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Pharm 2 > z. Exam 1 Concepts > Flashcards

z. Exam 1 Concepts Flashcards

1
Q

Yearly Process for FDA Approval

A

0-4 Years: Computer models and animal studies
4: Healthy human volunteers (male, young, no previous medical conditions)
6ish: Target population
9: Market, expanded to elderly, liver/kidney
20 years: Patents and generics

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2
Q

Lab Testing in Vitro

A

In test tubes or dishes

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3
Q

Lab Testing in Vivo

A

On living organisms

Vitro: the ‘t’ is for trial or laboratory setting

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4
Q

Medication Death: Misfeasance

A

Negligence - wrong drug or dose given
“missed the mark”

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5
Q

Medication Death: Nonfeasance

A

Omission- not giving prescribed medication

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6
Q

Medication Death: Malfeasance

A

Giving the correct dose but through wrong route

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7
Q

Pharmacogenetics

A

Variations of the predicted drug response due to patients individual genetic factors

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8
Q

Biologic Variations (Asian/African American)

A

Asian: Decreased Response to drugs r/t CTP2D6 enzyme
AA: Respond poorly to anti-hypertensives

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9
Q

Disintegration

A

Stage 1 in physically breaking down a medication

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10
Q

Dissolution

A

Drug becomes a solution that can cross biologic membrane and available for the body absorb/use

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11
Q

Absorption

A

Movement of drug particles from the GI tract to the body fluids

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12
Q

Distribution

A

Drug becomes available to body fluids and tissue

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13
Q

Metabolism

A

Body (individual cells) inactivates the drug

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14
Q

Excretion

A

How the body gets rid of the drug (kidney/liver)

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15
Q

Effects on Absorption

A
  • Drug forms, route, GI mucosa’s, food, metabolism
  • Absorption is reduced if there are fewer villi in small intestine (r/t disease or surgery)
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16
Q

First pass effect

A

Medication passes through the liver before it reaches systemic circulation

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17
Q

Bioavailability

A

What % of the dose reaches the systemic circulation
IV - 100%
IM/SC - 75%-100%
PO - 5%-100%
Rectal - 30% - 100%

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18
Q

Blood brain barrier and its effect on distribution

A

Only lipid soluble medications are able to pass, making treatment for brain injuries challenging

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19
Q

Drug Classifications for Pregnancy

A

A, B, C, D, X
Where X is never
Ex Thalidamide

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20
Q

Liver Disease and the effects on metabolism

A

Since most medications are metabolized by the liver, a damaged liver extends the half life and could lead to toxicity

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21
Q

Main route of excretion

A

Kidneys
Others: Liver, feces, lungs, saliva, breast milk, sweat

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22
Q

Effects of GFR on excretion

A

A decreased GFR impairs drug excretion and can lead to accumulation of the drug in the system

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23
Q

Pharmacodynamics

A

Study of biochemical and physiological effects of drugs (what the drug does to the body)

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24
Q

Pharmacodynamics - Primary effect

A

Desirable and what the medication is supposed to do

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25
Q

Pharmacodynamics - Secondary effect

A

Can be desirable or undesirable leads to off-label uses of medications

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26
Q

Maximal Efficacy

A

Where giving more of a medication will not change its maximal effect

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27
Q

Agonists

A

Drugs that produce a response and enhance another drug

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28
Q

Antagonists

A

Drugs that block a response, prevent receptor activation
Ex: Narcan on Opioids

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29
Q

Nonspecific drug effect

A

Act on multiple same receptors throughout body

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30
Q

Nonselective

A

Acts on multiple different types of receptors (Epinephrine acts on alpha 1, beta 1, beta 2)

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31
Q

Drug Action - Stimulation/Depression

A

Narcotics, Amphetamines

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32
Q

Drug’s Action in Body - Replacement

A

Synthroid, insulin

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33
Q

Drug Action - Inhibition of killing organisms

A

Antibotics

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34
Q

Drug Action - Irritation

A

Laxative

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35
Q

Therapeutic Index

A

Margin of safety of a drug. Between it not working and not having toxic effects

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36
Q

Loading Dose

A

Larger dose of drug given when first starting new drug

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37
Q

Side Effects

A

Physiologic effects that are not related to the desired drug effects. Some are desirable some undesirable

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38
Q

Adverse Reactions

A

Always undesirable and normally severe, must be reported and documented

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39
Q

Patient Genetic Variances in Stable Warfarin Dose

A

Extensive 4-5 days
Intermediate 8-10 days
Poor metabolizer 12-15 days

40
Q

Tolerance

A

Needing more medication to get the same effect

41
Q

Tachyphylaxis

A

Rapid decrease in response to drug, where it does not have a therapeutic effect on the patient

42
Q

Placebo Effect

A

psychological benefit from a ‘sugar pill’

43
Q

Teratogens

A

Cause birth defects

44
Q

Carcinogens

A

Cause cancer

45
Q

Metabolites

A

End product of metabolism

46
Q

Placebos

A

Drugs with no pharmacologic activity

47
Q

What is an excipient

A

An inactive ingredient that does not have a pharmacological effect
Ex: dyes, preservatives, binding materials, flavorings

48
Q

Problems with Excipients

A

Some have excessive sodium or some may have an allergic or adverse reaction to the excipients

49
Q

Neurobiology of Addictive Drugs

A

Many allow for higher levels of dopamine, either by increasing its secretion, or decreasing it absorption

50
Q

Tolerance

A

Needing more of a drug or medication to get the same effect

51
Q

Physical Dependence

A

When the drug is ceased a person will go into withdrawal syndrome normally with in 24-48 hours

52
Q

Psychologic Dependence

A

The drug is associated with a lot of different tasks and activities, many people just feel better when on the the medication

53
Q

Cue-Induced Craving

A

Different activities that would cue the patient to reach for the drug again

54
Q

Withdrawal Syndrome

A

Groups of signs and symptoms that occurs in a physically dependent person when the drug is stopped

55
Q

Nicotine - Side effects

A

cardiovascular stimulation, increase CNS stimulation, tremors, increased alertness and arousal, promotes relaxation and relief of anxiety

56
Q

How is caffeine related to nicotine, what should you tell patients who are quitting

A

When decreasing nicotine intake they also need to decrease caffeine

57
Q

What is a pack year history

A

One pack a day is a one year history
Two packs a day for a year is a two year history and so on.
If a patient smokes 2 PPD for 30 years they have a 60 pack year history

58
Q

Caffeine OD treatment

A

Reduce hypertension, dysthymias and other side effects while you wait for the drug to leave the system

59
Q

Acetaldehyde Syndrome

A

The accumulation of acetaldehyde r/t drinking on antebuse causes N/V, CP and hypotension

60
Q

Barbiturates, Benzos and their relation to tolerance

A

While the patient may not feel the same effects there is no developed tolerance for respiratory depression.

61
Q

Signs of opioid overdose

A

Pinpoint pupils, clammy skin, depressed respiration, coma or death

62
Q

Drug Interaction

A

Altered of modified actions or effect of a drug as a result of an interaction with another drug

63
Q

Adverse Drug Reaction

A

Undesirable drug effect that ranges from mild effects to severe toxicity (anaphylaxis or hypersensitivity reactions)

64
Q

Drug Incompatibility

A

Chemical or physical reaction that occurs among two or more drugs

65
Q

Drug interactions: Physiological Changes with Absorption

A

Changes gastric emptying times (Laxatives), changes PH (antacids, asprin), forms different drug complexes (dairy products and ciprofloxacin)

66
Q

Drug interactions: Changes with Distribution

A

Competition for proteins binding sites (warfarin and glyburide both protein bound)

67
Q

Drug interactions: Changes with Metabolism

A

Inhibition or induction of liver enzymes (tagament inhibits the metabolism of theophylline - causing seizures and arrhythmias)

68
Q

Drug interactions: Changes with Excretion

A

Changes in the rate of excretion (lasix decreases K+ levels)

69
Q

Additive Drug Effect

A

1+1 = 2

70
Q

Synergistic drug effect (Potentiation)

A

1+1 > 2

71
Q

Antagonistic drug effect

A

1 + (-1) = 0

72
Q

Drug/Food interactions

A

Can increase, decrease or delay absorption, bind with drugs, some specifics may need to be avoided
Ex: Grapefruit juice effect

73
Q

Creatinine Clearance, factors effecting

A

Measures GFR and will tell us how well the kidneys are working. Compare’s creatinine level in the blood with level in urine
Lower values expected in patients with decreased muscle mass

74
Q

Peaks and Troughs

A

Peak - highest drug concentration
Trough - lowest concentration
Used to evaluate the appropriate dosage of many medications due to a narrow therapeutic range
Main meds: Digoxin, Vancomycin

75
Q

Drug Induced photosensitivity

A

patients should avoid the sun when on sulfa and bactrim antibotics

76
Q

Importance of OTC medication

A

Can cause interactions, including inactive ingredients, make sure to ask patients about OTC

77
Q

Polypharmacy

A

Confusion with the use of herbs, OTCs and multiple providers
Many tend to keep discontinued medications and share with neighbors and friends
ASK ABOUT OVER THE COUNTER

78
Q

Changes to the geriatric pharmacodynamics/pharmacokinetics

A

Lack of affinity to receptors, ages changes r/t CNS changes, less drug receptors
in general patients are more or less sensitive to medications

79
Q

Geriatric effects on Hypnotics

A

Drugs with short to intermediate half life should be used
Drug examples: ramelteon (rozerem) diazapam (valium) and lorazepam (ativan)

80
Q

Geriatric effects on Diuretics and antihypertensives

A

Those on diuretics should be closely monitored for electrolytes since they are at risk for imbalances. Alpha1 blockers and Alpha 2 agonists are infrequently prescribed because of orthostatic hypotension

81
Q

Geriatric effects on Cardiac Glycosides (Dig)

A

Most of digoxin is eliminated by the kidneys, so a decline in kidney function can cause digoxin accumulation, which can cause bradycardia. Digoxin should not be given to any patient with a pulse less than 60 beats per minute

82
Q

Geriatric effects on anticoagulants

A

Decreased serum albumin, risk for falls, increased risk for hemorrhage
Assess PT/INR and signs of bleeding

83
Q

Geriatric effects on Antibacterials

A

Aminoglycosides (-mycin) are not frequently prescribed due to the excretion in the urine

84
Q

Geriatric effects on GI drugs

A

Cimetidine (tagament) is not a good choice because of the confusion, as well as the
-prazoles because of C. Diff potential and fracture potential
Elderly patients also tend to abuse laxatives that cause electrolyte imbalances and interfere with absorption of other meds

85
Q

Geriatric effects on Antidepressants

A

The dosage is 30-50% less then the dosage prescribed for young adults
Tricyclic antidepressants can have increased SE: dry mouth, tachycardia, constipation, urinary retention and can contribute to narrow-angle glaucoma

Patients should be described SNRI’s and SSRI’s with a shorter half life

86
Q

Geriatric effects on Opioids

A

More dose related adverse reactions (hypotension and respiratory depression)
More constipation

87
Q

Special Nursing Coniderations for the Elderly to make sure information is understood

A

Eye glasses clean, hearing aids charged and in place, clear tones, face to face speaking, large print and bold colors, review all medications, simple dosage schedule (more at once, not spread out)
Encourage the communication of and side effects

88
Q

Changes to pediatric pharmacokinetics: Absorption

A

Age, health status, underlying disease, hydration, route of administration, gastric acidity, enzyme levels, peripheral perfusion, effectiveness of circulation, children’s skin is thinner and more porous (faster absorption for topicals)

89
Q

Changes to pediatric pharmacokinetics: Distribution

A

Body fluid composition (neonates and infants are 70% water, require a higher dosage of water soluble medication)
Body tissue composition (neonates and infants have less body fat and require lower doses of fat-soluble medications)
Neonates/infants have less albumin and fewer protein receptor sites (require less protein-bound medication)
Immature BBB at birth and makes them sensitive to drugs interacting on CNS

90
Q

Changes to pediatric pharmacokinetics: Metabolism

A

Children have a higher metabolic rate
Neonates (under 3 mo) are sensitive to drug eliminated by hepatic metabolism, need lower dosages
By 3 mo infants have adequate drug metabolizing enzymes

91
Q

Changes to pediatric pharmacokinetics: Excretion

A

Kidneys: Infants have decreased renal blood flow, GFR and renal tubular function

92
Q

Pediatric Nursing Implications

A

Watch for allergies, calculate safe dosages (body weight, body surface areas, height or age) Trust assessment skills and stop medications if you see s&sx of toxicity stop medication

93
Q

Safe pediatric med admin

A

Atraumatic cares and maintaining safety with minimal restraint, mix local anesthetics ex LET (lidocaine, epinephrine and tetracaine) and distraction for pain and anxiety control

94
Q

Preferred IM/SC/IV sites for peds

A

Ventrogluteal or vastus lateralis (deltoid is underdeveloped)
SC in leg or upper arm over abdomen
IV: fluid overload happens quickly

95
Q

Current parent recommendation for OTC cough and cold treatment for peds

A

no longer recommended to swap ibuprofen and acetaminophen because of the complication and risk for OD

96
Q

Treatment for cough in children

A

Honey most effective (not for use in children under 1)

97
Q

Child Med Safety

A

Do not round up, no leading or trailing 0’s, Label the unit of measurement

Pharm 2 (13 decks)

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