Module 2 study guide

Question 1

Idiosyncratic reaction

Answer 1

Adverse effects that are completely unexpected and not previously known to be associated with a particular medicine.
Involves abnormal susceptibility to a medication, possibly from genetic trait or dysfunction of a metabolic enzyme.

Question 2

Medication biotransformation

Answer 2

Occurs in liver
Ability to cause biotransformation
Kidney, skin, lungs, GI tract
Four possible effects on body
Inactive substance can become active - Metabolite
Capable of producing desired or unwanted clinical effects
Inactive medication can be changed into another active medication- active metabolite
Active medication, may be completely or partially inactivated- inactive metabolite
Medication is transformed into a substance that is easier for the body to eliminate- inactive/ active metabolite

Question 3

Steven johnson syndrome

Answer 3

Severe and possibly Fatal reaction that mimics a burn
May be caused by some antibiotics and anti seizure meds

Question 4

Lipid soluble vs. water soluble

Answer 4

Lipid or fat soluble meds require higher weight based dose in older adults because of their higher body fat percentage and increased fat distribution
Water soluble requires higher weight based dose for infants because they have a higher percentage of body water
All but the larger lipid soluble medication can easier pass through cell Membranes

Question 5

Acetylcholinesterase inhibition

Answer 5

Nerve agent toxicity which permits excessive release of ACH which leads to elevated levels in the body
Atropine is treatment

Question 6

Synergism

Answer 6

Two meds with similar effects combined to produce an effect greater than the sum of the meds effects\
EX: fentanyl and versed acts as a chemical sedative

Question 7

Potentiation

Answer 7

Definition: effect of one med is greatly enhanced by the presence of another med which does not produce the same effects
EX: promethazine is given to increase the effects of codeine or other antitussives for more improved relief of cough than is achieve by the antitussives alone.

Question 8

Bioavailability

Answer 8

Definition: percentage of the unchanged med that reaches systemic circulation
Varies significantly from one med to another except when administered by IV
Meds by IV have 100% bioavailability
Irrelevant with meds that are sequestered such as activated charcoal
EX: the reduction in bioavailability due to first pass hepatic metabolism has already been taken into account with oral dosing explaining why the oral doses are significantly higher than IV doses given for the same purpose

Question 9

Biotransformation

Answer 9

A process with four possible effects on a medication absorbed into the body: (1) an inactive substance can become active, capable of producing desired or unwanted clinical effects. (2) an active medication can be changed into another active medication. (3) an active medication may be completely or partially inactivated. (4) a medication is transformed into a substance (active or inactive) that is easier for the body to eliminate

Question 10

Acetaminophen contraindications

Answer 10

Hypothermia either related to the toxic affects of the med
Environmental exposure
Known hypersensitivity
Severe active liver disease

Question 11

Ace inhibitor side effects

Answer 11

Chronic dry cough, life threatening angioedema

Question 12

Immune mediated medication response

Answer 12

Medications and substances present in the environment can trigger an exaggerated response from the body’s immune system, which is generally described as an allergic reaction. (medication sensitivity, anaphylaxis)

Question 13

Alpha blocking medications

Answer 13

Alpha adrenergic receptor antagonists
Prevent endogenous catecholamines from reaching alpha receptors, primarily in smooth muscle of blood vessels
Lower BP (particulars diastolic)
Decrease systemic vascular resistance
Pts taking alpha blockers at home are susceptible to orthostatic hypotension and tachycardia.
Prescribed to pts with hypertension, enlarged prostate gland, glaucoma

Question 14

Renal Failure

Answer 14

More susceptible to the adverse effect of medications than other patients. Renal Failure hinder the capability of the kidneys to eliminate medications properly. (last step in Pharmacokinetics)

Question 15

Liver Failure

Answer 15

Patients with liver dysfunction are at risk of toxicity from oral medications, even at their conventional dose because the first pass effect is impaired in these individuals
A larger amount of the medication will reach their circulatory system

Question 16

Alpha-1 Receptors

Answer 16

Adrenergic Receptor, Alpha-1 receptors primarily cause vasoconstriction

Question 17

Alpha-2 Receptors

Answer 17

Adrenergic Receptor, Alpha-2 receptors generally cause smooth muscle contraction, inhibition of insulin release, induction of glucagon release, and suppression of further norepinephrine release

Question 18

Lb to kg calculation

Answer 18

Lbs÷2.2 (on calculator)
Lbs÷2 then minus 10% (for freehand)

Question 19

Osmolarity

Answer 19

The concentration of particles dissolved in a fluid

Question 20

Hypertonic solution

Answer 20

Has a relatively higher osmotic pressure that does the interstitial( in the brain) fluid
Shifts fluids into vascular space
Can cause excess fluid drain from the tissue into the blood
can decrease swelling in the brain, help stabilize BP increase urine output and reduce edema
Specifically 3% sodium chloride is used as temporary measure to draw out fluids and reduce intracranial pressure
Pulls fluids and electrolytes form intercellular components into intravascular compartments
Because of higher sodium concentration then the cell water is drawn out of cell and may cause cell to collapse from increased extra cellular osmotic pressure
Contraindicated for patients in diabetic ketoacidosis or patients at risk of cellular dehydration

Question 21

Hypotonic Solution

Answer 21

Lower osmolarity(sodium) than serum, dilutes the serum.
Hydrates the cells and depletes the intravascular space.

Question 22

Isotonic Solutions

Answer 22

Two Solutions: Normal Saline(Sodium Chloride 0.9%) & Lactated Ringers
Normal Saline- Has similar osmolarity as other body fluids, Ex: blood)
Expands the intravascular space without shifting to other spaces or change of cell shape.

Question 23

Vasovagal Response

Answer 23

A triggering response
Venous vasculature dialtes, decreases blood pressure, decreases blood flow to the brain; Syncope.

Question 24

Lactated Ringers

Answer 24

(LR)- used for blood loss, contains lactate which metabolizes in the liver.
NOT for those with liver issues.

Question 25

Amiodarone

Answer 25

Prolongs the QT interval. Blocks sodium, potassium, and calcium channels: prolongs the action potentials duration and delays depolarization; decreases AV conduction and sinoatrial (SA) node function.

Question 26

L to mL

Answer 26

Multiply L by 1000 to get mL

Question 27

mL to L

Answer 27

Divide mL by 1000 to get L

Question 28

Dopamine Calculations

Answer 28

1600 mcg/mL or 800mcg/500mL
Admin via infusion pump typically in mcg/kg/min (2-10 or 5-20 mcg/kg/min)

Question 29

Volutrol

Answer 29

Pediatric IV microdrip set (aka Buretrol or Burette) that helps to avoid inadvertent fluid overload. Chamber holds about 100-200mL
Precalibrated drip chamber that only administers preset amount of fluid

Question 30

Rhonchi

Answer 30

a coarse low pitched respiration
Typically from aspiration of fluid
Indicative of bronchitis/pneumonia

Question 31

Rales

Answer 31

crackles, wet rattling, bubbling, fluid in small airways

Question 32

Wheezes

Answer 32

high pitched whistling sound, air forces through narrow airway causing vibration. Asthma,CHF, bronchus obstruction

Question 33

Tidal Volume

Answer 33

amount of air moved in and out in single breath. Average 500 ml for adults
Minute volume = TV x RR

Question 34

Neonate Pulse Rate/ bp

Answer 34

Pulse Rate awake: 100-205 asleep: 90-160 BP Systolic 67-84 Diastolic 35-53 MAP 45-60. Pulse should be taken at Brachial Artery for min 30 seconds then multiplied X2.

Question 35

Pediatric Pulse Rate/bp

Answer 35

Pulse Rate awake 100-180 asleep 90-160 BP Systolic 72-104 Diastolic 37-56 MAP 50-62
70 + (2 x age in years)

Question 36

Adult Pulse Rate/bp

Answer 36

Pulse 60-100 BP 90-140. Pulse should be palpated at radial artery.

Question 37

Subdural hematoma

Answer 37

Collection of blood in the subdural space resulting from tearing of a cerebral vein

Question 38

URI in children

Answer 38

Upper respiratory infection. Children lose “passively acquired immunity” and develop their own immunity called “Acquired immunity.”

Question 39

Menopause

Answer 39

When a woman reaches the end of child-bearing age, between the ages of 40-50. Menstruation cycles become less frequent. This change can result in loss of bone density and the development of cardiovascular disease

Question 40

Bruit

Answer 40

Abnormal whooshing sound heard over a main blood vessel that indicates turbulent blood flow within the blood vessel. Often indicates localized atherosclerosis

Question 41

Pathological Fracture

Answer 41

A fracture that occurs in an area of abnormally weakened bone. When normal forces apply to abnormal bone structures. Often occurs as a result of decreased bone density

Question 42

Diplopia

Answer 42

double vision

Question 43

Anisocoria

Answer 43

Condition where pupils are asymmetric (differing in size greater than 1mm)
Found in 30% of the population. It sometimes indicates significant ocular or neurologic pathology, but must be correlated with overall presentation of patient

Question 44

Ptosis

Answer 44

Sagging or drooping of eyelids.
Can indicate Bell’s Palsy or Stroke

Question 45

Bounding Pulse

Answer 45

Strong pulse consistent with Circulatory overload and Hypertension

Question 46

Thready Pulse

Answer 46

Weak, Fast, and difficult to palpate