Week 1 Quiz Flashcards
Minimum Effective Concentration [MEC]
the minimum plasma concentration of a drug needed to produce the desired pharmacologic response
Bioavailability
-percent of administered drug that actually makes it to the systemic circulation
First-Pass Effect
- liver metabolizes PO drug
- results in a reduced concentration of the active drug once it reaches the systemic circulation
Blood Brain Barrier [BBB]
highly selective w distribution
-screens out a lot of chemicals
Therapeutic Action
intended effects of the drug
Adverse Reaction
nontherapeutic + unintended effects of the drug that occur at a therapeutic dose
- may be predictable, well known, or unpredictable
- range fr annoying, tolerable to life threatening
Allergic Reaction
most severe type of adverse rxn
-range fr itching + rash to anaphylactic shock
Anaphylaxis
exaggerated response of body’s immune system to a drug
- massive release of histamine+ other chem mediators into into body
- swelling of eyes, face, mouth, throat, difficulty breathing wheezing, rapid HR, low BP, cardiac arrest
Contraindication
- reasons why you should HOLD the drug
- potential to cause serious life-threatening ADR
- ALL DRUGS ARE CONTRAINDICATED IF PATIENT IS ALLERGIC
Therapeutic Classification
“WHY”
ex) analgesic to relieve pain, antihypertensive to lower BP
Pharmacologic Classification
“HOW”
ex) opioids, cholinergic, anticholinergic, benzodiazepine
Chemical Name
scientific name based on the compound’s chemical structure
Generic Name
the official name a company gives a drug they developed
- not capitalized
ex) Tylenol is the brand name, acetaminophen is the generic
Trade [Brand] Name
the drug’s commercial or proprietary name
- capitalized + in parenthesis
- may vary depending on the company producing it
ex) Tylenol is the brand name, acetaminophen is the generic
Addiction
harmful behavior associated with substance abuse
-craving
Dependence
the body requires a specific dose of a particular drug, such as a prescription opioid, in order to prevent withdrawal symptoms
7 Methods of Action of Drugs
1 stimulation 2 depression 3 irritation 4 replacement 5 cytotoxic 6 antimicrobial 7 mod of immune status
Tachyphylaxis
an acute, sudden drop in response to a drug after its administration
i.e. a rapid and short-term onset of drug tolerance
Additive Effect
when the combined effect of 2 drugs you give together is THE SAME as each drug you give alone in same doses
- 1+1=2
Synergistic Effect
when the effect of 1 drug is GREATER if you give it w another drug
- 1+1=3
Controlled Substance
medications that can cause physical and mental dependence, and have restrictions on how they can be filled and refilled
-regulated + classified by the DEA (Drug Enforcement Admin
Teratogenic drug classification
drugs/foods that a pregnant woman can ingest + can cross placenta into fetus
- can cause malformation of developing fetus
- CATEGORY D = possible risk
- CATEGORY X = relationship w fetal malformation
Therapeutic Range / Index
concentration of drug in the blood serum that produces the desired effect wo toxicity
Plasma HALF-LIFE of drug
amount of time it takes for 50% of blood concentration of drug to be eliminated fr body
Loading dose
an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower “maintenance dose”
-shoots up the drug in blood quickly
Maintenance dose
maintenance dose is the maintenance rate [mg/h] of drug administration equal to the rate of elimination at steady state
Toxicity
occurs when a client receives drugs in excessive dosages resulting in negative physiologic effects
-can also happen w impaired excretion or metabolism leads to a build up
Agonist
drugs that bind to receptors + precipitate a GREATER THAN TYPICAL response
Antagonist
drugs that bind to receptors + either BLOCK (noncompetitive) or precipitate a LESSER THAN TYPICAL response (competitive)
Antidote
a substance that can counteract a form of poisoning
- drugs can be prescribed as a treatment for another drug’s side effect
ex) naloxone for opioids
Advantages + Disadvantages of Over the Counter Drugs
- enable people to relieve many annoying symptoms and to cure some diseases simply and without the cost of seeing a doctor
- busing OTC drugs can lead to health problems including memory loss, kidney failure, heart problems and death
Rights of Drug Administration
1 drug 2 patient 3 dosage 4 route 5 time 6 reason 7 assessment 8 documentation 9 response 10 to education 11 to refuse
Drug Administration Abbreviations
PO-oral Q- every AC- before meal PC- after meal PRN-as requested/needed
Medication Reconciliation
process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider
Polypharmacy (causes + interventions)
the simultaneous use of multiple drugs to treat a single ailment or condition
Anticholinergic Effects
drugs that block the action of acetylcholine
- inhibit the parasympathetic nervous system
- cant see, cant pee, cant shit, cant spit
Cholinergic/Muscarinic Effects
mimics the action of acetylcholine on muscarinic receptors and causes cardiac slowing, contraction of smooth muscles (intestinal tract, bronchioles, detrusor muscle, urethra, and iris muscle)
-SLUDGE: incr secretions
Nursing responsibilities w med admin
- 11 rights
- advocate
- assess
- document
APAP
acetaminophen
ASA
aspirin
USP
United States Pharmacopeia
-defines the drug standards for dosage forms, substances, compounded preparation
Federal Classification
-based on FDC Act of 1938
-2 categories:
1 prescription
2 nonprescription/OTC
Prescription classification is further divided into 2 categories
1 prescription
2 controlled substances
Controlled Substances
- defined by fed law
- classified into “schedules”
- type of prescription drug
Schedules of Controlled Substances
Sched 1 - WORST, no accepted med use Sched 2 - dangerous but w med use Sched 3 Sched 4 Sched 5 - least worst
examples of schedule 1 drugs
LSD, marijuana, heroin
examples of schedule 2 drugs
- cocaine for anesthesia of nasal cavity
- methadone for opioid
- fentanyl
are OTC drugs “safe”?
- they can still be harmful
- MUST READ THE LABELS
APAP + ASA and their target organs
APAP> liver
ASA> kidney
off-label prescription
- when a drug is legally made for one effect but the Dr prescribes the drug for other functions that is “off label”
ex) drug for pulmo hypotension is prescribed for boner town - erectile dysfunction is the “off label” reason
pharmacoKINETICS + their types
effects of body on drugs
1 absorption
2 distribution
3 metabolism
4 excretion
when is PO contraindicated?
- altered LOC
- NPO
- dysphagia
- vomiting
- STROKE (when patient has a stroke, they are instantly NPO)
Transdermal
- patch
- maintains consistent level, does NOT fluctuate
- drawbacks: poor skin integrity, elderly, poor circulation
which pharmacokinetic is affected by the “first pass effect”
metabolism
_____ bypasses the first pass effect
IV
grapefruit juice
either inhibits first pass effect or increases metabolism
-do not give w drugs
herbal products that increase bleeding
- 4G
- cinammon
- vit E
- fish oil
how does protein binding affect drug activity?
any drug that binds w protein doesnt work anymore
-high serum albumin means is a sign that the drug might not work as well
how does DM affect perfusion?
high glucose levels>
laceration of blood vessels>
atherosclerosis> narrowing of vessels>
DECREASED BLOOD FLOW
category ABCDX
A - safe for babies
BCD - gray area
X - aborts or leads to fetal abnormalities
where does excretion occur?
mostly KIDNEYS
-breast milk, sweat, RESPIRATION, sweating
which antibiotics + drugs are nephrotoxic?
class of aminoglycosides (abx), NSAIDs, ASA
how does kidney dysfunction affect dosage?
DECREASE DOSAGE
how does liver dysfunction affect dosage?
DECREASE DOSAGE
If the patient is 6’9, thicc, athletic, how does that affect dosage?
INCREASE DOSAGE
how does half-life affect frequency?
long half-life> less frequent (daily)
short half-life> more frequent (BID, QID)
how does elderly patients affect dosage?
low + slow
- start w HALF the normal dose
- slowly increase in dosage
PharmacoDYNAMICS
effects of drugs on body
Onset
how long it takes for the drug to work
Peak
highest drug serum level
–we want to make sure it is UNDER the toxic level
MEC
minimal effect concentration
-minimum drug serum level for the drug to work
Duration
how long the effect lasts
you want the through to be ______
above the MEC
potency
how much of the drug we need to give
-similar to dosage
efficacy
magnitude of the maximum response
trough level test
to check if above MEC
- done 30 mins before the admin of the next dose
- always done for vancomycin
peak level test
-to check if its under the toxic levels
prophylactic
used for PREVENTION
ex) abx that are administered BEFORE there is an existing infection is a PROPHYLACTIC ABX
antidotes for opioids, benzos, APAP
opioids- naloxone
benzo - flumazenil
APAP - acetylcysteine
max dose of APAP
4g
why can’t some drugs like insulin be taken PO?
because it can’t be absorbed in the GI tract
therapeutic range/index
area between toxic level and MEC
it the therapeutic range is narrow, then
small changes in the dosage can potentially go from being effective to fatal
how to prevent Reye’s syndrome
don’t give young kids with flu-like symptoms (fever)
are the side effects less with the transdermal route?
no
why is the transdermal route contraindicated for the elderly?
elderly have poor circulation
enteric means
large intestine
miosis vs mydriasis
myosis - constriction - cholinergic
mydriasis - dilation - adrenergic
