Chapter 1 Flashcards
(190 cards)
1
Q
What is pharmacokinetics?
A
Pharmacokinetics is the process of how medications travel through the body.
2
Q
What are the 4 phases of pharmacokinetics?
A
- Absorption
- Distribution
- Metabolism
- Excretion
3
Q
A
4
Q
What is absorption in pharmacokinetics?
A
Absorption is the process of a medication moving from the site of administration into the bloodstream.
5
Q
Where can absorption happen in the body?
A
Absorption can happen through the GI tract, muscle, skin, mucous membranes, or subcutaneous tissue.
6
Q
What are the most common routes of medication administration?
A
Enteral (through the GI tract) and parenteral (by injection).
7
Q
What does the rate of medication absorption affect?
A
It affects how soon the medication takes effect.
8
Q
What does the route of administration affect?
A
It affects the rate and amount of absorption.
9
Q
What does the amount of medication absorbed affect?
A
It affects the intensity of the medication’s effects.
10
Q
What factors affect absorption of oral medications? (1 of 4)
A
Stability and solubility of the medication (how well it dissolves).
11
Q
What factors affect absorption of oral medications? (2 of 4)
A
GI pH and gastric emptying time (how fast the stomach empties).
12
Q
What factors affect absorption of oral medications? (3 of 4)
Whether food is in the stomach or intestines.
A
Whether food is in the stomach or intestines.
13
Q
What factors affect absorption of oral medications? (4 of 4)
A
The form of the medication (like enteric-coated or extended-release).
14
Q
What is a barrier to absorption for sublingual or buccal medications?
A
Swallowing the pill too soon — stomach acid breaks it down before it can work.
15
Q
What is the absorption pattern for sublingual/buccal medications?
A
They absorb quickly into the bloodstream because of highly vascular mucous membranes.
16
Q
What are barriers to absorption for vaginal or rectal medications?
A
Stool or infectious material can block contact with tissue, limiting absorption.
17
Q
What is the barrier to absorption for intradermal and topical medications?
A
Because epidermal cells have close proximity and are tightly packed, absorption is slow and gradual.
18
Q
How do intradermal and topical medications work?
A
They mainly have local effects, but can also work systemically—especially if the drug is lipid-soluble and passes into subcutaneous tissue.
19
Q
Do intradermal/topical meds face a capillary barrier?
A
No. Capillary walls have large gaps between cells, so there’s no barrier to absorption into the bloodstream.
20
Q
What is distribution in pharmacokinetics?
A
Distribution is the transportation of medications to sites of action by bodily fluids like blood.
21
Q
How does circulation affect distribution?
A
Poor circulation (like in peripheral vascular disease or cardiac disease) can reduce blood flow, making it harder for medications to reach their target areas.
22
Q
How does cell membrane permeability affect distribution?
A
Medications must pass through tissues and membranes to reach their target.
Lipid-soluble drugs (like nitroglycerin or levodopa) can cross the blood-brain barrier and placenta more easily.
23
Q
How does protein binding affect distribution?
A
Medications bind to proteins in the blood (mostly albumin), which limits how much drug can leave the blood and reach body tissues.
24
Q
What happens when two drugs compete for the same protein binding site?
A
They can displace each other, increasing the amount of free drug in the blood, which may cause toxicity
25
What is another name for metabolism in pharmacokinetics?
Metabolism is also called biotransformation.
26
What happens during metabolism?
The body uses enzymes to change medications into a less active or inactive form.
27
Where does metabolism mainly occur?
Metabolism mainly happens in the liver, but can also occur in the kidneys, intestines, blood, and lungs.
28
How does age affect metabolism in infants?
Infants have a limited ability to metabolize medications, so drugs stay in their bodies longer.
29
How does age affect metabolism in older adults?
Older adults have reduced liver and kidney function, so they metabolize drugs more slowly.
30
Why do older adults need smaller doses of medication?
Because their bodies process drugs slower, which can lead to drug buildup (accumulation) and toxicity.
31
How does carbamazepine affect metabolism?
Carbamazepine increases enzyme activity, so medications are broken down faster and may need a higher dose to stay effective.
32
What is the first-pass effect?
And how does it effect metabolism
When the liver inactivates some medications the first time they pass through it, reducing their effect.
33
34
What is an intervention for medications with a high first-pass effect?
Give the medication sublingually or by IV to bypass the liver.
35
What happens if two drugs use the same metabolic pathway and how does this effect metabolism ?
The rate of metabolism slows down, which can cause accumulation and toxicity.
36
How does nutritional status affect metabolism?
Malnourished patients may lack the nutrients needed to make metabolizing enzymes, which slows drug metabolism.
37
Which of the following situations may require an increased medication dosage?
A. Increased renal excretion
B. Peripheral vascular disease
C. Increased medication-metabolizing enzymes
D. Liver failure
Correct Answers: A, B, C
Wrong Answer: D (Liver failure requires a decreased dose)
38
39
Which of the following situations may require a decreased medication dosage?
A. Liver failure
B. Malnourishment
C. Concurrent medications using the same metabolic pathway
D. Increased renal excretion
Correct Answers: A, B, C
Wrong Answer: D (Increased renal excretion may require an increased dose)
40
Where are medications excreted from the body?
Mainly the kidneys, but also the liver, lungs, intestines, and exocrine glands like breast milk.
41
What does it mean if the plasma medication level is in the therapeutic range?
The drug is effective and not toxic.
42
What does a high therapeutic index mean?
The drug has a wide safety margin and usually doesn’t need blood level monitoring.
43
What affects the timing of peak levels in medications?
The route of administration
44
What is the peak time for oral medications?
1–3 hours after administration.
45
What is the peak time for IV medications?
10 minutes after administration.
46
What is a trough level?
The lowest plasma level of a medication.
47
When should a trough level be drawn?
Immediately before the next dose.
48
What is a plateau in medication levels?
A steady concentration of medication in the blood during multiple doses.
49
What is half-life?
The time it takes for 50% of the drug to be eliminated by the kidneys and liver.
50
What happens when intake = metabolism + excretion?
The drug reaches a steady level in the blood.
51
How many half-lives to reach steady state?
4 half-lives.
52
What is a short half-life?
Drug leaves the body quickly (about 4–8 hours).
53
How does a short half-life affect dosing?
Needs shorter intervals between doses to maintain effect.
54
What is a long half-life?
Drug leaves the body slowly (over 24 hours).
55
What are the risks with long half-life drugs?
Higher risk of toxicity and accumulation.
56
Can long half-life drugs be given less often?
Yes, they can be given at longer intervals without losing effect.
57
Do long half-life drugs take longer to reach steady state?
Yes, they take a longer time to reach steady blood levels.
58
What is pharmacodynamics?
It’s the interaction between medications and target cells, organs, or systems to produce an effect.
59
What is an agonist?
A medication that mimics or activates the body’s natural chemicals by binding to receptors.
60
What is an example of an agonist?
Morphine – it binds to receptors to cause pain relief, sedation, and constipation.
61
What is an antagonist?
A medication that blocks receptors, preventing natural chemicals or other drugs from activating them.
62
What is an example of an antagonist
Losartan – it blocks angiotensin II receptors on blood vessels, preventing vasoconstriction.
63
What is pharmacokinetics?
The study of how drugs move through the body over time.
64
What are the four main processes of pharmacokinetics?
Absorption, distribution, metabolism, and excretion.
65
True or False: Pharmacokinetics focuses on the effects of drugs on the body.
False. It focuses on the body's effect on drugs.
66
Fill in the blank: The process of drug absorption refers to how a drug is ______ into the bloodstream.
taken up
67
What term describes the fraction of an administered dose of unchanged drug that reaches the systemic circulation?
Bioavailability
68
Which pharmacokinetic process involves the transport of a drug to its site of action?
Distribution
69
True or False: Metabolism usually converts drugs into more active forms.
False. Metabolism typically converts drugs into inactive forms.
70
What is the primary organ responsible for drug metabolism?
The liver
71
What is clearance in pharmacokinetics?
The volume of plasma from which a substance is completely removed per unit time.
72
Fill in the blank: The half-life of a drug is the time it takes for the concentration of the drug in the plasma to be reduced by ______.
half
73
What is the term for a drug's distribution in the body relative to plasma concentration?
Volume of distribution
74
Multiple Choice: Which of the following factors does NOT affect drug absorption? A) pH of the stomach B) Drug formulation C) Patient's age D) Liver function
D) Liver function
75
What is first-pass metabolism?
The process by which the concentration of a drug is significantly reduced before it reaches systemic circulation.
76
True or False: Drugs can only be eliminated from the body through urine.
False. Drugs can be eliminated through urine, bile, sweat, and other routes.
77
What is the significance of the therapeutic window?
It is the range of drug concentrations in the blood that produces the desired effect without toxicity.
78
Fill in the blank: The rate of drug elimination is often described by ______ kinetics.
first-order
79
What does the term 'loading dose' refer to?
A higher initial dose of a drug to quickly achieve therapeutic levels.
80
Multiple Choice: Which of the following is NOT a route of drug administration? A) Oral B) Intravenous C) Subcutaneous D) Inhalation D) Transdermal E) None of the above
E) None of the above
81
What is the role of plasma protein binding in pharmacokinetics?
It affects the distribution and availability of the drug in the body.
82
True or False: Pharmacokinetics is concerned with the relationship between drug concentration and patient response.
False. That is the focus of pharmacodynamics.
83
What is the primary aim of pharmacokinetics in drug development?
To understand the absorption, distribution, metabolism, and excretion of drugs.
84
Fill in the blank: The term 'steady state' refers to a condition where the overall intake of a drug is ______ to its elimination.
equal
85
What does the term 'clearance rate' signify in pharmacokinetics?
The efficiency with which a drug is removed from the body.
86
What is the effect of age on pharmacokinetics?
Age can affect drug absorption, distribution, metabolism, and elimination.
87
Multiple Choice: Which pharmacokinetic parameter is most important for determining drug dosing regimens? A) Half-life B) Volume of distribution C) Bioavailability D) Clearance
D) Clearance
88
What is a partial agonist?
A drug that acts as both an agonist and antagonist because it doesn’t bind strongly or fully to receptor sites.
89
Example of a partial agonist and its actions?
Nalbuphine – agonist at kappa receptors, antagonist at mu receptors.
90
What are mu receptors and what do they control?
Mu receptors are opioid receptors that control pain, mood, and breathing.
91
What forms are included in oral/enteral medication routes?
Tablets, capsules, liquids, suspensions, elixirs, and lozenges.
92
When are oral medications contraindicated?
Vomiting,
decreased GI motility
decreased LOC
absent gag reflex
93
What position should a patient be in when taking oral meds?
Sitting at a 90-degree angle.
94
How should meds and analgesics be given with food?
With a small amount of food only.
95
What should you avoid if the patient can’t take the full med dose?
Avoid giving large amounts of food or beverages.
96
What juice is contraindicated with most meds?
Grapefruit juice.
97
What does “take on an empty stomach” mean?
(regarding the time frame)
30 min–1 hr before meals or 2 hrs after meals.
98
Directions for pouring liquid meds (suspensions/elixirs)?
1.Place med cup on a flat surface
2. read dose at base of meniscus (the lowest level of fluid)
99
100
Disadvantages of oral medications?
Variable absorption, inactivation in GI tract (first-pass effect), requires patient cooperation and consciousness.
101
102
What is the sublingual route?
Medication placed under the tongue
103
What is the buccal route?
Medication placed between the cheek and gums.
104
How do sublingual and buccal meds enter the body?
They enter the bloodstream directly and bypass the liver.
105
Patient education for sublingual/buccal meds?
Keep med in place until fully dissolved; don’t eat or drink until then.
106
Can a patient with an NGT receive sublingual medications?
Yes, if they are alert and able to let the med dissolve under the tongue (since it doesn’t go through the GI tract).
Never put a sublingual med in the NGT
107
How are meds administered through an NGT?
Use a syringe to let the med flow by gravity or gently push with a plunger.
108
How do you prevent clogging during NGT med administration?
Flush the tube before and after each med, ending with 15–30 mL of warm sterile water
109
What are some forms of topical medications?
Powders
sprays
creams
ointments
pastes
Oils
suspension-based lotions.
110
How should topical meds be applied?
With gloves, a tongue blade, or a cotton-tipped applicator—never with bare hands.
111
What should be done before applying topical meds to the skin?
Wash the skin with soap and water, then pat dry.
112
What technique should be used for open wounds when applying topical meds?
Use surgical asepsis.
113
What is a transdermal medication?
A med in a skin patch that’s absorbed through the skin to produce systemic effects.
114
How should the skin be prepared for a transdermal patch?
Wash with warm soap and water; apply to a hairless area.
115
Why rotate transdermal patch sites daily?
To prevent skin irritation.
116
How should a patient be positioned for eye medication?
Sitting upright or lying supine, with head tilted slightly back and eyes looking up
117
Where should you place your hands when giving eye drops?
(Regarding dominant and non dominant)
Dominant hand on the patient’s forehead; hold the dropper 1–2 cm above the conjunctival sac.
118
Where should eye medication be placed?
Into the conjunctival sac—not directly on the cornea.
119
Q: What should the patient do after receiving eye drops?
Close eyes gently; if they blink during administration, repeat the process.
120
Why apply gentle pressure to the nasolacrimal duct after giving eye meds?
To prevent systemic absorption—hold for 30–60 seconds with a clean tissue.
121
How long should you wait between administering multiple eye meds in the same eye?
At least 5 minutes.
122
How do you apply eye ointment?
Apply a thin ribbon along the lower eyelid from inner to outer canthus.
123
How should the patient be positioned for ear medications?
Sitting upright or lying on their side
124
How do you position the ear for drops in a child under 3?
Pull the auricle down and back.
125
How do you position the ear for drops in an adult?
Pull the auricle up and outward.
126
How far above the ear canal should the dropper be held?
About 1 cm.
127
How long should the patient stay side-lying after ear drops?
2–3 minutes.
128
Why should ear drops be warmed in your hand before use?
Cold drops can cause dizziness.
129
What do you do after administering ear drops?
Gently press the tragus (unless painful) and place a cotton ball in the outer ear (not deep inside).
129
What do you do after administering ear drops?
Gently press the tragus (unless painful) and place a cotton ball in the outer ear (not deep inside).
130
What technique is used for nasal med administration?
Medical asepsis
131
How should the patient be positioned for nasal meds?
Lying supine so the meds reach the correct nasal passage.
132
How should hands be positioned when giving nasal drops?
Dominant hand gives the drops, non-dominant hand supports the head
133
What instructions should be given during and after nasal med administration?
Breathe through the mouth, stay supine, and don’t blow nose for 5 minutes.
134
Q: How should nasal spray be administered?
Prime if needed, insert tip against bare nose, point nozzle away from septum, and spray during inhalation.
135
What position is used for rectal medication insertion?
Left lateral or lateral semi-prone (recumbent) position.
136
How far should a rectal suppository be inserted?
Just beyond the internal sphincter.
137
How long should the patient remain in position after rectal med insertion?
At least 5 minutes in the flat or left lateral position
137
What position is used for vaginal medication insertion?
Supine, knees bent, feet flat, hips closed—modified lithotomy or dorsal recumbent.
138
Where should a vaginal suppository be inserted?
Along the posterior vaginal wall
139
How long should the patient remain in position after rectal med insertion?
At least 5 minutes in the flat or left lateral position
140
What position is used for vaginal medication insertion?
Supine, knees bent, feet flat, hips closed—modified lithotomy or dorsal recumbent.
141
How far do you insert vaginal suppositories?
A: 7.5–10 cm (3–4 inches).
142
How far do you insert vaginal creams, jellies, or foam?
A: 5–7 cm (2–3 inches)
143
How long should the patient remain supine after vaginal med insertion?
.
5 minutes
144
What does MDI stand for?
Metered-Dose Inhaler.
145
How many times should you shake an MDI before use?
Shake 5–6 times vigorously.
146
How should you hold an MDI?
Mouthpiece at the bottom, thumb near mouthpiece, index/middle fingers on top.
147
147
How far should the MDI be from your mouth?
2–4 cm (1–2 inches) away or around the mouthpiece.
148
How do you breathe when using an MDI?
Exhale, tilt head back, press inhaler while inhaling slowly and deeply for 3–5 seconds, hold breath for 10 seconds, then exhale with pursed lips.
149
How long should you wait between MDI puffs?
: At least 1 minute.
150
What is the purpose of a spacer with an MDI?
Holds meds longer, delivers more to the lungs, and less to the oropharynx.
151
Should you shake a DPI (Dry Powder Inhaler)?
No, do not shake.
152
How do you use a DPI?
Follow manufacturer instructions (usually load dose or turn wheel), inhale, and hold breath for 5–10 seconds.
153
How often should you clean an inhaler, cap, and spacer?
Once a day with warm water, then let dry completely.
154
What is the best IM injection site for infants (under 1 year) and toddlers (12–24 months)?
Vastus lateralis
155
Which site is preferred for IM injections over 2 mL?
Ventrogluteal site.
156
Why is the deltoid site limited for IM injections?
It has a small muscle mass, so it can only hold up to 1 mL of fluid.
157
What type of syringe should be used for doses less than 0.5 mL?
A TB (tuberculin) syringe.
158
Where should you avoid giving injections?
Areas with edema, inflammation, moles, birthmarks, or scars.
159
What are intradermal injections used for?
TB testing and checking for med/allergy sensitivity.
160
How much medication is used in an intradermal injection?
0.01–0.1 mL.
161
What type and size of needle is used for intradermal injections?
25–27 gauge, 1/4–5/8 inch needle.
162
At what angle should you give an intradermal injection?
10–15° angle, with bevel up.
163
What are recommended sites for intradermal injections?
Inner mid-forearm and scapular area of the back.
164
What should appear after an intradermal injection, and what should you not do?
A small bleb should appear—do not massage the area.
165
What types of meds are given subcutaneously?
Small doses of non-irritating, water-soluble meds (e.g., insulin, heparin).
166
What needle size is used for SubQ injections?
3/8–5/8 inch, 25–31 gauge.
167
What is the maximum volume for a SubQ injection?
1.5 mL.
168
What are recommended SubQ injection sites?
Abdomen, upper hips, lateral upper arms, and thighs.
169
At what angle should you inject SubQ meds in an average-size patient?
45–90°, with skin pinched.
170
At what angle should SubQ meds be injected in obese patients?
90°
171
What is the typical solution volume for IM injections?
1–3 mL per injection.
172
What do you do if the IM med volume is more than 3 mL?
Split into 2 syringes and use 2 different injection sites.
173
What are the advantages of IM injections?
Good for poorly soluble meds and slow-absorbing (depot preparations )
174
What are the disadvantages of IM injections?
Risk for pain, local tissue damage, nerve injury, and infection at the site.
175
What are IVs used to administer?
Meds, fluids, and blood products.
176
What are the types of IV access?
Short-term: peripheral catheter.
Long-term: PICC line or tunneled catheter.
177
What IV gauge is used for trauma?
16 gauge.
178
What IV gauge is used for blood administration?
18 gauge
179
What IV gauge is used for children, older adults, and post-op patients?
22–24 gauge.
180
Where are preferred IV sites in adults?
Peripheral veins in the arms or hands, based on patient preference.
181
What IV sites are used in newborns?
Veins in the lower leg, head, or feet.
182
When is the Z-track method used?
For irritating fluids or those that can stain tissue.
183
Why is the Z-track method used?
To prevent leakage into subcutaneous tissue.
184
What effect does free-floating air have on irritating meds?
It can dilute them.
185
What is the purpose of an epidural?
To give IV opioid analgesics like morphine or fentanyl.
186
Where is the epidural catheter inserted?
Into the epidural space, between L4–L5 vertebrae.
187
What device is used to administer an epidural?
An infusion pump
