The MIDDY! Flashcards
the time it takes for half the drug concentration to be eliminated from the body
Half life
What measures the rate drugs are removed from the body
Half life
Also known as:
what the BODY does to the DRUG
PharmacoKINETICS
What are the 4 processes of pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
What is the movement of a drug from the site of administration, into the blood stream
Absorption
What is the movement of the drug into the cells
Distribution
The method by which drugs are inactivated (biotransformed) by the body
Metabolism
Where does metabolism primarily occur?
The liver
Biotransformation refers to which pharmacokinetic process?
Metabolism
What refers to the elimination of a drug from the body?
Excretion
What factors affect absorption?
GI Function
Route
Dosage
Lipid Solubility
Blood Flow
Surface Area
(GI.R.D.L.B.S)
Gee I. Really. Dont. Like. Bull. Shit.
What factors affect distribution?
Protein Binding
Blood Flow to the tissues
Solubility
(P.B.S)
PBS “distributes” (broadcasts) TV shows
What is the INITIAL biotransformation (metabolism) of a drug that produces altered pharmacologically active molecules?
First Pass Effect
What is the most common route of excretion?
Urine
What is the rate at which drug molecules disappear from the circulatory system?
Clearance
What enzyme system is key to liver metabolism
The P450 system
Drugs circulate in the plasma either bound or unbound to plasma proteins
Protein binding
What protein contributes to most of the the body’s protein binding
Albumin
Drugs given by what route may be extensively metabolized before reaching the systemic circulation.
Give an example.
PO
Nitroglycerin
(First pass effect)
What INCREASES metabolism and excretion
Inducers
What are 2 examples of inducers
Tobacco
St. John’s Wort
There was a TOBACCO farmer named St. JOHN who’s pregnant wife had to be INDUCED while on the farm!! 😨
Clearance is affected by factors such as ______.
Gender
What DECREASES metabolism and excretion
inhibitors
What are 2 examples of inhibitors
Benadryl
Grapefruit
Ben was a Grapefruit. Idk make it work lol
Drugs given by what route, bypass the liver and prevent first pass effect
IV
IM
IN
subcut
ntg
inhaln
mucosa
transdermal
When 2 highly protein bound drugs displace one another this is called
Displacement
They fight for protein binding
What is highly selective and nearly impermeable
The blood brain barrier
When bound to a protein, a drug is unable to pass through what? (causing it to have no effect)
Capillary walls
- because when the drug molecule is bound to a protein, the bound drug molecule is so big that it can’t fit passed the capillary wall. Thus, it can’t make it to the target cell to have an effect until the molecule becomes unbound
What causes drug molecules to become free from their protein bonds
When these bonds dissolve
- a drop in serum drug level
What do you call drug molecules that are not protein bound?
Active
Drugs administered by what route take longer to be absorbed?
Orally
Which route of med administration is absorbed more rapidly;
Enteral or Parenteral?
Parenteral
Which liquid meds are absorbed the fastest?
Elixirs
Syrups
Which type of oral medication is absorbed the slowest?
Enteric coated
Drugs cause their effects by interfering with what system?
The enzyme cascade system
Think about it:
Liver damage causes what?
Higher levels of ACTIVE drug
More Toxicity
What labs do you monitor for liver damage?
ALT
AST
Albumin
Total Protein
What do you assess for with liver damage?
Jaundice
Enlarged liver
Ascites
The liver changes drugs from ______ soluble to _______ soluble?
From FAT soluble to LIQUID soluble
The kidneys can only excrete drugs when they are _____ soluble?
Liquid
Think about it:
Kidney diseases cause what?
Decreased effectiveness of drug excretion
Increased risk for adverse drug reactions
What are 2 major modes of drug clearance?
Hepatic metabolism
Renal excretion
Who’s gonna rock this middy?!
You!
Lol keep going!
What labs do you monitor for Renal diseases?
BUN
Cr
Medication Drug Levels
Constipation does what to drug contact time?
Leading to what kind of effects?
It increases drug contact time (poop traffic)
Because there’s a poop blocking the way 💩🚧
Leading to increased drug effects / toxicity ☣️
In regards to ABSORPTION
Explain Geri’s gastric mobility
Slow gastric mobility- unpredictable rates of absorption
💡 Geri is an old woman. And everything about Geri low or slow
In regards to ABSORPTION
How is Geri’s gastric pH?
High
Less acidic
(More alkaline)
In regards to ABSORPTION
How is Geri’s peristalsis?
Slow
In regards to ABSORPTION
How is Geri’s blood flow in her GI tract?
Reduced
(Low/slow)
The attraction between albumin and drug is represented by what?
Percentages
PROTEIN BINDING:
89% and above is considered to
Highly bound
PROTEIN BINDING:
60-89% is considered to be:
Moderately bound
PROTEIN BINDING:
Less then 30% is considered to be:
Low bound
Nutritional status effects what?
(think liver)
Protein binding
A patients diet needs to have?
Adequate protein
In regards to DISTRIBUTION:
Geri’s blood brain Barrier is?
Less effective
In regards to DISTRIBUTION:
Geri’s Lean body mass is:
Decreased
In regards to DISTRIBUTION:
Geri’s total body water content is:
Reduced
In regards to DISTRIBUTION:
Geri’s protien binding sites are?
And why?
Reduced
Due to aging liver
In regards to DISTRIBUTION:
Geri’s fat content is:
INCREASED!
Remember Geri also put on some lbs with age 😅
In regards to METABOLISM:
Geri’s liver?
Decreased in size/mass
In regards to METABOLISM:
Geri’s liver blood flow?
Decreased
In regards to METABOLISM:
Geri’s overall metabolism is?
Decreased
In regards to EXCRETION:
Geri’s renal filtration rate is?
Decreased
In regards to EXCRETION:
Geri’s renal blood flow is?
You guessed it
Decreased
In regards to EXCRETION:
Geri’s nephron levels are?
Decreased
Aging leads to a greater incidence of
Toxicity
What is the USP-NF?
United States Pharmacopoeia National Formulary
What does the USP-NF do?
Sets high drug standards used in the US
How often is the USP-NF standards revised?
Every 5 years
What kind of agency is the USP?
NOT a Government agency
The USP does what?
The Federal Government does what?
The USP reviews meds and sets standards
The FEDs enforce and control those standards
The time it takes to reach minimum effective concentration
(MEC)
Onset
The time it takes to reach highest blood or plasma concentration
Peak
The length of time the drug has pharmacological effect
Duration
Where the drug is at highest level concentration
Peak
Where the drug is at lowest level concentration
Trough
Thick, sugary liquid- PO med
Syrup
Clear, Liquid- PO med
Elixir
Suspension solutions, usually oily
Emulsion
What liquid PO meds absorb 2nd fasted to Syrups and Exlixirs
Emulsions
TID
3 times a day
BID
2 times a day
What time is breakfast
0800
What time is lunch
1200
What time is dinner
1700
1 tsp= x mL
5 mL
3 tsp = x tbsp
1 tbsp
1 tbsp= x mL
15 mL
1 oz = x tbsp
2 tbsp
1 oz = x mL
30 mL
1 cup = x oz
8 oz
1 cup = x mL
240 mL
1 pint = x cups
2 cups
1 pint = x oz
16 oz
1 quart = x pint
2 pint
1 quart = x oz
32 oz
1 quart = x cups
4 cups
1 gallon = x quarts
4 quarts
1 gram = x milligrams
1000
1 kilogram= x grams
1000 grams
1 kilogram = x lbs
2.2 lbs
1 milligram = x micrograms
1000
1 liter = x mL
1000 mL
1 mL = x cc
1 cc
1 grain (gr) = x mg
60 mg
Who can prescribe meds?
HCPs:
NP
PA
MD
Dentist
Dermatologist
NP,PA,MD,D,D
Drug names that are capitalized
Trade/ Brand name
Drug names that are lower case
generic
Drug names that sound alike
Trade/Brand names
Drugs that are usually more expensive
Trade/ Brand names
Drugs that have the “circled R” symbol
Trade/ brand
Drugs that are more affordable
Generic names
What are core pt variables
Culture
Health status
Inherited traits
Life span
Diet
Life style
Environment
Habits
Gender
C.H.I.L.D. L.E.H.G
(Child leg) 🤷♂️
The desired, therapeutic effect of the drug
Pharmacotherapeutics
What the BODY does to the DRUG
The change that occurs to the DRUG when it is inside the BODY
Pharmacokinetics
What the DRUG does to the BODY
The effects of the DRUG on the BODY
Pharmacodynamics
Conditions under which the drug must be carefully monitored
Precautions
Conditions under which the drug should not be used at all
Contraindications
Effects that may occur when the drug is given along with another drug, food, or substance
Drug interactions
The unintended and usually undesired effects that may occur with the use of the drug
Adverse/ side effects
Basic teaching to pt and family
Reason for prescription
Adverse effects
Intended effect
Drug name
R.A.I.D
you want to raid the room to teach the pt
Digoxin toxicity s/s
Visual disturbances (seeing Halos, usually blue/green)
Bradycardia
Anorexia
Abdominal pain
n/v
Established official standards and requirements for accurate labeling
1906
Pure Food Drug acts
Strengthened 1906 law, prohibiting fraudulent therapeutic claims of drug effectiveness
1912
Shirley Amendment
Shirley sure was a fraud
And had 12 kids
Required that drugs must meet standards of purity and strength; labeling requirements established- penalties for fraudulent claims and misleading labels
1938
Food, Drug, and Cosmetics Act
FDA was established and charged with enforcing the law; gave FDA control over drug safety
1938
Food, Drug, and Cosmetics Act
Designated that drugs must be prescribed by a licensed HCP and dispensed by a pharmacist
1951
Durham-Humphrey Amendment
These guys were both pharmacists who liked to hump 🤷♂️
And they were both 51 years old
Increased control on drug safety; more extensive testing on new drugs; manufacturers must prove safety and efficiency;
1962
Kefauver-Harris Amendment
Authorized FDA to establish official names for uniformed nomenclature; gave federal authority to standize drug names
1962
Kefauver-Harris Amendment
Regulated distribution of narcotics and categorized narcotics according to therapeutic usefulness and potential for abuse
1970
Comprehensive Drug Abuse Prevention and Control Act
Updated and replaced all previous narcotic laws
1970
Comprehensive Drug Abuse Prevention and Control Act
Required inclusion of women and minorities in NIH funded research studies
1993
NIH Revitalization Act
Established federal law that regulates OTC sale of ephedrine, pseudoephedrine, and phenylpropanolamine due to their use in manufacturing methamphetamine
2005
Combat Methamphetamine Epidemic Act
By way of the intestines
Enteral
By way OTHER THAN the intestines
Parenteral
High protein bound drugs have _______ duration
Longer
Low protein bound drugs have _______ duration
Shorter
High protein bound drugs have _______ affinity to proteins
High
Low protein bound drugs have _______ affinity to proteins
Low
What happens to normal cell function, when a single step in the enzyme cascade function is blocked?
The normal cell function is disrupted
How can we maximize therapeutic results of drugs
Administer drug in a way that promotes absorption
Administer drug at the appropriate time
Monitor lab values
How can we minimize adverse effects of drugs
Allergies
Discontinue or withhold if needed
Administer safely
Monitor pt and labs
Contraindications
Assessment to detect onset of adverse effects
Report adverse effects
techniques: crushing pills, etc
A.D.A.M. C.A.R.T.
7 rights of drug administration
Right patient
Right drug
Right dose
Right route
Right time
Right reason -6
Right documentation -7
How many time do you check the 5 rights before administering
3x
When pulling meds
After pulling meds
Before administration
7 Elements of a medication order
Pt name
Drug name
Drug dose
Drug route
Drug frequency
Provider signature
Date and time ordered
How much air do you draw into the syringe before drawing from a vial
Equal to the amount of liquid you are drawing out of the vial
Electrolytes to check for digoxin
K
Mag
Ca
Electrolytes to check for flurosemide
Na
Cl
Ca
K
Mag
Electrolytes to check for enoxaparin
None
Electrolytes to check for insulins
Glucose
Time frame to give meds
0900-2200
How long before or after the scheduled time may you administer medication
30 min before or after the scheduled time
30 min before meals or after meals is best unless indicated otherwise
Where do you administer enoxaparin
Subcut
Love handles
(Lateral abdomen)
How do you know if digoxin working?
Decreased severity of HF
Increase in cardiac output
How do you know if furosemide is working?
Urine output
Decreased BP
Decreased edema
What do you assess for with digoxin?
Apical pulse for 1 before administration
- to make sure HR is above 60 BPM
Electrolyte/dig levels
BUN/Cr
ALT/AST
Input & output
What do you assess for with furosemide?
Daily weight
Input & output
SBP > 100
Electrolyte levels
BUN/Cr
ALT/AST
Refers to the progressive increase in the pre-meal or night time insulin dose, based on pre-determined blood glucose ranges
Sliding scale
What approximates daily insulin requirements
Sliding scale. Insulin regimens
When using a sliding scale, how should you regulate your carbohydrate intake with each meal?
Eat the same amount of carbohydrates at each meal
Which insulins are you able to mix?
Regular and NPH
When mixing insulins, which insulin do you draw up first?
Regular
Where is the best site to administer insulin
Abdomen
Must rotate sites
Why must you rotate insulin sites?
Lipodystrophy: condition when fat either breaks down or builds up under the skin; causing lumps or indentations that can interfere with insulin absorption
What must you do when giving an insulin that is a HIGH ALERT med
Have another nurse check!
Subcut needle size
25-30 G
3/8 - 1 inch (most common 3/8- 5/8)
IM needle size
20-25 G
5/8-1.5 inch
Drugs should be ordered by what name?
generic
What categorizes drugs by the disease state that they are used to treat
Therapeutic classification
Categorizes drugs based on the drugs mechanism of action (MOA)
Pharmacological classification
What kind of environment do drugs love?
Acidic environments
What are the stages of tablet breakdown
Tablet > disintegration > dissolution
How many half lives are needs to achieve steady state?
4-5 half lives
BETA 1 receptors are located in the _______.
Heart
BETA 2 receptors are located in the ________.
Lungs
Calcium channel receptors are located in the _____.
Heart/ blood vessels
Drugs ending in __pine do what
Slow the movement of calcium into the heart and blood vessels
What is the difference between the effective dose and the therapeutic dose?
Therapeutic index
What is located between the peak and trough, an average range
Therapeutic index
Unusual response to a drug and may be the opposite of what is anticipated
Idiosyncratic response
Response specific to an individual person and sometimes has genetic cause
Idiosyncratic response
Study of drugs that alter functions of living organisms
Pharmacology
Pharmacology include what 3 aspects
Pharmacotherapy
Pharmacodynamics
Pharmacokinetics
Theory that describes the way drugs exert their effects by binding with receptors
Receptor theory
Binding either stimulates or inhibits normal cell functions (agonist vs. antagonist)
Physiochemical reaction
Changes in the permeability of cell membrane to one or more ions
May open or close ion channels (calcium channel antagonists -pine)
Modify the synthesis, release, or inactivation of
Neurohormones that regulate physiologic processes (acetylcholine, norepi):
Direct acting vs. indirect acting drugs
Nonreceptor drug actions
- Anti acids: act chemically
- Drugs structurally similar to nutrients required by the body: Interfere with normal cell function
Osmotic diuretics: increase osmolarity
Metal chelating agents: combined with toxic metals to be more readily excreted
How is the PNS subdivided
Somatic nervous system (voluntary)
Autonomic nervous system (involuntary)
s/s of SNS and PSNS
SNS: fight or flight
PSNS: rest and digest
Identify neurotransmitters of the sympathetic nervous system
Norepinephrine
Identify neurotransmitters of the parasympathetic nervous system
Acetylcholine
What is the function of norepinephrine
Increases HR
Increases BP
What is the function of Acetylcholine
Contracts muscles
Dilates blood vessels
Slows HR
What are the receptors of the sympathetic nervous system
Adrenergic receptors
What are the receptors of the PSNS?
Cholinergic receptors
Are adrenergic receptors agonists or antagonists?
Agonist receptors
Are cholinergic receptors agonists or antagonists?
Antagonist receptors
What is the function of adrenergic receptors?
Bring about the effects of SNS
What is the function of cholinergic receptors?
Bring about the effects of the PSNS
Variables that effect drug action?
Dosage- serum drug level
Route
Drug-diet
Pt related variables
What are pt related variables
Age
Race
Culture
Weight
Genetics
Gender
Preexisting conditions
Psych factors
Pg2craw
What drugs have adverse effects
All drugs
Strongest warning from the FDA
Black Box Warning
