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Pharmacology > Chp 3-4 Infants & Elderly/Cultural, Legal, Ethical > Flashcards

Chp 3-4 Infants & Elderly/Cultural, Legal, Ethical Flashcards

1
Q

During pregnancy, how do drugs cross the placenta?

A

by diffusion

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2
Q

When is drug transfer to the fetus most likely to occur?

A

during the last trimester of pregnancy

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3
Q

When is exposure of the fetus to drugs most detrimental?

A

during the first trimester of pregnancy

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4
Q

When is the fetus at greatest risk for drug-induced developmental defects?

A

during the first trimester of pregnancy

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5
Q

Can/should a women take high blood pressure medication during pregnancy?

A

Yes women need to take medications to control situations such as high blood pressure.

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6
Q

A patient younger than 38 weeks gestation is classified as what?

A

premature or preterm infant

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7
Q

A patient younger than 1 month is classified as what?

A

neonate or newborn infant

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8
Q

A patient age 1 month up to 1 year is classified as what?

A

infant

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9
Q

A patient age 1 year up to 12 years is classified as what?

A

child

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10
Q

Neonatal/pediatric Pharmacokinetics - Absorption considerations:

A
  • gastric pH less acidic
  • gastric emptying slowed
  • intramuscular absorption faster and irregular
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11
Q

Neonatal/pediatric Pharmacokinetics - Distribution considerations:

A
  • greater total body water means lower fat content
  • decreased level of protein binding
  • immature blood-brain barrier (more drugs enter the brain)
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12
Q

Neonatal/pediatric Pharmacokinetics - Metabolism considerations:

A
  • liver immature, does not produce enough microsomal enzymes
  • older children may have increased metabolism, requiring higher doses than infants
  • other factors such as status of liver enzyme production, genetic differences, and substances to which the mother was exposed during pregnancy.
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13
Q

Neonatal/pediatric Pharmacokinetics - Excretion considerations:

A
  • kidney immaturity affects glomerular filtration rate and tubular secretion
  • decreased perfusion rate of the kidneys may reduce excretion of drugs
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14
Q

What are the factors that affect pediatric drug dosage?

A
  • skin is thin and permeable
  • stomach lacks acid to kill bacteria
  • lungs have weaker mucus barriers
  • body temp less well regulated, and dehydration occurs easily
  • liver and kidneys are immature, impairing drug metabolism and excretion
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15
Q

What are the methods of dosage calculation for pediatric patients?

A
  • body surface area method (uses West nomogram)
  • always use weight in kilograms, not pounds
  • body weight dosage calculations (uses mg/kg)
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16
Q

When prescribing medications, what are the considerations for elderly patients (over 65)?

A
  • high use of medications
  • polypharmacy
  • noncompliance, nonadherence
  • increased incidence of chronic illnesses
  • sensory and motor deficits
17
Q

What is polypharmacy?

A

the use of a large number of medications, commonly considered to be the use of five or more.

18
Q

Elderly Pharmacokinetics - Absorption considerations:

A
  • gastric pH less acidic
  • gastric emptying slowed
  • movement through GI tract slowed
  • blood flow to GI tract reduced
  • use of laxatives may accelerate GI motility
19
Q

Elderly Pharmacokinetics - Distribution considerations:

A
  • lower total body water percentages
  • increased fat content
  • decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)
20
Q

Elderly Pharmacokinetics - Metabolism considerations:

A
  • aging liver produces fewer microsomal enzymes, affecting drug metabolism
  • reduced blood flow to the liver
21
Q

Elderly Pharmacokinetics - Excretion considerations:

A
  • decreased glomerular filtration rate

- decreased number of intact nephrons

22
Q

What are problematic medications for the elderly? (8)

A
  • analgesics, including NSAIDs and opioids
  • anticoagulants
  • anticholinergics
  • antidepressants
  • antihypertensives
  • cardiac glycosides (digoxin)
  • sedatives and hypnotics, CNS depressants
  • thiazide diuretics
23
Q

What three areas can the factors that contribute to the safety or potential harm of drug therapy during pregnancy be broken down into?

A
  1. drug properties
  2. fetal gestational age
  3. maternal factors
24
Q

drug polymorphism

A

the effect of a patient’s age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs.

25
Q

What factors need to be considered when making a cultural assessment? (9)

A
  • language spoken
  • health beliefs and practices
  • past uses of medicine
  • herbal treatments, folk remedies, home remedies
  • OTC drugs and treatments
  • usual response to illness
  • responsiveness to medical treatment
  • religious practices and beliefs
  • support from the patient’s cultural community
    dietary habits
26
Q

What are legal nursing considerations?

A
  • State and federal legislation (dictate the boundaries for professional nursing practice)
  • Nurse practice acts (identify the definition of the scope and role of the professional nurse)
  • Guidelines from professional nursing groups (American Nurses Association AMA); Institutional policies and procedures; State and federal hospital licensing (help to identify the legal boundaries of nursing practice.)
  • Case law or common law (prior court rulings that affect professional nursing practice)
  • HIPAA (legal-ethical dimensions of professional nursing care)
27
Q

What are the nurse practice acts?

A

state laws that are instrumental in defining the scope of nursing practice and protect public health, safety, and welfare. Acts define and identify:

  • scope of nursing practice
  • expanded nursing roles
  • educational requirements
  • standards of care
  • minimally safe nursing practice
  • differences between nursing and medical practice
28
Q

What does HIPPA stand for?

A

Health Insurance Portability and Accountability Act

29
Q

expedited drug approval

A

“fast track” approval - allows pharmaceutical manufacturers to shorten the approval process and allows prescribers to give medications that showed promise during early phase I and II clinical trials to qualified patients.

30
Q

What is the drug approval process?

A
  1. preclinical testing phases (in vitro studies using tissue samples and cell cultures, and animal studies)
  2. clinical (human) studies - 4 phases
31
Q

in vitro

A

performed or taking place in a test tube, culture dish, or elsewhere outside a living organism.

32
Q

When is a drug put on the market?

A

after phase III is completed if an investigational new drug application submitted by the manufacturer is approved by the FDA.

33
Q

What is the collective goal of the drug approval process phases?

A

to provide info on the safety, toxicity, efficacy, potency, bioavailability, and purity of the new drug.

34
Q

What must be obtained from patients before they can be enrolled in an investigational new drug (IND) study during the clinical phase?

A

informed consent

35
Q

What happens during phase I of the clinical drug study?

A

Studies involve small numbers of healthy subjects rather than those who have the disease that the drug is intended to treat.
Purpose - to determine the optimal dosage range and pharmacokinetics of the drug and ascertain if further testing is needed.
(includes blood tests, urinalyses, assessments of vital signs, and specific monitoring tests)

36
Q

What happens during phase II of the clinical drug study?

A

Studies include a small number of volunteers who have the disease.
Purpose - to determine the drug’s effectiveness and identify any adverse effects.
(therapeutic dosage ranges are refined)

37
Q

What happens during phase III of the clinical drug study?

A

Studies involve large number of patients who are followed by medical research centers and other types of health care entities.
Purpose - to provide info about infrequent or rare adverse effects that may not yet have been observed during previous smaller studies.

38
Q

What are the objectives of phase III of the clinical drug study?

A

to establish the drug’s clinical effectiveness, safety, and dosage range.

39
Q

What happens during phase IV of the clinical drug study?

A

postmarketing studies that are voluntarily conducted by pharmaceutical companies to obtain further proof of the therapeutic and adverse effects of the new drug.
(Data gathered for at least 2 years after the drug’s release)

Pharmacology (12 decks)

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