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NURS 365 - Pharmacology in Nursing > Week 3 - ADR/SE/Types > Flashcards

Week 3 - ADR/SE/Types Flashcards

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1
Q

Types of Medication Effects

A
  1. Therapeutic Effect

2. Secondary Effects

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2
Q

Therapeutic Effect

A

Effect wanted to be done - done by the main ingredient

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3
Q

Seconary Effects

A

Different terminology - may be beneficial - may not be beneficial or even unexpected

ex: Sedation/Drowsiness from Benadryl

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4
Q

ADR

A

Adverse drug effect

any unintended or undesirable consequence of drug therapy

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5
Q

What is the difference between side effect and ADR

A

SE tends to be used for expected non-emergency things, while ADR is for more emergency

However, in this class it is used interchangeable

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6
Q

Predictable Variables that influence drug action and also ADRs

A 
Sex
Age
Body Mass
Environment
Genetics
Pathologic State
Psych Factors
Chronobiology
Pregnancy and Lactation
Drug Administration Factors
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7
Q

There are higher numbers of ADR in ___ and why?

A

females

This could be reported incidence, but also the hx of drug testing was always on men not women - so there was underrepresentation occurring

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8
Q

Why does age influence ADRs and drug action in Geriatrics

A
  1. Decreased GI Absorption as we age
  2. Blood flow increased to brain and heart; decreased to kidney (excretion) and liver (metabolism)
  3. Change in plasma proteins (less inactivated = more free drug); increased fat%; decreased metabolism
  4. Many diseases common to elderly are treated with drugs
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9
Q

Why does age influence ADRs and drug action in Children

A
  • Children have numerous peculiar ADRs as well as predicted ones*
    1. Liver and kidney not yet mature
    2. Decreased protein stores in general
    3. Weight and fat distribution varies among children
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10
Q

Why is body mass more important than weight when it comes to drugs

A

because it tells compositions - obese, thin, muscular but weight does not tell fat and muscle distribution

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11
Q

In what ways is body mass influencing ADRs and drug action

A
  1. Nutritional state will affect drug action - proteins are important!!!
  2. Dosages get suggested based on an “average”
  3. Body surface area is important
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12
Q

What is the most accurate way to decide dosage in children

A

Body Surface Area - they have large skin SA to size

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13
Q

What sort of environmental factors influence drug action and ADRs

A

physical - altitude, light, temperature, stress

chemical - O2 tension, pollution, climate, diet

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14
Q

What sort of factors are impacted by environment predictable factors

A

blood flow

hepatic renal and gastric function

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15
Q

How does genetics impact drug action and ADRs

A

PROBABLE susceptibility to ADRs is partially geneticall induced

ex: penicillin allergies, anesthesia

partial influence on ADR

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16
Q

WHy can pathologic state influence ADR and drug action

A

disease states can alter pharmacokinetics and responses; liver working, kidney working, heart pumping? etc

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17
Q

How does psychological factors impact drug action

A

symbolic meaning is very powerful

ex: Placebo

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18
Q

Chronobiology

A

study of the rhythms in biologic phenomena

If we look at body rhythms and correlate with drug and kinetics the body may become more responsive to different drugs at different times of day (ex: steroids have natural increase during pre-dawn time due to stimulation by liver)

Basically some things work better at different times of day

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19
Q

How is drug action and ADRs influenced by pregnancy and lactation

A

physical changes will induce altered response to some drugs in pregnant women

Also, infants are exposed to a wide variet of food and medications - and breast milk can also hold these things - and dependency can start in the fetus

Immune system lowers during pregnancy

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20
Q

What sort of drug administration factors influence ADRs and drug action

A 
Amount of Drug
Route
Bioavailability
Degree of Exposure
Mult. Drug Therapy
Drug Interactions
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21
Q

How is topical medication an example of how route can influence ADRs

A

topical drugs have high sensitization - can cause sensitivity where at first you do not see a problem but over time you become more sensitive and notice effects like a rash or redness when using

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22
Q

How is parenteral medication an example of how route can influence ADRs

A

Anything injected or IV

More severe reactions can be seen this way

Less than 30% of drugs have the first pass

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23
Q

Bioavailability

A

Drugs vary in ingredients and from process of drug manufacture - so secondary ingredient influences can influence drug action

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24
Q

Degree of Exposure

A

SE: more likely with higher dose and prolonged administration - so you want to start at hte lowest amount for the shortest amount of time and adjust from there

ex: Ibuprofen if taken once in a while is ok, but 4 times a day leads to increased risk for GI bleeding and ulceration

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25
Q

What sort of things can interact with drugs

A

lab tests

foods

diseases

other drugs

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26
Q

Rest and Digest system

A

PNS

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27
Q

Fight or Flight system

A

SNS

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28
Q

Summation Drug Interactions/Actions

A

(additive) 2 or more drugs added together - give double/added effect

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29
Q

Synergism Drug Interactions/Actions

A

two drugs, but causes a GREATER EFFECT THAN EXPECTED from the 2 drugs

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30
Q

Potentiative Drug Interactions/Actions

A

intensify effects og drug (positive or negative) - used interchangeably with synergism

But it can be used for positive OR negative effects not just positive

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31
Q

Antagonism Drug INnteractions/Actions

A

effect is decreased or blocked when two drugs are given - one blocks effect

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32
Q

Cumulation Drug Interactions/Actions

A

body cannot metabolize one dose of a drug before another dose is administered

drugs are excreted slower than absorbed - so they accumulate over time

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33
Q

Tolerance

A

Decreased physical response to repeated adminsitration of a drug

You respond less to medication doses than you used to (ex: opioid for pain relief needs more for the same response)

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34
Q

Dependence

A

Reliance on drugs to maintain state of well being

WHO recommends this term rather than using addiction and habituation

Involves mental and emotional factors on top of physical - which is different than tolerance which is just physical ones

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35
Q

No drug is totally safe …

A

and absolutely free of toxic effects

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36
Q

Side effects are often ___

A

predictable

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37
Q

Black Box Warnings

A

strongest safety warning a drug can carry - has to do with FDA labelling requirements, and they are significant and people should be aware of them before taking a drug

OTCs can even have this - serious and common enough ADRs would occur that the public needs to know

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38
Q

Adverse Drug Reactions

A

one way to characterize drug responses that have NOT been optimally, clearly, or distinctly defined

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39
Q

__-__% of ADRs are predictable and __-__% are not predictable (suprising and unknown); allergy and idiosyncrasy

A

70-80% predictable; 20-30% non-predictable

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40
Q

Predictable Drug Reactions

A

Often an extension of the action of a drug

documented in testing of the drug

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41
Q

Iatrogenic Disease

A

Iatro = Physician’ Genic = Produce

It is a disease occurring as a result of care, treatment, or medication result - will look like a real condition but is due to a medication (or other treatment)

a specific predicatable reaction to medicaiton oftentimes

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42
Q

What are some of the adverse effects caused unintentionally/iatrogenically that we will need to treat despite predicting them due to medications

A

Blood Dycrasias (Agranulocytosi, thrombocytopenia)

Hepatic Toxicity (hepatisi - inflamed liver)

Renal Damage (glomerular)

Teratogenic Effects (malformation in fetus)

Dermatologic Effects

Ocular Effects

Sexual Dysfunction

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43
Q

What sort of iatrogenic conditions can ASA and steroids cause

A

gastric and blood ulcers

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44
Q

ASA

A

aspirin

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45
Q

What sort of iatrogenic conditions can oral contraceptives cause

A

thrombi/emboli (blood clots)

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46
Q

Carcinogenic Effects

A

cancer causing effects

chemo meds can even cause this

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47
Q

What are 2 types of non predictable suprising responses to medication

A
  1. Drug allergy (could be allergic to one person but not another)
  2. Idiosyncracy
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48
Q

Idiosyncracy Effect

A

any abnormal or peculiar response to a drug

generally thought to result from genetic enzymatic deficiencies that lead to abnormal mechanisms of metabolized drugs

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49
Q

What sort of things does ANS control

A

heart

secretory glands

saliva

sweat

gastric and bronchial

smooth muscle like blood vessels, bronchi, GI, GU

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50
Q

Principal Functions of PNS

A

slow heart rate

increased gastric secretion

emptying bladder

emptying bowels (Cleaning out the system)

focus eye for near vision

constriction of pupil

contract bronchial smooth muscle (narrower airways)

rest and digest

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51
Q

Principal Functions of SNS

A

regulate CV system (increase HR and BP)

dilate bronchi

dilate pupils

mobilize stored energy

shunt blood to skeletal muscles

regulate body temperature

fight or flight

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52
Q

What is not a part of ANS

A

skeletal muscles

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53
Q

75% of PNS fibers leave the CNS via the ___ cranial nerve (___)

A

10th - Vagus

Vasovagal response drops things

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54
Q

Major NTs

A

Acetylcholine (ACh)

EP

NEP

Dopamine

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55
Q

How do skeletal muscle innervation differ from PNS and SNS innervation

A

they do secrete NTs, but the synapse axons directly with skeletal muscle neuromuscular junction - and have no ganglion (so its just one neuron)

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56
Q

NT types (Major 4 in ANS)

A

Adrenergic (NEP/EP)

Cholinergic (ACh)

Nicotinic

Muscarinic

57
Q

NTs in the ANS do what 4 things

A

synthesized

stored

released

inactivated

58
Q

Why is information on Dopamine not clear regarding the ANS

A

it may have a modulating role at ganglion

it is a precursor for NEP

its prominent in the CNS

also has renal, mesentary, and heart effects

59
Q

Cholinergic NT

A

Acetycholine - PNS System

60
Q

Adrenergic NT

A

“Catecholamines”

NEP/EP - SNS

61
Q

Where is ACh found

A

skeletal - neuromuscular junction

ANS: Preganglionic fibers of BOTH PNS and SNS; Postganglionic fibers of PNS; a FEW postganglionic fibers of SNS (Sweat glands, pilomotor)

62
Q

ACh is inactivated by ?

A

Acetylcholinesterase/Cholinesterase

63
Q

How is NEP inactivated

A
  1. 50-80% reuptake by the neuron to be reused or broken down (by MAO)
  2. Diffusion to surrounding body fluids and destroyed by enzymes (COMT outside neuron or in distance in liver/GI tract)
64
Q

Types of Cholinergic Receptors

A

Nicotinic

Muscarinic

65
Q

Nicotinic Receptor 1 (n)

A

ACh receptor that stimulates effects on ganglia, adrenal medulla

66
Q

Nicotinic Receptor 2 (m)

A

ACh receptor stimulating effects of skeletal muscle

67
Q

Usually when discussing cholinergic receptors it is in reference to ___ receptors

A

muscarinic

68
Q

Muscarinic Receptors

A

ACh receptors

named after the effect of some mushrooms

affect receptorsat effectors in post ganglionic areas (especially cardiac muscle, smooth muscle, and glands)

69
Q

2 Types of Adrenergic Receptors

A

Alpha

Beta

70
Q

Alpha 1 Adrenergic Receptors

A

VASOCONSTRICTOR

generally - contract and mediates vasoconstrictor effects with NEP

Also impacts sex organs and the eye

71
Q

Alpah 2 Adrenergic Receptors

A

Controls amount of NEP released

Dose not have much effect on pharmacology in ANS - therefore not many meds are this kind (some are)

72
Q

Beta Adrenergic Receptors are huge for what areas

A

Respiratory and Cardiac

73
Q

Beta 1 Adrenergic Receptors

A

Cardiac Control (increases atrial firing and contraction from SA node)

74
Q

Beta 2 Adrenergic Receptors

A

Controls smooth muscles of bronchioles, arterioles and other viscera

Dilates bronchi, relaxes uterus, dilates vessels in the heart, lung, and muscles

Promotes Glycogenolysis (breakdown of glycogen to glucose)

75
Q

What is Dominant Organ Control (Basal Control) regarding PNS/SNS

A

Most organs are dominantely controlled by one or the other of PNS and SNS yet are innervated by both

So, usually in the same organ they will produce opposite and mutually antagonistic effects

ex: HEART SNS - increased heart rate (SA node); PNS decreased heart rate (vagus)
ex: Somtimes they do complementary effects though like PNS-erection and SNS-ejaculation

76
Q

Discrete Discharge is

A

PNS

77
Q

Mass Discharge is

A

SNS

78
Q

Tone of the PNS/SNS

A

not everything is all or nothing all of the time - in general airways and blood vessels are in the middle in order to go down or up when needed

So, there is a balance like with SNS - vasoconstriction but there is a middle ground where vessels are kept at 1/2 blood vessel maximum diameter - so it can constrict or relax

79
Q

What is the general pathway of the PNS/Cholinergic System

A

Spinal Cord –> Pre Ganglionic and Post Ganglionic (2 Fibers) w/ ACh –> Organ

Only 1 NT: ACETYLCHOLINE

80
Q

What is the general pathway of the SNS/Adrengeric System

A

3 Paths:

  1. Pre-ganglia releases ACh –> NEP released at various organs
  2. Pre Ganglia releases ACh –> sweat glands use ACh (exception for ACh)
  3. Pre ganglia –> EP at the adrenal gland
81
Q

____ is always the pre ganglia synaptic NT

A

acetylcholine

82
Q

What is the general pathway of the Somatic Motor (Skeletal Muscle) pathway

A

ACh is used in one long neuron (no ganglion) working on skeletal muscle

83
Q

Usually ACh works in the PNS on organs, what are the exceptions where it works for SNS effect

A

1 Sweat Glands - It is used in the SNS system to cause sweating

  1. Pilomotor - goosebumps and body hair rising
84
Q

What are the NT and Receptors available pre-ganglia in the SNS and PNS

A

Acetylcholine - NT

Cholinergic - nicotinic - Receptor

(Both systems are the same pre ganglia)

85
Q

What are the NT and Receptors post ganglia in the PNS

A

Cholinergic

ACh (All ACh in PNS)

Cholinergic – Muscarinic Receptors

86
Q

What are the NTs and Receptors post ganglia in the SNS

A
  1. Adrenergic Receptors with NT Catecholamines like NEP, EP, and Dopamine
  2. ACh (exceptions): Cholinergic-Sympathetic on Pilomotor and Sweating

Receptors: Adrenergic Alpha 1 and 2, Beta 1 and 2

87
Q

4 Groups of Autonomic Drugs that mimic (imitate) or block (inhibit) SNS or PNS

A
  1. Cholinergic
  2. Cholinergic Blocking
  3. Adrenergic
  4. Adrenergic Blocking
88
Q

Cholinergic Drugs

A

act like mediators of the PNS (mimic PNS - slow things) (Parasympathomimetic)

generally PNS with the normal exceptions

89
Q

Cholinergic Blocking Drugs

A

block PNS (parasympatholytic)

90
Q

Adrenergic Drugs

A

Act like SNS (Sympathomimetic - mimic SNS)

91
Q

Adrenergic Blocking Drugs

A

Blocks SNS (Sympatholytic - lytic means break up or disrupt)

92
Q

What are Cholinergic Drugs used to do

A

lower intraocular pressure of glaucoma (decrease muscle contraction and eye secretions)

Terminate curarization (paralysis; adjunct to anesthesia; Curare causes paralysis) so this stops paralysis

Treats myasthenia gravis (muscle weakness disorder destroying ACh receptors in muscles so weak by end of day) but stimulates muscles with ACh

Promote salivation and sweating (exception to ACh)

Dilate peripheral blood vessels in conditions of vasospasm, stimulate intestines and bladder postoperatively

93
Q

Cholinergic fibers are ___ and stimulate what

A

widespread; stimulate motor and secretory action

94
Q

Side Effects of Cholinergic Drugs

A

Bradycardia

Decreased BP

Salivation

Vomiting

Diarrhea

Cramps

Heartburn

Bronchoconstriction

tearing (Eye)

Visual disturbances

(The results of the PNS or too much ACh - extreme rest and digest)

95
Q

2 Types of how Cholinergic Stimulating Medications work

A
  1. Med is like ACh and works and acts like it - DIRECT ACTING
  2. Does not go right to receptor, rather inhibits ACh breakdown - INDIRECT ACTING
96
Q

Cholinergic Meds mostly do what?

A

PNS effects AND stimulate sweat glands

97
Q

Cholinergic Blocking Agents

A

“Parasympatholytic” / “Anticholinergics” / Antimuscarinics (opposite of SNS)

98
Q

What is the action of cholinergic blocking agents

A

they do NOT stop ACh release; they just take the spot on the receptor and ACh cannot connect and stimualte action that way

99
Q

Uses for Cholinergic Blocking Meds

A

Relax Smooth muscles - especially bronchioles

Inhibit secretion of duct glands (including sweat and salivary)

Pre-op use for decreasing secretions

Dilate pupils (local action) for diagnostic purposes

GI - decrease motility and secretion (maybe slow down loose stools)

GU - relax motility and secretion but constrict bladder sphincter (allows filling and encourage urinary retention)

Treat Enuresis

Cardiac - stop or prevent bradycardia if due to vagus/vasovagal nerve/response (large doses) - Like with anesthesia

Dilates airways since PNS will constrict

Dries up pre op secretions to prevent aspiration and aspiration pneumonia

100
Q

Why would we give an anticholinergic (like Atropin) pre-op/intra-op

A

lots of anesthesia will slow heart rate too much, so Atropin will stop or prevent bradycardia so the heart does not go too slow

101
Q

ADRs of Anticholinergics

A

Wide margin of safety

However, toxic effect could be paralysis

Large doses can cause CNS excitement - main use is due to peripheral action

102
Q

Adrenergic Medication

A

Sympathomimetic drug

Mimics SNS

Affects alpha and beta - used for respiratory and cardiac conditions

103
Q

In general, Alpha Adrenergic Drugs produce what kinds of effects

A

Excitatory Effects - EXCEPT GI and Eye

104
Q

In general, Beta Adrenergic Drugs produce what kinds of effects

A

Inhibitory Effects - EXCEPT Heart (Beta will be excitatory on heart, alpha not much effect)

105
Q

The Inhibitory Effects (Exceptions to the Normal Excitatory Effe ts) of Alpha I Adrenergic Drugs

A
  1. Vasoconstriction! of arterioles of skin and splanchnic area
  2. Pupil dilation
  3. Relaxation of GI
106
Q

Examples of Exictatory Actions of Adrenergic Alpha I Drugs

A

Contract pylorus

Constrict bladder trigone and sphincter

Contract uterus

Blocks insulin release

Stimulates Ejaculation

107
Q

Alpha 2 Drugs/Receptors are…

A

not used much at this time for therapeutics

108
Q

4 Receptors used with Adrenergic Drugs

A

Alpha 1 and 2

Beta 1 and 2

109
Q

Beta 1 Drug effects on the heart

A

Cardiac Acceleration and Increased Contractility

Chronotropic, Dromotropic, Inotropic

110
Q

Chronotropic

A

Cardiac Rate

Beta 1 Drugs will increase pulse rate

111
Q

Dromotropic

A

Cardiac Condutction

Beta 1 Drugs will increase conduction

112
Q

Inotropic

A

Cardiac Contractility

Beta 1 Drugs will increase contraction (force of contraction)

113
Q

Beta 1 Drugs stimulate cardiac receptors but…

A

you will increase cardiac need for O2 consumption so you may eventually diminish heart efficiency

114
Q

Beta 2 Drug Effects

A
  1. Bronchial Relaxation (increases breathing capacity)
  2. Vasodilation of arterioles supplying skeletal muscle for fight or flight
  3. Uterine Relaxation
  4. Metabolism - Glycogenolysis (increase Glc levels)
    - Decrease Stomach Motility and Tone
    - Relax Bladder Detrusor (increase peeing)
    - Increase free fatty acid release
115
Q

Adrenalin

A

EP - comes from adrenal medulla

used in emergencies

116
Q

NEP

A

highest proportion NT in the body

Important transmitter of nerve impulses

117
Q

EP stimulates Alpha (1), and Beta 1 and 2 Receptors - so what does it due in emergency conditions or Fight or Flight

A

B1 - Stimulates heart, increases rate force and conduction - makes heart more responsive to defibrillation in cardiac arrest

B2 - dilate bronchi (increase tidal volume and vital capacity) - dilates arterioles to vital organs and muscles

Alpha - Constricts arterioles of bronchioles and inhibits histamine release - prevents edema and congestion; decreases nasal congestions

118
Q

What is EPs overall effect on the CNS

A

it stimulates - yet we do not know how since it doesnt cross the blood brian barrier directly

119
Q

ADR of EP

A

CNS - nervousness, dizziness, restlessness, HA

CV - palpitation, tachycardia, angina, increased BP, arrhythmia

Skin - pallor (blood vessels constricted and shift blood to vital organs when stressed)

Resp - bronchial irritation, pulmonary edema, rebound bronchospasm - too much stimulation

Metabolic - increased blood glc

120
Q

Adrenergic Blockers (Antagonist) Drugs

A

Stop SNS Activity - these would act a lot like cholinergic stimulating drugs and have some similarities

Some of these drugs are used in HTN and other cardiac conditions (ex: Beta blockers)

121
Q

Alpha Adrenergic Blocking Agents (Drugs) can be used for what

A
  1. HTN - postural hypotension is a problem but you can get other SE as well
  2. BPH - improve flow to prostate
122
Q

ADRs of Alpha Adrenergic Blocking Agents

A
  1. CV - distinct fall in BP, especially postural hypotension (IMPORTANT)
  2. GI - increased motility (can lead to diarrhea)
  3. GU - impotence
  4. CNS - most have few CNS; can have sedation and depression though
123
Q

Beta Adrenergic Blocking Agents (Drugs)

A

more useful overall than alpha blockers (as they do a lot more) can affect B1 and B2 if non-selective Beta, or just B1 or B2 if selective

124
Q

Action of Beta Adrenergic Blocking Agents

A

Beta blockers antagonize all throughout the body

Potentiates effects of epinephrine on alpha receptors by blocking its beta receptor effects

125
Q

Uses for Beta Adrenergic Blocking Agents

A

Cardiac Arrhytmias (BB1 will slow down)

Angina (slow down heart and need less O2 and then chest pain can go away)

HTN

Digoxin Toxicity

126
Q

ADRs of Beta Adrenergic Blocking Agents

A
  1. Serious, due to heart action, low BP and HR
  2. CNS - insomnia, dizziness, and depression - blockage of SNS caused
  3. Suppress normal SNS reflex to hypoglycemia (dont have hypoglycemic symptoms though from SNS such as sweating, increased pulse and anxiety) - adrenergic usually give hypoglycemic symptoms but if on a beta blocker you may not have the normal symptoms and may miss that you are hypoglycemic
  4. N/V, diarrhea, visual issues, skin reactions
127
Q

Why should beta blockers not be discontinued abruptly

A

Wean them off - HR can fly back up and put them into angina

never want them running out of beta blockers

128
Q

Ganglionic Agents

A

Works on the ganglion and blocks something there which stops info transfer early on - so this blocks entire organ action not just specific things

only used in specific situations

Always acts on ACh since thats what is there

129
Q

Ganglionic agents have widespread action effects on the body, why?

A

Because they act on the NS at the ganglion much earlier than the others

130
Q

The NT at all ANS ganglia is ___

A

ACh - nicotinic 1 receptor

131
Q

WHy are ganglionic agents rarely used

A

widespread effects - both planned and adverse

132
Q

2 Types fo Ganglionic Agents

A
  1. Ganglionic Stimulator

2. Ganglionic Blocking

133
Q

Ganglionic Stimulator

A

Mimics ACh

Only therapeutic use is nicotine gum or patches to help stop smoking

134
Q

Ganglionic Blocker

A

interrup entire ANS - but overall effect given for is decreased SNS tone, especially Cardiovascular

Sometimes helpful with HTN (sever and malignant) but is not the first choice drug

May use with autonomic dysreflexia which occurs in spinal cord injury (drop in BP and restore fxn in autonomic dysreflexia)

135
Q

Your pt. has chronic renal failure. He is receiving a medication that is excreted via the kidneys. You would expect to use:

A - A larger dose than normal

B - A smaller dose than normal

C - more frequent dosing

A

B - A smaller dose than normal

This is because if the kidneys do not work well we need to give a lower dose since they are not excreting the old drugs

136
Q

If a drug is nephrotoxic, what would you monitor:

A - ALT and AST levels

B - Cognitive Fxn

C - I&O’s

D - Balance and Strength

A

C -I&O’s

Nephro = Nephron = Kidney; With the kidneys we worry about excretion (I&O)

137
Q

Which timing is more likely to lead to teratogenic effects of drug therapy?

A - First Trimester

B- Second Trimester

C - Third Trimester

D -All 3 have equal risk

A

A -First Trimester

138
Q

In the elderly pt., fat soluble drugs may need to be ___ to avoid toxicity.

A - Increased

B - Decreased

C - Neither of the Above

A

A - Decreased

As people age they have a higher fat % to lean muscle so they hold onto drugs more if it is fat soluble

NURS 365 - Pharmacology in Nursing (15 decks)

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