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Pharmacology > Unit 1 > Flashcards

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
Q

Pulmonary inhalation pros and cons

A

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
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26
Q

Topical and transdermal application pros and cons

A

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

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27
Q

What is the distribution of a drug throughout the body dependent on?

A

Blood flow, plasma protein binding, lipid solubility, BBB, placental barrier, capillary permeability, differences between blood/tissue and volume of distribution

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28
Q

How can side effects occur?

A

When the drug binds to other sites in addition to the target tissue

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29
Q

What factors impact that blood flow and delivery of medications

A

Decreased blood flow, blocked vessels, constricted vessels (due to uncontrolled hypertension), or weakened pumping by the heart muscle

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30
Q

What happens to a drug once it is in the blood stream

A

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.

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31
Q

What route of administration has to lowest bioavailability? What has the highest?

A 
Oral route 
(First pass response)

Liquid (IV)

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32
Q

Affinity

A

How strong a drug binds to a receptor site

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33
Q

Medications NOT given orally / GI route will have a _____ because they do not go through first pass effect

A

Lower

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34
Q

Describe pro drugs

A

In hand, inactive. Once they enter the GI tract they become active - no first pass effect

Require a lower dose

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35
Q

What are the subcutaneous sites on the body that have the most bioavailability

A 
Abdomen
Deltoid (IM)
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36
Q

Why might someone with low levels of albumin be at high risk for toxicity when taking medications

A

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

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37
Q

The first pass effect _____ the bioavailability of a medication administered via the oral route

A

Decreases

38
Q

The first pass effect impacts absorption of medications administered via the _____ route(s)

A

Oral
Parenteral
Pulmonary
Topical

39
Q

Distribution of a drug is dependent on what?

A

Blood flow, plasma protein bind, lipid solubility, BBB, placental barrier

40
Q

Capillary permeability

A

Difference between blood/tissue, and volume of distribution

41
Q

What are lifespan considerations in regards to the distribution of drugs in neonates and pediatrics?

A

Decreased fat content in young patients
Immature liver, decreasing protein binding activity
BBB developing, allowing more drugs to enter CNS

42
Q

What are considerations to take in regard to the distribution of drugs in older patients

A

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
Q

Half life

A

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
Q

Leading dose

A

When you have to take two pills on the first day of a medication and one pill the rest of the days

45
Q

Where does metabolism generally take place?

A

Liver

46
Q

What are considerations to take in regard to the metabolism of drugs in neonates and pediatrics?

A

Immature liver of neonates

— older children have increased metabolism and will need higher doses of medications

47
Q

What are considerations to take in regard to the metabolism of drugs in older adults?

A

Liver function decreases with age
— first pass metabolism also decreases with age
— higher risk of toxicity
— lower doses required

48
Q

What labs can be used to determine the functioning of the liver?

A

AST and ALT

— will be elevated in poor liver

49
Q

What is important to know about grapefruit juice?

A

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
Q

What is the acronym for the meds you shouldn’t take with grapefruit juice

A

Anti-anxiety meds (all)
Calcium channel blockers (anti-arrhythmia) meds
Lipid lowering (statin) meds
Seizure meds

51
Q

Kidney function is dependent on what?

A

BUN
Serum creatinine
Glomerular filtration rate

52
Q

What are BUN, serum creatinine and glomerular filtration rate

A

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
Q

What are considerations in regard to the excretion of drugs in neonates and older adults?

A

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
Q

Pharmacodynamics

A

How the body responds to medication

— receptor sites are specific and nonspecific

55
Q

Agonist

A

Binds to a receptor to cause a desire affect

56
Q

Antagonist

A

Compete with other molecules to block the action or response at the receptor site

57
Q

Summarize prescription med

A
  • listened provider

- regulated through FDA

58
Q

Summarize generic medications

A

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
Q

Summarize OTC meds

A
  • 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
Q

Summarize herbal supplements

A

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
Q

Onset of medication

A

When medications begin to take effect

62
Q

Peak

A

Maximum concentration of medication in the body and patient shows greatest therapeutic effect

63
Q

Duration

A

Length of time a med produces its desired therapeutic effect (how long it lasts)

64
Q

Shorter half-life _____ frequency of dosing to maintain therapeutic levels

A

Increases

65
Q

Therapeutic window

A

Safest and most effective window for treatment

66
Q

Peak and trough

A

Titrating dose to receive the therapeutic window

67
Q

How is peak drawn?

A

During or soon after when medication is being administered and level is at the highest concentration in the bloodstream

68
Q

How is trough drawn?

A

Right before the next dose when med is at its lowest concentration

69
Q

Therapeutic index

A

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
Q

Potency

A

The amount of drug required to produce the desire effect

71
Q

Selectivity of a drug:

A

How readily the drug targets specific cells to produce the intended therapeutic effect

72
Q

Side effect

A

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
Q

Adverse effect

A

Relatively unpredictable, severe and reason to discontinue the medication

74
Q

What does approval by the FDA mean?

A

The medication effects have been reviewed and benefits outright the known and potential risks to the intended population

75
Q

Black box warning

A

Safety problems surface AFTER drug has been available on the market
— done to call attention to serious or life threatening risks

76
Q

What does the drug enforcement agency do?

A

Enforces the controlled substance law and regulation in the US

77
Q

DEA: schedule I

A

No currently accepted medical use and a high potential for abuse
- heroin, LSD, pot

78
Q

DEA: schedule II

A

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
Q

DEA: schedule III

A

Moderate to low potential for physical and psychological dependence
— Tylenol with codeine, ketamine, anabolic steroids, testosterone

80
Q

DEA: schedule IV

A

Low potential for abuse and low risk of dependence

- Xanax, Soma, Valium, Ativan, talwin , ambien, tramadol

81
Q

DEA: schedule V

A

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
Q

Drug diversion

A

The transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use

83
Q

What are the 5 rights

A

Right patient, drug, route, time, dose

Documentation, action, form, response, refuse

84
Q

What is the acronym for remember the high risk medications?

A

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
Q

Polypharmacy

A

The use of multiple meds (more than 5)

86
Q

What is the nursing process?

A 
Assessment
Diagnosis
Planning 
Interventions
Evaluation
87
Q

How do IV pumps deliver?

A

mls/hour
— volume to be delivered/time in hours
— this answer can be decimal

88
Q

How are intravenous solutions measured in administrations

A

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
Q

How are parenteral drugs calculated to be administered

A

Dose ordered / dose on hand * volume to be administered

90
Q

What is the formulation for dose to be administered for oral drugs?

A

DO / DH * tablets/capsules/liquid = dose to be administered

91
Q

1L = ___mL= ___ quart

A

1L = 1000 mL = about 1 quart

Pharmacology (10 decks)

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