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Pharm > Week 2 > Flashcards

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
Q

Alcohol

A

Absorbed in blood stream, most in small intestines & stomach

Metabolized by liver

Excreted by urine, breath and sweat

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26
Q

Alcohol pharmacology

A

CNS depressant

Affects GABA, glutamate, dopamine, opioid, enhances inhibitory effects of GABA

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27
Q

Alcohol on frontal lobe

A

Judgement and reasoning altered

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28
Q

Alcohol and midbrain

A

Pleasure, loss of emotional control

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29
Q

Alcohol and cerebellum

A

Loss of coordination and balance

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30
Q

Alcohol and hippocampus

A

Alters long term memory formation

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31
Q

Alcohol toxicity

A 
Can’t communicate
Irregular/slow HR
Hypothermia
Respiratory depression
Coma
Death

Dangerous in combination

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32
Q

Physiological effects of cocaine

A 
Last 1-2 hrs
Increased energy and motor activity
Increased HR & BP
Euphoria
Decreased appetite 
Mental alertness
Increased body temp
Dilated pupils
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33
Q

Cocaine toxicity

A 
Rapid heart beat
Hallucinations
Paranoid delusions
Tremors and convulsions
Respiratory failure
Heart attack or heart failure
Stroke
34
Q

Physiologic effects of meth

A 
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
Q

Meth toxicity

A 
Neurotoxic: serotonergic & dopaminergic neurons
Permanent psychosis
Hyperthermia (high body temp)
Kidney failure
Coma
Stroke
Heart attack
36
Q

Special needs of drug abusing patients

A

Surgical patients & pain management

37
Q

Rights of the nurse

A 
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
Q

High alert meds

A

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
Q

Pregnancy FDA classification

A

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
Q

Characteristics of drugs

A

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
Q

Reversible action:

A

Appropriate start and end time

Effects of drug will wear off

Antibiotics should NOT have a reversible action

42
Q

Ease of admin

A

Simple admin = patient compliance

43
Q

Freedom from drug interactions

A

Causing drugs to become more or less potent because of one another

44
Q

Low cost

A

Producing affordable meds, because meds can be a financial burden

45
Q

Chemical stability

A

Drugs can lose effectiveness during storage

46
Q

Pharmacotherapeutics

A

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
Q

Drug classification

A

Grouping of drugs w similar effects on the body

48
Q

Clinical pharm

A

Study of drugs in humans

Application of drugs in the real world, from discovery & development -> effects on people

49
Q

Pharmacodynamics

A

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
Q

Establish baseline measurement

A

Parameters the dug is being used to modify need to be determined to evaluate whether or not this response in achieved

51
Q

Anticipate adverse effects

A

Have ability to produce side or adverse effects. They are usually known. Baseline measurements can help identify if effect has occurred

52
Q

Identify high risk patient

A

Individual characteristics may put patient at higher risk of having side/adverse effects. Characteristic predisposed to an effect depends on drug

53
Q

Determine self care capacity

A

Patient must be willing and able to self administer the med as prescribed. If unable make arrangements

54
Q

Objective

A

Obtaining vitals

55
Q

Subjective

A

How patient feels

Info from family or friends

56
Q

Drug interaction

A

Interaction b/w drug & substance that effects the performance of the drug

Increase action of drug
Drug less effective
Produce a new response

57
Q

Drug-drug

A

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
Q

Pharmacokinetic interactions

A

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
Q

Pharmacodynamics interactions = additive effect (summation)

A

2 drugs = sum of effect of drugs taken separately. Due to the drugs acting on the body in the same way

60
Q

Synergistic effect

A

2 drugs together > than separate effects

61
Q

Antagonistic effect

A

2 drugs < than separate effect, 1 drug decreases or blocks effect of other drug

62
Q

Drug to food

A

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
Q

Drug supplement

A

Vitamins, minerals, amino-acids, herbs/botanicals may lead to toxicity or reduction in response

64
Q

Drug-lab

A

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
Q

Allergic rxn

A

Immune response, releasing histamines

Can by mild (rash) or severe (anaphylaxis)

66
Q

Idiosyncratic rxn

A

Time related and occur w consistent exposure over time

Teratogens - birth defects

Carcinogenic - cancer

67
Q

Paradoxical rxn

A

Body responds in opposite manner than what’s expected

68
Q

Minimizing adverse effects

A 
Producing safe drugs
Limit # of drugs taken
Pro/cons of prescribing
Know ADRs
Educate patients on signs of ADRs
69
Q

Med guides

A

Educational tool to de risk and potential harm from certain meds. Has description of drug, adherence to therapy and side effects

70
Q

Boxed warnings

A

Black box, when drug can cause serious or life threatening ADRs. Potential benefits of drug. Strongest safety warning

71
Q

Risk eval and mitigation strategy (REMS)

A

Minimizing harm associated w certain meds. Involves patients, prescribers and pharmacists

72
Q

Reporting ADRs

A

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
Q

Documentation of ADRs

A

Use of EHR prevent ADRs. Easy to create, update, maintain active med lists. Alerted when new med is prescribed

74
Q

Human errors

A 
Performance deficits
Knowledge deficits
Improper prep or admin
Computer error
Stocking error
Transcription error
Stress
Fatigue/lack of sleep
Dosage miscalc
75
Q

Communication errors

A

Poor handwriting 15.8%

Poor comm on home meds leads to wrong prescriptions

76
Q

Name confusion

A

Meds w look/sound alike names

77
Q

Packaging, formulations, delivery

A

Formulations = tabs/caps that look similar but have different drug/strengths; inappropriately packaged; malfunctioning delivery device

78
Q

Labeling and reference materials

A

Meds labeled on dispensed products; inaccurate, misleading and outdated info

79
Q

Med reconsiliation

A

Process that new meds are compared to meds already being taken. Avoid errors, duplication, omission, dosage, interactions, transition in care

80
Q

Just culture

A

Don’t blame and tries to come up with a better way to avoid that error

Pharm (7 decks)

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