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Week 2 Flashcards

1
Q

Pharmacodynamics pediatric

A

Differences in body comp

Variability in body water, fat stores, protein amounts

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2
Q

Pharmacokinetics pediatrics

A

Immaturity of organs and systems

Greatest effect in newborns and infants

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3
Q

Absorption peds

A

Reduced gastric activity
Irregular gastric emptying
Thinner skin - topical easily absorbed

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4
Q

Distribution peds

A

More body water = Lower drug concentration

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5
Q

Metabolism peds

A

Higher metabolic rates

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6
Q

Excretion peds

A

Immature kidneys

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7
Q

Infants administration and dosages

A

Methods: dropper, oral syringe or bottle nipple, inner aspect of cheek
Dosages: variations, immaturity of liver and kidneys, immunizations

WEIGHT BASED DOSAGES

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8
Q

Toddlers - meds & doses

A

Curiosity, mobility, safety, educate parents on keeping them safe

Administration - minimal choices, simple & short explanations, adult needs to control administration

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9
Q

Preschooler admin

A

Play acting, allow some choice/control

Give meds with food they like, before or after snacks

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10
Q

School age admin

A

Developmental issues, provide more detail of their meds, offer choices, don’t want others to know why they had to go to the nurses office

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11
Q

Adolescents admin

A

Developmental issues, privacy & control, self care, self medication (only if they understand), parents need to control and double check

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12
Q

When a child needs an injection, what way can the child cope with getting it?

A

Child can sit in moms lap, don’t look at needle, talk to her, hide needle but explain what is happening

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13
Q

Geriatric pharmacology

A

Physiologic changes: GI, CV, hepatic, renal

Polypharmacy: lots of meds mixed together

Decreased dietary intake, hearing , ADLs, motility, cardio

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14
Q

Geriatric pharmacokinetics

A

A = low acidity, motility, & blood flow

D = low protein binding sites, body water, high body fat

M = low liver function

E = low kidney function

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15
Q

Geriatric pharmacodynamics

A

Low receptors, affinity, compensatory responses, altered response to drugs r/t CNS changes

Significance? Higher risk of ADR, may need smaller doses but more dosing intervals

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16
Q

Hypnotics

A

Insomnia, short term therapy only

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17
Q

Diuretics/antihypertensives

A

Lower doses, risk for falls

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18
Q

Cardiac glycosides

A

Careful monitoring

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19
Q

Anticoagulants

A

Warfarin highly protein bound, low albumin levels lead to high free drug

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20
Q

GI drugs

A

Anti-ulcer agents (avoid tagamet)

Laxatives

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21
Q

Antidepressants

A

Start low and go slow

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22
Q

Reasons for med no adherence

A 
Polypharmacy
Economic factors
Lack of knowledge
Lack of symptoms
Physiologic impairments
Cognitive decline
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23
Q

Drug abuse

A

Substance abuse - overuse of any kind of drug, can interact w meds in bad ways

Craving, dependence, tolerance, withdrawal syndrome, stimulants, depressants, hallucinogens

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24
Q

Common abused drugs

A

Heroin, alcohol, cocaine, meth, ecstasy, LSD, marijuana, nicotine, caffeine

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25
Alcohol
Absorbed in blood stream, most in small intestines & stomach Metabolized by liver Excreted by urine, breath and sweat
26
Alcohol pharmacology
CNS depressant Affects GABA, glutamate, dopamine, opioid, enhances inhibitory effects of GABA
27
Alcohol on frontal lobe
Judgement and reasoning altered
28
Alcohol and midbrain
Pleasure, loss of emotional control
29
Alcohol and cerebellum
Loss of coordination and balance
30
Alcohol and hippocampus
Alters long term memory formation
31
Alcohol toxicity
``` Can’t communicate Irregular/slow HR Hypothermia Respiratory depression Coma Death ``` Dangerous in combination
32
Physiological effects of cocaine
``` Last 1-2 hrs Increased energy and motor activity Increased HR & BP Euphoria Decreased appetite Mental alertness Increased body temp Dilated pupils ```
33
Cocaine toxicity
``` Rapid heart beat Hallucinations Paranoid delusions Tremors and convulsions Respiratory failure Heart attack or heart failure Stroke ```
34
Physiologic effects of meth
``` Lasts 8-12 hours Similar to cocaine effects Irritability and aggression Anxiety/paranoia/nervousness Increased wakefulness Tremors/convulsions Decreased appetite Insomnia High HR & BP ```
35
Meth toxicity
``` Neurotoxic: serotonergic & dopaminergic neurons Permanent psychosis Hyperthermia (high body temp) Kidney failure Coma Stroke Heart attack ```
36
Special needs of drug abusing patients
Surgical patients & pain management
37
Rights of the nurse
``` Right to avoid distraction Right to not give a med = detrimental to patient Right to control prn = patient wants med sooner than ordered Assessment Documentation Education Evaluation Refuse ```
38
High alert meds
More serious if error occurs Many classes/categories Optimize safety - standardizing order, storage, prep, admin, access to info, limited access to meds, automated alerts, redundancies Look alike and sound alike names
39
Pregnancy FDA classification
A - no risk to fetus B - no risk in animal studies C - animal studies indicate risk = risk vs. benefit D - risk to fetus proved = might be used in life threatening condition X - risk to fetus proved = risk outweighs benefit
40
Characteristics of drugs
Effectiveness: elicit the appropriate and intended response Safety: not only be effective, but also safe for the patient (including drugs that require high & prolonged uses) Selectivity: only eliciting response for which it is given
41
Reversible action:
Appropriate start and end time Effects of drug will wear off Antibiotics should NOT have a reversible action
42
Ease of admin
Simple admin = patient compliance
43
Freedom from drug interactions
Causing drugs to become more or less potent because of one another
44
Low cost
Producing affordable meds, because meds can be a financial burden
45
Chemical stability
Drugs can lose effectiveness during storage
46
Pharmacotherapeutics
Studies therapeutic use of a drug to prevent/treat a disease, or to prevent a pregnancy. Influenced by the body’s cell response to chem aspects of a med
47
Drug classification
Grouping of drugs w similar effects on the body
48
Clinical pharm
Study of drugs in humans Application of drugs in the real world, from discovery & development -> effects on people
49
Pharmacodynamics
What a drug does to the body once at the target site(s) Actions receptor binding, enzymes, no selective interactions Can only change strength/rate of a cell but cant make the cell perform a different function out of its normal physiology
50
Establish baseline measurement
Parameters the dug is being used to modify need to be determined to evaluate whether or not this response in achieved
51
Anticipate adverse effects
Have ability to produce side or adverse effects. They are usually known. Baseline measurements can help identify if effect has occurred
52
Identify high risk patient
Individual characteristics may put patient at higher risk of having side/adverse effects. Characteristic predisposed to an effect depends on drug
53
Determine self care capacity
Patient must be willing and able to self administer the med as prescribed. If unable make arrangements
54
Objective
Obtaining vitals
55
Subjective
How patient feels Info from family or friends
56
Drug interaction
Interaction b/w drug & substance that effects the performance of the drug Increase action of drug Drug less effective Produce a new response
57
Drug-drug
Altered/modified action or effect of drug bc of interaction w mult. Drugs Maybe intended OR unintended Direct chem or physical interaction, combined toxicity, pharmacokinetics interaction, pharmacodynamics interaction
58
Pharmacokinetic interactions
A = 2 drugs at the same time, rate of absorption of drugs can change. - drug can block, decrease or increase absorption by in or de gastric emptying time, changing gastric pH, forming drug complexes D = altered by competition for protein building or alteration of extra cellular pH M = occur w induction, inhibition of hepatic microsomal systems. Can in metab of other by stimulating liver enzymes = produce a cascade effect in drug function E = filtered through glomeruli and excreted in urine. Some drugs are excreted in bile, passes in intestines. Can in or de Neal excretion and have effect on excretion of others De cardinal output > de blood to kidneys > de blood flow > de glomerular filtration rate > de drug excretion
59
Pharmacodynamics interactions = additive effect (summation)
2 drugs = sum of effect of drugs taken separately. Due to the drugs acting on the body in the same way
60
Synergistic effect
2 drugs together > than separate effects
61
Antagonistic effect
2 drugs < than separate effect, 1 drug decreases or blocks effect of other drug
62
Drug to food
When a food or beverage in or de absorption In absorption: heightened peak effect & potential toxicity - grapefruit juice, inhibit metab, in blood levels De absorption: de drug absorption, delays onset of effects but doesn’t alter peak effects. Reducing absorption de in intensity of peak effect. Therapeutic effectiveness of drug diminishes. Interaction be ca+ containing foods and tetracycline antibiotics
63
Drug supplement
Vitamins, minerals, amino-acids, herbs/botanicals may lead to toxicity or reduction in response
64
Drug-lab
Interference w enzymes, altering chem rxns, cross reaction with antibodies Lab results may be misinterpreted or invalidated and unnecessary repeat or additional tests and missed or erroneous diagnoses
65
Allergic rxn
Immune response, releasing histamines Can by mild (rash) or severe (anaphylaxis)
66
Idiosyncratic rxn
Time related and occur w consistent exposure over time Teratogens - birth defects Carcinogenic - cancer
67
Paradoxical rxn
Body responds in opposite manner than what’s expected
68
Minimizing adverse effects
``` Producing safe drugs Limit # of drugs taken Pro/cons of prescribing Know ADRs Educate patients on signs of ADRs ```
69
Med guides
Educational tool to de risk and potential harm from certain meds. Has description of drug, adherence to therapy and side effects
70
Boxed warnings
Black box, when drug can cause serious or life threatening ADRs. Potential benefits of drug. Strongest safety warning
71
Risk eval and mitigation strategy (REMS)
Minimizing harm associated w certain meds. Involves patients, prescribers and pharmacists
72
Reporting ADRs
50% of all drugs have serious ADRs that aren’t revealed during phase 2&3 trials. Important to check post evals New symptoms = check post evals New unknown symptoms = medwatch
73
Documentation of ADRs
Use of EHR prevent ADRs. Easy to create, update, maintain active med lists. Alerted when new med is prescribed
74
Human errors
``` Performance deficits Knowledge deficits Improper prep or admin Computer error Stocking error Transcription error Stress Fatigue/lack of sleep Dosage miscalc ```
75
Communication errors
Poor handwriting 15.8% | Poor comm on home meds leads to wrong prescriptions
76
Name confusion
Meds w look/sound alike names
77
Packaging, formulations, delivery
Formulations = tabs/caps that look similar but have different drug/strengths; inappropriately packaged; malfunctioning delivery device
78
Labeling and reference materials
Meds labeled on dispensed products; inaccurate, misleading and outdated info
79
Med reconsiliation
Process that new meds are compared to meds already being taken. Avoid errors, duplication, omission, dosage, interactions, transition in care
80
Just culture
Don’t blame and tries to come up with a better way to avoid that error

Pharm (7 decks)

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