Pharmacology Flashcards
1
Q
What is pharmacokinetics of medication?
A
It is the process of drug movement throughout the body necessary to achieve an action.
2
Q
What are the four phases of movement of medication in the body?
A
Absorption
Distribution
Metabolism
Excretion.
3
Q
What is pharmacodynamics of medication?
A
This is the study of the effects of the drugs on the body.
4
Q
True or false. Medication can cause a primary or secondary physiologic effect or both on the body.
A
True.
The primary effect is the desired therapeutic effect.
The secondary effect are all other effects which may beneficial or harmful.
5
Q
What is the trade name of the medication?
A
The name given to the drug by the companies which manufacture the drug. Individual drugs can have several different trade names, e.g Panadol
6
Q
What is the generic name of medication?
A
The chemical name of the medicine, it is the same name no matter how the companies manufacture it, e.g. Paracetamol.
7
Q
Define disintegrate of a drug in it’s solid form.
A
Tablet or capsule must disintegrate into small particles and combine with a liquid to form a solution. This is also known as dissolution.
8
Q
True or false. The rate of dissolution is the time it takes for the drug to disintegrate and dissolve to become available for the body to absorb it.
A
True.
Also drugs that are disintegrated and absorbed faster in acidic fluids with the pH of 1 or 2 rather than a pH greater than 7.
9
Q
Blood flow, pain might affect drug absorption. What are four others?
A
Stress
Hunger
pH
Foods that are solid, hot, or higher in fat content.
Poor circulation.
Exercise.
10
Q
Explain absorption of medication.
A
Occurs across the mucosal lining of the small intestine, involving 2 processes - diffusion and facilitated diffusion.
11
Q
What is facilitated diffusion?
A
The drug relies on a carrier protein to move it from an area of higher concentration to an area of lower concentration.
12
Q
True or false. Lipid soluble drugs can easily pass through the mucous membrane?
A
True. This is because the mucous membrane lines the GI tract is composed of lipids and protein - therefore it easily moves.
13
Q
Why is water soluble drugs harder to pass through the mucous membrane?
A
Water soluble drugs need a carrier, either an enzyme or protein to pass through the mucous membrane.
14
Q
What are some examples of fat soluble drugs?
A
Some steroids, benzodiazepines and the statins.
15
Q
What are some examples of water soluble drugs?
A
Antibiotics - penicillin, antihypertensive drugs (beta blockers) and certain antiviral drugs.
16
Q
When injecting medication into the muscle, what area is best choice and why?
A
In the deltoid as it has faster blood flow and therefore absorbed faster.
17
Q
Is absorption faster for medication given subcutaneous or via intramuscularly?
A
Via IM as it has faster blood flow.
18
Q
What are two reasons would we not want to administer drugs via rectum?
A
Absorbed slower than orally.
The composition of the suppository base affects the drug absorption.
19
Q
What is first pass effect for medication?
A
In the liver some drugs will be metabolised to an inactive form and then excreted. This will reduce the amount of active drug available to exert a pharmacological effect.
20
Q
Does medication that is absorbed from the oral cavity subject to first pass metabolism?
A
No. It will enter the systemic circulation directly without entering the portal system, bypassing the liver. This could be medication give sublingual or buccal routes.
21
Q
Is the stomach or small intestine the major site for absorption of medication?
A
The small intestine is.
The stomach has tight intracellular junctions and small surface area.
22
Q
What effect does an empty stomach have on drug absorption?
A
With sufficient water, it will ensure dissolution and rapid passage into the small intestine. This is why many medication is given on an empty stomach.
23
Q
Why is drug absorption predominately done in the small intestine?
A
It is highly vascularised.
Significantly larger area for absorption.
the pH of intestinal fluid is close to neutral.
24
Q
Rectal drug administration maybe used for unconscious patients. What are two other reasons why?
A
- fasting patients.
2 Patient who can not swallow or severe vomiting.
25
Define bioavailability of medication.
It is the proportion of the administered dose that reaches the systemic circulation intake. Usually expressed as a % and the symbol F.
26
Administration of medication with food and other drugs will affect bioavailability of medication? What are 4 more?
Drug form
changes in liver metabolism
route of administration
Gastric mucosa and motility.
27
Define pain threshold.
Reflects the level of stimulus needed to create a painful sensation, and individual genetic makeup contributes to variations to pain threshold from one person to another.
28
Define pain tolerance?
Is the amount of pain a person can endure without having it interfere with normal functioning.
29
True or false.
Pain is as determined by the RN making the assessment?
False. It is what ever the patient informs you that they are experiencing.
30
What is nociceptive pain?
Inflammation of and damage to tissues activating specialized pain receptors. Sometimes this is in response to physiological or inflammatory pain. This type of pain is usually localized.
31
What is some differences between acute and chronic pain?
Acute - usually lasts less than 3 months, can be specific and treatable and usually subsides as healing and responsive to treatment.
Chronic is persistent, for more than 3months and can sometimes be difficult to determine the cause and difficult to treat.
32
Where do we find nociceptors?
a. skin
b. muscles
c. joints
d. visceral organs
e. all of the above
All of the above - these are activated when they detect extreme heat or cold and certain harmful chemicals.
33
Explain the pain gate theory?
Tissue injury activates nociceptors and causes the release of chemical mediators.
These substances initiate an action potential along the sensory nerve fibre and sensitize pain receptors.
Nociceptive action potential are transmitted via different afferent nerve fibres.
34
Are A pain fibres myelinated or unmyelinated?
They are myelinated and therefore fast or rapidly conducting -12-30m/s.
35
Are C fibres myelinated or unmyelinated?
Unmyelinated and therefore slow conducting.
36
How many neurons are involved in the spinothalamic pathway - bringing an impulse to the cerbral cortex.
Three - First order neuron - transmits pain impulses.
Second order neuron - carry the pain stimuli to the thalamus.
Third order neuron - reaches the cerebral cortex.
37
What are the four process of the physiology of pain?
Transduction
Transmission / conduction
Perception
Modulation
38
What is the main neurotransmitter responsilble for transmission of pain signals in the spinal cord?
Glutamate - these bind to the receptors causing it to open to cations (sodium and calcium). These enter the postsynaptic membrane resulting in deploraisation.
39
For opioid drugs, what are the key targets?
Synapses are the key targets for opioid drugs.
40
What are the 5 symptoms of inflammation?
redness
heat
swelling
pain
altered function
41
During the inflammation process, why might we see swelling, heat, redness and pain?
We will see redness as there is an increase in blood flow to the area.
Vasodilation occurs which is why we see redness.
An increase in vascular permeability causes plasma to leak from small blood vessels into the area of damage which we will see as swelling.
This leaking plasma brings clotting factors to the injured area.
42
How does pain occur in the inflammation process?
An increase in vascular permeability occurs, which is swelling. This swelling will stimulate the nociceptive neurons, which will sends a message to the brain.
43
What is the main prostaglandin involved in the inflammatory process with pain?
Prostaglandin E2 - it plays a role in transmitting pain signals in the spinal cord and hypothalamus.
44
What is the target for non-steroidal anti-inflammatory drugs (NSAIDS) in the pain pathway?
NSAIDS will synthesis the prostaglandin.
45
What is the key enzyme in the synthesis of prostaglandin?
Cyclo-oxygenase or COX and there are two, COX1 and COX2.
46
What is the difference between COX1 and COX2?
COX1 is involved in:
maintaining the integrity of gastric mucosa.
Inhibition of gastric acid secretion.
Smooth muscle contraction.
COX2 is the key enzyme in the inflamed area.
47
What role does Mast cells play in the inflammation process?
Release histamine, prostaglandins and neutrophil-attracting mediators.
Antihistamines - block the action of histamine.
Corticosteroids - reduce the release of mediators from mast cells.
Mast cell stablizers - help prevent the release of mediators from mast cells.
48
Where is paracetamol metabolised and what is the antidote in case of toxicity?
Metabolized in the liver - the risk of liver damage (hepatotoxic) and the antidote is N-acetylcysteine.
49
Opioids mimic the body's own analgesic system. What do they bind to and inhibit the transmission of?
They bind to opioid receptors and inhibit the transmission of nerve impulses across the synapse.
50
What are the three main opioid receptors and their role in pharmacological action?
Mu receptors - analgesia, sedation, respiratory depression.
Kappa receptors - hypothermia, miosis
Delta receptors - dysphoria.
All have opioid effects.
51
Do opioids act on the CNS or PNS?
CNS - primarily activating the u-receptors.
52
What is the difference between local and general anaesthetics?
Local anaesthetics block calcium channels on nociceptive neurons which inhibit the transmission of pain signals to the brain.
Where general anaesthesia have actions on the CNS that induces analgesia, hypnosis and amnesia.
53
What is the antidote for a patient who has opioid overdose or toxicity?
Naloxone.
54
For a patient taking paracetamol, what should the nurse do?
a. teach the patient that caffeine decreases the effects of acetaminophen.
b. teach the female patient that oral contraceptives can increase the effect of acetaminophen.
c. encourage the patient to check package labels of OTC drugs to avoid overdosing.
d. report side effects immediately, as toxicity can cause severe hepatic damage.
e. monitor routine liver enzyme tests.
Encourage patient to check package labels of OTC to avoid overdosing.
Report side effects immediately.
Monitor routine liver enzyme tests.
55
What is the most appropriate way to assess the pain of a patient who is orientated and has recently had surgery?
a. ask the patient to describe the effect of pain on the ability to cope.
b. assess the patient's body language.
c. observe cardiac monitor for increased heart rate.
d. ask the patient to rate the level of pain.
Ask the patient to rate the level of pain.
56
A patient states during a medical history that he takes several paracetamol tablets throughout the day for pain. The nurse teaches the patient that the dosage should not exceed which amount?
a. 1gm per day
b. 4g per day
c. 3g per day
d. 2g per day
4g per a day.
57
A patient recieving periodic morphine via IV push, which of the following findings would be of utmost concern to the nurse?
a. Increased temp.
b. Decreased respirations.
c. Decreased bowel sounds.
d. Increased RBC count.
Decreased respirations.
58
The nurse is caring for 2 patients. The first patient had a hysterectomy after a complicated birth. The second patient also had a hysterectomy due to uterine cancer. What will most likely influence the experience of pain for these two?
a. meaning of pain.
b. posteroperative support personnel.
c. competency of the surgeon.
d. neurological factors.
Meaning of pain.
59
What is the difference between stable and unstable angina?
Stable = pain on exertion and no pain at rest.
Unstable = pain at any time - unpredictable.
60
Prostaglandins are released during the inflammation. What type of medication targets prostaglandins?
Non-steroidal anti-inflammatory drugs such as diclofenac and ibuprofen.
61
What is the key enzyme in the synthesis of prostaglandins during the inflammation process?
COX - cyclo-oxygenase.
62
What are the two COX that have a pharmacological significance?
COX 1
COX 2
63
COX 1 is involved in maintaining the integrity of the gastric mucosa. What are two other functions?
Inhibition of gastric acid secretion.
Smooth muscle contraction
64
What are mast cells?
Found in connective tissues and involved in inflammation.
65
What do mast cells secrete?
Histamine, prostaglandins and neutrophil-attracting mediators.
66
Antihistamines target mast cells. What do they do?
Block the action of histamine.
67
Corticosteroids will target mast mediators. What do they do?
Reduce the release of mediators from mast cells.
68
Where is paracetamol metabolised and what is the risk there?
Metabolised in the liver and risk of liver damage (hepatotoxic).
69
What is the antidote used in paracetamol toxicity?
Acetylcysteine.
70
Opioids bind to opioid receptors. What do they inhibit?
Inhibit the transmission of nerve impulses across the synapse.
Examples of opioids - codeine, morphine
71
Where do we find opioid receptors?
In the CNS - brain, medulla and spinal cord.
72
What are the three opioid receptors that have a pharmacological role in the body?
Mu receptors - opioid effects - analgesia, sedation, respiratory depression.
Kappa receptors - hypothermia, miosis.
Delta receptors - dysphoria.
73
There are two types of anaesthetics. What are they and what do they do?
General anaesthetic - unconscious and pain free.
Local anaesthetic - blocks calcium channels on membranes. This will inhibit the transmission of pain signals to the brain.
74
True or false. Opioids mimic natural opioid like peptides
True. They work in synapses between nociceptive neurons to dampen pain after an injury.
75
What three drug classes may help with neuropathic pain?
Analgesics, antidepressants or anti-epileptic drugs.
76
What is the antidote used when opioid overdose is suspected?
Naloxone is used. Can also be used for opioid-induced respiration depression.
77
Describe the drug half life?
It is the time it takes for the drug in the body to be reduced by half. Drugs with shorter half lives will need more frequent administration.
78
What are some pharmacological nursing considerations when nursing a patient who has a long-term history of alcohol?
They may develop cirrhosis of the liver which results in a loss of enzyme-containing liver cells. This can mean that the medication remains in systemic circulation for longer and results in an increase in side effects or overdose.
79
What is the difference between gram negative and gram positive bacteria when stained?
Gram positive stains purple due to the thick cell wall which is composed of peptidoglycan.
Gram negative stains pink due to thin peptidoglycan layer.
80
Beta Lactam is a class of antibiotics. What are two others?
Macrolides
Quinolones
81
Do we use an antibiotics to fight virus or bacterial infections?
Bacterial infections.
82
Bactericidial means to kill bacteria so they cannot replicate. What is bacteriostatic mean?
Bacteriostatic means it will stop the bacteria from growing. They do not kill the bacteria, they stop it from growing and the immune system clears it up.
83
Antibiotics don't work against all types of bacteria. What are these classified as?
A. Narrow spectrum
B. Broad spectrum
Narrow spectrum.
broad spectrum - cover a wide range is bacteria.
84
Narrow spectrum is only effective agaisnt killing a narrow range of bacteria. What type of bacteria and why?
Very effective at killing gram positive bacteria. Narrow spectrum is used because they don't kill off the 'good' bacteria that lives inside of us.
85
Why might we use a broad spectrum antibiotic?
In case of a severe infection with an unknown microbe.
86
What is one issue we see when using broad spectrum antibiotics?
They can often kill the patients ' good' bacteria as well.
87
What are three mechanisms of antibiotics?
Block cell wall synthesis
inhibit DNA replication
Inhibit protein synthesis.
88
What is the major cause of coronary artery disease?
Atherosclerosis is the major cause. This can turn into angina, heart failure, MI or cerebral artery disease.
89
What are 3 ways you can manage hyperlipidaemia?
Lifestyle chages through diet.
Lifestyle changes through identifing modifiable risk factors - decrease alcohol / weight.
Medication - lipid lowering drugs.
90
Why might we prescribe lipid lowering drugs in the body?
To reduce the concentration of LDL or triglycerides or both.
91
What are low-density lipoprotein (LDL) receptors?
LDL receptors are found on the surface of cells - particularly liver cells. LDL receptors remove and reduce LDL circulating in the blood.
92
THe number of LDL receptors on the surface of liver cells can influenced by diet, what are three others?
Genetic mutations
Exercise
certain medications.
93
What does the pro-protein covnertase subtilsin / kexin 9 (PCSK9) target?
It is an enzyme that regulate the the LDL receptor. It binds to the LDL receptor causing them to degrade, resulting in less uptake of LDL.
94
Statins block the enzyme that produce HMG-CoA. What does this lead in the body?
It will reduce the plasma cholesterol, less cholesterol is made.
95
Myositis and Myalgia are adverse reactions of Statins. What might these present as?
Myalgia - is a muscle aches and pain in the body that is not due to disease.
Myositis - rare disease that involves inflammation of the muscles.
96
What enzyme metabolizes statins in the body? Does it undergo first pass effect?
CYP3A4 metabolizes statins, which is found in the liver and therefore undergoes first pass effect.
97
Why should we not eat or drink grapefruit while on medication that is metabolised by enzyme CYP3A4?
Grapefruit juice inhibits the enzyme CYP3A4, which will increase bioavaliablity of the drug and the concentration of it in the body, increasing its likelihood of adverse effects.
98
Atorvastatin works by inhibiting the enzyme in liver called HMG-CoA. What effect does this have in the body?
HMG-CoA produces cholesterol in the body. Atrovastatin inhibits this enzyme, therefore reducing the amount of cholesterol that is produced, which leads to a decrease in blood cholesterol levels.
99
Drugs that enhance the action of the cell are called?
Agonist
100
Drugs that suppress the action of a cell are called?
Antagonist
101
Efficacy refers to?
How much drug is needed to produce the desired result.
The ability of the drug to produce the desired result?
The ability of the drug to produce the desired result.
102
T or F. A more potent drug will produce the desired result at a lower dose?
True.
103
Absorption can be affected by changes to gastric emptying time, small bowel surface area and..
a. body temp
b. fluid volume
c. gastric pH
Gastric pH
104
T or F. As we age, total body water increases while body fat decreases.
False.
105
With less plasma protein, there is less binding of medications. This leads to:
a. lower levels and lower efficacy of drugs like warfarin and phenytoin. OR
b. higher levels and higher efficacy of drugs like warfarin and phenytoin.
B. Higher levels and higher efficacy of drugs like warfarin and phenytoin.
With less of the drug bound to plasma proteins, there's higher circulating levels and this can lead to toxic effects.
106
What organ metabolises many medications?
a. the liver.
b. the kidneys.
c. the GI tract.
The Liver
107
What system is a key player in drug elimination?
a. the liver
b. the kidneys.
c. the GI tract.
The kidneys.
108
Dosing in children is often based on:
a. age.
b. weight.
c. height.
Weight.
109
T or F. Variability in gastric pH comes into play with penicillin, which has lower peak concentrations in a neutral pH envrionment.
False. Pencillin has higher peak concentrations in a neutral pH environment.
110
Where does PO drug absorption occur?
a. in the stomach.
b. in the small intestine.
c. in the colon.
In the small intestine.
111
The longer a medication sits in the stomach, the ______ absorption will occur.
a. more
b. less.
Less.
112
Why can topical medications lead to systemic toxicity in young children?
Young children have thinner skin and larger body surface area relative to their size in adults.
113
What is the significance of infants having decreased plasma proteins?
a. they'll need a higher dose of protein bound drugs.
b. more drugs is available, which can lead to toxicity - therefore lower dose required.
B. More drug is available, which can lead to toxicity - so lower dose required.
114
What is the significance of infants having a higher % of total body water?
a. They'll get higher doses of hydrophilic drugs.
b. They'll get higher doses of hydrophobic drugs.
A. They'll get higher doses of hydrophilic drugs.
115
Most ____ medications are administered PO (by mouth) are:
a. enteral
b. parenteral
Enteral
116
Why is it important your patient does not move a medication intended for buccal administration to under the tongue?
It would absorbed too rapidly.
117
T or F. Medications administered rectally and sublingually forgo first-pass metabolism.
False.
118
Local anaesthetics, the tuberculin skin test and allergy testing injections are examples of what type of administration?
a. Intradermal.
b. Subcut.
c. Intramuscular.
Intradermal.
119
With intradermal administration, the bevel faces up and the needle is inserted at:
a. 5-10degrees
b. 10-15degrees
c. 15-20degrees
d. 20-30degrees
10-15 degrees
120
Heparin and insulin are examples of medications administered via what route:
a. Intradermal
b. subcut
c. intramusclar
Subcutaneous.
121
For a subcut injection, the needle is inserted at:
a. 10-15degrees
b. 30-45degrees
c. 45-90degrees
45-90degrees
122
The ventrogluteal site is used for _______ injection?
a. subcut
b. IM
IM injection
123
Eye ointments are applied:
a. from the outer to inner canthus.
b. from the inner to outer canthus.
From the inner to outer canthus.
124
T or F. When administering otic medication to adults and older children, you pull the pinna up and then back.
True.
125
What does BID and TID mean?
BID - twice a day.
TID - three times a day.
126
What is the key difference between hormones and neurotransmitters?
Hormones exert their action at a distant site in the body while neurotransmitters exert their influence on a neighbouring nerve cell.
127
T or F. Vasopressin acts as both a hormone and neurotransmitter?
True. Vasopression acts a hormone to regulate fluid volume, and acts a neurotransmitter to influence thermoregulation, ACTH release and the circadian rhythm.
128
Is this a positive or negative feedback loop? When thyroid hormone levels are adequate the release of thyroid-stimulating hormone is inhibited.
Negative feedback loop.
129
What hormones does the posterior pituitary store and secrete?
a. ADH
b. Norepinephrine
c. Thyroid stimulating hormone
d. Corticotropin release hormone
e. Oxytocin
d. Cortisol
ADH and oxytocin
130
Which hormone from the anterior pituitary triggers the release of cortisol, epinephrine and norepinephrine?
a. ACTH
b. ADH
c. TSH
D. Prolactin
ADH / TSH / Prolactin
131
Which hormone from the anterior pituitary stimulates the mammary glands to produce breast milk?
a. ACTH
b. Prolactin
c. Oxytocin
d. Luetenizing hormone
Prolactin
132
Which hormone from the anterior pituitary stimulates the thyroid gland to produce T3 and T4?
a. ACTH
b. ADH
c. Corticotropin releasing hormone
d. TSH
TSH
133
The adrenal cortex produces and secretes?
a. Aldosterone
b. Antidiuretic hormone
Aldosterone.
134
The vomiting reflex involves a complicated coordinated response between two areas. One is the vomiting centre (located in the medulla), what is the other?
The chemoreceptor trigger zone - located in the ventricle of the brain. It is activated by emetics which include chemical toxins and drugs.
135
The chemoreceptor trigger zone relays messages to the emetic centre through the actions of neurotransmitters. Acetylcholine is one, what are three others?
5-HT
Histamine
Dopamine
136
During drug trials, experiements can be conducted in vivo or in vitro. What experiment is where the research is done with or within an entire living organism?
In Vivo.
In vitro is used to describe work that is performed outside of a living organism. This can include studying cells in culture or methods of testing the antibiotic sensitive of bacteria. It is generally done in a test tube - in vitro.
137
