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Pharmacology > Midterm > Flashcards

Midterm Flashcards

1
Q

Gender differences in relation to pharmacokinetics and medication compliance

A

• Can affect success of medication tx
• Seeking medical attention, compliance with medications, elimination rates differ
• Side effects of meds can be gender specific and affect compliance
o Anti-hypertensives can cause male impotence problems
o FDA mandates that drugs are tested on both genders
o Insurance coverage differences (ie. OCP and females)

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2
Q

5 rights

A
  • Right Patient
  • Right Drug
  • Right Dose
  • Right Route
  • Right Time
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3
Q

Pharmacokinetic principles

A
  • How drugs move through the body.
  • Absorption, Distribution, Metabolism, Excretion
  • Factors affecting drug absorption: route of administration, drug formulation, drug dosage, digestive motility, digestive tract enzymes, blood flow at administration site, degree of ionization of drug (acidic or alkaline), pH surrounding environment, drug-drug/drug-food interactions, dietary supplement/herbal product-drug interactions
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4
Q

Buccal

A

tablet or capsule is placed in the oral cavity between the gum and the cheek. This route is preferred over the sublingual route for sustained-release delivery because of the greater mucosal surface area

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5
Q

Sublingual

A

medication is placed under the tongue and is allowed to dissolve slowly. This route results in a more rapid onset of action because of the rich blood supply

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6
Q

Sustained Release (SR)

A

tablets or capsules are designed to dissolve very slowly. This releases the medication over an extended time and results in a longer duration of action for the medication

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7
Q

Extended-release (XR) or long-acting (LA)

A

allow for the convenience of once or twice day dosing. Must not be crushed or opened

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8
Q

Topical drugs

A

applied locally to the skin or the membranous lining of the eye, ear, nose, respiratory tract, vagina, and rectum
o Applications include:
• Dermatological preparations- drugs applied to the skin, the topical route most commonly used. Formulations include creams, lotions, gels, powders, and sprays.
• Instillations and irrigations- drugs applied into the body cavities or orifices. These routes may include the eyes, ears, nose, urinary bladder, rectum, and vagina
• Inhalations- drugs applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing apparatuses

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9
Q

Intra-dermal (ID)

A

injection is administered into the dermis layer of the skin. This layer contains more blood vessels than the deeper subQ layer allowing for drugs to be more easily absorbed. Limited to small volumes of drug

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10
Q

Pharmacokinetics (absorption) during pregnancy trimesters

A
  • Abdominal/gastric changes affect absorption
  • Inhaled drugs may be absorbed faster
  • Changes in cardiac output, plasma volume, and regional blood flow change distribution and metabolism
  • Drug excretion rates may increase
  • Pre-implantation period: 1-2 weeks of 1st trimester, teratogen either causes death of the embryo or has no effect
  • Embryonic period: 3-8 weeks, period of maximum sensitivity to teratogens
  • Fetal period: 9-40 weeks or until birth, medications have prolonged duration of action
  • Pregnancy categories: A,B,C,D,X (X is the worst)
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11
Q 
ADRs
Adrenergic agents (Sympathomimetics) (phenylephrine (neo-synephrine))
A

tachycardia, hypertension, dysrhythmias, CNS excitation and seizures, dry mouth, nausea and vomiting, anorexia

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12
Q 
ADRs
Anticholinergic agents (benzotropine mesylate (Cogentin))
A

dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, glaucoma

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13
Q 
ADRs
Cholinergic agents (Parasypathomimetic)(miniopress))
A

profuse salivation, sweating, increased muscle tone, urinary frequency, bradycardia

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14
Q

ADRs

Salicylates (Aspirin)

A

with high doses may cause GI distress and bleeding, may increase action of oral hypoglycemic agents

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15
Q

ADRs

Vancomycin

A

nephron/ototoxicity, peak/trough with the 3rd dose, Red Man Syndrome

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16
Q 
ADRs
Hydantoins phenytoin (Dilantin)
A

CNS depression, gingival hyperplasia (soft bristle tooth brush), skin rash, cardiac dysrhythmias, hypotension

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17
Q

ADRs

Succinylcholine

A

malignant hyperthermia (fast rise in temp. and severe muscle contractions), (Dantrolene Sodium is the preferred tx)

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18
Q

ADRs

Glucocorticoids (Corticosteroids) (Prednizone)

A

adrenal gland suppression, hyperglycemia, mood changes, cataracts, peptic ulcer disease, osteoporosis and “masking infections”, Cushing’s Syndrome as a result from long term therapy

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19
Q

ADRs

Aminoglycosides (Gentamicin)

A

ototoxicity, nephrotoxicity

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20
Q

ADRs

Fluoroquinolones (Cipro)

A

may cause tendon inflammation/irritation/rupture

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21
Q

ADRs

Rifampin

A

can turn body fluids orange

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22
Q

Penicillin injections

A

highest allergy incidence, observe pt for 30 minutes after dose, given IM because it has a poor oral absorption rate

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23
Q

Dilantin

A

given IV deserves caution because it can cause tissue damage, do not use hand veins, it may also cause a severe rash

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24
Q

Tylenol

A

liver damage with high doses

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25
Q

Epoetin alfa

A

gental rotation of vial, subQ route, given for side effects and not for the cancer itself

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26
Q

KCI

A

always give medication while pt is upright to prevent esophagitis, do not crush tablets or allow pt to chew, dilute liquid forms before giving orally or through NG tube, never administer IV push or in concentrated amounts, be careful to avoid extravasation and infiltration

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27
Q

Food/drug interactions

Metronidazole

A

Disulfiram like effects with alcohol

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28
Q

Food/drug interactions

PCNs

A

decrease the effectiveness of OCPs, aminoglycoside antibiotics

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29
Q 
Food/drug interactions
Valporic acid (Depakote)
A

alcohol, phenobarbital and phenytoin

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30
Q

Food/drug interactions

Tetracyclines

A

OCPs, dairy products interfere with absorption

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31
Q

Food/drug interactions

Spironolactone (Aldactone)

A

hawthorne, ammonium chloride, aspirin, digoxin, potassium supplements, ACE inhibitors, angiotensin-receptor blockers (ARBs), antihypertensives

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32
Q

Anticholinergics

A

Inhibit parasympathetic impulses. Suppressing the parasympathetic division induces symptoms of flight-or-fight response

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33
Q

Naloxone (Narcan)

A

pure opioid antagonist, blocking both mu and kappa receptors. Used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected

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34
Q

Antibiotics

A

encourage compliance to prevent possibility of antibiotic resistance, monitor for allergies because of the high allergenicity, clients who are allergic to one have a high chance of being allergic to others (PCNs)

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35
Q

Acetaminophen

A

avoid alcohol because of the possibility of liver toxicity with high doses

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36
Q

Spirituality

A

Incorporates the capacity of love, to convey compassion and empathy, to give and forgive, to enjoy life, and to find peace and fulfillment in living. The spiritual life overlaps with components of the emotional, mental, physical, and social aspects of living

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37
Q

Potassium rich foods

A

Bananas, white beans, dark leafy greens, yogurt, fish, avocado

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38
Q

Who is the father of Pharmacology

A

John Jacob Abel

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39
Q

What are the 3 types of drugs

A

Synthetic
Biologic
Herbal

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40
Q

Why is it important to ask patients if they are taking Herbal medication

A

Because you can never be sure how much they are taking

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41
Q

Who regulates medications in the US

A

FDA

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42
Q

How long and how many phases are there in the approval process of a drug

A 
4 phases: 
Preclinical (1-3 yrs)
Clinical (2-10 yrs)
Review of new drug
Postmarking
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43
Q

What is an ADR

A

Allergic: non-life threatening
Anaphylactic: life threatening

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44
Q

Name 2 ways drugs are categorized

A

Therapeutic

mechanism of action

45
Q

What is a prototype drug

A

A model drug that is well understood, has known action and adverse effects

46
Q

Which class of controlled substances are considered highest risk of abuse potential

A

Class 1

47
Q

What age groups commonly require further caution when administering drugs

A

Pregnant and breastfeeding
young and elders
any age with chronic health issues

48
Q

Which pharmacokinetic elements change during pregnancy

A

Metabolic rates

49
Q

Which period of pregnancy is considered at highest risk for teratogenic exposure/consequence

A

Embryonic period: 3-8 weeks

50
Q

Which FDA category of drug poses the lowest risk when consumed by a pregnant woman

A

Cat A

51
Q

How are medication doses commonly calculated

A

by weight in kg/mg

52
Q

Where is a consistent area to inject medications in the pediatric population

A

vastus lateralis in the thigh

53
Q

Which age group is known for polypharmacy

A

older adults

54
Q

Describe some important nursing teaching interventions for the older adult group

A

Making sure that they understand how to take medications

55
Q

What are 2 types of immune modulators

A

stimulator

suppressor

56
Q

Which vaccine type deserves extra caution when administering

A

Live vaccinations

57
Q

What are 2 types of biologically developed cytokines

A

Interferons

Interleukins

58
Q

Why are immunosuppressants given

A

To suppress the immune system so that it doesn’t attack a foreign substance (organ transplant, autoimmune disorder, various inflammatory disorders)

59
Q

When taking Cyclosporines, what specific nursing advice should be given

A

Don’t drink grapefruit juice

60
Q

What is inflammation

A

Non-specific defense with a goal of containing injury or destroying invading pathogen

61
Q

Name 2 classes of anti-inflammatory drugs

A

NSAIDs

Glucocorticoids

62
Q

What is the common mechanism of action for anti-inflammatory drugs

A

prevent prostaglandins (pain messages)

63
Q

What is the FDA black box warning for IBU

A

Contraindicated in use for tx of preoperative pain in the setting of coronary artery bypass graft surgery due to potential for stroke or MI

64
Q

Which NSAID can cause Reye’s syndrome in the pediatric population

A

Aspirin

65
Q

Is Tylenol considered a NSAID

A

No, it is used for tx of fever and pain but it is not an anti-inflammatory

66
Q

What are causes for bacterial mutation

A
  • Not taking medications as prescribed
  • Taking medications for the wrong infection
  • Partial tx
  • Nonsocomial infections
67
Q

Which class of drugs is commonly associated with ototoxicity

A

Aminoglycosides

68
Q

Why are patients often non-compliant with tx of TB

A

pts often times don’t experience symptoms till the TB becomes active and with the medications they have a lot of symptoms

69
Q

Cyclosporine (Neoral, Sandiummune)

A
  • Immunosuppressant-inhibits helper T cells
    -Tx of: organ transplants, Crohns disease, ulcerative colitis
    ADRs: Oliguria, HTN, tremors, gingival hyperplasia
    -Interactions: phenytoin, phenobar, carbamazepine, rifampin, azoles, ACE inhibitors, NSAIDs, macrolides, GRAPEFRUIT JUICE
70
Q

ADRs of vaccinations

A

site tenderness
low grade fever
fatigue
dizziness

71
Q

Interferon alfa-2b (Intron A)

A
  • Immunostimulant- normal cell protectors, WBC enhancement-better defense
  • Tx: Cancers and viral infections
  • ADRs: flu-like symptoms, depression/suicidal ideation, hepato/neurotoxicity
  • Interactions: Zidovudine (hematologic toxicity)
72
Q

PCNs

A
  • Tx: G+ cell wall inhibitors
  • cillin in the name
  • high allergenicity profile
  • Interacts with OCP
73
Q

Cephalosporins

A
  • Tx: G+ (1st gen.), G- (3rd gen), cell wall inhibitors
  • cef, kef
  • Caution in PCN allergic pts
  • Disulfiram-like effect with ethos
  • Interacts with cumadin
74
Q

Tetracylines

A

-Tx: G+/-, ribosome function inhibition
-cycline
-Teratogenic
-bone growth stunting, tooth staining
-binds with minerals
do not give with dairy

75
Q

Macrolides

A
  • Tx: G+/-, ribosome function inhibitor
  • mycin
  • drug interactions: cyclosporin, anticonvulsants, cumin
  • oral table dissolves with acid, NO JUICE!
76
Q

Aminoglycosides

A
  • Tx: G+/-, protein synthesis inhibitors
  • micin, mycin
  • ototoxic/nephrotoxic
  • serum levels of drug often drawn for therapeutic benefit/toxicity
  • interacts with many drugs (ampho B)
  • peak/trough levels with 3rd dose
77
Q

Fluoroquinolones

A
  • Tx:G+/-, bacterial DNA enzyme inhibitor
  • oxacin
  • no use in pediatric puts
  • binds with minerals (no dairy/multivitamins
  • FDA black box warning: tendon inflammation
78
Q

Sulfonamides

A
  • Tx: G+/-, folic acid inhibitors
  • sulfa
  • drug interactions: coumadin, phenytoin
  • causes urine crystals
  • caution in: megablastic anemic pts, hx of kidney diseases due to crystals
79
Q

Metronidazole

A
  • Tx: anaerobic/non-malarial protozoans
  • Flagyl
  • Disulfiram-like effects with alcohol consumption
  • common metallic taste in mouth
80
Q

Clindamycin-not an amino glycoside or macrolide

A
  • Tx: G+/-, bacterial protein synthesis inhibitor
  • cleocin
  • Associated with Antibiotic Associated Pseudo-membranous Cellulitis (AAPMC)
81
Q

Linezolid

A
  • Tx: MRSA (G+)
  • Zyvox
  • Causes thrombocytopenia
  • caution in pots taking SSRIs- HTN crisis!
82
Q

Quinupristin Dalfopristin

A
  • Tx: VRE
  • Synercid
  • Risk for hepatotoxicity and pseudo-membranous colitis
83
Q

Vancomycin

A
  • Tx: G+
  • big gun, use in sepsis, severe infection or resistance concerns
  • Vancocin
  • Ototoxicity/Nephrotoxicity
  • Red Man Syndrome- decrease rate of infusion
84
Q

What are the 4 drugs for the tx of TB

A
  • Isoniazid (INH)
  • Rifampin
  • Pyrazinamide
  • Ethambutol
85
Q

What drugs are used for malaria

A

chloroquine

primaquine

86
Q

Is tx for HIV a single or multi drug regime

A

multi

87
Q

What is the goal of HIV tx

A

Reduce HIV RNA copies in the blood

  • Increase lifespan
  • Higher quality of life
  • Decreased risk of transmission from mother to child
88
Q

What are common labs to measure HIV status

A

-CD4 count
-HIV RNA assays
-amylase (assess for pancreatitis)
-CBCs
-lipid levels
LFT (liver function test)

89
Q

What is the function of interferon therapy when treating a viral infection

A

Reprogram infected cells to inhibit replication

90
Q

Which antineoplastic drugs have the risk of secondary malignancy following tx

A

Alkylating agents and Antitumor Antibiotics

91
Q

What is a unique ADR to the alkylating agents

A

secondary malignancy

92
Q

When taking hormone/hormone antagonist drugs, what type of side effects can the patient expect

A

menopausal symptoms for both men and women

93
Q

What are some ADRs of diphenhydramine

A
  • drowsiness, occasionally paradoxical
  • CNS stimulation and excitability
  • Anticholinergic effects: dry mouth, tachycardia, mild hypertension, photosensitivity
94
Q

When using steroid inhalers, how long does it take to observe positive effects

A

2-3 weeks

95
Q

What is a hallmark ADR of cyclophosphamide (cytoxan)

A

hemorrhagic cystitis

96
Q

What beverage should a pt taking theophylline, a xanthine bronchodilator avoid

A

caffine

97
Q

Name 2 LABA drugs

A

Salmeterol

Arfomoterol

98
Q

Name 2 SABA drugs

A

Albuterol

Xopenex

99
Q

What device is used to administer MDIs

A

a spacer

100
Q

When comparing drowsiness effects with antihistamines, which generation has the highest drowsiness

A

1st generation

101
Q

What is the antidote for benzos

A

Flumazinone

102
Q

How long does a patient need to wait before starting Buspar when discontinuing an MAOI

A

14 days because hypertensive crisis may result

103
Q

What time of day should an SSRI be taken and why

A

take in the morning because can cause sleep disturbances

104
Q

How do SSRIs work

A

Selectively inhibit serotonin reputake, allowing more serotonin to stay at the junction of the neurons

105
Q

4 common effects from SSRIs

A 
weight gain
GI bleeding
sexual dysfunction
diaphoresis tremor
nausea
fatigue
106
Q

when taking an SSRI when should a patient expect therapeutic results

A

up to 4 weeks

107
Q

What is the enzyme required for HIV to replicate itself

A

Protease

108
Q

Which drugs are used to treat influenza and when are they used

A
  • Tamiflu, Relenza

- Must be used within the 1st 48 hours and only for high risk groups

Pharmacology (18 decks)

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