intro and basics

Question 1

What is pharmacotherapeutic’s

Answer 1

Drugs and the study of drugs in humans

The use of drugs to diagnose prevent or treat disease

Question 2

What are the properties of the perfect drug

Answer 2

Effective
 Safe with minimal side effects
 Easy to administer
 No drug interactions with other drugs
 Relatively inexpensive
NOTE: the 'perfect drug' does not exist

Question 3

What are the principles of pharmacokinetics (drug movement throughout the body)

Answer 3

1. absorption - site of administration into the blood
2. distribution - drug movement from the blood to the interstitial space
3. metabolism - the breakdown and transformation of the drug
4. excretion - movement of the drug and metabolites out of the body

Question 4

Factors that influence drug doses

Answer 4

Kidney and liver function

Results of blood test by a lab

Question 5

Seven processes in neurotransmitter action

Answer 5

1. neurotransmitters are synthesized
2. neurotransmitters are stored in vesicles
3. neurotransmitters are leaked and destroyed by enzymes
4. action potentials cause vesicles to release the neurotransmitter into the synapse
5. neurotransmitter binds with auto-receptors which inhibit subsequent neurotransmitter release
6. Neurotransmitter binds to post synaptic receptors
7. the released neurotransmitter molecules are deactivated either by re-uptake or enzymatic degradation

Question 6

Agonists

Answer 6

Drugs that occupy receptors and activate them

It activates the nerve to make the nerve fire

Question 7

Antagonists

Answer 7

Drugs that occupy receptors but do not activate them. They block receptor activation by agonist

Question 8

Agonist drug effects

Answer 8

• Increase synthesis
• Increases the release of neurotransmitter molecules
• The drug binds to auto receptors which block inhibitory effect
• either activate or increase the effect on postsynaptic receptors
• blocks the deactivation and degradation or reuptake

Question 9

Antagonist drug affects

Answer 9

• blocks the synthesis
• causes transmitters to leak from vesicles and get destroyed by enzymes
• blocks the release of neurotransmitter molecules from terminal buttons
• activate autoreceptors and inhibits neurotransmitter release
• it is the receptor blocker at postsynaptic receptors

Question 10

Seratonin OR 5-HT function and (+/-) levels

Answer 10

Body = B.P. and gut control 
Brain = mood, emotions, sleep/wake, feeding, temp.reg.
\+ = feel sick, get hungry, headaches/migraines
- = depressed, drowsy

Question 11

Dopamine function and (+/-) levels

Answer 11

Brain: muscle tension, perceptions, sorts out what is real, important, imaginary
+ = schizophrenia, too much perception
- = muscles tighten, Parkinson’s

Question 12

Noradrenaline (norepinephrine) function and (+/-) levels

Answer 12

Body = heart and B.P.
Brain = controls sleep, wakefulness, arousal, mood, emotion and drive
\+ = anxious, jittery
- = depressed, sedated, dizzy, low B.P.

Question 13

Acetylcholine function and (+/-) levels

Answer 13

Body = motor function from the brain to the body. passes the message from the nerve to the muscle
Brain =  Controls arousal, ability to use memory, learning tasks
\+ = muscles tighten up
- = dry mouth, blurred vision, confusion, poor memory/learning (Alzheimer's)

Question 14

Glutamate function and (+/-) levels

Answer 14

Brain = acts as the "accelerator"
\+ = anxious, overactive/excited
- = drowsy, sedated

Question 15

GABA function and (+/-) levels

Answer 15

Brain = acts as the "brake"
\+ = drowsy, sedated
- = anxious, excited

Question 16

nurses role in pharmacotherapy - the 7 R’s

Answer 16

Make sure you understand the use of the medication and the possible actions consequences of the drug
7 R’s: Right: drug, Pt., dose, route, time, indication, documentation.

Question 17

Regular release: drug formulations

Answer 17

Medicine that is formulated to release into the body quickly which increases the dosing frequency
IR - Immediate Release

Question 18

Sustained release: drug formulations

Answer 18

Medicine that is formulated to release into the body steadily over a period of time which which reduces the dosing frequency
LA - Long Acting
CR - controlled release
SR - Sustained release
XL - extra long
PA - prolonged action
CONTIN - longer acting
Patches (slower absorption)

Question 19

What is a MAR

Answer 19

Medical Administration Record given to nurses to guide their daily drug admin to Pt’s

Question 20

types of parenteral drug administration

Answer 20

Intraveneous (IV) - directly into blood stream, rapid onset, irritant drugs may be better tolerated by Pt.
Intramuscular (IM) - directly injected into large muscle. Used for Depot (long acting)drugs
Subcutaneous (SC) - injected just under the skin (i.e.insulin).

Question 21

Key points to topical drug administration

Answer 21

patches, creams, ointments.

Easy to administer, slow absorption, messy. If toxicity occurs take the patch off

Question 22

Key points to inhalation drug administration (puffers)

Answer 22

Messy and hard to administer

local administration with low systemic toxicity

Question 23

Key points to ocular drug administration (drops and ointments)

Answer 23

Messy and hard to administer

local administration with low systemic toxicity

Question 24

Key points to ear drug administration

Answer 24

Messy and hard to administer
local administration with low systemic toxicity
difficulty hearing

Question 25

Keep points to rectal or vaginal drug administration

Answer 25

Fast absorption, reduces stomach irritation

Maybe uncomfortable, administration may be messy

Question 26

+/-‘s of drug to drug interactions

Answer 26

INCREASE therapeutic effect: GOOD - probencid increases the effects of penicillin by blocking the renal excretion.
BAD - Fibrates increase the risk of muscle damage when combined with Statins (kidney failure - ask the Pt regularly how they are feeling)
DECREASE therapeutic effect: Naloxone reverses the effects of narcotics (antidote for overdose in emerg)

Question 27

Drug - Food/Herbal interactions examples

Answer 27

1. phenylzine (depression Rx) and food rich in tyramine (cheese) = +BP = stroke
2. grapefruit juice and cardiovascular medications = liver function to slow = decreases breakdown of drug = increase risk of MI
3. Vitamin K (green veggies) and warfarin (kumadin / blood thinner / rat poison). K decreases warfarin effects = clogs blood = MI
4. (Herbal) St.John’s wort and antidepressants. Be EXTREMELY CAUTIOUS with mixing. talk to doctor!

Question 28

Adverse effect

Answer 28

Is a noxious unintended, and undesired effect that occurs at normal drug doses.
COMMON = predictable, known (i.e. skin rash, nausea)

IDIOSYNCRATIC = Unpredictable, but known (very rare!)

• reaction resulting from a genetic predisposition OR immune mediated toxicity
  i. e. Steven Johnson Syndrome (from penecillin = burns skin)

Question 29

physiological changes in the geriatric client

Answer 29

Cardiovascular: decreased cardiac output & blood flow = (-) absorption and distribution.
Gastrointestinal: increased pH = decreased peristalsis (drug dissolves slower)
Hepatic: decreased enzyme production & blood flow = decreased metabolism
Renal: decreased blood flow, function, glomerular filtration rate = decreased excretion