Test #1 Flashcards
What is Parenternal route of administration
Outside the GI (IV, IO, IM)
What effect will dehydration have on the admission of drugs?
- Less body water = water soluble drugs have smaller area for distribution which increases concentrations of the drug in the blood
- Loss of electrolytes can cause cell channels to function improperly causing drug to not be used
what is Xerostomia?
dry mouth
what is St. Johns Wort
Wild-growing with yellow flowers, this herb has been used for centuries in the treatment of mental disorders. Today, it is popular for mild to moderate depression.
toxidrome
the toxic effect of a medication
when was the comprehensive drug abuse prevention and control act?
1970
comprehensive drug abuse prevention and control act did what?
- legal basis for manufacturing, importation, possession, and distribution.
- law established 5 scheduled classes
Who enforces controlled substances laws and monitors the need for changing schedules for abused drugs.
DEA- drug enforcement administration
what are some key things that the DEA enforces for controlled drugs?
- drug storage
- sign in and out drugs
- 2 lock method
- witnessed waste
What is a Schedule 1 Drug?
no accepted medical use, abuse potential high, potential for addiction high, examples: heroin, LSD, peyote, marijuana.
what is a scheduled 2 drug?
accepted medical use, abuse potential high, may lead to severe physical and psychologic dependence, examples: morphine, codeine, opium, ritalin.
what is a schedule 3 drug?
accepted medical use, abuse potential moderate, moderate physical and psychologic dependence, examples: anabolic steroids, vicodin.
what is a schedule 4 drug?
accepted medical use, abuse potential low, limited physical and psychologic dependence, examples: benzodiazepines, diazepam, lorazepam.
what is a schedule 5 drug?
accepted medical use, abuse potential low, limited physical and psychologic dependence, examples: medications for relief of diarrhea and cough.
what is the United States Pharmacopeia - National Formulary (USP-NF)
Designated by The U.S. Federal Food, Drug, and Cosmetics Act
Official reference source for drugs marketed in the United States.
The Harrison Narcotics Act of 1914
Established the word “narcotic”
Regulated the importation, manufacture, sale, and use of opium, codeine, and their derivatives and compounds.
Who does the FDA over see?
oversees the general safety standards in the production of drugs
regulates biologic products, vaccines, blood products, tissues, ect.
What happens during the preclinical testing?
- prehuman testing, evaluates drug absorption, distribution, metabolism, elimination, toxicity, and useful effects.
what happens during Phase 1 of Drug testing?
human clinical testing (metabolism and MOA)
what happens during Phase 2 of Drug testing?
larger number of human clinical testing (side effects and risks)
what happens during Phase 3 of Drug testing?
clinical testing on patients with disease, file application with FDA
what happens during Phase 4 of Drug testing?
released for general use, post-market surveillance. (not monitored by FDA)
on average how long does the drug testing process take for the FDA?
15-20 years
What is Enteral Drug route?
passes through the digestive track
what is the sublingual route?
under the tongue, Nitro
Oral route?
PO
by mouth,
first pass effect
Buccal route?
placed in the mouth between the gum and mucous membrane aof cheek.
Rectal route?
suppository.
child seizing, valium
gastric
gastrostomy tube,
activated charcoal
parenteral drug
NOT through the digestive tract
Intravenous Route
KVO?
IV, into the venous circulation
KVO-Keep vein open
Intraosseous route
IO- emergency situation, through the bone.
intracardiac
injection directly into the ventricle of the heart
endotracheal
injection directly into the ventricle of the heart
Endotracheal
administed into the ET tube (2x the dose)
Inhalation
SVN?
(small volume nebulizer)
albuterol
intranasal
IN?
nasal passages (MAD device)
intralingual
injected into the tounge
Intramuscular
IM
skeletal muscle
- 90 degree to pt
- 1” - 2” needle
subcutaneous
SQ?
under the skin, subcutaneous layer
- 45 degrees
- 3/8 to 5/8 needle
topical route
applied on skin
small volume Neb
SMV.
what rate for O2?
6-10 lpm
What is pharmacokinetics?
its how the drug moves through the body.
Facilitated Transport?
no energy expended, lock and key protein, high concentration to low.
Absorption?
absorbed into the bloodstream
Distribution, how does it get moved through the body?
travel through bloodstream, lymph, target site, organs with high blood flow, brain, heart, liver, kidneys.
Biotransformation
chemical modification of the original drug in body, metabolism in liver.
- Bioavailability refers to the extent and rate at which the active moiety (drug or metabolite) enters systemic circulation, thereby accessing the site of action. Bioavailability of a drug is largely determined by the properties of the dosage form, which depend partly on its design and manufacture.
Elimination
kidneys - urine, liver, lungs, sweat, salivary glands, and mammary glands.
what pt have a hard time eliminating drugs?
People who have a liver or a kidney disease. Impaired ability to eliminate drugs. there becomes a build up of the drug in the system, its not processed properly.
Efficacy
the ability of a drug to produce a physiologic response after attaching to a receptor
Therapeutic Index
• Its the calculated amount that has been decided to allow medication to work the best.
◦ Atropine is is a good example of having to stick to the minimum dose, other wise it doesn’t work right. Also there is a max before it also stops working
‣ LD50- lethal dose (going off 50% of population we have given it too)
factors that influence drug action?
age, gender, body weight, environment, general health, genetics, culture, emotional, psychological, time, route, medication hx, diet.
what is Teratogen?
a drug or agent that is harmful to the development of an embryo or fetus.
Pregnancy Risk categories
A
no evidence of risk exists.
Pregnancy Risk categories
B
the risk of human fetal harm is possible but remote.
Pregnancy Risk categories
C
human fetal risk cannot be ruled out.
Pregnancy Risk categories
D
positive evidence of human fetal risk.
Pregnancy Risk Categories
X
contraindicated during pregnancy
what happens during the post market study?
• It’s the study of a drug after it hits the market, and the long based effects of a drug and things they find. (There are things they can’t predict. The contraindications and so on.)
◦ Ex: erectile drugs, originally was trying to use as a blood pressure medication.
Black Box warning-
warning that comes out post the drug being on the market
◦ Example is Droperidol (saying that don’t give it if they have long QT interval, puts them into torsades de pointes )
‣ We still give it without having to do a full cardiac work up.
‣ Droperidol is for combative pt.
‣ So if they go into cardiac arrest! Know why, so you can fix it.
Untoward Effects
Unpredictable, Harmful Effects
What are some important things to know about drug storage?
The box should be evaluated for contents, expiration dates, quantity, and locking mechanisms.
Storage of medication is important. (light and temperature)
What effect will dehydration have on the admission of drugs
Less body water = water soluble drugs have smaller area for distribution which increases concentrations of the drug in the blood Loss of electrolytes can cause cell channels to function improperly causing drug to not be used
This is why older people we have to be very careful with drug dosing
What is biotransformation? And how it works according to liver failure
Metabolism of the drug forming metabolites. Liver failure will leave drug in system longer and not metabolize
You have given the wrong drug, what do you do?
Reverse the action if possible, immediately notify the receiving medical doctor, physician advisor, and document.
For a drug to be official, what does it need at the end of the name?
USP
Pure food and drug act 1906
First legislation. Little more than labeling of drugs. Created FDA
Why are peds, pregnancy and geriatric patients a special consideration when giving drugs
Peds all weight based, certain drug can affect fetus, drug interact differently for geriatrics (body water, metabolism, liver failure, kidney failure)
Therapeutic dose, min. dose, max dose, and toxic dose
Therapeutic = effective, beneficial in
50% Min = minimum to have beneficial effect
Max = below is therapeutic, above is toxic. 24 hours
Toxic = Toxicity in 50%
Renopathy effects elimination
Kidneys. If they don’t work, drug wont leave
What are the 6 pt rights?
- Right Pt
- Right Medication
- Right route
- Right Dose
- Right date/ time
- Right documentation
what should you label on a bag that you infused a drug into?
- Drug Name
- concentration
- Time/Date
- Name
What are drugs?
they are chemicals used to
- diagnose
- treat
- and prevent disease
what 3 things do you need to know about a drug before you give it?
- indications to give the drug
- contraindications to not give the drug
- check the name of the drug 3 times
what is pharmacology?
the study of drugs and their actions on the body.
what is the chemical name of drugs mean?
its the chemical compound and molecular structure
what is the generic name of the drug mean?
usually suggested by the manufacture. Usually is a combined chemical name.
what is the official name for a drug?
it is the generic name, that then is approved and has to have the USP on the back.
what is the brand name?
trade name, or proprietary name (like Benadryl). it is the company name and can exclusively make it for 18-22 years.
what are the actions of drugs?
- bind to receptor sites
- change physical properties
- chemically combine with other substances
- altering a normal metabolic pathway
what do agonist do?
they allow receptor sites to react
what do antagonist do?
they block the receptor sites from agonist (think beta blocker, or narcan, or ARBs)
How does aspirin work?
it keeps the platelets from building up
what is thromboxane a2?
The messenger cells that call for more clotting, aspirin stops that message.
4 complications of IV therapy
Pain, local infection, pyrogenic reaction, cath shear, arterial puncture, thrombus formation, air embolism, necrosis
vermilion border
is the normally sharp demarcation between the lip and the adjacent normal skin
