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NURS 316 > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

PHARMACODYNAMICS

A

What the drug does to the body/How it changes the body

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2
Q

PHARMACOKINETICS

A

What the body does to the drug
Movement of the drug through the body after Absorption, Distribution, Metabolism and Excretion

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3
Q

10 RIGHTS OF DRUG ADMINISTRATION

A

Drug
Informed consent (right to refuse)
Dose

Time (delivery & Frequency)
History & Assessment
Education & Info

Documentation
Route
Interactions Evaluations
Patient

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4
Q

3 CHECKS

A

When gathering medication
During Med Prep
Right before administering

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5
Q

PHARMACOTHERAPEUTICS

A

Administration of drugs for the purpose of disease prevention or treatment and relief of suffering

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6
Q

NATURAL HEALTH PRODUCTS

A

Naturally occurring health substances used to maintain or restore health
Eg) herbs, vitamins, minerals etc

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7
Q

BIOLOGICS

A

Agents naturally produced in animal cells that are used to treat and prevent various illnesses Eg) vaccines, hormones

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8
Q

Canadian Drug Regulation

A

The company must prove that the drug is both safe AND effective for a specified purpose

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9
Q

Steps for Marketed Drug Approval

A

1) Initial drug research is conducted
2) Preclinical studies in cultured cells, living tissue and species of animals are performed
3) Has 3 phases
4) Pharma company completes a New Drug Submission to Health Canada (includes safety and efficacy info like testing data, how it’ll be produced and packaged, expected therapeutic and adverse reactions)
5) A committee of drug experts reviews the NDS to identify potential risk and benefits
6) Health Canada reviews information
about the drug product and passes
on important details to healthcare
provider and consumers
7) Health Canada issues a Notice of Compliance (NOC) and DIN (both are required for manufacturing)
8) Health Canada monitors the drug for an concerns after it’s marketed

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10
Q

3 Phases of Step 3

A

Phase 1 - “Safety Phase”, small group of healthy humans
Phase 2 - “Effectiveness Phase”, Small group of humans WITH target disorder
Phase 3 - “Confirmation Phase”, LARGE group of humans with disorder

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11
Q

Therapeutic Classification

A

Organizes drugs based on their therapeutic usefulness in treating disease
Eg) Anticoagulant, Antihypertensive

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12
Q

Pharmacological Classification

A

Describes how the drug works at the molecular, tissue and body system level
Eg) Vasodilator, Calcium channel blocker

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13
Q

3 Drug Names

A

Chemical - Drugs named after chemical composition

Generic - assigned international non-proprietary name (ONE name per drug)
Eg) Ibuprofen

Brand/Trade - Name selected by company
Eg) Tylenol, Advil

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14
Q

Bioavailability

A

amount of drug that is absorbed into the systemic circulation and is physiologically available to reach the target cells and produce a reaction

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15
Q

Controlled Substances

A

Drugs whose use is restricted by the Controlled Drugs and Substances Act (CDSA) and the Narcotic Control Regulations, because of the potential for ABUSE

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16
Q

Adverse Vs Side Effect

A

Adverse = Negative effect
Side Effect = Associated effect that isn’t necessarily bad (Eg Viagra originally for heart but had other good effects too)

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17
Q

Nursing Process with Pharmacotherapeutics

A

A-D-P-I-E
Assessment
Diagnosis
Plan (whatcha gonna do)
Intervention
Evaluation (How did it work)

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18
Q

Responsibilities to ensure effective pharmacotherapy

A
  • Ensuring all drugs and treatment options have been considered before beginning pharmacotherapy
  • Determining the ideal drug to be prescribed to the client to treat the current condition
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19
Q

Factors Affecting Medication Administration Routes

A

Drug to target tissues
Clinical setting
Medical situation
Drug Dynamics

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20
Q

Medication Administration Routes

A

ORAL (PO) - Systemic, Enteral, passes through lower GI tract By mouth or by tube Eg) Peg tube
SUBLINGUAL (SL) - Under the tongue, capillary absorption into bloodstream Faster than PO because no GI Tract
INTRANASAL - Absorbed through caps, can have systemic, localized or CNS depending on preperation
INHALATION (INH) - breathed into lungs, rapid effects into lung capillary
ENDOTRACHEAL
TOPICAL (TOP)
IV - Best bet to get close to 100% viability and have exact amount of medication systemic effect
INTRAMUSCULAR - 90 degrees insertion
SUBCUTANEOUS - 45 degrees insertion, injected into adipose tissue of the hypodermis
TRANSDERMAL - slow and steady medication release Eg) nicotine patch
RECTAL - lower GI/rectum insertion

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21
Q

Lipid Bilayer/Plasma Membrane

A

Lipophilic (attracted to lipids) and semi-permeable
Small, non-ionized & lipid-soluble molecules can pass through via diffusion (O2 & CO2)
Small, water-soluble molecules enter through pores of the membrane
Large, Ionized and Water-soluble molecules need active transport or a carrier protein

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22
Q

Passive Diffusion

A

Movement from higher concentration to lower concentration WITHOUT ENERGY
Molecules have to be small and lipophilic with no electric charge!

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23
Q

Facilitated Diffusion

A

Movement into a cell along its concentration gradient WITH THE HELP OF A CARRIER PROTEIN*
NO ENERGY
Selective proteins

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24
Q

Active Transport

A

Movement of molecules across the cell membrane AGAINST the concentration gradient (low to high)
ATP IS REQUIRED
Carrier proteins are called ‘pumps’

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25
Q

ADME General Rule

A

Lipophilic, non-ionized, small = easy Absorption & Distribution
Hydrophilic, ionized = east excretion

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26
Q

Absorption

A

Movement of substance from its site of administration to the bloodstream
**Primary pharmacokinetic factor in determining medication’s onset of action (SMALL INTESTINE is the primary pace for medication absorption)

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27
Q

Effects on Absorption

A

-Route of Administration
-Molecular Characteristics (size, lipid solubility, ionization)
-Physical Form (tablet vs coated vs syrup)
-Blood Flow (to site of administration)
-Digestive Motility (and interaction with food or other medications)

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28
Q

First-Pass Effect

A

Drugs absorbed from the stomach and small intestine first travel to the liver before they reach target organs

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29
Q

Degree of Ionization

A

Acids in acids (because they are nonionized) and bases in bases
Stomach is acidic and Small intestine is basic.

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30
Q

Absorption of Drug Forms

A

REGULAR - (uncoated) acidic products dissolve and absorb in the stomach
COATED - Enteric-coated products are intended to be absorbed in the small intestine (alkaline). Coating protects it from the acidic stomach (if crushed or opened, can react and upset stomach producing nausea/vomiting
BUFFERED - Contain ions that decrease gastric acidity and slow the absorption of acid drugs

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31
Q

Food Interaction

A

-Acidic drug absorption can be quickened by ingesting citric juices which increase gastric acidity
-Alkaline bevies (milk) can break down the enteric-coated coating before reaching small intestine
-High fat meals can slow stomach motility and delay stomach absorption
-Grapefruit juice inhibits activity of an enzyme which affects the absorption of some drugs
-Dairy products can bind some antibiotics and make them ineffective

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32
Q

Peristalsis

A

Wavelike muscular contraction of GI Tract that propels stomach and intestinal content through GI system

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33
Q

Drugs exerting Laxative Effect

A

decrease time spent in GI system and decrease absorption (herbal weight loss products, dietary supplements)

34
Q

MAOIs

A

Block monoamine oxidase (enzyme that breaks down excess tyramine in body) which can help relieve depression

35
Q

DISTRIBUTION

A

Describes how pharmacological agents are transported throughout the body after they are absorbed or injected
Explains transportation of drug from systemic circulation to target tissue

36
Q

5 Factors Affecting Distribution

A

1) Blood Flow to Tissues
2) Molecular Characteristics
3) Tissue Storage - some tissues can store drugs after absorption Eg) bone marrow, teeth, eyes, adipose tissue
4) Special Barriers - Eg) Blood Brain Barrier
5) Plasma-Protein Binding** MAIN FACTOR

37
Q

Blood Brain Barrier

A

-Highly selective
-Caps in CNS are lined with endothelial cells that are sealed by tight junctions and a thick basement membrane
-Protects the brain from pathogens and toxic substances
-NOT in the hypothalamus
-Becomes MORE permeable when it is inflamed from infections
-Not developed in neonates so drugs flow through very easily

38
Q

Fetal-placenta barrier

A

Serves an important protective function by preventing potentially harmful substances from passing from the mother’s bloodstream to the fetus.
Alcohol, cocaine, coffee and meds can EASILY cross this barrier

39
Q

Plasma-Protein Binding**

A
  • MAIN FACTOR
    -Drugs have a different affinity to plasma proteins and bind reversibly to form drug-protein complexes (Eg. Basic = albumin, acidic = Alpha-1-acid glycoprotein)
    -DECREASES DISTRIBUTION
  • Unbound drugs = Higher distribution
    -Competitive, reversible and saturable
40
Q

Volume of Distribution (Vd)

A

Estimates a drug’s tendency to either remain in the plasma or redistribute to other tissue compartments
HIGH Vd = Propensity to LEAVE plasma = MORE distribution (need more of a drug Eg) morphine))

LOW Vd = Propensity to REMAIN in plasma = LESS distribution (need less of a drug Eg. furosemide

41
Q

Metabolism Definition

A

-AKA Biotransformation
-Process of chemically changing a drug to something that is more easily removed from the body
-Detox
-LIVER is PRIMARY site for this (Kidneys, lungs and cells also help)

42
Q

Biotransformation

A

Active drug -> inactive metabolite
Active drug -> active metabolite
Inactive drug -> active drug

43
Q

Prodrug

A

Medications that require metabolism to produce their therapeutic actions Eg) Codeine (Codeine + CYP 2D6 = Morphine (Inactive to active)

44
Q

CYP 2D6

A

Enzyme that is lipophobic and hydrophilic

45
Q

Enzymes do what…?

A

Inactivate drugs and accelerate their excretion by changing them from Lipid-soluble to water-soluble (Polar/ionized)
“Active drug to Active Metabolite”

46
Q

2 Phases of Metabolism

A

Phase 1:Involves hydrolysis, oxidation and reduction to remove hydrogen ion and add oxygen. Removes electrons so that is becomes charged and water-soluble. Catalyzed by CYP enzyme (3A4 & 2D6)

Phase 2: Involves “conjugation” (increases water solubility by adding a group)

47
Q

CYP Inducers and Inhibitors

A

INDUCER: Increased production = increased metabolism Eg. Tobacco, rifampin
INHIBITOR: Decrease production of CYP = Decreased metabolism Eg. Grapefruit juice, some other antibiotics

48
Q

Hepatic Enzyme Activity in older Adults

A

= Reduced Metabolism, lower doses needed

49
Q

Excretion Definition

A

Elimination of drugs from the body by the kidneys

50
Q

Renal Excretion

A

-Free drugs, inactive metabolites, water-soluble agents,
electrolytes, and small molecules are easily filtered by the glomerulus.
- Protein, blood cells, conjugates, and drug-protein complexes are NOT filtered because they’re too big (they need to be actively transported to the distal tuble via Tubular Secretion)

51
Q

Reabsorption***

A

Following filtration, small non-ionized and lipid-soluble (hydrophobic) drugs cross renal tubular membranes easily and return to the circulation.
-Ionized and water-soluble drugs remain in filtrate for excretion

52
Q

Kidney Function Indicators

A

Creatinine and estimated Glomerular Filtration Rate (eGFR)
are important indicators of kidney function.

53
Q

Clearance

A

-Rate of elimination of a drug in an hour
-In 1st Order Elimination K, Elimination is proportionate to drug serum
-In Zero Order Elimination Kinetics clearance is CONSTANT

54
Q

4 Factors AffectingRenal Excretion

A

1) Molecular Characteristics - Plasma Protein binding, Urinary pH, Lipid soluble, metabolic activity

2) Cardiac Output - Renal blood flow

3) Renal History - 1%/yr decline in elderly, young infants/neonates have low function, renal disease

4) Urinary Output - pH changes can cause quick excretion (weak acids excreted faster when filtrate is slightly alkaline)

55
Q

Non-Renal Excretion

A

1) Pulmonary Excretion
2) Glandular Excretion
3) Fecal Excretion
4) Biliary Excretion

56
Q

Pulmonary Excretion

A

Drug diffuses from the plasma into the
alveolar space and is excreted during
expiration.
Gaseous lipophilic substances.
E.g. inh anesthetics, nebulized medication.
-Depends on pulmonary blood flow, gas solubility and diffusion

57
Q

Glandular Excretion

A

-Some water-soluble drugs may be secreted into the saliva, sweat, or mammary glands.
-Eg. Sweat
Breast milk excretion is important because drugs can affect nursing baby

58
Q

Fecal Excretion

A

Certain oral drugs travel through the GI tract without being absorbed and are excreted in the feces.

59
Q

Biliary Excretion

A

Secreted into bile in the liver
-Will enter the duodenum and eventually leave via feces
However, most bile is circulated back to the liver via “Enertohepatic Recirculation” (Then ultimately metabolized by liver and excreted by kidneys)

60
Q

Minimum Effective Concentration

A

Amount of drug required to produce a therapeutic response

61
Q

Total Concentration

A

Level of drug that will result in serious adverse effects

62
Q

Therapeutic Drug Range

A

Plasma drug concentration between the minimum effective concentration and the toxic (Total) concentration.
Range where the medication works but it’s not toxic
Ideally a Wide/large range

63
Q

Therapeutic Drug Monitoring

A

Helps keep drug dose in therapeutic range

64
Q

Onset of Action

A

Amount of time it takes for drug to kick in and produce therapeutic reaction
Dependent on A-D-M-E

65
Q

Duration of Action aka Half-life

A

Time required for a medication
to decrease concentration in the plasma by one-half after administration.
-How long the medication works

66
Q

Loading Doses

A

-Higher amount of a drug, given once
or twice, to “prime” the bloodstream to quickly induce a therapeutic response.
-Therapeutic level is reached faster* and then intermittent maintenance doses are given to keep it in range
-Drug Plasma levels fluctuate
-Important for drugs with pro-longed half-life and critical situations

67
Q

Continuous Infusion

A

Quicker plateau level with little
or no fluctuation in drug plasma levels.

68
Q

Repeated Dosing

A

Allows a plateau drug plasma level to be reached

69
Q

Therapeutic Index

A

expressed mathematically as (lethal Dose) LD50÷ (effective dose) ED50, is a value representing the margin of safety of a drug. The higher the therapeutic index, the safer the drug.

70
Q

What phase may toxicity occur in?

A

Phase 3

71
Q

Dose-Response Curve

A

Describes how the therapeutic response to a medication increases as the dose increases.

72
Q

Potency

A

-The dose of medication required to produce a particular response
-It is a reflection of a drug’s ability to bind to a receptor.
Potent Drug = Lower dose needed

73
Q

Efficacy

A

Magnitude of maximum response to drug
Difference in how effective it is

74
Q

Drug Receptor Binding

A

Drug-Receptor interactions may produce a response that mimics the effect of the endogenous regulatory molecule
Receptor are saturable
Intrinsic activity

75
Q

Intrinsic Activity vs Receptor Affinity

A

INTRINSIC - The extent to which a
drug activates or stimulates a receptor once bound.

RECEPTOR - “Strength” of drug binding to receptor

High Affinity = High Receptor = Strong Action

76
Q

Tolerance vs Resistance

A

Tolerance: Cellular response diminishes with repeated use

Resistance: Doesn’t work at all and never did

77
Q

3 Types of Agonists

A

Agonist: Drug mimics endogenous substance, readily binds to receptor

Inverse Agonist: Induces opposite effect as regular agonist

Partial Agonist: Maximum response is smaller even if receptors are all occupied

78
Q

Functional Antagonist

A

inhibit the effects of an
agonist by changing pharmacokinetic factors.

79
Q

Overdose Treatment

A

Adsorption (substance binds to drug to decrease absorption Eg Activated charcoal)

Induce Metabolism

Increase Elimination

80
Q

Pediatric Pharmacotherapy

A

-Calculated by body mass

NURS 316 (3 decks)

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