Exam1 Pharm: REV Flashcards
(121 cards)
1
Q
Acebutolol HCl (Sectral), a beta blocker, has negative chronotropic effects, what are they?
A
could cause symptomatic bradycardia and/or heart block
1
Q
Cholinergic effects mimic which nervous system
A
parasympathetic (rest & digest)
1
Q
The nurse is reviewing a patient’s list of medications with the patient. The nurse understands that the older adul’s slower absorption of oral meds is primarily because of…
A
increased pH of gastric secretions
1
Q
Detrol
A
- overactive bladder
1
Q
Decreased albumin level is expected in
A
- Elderly
- Newborns
- Liver Disease
- Manourished.
2
Q
Drug movement from the blood to the interstitial space of tissues and from there into the cells.
A
Distribution
2
Q
Which physiologic change that normally occurs in the older adult has implications for the nurse assessing drug response?
A
Drug half life is lengthened (shorter half life is better)
2
Q
Which drug can be taken orally, noncat or cat?
A
Noncatecholamine
2
Q
An example of this category drug would be accutane.
A
Category X
3
Q
has an antagonistic effect with warfarin and will inhibit its effects.
A
Vitamin K
3
Q
How is cardiac output measured?
A
- heart rate,
- blood pressure
- urine output
3
Q
Psychological benefit of a drug despite no chemical drug effect
A
Placebo Effect
4
Q
The nurse assesses a patient receiving an adrenergic (sympathomimetic) agent. Which finding will be of greatest concern to the nurse?
A
Weak peripheral pulses and decreased heart rate
4
Q
Atropine
A
- pre-op med to decrease salivary secretions and maintain heart rate
- increase heart rate
5
Q
Adverse reactions of Atropine
A
- asal congestion
- tachycardia
- hypotension
- pupillary dilation
- abdominal distention
- palpitations.
6
Q
Scopolamine
A
decreased Gi Motility, Motion sickness
7
Q
Cholinergic/Parasympathetic Actions
A
- Salivation
- Broncho Constriction
- GI peristalsis
- Pupil Constriction
7
Q
Cholinergic Neurotransmitter
A
Acetycholine
8
Q
Schedule III Drug
A
moderate or low physical dependence.
9
Q
Drug that creates a response
A
Agonist
9
Q
If a drug becomes ionized what will happen?
A
it will not pass a lipid soluble
10
Q
Atropine Toxicity
A
MAd as a hatter (confusion), dry as the street, hot as the summer, red as a beet.
11
Q
If a patient has diabetes, what would the best beta blocker be for that patient?
A
Lopressor, Tenormin
12
Q
The nurse takes all precautions in order to ensure that the pediatric patient will receive a drug dosage that is accurate based on body surface area. To which step of the nursing process does this action most closely correspond?
A
planning
13
The nurse is caring for a patient who is prescribed propranolol (Inderal). Which assessment finding will reveal if the medication is having a therapeutic effect?
The patient’s blood pressure is 130/75 mm Hg
13
Which symptom presenting in an older adult would cause the nurse to suspect drug toxicity?
Confusion
14
Movement of the drug and their metabolites out of the body.
Excretion
14
Hypertension Treatment ABCD
* **A**ce inhibitor
* **B**eta Blockers
* **C**alcium channel Blockers
* **D**iuretics
15
Pharmacokinetics Includes These 4 Things
1. Distribution
2. Excretion
3. Metabolism
4. Absorption
15
BBB
* Blood Brain Barrier
* semipermeable in the CNS
* protects brain from foreign substances
* highly lipid drugs cross
* *water soluble drugs do not make it across*
15
The nurse is administering medication to an older adult. The nurse anticipates that this patient’s renal system will have which effect on the medication?
the medication will be excreted slower
15
What are the reasons for the lack of research done for Pediatric Pharmacology?
* difficult to get large enough study sample
* Diseases occur in small numbers
15
If an acid is exposed to an alkaline environment what happens
it becomes ionized
17
A decrease in the responsiveness of the drug over the course of therapy.
Tolerance
17
An estimate of the margin of safety of a drug.
Therapeutic Range
18
A nurse is monitoring a patient receiving atropine. Which finding requires nursing action?
Blood pressure of 90/40 mm Hg
20
Absorption of Medications:
* Lipid soluble medications absorb easily through the GI membrane because the GI membrane is composed mostly of lipids.
* Nonionized substances pass easily through the GI membrane.
* Water soluble medications require a carrier to pass through the GI membrane (active absorption).
21
A 2 year old patient is to receive a topical medication. The nurse considers which factro when administering this medication?
thinner skin in children allows for rapid absorption.
23
an antispasmodic cholinergic blocker used to decrease GI motility in patients with functional GI disorders such as irritable bowel syndrome.
Dicyclomine (Bentyl)
24
Atrovent
used for asthma COPD, and rhinitis
26
A disease characterized by spasm of the arteries in the extremities, especially the fingers. It is typically brought on by constant cold or vibration, and leads to pallor, pain, numbness, and in severe cases, gangrene.
Raynaud's Disease
27
Hypertension Nursing Care
* **D**aily Weight
* **I**ntake & Output
* **U**rine Output
* **R**esponse of BP
* **E**lectrolytes
* **T**Ake pulses
* Ischemic Episodes
* **C**ompications (4C's)
28
"protein binding" refers to...?
* "free" drug (drug not bound to protein) that will be able to create a pharmacologic response
* When two drugs are given together that are both "highly protein-bound" drugs, the pateint is at greater risk of drug accumulation (drug toxicity).
* Ibuprofen is a 98% protein bound drug. This means that 98% of the drug is bound to protein (albumin), and only 2% of the drug is "free".
29
What organ metabolizes the lipid soluble drug to trasnform it to a water soluble drug for renal excretion
Liver
30
Alpha 1 Agonist Used for...
* Bradycardia
* Low BP
* GI
32
Which is a priority nursing diagnosis for a patient receiving an anticholinergic (parasympatholytic) medication?
Impaired gas exchange related to thickened respiratory secretions
32
If a patient has renal disease what happens to drug excretion
slowed or impaired. Drug accumulation
34
Hypertension Treatment
ABCD
* Ace inhibitors/ARBs
* Beta Blockers
* Calcium channel blockers
* Diuretics
36
Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which adjustment to minimize the risk of toxicity?
A decrease in the dosage of drug given
38
During this phase a drug in **solid form** must be disintegrated to dissolve and be absorbed
pharmacoceutic
40
Cholinergic Agonist Effects
Sludge BAM
* **S**alivation/Sweating/Secretions
* **L**acrimation
* **U**rination
* **D**efecation
* **G**I Upset
* **E**mesis
* **B**radycardia
* **A**b Cramps
* **M**iosis
41
A patient with poor renal function (low glomerular filtration) will have what type of creatinine?
* elevated **blood** creatinine levels
* low **urine** creatinine levels.
* drug dosages typically need to be decreased.
42
Adverse drug reaction from excessive dosing of the drug
Toxic Effect
43
Adrenergic Neurotransmitter
norepinephrine, epinephrine
44
Abrupt withdrawal of a beta blocker can cause
rebound hypertension
46
The term used for a drug that is approved for one thing but used for something completely different?
Off Label
47
Predictable secondary effect of the drug. Can be desirable or undesirable
Side effect
48
beta blockers are used to treat:
1. Angina pectoris
2. Congestive heart failure (CHF)
3. Hypertension
50
The process in which a drug passes first through the liver after absorption.
First Pass Effect
51
Schedule I Drug
high abuse, no current medical use
52
why would a protein supplement be prescribed for an older adult?
increases circulation of free drug
53
A patient taking an alpha 1 blocker. What side effect should the patient be cautioned about
reflexive bradycardia
54
Which crosses the blood brain barrier, noncatecholamine or Catecholamine?
NonCatecholamine
55
Drugs that blocks a response
Antagonist
57
What type of food decreases the absorption rate of enteric coated medications?
high fat
58
This is the percentage of the administered drug dosage that reaches the blood stream (systemic circulation).
bioavailability
59
The older adult patient has questions about oral drug metabolism. What is the most important information to include in this patients teaching plan?
first pass effect
60
If excretion is impaired what risks are there for medication?
toxicity
61
Category B Risk for the pregnant woman
May have some risk on animals but none to humans
63
A patient is admitted to the emergency department with an expected cholinesterase inhibitor overdose. What is the nurse’s primary action?
Administer ordered anticholinergic medication
64
Mneumonic
You have 1 heart and 2 lungs
* Beta 1: Heart
* Beta 2: Lungs
65
The nurse uses an appropriate drug reference to obtain drug parameters prior to administration of a medication. To which step of the nursing process does this action most closely correspond?
Nursing Intervention
67
Propranolol (Inderal) is nonselective—it blocks
both beta1 and beta2 receptors at therapeutic dose
68
Movement of a drug from the site of administration to body fluids
Absorption
70
This organ cannot excrete lipid soluble drugs
Kidneys
71
This is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects
Atropine
72
This can directly penetrate membranes. The drug will dissolve into the membrane and cross to the other side.
Lipid Soluble
73
the study of what the body does to the drug
Pharmacokinetics
75
The protein bound drug gets released into the blood stream
free drug
77
"lol" =
beta blockers
78
This is the drug that creates the action desired
Free Drug
79
Adrenergic agents stimulate the
* sympathetic nervous system
80
atenolol selectively blocks which beta blocker?
* *only the beta1 receptors in the heart,*
* not the beta2 receptors located in the lungs
82
What organ is responsible for the majority of drug excretion
kidneys
83
A neonate with lower than normal albumin levels. The nurse is ordered to administer medication that is highly protein bound. The nurse know that what must occur in response to these factors?
Dose should be decreased because of increased unbound active medication
85
a test to determine renal function by comparing the level of creatinine in the blood with the level of creatinine in the urine
Creatinine Clearance
86
This can be used as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion
anticholinergic
87
Secondary effect of the drug. Always undesirable.
Adverse Effect
88
Bentyl
used for irritable bowel syndrome
89
he nurse realizes that a drug administered by which route will require the most immediate evaluation of therapeutic effect?
intravenous
91
What effect may the older adult’s cardiac system have on drug administration in this patient?
Delayed transportation of drugs to the body tissues
92
The nurse recognizes that the administration of a drug influences cell physiology. What is the term for this concept?
Pharmacodynamics
93
This category drug may be used for a pregnant woman experiencing life threatening conditions. When benefit for risk must be determined
Category D Drug
94
Risk for pregnant woman with a category A Medication
No risk to the Fetus
95
A 3-year-old child has been started on a new medication. What is the most important information to convey to the parents?
“Observe the child for potential adverse effects of the medication.”
96
The nurse is caring for a patient who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect?
Increased gastrointestinal (GI) motility
97
Antimuscarinic/Anticholinergic Side Effects
The ABCD'S of Anticholinergic Side Effects
* **A**norexia
* **B**lurry Vision
* **C**onstipation/Confusion
* **D**ry Mouth
* **S**tasis of Urine
98
The nurse understands the differences between drug excretion in children and that in adults. With this knowledge, what does the nurse consider when administering medications to children?
evaulate for drug accumulation, because the excretion of drugs in children is slower
99
This type of drug solubility cannot dissolve into the lipid membrane of the cells. They need a **carrier**.
Water Soluble
100
Schedule II Drug
potential for abuse both physiological and psychological. Ritalin
101
Effects for a beta blocker used for a COPD patient or Diabetic
* Broncho Dilator
* Effects Blood Sugar
* Increase Heart rate
102
Occurs when the drug reaches its highest blood or plasma concentration
peaked
103
Adrenergic/Sympathetic Actions
* Incease HR
* Increase BP
* Pupil Dilation
* Broncho dilation
104
Drugs for Bradycardia and Low Blood Pressure (IDEA)
* **I**soprotonel
* **D**opamine
* **E**pinephrine
* **A**tropine Sulfate
105
This is not a singular entity but rather a group responsible for drug metabolism
Cytochrome P450
106
Which factors will influence the absorption of oral medications?
1. presence of food in the stomach
2. pH of the stomach
3. form of drug preparation
4. pain
107
For a schedule V drug is the potential for abuse small or large?
small
108
What are influencing factors for pharmacokinetics in children related to absorption?
* weight
* age
* health status
* disease
* hydration
109
What are influencing factors for pharmocokinetics in children related to route of admin?
* pH more **ALKALINE**
* gastric emptying
* breast feeding?
* GI surface areas INCREASED
110
Absorption problems IM/SubQ with Children
* peripheral perfusion
* decreased muscle, subq fat
* circulation effects
111
What is a child \< 2years first pass effect?
decreased hepatic enzymes
112
Factors influencing pharmacodynamics in older adults
* altered therapeutic range
* increase sensitivity
* change in organ function
* compensatory response to phys changes
113
Absorbtion factors in older adults
* decreased GI blood flow & motility
* increased Alkaline secretions
114
Distribution facors for older adults
* decreased albumin levels
* decreased mobility (IM)
*
115
*Adrenergic Receptors*
* Alpha 1
* Alpha 2
* Beta 1
* Beta 2
116
Alpha 2 Characteristics
* Reduced Norepi (dec BP)
* decrease GI Tone and motility
* smooth muscle
## Footnote
*postaganglionic, decrease vasoconstriction*
117
Alpha 2
* Blood Vessel
* Eye
* Bladder
* Prostate
## Footnote
*blood vessels, causes vasoconstriction*
118
Anatomy involved in Beta 1 Receptor
* Heart
* Kidney
119
Anatomy Involved in Beta 2 Receptor
* Smooth Muscle
* Lungs
* Uterus
* Liver
120
Beta 1 causes
the release of renin into the blood
121
Beta 2 & muscles
* relaxes uterine smooth muscles
* dilates arterioles in heart, lungs, skeletal muscles
