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2020 Pharmacology I > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

(116 cards)

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1
Q

absorption

A

tramission of med from site of entry to bloodstream

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2
Q

rate of absorption

A
  • how soon med takes effect
  • affected by formulation, route of admin
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3
Q

What determines how strong the effect of a med will be?

A

amount of med absorbed

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4
Q

first-pass effect

A

med goes through liver first and is partly metabolized, reducing the amount available to cause therapeutic effect

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5
Q

pros and cons of PO route

A
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6
Q

pros and cons of IV route

A
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7
Q

distribution

A

transportation of med from blood stream to site of action

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8
Q

traffic

A
  • perfusion
  • what’s in the way
  • how fast it’s moving
  • ability to travel between cells
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9
Q

plasma protein binding

A
  • some meds need to bind to protein for transportation
  • albumin most common
  • meds can compete for binding sites
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10
Q

unbound drug

A
  • free drug = drug effects
  • can lead to toxicity
  • check serum protein if giving multiple protein-binding meds
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11
Q

metabolism

A
  • biotransformation
  • turns drug into less active or inactive form
  • happens primarily in liver, but also in kidneys, lungs, bowel, blood
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12
Q

factors affecting metabolism

A
  • requires higher dose
    • ↑ enzymes: rapid metabolism
    • first-pass effect (PO): inactivates portion of dose
  • possible toxicity
    • similar meds: use same pathway
  • requires lower dose
    • nutritional status: ↓ enzymes produced
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13
Q

toxicity

A
  • unbound drug accumulation
  • can be caused by
    • poor metabolism
    • poor excretion
    • competing drugs
  • check organ fxn, plasma drug levels before admin
  • know s/sx of toxicity for meds you give
  • stop med, notify provider
  • give antidote if applicable
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14
Q

hepatotoxicity

A
  • liver highly susceptible
  • alterations in liver enzyme may not show sx
  • polypharmacy ↑ risk
  • teaching: Tylenol, ETOH ↑ risk
  • assess fxn before giving meds
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15
Q

s/sx of hepatotoxicity

A
  • jaundice: yellowing of skin, sclera
  • fatigue
  • loss of appetite
  • N&V
  • wt loss
  • dark or tea-colored urine
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16
Q

excretion

A
  • primarily through kidneys, but other pathways exist (sweat)
  • kidney fxn will affect excretion
  • check BUN, Cr
  • kidney dz = smaller dose
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17
Q

MEC

A

minimum effective concentration

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18
Q

minimum effective concentration (MEC)

A

lowest amount of drug needed in blood to produce therapeutic effect

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19
Q

therapeutic range

A

drug blood level at which therapeutic effect is achieved, but toxicity is not

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20
Q

therapeutic index

A
  • width of therapeutic range
  • high = better safety margin
  • low = high risk (narrow therapeutic range)
    • close monitoring of plasma drug levels required
    • trough levels drawn immediately before next dose
    • peak levels drawn at time indicated by pharmacy
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21
Q

half life

A
  • time it takes for med in body to drop by 50%
  • short (4-8 hr): more frequent dosing
  • long: less frequent dosing, takes longer time to reach plateau
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22
Q

assessment before medication therapy

A
  • health hx
    • age
    • chief complaint
    • all Dx health problems
    • adverse effects/side effects
    • herbal/natural products used
    • caffeine, tobacco, ETOH, street drug use
    • pt’s understanding of med purpose
    • pt’s beliefs, concerns, feelings about med
    • FOOD AND MED ALLERGIES
  • physical exam - focused or comprehensive
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23
Q

components of Rx

A
  • pt name
  • date and time of Rx
  • name of med
  • dosage of med
  • route of admin
  • time and frequency
  • signature of provider
  • ALL REQUIRED
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24
Q

six rights of safe med administration

A
  • right medication
  • right dose
  • right route
  • right time
  • right documentation
  • 7TH RIGHT: right of pt refusal
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25
common med errors
* wrong med of IV fluid * incorrect dose or IV rate * wrong pt * wrong route * wrong time * admin of known allergic med * omission of dose * inccorect D/C of med or IV fluid
26
how to prevent med errors
* know about the **medication** * get info about pt's **Dx** and **conditions** (allergies, organ failure, deficiencies, etc.) * know pt **allergies** * get **assessment** data (VS, labs, etc.) * omit or delay as indicated by pt condition, and **NOTIFY PROVIDER** * practice **six rights** every time * interpret Rx accurately; look out for * error-prone abbreviations * confused medication names * high-alert meds * confusing decimals * verify with provider if unclear or seems inappropriate
27
when to report med errors
EVERY TIME, as soon as pt is taken care of
28
culture of safety
* ALWAYS report med errors * focus on system changes to prevent errors * point out near misses * notify provider of error; pt should be told * follow facility policy on reporting * don't mention reporting form in pt chart
29
side effect
* a secondary effect of a drug * mild, do not require stopping medication * example: drowsiness with morphine
30
adverse effect
* undesired, inadvertent, unexpected, **SEVERE** response to med * stop med immediately, treat rxn * report to FDA medWatch
31
anticholinergic effects
* muscarinic receptor blockade * most effects in * eyes * smooth muscle * exocrine glands * heart * teaching: how to minimize dicomfort (↑ fluids, etc.) * ABCDs * agitation * blurred vision * constipation/confusion * dry mouth * stasis of urine/sweating * AKA * can't pee * can't see * can't spit * can't shit
32
immunosuppression
* decreased or absent immune response * **agranulocytosis**: caused by some meds that damage bone marrow * immunosuppressant meds (i.e. steroids) **mask sx** (fever, inflammation, etc.) * monitor for delayed wound healing, s/sx of infection * teaching: **avoid contagions** (hand sanitizer, sick people, mask, etc.)
33
agranulocytosis
* ↓ in infection-fighting granulocytes in the blood * may occur * in some leukemias * after treatments toxic to bone marrow (e.g., chemotherapeutic agents; clozapine)
34
non-opioid analgesics
* pain meds w/o opioid * pain assessment: faces, 0-10, FLACC * for mild-moderate pain * desired outcome: ↓ **pain**, ↓ fever, ↓ inflammation * also used as * antipyretic (no ASA in children) * anti-inflammatory (not acetaminophen)
35
acetaminophen
* non-opioid analgesic, antipyretic * modulates pain signal transmission by slowing production of prostaglandins in CNS * route: OTC PO, Rx IV forms * interactions * ETOH: \> 1-2 drinks/day * caution with warfarin (bleeding risk) * read labels, avoid OD with **combo meds**
36
acetaminophen toxicity
* one of the most common ODs * antidote * **acetylcysteine** * IV or PO * within 8-10 hr of ingestion * higher initial dose * *toxic dose (if available): \> 7.5 g in adults, 150 mg/kg in children* * *max safe dose = **4 g/day** for adults, 90 mg/kg in children* * interventions * labs * electrolytes * LFT, BUN, Cr * acetaminophen level, toxicology * CBC, PT * BG * urine tox screen * Hcg (if appropriate for pt) * activated charcoal (best within 4 hr of ingestion) * ICU * s/sx 1. nausea 2. vomiting 3. malaise 4. diarrhea 5. diaphoresis 6. abd pain 7. ↑ blood/urine level of acetaminophen 8. ↑ liver enzyme in first day 9. jaundice, altered coagulation in first 36 hr 10. liver failure 11. coma 12. death
37
NSAIDs
* MOA: inhibits enzyme that produces prostaglandins (COX-1 and COX-2) → ↓ inflammation, pain, fever * complications * ↑ risk of GI ulcer, bleeding, renal impairment * ↑ risk of MI and stroke (except ASA) * interactions * risk of bleed with anticoagulants, glucocorticoids, other NSAIDs * admin * stop as directed before procedures * notify provider about bad SE: bleeding, N&V, abd pain * routes: PO, IV, IM * contraindication: hypersensitivity to ASA (applies to all NSAIDs) * precautions * bleeding disorders * GI bleed * severe hepatic, renal, or CV dz * pregnancy: safe use not established, avoid during second half
38
complications of ASA
* Reye syndrome (rare, but serious) * salicylism (mild toxicity)
39
Reye syndrome
* rare, but serious * happens when used as antipyretic in children with viral illness * s/sx * diarrhea * tachypnea * vomiting * severe fatigue * fever * hypoglycemia → confusion, sz, LOC
40
slicylism
* mild ASA toxicity * s/sx * tinnitus * sweating * HA * dizziness * resp alkalosis * stop taking and notify provider
41
ASA toxicity
* progresses from slicylism * s/sx * high fever * sweating * acidosis * dehydration * electrolyte imbalances * coma * resp depression * **medical emergency** * interventions * gastric lavage/activated charcoal * hemodialysis * cooling with tepid water * IV fluid correction * acidosis: Tx with bicarb
42
opioid agonist common side effects
* resp depression * monitor VS * do not give if RR \< 12 * worse with concurrent ETOH, CNS depressants * sedation * fall risk * monitor VS * avoid certain activities * worse with concurrent ETOH, CNS depressants * constipation * prevention (↑ fluid and fiber, docusate sodium) * acute Tx: laxative * long-term use: opioid antagonist * N&V: antiemetic (promethazine = synergist, or ondansetron * orthostatic hypotension * fall risk * move slowly * worse with antihypertensives * urinary retention * monitor I&O * encourage voiding Q4H * assess for distention * worse with BPH and concurrent anticholinergics
43
opioid long-term use
* **physical dependence** * can lead to abuse or illicit use * withdrawal: **must taper** * **tolerance** * diminished therapeutic response * will not get relief or SE from normal dose
44
acute opioid OD
* s/sx * resp depression * coma * pinpoint pupils * Tx * stop med * CPR * antidote: **naloxone** * mechanical ventilation
45
PCA
panti-controlled analgesia
46
PCA pump
* allows self-admin * pt must be awake * don't let family push button * on-demand only or basal rate with PRN dose * when switching to PO: ensure adequate pain control
47
NSAIDs to know
* 1st gen (COX-1 and COX-2) * ibuprofen (Advil, Motrin) * aspirin (Bayer, etc.) * naproxen (Aleve) * indomethacin * diclofenac * ketorolac (Toradol) * meloxicam (Mobic) * 2nd gen (COX-2) * celecoxib (Celebrex)
48
diuretics
* baseline and ongoing assess * wt * VS * I&O * electrolytes * BG * LFT * cholesterol * teach about s/sx of electrolyte and fluid imbalance * usually given early in day, esp when scheduled * consider foley in immobile pts * add to fall risk
49
loop diuretics
* MOA: block reabsorption of Na and Cl to prevent water reabsorption * used when large amts need to be excreted (pulmonary edema, conditions not responsive to other diuretics) * ototoxic - monitor for tinnitus * can cause hypokalemia * vomiting, fatigue, cramps, weakness * monitor labs * teaching: high-K+ foods: bananas, potatoes, dried fruit, nuts, spinach, citrus
50
diuretics to know
* loop * furosemide (Lasix) * thiazide * hydrochlorothiazide (Microzide) * K-sparing * spironolactone (Aldactone) * osmotic * mannitol (Osmitrol)
51
loop and thiazide diuretics interactions
* digoxin toxicity: monitor cardiac status and K levels * antihypertensives: ↑ hypotension, monitor VS * lithium: ↑ effects → toxicity, esp if hyponatremic * NSAIDS: block diuretic effects
52
thiazide diuretics
* MOA: same as loop, but milder effects * same interactions as loop * **first line med for essential HTN** * risk for hypokalemia * hyperglycemia - monitor BG * hyperuricemia, hypomagnesemia, ↑ lipids * monitor labs * hypomagnesemia s/sx: weakness, muscle twitching, tremors
53
s/sx of hypokalemia
* vomiting * fatigue * leg cramps * weakness
54
s/sx of hypomagnesemia
* weakness * muscle twitching * tremors
55
hyperuricemia
excess uric acid in blood
56
K-sparing diuretics
* MOA: block action of aldosterone → K+ retention, Na and water excretion * combined with other diuretics to spare K+ in HTN Tx * monitor for hyperkalemia * \> 5 * weakness * fatigue * dyspnea * dysrhythmias * N&V * endocrine SE * impotence * gynecomastia * hirsuitism
57
s/sx of hyperkalemia
* weakness * fatigue * dyspnea * dysrhythmias * N&V * K+ \> 5
58
K-sparing diuretics interactions
* ACE inhibitors → ↑ K+ retention * K+ supplements: hyperkalemia
59
K-sparing diuretics contraindication
* kidney failure * anuria
60
osmotic diuretics
* MOA: ↑ serum osmolality: pulls water into vascular system for excretion * uses: ↓ ICP, IOP; protect kidneys during AKI * complications * HF, pulmonary edema: crackles, dyspnea, wt gain NVD * rebound ICP: change in LOC, HA, N&V * metabolic acidosis: restlessness and drowsiness * contraindications * active intracranial bleed * anuria * severe pulmonary edema * dehydration * renal failure * interactions * lithium: monitor lithium levels, may need ↑ dose * ↑ risk for hypokalemia with cardiac glycosides
61
potassium
* reference: 3.5-5.0 mEq/L * monitor lab, ECG * s/sx of hypo * anorexia * N&V * lethargy * muscle weakness * leg cramps * LOC/orientation: confusion, anxiety, apathy, irritability, coma * CV changes * s/sx of hyper * muscle weakness: legs → trunk * fatigue * nausea * bradycardia * possible dysrhythmia * parathesias * dietary * hyper: avoid high-K+ foods * hypo: eat more potatoes, bananas, nuts, dried fruit, spinach
62
s/sx of hypoglycemia
* ↓ BG * shaking * tachycardia * diaphoresis * dizziness * anxiety * hunger * vision changes * weakness * fatigue * HA * irritability * → insulin shock
63
s/sx of hyperglycemia
* extreme thirst * urinary frequency * dry skin * hunger * blurred vision * drowsiness * slow wound healing
64
insulin
* MOA: promote cellular uptake of glucose; glucose → glycogen; move K+ into cells * use: control BG, Tx for acute hyperkalemia
65
types of insulin
* rapid * **lispro (Humalog)** * aspart (NovoLog) * glulisine (Apidra) * short: regular (Humulin R, Novolin R) * intermediate * **NPH (Humulin N)** * detemir (Levemir): dose-dependent (more med = longer duration), so 0.4 U/kg = 20-24 hr, long-acting; **do not mix**, do not give IV * long: glargine (Lantus)
66
insulin dosing
* titrated to pt needs * pt should track BG * A1c: average BG over 3 mo * intermediate/long: adjusted over time * rapid and short: based on BG level or CHO count * pts may need larger dose when * sick * stressed * growing * pregnant * taking meds * eating more * pts may need smaller dose when exercising or early pregnancy
67
mixing insulin
* inject air: cloudy, then clear * draw up: **clear, then cloudy**
68
abrupt onset hypoglycemia
* SNS effects * tachycardia * palpitations * diaphoresis * shakiness
69
gradual onset hypoglycemia
* PNS manifestations * HA * tremors * weakness
70
Tx of hypoglycemia
* conscious pts: snack of 15g carbs * 4 oz OJ * 2 oz grape juice * 8 oz milk * glucose tabs per package instructions * unconscious pts: IV glucose or SQ/IM glucagon * encourage medical alert bracelet
71
self-injection teaching
* rotate injection sites with 1 in between to prevent lipohypertrophy * stay a few inches from umbilicus * pinch skin up if not enough SQ fat for needle
72
glucagon
* use: ↑ BG in hypoglycemic emergency * routes: SQ, IM, IV * give food when pt conscious * look for BG \> 50 after admin
73
s/sx of hypothyroidism
* intolerance to cold * receding hairline, hair loss, brittle hair and nails, dry skin * extreme fatigue, lethargy, apathy * dull, blank expression * facial and eyelid edema, thick tongue * anorexia, constipation * muscle aches, weakness * menstrual disturbances * late s/sx * ↓ body temp * bradycardia * wt gain * ↓ LOC * thick skin * cardiac complications
74
levothyroxine
* synthetic thyroid hormone replacement * most common, though others exist * overmedication = hyperthyroidism * ↑ metabolic rate and fxn * **start low and go slow** * watch for and report s/sx of hyperthyroidism * admin: take on empty stomach **with no other meds** * monitor: TSH, T4 * **lifelong therapy** needed * eval: better mood and energy, ↑ appetite, stable temp, ↓ wt
75
s/sx of hyperthyroidism
* intolerance to heat * fine, straight hair; finger clubbing; localized edema * tremors, muscle wasting * diarrhea, wt loss * bulging eyes, enlarged thyroid * facial flushing, ↑ systolic BP * breast enlargement, menstrual changes
76
anti-thyroid meds
* propylthiouracil (PTU) * methimazole * radioactive iodine * Lugol's solution (strong iodine)
77
PTU and methimazole
* blocks synth of thyroid hormone, inhibits iodine use by gland * overmedication = hypothyroidism * complications: agranulocytosis, hypatotoxicity * teaching * report * s/sx of hypothyroid * sore throat * fever * monitor CBC, LFT * onset: 1-2 wks * do not d/c abruptly
78
radioactive iodine
* destroys thyroid tissue **permanently** * high dose: treat hyperthyroid * low dose: thyroid scan * complications * radiation sickness (monitor for s/sx) * hematemesis * epistaxis * severe N&V * bone marrow depression (monitor CBC) * teaching/admin * limit contact with others to 30 min/day * 2-3 L of fluid/day * follow protocol for human waste disposal
79
Lugol's solution
* non-radiactive iodine * MOA: inhibits thyroid hormone production and blocks release of hormone to bloodstream * uses: ↓ size of thyroid before surgery, emergency Tx of thyrotoxicosis * complication: iodism * s/sx * metallic taste * stomatitis * sore teeth, gums * HA * rash * severe GI distress * swelling of glottis * notify provider, stop Tx * give thiosulfate, gastric lavage * teaching/admin * ↓ Na intake * eval: wt gain, normal sleep, WNL HR
80
antidiuretic hormone
* vasopressin * desmopressin (DDAVP)
81
diabetes insipidus
* body can't manage water balance * polyria, polydipsia * UOP up to 15 L/day * Tx: ADH (vasopressin, desmopressin)
82
ADH
* promotes reabsorption of water in kidney * vasoconstriction * uses * Tx of diabetes insipidus * sometimes in code blue to ↑ central blood flow * control some types of bleeding * desired outcomes * ↓ UOP, about 1.5-2 L/day * ↑ BP (code blue) * controlled bleeding * desmo: hemophilia * vaso: GI bleed
83
ADH SE and interactions
* water intoxication * reabsorb too much water * monitor for s/sx * sleepiness * pounding HA * ↓ H2O intake * myocardial ischemia * contraindicated in CVD * monitor ECG, BP * monitor I&O, UA specific gravity, electrolytes
84
adrenal hormone replacement
* hydrocortisone, prednisone * SE * **hyperglycemia** * monitor BG, insulin needs * osteoporosis (long-term use) * Ca and vit D supplements * adrenal insufficiency (abrupt d/c) * **TAPER** * PUD, GI discomfort * monitor for blood in stool, abd pain * prophylactic H2 blocker * infection: monitor for s/sx * eval: relief of sx of adrenal insufficiency * weakness * hypoglycemia * hyperkalemia * fatigue
85
s/sx of adrenal insufficiency
* weakness * hypoglycemia * hyperkalemia * fatigue
86
med types for Tx of PUD
* abx * H2 blockers * PPIs * antacids * prostaglandin E analog * mucosal protectant
87
abx for PUD
* amoxicillin (Amoxil) * bismuth (Pepto-Bismol) * clarithromycin (Biaxin) * metronidazole (Flagyl) * tetracycline * tinidazole
88
general rules for abx
* take all of medicine, even if you start feeling better * the more frequent the dosing, the higher risk of noncompliance * for nausea: take with small amount of food unless contraindicated * report allergic rxn: rash, hives, itching, anaphylaxis * treat anaphylaxis as emergency * wheezing * swelling of lips, tongue, throat * difficulty breathing
89
H2 blockers
* not antacids * MOA: block histamine, one of the first stimuli for acid production * onset: within 1 hr * duration: 9-12 hr
90
PPIs
* MOA: block proton pump that exchanges H+ for K+, suppressing acid secretion * onset: up to 4 days * duration: 1-3 days * greater acid suppression than H2 blockers: suppresses all acid secretion, not just one stimulus
91
antacids
* MOA: directly neutralize acid in stomach * onset: 5 min * duration: 30-60 min * Al and Ca compounds: constipation * Mg compounds: diarrhea * **MANY interactions**; should be taken 1 hr before or 2 hr after any other meds
92
prostaglandin E analog
* misoprostol * acts like prostaglandins, which protect stomach mucosa * **pregnancy risk category X**
93
PUD emergent sx
* acute severe abd pain * blood in stool or vomit * coffee-ground emesis (hematemesis)
94
things to avoid with PUD
* spicy foods * caffeine * nicotine * NSAIDs * anticoagulants
95
bulk-forming laxatives
* psyllium * can cause obstruction of esophagus, intestines
96
surfactant laxatives
* stool softener * docusate sodium * often given as preventative with opioids
97
stimulant laxatives
* bisacodyl * alters fluid/electrolyte transport * fluid accumulation in bowel stimulates peristalsis
98
osmotic laxatives
* magnesium hydroxide * lactulose * bowel prep
99
laxative considerations
* Hx: **duration** of use * bulk laxatives: **take with water** to prevent obstruction * all can lead to **diarrhea** * goal: return to regular, soft, easy BMs
100
laxative contraindications
* fecal impaction * bowel obstruction * acute surgical abd (risk of perforation) * nausea, cramping, abd pain * ulcerative colitis, diverticulitis (**except bulk-forming**)
101
some roles of vitamins and minerals
* RBC production * bone building * nerve cell fxn * hormone production
102
complications of vitamin and mineral deficiency
* anemias * heart dz * cancers * osteoporosis
103
iron supplement SE
* constipation * nausea * diarrhea * vomiting * backache
104
iron supplement teaching
* take on empty stomach 1 hr before meal unless GI distress occurs * extra vitamin C helps absorption of PO Fe * harmless green or black stools * therapy duration: 1-2 mo * eat foods high in Fe * liver * egg yolk * muscle meat * yeast * grains * green, leafy veggies
105
evaluation: iron supplement
* 4-7 days: ↑ reticulocyte * 1 mo+: ↑ Hgb of 2 g/dL * improvement in skin and mucuous membrane pallor, energy level, fatigue
106
potassium chloride
* essential for conduction of nerve impulses, electrical excitability of muscle, regulation of acid/base balance * use * hypokalemia * supplement for K+-depleting meds * excessive vomiting, diarrhea, laxatives, intestinal drainage, GI fistula
107
potassium chloride complications
* GI distress and ulceration * N&V * diarrhea * abd pain * esophagitis * take with food or 8 oz water * hyperkalemia * eval with serum level * for IV admin: monitor for s/sx of hyperkalemia
108
supplements in medication Hx
* always ask what they're taking and why * be respectful * put on list, tell provider and pharmacist * recognize serious SE/AE * teach pt
109
asthma
* chronic airway dz * inflammatory disorder: inflammation or hyper-responsiveness * intermittent and reversible * airway obstrution - small airway dz * leads to * bronchoconstriction * bronchospasm * **can be sudden**
110
COPD
* chronic * constant, often with worsening periods * progressive * largely irreversible * airflow restrictions and inflammation * most cases preventable (smoking)
111
lower resp disorder Tx
* bronchodilators (beta2-adrenergic agonists) * methylxanthines * inhaled anticholinergics * anti-inflammatory meds * glucocorticoids * mast cell stabilizers * leukotriene modifiers
112
beta2-adrenergic agonists
* prototype: albuterol (Ventolin, Pro-Air) * action: activate receptors in bronchial smooth muscle to relax and dilate * bronchospasm relieve, histamine blocked, diliary motility increased * routes: inhalation (short-acting), oral * uses: prevention of exercise-induced asthma, bronchospasm, long-term control of asthma
113
beta2-adrenergic agonist complications
* tachycardia, agina * monitor for chest, jaw, arm pain or palps; notify of HR increase \> 20-30 bpm * avoid caffeine * may need lower dose * tremors: usually resolve with continued use
114
anticholinergics (inhaled)
* prototype: ipratropium (Atrovent) * other: tiotropium * MOA: blocks muscarinic receptors for bronchodilation * use: relieves bronchospasm * COPD * allergen- or exercise-induced * off-label: asthma
115
methylxanthines
* prototype: thophylline * relaxes bronchial smooth muscle * route: PO or IV (emergency only) * acts like caffeine (avoid drinking caffeine when using)
116

2020 Pharmacology I (21 decks)

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