drug interaction
Pharmaceutical - Dosage form determines the rate (not absorption, but close)
drug dissolution (dissolving of solid dosage forms and their absorption from the GI tract). goes from solid and breaks down in gut
🞑 Enteric-coated tablets
🞑 Extended-release form
Pharmacokinetic
Pharmacokinetic
Pharmacokinetic (body kinetetics changes a drug)
The study of what the body does to the drug
- Absorption
- Distribution
- Metabolism
-Excretion
- drug receptor interaction
- drug receptor interaction
Absorption (absorb the bupe into your bloodstream to your sore muscles)
the movement from administration into the bloodstream for distribution to the tissues
Distribution
Distribution
Metabolism,
Metabolism,
elimination
elimination
Use Nursing Assessments to identify unusual
and adverse effects of drug therapy.
Use Nursing Assessments to identify unusual
and adverse effects of drug therapy.
Drugs do not confer any new functions on a
tissue or organ in the body; they only
modify
existing functions.
Drugs in general exert multiple actions rather
than
a single effect.
Drug action results from a physiochemical
interaction between the (just the drug and a specific molecule - makes sense)
drug and a
functionally important molecule in the body
Pharmaceutics (the suits control the dosage and how it affects the body)
the study of how various dosage forms influence the way in which the drug affects the body
Pharmacodynamics involves..(the drug and receptor are dynamic)
drug-receptor relationship.
the mechanism of drug actions in living tissues
Pharmacokinetics is the study of what the…(kinetics is a rush) WHICH includes AD ME
body does to the drug.
- Absorption
- Distribution
- Metabolism
-Excretion
pharmaceutics -Dosage form determines the rate of (not absorption, but close)
drug dissolution (dissolving of solid dosage forms and their absorption from the GI tract).
Enteric-coated tablets
🞑 Extended-release forms
pharmokinetics (kinetics is down with O/P/D)
A drug’s time to Onset of action, time
to Peak effect, and Duration of action
pharmokinetics is the study of what happens to a drug from the time it is put into the body until the (parents are kin)
the parent drug and all metabolites have left the body
pharmacokinetics: absorption - (absoption goes from admin to bloodstream)
Movement of a drug from its site of administration into the bloodstream for distribution to the bioavailability and first pass
absorption (compare theabsportionw/onsetandduration)
A comparison of drug Onsets and Duration of Action by Route of Administration. Fastest is IV - bypasses the liver.
A drug’s route of administration affects the (and types of routes - PET the route)absorption????
the rate and extent of Absorption of that drug
🞑 Enteral (GI tract)
🞑 Parenteral
🞑 Topical
enteral routes
The drug is absorbed into the systemic circulation
through the oral or gastric mucosa or the small
intestine
examples of enteral routes (enteral BROS)
- Oral
- Sublingual
-Buccal
-Rectal (can also be topical)
types of parenteral routes (VAAT D MC)
Intravenous (fastest delivery into the blood circulation)
Intramuscular
Subcutaneous (insulin)
Intradermal
Intraarterial
Intrathecal (in spinal column)
Intraarticular (into joint)
topical route (LEEN RVS are topical) start with skin, then top of head - eyes, etc.)
Skin (including transdermal patches)
Eyes
Ears
Nose
Lungs (inhalation)
Rectum
Vagina
distribution (distribute from the blood to the worksite)
The transport of a drug by the bloodstream to its
site of action
types of distribution (distribute the protein, water, and bbb)
Protein-binding
Water-soluble vs. Fat-soluble
Blood-brain barrier
distribution - Areas of rapid distribution - the basic organs (HLK B rapid)
Heart, Liver, Kidneys, Brain (if you are in trauma, body will wall off heart, lungs and brain - most important)
distribution - Areas of slow distribution (MS F is slow)
Muscle, Skin, Fat
Distribution - A loading dose is administered to…
reach a therapeutic response level rapidly. Maintenance
doses are administered at prescribed intervals to
maintain a therapeutic drug response.
distribution - Maintenance doses are administered at
prescribed intervals to maintain a therapeutic drug response.
metabolism/biotransformation (transform into active)
*The biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite
organs involved in metabolism/biotransformation (I’LL SKP biotransformation)
Liver (main organ)
Skeletal muscle
Kidneys
Lungs
Plasma
Intestinal mucosa
Factors that decrease metabolism (metabolism goes down when my heart and kidneys are starving. Also when I’m yellow from acetylate or ketoconazale)
Cardiovascular dysfunction
Renal insufficiency
Starvation
Obstructive jaundice-Yellow skin, eyes,, Liver CA, blocked Bile (also overdose of asprin)
Slow acetylator-Liver can’t detoxify becomes toxic
Ketoconazole therapy- tx for fungus or yeast infections
Factors that increase metabolism (metabolism goes up during BAR PH (ight)
already outlined
excretion is (excrete that drug)
The elimination of drugs from the body
organs involved in excretion (excretion is BBBLEK (bleak) (don’t need to know all of this)
Kidneys (main organ)
Liver
Bowel
🞑 Biliary excretion
🞑 Enterohepatic recirculation
Biliary recycling
half life
The time it takes for one half of the original
amount of a drug to be removed from the body…
A measure of the rate at which a drug is
removed from the body
Most drugs considered to be effectively removed
after about five half-lives
Steady state- constant drug level- 2, 4, 5X 1/2L
bioavailability Refers to the (my percent in bio met the target)
percentage of active drug substances absorbed and available to reach the target tissues following drug administration
Drug actions (the actions just occur on a cellular level)
The cellular processes involved in the drug and cell interaction
Drug effect (chiva effect is OD or O/P/D)
The physiologic reaction of the body to the drug
Includes onset, peak, and duration of action
Onset (onset is therapeutic)
The time it takes for the drug to elicit a therapeutic response
Peak (the peak is the max)
The time it takes for a drug to reach its maximum
therapeutic response
Duration (duration is therapy)
The time a drug concentration is sufficient to elicit a
therapeutic response
therapeutic drug monitoring - Peak level
Highest blood level
therapeutic drug monitoring - lowest blood level (the trough is low)
Trough level
Pharmacotherapeutics / Pharmaceutics
Therapeutic index represents the**Need to know for test) (theaputic is lethal)
ratio between two factors:
▪Lethal dose (LD50)
▪Effective dose (ED50)
TI = LD50/ED50
drugs w/ a narrow therapeutic index (PLAD VW is very narrow)***Know for TEST (amen w/ dog drooling over phentanyl at war w/ valerie)
- Aminoglycosides (Gentamicin®)
- Digoxin (Lanoxin®)
- Lithium (Lithobid®)
- Phenytoin (Dilantin®)
- Valproic Acid (Depakote®)
- Warfarin (Coumadin®)
Pharmacodynamics:
Mechanisms of Action (REN took action)
Receptor interactions-
Enzyme interactions-
Nonselective interaction-
Receptor interactions- (receptors are on the surface and inside)
reactive site on cell surface or inside cell
Enzyme interactions-
catalyst most biochemical rx in cell
Enzyme interactions-
catalyst most biochemical rx in cell
Nonselective interaction (just doesn’t do the other 2 things)
No Rx with receptors or enzymes.
drug-receptor interactions - agonist
drug binds to the receptor; there is a response
drug-receptor interactions - partial agonist
drug binds to the receptor; the response is diminished compared to agonist
drug-receptor interactions - antagonist
drug binds to the receptor: there is no response. drug prevents biding of agonists.
drug-receptor interactions - competitive antagonist
drug competes w/ agonist for binding to the receptor: if binds, there is no response.
drug-receptor interactions - non-competitive antagonist
drug combines with different parts of the receptor and inactivates it; agonist then has no effect.
agonists (mimic the agonist)
• Mimics action of the receptor
• A drug that has high affinity and intrinsic activity-(ability of drug to be bound to receptor)
antagonist
• Blocks action of the receptor
• Acts to prevent receptor activation by
endogenous(internal origin) regulatory
molecules and agonist
drugs
Pharmacotherapeutics:
Types of Therapies - ON TEST (MSS PPE therapy)
Maintenance therapy
Supplemental/replacement therapy
Palliative therapy
Supportive therapy
Prophylactic therapy
Empiric therapy
contraindications
Any characteristic of the patient, especially a
disease state, that makes the use of a given
medication dangerous for the patient
It is important to assess for contraindications!
(ex. pregnant women can’t take tylenol)
monitoring - must be familiar with what?
Evaluating the clinical response of the patient to
the treatment
One must be familiar with the drug’s:
• Intended therapeutic action (beneficial)
• Unintended but potential adverse effects
(predictable, adverse drug reactions)
monitoring 2
Therapeutic index- ratio TI=LD50/ED50
Drug concentration
Patient’s condition-infection/CV/GI/Stress/ depression/anxiety
Tolerance and dependence-I
is physiological or psychological response to repeated doses
Drug interactions (additive effect, synergistic
effect, antagonistic effect, incompatibility)- action
of one drug by another
Adverse drug events-
( Additive effect= 1+1=2, Synergistic effect= 1+1>2, Antagonistic effect= 1+1 < 2 ,
Incompatible effect= Chemical deteriorated & precipitates )
monitoring 3
Adverse drug reactions
Pharmacologic reactions, including adverse effects-
(drug too effective dec BP)
Hypersensitivity (allergic) reaction
Pt immune sys, histamines cytokines-
rash- airway
Idiosyncratic reaction- unexpected rx
Drug interaction-
2 or more drugs together in body
cause unusual effect
other drug related effects (TMC is all genic)
Teratogenic
Mutagenic
Carcinogenic
drug effects (SAAD side effects)
• Side Effects
• Adverse Effects
• Allergic Effects
• Drug Induced Reaction
Side effects are usually
predictable
secondary effects such as anorexia, nausea, vomiting, dizziness, drowsiness, dry mouth, abdominal gas or distress, constipation, and diarrhea.
adverse effects are
unintended, undesirable, and
often unpredictable drug effects that range from
mild to fatal.
Drug-Induced Reactions
Drug-Induced Reactions: (you have these definitions in your cards)
Tolerance
Tachyphylaxis
Cumulative effect
Idiosyncrasy
Drug dependence
Drug interaction
Drug antagonism
Summation
Synergism
Potentiation
cultural assessment
Languages spoken
Health beliefs and practices
Past uses of medicine
Herbal treatments, folk remedies, home remedies
Over-the-counter drugs and treatment
cultural assessment 2
Usual response to illness
Responsiveness to medical treatment
Religious practices and beliefs
Support from the patient’s cultural community
Dietary habits
legal nursing considerations
State and federal legislation- FDA, DEA, CA Board of Nursing, DPH
Nurse practice acts
oScope of nursing practice-
oExpanded nursing roles
oEducational requirements
oStandards of care
oMinimally safe nursing practice
oDifferences between nursing and medical practice
(Nursing= Caring Medical= Curing)
Only MD, APN, NP, OD, Dentist, Podiatrist can prescribe Drugs.
legal nursing considerations 2
Guidelines from professional nursing groups
Institutional policies and procedures, state and
federal hospital licensing
Case law or common law- relies on records of similar
situations/status d/t no official legal code to apply to the
case.
HIPAA- Privacy Lay for Healthcare records
ethical considerations
American Nurses Association (ANA) - Code of
Ethics for Nurses- www.nursingworld.org
International Council of Nurses (ICN) - Code of Ethics
for Nurses
Duty
Breach of Duty
Causation
Damage
( Book, page 58, 8th ed.)
Tachyphylaxis
refers to a quickly developing tolerance that occurs after repeated administration of a drug. (NTG in chest pain)
Cumulative effect
occurs when the body cannot metabolize one dose of a drug
before another dose is administered. (1+1 = 1.5)
Summation (addition or additive effect) occurs when (the sum, 1 + 1 = 2)
the combined effect of two drugs produces a result that equals the sum of the individual effects of each agent. (1+1 =2)
Tolerance refers to a
decreased physiologic response that occurs after repeated
administration of a drug or a chemically related substance
Drug Dependence is the (can be both)
term preferred over the previous terminology of
“habituation” and “addiction” can be physical or psychological
Synergism describes a
drug interaction in which the combined effect of drugs is
greater than the sum of each individual agent acting independently. (1+1 =3)
Idiosyncrasy is (Ritalin)
any abnormal of peculiar response to a drug which may manifest by itself by (benadryl makes a kid hyper)
1)over response or abnormal susceptibility to a drug
2) under response, which demonstrates abnormal tolerance
3) a qualitatively different effect from the one expected, such as excitation after the
administration of a sedative
4) unpredictable and unexplainable symptoms. often from genetic enzymatic
deficiencies
Potentiation refers to
the concurrent administration of two drugs in which one drug
increases the effect of the other drug. (PI booster in HIV therapy)
Which of the following describes the process of the movement of drug molecules from the site of entry into the body?
absorption
drugs do not confer
anything
critical care
what is white count, infection. Bambis are baby warriors. (band shift)
remove old patch and
add new patch to a new area
cardivascular decreases…
metabolism.
will be on test
The nurse is giving a medication that has a high
first-pass effect. The physician has changed the
route from IV to PO. The nurse expects the oral dose
to most likely be:
1. higher because of the first-pass effect.
2. lower because of the first-pass effect.
3. the same as the IV dose.
4. unchanged.
Pharmacotherapeutics: ON TEST
Types of Therapies
Acute therapy- CC
Maintenance therapy- Prevent progression of disease, tx;HTN, BC
Supplemental/replacement therapy- replace substance needed, tx;
Insulin, thyroid
Palliative therapy- EOL, C/care
Supportive therapy-recovery post Op or trauma, bld after surgery
Prophylactic therapy- prevent illness, vaccines
Empiric therapy- clinical problem- ex: antibx for sepsis
Pharmacotherapeutics:
Types of Therapies
Acute therapy- CC
Maintenance therapy- Prevent progression of disease, tx;HTN, BC
Supplemental/replacement therapy- replace substance needed, tx;
Insulin, thyroid
Palliative therapy- EOL, C/care
Supportive therapy-recovery post Op or trauma, bld after surgery
Prophylactic therapy- prevent illness, vaccines
Empiric therapy- clinical problem- ex: antibx for sepsis
Drug polymorphism - ON TEST
various drug resistance d/t pt age, gender,
size, body composition
Barriers to adequate health care for culturally diverse-
Language, poverty, access, pride, belief in medicine, need for
Cultural Assessment
Cultural Assessment
Languages spoken
Health beliefs and practices
Past uses of medicine
Herbal treatments, folk remedies, home remedies
Over-the-counter drugs and treatment
Cultural Assessment - 2
Cultural Assessment
Usual response to illness
Responsiveness to medical treatment
Religious practices and beliefs
Support from the patient’s cultural community
Dietary habits
Legal Nursing Considerations
Guidelines from professional nursing groups
Institutional policies and procedures, state and
federal hospital licensing
Case law or common law- relies on records of similar
situations/status d/t no official legal code to apply to the
case.
HIPAA- Privacy Lay for Healthcare records
Ethical Considerations
American Nurses Association (ANA) - Code of
Ethics for Nurses- www.nursingworld.org
International Council of Nurses (ICN) - Code of Ethics
for Nurses
Duty
Breach of Duty
Causation
Damage
( Book, page 58, 8th ed.)
absorption involves…(absoption is available at first pass)
🞑 Bioavailability
🞑 First-pass effect (liver says gimme first, then everything else goes into circulatory)
- Fast acetylator - decrease or increase metabolism?
increase
- Barbiturate therapy CNS depressant, Tx Sz, Anesthesia - increase or decrease metabolism?
increase metabolism
- Rifampin therapy- TB meds.
- Phenytoin therapy- Sz - seizures - increase or decrease metabolism?
-increase
MH - hypothermia - increase or decrease metabolism?
increase. - their bodies react - code MH - have to have meds or their temp goes up one degree a minute. Then they get lock jaw.
Affinity (seen with agonists)
promotes binding (level of degree drug attaches or binds with receptor)
• Intrinsic Activity (seen w/ agonists)
allows the bound agonist to activate the receptor
antagonist - what’s the deal w/ affinity and intrinsic activity
• High affinity but no intrinsic activity
pharamacotherauptic - Maintenance therapy
Prevent progression of disease, tx;HTN, BC
Supplemental/replacement therapy
replace substance needed, tx;Insulin, thyroid
Palliative therapy
EOL, C/care
Supportive therapy(postop)
recovery post Op or trauma, bld after surgery
Prophylactic therapy
prevent illness, vaccines
Empiric therapy(clinical problem)
clinical problem- ex: antibx for sepsis (like broadspectrum antibiotics)
drug related effects - Teratogenic
Structural defects to Fetus
drug related effects - Mutagenic
Permanent change to genetic DNA:
Radiation/virus/chemicals
drug related effects - Carcinogenic
Cancer causing
pharamacokenetics
the branch of pharmacology concerned with the movement of drugs within the body
metabolism/biotransformation involves what organs or systems? (I’LL SKP biotransformation)
Liver (main organ)
Skeletal muscle
Kidneys
Lungs
Plasma
Intestinal mucosa
pharmacotherapeutics focuses on (therapy - it’s in the name)
clinical use of drugs and how to prevent and treat diseases.
can granules be crushed?
no
remember, inhalers are what form of ingestion?
topical
parents are kin
pharmacokinetics - what happens to the drug between the time of administration until the parent drug and all of its metabolites have left the body
first pass
if a large amount of drug is absorbed by liver, less amount will be circulated.
high first pass rate
a large amount of drug is absorbed by liver and less will reach target sites
first pass reduces what?
the bioavailability
how bioavailable are IV drugs?
100%, because none is absorbed by the liver
what changes absorption of drug after it leaves the liver?
stomach acid, food or water or no food or water, changes in intestines
short bowel syndrome
stomach contents are delivered to intestines more rapidly, resulting in gastric dumping
