Exam 1 Pink Packet Flashcards by Rebecca Nims

What are the three phases of Drug Action?

Pharmaceutic (PO Only)
Pharmacokinetic
Pharmacodynamics

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What are the four parts of the Pharmacokinetic Phase?

Absorption
Distribution
Metabolism
Excretion/Elimination

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What are the three types of absorption?

Passive
Active
Pinocytosis

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What is the primary site for metabolism?

Liver
sn: liver disease can cause decreased drug metabolism, leading to toxicity.

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What is the main route for Excretion/Elimination?

Kidneys
sn: Drug accumulation can occur with kidney disease.

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Normal range Creatinine clearance (lab test to determine kidney function)?

85-135 ml/min

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Agonist

Produces a response

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Antagonist

Block a response

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What is the Pharmacodynamic Phase?

Study of drug concentration and it’s effect on the body.
Onset, Peak, Duration of action.

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What do Adrenergic Agonists do?

Hint: Similar to Cholinergic Antagonists

Dilate Pupils
Bronchiole Dilation
Increased HR
Vasoconstriction
Relax Bladder, GI, uterus

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What do Adrenergic Antagonists do?

Hint: Similar to Cholinergic Agonists

Pupil Constriction
Bronchiole Constriction
Decreased HR
Vasodilation
Contract Uterus

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What do Cholinergic Agonists do?

Hint: Similar to Adrenergic Antagonists.

Constrict Pupil
Bronchiole Constriction
Decreased HR
Vasodilation
Contracts Bladder
Increased Peristalsis (Diarrhea)
Increased secretions

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What do Cholinergic Antagonists do?

Hint: Can’t Spit

Dilated Pupils
Bronchiole Dilation
Increased HR
Urinary Retention
Constipation
Decreased secretions

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Mr. Jones has liver and kidney disease. He is given a medication with a half-life of 30 hours. You expect the duration of action of this medication to:
A. Increase
B. Decrease
C. Remain Unchanged
D. Dissipate

A. Increase

Due to Mr. Jones’s kidney and liver disease, his body metabolizes the drug at a slower rate.

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Which of the following is a correctly written goal?
A. EZ will administer the prescribed dose.
B. EZ will learn to administer insulin.
C. EZ will know how to take insulin correctly.
D. EZ will independently administer prescribed dose of insulin at end of 1 hour of instruction.

D. This statement is client centered, states expected change, is realistic and measurable, and has a realistic deadline.

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Adverse reactions and drug interactions occur frequently in the older adult due to which of the following. (Select all that apply)
A. Consumption of numerous drugs due to multiple chronic illnesses.
B. Drugs ordered by several health care providers.
C. Increased incidence of allergic responses.
D. Self-medication with OTC preparations.

A, B, D.

Polypharmacy is a large risk with older adults. Allergic responses are no more significant in any age bracket.

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What are some nonpharmacological treatments to help with sleep disorders like insomnia?

Arise at the same time
Avoid daytime naps
Avoid caffeine <6hrs b4 hs
Avoid heavy meals/exercise b4 hs
Warm bath, reading, music, milk
Decrease noise
Decrease large amounts of fluid

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Sedative Hypnotics Uses

Sedation or hypnotic effect (natural sleep)
High dose anesthesia

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Sedative Hypnotics Side Effects/Adverse Reactions

Hangover
REM Rebound
Dependence
Tolerance
Withdrawal symptoms
Excessive depression
Respiratory depression
Hypersensitivity

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What is the normal respiratory rate for adults?

12-20

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What are the four categories of sedative hypnotics?

Barbituates
Benzodiazepines
Nonbenzodiazepines
Melatonin Agonists

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What happens to your blood pressure when you take any medication that affects your brain?

Decreases, watch for orthostatic hypotension.

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What are the three types of barbituates?

Short-acting
Intermediate-acting
Long-acting

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What do we use long-acting barbituates, like phenobarbitol, to treat?

Seizure disorders, due to the 23 hour half life we do not use these for sleep.

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What do we use short-acting barbituates, like secobarbitol or pentobarbitol, to treat?

Used to induce sleep for those that have trouble falling asleep. Short half life.

What do we use intermediate-acting barbituates to treat?

Used to maintain long periods of sleep. Takes approx 1 hour to take effect.

Which type of barbituate is most prone to a hangover?

Intermediate acting

What is the recommended period of time you should use barbituates?

<2 weeks to avoid tolerance and side effects

What are some contraindications to barbituates?

Hepatotoxicity Pregnancy Respiratory Depression Nephrosis

What are common side effects of barbituates?

N/V/D Lethargy Drowsiness Hangover Dizziness Rash

What are some adverse reactions of barbituates?

Dependence Tolerance Urticaria (rash) Hypotension Respiratory Depression Laryngospasm

What two endings do all benzodiazepines have?

Pam Lam Restoril (temazepam) Ativan (lorazepam) Valium (diazepam)

What is the recommended amount of time you should use a benzodiazepine?

No longer than 3-4 weeks to prevent REM Rebound.

Which Sedative Hypnotic is a highly protein bound narcotic?

Benzodiazepines

What is the main use of Benzodiazepines?

To treat insomnia

What are some contraindications for benzodiazepines?

Pregnancy Lactation Renal diseases Liver disease Mental Disorders

What contraindications do Benzodiazepines and Barbituates have in common?

Pregnancy Hepatotoxicity/Liver Disease Nephrosis/Kidney Disease

What are side effects of benzodiazepines?

Drowsiness Lethargy Hangover Dizziness Confusion N/V/D

What a side effect for benzodiazepines that is not a side effect for barbituates?

Confusion

What is the antidote to benzodiazepines?

Flumazenil

What are the adverse reactions to benzodiazepines?

Tolerance Dependence Depression Hypotension Coma with overdose

What a side effect for barbituates that is not a side effect for benzodiazepines?

Rash

What is an adverse reaction to benzodiazepines that is not an adverse reaction to barbituates?

Coma with overdose Depression

What is an adverse reaction to barbituates that is not an adverse reaction to benzodiazepines?

Urticaria (rash) Respiratory Depression Laryngospasm

What category of sedative hypnotics does Zolpidem (Ambien) fall in?

Nonbenzodiazepines

What category of sedative hypnotics does Ramelteon (Rozarem) fall in?

Melatonin Agonists

Which antihistamine is also used as a sedative hypnotic?

Diphenhydramine (Benadryl, Nyquil)

What two vital signs are the most important to monitor when giving a sedative hypnotic?

Blood pressure Respiratory Rate (check back in an hour)

What two labs will you make sure to check before giving a sedative hypnotic?

Liver Renal

Why do patients pre-medicate with a narcotic analgesic (versed) and an anticholinergic (atropine) before surgery?

Dries secretions Relaxes them

What combination of medications is given with balanced anesthesia? (3)

Short acting barbituate (pentothol) Inhaled gas (nitrous oxide) Muscle relaxant

What are the different types of anesthesia? (5)

Inhalation IV Topical ~caine Local Spinal - remain flat!

What are the 5 cardinal signs of inflammation?

Redness Edema Drainage Heat Pain

What chemical mediator triggers inflammation and pain?

COX 2

What chemical mediator triggers clotting and protects the stomach lining?

COX 1

What are the three groups of anti-inflammatory drugs?

NSAIDs (nonsteroidal anti-inflammatory drugs) Corticosteroids DMARDs (disease modifying antirheumatic drugs)

Which medication is used for it's anti-inflammatory, antipyretic, analgesic, and anti-platelet functions?

Acetylsalicylic acid (ASA) Aspirin

What interactions does Aspirin have?

Anticoagulants Hypoglycemics (increase risk)

What adverse reactions are associated with Aspirin?

Tinnitus Vertigo Bronchospasm urticaria ulceration thrombocytopenia bleeding

What three adverse reactions are associated with ASA toxicity?

Tinnitus Vertigo Bronchospasm

Can we give Aspirin to children?

No, this can lead to Reye's syndrome

What are some interventions for taking Aspirin?

Take with food Monitor for bleeding Do not crush Avoid during/2 days before menses Avoid before surgery Avoid alcohol Avoid giving to children with flu-like symptoms

What is the main difference between aspirin and NSAIDs?

NSAIDs are not an anti-platelet and do not cause ototoxicity

What anti-inflammatory drug is given for rheumatoid and osteoarthritis?

NSAIDs

What interactions do NSAIDs have? (7)

Increase effects of warfarin sulfonamides certain cephalosporins phenytoin insulin oral hypoglycemics some herbs

What adverse reactions do NSAIDs cause?

Bleeding Gastric upset N/V Edema

NSAIDs have most of the same adverse reactions as Aspirin, what are the differences?

Aspirin can not be given to children. NSAIDs interact with dong quai, garlic, feverfew, and gingko.

Can I take Aspirin and Ibuprofen together?

No, avoid taking ASA and NSAIDs.

What benefit does selective COX-2 inhibitors have when taking NSAIDs?

They decrease GI problems and bleeding

What is the one adverse reaction to selective COX-2 inhibitors? Celecoxib (Celebrex) Meloxicam (Mobic)

Edema

What labs will you monitor for selective COX-2 inhibitors?

Renal BUN/creatinine

What ending do all corticosteroids have?

~one Prednisone Prednisolone Dexamethasone

The half-life of corticosteroids is 24 hours, how often would some be taking them?

Once daily

What are some considerations when on steroids? (4)

Increase WBC Taper dose Elevated blood sugars Immunosuppression

What are the main uses of DMARDs?

Rheumatoid Arthritis (Antimalarials) Cancer suppression (Immunosuppressives) Delay disease progression (immunomodulators)

How long does it take for antimalarials to have a positive effect on RA?

4-12 weeks

What disease attacks joints, tendons, and other tissues causing hyperuricemia?

Gout

What is the drug used for gout?

Colchicine

What are the three main side effects of Colchicine?

N/V/D

What should be avoided when taking Colchicine?

foods rich in purines (wine, alcohol, organ meats, sardines, salmon, gravy) ASA - instead take acetaminophen for pain Make sure to increase fluid intake!!

What contraindications are associated with Colchicine?

Sever renal disease GI problems

Which drug lowers serum uric acid by getting "all the purines out"? Used to prevent gout

Allopurinol

What nursing implications are associated with allopurinol? (3)

Increase water intake Avoid alcohol, caffeine, & thiazide diuretics Yearly eye exam

What drug increases the rate of uric acid excretion by inhibiting its reabsorption? Used for chronic gout

Uricosurics

What are the 7 types of pain?

Acute - non narcotic and narcotic Cancer - narcotic Chronic - non narcotic and narcotic Somatic - NSAIDs Superficial Vascular - non narcotic Visceral - narcotic

What are some nonnarcotic analgesics? (4)

ASA NSAIDs Acetaminophen (tylenol) Antipyretics

Does tylenol have anti-inflammatory properties?

No, tylenol is only an anelgesic and antipyretic.

What are adverse reactions to acetaminophen?

Overdose is life threatening Hepatotoxicity (look for N/V/D, abdominal pain)

Narcotic analgesics act on the CNS, so what two vitals signs will you watch?

Blood Pressure Respiratory Rate

What are some of the uses of narcotic analgesics?

Moderate/severe pain Antitussive (cough) Antidiarrheal

What are some common side effects of narcotic analgesics? (6)

N/V constipation Decreased BP Urinary Retention Tachycardia Drowsiness

What are some common adverse reactions of narcotic analgesics? (5)

Orthostatic hypotension Respiratory depression Tolerance Dependence Abstinence syndrome

What is the antidote for narcotic analgesics?

Naloxone (Narcan)

What different ways can you administer morphine?

IV - frequently PCA PO SC IM

When giving the opioid morphine via IV push, how quickly are you pushing it?

Slowly! Over 4-5 minutes

What are some uses of morphine?

Acute MI - relaxes coronary vessels CA acute pain Severe pain

What is the generic name for hydromorphone?

Delaudid

Delaudid is six times more potent than morphine, yet has a shorter duration of action. What must you do when giving delaudid IV?

IV push slowly over 2-5 minutes Must dilute with normal saline

What are two other types of narcotic analgesics besides morphine and hydromorphone?

Combination - hyrdocodone/acetaminophen - vicoden codeine/acetaminophen - Tylenol #3 Transdermal opioid - fentanyl patch

What do all anticonvulsants have in their name?

~gaba

What drugs help to decrease spasticity and pain related to muscular hyperactivity?

Muscle relaxants - no longer than 3 weeks

Exam 1 Pink Packet Flashcards

(101 cards)