week 3 : Pharmacology (drug theraphy) Flashcards
The applications of pharmacology in patient care, we focus on eight aspects of drug therapy, what are they?
1.Pre administration assessment
2. Dosage and administration
3.Promoting therapeutic effects
4.Minimizing adverse effects
5.Minimizing adverse interactions
6.Making as “need” PRN decisions
7.Evaluating responses to medication
8.Managing toxicity
Doing a pre-assesment in administering a drug , what do you have to consider
collecting data baseline
identifying high risk patient (allergies, life span considerations, etc).
Certain drugs have more than one indication such as ( most common ) ?
Aspirin: is given in low doses to relieve pain and in high doses to suppress inflammation
morphine can only be administered through injection?
false, it can be through injection and orally.
True or false. Drug therapy can often be enchaced by non pharmacologic measures.
true
Promoting Therapeutic Effects:
Name some non pharmacologic approaches when dealing with an asthma patient.
breathing exercises, biofeedback, and emotional support
Name some non pharmacologic approaches when dealing with an arthritis patient, what ‘drug’ therapy could enhanced this?
through exercise, physical therapy, and rest
Name some non pharmacologic approaches when dealing with hypertension, what ‘drug therapy’ could enhanced this?
enhancing drug therapy of hypertension through weight reduction, smoking cessation, and sodium restriction.
what does PRN mean?
latin for as needed
True or false. A PRN medication order is one in which the nurse has discretion regarding when to give a drug and, some situations, how much of the drug to give.
true
____ orders are common for drugs that promote sleep, relieve pain, and reduce anxiety
PRN
This is the process that tells us whether a drug is producing a benefit of causing harm
evaluation responses to medication
Application of Pharmacology in Patient Education
( You must give the patient the following information)
1.Drug name and therapeutic category
2.dosage
3.dosing schedule
4.route and technique of administration
5.expected therapeutic response, and when it should develop
6.non drug measures to enhance therapeutic responses
7.duration of treatment
8.method of drug storage
9.symptoms of major adverse effects, and measures to minimize discomfort and harm
10.major adverse drug and drug interactions
11.whom to contact in the event of therapeutic failure, severe adverse reactions, or severe adverse interactions.
What is the generic name for tylenol
acetaminophen
what is the therapeutic effects of tylenol
reduction in fever
reduction in pain
true or false. Tylenol is an anti-inflammatory agent ?
false, it is not an anti- inflammatory agent
this drug reduces fever by acting directly on hypothalamic heat-regulating center.
tylenol (acetaminophen)
true or false. Analgestic mechanism is through inhibition of prostaglandins in the CNS
true
Can you give tylenol orally or rectally?
yes, you can give tylenol orally or rectally
tylenol maximum dose over 24 hour period: adults and geriatric
4000 mg adults
3000 mg geriatric
True or False. Tylenol should be use cautiously with impaired hepatic function , chronic alcoholism
true
what are some side effects of tylenol
renal damage
hypersensivity: rash, fever
hepatotoxicity (damage to liver)
nursing considerations
assess history and physical condition related to liver and kidneys
Monitor LFTs (liver function test) if concerned
Avoid using multiple preparations with acetaminophen
what key words link to the “perfect drug”?
effective - works well and does exactly what it supposed to do
safe- unlikely to produce harm even if taken in large amts for a long period
selective: drug that does ONLY what we want it to with no unintended side effects
note: no drug is safe, all have side effects
when it comes to drug names, what is the safest practice to use?
generic or brand name
generic
why are all barriers bypassed when using intravenous as a major route of admnistration?
because it is directly put into the bloodstream, thus why all the barriers are bypassed.
the only parenteral route that permits the use of large volumes of fluid
IV route
When drugs are administered in a large volume, fluid overload can occur. This can be a significant problem for patients with _____, ______, _____
hypertension, kidney disease, and heart failure
true or false. The IM route can be used for parenteral administration of poorly soluble drugs
true
what does depot preparation mean?
it is a special preparation of the medication, which is given by injection.
What does PO mean?
it’s another word for oral, PO sin latin is the way of the mouth
after oral admission, drugs may be absorbed where?
it may be absorbed in stomach, the intestine or both
As nurses it is important to supply our patient with effective, safe, and selective drug therapy ( now define what they mean) —> i know its sucked in and easy but practice makes perfect. Thank yew
effective meaning it works well and does exactly what it’s suppose to do
safe includes it is unlikely to cause any harm even if taken in large amounts for a long period
Selective means that the drug ONLY does what we want it to with no unintended side effects
What does MAR stand for?
medication administration record
this is used for discharged or out patient, require patient education
prescription
for in patient : MAR (medication administration)
medication order
name the brand names for these generic names :
acetaminophen
citalopram
celexib
furosemide
omeprazole
tylenol,pracetemol,tempra
celexa
celebrex
lasix
losec
True or False. Appropriate Patient Assessments occurs before, during, and after
true
what are the 10 rights of medication administration ( this is a must when supplying a patient drug theraphy)
- right drug
2.right patient - right dose
- right time/schedule
- right route
- right documentation
- right assesment
8.right to refuse - right evaluation
- right education
medication knowledge terms:
indication
contraindications
relative contraindications
medical conditions for which the drug is given; maybe more than one indication
contraindication is conditions not to give the drug
risks and benefits are weighed
medication knowledge terms :
idiosyncratic effect
paradoxical effect
uncommon response ; genetic predisposition
opposite of intended purpose
what is nephrotoxic and hepatotoxic ?
nephro- kindey toxic
hepa- liver toxic
what are the four basic pharmacokinetic processes ?
- Absorption
- distribution
- metabolism
- excretion
True or false. For a drug to move across the body drugs must cross membranes
yes that is true
the three most important ways a drug cross cell membrane
- passage through channels or pores
2.passage within the aid of transport system - direct penetration of the membrane itself
acids are absorbed in _____ environment
while
bases are absorbed in _____ environment
acidic
alkaline
Aspirin is a weak acid drug that stay non ionizede in acid environment, and get ionized in alkaline environment, in which part of the body is acidic and alkaline?
acidic is stomach and alkaline is small intestines
In the stomach morphine becomes ionized ( not absorbed) but once it reaches the small intestine what happens?
the remaining non ionized form is then absorbed
this is the movement of a drug from its site of administration into the blood
absorption
site of administration meaning ?
the site/location at which the drug is applied ( oral, iv,etc)
name enteral, parenteral examples
enteral ( gi route)
- PO (oral)
- PR (per rectum )
- sublingual or bucal ( under the tongue or back of the cheeck)
parenteral
- subcutaneous
intramuscular
intravenous
epidural etc,,
when are PRN orders most common?
drugs to promote sleep, relieve pain and reduce anxiety
the way the body gets the medication throughout the body via blood stream
distribution
True or false. BBB ( blood brain barrier) there are tight junctions between the walls of most capillaries in CNS. Therefore, they prevent drug passage to leave the blood and reach sites of action within the brain.
true
name factors affecting distribution
the blood brain barrier
protein binding
True or false. A drug must be able to pass through cells of capillary wall, only drugs that are polarized or have a transport system can cross the BBB to a significant degree.
false, ONLY lipid soluble ( non polarized)
protein binding, in other words, what always stays in the bloodstream, and why does it stay there?
protein binding in other words known as albumin is a large molecule that cannot surpass the capillary wall, therefore they stay in the bloodstream.
Case application : Protein Binding :
Ric and William was prescribed Levothroxine 50 mcg orally daily
Levothroxine is 98.99 % protein bound in the body
Does that mean it is highly bio-available or poorly bio available after administration?
will this drug work quickly or slowy based on the protein binding percentage?
well look what the cat dragged in …. Ric and william
looking at the percentage of both Ric and william, we know right off the bat, it’s sucked in
because there are only 1.01 unbound ( free) drugs working that could penetrate, the bioavailability is very poor for both sucked in mfs.
This is also known as biotransformation, defined as the chemical alternation of drug structure
metabolism
Hepatic Microsomal Enzyme system is also referred to as ______…
P450
True or false. Although metabolism is seen as the breakdown to smaller molecules. It can also result in the synthesis of a molecule that is larger than the parent drug?
true.
Where does metabolism occur?
the liver
Name the 6 therapeutic consequences of drug metabolism.
- Accelerated renal excretion of drugs
2.increased toxicity
3.decreased toxicity
4.activation of prodrugs
5.inactivation of the drug
6.increase therapeutic actions
True or false. In the statements below define if it is true or false.
Kidney is unable to excrete drugs that are highly lipid soluble- therefore you have to convert into water soluble. By doing so metabolic conversion can accelerate the renal excretion of many agents.
By converting morphine into codeine, this drug increase the therapeutic action.
By converting drugs into inactive forms, metabolism can decrease toxicity.
true
false ( other way around, codeine is a much weaker drug than morphine, therefore sometimes to aggravate the drug we convert the two)
true ( essentially it’s inactive, therefore there’s no drug circulating in your system= no therapeutic action )
what are the 5 consideration in drug metabolism
- Age
- the induction and inhibitor of liver enzymes
- first-pass effect
4.nutritional status - competition between drugs
Expand on Induction and Inhibitor of liver enzymes
Inducers are drugs that act on the liver to increase rates of drug metabolism. However when we increase it, plasma drug level falls down. ( This can lead to lower drug concentrations in the bloodstream, reducing the drug’s therapeutic effect.)
Inhibitor = decrease the rate of drug metabolism. ( slow) As a result, drug concentrations in the bloodstream may increase, potentially leading to a greater therapeutic effect or an increased risk/ toxicity).
What is a First-Pass effect?
rapid hepatatic inactivation of the drug
in other words, metabolize of the drug is extremely high, initially there are no drug that is occurring( not working).
From ADME ( absorption, distribution, metabolism, excretion)
How will the first pass effect typically occurs ( step by step)
absorption
metabolism
distribution
metabolism
excretion
which routes by-pass the first pass effect?
intravenous
intramuscular
transdermal
( basically anything that does not use your GI tract or digest the drug)
this is the removal of drugs from the body
excretion
name some ways on how drugs can exit from your body
urine
sweat
breast milk
bile
what is the most important organ for drug excretion?
kidney
what are the 3 major steps for excretion
glomerular filtration
passive tubular reabsorption
active tubular secretion
what happens in the glomerular filtration?
in the second statement of the answer, why does that occur?
filtration moves drug from blood to urine
protein bound drugs are not filtered
protein bound drugs are not filtered, since they are too huge ( large molecules) they do not surpass the filtration.
what happens in passive reabsoprtion?
lipid soluble drugs move back into the blood, and polar and ionized drugs remain in the urine
lipid soluble drugs or non ionized drugs have the ability to go back because they can cross membrane with no problem
polar and ionized in the other hard have a hard time crossing, therefore they stay in the urine to be excreted.
what happens in active transport of excretion?
tubular pumps organic acids, while bases move drugs from blood to urine
true or false. Because lipid soluble drugs can readily cross the membrane that compose the tubular and vascular walls, drugs that are lipid soluble undergo passive reabsorption from the tubule back into the blood.
true
albumin is made by what organ?
liver
name the three time course of drug responses
1.plasma concetration (minimum and maximum effective concentration )—> therapeutic range
2.onset of action
3.duration
True or false. the objective of drug is to maintain drug levels within the therapeutic range.
true
defined as the plasma drug level below which therapeutic effects will not occur
minimum effective concentration
(t1/2) also means
half time
it takes ____ half lives for a drug to reach steady state for therapeutic effects.
4
Define what loading and maintenance dose mean?
large initial dose is called initial dose
maintenance dose is smaller dose
true or false. the shorter the half life of a drug has, the longer the time interval will be and the drug will be given frequently. The longer the half life of a drug, the the time interval between doses will shorter.
false, the other way around.
Efficacy and potency , define what they mean
efficacy ( indicated by the height) maximal response a drug can produce
potent (lower in hight) - how much a drug has to be administered to elicit a response
true or false. receptors are the special chemical sites in the body that most drugs interact with to produce effects
true
true or false: protein bound drugs are filtered in the process of extortion (glomerular filtration)
false, its bond to albumin (too bing to pass the membrane)
difference between therapeutic range and index
index - measure of a drug’s safety (large index - safe, small index - unsafe)
range - min effective con to max effective con (on a graph - middle portion)
true or false.Because drug action is limited to mimicking or blocking body’s own regulatory molecules, drugs cannot give cells new functions. Rather, drugs can only alter the rate of pre existing processes. In other words, drugs cannot make the body do anything that is not already capable of doing,
True.
True or False. receptors chemical sites in the body the most drugs interact with to produce effects.
True
what is an agonist ?
mimic the action of endogenous regulatory hormones
molecules that activate receptors neurotransmitters,hormones, and all other endogenous regulators of receptor function activate the receptors to which they bind, all of these compounds are considered
Agonists
True or false. Agonist is both affinity and high intrinsic activity.
Expand on the term affinity and high intrinsic activity
True
Affinity - bind to receptors
Intrinsic activity - bound agonist to activate or turn on receptor function
true or false. Important to note that the response to an antagonist is determined by how much agonist is present:
True
______ have virtually no effects of their own on receptor function
Antagonist
True or false. If there is antagonist present, administration of an agonist will have no observable effect.
False. It’s the other way around
Expand what no competitive antagonist is
Bind to irreversibly to receptors
Decrease the # of receptors available for activation
Reduce the maximal response that an agonist can elicit.
True or false. Inhibition by non competitive antagonist cannot be overcome, no matter how much agonist may be available
True
What are the two classes in antagonist ?
1) non- competitive
2) competitive
Expand on competitive antagonist
bind reversibly to receptors
competes with agonists for receptor binding
because they bind reversely the inhibition they cause is overcome
True or false. Competitive antagonist drug, competes with drug and whichever has higher concentration will attach reversible.
True
Does antagonist have intrinsic factor and not affinity
false, it has affinity but not intrinsic factor
What are the four primary receptor families
1) cell membrane embedded enzymes
2)ligand gated ion channels
3)g-protein coupled receptor systems
4) transcription factors
Where is the ligand binding domain located?
Cell surface and the enzyme catalytic site is inside
True or false. Binding of an endogenous regulatory molecule or agonist drug ( one that mimics the action of the endogenous regulatory molecule) activated the enzyme.
True
what is a good example of endogenous ligand that acts through this type of receptor
Insulin
Out of which of the 4 receptor families which one span the cell membrane?
Ligand - gated ion channels
what is the function of ligand gated ion channels
To regulate the flow of ions into and onto the cell
is it true that in ligand gated ion channels, each ligand-gated chann is specific for a particular ion
True
True or false.
ligand- gated ion channels
when an endogenous ligand or agonist drug binds the receptor, the channel closes, therefore not allowing ions to flow inward or outward
False.
G protein-coupled receptor systems
Have three receptors, what are they?
The receptor itself
G protein
Effector
These work to bind endogenous ligand or agonist drug activated the receptor, which in turn activate G protein which in turn activate the effector
G protein coupled receptor systems
True or false. Transcription factors .Responses to activation of these receptors are delayed
True
Low calorie meal can double absorption rate?
False
High fiber foods can reduce absorption?
True
Calcium containing foods can increased absorption (milk products or calcium supplements)
False, it reduces it
Grapefruit juice inhibits metabolism (raising Serum
drug levels)
True
Timing around drugs
If absorption decreased what would you do?
If absorption increased what would you do?
If it causes your GI to be upset, what would you do?
Take in empty stomach
Take with food
Take with food
