Core Concepts (3/19/15) Flashcards Preview

Pharmacology-Tong > Core Concepts (3/19/15) > Flashcards

Flashcards in Core Concepts (3/19/15) Deck (128):
1

The study of medicine and the effects of chemicals/drugs on the human body and animals is called?

Pharmacology
Pharmakon = medicine drug
Logos = study

2

A chemical must have ______ value without damaging properties to become a useful drug.

Therapeutic

3

The ______ must outweight the ______ when using a drug.

Benefits; risks

4

All ____ are drugs but not all drugs are _____.

medications;medications

5

The nurses responsibilities in medication administration include:

1. Assessing for adverse effects
2. Intervening to make the regimen more tolerable
3. Educating about the drug and drug regimen
4. Monitoring
5. Prevention of drug error

6

The branch of pharmacology that uses drugs to treat, prevent, and diagnose disease. It focuses on the drug's effect on the body and the body's response.

pharmacotherapeutics

7

Drug effects can be either ______ or ______.

therapeutic or adverse

8

There are four different types of drug therapy: acute, ______, ______, and palliative (for pain-like morphine).

-maintenance (Blood pressure med taken to maintain BP)
-supplement/replacement (hormone replacement/insulin is an example)

9

Before taking Beta blockers, you were nervous and dreading giving a speech. BUt after taking it, you were relaxed and laughing. What is the beta blocker suffix?

LOL

Just remember you were able to laugh out loud at how nervous you were before taking the drug

10

Drugs can come from natural or lab sources. Natural sources are plants, animals, minerals. Lab source are _____ or _____ compounds. Sometimes drugs are a combination of btoh natural and lab sources.

inorganic or synthetic.

11

How many stages of approval are there for therapeutic and biologic drugs?

4

12

During the ______ phase, extensive laboratory research is done. Chemicals are tested on animals and cells cultured in the lab.

pre-clinical

13

During phase ____, chemicals are tested on "healthy" human volunteers. This is when proper dosage is determined and adverse effects are assessed (keep in mind LT effects will not show at this time).

I (One)

14

During phase ____, drugs are tried on informed clients and clients with the particular disease.

II (Two)

15

During phase ____, drugs are now used on the clinical market. They remain under review.

III (Three)

Memorization trick - tried on 3 groups so far: animals, humans, public.

16

During phase ____, the drug is continued to be evaluated but is approved.

IV (Four)

17

T or F: There is a governing agency that oversees supplements.

False. It false between drugs and food.

18

What is the name of the governing agency that regulates testing and confirmation of safety and efficacy of food, drugs and cosmetics?

FDA (Food and Drug Administration)

19

What is the name of the governing agency that regulates the categorization, manufacture, distribution and dispensing of drugs and narcotics?

DEA (Drug Enforcement Agency)

20

Controlled substances are categorized into schedules from I to V. Which class has the highest abuse potential and no accepted medical use?

I - One

(Includes LSD, heroin)

21

Which class has the lowest potential for abuse?

V - Five

22

Which class has high abuse potential with severe dependency liability?

II - Two (Marijuana, narcotics, amphetamines and barbiturates are in this group.)

23

Can drugs change which schedule they belong to?

Yes. Vicodin is an example.

24

What is the general rules for administering medication to pregnant women?

1. generally you do not give it; however,
2. if the benefits outweight the risks, you can

25

Pregnancy categories range from A to X. Is the beginning of the alphabet higher or lower risk than X?

Lower. X is the worst. Think X this one off your list.

26

Medications have three names, what are they?

Chemical, generic, and trade

27

The _____ name is the one we need to know. It is assigned by the US Adopted Names council and to a particular category of chemicals that have a particular effect.

generic

28

The patented/proprietary name is called the _____ name and belongs to the developing company. No one can make the drug until its patent has run out.

Trade

29

What is the difference between trade named drugs and the generic versions?

Fillers/binders

Generic brands don't always work because they don't have the correct binders

30

There are three types of drugs - OTC, prescription and _____ drugs.

orphan drugs - not available for use by those who could benefit from them, usually because they are not financially profitable - such as HGH

31

A _______ is used to compare drugs within the same classification.

Prototype

32

What are some concerns with OTC medications?

1. can mask the signs and symptoms of underlying disease
2. can result in drug interaction if taken with prescription medication.
3. Could result in overdose (remember the story of the daughters who gave their mom three meds with acetaminophen because they did not pay attention to labels)

33

What is the safe standard for acetaminophen?

2500mg/ day

34

__________ is the science of dealing with the interactions between living organisms and foreign chemicals; the branch of pharmacology concerned with the effects of drugs and the mechanism of their action.

pharmacodynamics

35

Drug clings to a target cell receptor which allows the drug to be _______.

selective/selectively toxic (kills bacteria but not human)

36

T or F: The better the fit between receptor site and chemical, the more pronounced the reaction.

True

37

_______ within the body are needed to break down the chemical to open up the receptor sites.

enzymes


Ideally drugs will act only on the enzymes essential for a pathogen.

38

What are four drugs actions?

1. replace or act as substitutes for missing chemicals (insulin)
2. Increase of stimulate certain cellular activities (ex.epinephrine - speeds up everything)
3. depress or slow certain cellular activities. (BP med)
4. To interfere with the functioning of foreign cells (chemotherapeutics - penicillin)

39

T or F: the goal for using medication is to have therapeutic effect without harming the host.

True.

40

What are the four main components of pharmacokinetics?

1. absorption
2. Distribution
3. biotransformation (metabolism)
4. excretion

41

Why would you take medication on a full stomach?

Empty stomach?

Avoid stomach upset;

For faster absorption (pH dissolves quicker)

42

When you eat something it goes from your stomach, then to your small intestine, and then into the liver through the _____ _____ ____ . The liver cleans the blood.

Hepatic Portal Vein

43

A higher dose than usually used for treatment, given up front, allowing drug to reach critical concentration quickly (inducing a therapeutic response)...

loading dose

44

The actual concentration that a drug reaches in the body (maintaining an amount)...

dynamic equillibrium

DE is effected by absorption, distribution, biotransformation (metabolism) and excretion.

45

The amount of drug needed to cause a therapeutic effect...

critical concentration

46

_______ is the movement of the drug from the site of administration into the blood.

Absorption

47

Absorption is affected by .... List some factors

1. Route of administration (IV is faster than IM, IM faster than oral)
2. blood flow to the area being treated
3. food in the gut
4. interactions with other drugs (the other drugs may use same receptor sites...)
5. Surface area (how fat is the pt?)
6.Lipid solubility
7. pH Partitioning (acid ionizes in base and vice versa)

48

Due to the _____ ______ ______ , oral medication are reduced in strength, so you have to take more orally.

(Liver generally renders a portion inactive by binding part of that drug with soluble compounds)

First Pass Effect - cleans/reduces the drug to an appropriate amount.

.

Definition of first pass effect - "Hepatic inactivation of certain oral drugs."

49

T or F: If the drug is lipid base the absorption is faster than if the drug is protein binding.

True

50

T or F: The blood brain barrier will only allow water soluble drugs to pass through?

False! Lipid soluble would make the statement true.

51

The process by which a drug is delivered to the tissues and body fluids is called _______

distribution

52

The main factors determining distribution are .....

1. Blood flow
2. cardiac output
3. body composition
4. vasoconstriction/vasodilation

53

Where is the site of biotransformation (metabolism) of drugs?

liver

54

WHat factors influence metabolism?

-liver function
-genetics
-stress
-age

(may be missing enzymes, or have decreased liver function)

55

The most important organ for excretion is the ______

kidney


some drugs are eliminated through lungs, sweat, tears, mammary glands and biliary system (bile related ducts/organs)

56

_____ ______ is the time it takes for the amount of drug int he body to decrease to one half.

half life

TO maintain a level of drugs in the body, for every half life you lose, you have to add back. This is how dosage is determined.

How half life works...

You take a pill and in 12 hours, 50mg becomes 25, in another 12 hours it is 12.5 and in another 12 its 6.25 and so on

57

If the half life is 6 hours, how often would you take the med?

every 4-6 hours


general rule:if the half life is 30-36 hours long, we give the pill once a day

58

If a patient has a decreased response to a drug over time, that person is experiencing ______ to a drug.

tolerance

If this happens, dosage will need to be increased

59

Physical dependence produces _______ symptoms when the drug is stopped.

withdrawal

60

Drugs can interact with ____ and other ______.

food; drugs

61

Drug Drug interactions can do one of the following:
1. additive (1+1=2)
2. enhance each other (potentiation 1+1=3)
3. ________

antagonistic (1+1=0)

62

A ______ dose is given to keep plasma concentration in the therapeutic range.

maintanence

63

A ____ dose results in serious adverse effects

toxic

64

A _____ dose gives us the desired effect and lies between the minimum effective level and the toxic level

therapeutic

65

______ is given by mouth, _______ is given elsewhere

enteral;parenteral

66

List ROUTES of administration....

enteral (GI tube is considered enteral)

parententeral - IV, TPN - total parenteral nutrition thru blood

percutaneous - injection

transdermal/topical - patches or creams

67

Why is it important to obtain a patient history before administering drugs?

History reveals:
- allergies, level of understanding (speak on their level - majority read at grade 6 level), disease (kidney or liver problems?), financial (can they afford med), issues swallowing (if so, may need diff method)

Helps you plan accordingly

68

What are the 8 rights?

First five are standard

1. Patient
2. Medication
3. Dosage
4. Time
5. Route
6. reason
7. approach
8. documentation

69

T or F: Nurses are required to adhere to "Informed consent" before administering medication.

True. Share the side effects, dosage, what the med is for, etc. Make sure patient understands what it does before they take it.

If pt refuses, document!

70

The nurse is responsible for observing and monitoring _________ after administering a drug.

therapeutic effects to make sure the med is doing what we want it to.

side/adverse effects (offer pt crackers for stomach upset, report any sever unexpected adverse effects)

vitals signs

lab values/serum levels

drug interactions

Don't forget to keep teaching!!

71

Effects of medication include: therapeutic, adverse, side, systemic, regional/local effects. What is the effect that is unexpected and rare?

Idiosyncratic effect - drug reactions may be defined as adverse effects that cannot be explained by the known mechanisms of action of the offending agent, do not occur at any dose in most patients, and develop mostly unpredictably in susceptible individuals only.

Memorization - Or as Dr. Tong said "You are an idiot because you don't know what it's doing."

72

What is the desired effect?

therapeutic

73

What effect is harmful and undesirable?

adverse effect which can lead to an adverse drug reaction

74

A mild and possibly expected occurrence is?

a side effect

75

What are the reasons an adverse drug reaction may occur?

drug may have other effects on the body besides therapeutic effect

pt. is sensitive to the drug

drug's action on the body causes other responses

pt. is taking up too much or too little of the drug

76

What are the types of adverse reactions?

primary action

secondary action

hypersensitivity reaction

77

A _______ is an overdose: extension of the desired effect

primary action

78

A _______ is an undesired effect produced in addition to the pharmacologic effect

secondary action

79

A _______ is an excessive response to the primary or secondary effect of the drug

hypersensitivity reaction

80

side effect vs. adverse reaction

a side effect is a common unintended effect of a drug while an adverse reaction is a negative effect that is rare and can be life threatening

81

What are the types of drug allergies?

anaphylactic reaction - (body reacts by forming antibodies and producing histamine; usually throat closing; epinephrine used to counter)

cytotoxic reaction - (produces antibodies that attacj to the drug on cell cites; cyto = cell; damages liver and kidney )

serum sickness reaction (antibodies damage tissues, manifests rash, fever/swollen joints and lymph nodes)

delayed allergic reaction (antibodies bind to WBCs, hives)

82

The body reacts strongly to a med by forming antibodies and immediately producing histamine. The histamine results in hives, closing of the throat, rash, and breathing difficulties. The nursing intervention is Epinephrine. This is which type of allergic reaction?

Anaphylactic reaction

83

The body produces antibodies that circulate in the blood and attach the antigens (the drug) on cell sites. There is a delayed reaction resulting in damage to the liver and kidneys. The nursing intervention is to discontinue meds. This is what type of allergic reaction?

cytotoxic reaction

84

A delayed allergic reaction in which antibodies circulate and damage various tissues. Resulting in rash, fever, swollen joints and lymph nodes. Nursing intervention is to discontinue meds and provide comfort measures. This is _____ ______ ______.

serum sickness reaction

85

________ allergic reaction is several hours after exposure. Antibodies bind to white blood cells resulting in rash or hives. Nursing intervention is to discontinue drug and provide skin care and comfort measures.

Delayed

86

what are the dermatologic reactions?

rash/hives: skin abnormalities, redness or blisters. discontinue meds

stomatitis: inflammation of mucous membranes, bleeding or blisters. frequent mouth care

87

_____________ is destruction of the body's normal flora

superinfections

assess for fever, diarrhea and vaginal discharge. provide supportive care and give anti-fungal meds. stop the drug responsible for infection

88

_______ ________ is bone marrow suppression

blood dyscrasia

assess for fever, chills and weakness. monitor blood counts and protective isolation

89

Which two organs are play a role in toxicity?

liver: assess fever nausea, jaundice, change in urine or stool, elevated liver enzymes. discontinue meds

kidneys: assess change in urinary pattern or elevated BUN and creatinine. notify physician, stop meds, or decrease dose

90

CBC

complete blood count

91

_____ and ______ determine measurement of kidney function

BUN and creatinine


Backstory ....
BUN = A blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of your body in the urine. A BUN test is done to see how well your kidneys are working.

Creatinine = If your kidneys aren't functioning properly, an increased level of creatinine may accumulate in your blood. A serum creatinine test measures the level of creatinine in your blood and gives you an estimate of how well your kidneys filter (glomerular filtration rate).

92

________ is what the muscles put out and the body breaks down

creatinine

Def: a compound that is produced by metabolism of creatine and excreted in the urine.

93

_________ occurs when an overdose of a drug damages multiple body systems and can lead to a fatal reaction

poisoning

94

If someone has ________, the assessment will show low serum blood glucose level. If they are awake and alert, feed them asap. If they are unconscious but have an IV access, give them ____.

hypoglycemia;

D50 (without an IV give glucagon)

intervention: restore glucose to the body (D50)- IV push

95

If someone has _________, the assessment will show high serum glucose level

hyperglycemia

intervention: administer insulin to decrease glucose level. The insulin gets the sugar from the blood and into the cells.

96

What is a normal glucose level ?

70-110mg/dl

97

indications of electrolyte imbalances:

hypokalemia (low potassium - will show on ECG)
hyperkalemia (high potassium)

98

_________ is a decrease in serum potassium level.

ALWAYS CHECK LEVELS BEFORE ADMINISTERING

hypokalemia

intervention: replace serum potassium (IV or oral) and monitor serum level of potassium

99

_________ is a increase in serum potassium level

ALWAYS CHECK LEVELS BEFORE ADMINISTERING

hyperkalemia

interventions: decrease the serum potassium concentration, monitor serum level of potassium, monitor cardiac rhythm

100

________ ________ results in visual changes. If a med is known to cause this you must monitor for it.

ocular toxicity

monitor for visual changes when giving meds known to cause ocular damage and discontinue meds after notifying a physician

101

_________ _________ results in damage to the eighth cranial nerve. Monitor for hearing loss. Discontinue the med after notifying the physician.

auditory damage

monitor for hearing loss, discontinue meds after notifying physician

102

Some medication can have effects on the CNS (neurologic effects)... What is a GENERAL effect we may see from taking an antihistamine such as Benadryl?

assess: altered level of consciousness (drowsiness)

common with antihistamines (Benadryl)

intervention: prevent injury

103

Atropine-like / Anticholinergic effects (neurologic effect)

assess: dry mouth, urinary retention, blurred vision

(Anticholinergic means against the parasympathetic nervous system aka against rest and digest. Dries saliva, closes down gastrointestinal tract and prevents urination)

intervention: sugarless lozenges to keep mouth moist, advise pt. to void before administration of meds

104

Antidepressants work by blocking dopamine, and can cause ______-____ _________; tremors and changes in gait are side effects.

Parkinson-like syndrome

intervention: discontinue meds (change which antidepressant)

105

Neuroleptic malignant syndrome can be caused by antidepressants (which block dopamine). Signs of this are?

extrapyramidal symptoms ( drug induced movement disorders )

Can also cause an extremely high fever.

intervention: discontinue meds

106

Which drug categories are safe for pregnancy?

A and B are relatively safe

107

_______________ drugs may harm the developing fetus or embryo

teratogenic

108

How do you prevent teratogenicity?

Through teaching!

let pregnant women know that any med can affect the baby

weigh actual benefits against potential risk

advise pregnant women to not take meds without checking with their health care provider

109

Dosing considerations:

sex
weight (standard weight is 150lbs)
age (for children use BSA)
physical condition
other drugs pt. is taking

110

Difference between drugs when dealing with children and adults

children absorb, distribute, metabolize, and excrete drugs differently than adults

children organs are not as developed as adults

111

Dosage for children is based on __________ _________ and ________ for adults.

surface area, weight

Especially used for kids and chemo patients

112

What is accurate dosing dependent on?

the prescriber who orders the drug

the pharmacist who dispenses the drug

the nurse who administers the drug

NURSES will always be responsible for any errors because we are suppose to check multiple times.

113

What are the 4 measuring systems used?

metric
apothecary
household
avoirdupois

114

Changes to health care in the 21st century

access to medical and pharmacologic info is available from many sources (TV, internet, etc.)

consumers are demanding specific treatments and considerations (I want that drug!)

alternative therapies are being offered and advertised (remember the story about the lady with her "special tea" that turned out to be why her platelets were low? It was supposed to be topical!!!!)

financial pressures are leading to early discharge (send the guy home in a shock vest?!)

patient teaching and home care provisions are vital

pharmacogenetics

115

Advertisement of drugs must include ___________, _____ _______, and ____________.

contraindications, adverse effects, precautions

116

What internet sources have drug info?

pharmaceutical company info sites

chatrooms w/ others taking the drug

online pharmacies

lists of government regulations

research reports about the drug and its effectiveness

117

What is your responsibility as a nurse if a patient comes to you with drug information from the internet?

explain the info to the patient and guide the patient to good reference material about the drug

118

When determining which internet site to use for drug info what factors should you take into consideration?

navigation( is the site easy to use), contributer (who prepared the site), (accuracy/reliability/updated

119

After two weeks of self treatment (drugs, herbals, etc.) the patient does not see any health improvements what should they do?

GO SEE THE DOCTOR!

120

Problems with OTC meds

can mask the signs and symptoms of disease

can interact with prescription drugs

can be taken in greater than the recommended dose leading to toxicity

121

_____ _____ _____ drugs are drugs that were "grandfathered" in, former prescription drugs that have been tested and found to be safe for the general public if used as directed

Over the Counter (OTC)

122

________ ________ can cause drawbacks. The active ingredient has not been tested by FDA, incidental ingredients are unknown, pts. do not always mention therapies to their health care provider. interactions may occur

alternative therapy

example: St. JOhn's wort. If you take it with oral BC, it will counteract the drug. Ginseng can cause hypoglycemia.

123

_______ _________ and _________ _________ are NOT controlled or tested by the FDA. Advertisement is not restricted because they are considered dietary supplements.

herbal medications, alternative therapies

124

________ __________ medication are used for an indication that is not approved by the FDA.

Off-label medications

Example: Viagra - was made for pulmonary HTN... :-P

125

What is the occurrence of off label medications?

commonly takes place in groups of pts. for whom there is little premarketing testing

used w/ pediatric and geriatric population

126

What are some factors leading to health care crisis?

high cost of care and drugs

huge research and equipment requirements to meet consumer demands

rising cost of health insurance

earlier discharge from hospitals

127

Measures to protect the public from bioterrorism

emergency preparedness at all levels of the government

Education of health care providers and public concerning recognition and treatment of infections causes by bioterrorism

128

____________ ________ is a substance that blocks the neurotransmitter acetylcholine in the CNS and PNS. The side effect is a dry mouth.

Anticholinergic agent