Pharmacology mod 1 Flashcards
Define pharmacology
the study of the biological effect of chemicals
Define pharmacotherapeutics
the use of drugs to treat, prevent, and diagnose
Describe federal oversight of drugs
o Control substance: any drug w/ abuse potential- physical or psychological
Schedule I
High potential for abuse
No medical use
Heroin, LSD
Schedule II
High potential for abuse; possible severe psychological or physical dependence
Cocaine- nasal surg- vasoconstriction
*Narcotics, amphetamines, barbiturates
Schedule III
Moderate to low potential for physical and psychological dependence; still has potential for abuse.
*Nonbarbiturates, sedatives, nonamphetamine stimulants, limited amounts of certain narcotics
Schedule IV
Low potential for abuse; low risk of dependence Some sedatives, antianxiety agents, nonnarcotic analgesics
Schedule V
Lowest potential of abuse
Limited quantities of certain narcotics
*Typical use: antidiarrheals, antitussives, and analgesics
o DEA: monitors the:
▪ Prescriptions
▪ Distribution
▪ Storage
▪ Use of controlled substances
* GOAL: decrease in substance abuse
o FDA:
▪ Decides on drug classification
▪ Responsible for regulation, evaluation and distribution policies
* Pregnancy drug risk classification:
o No drug is safe- ASK: does the benefit outweigh the risk?
o Teratogenicity- adverse effects on the fetus
o Category X: NEVER GIVE
o New Risk Classification:
▪ Pregnancy
▪ Lactation
▪ Reproduction potential
Differentiate between generic and brand name drugs
o Generic:
▪ The original name given to the drug when it was submitted to the FDA for approval ▪ Once patent is up other manufactures can make drugs
▪ Less expensive
▪ Same active ingredients
▪ Generic drugs are safe
o Brand:
▪ Name given by company after FDA approval
▪ Companies with brand name perform all the research and testing-eat up more cost ▪ More expensive
▪ Inactive ingredients can vary- interfere with biodegradable
▪ Authorization issues
▪ If ordering provider wants brand name needs to write DAW
Differentiate between over-the-counter (OTC) and prescription (Rx) drugs.
o OTC:
▪ Available w/o RX
▪ Safe when taken as directed
o RX:
▪ Require RX
▪ Some RX are changed to OTC, once deemed safe
Explain the benefits and risks associated with the use of over-the-counter (OTC) drugs.
- Can mask symptoms
- Can interact w/ other drugs being taken
- Serious overdose
- Tend to not be reported as taken
Explain the principles of pharmacodynamics
o How the drug affects the body
▪ Mechanism of Action- how the drug works in the body to have an effect
* Receptor action
o Act on receptors on cell membrane
▪ Agonist
* Binds to receptor to increase/stimulate response
▪ Antagonist
* Binds to receptor to depress/block/slow response
* Physical Action
o Change physical properties of cell or body fluids
▪ Damage cell or alter PH
* Act on other chemicals in the body
o Creating chemical reactions
▪ Our body is a chemical reaction→new drug enters→ can interfere
with cell function
* Enzyme/metabolic action
o Process in the body requires multiple steps to have an effect
o Drugs can interfere w/ one of the steps by stopping, delaying or speeding it
up
Explain the meaning of half-life of a drug and calculate the half-life of a given drug.
The time it takes for the drug in the body to decrease by one half of the previous dose. ▪ Exam. 500 mg of med given at 8:00. Meds half-life is 3 hours. At 3 hours it is now 250 mg
8:00
500 mg of med
11:00
250mg of med remains
14:00
125mg of med remains
17:00
62.5mg of med remains
Discuss factors that can influence the effectiveness of drugs in the body.
o Weight- drugs are tested on average of 150 lb
o Age-
▪ Children→ immature organs=faster metabolism.
▪ Geriatric→ slower metabolism
o decrease plasma proteins
o Poly pharmacy
o less efficient profussion
o alteration on metabolism due to liver changes
o fewer effective secretions due to renal function
o start low and go slow
o Gender- Male→ more vasc muscles→ IM injections benefits will be seen sooner * Female→ increase fat cells→ drugs deposited into fat may have prolonged effects o Physiological Factors→ hydration, electrolytes
o Pathological Factors→disease drug is intended to treat
▪ Liver and/or kidney dysfunction
▪ GI disorders
o Genetic Factors→Pharmacogenomics→see above
o Immunological Factors→ allergies
o Environmental factors→ atmosphere, mood, temperature
o Tolerance→drug no longer causes same reaction
▪ Large doses needed
▪ start with smaller doses or combining with other meds
o Accumulation → toxic levels and adverse effects
Define drug-drug, drug-alternative therapy, drug-food, and drug-laboratory test interactions.
interactions ▪ Always check the drug guide for potential interactions**
▪ An interaction of when two or more substances are taken together. They can interfere with ADME, cause an alteration in therapeutic effect, increase adverse reactions→some drugs have a very narrow margin of safety(small window between therapeutic and harm dose) o Drug-drug and Drug-alternative therapy
▪ RX drugs
▪ OTC drugs
▪ Herbal treatments
▪ Supplements
▪ vitamins
o Drug-food
▪ Typically occurs w/ direct contact in stomach
* Exception: grapefruit- DO NOT CONSUME if med can have an interaction
▪ Oral meds→ better on empty stomach
o Drug laboratory test
▪ Administration of a drug can alter test results
Explain the safety concerns of drug interactions.
o Adverse Effects
▪ Undesired effects that may be unpleasant or dangerous
▪ Other effects besides the intended therapeutic effect
▪ Mild, moderate or deVere
▪ Patient sensitivity
▪ Drugs action on the body
▪ Not taking the correct dose
Describe the different types of adverse drug effects and explain the clinical significance.
Primary actions→Too much of desired effect-overdose→ HTN meds causing hypotension o Secondary actions→ effects on the body that are not the intended therapeutic effect→ pain meds causing constipation
o Drug allergy→ antibodies are formed to a particular drug
* When the person is exposed to the drug, thee reaction occurs
* Cross allergies to drugs in the same class
Discuss anaphylactic allergic reactions to a drug including assessment findings and nursing interventions.
o Action:
▪ Immediate
▪ Release of histamine→ mucous membrane swelling
▪ Bronchi constriction
o Assessment:
▪ Hives, Rash
▪ Trouble breathing
▪ Changes in BP
▪ Dialted pupils
▪ Diaphoresis
▪ Increased HR
▪ Panic/impending doom
▪ Resp arrest
o Interventions:
▪ Stop drug
▪ Epinephrine
▪ Notify provider
▪ Prevention→ medica-alert bracelet and Epi pen
Identify specific examples (see list below) of toxic effects of drugs including appropriate nursing interventions.
dermatologic reactions
hepatic/liver injury
renal/kidney injury
poisoning
general central nervous system effects
teratogenicity
o Dermatologic reactions
▪ Rashes/Hives
* Assess skin for rashes and lesions
* Systemic effects: enlarged lymph nodes, fever, hepatomegaly
* Stevens-Johnson-Syndrome: rare, but very serious- dark red papules
* Interventions:
o Benefit vs discomfort: skin care, meds, teaching
o Severe cases: d/c med
▪ Stomatitis
* Gingivitis, glossitis, difficulty swallowing, bad breath, oral pain
* Interventions:
o Mouth care, small meals, dental consult
o Meds: antifungal, local anesthetics
o Hepatic injury-need to check LFT’s prior to admin drugs
▪ CNS: fever malaise
▪ GI: N/V, Abd pain, change in urine(blood)/stool color(pale)
▪ Skin: jaundice
▪ Labs: AST, ALT, PT/INR, PTT
▪ Interventions:
* d/c drug, small frequent meals, skin cae, cool environment, rest periods
o Renal/kidney injury-need to check labs prior to admin of drugs
▪ CNS: FATIGUE, MALAISE, IRRABILITY
▪ Skin: Rash, Edema
▪ Decreased UOP
▪ Labs: BUN, Cr, decreased HCT, electrolyte imbalances
▪ Interventions:
* Positioning, diet/fluid restrictions, skin care, electrolyte replacement, rest. D/C drug→dialysis in severe cases
o Poisoning
▪ Damage to multiple body systems due to OD→assessment/TX is dependent on the drug→emergency/life support measures→may results in death
o General central nervous system effects
▪ Assessment:
* confusion, delirium, hallucinations
* Insomnia, drowsiness, bizarre dreams
* Hypo or hyper relexia
* Numbness, tingling, paresthesia
* Seizures
* Interventions:
o Safety measures to prevent injury
o Patient education on safety measures
o Orientation as needed
o Decrease dose or d/c drug
o Teratogenicity→drugs can cause death or congenital defects in a developing embryo→ some drug effects are known and some are not→ benefit vs risk→ pregnant women must be informed and must consent
Explain what is involved in each step of the nursing process as it relates to drug therapy.
o Assessment
▪ History
* Med conditions
* Current meds
* Allergies
* Finances
* Literacy/education level
* Culture
* Understanding of disease/drug
* Reactions
* Social support
* Health seeking behaviors
▪ Physical Assessment/exam
* Age
* Weight
* Side effect of medication
* Therapeutic effects
▪ Diagnostic Test
* Labs
* imaging
o Nursing Conclusion (nursing diagnosis)→ nursing focused, based on drug therapy, personalize to your patient→ not disease
▪ Contraindications
* Absolute
o Life threatening
o Never administer
* Relative
o Benefit vs risk
o Contact provider
▪ Cautions
* May administer w/ additional nursing considerations
o Planning/prioritizing
▪ Goals/outcomes
* Response to medication
* Prevention or treatment of adverse effects
* Patient education
▪ Prioritize
o Implementation
▪ Drug administration
* Safety/prevention of errors
▪ Comfort measures
* Comfort measures
* Lifestyle modifications
* Placebo effect
▪ Patient and family education
o Evaluation
▪ Patient response to the drug
* Therapeutic effect
* Adverse effect
▪ Adverse effects
▪ Any interactions
▪ Effectiveness of nursing interventions including education
▪ Compliance
Describe the role and responsibilities of the nurse and the patient in drug therapy and the prevention of medication errors.
o Nursing role/responsibilities
▪ Administer drugs
▪ Assess drug effects
▪ Intervene when adverse effects occur
▪ Provide patient teaching
▪ Monitor to prevent errors
o Patient responsibility
▪ Speak up
▪ Up-to-date med list
▪ Know reason for meds
▪ Read label and follow instructions
▪ Store meds correctly and safely
▪ Use age-appropriate meds
▪ Measure liquid meds appropriately
▪ Call provider if no improvement or adverse effects occur
* MEDICATION RIGHTS:
o Right patient
o Right drug
o Right reason
o Right storage
o Right route
o Right dose
o Right preparation
o Right time
o Patent education
o Right documentation
* Reporting Med errors:
o Institutional level
▪ Follow policies and procedures
o National level
▪ US Pharmacopeia
▪ FDA
Explain the principles of pharmacokinetics
o How the body acts on the drug
▪ Timing of drug action
* Onset→ when the drug starts to work
* Peak→drug most effective
* Duration→ how long it will last
▪ Critical Concentration
* Amount of drug needed to cause a therapeutic effect
o Too much can cause harm
o Too little will be ineffective
▪ Loading Dose
* Higher dose than that usually used for treatment
o This is to get to the critical concentration fast→dose lowered once obtained * Recommended dosing schedule is followed once critical concentration is reached ▪ Therapeutic Index
* Ratio comparing the blood concentration at which a drug becomes toxic with the concentration at which the drug is effective
▪ Dynamic equilibrium
* The actual drug level in a person’s body
o Absorption- getting drug into system→point of administration to body fluids by:
▪ Passive Diffusion
* Drugs are absorbed through concentration gradient
o High drug concentration to Low drug concentration
▪ Active Transport
* Uses energy to move molecules across cell membrane
o Needed if too large or against concentration gradient
▪ Filtration
* Movement of drug through pores
❖ Factors influencing absorption →
o Route→ IV/IM fastest
o Solubility→ water v. lipid
o Tissue perfusion→ adequate
o Ionization→ no charge is best
o Size→ smaller = faster
o Distribution-getting drug to its target
▪ Most drugs bound to protein→ the tighter they are bound the longer it takes→ loosely bound→ active faster and excreted faster
▪ Only free particles cause a therapeutic effect
▪ Competing for protein binding sites→can cause toxicity or effects of a drug
▪ Drugs must be lipid-soluble to cross blood brain barrier or damaged barrier
▪ Can affect fetus/neonate→ check before administration
o Metabolism-making drug active
▪ Organ responsible for metabolism→ liver
▪ First pass→oral meds absorbed from small intestine→liver by portal vein→ liver enzymes deactivate a large portion of drugs
* Inactive→ gets excreted
* Active→ transported to target tissue by circulatory system
▪ Parental Administration (IV/IM/Subq)
* No first pass effect
* Lower med doses needed
* Still metabolized in liver
▪ Hepatic Enzyme system
* Enzymes responsible for metabolizing drugs
* Cytochrome P450 system(enzyme)
* Drugs can increase or decrease the enzymes
o Increase→ enzyme induction→ increase in
metabolism of drug
o Decrease→ inhibit→ won’t be broken down→ can
lead to toxicity
* Liver function
o Excretion- getting drug out of system
▪ Organ responsible: Kidneys
▪ Methods:
* Glomerular Filtration→ Water and water soluble
o pass from blood into renal tubule
* Active Transport→ not water soluble
o Exchange of drug molecules for acid or bicarbonate
molecules
Explain the principles of pharmacogenomics.
the study of how a person’s genetic makeup influences their response to medications, aiming to personalize drug therapy by considering individual genetic variations to optimize treatment efficacy and minimize adverse drug reactions, essentially matching the “right drug to the right person” based on their genetic profile.
