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Unit 1 Flashcards

1
Q

Pharmacology

A

The science of dealing with drugs in the body

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2
Q

Pharmacokinetics

A

Describes the stages of absorption, distribution, metabolism, and excretion of drugs

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3
Q

What are the 4 basic stages for a medication to go through within the human body

A

Absorption - occurs after med enters body and travels from the site of administration into the bodies circulation
Distribution - process by which medication is distributed throughout the body
Metabolism - breakdown of a drug molecule
Excretion - way of which body eliminates waste

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4
Q

Pharmacodynamics

A

The effect of drugs in the body and the mechanism of their action

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5
Q

Affinity

A

The strength of binding between a drug and receptor (lock and key)

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6
Q

Bioavailability

A

The ability of a drug or other chemical to be taken up by the body and made available in the tissue where is it needed

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7
Q

Pharmacogenetics

A

How peoples genes affect their response to medicines

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8
Q

What are common routes to administer medications

A 
Oral
Enteral (administering to the GI tract (NG))
Rectal 
Inhalation
Intramuscular 
Subcutaneous
Transdermal (nicotine patch)
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9
Q

Why do oral and enteral medications face the biggest challenge with their route of administration?

A

They have to go through the GI tract where they can easily become inactivated by either the stomach/duodenum or the liver

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10
Q

First pass effect

A

The phenomenon that states that if a drug has to go to the GI tract for absorption, the concentration is greatly reduced before it reaches systemic circulation

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11
Q

Why might several doses of an oral or enteral medication be needed before seeing results?

A

First pass effect

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12
Q

How can you find a way around the first pass effect?

A

Find another route of administration

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13
Q

What are downsides to medications that are administered through injection?

A 
Painful
Break the skin (infection)
Hard to administer daily 
Localized side effects 
Costly
Contribute to unpredictable fluctuations in medication blood vessels
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14
Q

What are benefits of transdermal medications

A

Slow, steady drug delivery that does not have to pass through the liver
Can be used for long periods of time to control symptoms

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15
Q

Transdermal medications:
Fentanyl
Scopolamine
Nitroglycerin

A
  1. Main management
  2. Motion sickness
  3. Chest pain
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16
Q

Afrezza: what is it and con to it

A

Insulin that you inhale

- if particles are too large it could be lodged into the lungs, if too small the particles will be exhaled

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17
Q

How long does it take acid-producing cells to mature in neonates and pediatrics

A

One or two years old

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18
Q

Why may gastric emptying be decreased in neonate or pediatric patient

A

Because of slowed or irregular peristalsis

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19
Q

What are considerations that should be noted for administration of drugs in neonates and pediatric patients

A

At the producing cells of the stomach are immature until 1 to 2 years old
Gastric emptying maybe decrease because of slowed or irregular peristalsis
Immature liver result in higher drug levels in the blood stream

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20
Q

What are considerations for older adults when administering drugs

A
  • They have decreased blood flow to tissues within the G.I. tract
  • Changes in the stomach PH
  • Variations in plasma proteins (many meds require protein to adhere to become inactive)

They can have higher levels of drug floating around, leading to higher risk of toxicity
— decreased cardiac output
— decreased peripheral circulation
— less body fat which decreases transcutaneous absorption

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21
Q

What should you consider when administering a subcutaneous or intramuscular injection to an older individual?

A

Decreased cardiac output - hard to move the med around the body

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22
Q

What is a great route for administering solid as well as liquid formulations

A

Oral or enteral

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23
Q

What are variables that may influence the rate of absorption for oral and enteral medications?

A 
Enteric coating or extended release formulations 
Acidity of gastric contents
Gastric emptying rate
Dietary contents 
Presence of other drugs
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24
Q

Pros and cons to parenteral injection

A

Pro:
- IV: fully available to tissues once in the blood stream offering complete bioavailability and immediate effect

Cons:
Subcutaneous and IM are costly, painful, hard to administer everyday, risk of infection, cause fluctuation in drug levels localized side fx to the skin

IV - painful, risk of infection, must be sterile, must check for compatibility of more than one med is administered at the same time, increased risk for toxicity

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25
Pulmonary inhalation pros and cons
Pro: - rapid absorption Con: - absorption depends on droplet size - the ability to create a good inhalation may influence how deep the med goes inside the bronchiole
26
Topical and transdermal application pros and cons
Pros: - absorption may be rapid - thru skin produces stead, long term effects that avoids first pass effect Cons: - absorption of medications is dependent on blood flow through the skin
27
What is the distribution of a drug throughout the body dependent on?
Blood flow, plasma protein binding, lipid solubility, BBB, placental barrier, capillary permeability, differences between blood/tissue and volume of distribution
28
How can side effects occur?
When the drug binds to other sites in addition to the target tissue
29
What factors impact that blood flow and delivery of medications
Decreased blood flow, blocked vessels, constricted vessels (due to uncontrolled hypertension), or weakened pumping by the heart muscle
30
What happens to a drug once it is in the blood stream
A portion of it may exist as a free drug, dissolved in plasma water. Some of the drug will be reversibly taken up by red blood cells and some will be reversibly bound to plasma proteins.
31
What route of administration has to lowest bioavailability? What has the highest?
``` Oral route (First pass response) ``` Liquid (IV)
32
Affinity
How strong a drug binds to a receptor site
33
Medications NOT given orally / GI route will have a _____ because they do not go through first pass effect
Lower
34
Describe pro drugs
In hand, inactive. Once they enter the GI tract they become active - no first pass effect Require a lower dose
35
What are the subcutaneous sites on the body that have the most bioavailability
``` Abdomen Deltoid (IM) ```
36
Why might someone with low levels of albumin be at high risk for toxicity when taking medications
Because the drug requires protein (albumin) to become inactive — if there are low levels the drug will remain active and be free floating in bloodstream
37
The first pass effect _____ the bioavailability of a medication administered via the oral route
Decreases
38
The first pass effect impacts absorption of medications administered via the _____ route(s)
Oral Parenteral Pulmonary Topical
39
Distribution of a drug is dependent on what?
Blood flow, plasma protein bind, lipid solubility, BBB, placental barrier
40
Capillary permeability
Difference between blood/tissue, and volume of distribution
41
What are lifespan considerations in regards to the distribution of drugs in neonates and pediatrics?
Decreased fat content in young patients Immature liver, decreasing protein binding activity BBB developing, allowing more drugs to enter CNS
42
What are considerations to take in regard to the distribution of drugs in older patients
Decrease in total body water and muscle mass Decrease in serum albumin — less binding and more “free” drug roaming around so they may need lower doses
43
Half life
The time it takes for half of the medication to reach its effect — influenced by liver and kidney function — if you have poor functioning, the half life will be extended because you can’t metabolize it correctly
44
Leading dose
When you have to take two pills on the first day of a medication and one pill the rest of the days
45
Where does metabolism generally take place?
Liver
46
What are considerations to take in regard to the metabolism of drugs in neonates and pediatrics?
Immature liver of neonates | — older children have increased metabolism and will need higher doses of medications
47
What are considerations to take in regard to the metabolism of drugs in older adults?
Liver function decreases with age — first pass metabolism also decreases with age — higher risk of toxicity — lower doses required
48
What labs can be used to determine the functioning of the liver?
AST and ALT | — will be elevated in poor liver
49
What is important to know about grapefruit juice?
Decreases the metabolism of medications resulting in increased level of medications (as well as sour orange juice) — enzyme in grapefruit juice that will decrease the metabolism, resulting in higher serum levels
50
What is the acronym for the meds you shouldn’t take with grapefruit juice
Anti-anxiety meds (all) Calcium channel blockers (anti-arrhythmia) meds Lipid lowering (statin) meds Seizure meds
51
Kidney function is dependent on what?
BUN Serum creatinine Glomerular filtration rate
52
What are BUN, serum creatinine and glomerular filtration rate
BUN = blood urea nitrogen — serum level 10-20 (elevated with poor kidney functioning) Serum creatinine = the waste product you are getting rid of through kidneys — most direct reflection of kidney function — serum level 0.6-1.2 (elevated with poor kidney function) — goes up with age Glomerular filtration rate (GFR) - goes down if kidneys are not functioning properly
53
What are considerations in regard to the excretion of drugs in neonates and older adults?
Neonates - immature kidneys and decreases GFR, weight based prescribing Older adults - K/L function decrease with age, increasing half life of drug, increased risk for toxicity, start low and go slow with dosage
54
Pharmacodynamics
How the body responds to medication | — receptor sites are specific and nonspecific
55
Agonist
Binds to a receptor to cause a desire affect
56
Antagonist
Compete with other molecules to block the action or response at the receptor site
57
Summarize prescription med
- listened provider | - regulated through FDA
58
Summarize generic medications
Safe alternatives to brand name at reduced cost — same active ingredient, may have different compounds — not necessarily as affective as brand because the compounds are different
59
Summarize OTC meds
- no prescription - regulated by FDA - some prescription meds are available for purchase OTC - ppl don’t always think about the side effects it could have with meds they are already taking
60
Summarize herbal supplements
Vitamins, minerals, enzymes and botanicals — NOT regulated by FDA — no guarantee the product contains what is listed on the label — could contain some of the same medications prescribed to patients resulting in OD
61
Onset of medication
When medications begin to take effect
62
Peak
Maximum concentration of medication in the body and patient shows greatest therapeutic effect
63
Duration
Length of time a med produces its desired therapeutic effect (how long it lasts)
64
Shorter half-life _____ frequency of dosing to maintain therapeutic levels
Increases
65
Therapeutic window
Safest and most effective window for treatment
66
Peak and trough
Titrating dose to receive the therapeutic window
67
How is peak drawn?
During or soon after when medication is being administered and level is at the highest concentration in the bloodstream
68
How is trough drawn?
Right before the next dose when med is at its lowest concentration
69
Therapeutic index
The relative safety of the drug — high TI means large winder between safe and toxic — low TI means there is a small window between safe and toxic, these are the drugs that require close monitoring with peak and trough, frequent monitoring of drugs levels
70
Potency
The amount of drug required to produce the desire effect
71
Selectivity of a drug:
How readily the drug targets specific cells to produce the intended therapeutic effect
72
Side effect
Effect other than intended effect — expected and we know about them — could be undesirable but may also be the purpose of the med administration
73
Adverse effect
Relatively unpredictable, severe and reason to discontinue the medication
74
What does approval by the FDA mean?
The medication effects have been reviewed and benefits outright the known and potential risks to the intended population
75
Black box warning
Safety problems surface AFTER drug has been available on the market — done to call attention to serious or life threatening risks
76
What does the drug enforcement agency do?
Enforces the controlled substance law and regulation in the US
77
DEA: schedule I
No currently accepted medical use and a high potential for abuse - heroin, LSD, pot
78
DEA: schedule II
Hi potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous — Vicodin, cocaine, methamphetamine, methadone, dilaudid, oxycodone, etc.
79
DEA: schedule III
Moderate to low potential for physical and psychological dependence — Tylenol with codeine, ketamine, anabolic steroids, testosterone
80
DEA: schedule IV
Low potential for abuse and low risk of dependence | - Xanax, Soma, Valium, Ativan, talwin , ambien, tramadol
81
DEA: schedule V
Lower potential for abuse than schedule IV and consist of preparations containing limited quantities of certain narcotics. Generally used for anti-diarrheal, antitussives, and analgesic purposes - Robitissin AC with codeine, Lomotil, Lyrica
82
Drug diversion
The transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use
83
What are the 5 rights
Right patient, drug, route, time, dose | Documentation, action, form, response, refuse
84
What is the acronym for remember the high risk medications?
A: anti-infective amphotericin (aminoglycosides) P: potassium and other electrolytes I: insulin (all insulin’s) N: narcotics and other sedatives (hydro morphine, oxy, morphine, fentanyl, benzos) C: chemotherapeutic agents (methotrexate, vincristine) H: heparin and anticoagulants (warfarin, enoxaparin)
85
Polypharmacy
The use of multiple meds (more than 5)
86
What is the nursing process?
``` Assessment Diagnosis Planning Interventions Evaluation ```
87
How do IV pumps deliver?
mls/hour — volume to be delivered/time in hours — this answer can be decimal
88
How are intravenous solutions measured in administrations
Drops per minute (gtt / min) — mls to be delivered per minute = volume to be delivered/time in minutes * drip factor = drop/min Always a whole number
89
How are parenteral drugs calculated to be administered
Dose ordered / dose on hand * volume to be administered
90
What is the formulation for dose to be administered for oral drugs?
DO / DH * tablets/capsules/liquid = dose to be administered
91
1L = ___mL= ___ quart
1L = 1000 mL = about 1 quart

Pharmacology (10 decks)

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