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Contemporary Pharmacotherapeutica > Application Of Pharmacotherapuetics > Flashcards

Application Of Pharmacotherapuetics Flashcards

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1
Q

What is an adrenergic drug?

A

Agent that produces effects similar to those produced by stimulation of the sympathetic nervous system and therefore has widespread effects on body tissues

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2
Q

Antigen

A

Foreign substance

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3
Q

The reuptake of ——— is a major way that sympathetic nerve transmission are terminated

A

Norepinephrine

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4
Q

Nonselective adrenergic drugs act on both ———- and ————-

A

Alpha and beta receptors

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5
Q

Antagonist

A

Drug that inhibits cell function by occupying receptor sites

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6
Q

Serum half life

A

Time required for the serum concentration of a drug to decrease by 50%

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7
Q

Pharmacokinetics

A

Drug movement though the body to reach sites of action, metabolism, and excretion

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8
Q

Serum or elimination half-life is determined by?

A

Drug’s rate of metabolism and excretion

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9
Q

Describe interactions which may increase the therapeutic or adverse affects of a drug

A

Additive effects; two drugs with similar actions are taken (ethanol and Valium)

Synergism; two drugs with different mechanisms of action produce greater effects of each drug

Interference; the metabolism of one drug is interfered by another intensifying the effects

Displacement of protein binding causing an increase in the effect of the displaced drug

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10
Q

Describe interactions which may decrease effects of drugs

A

Taking an antidote drug

Decreased intestinal absorption of drugs; usually occurs when combined with other substances creating nonabsorbable compounds

Activation of drug-metabolizing enzymes in the liver which increase the metabolism of the drug

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11
Q

Describe cross-tolerance

A

Tolerance to pharmacologically related drugs such as alcohol and sedative type drugs due to the activation of drug-metabolizing enzymes in the liver which accelerates metabolism and excretion.

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12
Q

Antidote to acetaminophen

A

Acetylcysteine

(Mucomyst oral or acetadote IV)

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13
Q

Antidote for beta blockers

A

Glucagon

Increases myocardial contractility and raises blood pressure

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14
Q

Antidote for calcium channel blockers

A

Calcium gluconate. Increases contractility

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15
Q

Antidote for benzodiazepines

A

Flumazenil

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16
Q

Antidote for thrombolytics

A

Amicable

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17
Q

Antidote for tricyclic antidepressants

A

Sodium bicarbonate

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18
Q

Describe the effect of beta 1 stimulation

A

Cardiac stimulation including an increase in myocardial contraction, an increase in heart rate, or and increase in the speed of electrical conduction (positive dromotropic effect).

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19
Q

Clinical effect in response to activation of beta 2 receptors

A

Bronchodilation and an increased blood flow to heart, brain, lungs, skeletal muscles. Also results in hepatic glycogenolysis and a decrease in insulin secretion leading to hyperglycemia. May relax smooth muscle in the uterus, GI tract, and urinary tract

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20
Q

Why do drugs which stimulate alpha 2 receptors produce an antiadrenergic response?

A

Alpha 2 receptors are usually presynaptic, situated in front of a synapse, thus inhibiting the neurotransmitter norepinephrine into synapses of the sympathetic nervous system.

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21
Q

Ephedrine has which adrenergic qualities?

A

Alpha and beta which causes bronchodilation, cardiac stimulation, nasal decongestion.

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22
Q

The usefulness of adrenergic drugs stems mainly from the drugs’ effects on which target organs?

A

Heart, blood vessels, and lungs

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23
Q

Prototype adrenergic drug

A

Epinephrine

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24
Q

Type I immunoglobulin E-mediated allergic reaction to an antigen, a foreign substance that has entered the body

A

What is anaphylaxis

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25
It is essential not to give what class of drug with adrenergic drugs due to the danger of respiratory depression, hypertensive crisis, severe dysrhythmia, or death.
MAO inhibitors
26
Drug of choice for treating withdrawal from alcohol and other CNS depressants
Benzodiazepines
27
Prototype benzodiazepine for the treatment of substance abuse
Chlordiazepoxide (Librium); provides adequate sedation and significant anticonvulsant effects
28
Pharmacodynamics
The effects of the drug on the body
29
3 sources of assessment data
Patient interview and history Physical exam Medical record
30
How can a nurse maximize the therapeutic effects of a drug
Administer in a manner that will promote the absorption Administer at the appropriate time Monitor lab values and effects
31
How can a nurse minimize adverse effects
Verify allergies Assess for contraindications Follow safety protocols Monitor the patient and relevant labs Discontinue or withhold drug based on findings And report them Modify administration techniques
32
Metabonomics
The study of metabolic responses to drugs, environmental changes, and diseases
33
What are the two major determinants of blood pressure?
Cardiac output (systolic) Peripheral vascular resistance (diastolic)
34
What are the recommended lifestyle modifications to lower blood pressure?
``` Weight loss Reduce sodium intake Regular physical activity Moderate alcohol consumption No smoking ```
35
What is the relationship between sodium and antihypertensive drugs?
Excessive sodium decrease the antihypertensive actions of antihypertensive drugs Excessive sodium intake with thiazides may cause hypokalemia Sodium restriction may decrease dosage requirements of antihypertensive drugs
36
Recommended initial antihypertensive drug therapy for African Americans?
Diuretics
37
Class of drugs recommended for treating hypertension in people with diabetes?
ACE inhibitors Captopril is the prototype. These drugs decrease the incidence of proteinuria and slow the progression of kidney failure with diabetes.... may increase the incidence in non-diabetics
38
ARB prototype
Losartan (Cozaar) ... this class of drug usually ends in “an”. Ex, valsartan, olmesartan
39
What is the action of an ACE inhibitor?
Block angiotensin I from turning into angiotensin II. ACE is primarily located in the endothelial lining of vessels and is responsible for vasoconstriction. Thus, ACE inhibitors block the vasoconstriction effect, thereby producing a vasodilatory effect lowering blood pressure.
40
Most common adverse reaction of ACE inhibitors?
Persistent dry cough
41
Class of drugs which block the strong blood pressure raising effects of angiotensin II
Angiotensin II receptor blockers ARB’s. Losartan (Cozaar) is the prototype
42
Difference between ACE inhibitors and ARB’s
ARB’s are similar in their effects to ACE inhibitors but are less likely to cause hyperkalemia and Persistent cough
43
Drugs which inhibit the activity of the SNS
Anti adrenergic
44
First drug of choice for African Americans with stage II Htn?
Calcium channel blockers
45
Define hypertension stage I
130-139 or 80-89
46
Define hypertension stage II
> 140 or >90
47
Adverse effects of losartan (ARB)
Dizziness, muscle cramps or weakness, heartburn, diarrhea
48
What are the recommendations for stage A heart failure?
Smoking cessation Alcohol avoidance Treatment of htn with ARB or ACE Control of blood sugar
49
Symptoms of digitalis toxicity
Very slow or rapid ventricular rhythm, nausea, vomiting, loss of appetite, abdominal distinction, blurred vision, and mental changes
50
Concurrent administration of what drugs decrease the absorption of digoxin?
Antacids (should be given an hour after digoxin). Cholestyramine
51
Factors that contribute to digoxin toxicity
Accumulation of maintenance doses Rapid loading or digitalization Extremes in age Electrolyte imbalance Hypoxia Combination with other heart drugs (quinidine, verapamil, procardia)
52
Therapeutic range of digoxin
.8-2.0
53
Aldosterone antagonist prototype drug
Spironolactone (aldactone)
54
How does aldosterone contribute to heart failure?
Leads to increased interstitial fibrosis, which decreases systolic function. Contributes to retention of sodium and water. Impairs vascular function.
55
Decreases the effects of spironolactone
Salicylates and licorice
56
What is the most significant contribution of pharmacogenetics to drug therapy?
Prevention of serious drug reactions
57
Which agreement made by the United Nations determined that the production, distribution, trade, use, and possession of narcotic substances are to be limited to medical and scientific purposes only?
UN Single Convention of 1961
58
What aspect of the world health status has been affected by the decades of increased criminalization of and militant action against the trade of illicit drugs?
Decreased access to HIV/AIDS prevention and diagnosis
59
What should be avoided when on statin medications?
Grapefruit and pomegranate juice
60
Do not give glibizide and hydrochlorothiazide with which type of allergy?
Sulfa
61
Antidepressant discontinuation syndrome
Flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal
62
Imipramine
Prototype drug for tricyclic antidepressants, the oldest and now second-line drug for treatment. May also be ordered for enuresis (bed wetting).
63
Black box warning regarding TCA’s and other antidepressants
May increase suicidal ideation in children, teens, and young adults
64
Adverse affects common with imipramine, especially in older people
Confusion, dysthymia, tachycardia, orthostatic hypotension, urinary retention. May also have serious adverse reactions with anesthesia. Anticholinergic symptoms (blurred vision, dry mouth, constipatuon).
65
First line drug of choice for treating depression. Include class and drug name.
SSRI’s... fluoxetine (Prozac, sarafem). Effective with fewer side effects than TCA’s
66
Describe Serotonin syndrome and how it might occur with antidepressants
Serious sometimes fatal reaction characterized by hypertensive crisis, hyperpyrexia, extreme agitation, muscle rigidity, and seizures. May occur with combined therapy with an SSRI and MAO inhibitor.
67
Prototype SNRI
Serotonin-Norepinephrine reuptake inhibitors. Venlafaxine (Effexor) is the prototype
68
Most serious adverse affect of MAOI and how it is most likely precipitated
Hypertensive crisis precipitated by foods containing tyramine
69
What does FARM stand for?
Findings Assessment Resolution Monitoring
70
Pharmacoeconomics
Identifies, measures, and compares the costs and consequences of drug therapy to healthcare system and society. Placing a value on drug therapy.
71
Indirect nonmedical costs
Cost of reduced productivity due to the morbidity or mortality of an illness
72
Direct nonmedical costs
Any costs for nonmedical services that are the results of illness or disease but do not involve purchasing medical services
73
How is human capital method used to estimate indirect cost related to the morbidity and mortality of disease?
Value bases losses on the individuals earning capacity. Ethical?
74
Examples of intangible costs related to healthcare
Pain, suffering, inconvenience, and grief
75
When is CMA or cost minimization analysis appropriate?
When comparing two or more therapeutically equivalent agents or alternate dosing regiments of the same agent
76
What is a cost-benefit analysis?
Method that allows for the identification, management, and comparison of the benefits and costs of a program or treatment alternative
77
What can be assumed by a treatment with a benefit to cost ratio of .6?
That the treatment is going to cost more than the benefit realized by it
78
Involves comparing programs or treatment alternatives with different safety and efficacy profiles measuring cost and outcomes expressed in units
Cost-effectiveness analysis
79
What pharmacoeconomic measurement should be considered when HRQOL is the most important outcome being examined?
Cost-utility analysis
80
During heparin therapy, the aPTT should be what?
1.5 to 2.5 times the control or baseline value. 45-70 seconds
81
Prototype DTI or direct thrombin inhibitor?
Lepirudin (refludan)
82
Prototype recombinant tissue plasma activator
Alteplase (Activase)
83
Antidote to rtPA?
Amicar or TXA
84
Adequate blood cell production
Hematopoiesis
85
Hormone secreted by the kidneys to stimulate bone marrow production of RBC’s
Erythropoietin
86
Prototype recombinant form of human erythropoietin that helps the body make more PRBCs
Epoetin Alfa (epogen, procrit)
87
The prototype drug which can help prevent infection by reducing the incidence, severity, and duration of neutropenia associated with chemotherapy
Filgrastim (neurogenic)
88
Symptoms of graft-vs-host disease
Delayed recovery of blood cell production in the bone marrow, skin rash, liver dysfunction, and diarrhea
89
Most common type of cancers that develop with long term immunosuppressive therapy.
Skin cancers and lymphomas
90
Prototype cytotoxic immunosuppressive agent
Mycophenolate (CellCept)
91
Mycophenolate sodium (Myfortic)
Cytotoxic immunosuppressive agent used after kidney transplant to prevent organ rejection
92
Nursing assessment of adverse drug affects with immunosuppressive therapy should include what?
Signs of infection, slowed wound healing, GI symptoms, dehydration, skin assessment for signs of rash, jaundice or pallor. Lab monitoring
93
Methotrexate (Rheumatrex)
Cytotoxic immunosuppressive agent used for the treatment of some cancers as well as autoimmune disorders such as rheumatoid arthritis and psoriasis
94
Prototype anti rejection agent
Cyclosporine (Neoral, Gengraf, Sandimmune)
95
Black box warning for cyclosporine
Risk of hypertension and nephrotoxicity. Also risk for serious infection
96
Prototype sulfonylurea
Glyburide (DiaBeta)
97
Prototype alpha-glycosidase inhibitor known best for improving glycosylated hemoglobin levels
Acarbose (Precose)
98
Prototype Biguanide drug
Metformin (glucophage)
99
What is the mechanism of action of Metformin?
Reduces the production of glucose by the liver. It also decreases intestinal absorption of glucose and increases insulin sensitivity.
100
Primary adverse affect of metformin?
Lactic acidosis
101
Prototype glitazone
Rosiglitazone (Avandia)
102
What are meglitinides?
Nonsulfonylureas. Repaglinide (Prandin) is the prototype. Lower blood sugar by stimulating pancreatic secretion of insulin. Depends on the existence of functioning beta cells in the pancreas
103
First line drug for type 2 diabetes
Metformin
104
What is possible negative effect of overuse of Tylenol?
Hepatoxicity

Contemporary Pharmacotherapeutica (1 decks)

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