Pharmacologic Principles Flashcards
0
Q
adverse drug event
A
any undesirable occurrence related to administering or failing to administer a prescribed medication
1
Q
additive effects
A
drug interactions in which the effect of combination of two or more drugs with similar actions is equivalent to the sum of the individual effects if the same drugs given alone (e.g. 1 + 1 = 2 [compare with synergistic effects])
2
Q
adverse drug reaction
A
any unexpected, unintended, undesired, or excessive response to a medication given at therapeutic dosages (as opposed to overdose)
3
Q
adverse effects
A
a general term for any undesirable effects that are a direct response to one or more drugs
4
Q
agonist
A
a drug that binds to and stimulates the activity of one or more receptors in the body
5
Q
allergic reaction
A
an immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication; a type of adverse drug event
6
Q
antagonist
A
a drug that binds to and inhibits the activity of one or more receptors in the body (antagonists are also called inhibitors)
7
Q
antagonistic effects
A
drug interactions in which the effect of a combination of two or more drugs is less than the sum of the individual effects of the same drugs given alone (1 + 1 = <2); it is usually caused by an antagonising (blocking or reducing) effect of one drug on another
8
Q
bioavailability
A
a measure of the extent of drug absorption for a given drug and route (from 0% to 100%)
9
Q
biotransformation
A
one or more biochemical reactions involving a parent drug (biotransformation occurs mainly in the liver and produces a metabolite that is either inactive or active; also known as metabolism)
10
Q
blood-brain barrier
A
the barrier system that restricts the passage of various chemicals and microscopic entities (e.g. bacteria, viruses) between the bloodstream and the central nervous system whilst still allowing the passage of essential substances (e.g. oxygen)
11
Q
chemical name
A
the name that describes the chemical composition and molecular structure of a drug
12
Q
contraindication
A
any condition, especially one related to a disease state or patient characteristic, including current or recent drug therapy, that renders a particular form of treatment improper or undesirable
13
Q
cytochrome P-450
A
the general name for a large class of enzymes that play a significant role in drug metabolism and drug interactions
14
Q
dependence
A
a state in which there is a compulsive or chronic need, as for a drug
15
Q
dissolution
A
the process by which solid forms of drugs disintegrate in the gastrointestinal tract and become soluble before being absorbed into the circulation
16
Q
drug
A
any chemical that affects the physiologic processes of a living organism
17
Q
drug actions
A
the process involved in the interaction between a drug and body cells (e.g. the action of a drug on a receptor protein); also called mechanism of action
18
Q
drug classification
A
a method of grouping drugs; may be based on structure or therapeutic use
19
Q
drug effects
A
the physiologic reactions of the body to a drug; they can be therapeutic or toxic and describe how the body is affected as a whole by the drug; the terms onset, peak and duration are used to describe drug effects (most often referring to therapeutic effects)
20
Q
drug-induced teratogenesis
A
the development of congenital anomalies or defects in the developing fetus caused by the toxic effects of drugs
21
Q
drug interaction
A
alternation in the pharmacologic or pharmacokinetic activity of a given drug caused by the presence of one or more additional drugs; it is usually related to effects on the enzymes required for metabolism of the involved drugs
22
Q
duration of action
A
the length of time the concentration of a drug in the blood or tissues is sufficient to elicit a response
23
Q
enzymes
A
protein molecules that catalyse one or more of a variety of biochemical reactions, including those related to the body’s physiologic processes as well as those related to metabolism
24
first-pass effect
the initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream
25
generic name
the name given to a drug by ___; also called the nonproprietary name
the generic name is much shorter and simpler than chemical name and is not protected by trademark
26
glucose-6-phosphate dehydrogenase (G6PD) deficiency
a hereditary condition in which red blood cells break down when the body is exposed to certain drugs
27
half-life
in pharmacokinetics, the time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50% (also called elimination half-life)
28
idiosyncratic reaction
an abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient
29
incompatibility
the characteristic that causes two parenteral drugs or solutions to undergo a reaction when mixed or given together that results in the chemical deterioration of at least one of the drugs
30
intraarterial
within an artery (e.g. intraarterial injection)
31
intraarticular
within a joint (e.g. intraarticular injection)
32
intrathecal
within a sheath (e.g. the theca of the spinal cord, as in an intrathecal injection into the subarachnoid space)
33
medication error
any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause patient harm
34
medication use process
the prescribing, dispensing, and administering of medications, and the monitoring of their effects
35
metabolite
a chemical form of a drug that is the product of one or biochemical (metabolic) reactions involving the parent drug
active metabolites are those that have pharmacologic activity of their own, even if the parent drug is inactive
inactive metabolites lack pharmacologic activity and are simply drug waste products awaiting excretion from the body (e.g. via the urinary, gastrointestinal, or respiratory tract)
36
onset of action
the time required for a drug to elicit a therapeutic response after dosing
37
parent drug
the chemical form of a drug that is administered before it is metabolised by the body's biochemical reactions into its active or inactive metabolites
a parent drug that is not pharmacologically active itself is called a prodrug; a prodrug is then metabolised to pharmacologically active metabolites
38
peak effect
the time required for a drug to reach its maximum therapeutic response in the body
39
peak level
the maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring
40
pharmaceutics
the science of preparing and dispensing drugs, including dosage form design
41
pharmacodynamics
the study of the biochemical and physiological properties of drugs and their pharmacologic interactions with body receptors
42
pharmacoeconomics
the study of economic factors impacting the cost of drug therapy
43
pharmacogenetics
the study of the influence of genetic factors on drug response, including the nature of genetic aberrations that result in the absence, overabundance, or insufficiency of drug-metabolising enzymes
44
pharmacognosy
the study of drugs that are obtained from natural plant and animal sources
45
pharmacokinetics
the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body
pharmacokinetics represent the drug absorption into, distribution and metabolism within, and excretion from the body
46
pharmacology
the broadest term for the study or science of drugs
47
pharmacotherapeutics
the treatment of pathologic conditions through the use of drugs
48
prodrug
an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body
49
receptor
a molecular structure within or on the outer surface of a cell; receptors bind to specific substances (e.g. drug molecules ), and one or more corresponding cellular effects (drug actions) occurs as a result of this drug-receptor interaction
50
steady state
the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose
51
substrates
substances (e.g. drugs or natural biochemicals in the body) on which an enzymes acts
52
synergistic effects
drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum if the individual effects of the same drugs given alone (e.g. 1 + 1 is > 2 [compare with additive effects])
53
therapeutic drug monitoring
the process of measuring drug levels to identify a patient's drug exposure and to allow adjustment of dosages with goals of maximising therapeutic effects and minimising toxicity
54
therapeutic effect
the desired or intended effect of a particular medication
55
therapeutic index
the ratio between the toxic and therapeutic concentrations of a drug
56
tolerance
reduced response to a drug after prolonged use
57
toxic
the quality of being poisonous (i.e. injurious to health or dangerous to life)
58
toxicity
the conditions of producing adverse bodily effects due to poisonous qualities
59
toxicology
the study of poisons, including toxic drug effects, and applicable treatments
60
trade name
the commercial name given to a drug product by its manufacturer; also called the proprietary name
61
trough level
the lowest concentration of drug reached in the body after it falls from it's peak level, usually measured in a blood sample for therapeutic drug monitoring
62
An elderly woman took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. The nurse recognises that this woman has experienced which type of reaction or effect?
A. allergic reaction
B. idiosyncratic reaction
C. mutagenic effect
D. synergistic effect
B. idiosyncratic reaction
63
While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur?
A. absorption
B. distribution
C. metabolism
D. excretion
C. metabolism
64
A patient who has advanced cancer is receiving opioid medications around the clock to "keep him comfortable" as he beats the end of his life. Which term best describes this type of therapy?
A. palliative therapy
B. maintenance therapy
C. supportive therapy
D. supplemental therapy
A. palliative care
65
The nurse is giving medications to a patient in heart failure. The intravenous route is chosen instead of the intramuscular route. The nurse knows that the factor that most influences the decision about which route to use is the patients's:
A. altered biliary function
B. increased glomerular filtration
C. reduced liver metabolism
D. diminished circulation
D. diminished circulation
66
A patient has just received a prescription for an enteric-coated stool softener. When teaching the patient, the nurse should include which statement?
A. "take the tablet with 2 to 3 ounces of orange juice"
B. "avoid taking all other medications with any enteric-coated tablets"
C. "crush the tablet before swallowing if you have problems with swallowing"
D. "be sure to swallow the tablet whole without chewing it"
D. "be sure to swallow the tablet whole without chewing it"
67
Each statement describes a phase of pharmacokinetics. Put the statements in order, with 1 indicating the phase that occurs first and 4 indicating the phase that occurs last.
A. enzymes in the liver transform the drug into an inactive metabolite
B. drug metabolites are secreted through passive glomerular filtration into the renal tubules
C. a drug that binds to the plasma protein albumin and circulates through the body
D. a drug moves from the intestinal lumen into the mesenteric blood system
A. 3
B. 4
C. 2
D. 1
68
A drug that delivers 500 mg has a half-life of 4 hours. How many milligrams of drug remain in the body after 1 half-life?
7.250 mg
69
pharmaceutical phase
disintegration of dosage form; dissolution of drug in body
70
pharmacokinetic phase
absorption, distribution, metabolism, excretion
71
pharmacodynamic phase
drug-receptor interaction
72
drug absorption of various oral preparations from fastest to slowest
```
oral disintegration, buccal tablets, and oral soluble wafers
liquids, elixirs, and syrups
suspension solutions
powders
capsules
tablets
coated tablets
enteric-coated tablets
```
73
dosage forms: enteral
tablets, capsules, oral soluble wafers, pills, timed-released capsules, times-release tablets, elixirs, suspensions, syrups, emulsions, solutions, lozenges or troches, rectal suppositories, sublingual or buccal tablets
74
dosage forms: parenteral
injectable forms, solutions, suspensions, emulsions, powders for reconstitution
75
dosage forms: topical
aerosols, ointments, creams, pastes, powders, solutions, foams, gels, transdermal patches, inhalers, rectal and vaginal suppositories
76
intravenous (IV) advantages
provides rapid onset (drug delivered immediately to bloodstream); allows more direct control of drug level in blood; gives option of larger fluid volume, therefore diluting irritating drugs; avoids first-pass metabolism
77
intravenous (IV) disadvantages
higher cost; inconvenience (e.g. not self-administered); irreversibility of drug action in most cases and inability to retrieve medication; risk of fluid overload; greater likelihood of infection; possibility of embolism
78
intravenous (IV) nursing considerations
continuous intravenous infusions require frequent monitoring to be sure that correct volume and amount are administered and that the drug reaches safe, therapeutic blood levels; intravenous drugs and solutions must be checked for compatibilities; intravenous sites are to be monitored for redness, swelling, heat, and drainage - all indicative of complications, such as thrombophlebitis; if intermittent intravenous infusions are used, clearing or flushing of the line with normal saline before and after is generally indicated to keep the intravenous site patent and minimise incompatibilities
79
intramuscular (IM); subcutaneous (SC) advantages
intramuscular injections are good for poorly soluble drugs, which are often given in "depot" preparation form and are then absorbed over a prolonged period; insets of action differ depending on route
80
intramuscular (IM); subcutaneous (SC) disadvantages
discomfort of injection; inconvenience; bruising; slower onset of action compared to intravenous, although quicker than oral in most situations
81
intramuscular (IM); subcutaneous (SC) nursing considerations
use landmarks to identify correct IM and SC sites
IM:
ventral gluteal muscle
1 1/2-inch needle
20- to 25-gauge needle (for aqueous solutions)
18- to 25-gauge needle (for viscous or oil-based solutions)
SC:
90-degree angle
1/2- to 5/8-inch needle
26- to 30-gauge needle
82
oral advantages
usually easier, more convenient, and less expensive; safer than injection, dosing more likely to be reversible in cases of accidental ingestion (e.g. through induction of emesis, administration of activated charcoal)
83
oral disadvantages
variable absorption; inactivation of some drugs by stomach acid and/or pH; problems with first-pass effect or pre-systemic metabolism; greater dependence of drug action on patient variables
84
oral nursing considerations
some medications are to be taken with or without food; taken with fluids; consider other medicines taken at the same time and concurrent use of dairy products or antacids; if given via nasogastric or gastrostomy tubes, placement in the stomach needs to be assessed and the patient's head is to remain elevated; flushing the NGT with at least 30 to 60 mL of water before and after to maintain potency and prevent clogging
85
sublingual; buccal advantages
absorbed more rapidly from oral mucosa and leads to more rapid onset of action; avoids breakdown of drug by stomach acid; avoids first-pass metabolism because gastric absorption is bypassed
86
sublingual; buccal disadvantages
patients may swallow pill instead of keeping under tongue until dissolved; pills often smaller to handle
87
sublingual; buccal nursing considerations
sublingual route are to be placed under the tongue; once dissolved, the drug may be swallowed; buccal route are placed between cheek and gum; both forms are relatively no no-irritating; drug is usually without flavour and water-soluble
88
rectal advantages
provides relatively rapid absorption; good alternative when oral route not feasible; useful for local or systemic drug delivery; usually leads to mixed first-pass and non-first-pass metabolism
89
rectal disadvantages
possible discomfort and embarrassment to patient; often higher cost than oral route
90
rectal nursing considerations
absorption is erratic and unpredictable; safe alternative when nausea and vomiting prevents oral dosing; patient must be placed on left side so that the normal anatomy of the colon allows safe and effective insertion; suppositories are inserted using a gloved hand and water-soluble lubricant
91
topical advantages
delivers medication directly to affected area; decreases likelihood of systemic drug effects
92
topical disadvantages
sometimes awkward to self-administer (e.g. eyes drops); can be messy; usually higher cost than oral route
93
topical nursing considerations
maximal absorption is enhanced with skin that is clean and free of debris; application must be done carefully and per instructions; gloves help to minimise cross-contamination and prevent absorption of drug into the nurse's own skin; if patient's skin is not intact, use sterile technique
94
transdermal advantages
provides relatively constant rate of drug absorption; one patch can last 1 to 7 days, depending on drug; avoids first-pass metabolism
95
transdermal disadvantages
rate of absorption can be affected by excessive perspiration and body temperature; patch may peel off; cost is higher; used patches must be disposed off safely
96
transdermal nursing considerations
transdermal drugs should be placed on alternating sites and on a clean, non-hairy, non-irritated area, and only after the previously applied patch has been removed and that area cleansed and dried
97
inhalation advantages
provides rapid absorption; drug delivered directly to lung tissues where most of these drugs exert their actions
98
inhalation disadvantages
rate of absorption can be too rapid, increasing the risk of exaggerated drug effects; requires more patient education for self-administration; some patients may have difficulty with administration technique
99
inhalation nursing considerations
medications are to be used exactly as prescribed and with clean equipment; instructions need to be given to the patient regarding medications to be used as well as proper use, storage, and safe-keeping of inhalers, spacers, and nebulisers
100
first-pass routes
hepatic arterial; oral; portal venous; rectal (leads to both first-pass and non-first-pass effects)
101
non-first-pass routes
aural (instilled into the ear); buccal; inhaled; intraarterial; intramuscular; intranasal; intraocular; intravaginal; intravenous; subcutaneous; sublingual; transdermal
102
diseases that decrease drug metabolism
cardiovascular dysfunction; renal insufficiency
103
conditions that decrease drug metabolism
starvation; obstructive jaundice; genetic constitution
104
drugs that increase drug metabolism
barbiturates; rifampin (P-450 inducer); phenytoin (P-450 inducer)
105
drugs that decrease drug metabolism
ketaconazole (P-450 inhibitor)
106
drug-receptor interactions: agonist
drug binds to receptor; there is a response
107
drug-receptor interactions: partial agonist (agonist-antagonist)
drug binds to the receptor; the response is diminished compared with that elicited by an agonist
108
drug-receptor interactions: antagonist
drug binds to the receptor; there is no response; drug prevents binding of agonists
109
drug-receptor interactions: competitive antagonist
drug competes with the agonist for binding to the receptor; if it binds, there is no response
110
drug-receptor interactions: non-competitive antagonist
drug combines with different parts of the receptor and inactivates it; agonist then has no effect
111
pharmacotherapeutic types of therapies
acute; maintenance; supplemental (or replacement); palliative; supportive; prophylactic (or empiric)
112
common food and drug interactions: leafy green vegetables
warfarin (anticoagulant); decreased anticoagulant effect from warfarin
113
common food and drug interactions: dairy products
tetracycline, levofloxacin, ciprofloxacin, moxifloxacin (antibiotics); chemical binding of drug leading to decreased effect and treatment failures
114
common food and drug interactions: grapefruit juice
amiodarone (antidysrhythmic); buspirone (antianxiety); carbamazepine (antiseizure); cyclosporine, tacrolimus (immunosuppressants); felodipine, nifedipine, nimodipine, nisoldipine (calcium channel blocker); simvastatin, atorvastatin (anticholesterol); decreased metabolism of drugs and increased effects
115
common food and drug interactions: aged cheese & wine
monoamine oxidase inhibitors; hypertensive crisis
116
common poisons and their antidotes: acetaminophen
acetylcysteine
117
common poisons and their antidotes: organophosphates (e.g. insecticides)
atropine
118
common poisons and their antidotes: tricyclic antidepressants, quinidine
sodium bicarbonate
119
common poisons and their antidotes: calcium channel blockers
intravenous calcium
120
common poisons and their antidotes: iron salts
deferoxamine
121
common poisons and their antidotes: digoxin and other cardiac glycosides
digoxin antibodies
122
common poisons and their antidotes: ethylene (e.g. automotive antifreeze solution), methanol
ethanol (same as alcohol used for drinking), given intravenously
123
common poisons and their antidotes: benzodiazepines
flumazenil
124
common poisons and their antidotes: beta blockers
glucagon
125
common poisons and their antidotes: opiates, opioid drugs
naloxone
126
common poisons and their antidotes: carbon monoxide (by inhalation)
oxygen (at high concentration), known as bariatric therapy
