IM1- PHARM COMPREHENSIVE QUIZ (PHARM 1,2,3,4 Flashcards
(243 cards)
1
Q
What is an adverse drug reaction (ADR)
A
“Any noxious, unintended, undesired effect that occurs at normal drug doses”
2
Q
What are some mild ADR effects?
A
- Drowsiness
- Itching
- Nausea
- Rash
3
Q
What are some severe ADR effects?
A
- Respiratory depression
- Organ injury
- Anaphylaxis
- Death
4
Q
What are some ADR Considerations?
A
- What increases the risk?
-Multiple illnesses
-age - What is the impact- for whom?
- How can harm be minimized
- Checking the mar
-Verify arm band - ask allergies
- Checking the mar
5
Q
Define side effect
A
A nearly unavoidable secondary drug effect produced at therapeutic doses
6
Q
Define toxicity
A
Any severe ADR, regardless of the dose that caused it
7
Q
Define allergic reactions
A
Immune response, the intensity of which is determined by immune system, not dosage
8
Q
Define idiosyncratic effect
A
Uncommon drug response resulting from genetic predisposition
9
Q
Define Paradoxical effect
A
The opposite of the intended drug response
10
Q
Define iatrogenic disease
A
Occurs as the result of medical care or treatment including disease produced by drugs.
11
Q
Define physical dependence
A
Body has adapted to drug exposure in such a way that abstinence syndrome will develop if discontinued
12
Q
Define carcinogenic effect
A
The ability of certain medications and chemicals to cause cancers
13
Q
Define teratogenic effect
A
Drug-induced birth defect
14
Q
What are some characteristics of hepatotoxic drugs. list 5
A
- Liver is the primary site of metabolism
- Drugs are leading cause of liver failure
- Over 50 commonly given drugs are hepatoxic
- Some drug metabolites are hepatoxic
- Combining hepatoxic drugs increases risk of liver injury.
15
Q
What are characteristics of QT drugs?
A
- QT drugs - prolong QT interval
- Can cause life-threatening dysrhythmias
- QT drugs found in several drug classes
- Females at higher risk
- Multiple QT drugs should not be given concurrently
16
Q
True or false: Some medications are not appropriate for patients with prolonged QT interval
A
True
17
Q
How are kidneys affected by ADR
A
- Because kidneys filter metabolites out of body cumulative exposure can cause damage
18
Q
How are the ears affected by ADR?
A
- Ototoxic reactions can cause permeant damage
19
Q
How are the lungs affected by ADR?
A
- Can be pneumotoxic
over 600 drugs are pneumotoxic
20
Q
What are some questions you should ask when trying to determine if your patient is having an ADR?
A
- Did symptoms appear shortly after the drug was first used?
- Did symptoms abate when the drug was discontinued
- Did the symptoms reappear when the drug was reinstituted
- Is the illness itself sufficient to explain to explain the event
- Are other drugs in the regimen sufficient to explain the event.
21
Q
What are some ways to minimize ADRs?
A
- Early identification is key
- Know major ADR’s that a drug can produce
- Monitoring of organ function if toxic drugs are being given
- Individualizing therapy
- Patient teaching
22
Q
What are black box warnings?
A
- Strongest safety warning a drug can carry and still remain on the market
23
Q
What does the black box warning contain?
A
Concise summary of the adverse effects of concern
24
Q
True or false: The most serious medication warning required by the FDA is the black box warning?
A
True
25
What are some considerations when faced with a BBW? (black box warning)
1. Does the potential benefit of treatment outweigh the risk?
2. Are there safer (and equally effective) alternatives?
3. Would a safer but less effective alternative be appropriate?
4. Is the boxed warning applicable to this specific patient?
5. Can action be taken to ameliorate the potential for an adverse reaction?
26
Define a medication error?
Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer
27
True or false: A medication error can cause both direct and indirect harm?
True
28
What are causes of medication errors?
1. Human factors
2. Communication mistakes = 90% of fatal errors
3. Name confusion
4 Packaging, formulations and delivery services
5. Labeling and reference materials
29
True or false: If the same dose of a drug is given to a big person and a small person, the drug concentration will be lower in the small person?
False- the drug concentration would be higher
30
What are some factors affecting individual response to a drug?
1. Body composition
2. Age
-Infants-- immature organ system
- Older adults -- decline in organ function
3. Pathophysiology
4. Tolerance
5. Comorbidities and drug interactions
6. Diet
7. Patient compliance
8. Medication Errors
31
How does kidney disease affect an individual response to a medication?
Reduces the rate of drug excretion- drugs may accumulate to toxic levels
32
How does liver disease affect an individual response to a medication?
Reduces rate of drug metabolism- drug may accumulate to toxic levels
33
How does tolerance affect an individual's response to a drug?
it decreases responsiveness to a drug as a result of repeated drug administration
34
How does comorbidities and drug interactions play a factor in an individual's response to a drug?
1. Drugs taken to manage one condition may complicate management of another
35
How does a diet play a factor in an individual response to a drug?
Good diet can elicit therapeutic responses and reduce harm from ADR's
Some foods can interact with drugs and cause ADR's
36
How does patient compliance play a factor in an individual's response to a drug?
1. Failure to take
37
What are some reason a patient may not be able to comply with taking medication?
1. Manual dexterity and visual acuity
2. Intellectual capacity & Psychologic state
3. Attitude and belief toward drugs
4. Ability to pay
38
What are some geriatric concerns with drug therapy?
1. Organ function
2. Comorbidities
3. Polypharmacy
4. Noncompliance
39
In the elderly the ability to to absorb drugs......?
1. Rate of absorption slows
2. Gastric acidity declines
40
In elderly the ability of distribution is affected by many factors including.....
1. Increased body fat % ---> plasma drug levels reduced
2. Decreased % lean body mass---> plasma drug levels increased
3. Decreased total body water---> plasma drug levels increased
4. Decreased serum albumin concentration ---> plasma drug levels increased
41
In Elderly metabolism tends to _____ with age
decline (highly variable)
42
In elderly excretion begins to decline progressively in _____ adulthood (wait... what?? not sure what I was asking here sorry)
Early
43
What is the most important cause of ADR's in older adults?
Excretion
44
True or false: ADR's are 7 times more common in older adults?
True
45
ADR"s in the elderly population account for what percentage of hospital admissions?
16 %
46
ADR's in the elderly population account for what percentage of all medication-related deaths?
50%
47
True or false: ADR's are mostly dose related in elderly?
True
48
True or false: ADR's in the elderly are unavoidable?
False-- Mostly avoidable
49
True or false: older adults are less likely to share alcohol or recreation drug use?
True
50
True or false: Symptoms of ADR's in the elderly tend to be nonspecific?
True
51
What are important risk factors for ADR's in the elderly?
1. Reduced renal function- drug accumulation
2. Polypharmacy
3. Greater severity of illness
4. Low therapeutic index drugs
5. Increased individual variation
6. Inadequate supervision of long-term therapy
7. Poor adherence
52
What is the goal of drug thearpy?
Reduce symptoms and improve quality of life
53
What should the nurse plan look like for drug therapy/preventing ADR's?
1. Assessment-- drug history, compliance
2. Monitoring-- clinical responses & Plasma drug levels
3. Teaching-- How to take meds, strategies for compliance
4. Advocating-- simplest regimen possible, easy to open containers, large print, cost
54
What are the different approaches to medicne?
1. Integrative health
2. Alternative medicine
3. Complementary medicine
55
What is integrative health?
A coordinated approach to using complementary and conventional medicine
56
What is alternative medicine?
Used in place of conventional medicine
57
What is complementary medicine?
used together with conventional medicene
58
What are some characteristics of conventional medicine?
1. Focuses on physical components of the ill patient
2. Emphasis is placed on dx and cure based on physical symptoms
3. Medicine, surgery, etc
59
What are some characteristics of alternative medicene?
1. Takes a holistic "multibody" approach
2. takes into considerations the complexity of each person
3. Embraces self-healing forces, spirituality, balance between internal/external forces
60
Complementary and alternative medicine thought process is as follows....
1. strong connection between mind and body---> self-reliance on healing---> body has own energy for healing---> use of nutrition and natural products--->emphasis on individuality --->
61
What has the use of CAM (Complementary and alternative medicine) increased?
1. Overall dissatisfaction with conventional healthcare
2. Desire for greater control over one's health
3. Need to blend cultural and philosophical congruence with personal beliefs about health and illness
4. belief in the effectiveness of alternative therapies
62
What are major areas of therapeutic objectives?
1. Anxiety
2. Pain
3. Illness
4. Depression
5. Insomnia
63
What are types of manipulative body and energy-based methods (complementary/alternative medicine)
1. Massage therapy
2. Reflexology
3. Accupressure
64
What benefits can acupressure/acupuncture have?
1. Pain relief
2. Helps relieve migraine/headache
3. Anesthesia
65
What benefits can yoga have?
1. Life forces correct balance and flow
2. Concentration, strength, flexibility, symbolic movements
3. Helps with breathing, movement and posture
66
What benefits can Tai chi have?
1. Promotes the flow of energy throughout the body
2. Reduces sx. of fibromyalgia
3. Used in cardiac rehab programs can lower BP
67
What is Reiki?
It is a Japanese technique for stress reduction and relaxation that also promotes healing
It is based on the idea that an unseen "life force energy" flows through us and is what causes us to be alive
68
What are some biologically based therapies?
1. Dietary therapies
2. Herbs
3. Aromatherapy
4. Vitamins
69
What are some reasons for dietary supplement?
1. Perceived as "safer and healthier"
2. Sense of control
3. Emotional comfort
4. Cultural influence
5. Limited access to healthcare
6. Convenience
8. Aggressive marketing
70
True or false: FDA categorized herbals as food and nutritional supplements not as drugs?
True
71
Dietary supplement health and education acts....( review slide 15 complementary and alternative medicine power points)
1. package labeling
2. adverse effects
3. Impurities, adulterants, variability
72
Current good manufacturing practices (CGMP).... review slide 15 on complementary and alternative medicine PowerPoint)
1. Require quality control procedures
2. Labeling to reflect active and inactive ingredients
73
What are some federal reporting requirements
dietary supplement (nonprescription drug consumer protection act)
1. Deaths
2. Hospitalizations
3. Life-threatening experiences
4. Persistent or significant disabilities
5. birth defects
74
What is the USP?
United states pharmcopia
75
What do the USP, ConsumerLab, NPA, NSF are private quality certification programs.... what do they help with... review slide 17
1. CGMP (current good manufacturing practice)
2. Purity
3. Identity
4. Potency
5. Dissolution
6. Accuracy of labeling
76
What do RNs need to know? Alternative med (herbals)
1. Major drawback:
May delay important diagnosis and treatment
2. Nursing intervention:
Make certain MD or PCP is aware of patient's use of herbals
3. Nursing Action:
What to assess & instruct patient regarding herbal therapy
77
What information should we try and gather from the patient about herbal information
1. Always ask about the use of herbals when getting medication history
2. What is their story- why the patient is using the plant medicine or alternative therapy
3. Teach patients to look for products labeled 'Standardized' - these more likely to have accurate amounts and a more purified form of the herb
4. Goal is to help patients be informed consumers
78
What are commonly used herbs?
1. Gingko Bilboa
2. Garlic
3. Ginger root
4. Feverfew
5. Echinacea
6. St. John's Wort
7. Valerian
8. Kava
9. Ephedra
10. Cannabis*
11. CBD*
79
What benefits can Ginko biloba have?
1. Reduce memory problems, dementia, peripheral vascular disease
2. Antioxidant & Vasodilatory properties
80
What should we be aware of when a patient is taking Ginko Biloba?
1.It can cause bleeding when used with anticoagulants
2. Avoid before surgery
81
What benefits can garlic have?
1. Lowers cholesterol, lowers BP, natural antibiotic
2. Natural anit-platelet agent
82
What should we be aware of when a patient is taking garlic?
1. Potentiates anti-diabetic drugs
2. avoid before surgery
83
What benefits can ginger root have?
1. Used to treat nausea, joint pain
84
What should we be aware of when a patient is taking ginger root?
1. Bleeding
2. Irregular heart rate
3. Blood pressure
4. Blood sugar levels
85
What benefits can feverfew have?
1. Helps with migraine prophylaxis
86
What should we be aware of when a patient is taking feverfew?
1. Increased risk of bleeding
2. Can cause uterine contractions. Avoid taking if pregnant can cause uterine contractions which can cause a spontaneous miscarriage
87
What benefits can Echinacea have?
1. Builds immunity
2. Wound healing
88
What are some things to be aware of when a patient is taking echinacea?
1. Immune system suppression after use over 8weeks
89
What are some benefits of St. John's wort
1. May ease mild to moderate depression
90
What are some things to be aware of when a patient is taking St. John's Wort
1. Contraindicated for major depression
2. Do not use with other anti depressants
91
What are some benefits of Valerian root?
1. Generally safe, but ineffective
92
What are some things to be aware of when patient is taking valerian root
1. Potentiates CNS depressants
93
What are some benefits of kava?
1. Relieves anxiety
2. Promotes sleep
3. Relaxes muscles
94
What are some things to be aware of if a patient is taking Kava?
1. Liver damage. No restrictions on the drug in the US but in Canada and European countries it is outlawed.
95
What are some benefits of Ephedra?
NONE- used to be used for a performance enhancement drug but it is NOT good for our bodies
96
What are some things you should know if a patient is taking ephedra?
1. Damaging to heart and CNS
2. Banned from sale in US
97
What are some things you should know about Cannabis/CBD
Cannabis is good for nausea. There is a prescription drug by the name of Marinol that is used in cancer patients.
CBD is not regulated at all for strength, purity
98
What are some mind & body interventions?
1. Yogo, medication, spirituality, relaxation, guided imagery, music, hippotherapy, equine therapy
99
What can musical therapy do?
Improve physical, emotional, cognitive and social well being
100
What is the nurse's role with the different types of "medicine"
1. Educate the public
2. Teach signals of fraudulent practice
3. Avoid healer who:
- promote immediate relief of success
- state that their way is the only sure therapy
- refuse to work with other health care prodders
- Claim to have all the answer
- Use testimonial's that claim amazing results
4. Be non-judgmental despite personal opinions
5. Build rapport by showing patient respect- if not, can be afraid to tell about CAM- drawback?
6. Understand that C.A.M can be beneficial when used correctly
7. Be aware that C.A.M can be dangerous if it interacts or interfere with conventional treatment
8. Be aware that use of C.A.M is popular and increasing and must be included in the history and physical
9. Know that herbals, in particular have significant effects on prescription drugs, body function and disease processes.
101
True or false: C.A.M can be beneficial and dangerous
true
102
Why are vaccines important?
1. Vaccines protect against harmful diseases
2. Vaccines are effective
3. People of all ages benefit from vaccines
4. vaccines protect public health
-protect individual
- protect populations
5. vaccines have been highly vetted by the CDC and FDA
6. Outbreaks can occur without heard immunity
103
Who benefits most from vaccines?
Immunocompromised and chronic, young and old
104
What are some vaccines for adults?
1. influenza
2. tetanus
3. diptheria
4. Shingles
5. Pneumonia
105
True or false: From the CDC: All adults need a seasonal flu (influenza) vaccine every year.
True
106
Who benefits the most from the flu vaccine.
1. People with chronic health conditions, pregnant women and older adults
107
How often should a person get a tdap vaccine?
Every adult should get the Tdap vaccine once if they did not receive it as an adolescent to protect against pertussis and then a Td booster shot every 10 years.
Women should get the Tdap vaccine each time they are pregnant. Preferably at 27 though 36 weeks
108
What does the shingles vaccine do?
It protects against shingles and the complications from the diseases
109
The shingles vaccine is recommended for?
Healthy adults 50 years and older
110
What does the pneumococcal polysaccharide vaccine (PPSV23) do?
protects against serious pneumococcal disease, including meningitis and bloodstream infections
111
The pneumococcal polysaccharide vaccine (PPSV23) is recommended for?
All adults 65 years or older, and for adults younger than 65 who have certain health conditions
112
What does the pneumococcal conjugate vaccine (PCV13) do?
Protects against serious pneumococcal disease and pneumonia
113
The pneumococcal conjugate vaccine (PCV13) is recommended for?
All adults with a condition that weakens the immune system, cerebrospinal fluid leak, or cochlear implant,
114
Vaccine information statements (VISs) are produced by who?
CDC
115
True or false: Vaccine information statements (VISs) are not required by law?
False- They are required by law
116
When do you give a Vaccine Information Statements (VISs)?
Prior to vaccination, every dose regardless of age and you must document that it was given
117
True or false: Vaccine information statements (VISs) are available in over 40 languages
True
118
What are some need to know facts about the Influenza vaccine
1. Strongly recommended for young/old and pregnant.
-- will benefit both mom and boby
2. If sick hold off till feeling better
3. It takes about 2 weeks to develop protection
4. Gilliam Baray syndrome can happen which can cause neurological disorders that progressive from the feet up the body causing paralysis. If a patient has experienced previously this they should not get the vaccine.
5. Inactivated virus
119
What are some things you should know about the Shingles vaccine?
1. Given in a 2 dose series
2. Do not give to pregnant women or breastfeeding women
120
What should your documentation for vaccines include?
1. The edition date of the VIS (found on the back at the right bottom corner)
2. The date the VIS is provided (i.e., the date of the visit when the vaccine was administered)
3. The office address and name and title of the person who administers the vaccine
4. The date the vaccine is administered
5. The vaccine manufacturer and lot number
121
You can get ______ through cuts, scratches or wounds?
Tetanus
122
Vaccines are an example of _______?
Active immunity
123
Young, old and smokers are at higher risk for _____?
Pneumonia
124
What is the abbreviations for tetanus and diphtheria
TD
125
People who have this should not get the flu vaccine?
1. Guillain-Barre
126
Antibody exposure can lead to ______
Acquired Immunity
127
When is flu season?
Occurs between October and May
128
Shingles is caused by.......
Varicellazoster
129
The transfer of antibodies leads to.....
Passive immunity
130
Tetanus can cause.....
muscle tightening
131
A thick coating in throat is called
Diphtheria
132
Who should get the shingles vaccine?
people who are 50 years or older
133
What is a reversible action?
Able to be metabolized by the body or chemically nullified by another drug
134
What is predictability in regards to pharmacology
knowing how the patient will respond
135
Define what a drug is
Any chemical that can affect the living process
136
Define pharmacology
The study of drugs and their interactions with living systems
137
Define Clinical pharmacology
The study of drugs in humans
138
Define therapeutics in pharmacology
The use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy
139
What are the three most important properties of an ideal drug
Effectiveness, selectivity, safety
140
What is ease of administration?
Convenient route, low number of doses per day
141
True or false: A patient is more likely to take a medication that is can be taken easily and as little as possible
true
142
True or False: The easier it is to administer the more willing a patient might be to take it
True
143
When thinking about an ideal drug what does freedom from drug interaction mean?
To not intensify or reduce effects of other drugs
144
When thinking about an ideal drug what does low cost mean
Easily affordable
145
When thinking about an ideal drug what does low cost mean
Easily affordable
146
True or false: A patient sometimes has to choose between providing for their family and taking an important medication due to cost
True
147
When thinking about our ideal drug what does chemical stability mean
Indefinitely retain effectiveness and potency
148
True or false: We would rather have a simple generic name that is easy to recall and pronounce?
True
149
True or false: We would rather have a simple generic name that is easy to recall and pronounce?
True
150
True or false: The toxicity of a drug means little to us
false
151
What is a big factor in how a medication might work on someone?
Weight
152
True or false: Patients who have poor liver and kidney function will have a variability in how drugs work.
True
153
True or false: The food we eat has no effect on the medications we take?
False- some food will have adverse (bad) reactions to some meds
154
True or false: No two people will respond the same to a medication?
True
155
Our therapeutic objective is what?
To provide maximum benefits with minimal harm
156
What is pharmacokinetics?
Explains how a drug moves through the body
157
What is pharmacodynamics
Explains how a drug effects the body
158
Nursing plan with pharmacology in mind---> What are 3 preadministration assessment goals?
Collect data, id high risk patients, assess patients' capacity for self-care.
159
True or false: A baseline of vitals is not important to the pharmacology aspect of nursing
False
160
Why is obtaining a baseline of vitals important?
Allows us to see what effect a drug may have on the patient.
161
Why collect baseline date?
Safety, response, id high risk patient and assess patients ability of self care
162
When obtaining our baseline data what are areas we should assess?
Patient history
Physical exam
lab results
blood pressue/vs
blood surgar
height and weight
163
Name some risk factors that would classify a patient as high-risk
1.liver and kidney functions-- this is because of their ability to metabolize drugs
2. Genetic Factors
3. Drug allergies
4.Pregnancy-- will the drug cause harm to mom or baby?
5. Elderly-- metobolism slows way down so drugs stay in system longer,
6- pediatric-- very small doses
164
True or false: As a nurse we are not allowed to make a medical dx but we are allowed to use our nursing judgement to make the best poss. decisions
true
165
True or false: An example of a nursing goal for a patient in pain could be-- for next 8 hours is to keep the patient pain free.
True
166
When we implement our plan for drug admin is patient education important?
Yes
167
Why would we evaluate the patient after administrating meds
To assess for therapeutic responses, assess for drug reactions and interactions, adherence to prescribed regimen, satisfaction w/tx.
168
What is the first stage of new drug development
Preclinical testing
169
What is the second stage of new drug development
Clinical testing
170
How many phases are in clinical testing?
3
171
During phase I of clinical testing who participates?
Healthy volunteers/healthy patient volunteers
172
During phase II of clinical testing who participates?
Patients in which the drug is targeted
173
What is the main purpose in clinical testing phase II
Testing for therapeutic use and dosage
174
What is the main purpose in clinical testing phase III
Testing for safety and effectiveness
175
When does FDA approval come during the new drug development stages?
In clinical stages-- phase III once the drug has been deemed safe and effective.
176
What is the main purpose of stage IV in clinical testing
Post clinical trial or surveillance
177
What are the requirements for OTC drug labels
Plain language, readable type and user friendly format
178
What is the label format for OTC drugs?
Active ingredients listed first, uses, warning, directions, inactive ingredients
179
What is pharmacokinetics?
How a drug moves through the body
180
What are some questions that should come to mind when thinking in terms of pharmacokinetics?
1. How does the drug get into the body and where does it go?
2. What does the body do to/with the drug?
3. How does the body get rid of the drug?
181
What is the process of a drug through the body?
1. absorption
2. distribution
3. metabolism
4. excretion
182
True or false: different drugs are metabolized by different organs?
True
183
True or false: the majority of drugs are metabolized by the liver
True
184
Where are the majority of drugs excreted?
Kidneys
185
What is absorption?
The movement of a drug from its site of administration into the blood
186
In pharmacology rate is determines what?
How soon a drugs effects will take place
187
In pharmacology amount determines what?
how intense the drugs effects will be
188
Name 6 factors that affect the process of absorption.
1. Rate of dissolution
2. surface area
3. blood flow
4. Lipid solubility
5. pH partitioning
6. Route of administration
189
True or false: With rate of dissolution the quicker a drug dissolves the slower the effect will be?
False
190
True or false: With surface area the larger the surface area the quicker the drug is absorbed
True
191
True or false: Our body prefer drugs that are lipid soluble because it is easier for them to enter our blood stream.
true
192
What are the two major groups in routes of administration?
Enteral (gastrointestinal GI tract)
Parenteral (outside of the GI tract)
193
Is oral meds considered enteral or parenteral?
enteral
194
Is IV, subQ and IM considered enteral or parenteral?
Parenteral
195
What are the advantages to PO meds?
1. Safer than injections
2. ideal for self-administration
3. easy, convenient and inexpensive
196
What are the disadvantages to PO meds?
1.Can cause GI irritation
2. Requires cooperative patient
3. Inactivation
4. Variability
197
What are some barriers to absorption with PO meds?
1. Epithelial lining of GI tract
2. capillary wall
198
What is the absorption pattern for PO meds?
Slow and variable
199
True or false: no one patient absorbs the drugs the same
true
200
What are some advantages of IV drugs? List 4
1. Rapid onset
2. Control
3. permits use of lg fluid volumes
4. permits use of irritant drugs (chemo drugs)
201
What are some disadvantages of IV drugs? List 4
1. High cost, difficulty, inconvenience
2. irreversibility
3. infection
4.high risk
202
What are the barriers of absorption for IV drugs?
None goes directly into blood stream
203
What is the absorption pattern for IV drugs?
Instantaneous and complete
204
What are the advantages of IM and subQ drugs?
1.Can be used for poorly soluble drugs
2. Can be used for depot preparations
205
What are depo preparations?
One time injection that last over a period of weeks to months
206
What are some disadvantages to IM and subQ drugs?
list 4
1. discomfort
2. inconvenience
3. can cause muscle and nerve injury with improper technique
4. bleeding risk
207
What are the barriers of absorption for IM and SubQ drugs?
None
208
What is the absorption pattern for IM and subQ drugs?
Water solubility
blood flow
209
When is parenteral administration preferred?
1. emergencies
2. situations requiring tight control
3. GI incompatibility
- destruction of drugs by GI system
- drugs that would cause GI injury
4. tx with drugs that cannot cross membranes
5. condition better treated with long-acting preparation
6. patients who cannot or will not take oral preparation.
210
True or false: if a patient is having a life threatening issue the best route of administration is the enteral administration
False
211
What is distribution?
The movement of drugs through the body
212
Review the distribution process on slide 15 on the pharm 2 lecture
review
213
What is drug metabolism?
The enzymatic alteration of drug structure to a more water-soluble form that can be excreted.
214
What are some special factors/consideration in drug metabolism?
1. age- the very young and very old have a decreased metabolism
2. first-pass effect- some meds are totally metabolized by the liver the first time they pass through
3. Nutrional status
4. competition between drugs. - One drug may completely neutralize the other
215
What is excretion?
the removal of drugs from the body
216
Drugs and their metabolites can exit the body through.....
1. bile
2. urine/feces
3.sweat/saliva
4. breast milk
5. expired air
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What is plasma drug levels?
Correlation between the response to a drug and level in plasma
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What are two important levels in monitoring of drug responses?
1. MEC- Minimum effective concentration
2. Toxic concentration
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What is the therapeutic range when monitoring drug responses?
Determines whether the drug can be safely given
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When monitoring drug responses what does drug- half life mean?
Determines dosing intervals
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Define drug half-life
Defined as the time required for the percentage of a drug in the body to decrease by 50%.
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Why is it important to understand a drugs half-life?
So we understand how often a patient needs to take a drug
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When monitoring drug responses what is repeated dosing mean?
Determines rate and extent of accumulation
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In repeated dosing what does peak mean?
Highest level of drug in the body--> normally peak of a drug is one to two hours after a dose
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In repeated dosing what does trough mean?
Lowest level of drug in the body--> usually just before the next dose
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What is a loading dose?
Its a higher dose to get blood levels of the drug up then taper to get a maintenance dose or everyday dose. Example is a zpack.
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What is pharmacodynamics?
It is the affect a drug has on the body
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What is dose-response relationship?
Relationship between the size of a an administered dose and the intensity of the response produced
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What is dose-response relationship?
Relationship between the size of an administered dose and the intensity of the response produced
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True or false: the more drug you give the more affects you should have?
True
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What is ED50
Stands for average effective dose. Typically the standard dose we use when starting a patient on a med
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What is LD50?
Lethal dose in 50% of test animals
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What does the dose-response relationship tell us?
It determines
1. Relative potency- min amount of a drug needed to elicit a response
2. maximum efficacy- max response a drug can elicit
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Understand the therapeutic index
Take time to review slide 28 on the pharm two power point
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True or false: we want to have a very wide range between the effective dose and the lethal dose?
True
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True or false: The narrower the space between the effective dose and lethal dose the safer the drug?
False- the wider the space the safer the drug
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What does the TI or therapeutic index tell us?
Allows us to know how wide of an index we have to work with when administering does of meds.
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What are three possible drug to drug interactions?
1. Potentiate
2. inhibit
3. new response
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What is potentiate?
Intensifies the effects of two or more drugs
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What is inhibit mean when talking about a drug to drug interaction?
reduce the effects
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What is a new response drug to drug interaction?
Effect not seen with single drug alone
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What does it mean to have an empty stomach?
At least 1hr before or 2 hours after a mean
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What are some drug-food interactions?
1. absorption
2. drug metabolism
3. drug toxicity
4. drug action
5. timing
