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Pharmacology > Midterm > Flashcards

Midterm Flashcards

1
Q

Gender differences in relation to pharmacokinetics and medication compliance

A

• Can affect success of medication tx
• Seeking medical attention, compliance with medications, elimination rates differ
• Side effects of meds can be gender specific and affect compliance
o Anti-hypertensives can cause male impotence problems
o FDA mandates that drugs are tested on both genders
o Insurance coverage differences (ie. OCP and females)

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2
Q

5 rights

A
  • Right Patient
  • Right Drug
  • Right Dose
  • Right Route
  • Right Time
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3
Q

Pharmacokinetic principles

A
  • How drugs move through the body.
  • Absorption, Distribution, Metabolism, Excretion
  • Factors affecting drug absorption: route of administration, drug formulation, drug dosage, digestive motility, digestive tract enzymes, blood flow at administration site, degree of ionization of drug (acidic or alkaline), pH surrounding environment, drug-drug/drug-food interactions, dietary supplement/herbal product-drug interactions
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4
Q

Buccal

A

tablet or capsule is placed in the oral cavity between the gum and the cheek. This route is preferred over the sublingual route for sustained-release delivery because of the greater mucosal surface area

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5
Q

Sublingual

A

medication is placed under the tongue and is allowed to dissolve slowly. This route results in a more rapid onset of action because of the rich blood supply

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6
Q

Sustained Release (SR)

A

tablets or capsules are designed to dissolve very slowly. This releases the medication over an extended time and results in a longer duration of action for the medication

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7
Q

Extended-release (XR) or long-acting (LA)

A

allow for the convenience of once or twice day dosing. Must not be crushed or opened

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8
Q

Topical drugs

A

applied locally to the skin or the membranous lining of the eye, ear, nose, respiratory tract, vagina, and rectum
o Applications include:
• Dermatological preparations- drugs applied to the skin, the topical route most commonly used. Formulations include creams, lotions, gels, powders, and sprays.
• Instillations and irrigations- drugs applied into the body cavities or orifices. These routes may include the eyes, ears, nose, urinary bladder, rectum, and vagina
• Inhalations- drugs applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing apparatuses

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9
Q

Intra-dermal (ID)

A

injection is administered into the dermis layer of the skin. This layer contains more blood vessels than the deeper subQ layer allowing for drugs to be more easily absorbed. Limited to small volumes of drug

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10
Q

Pharmacokinetics (absorption) during pregnancy trimesters

A
  • Abdominal/gastric changes affect absorption
  • Inhaled drugs may be absorbed faster
  • Changes in cardiac output, plasma volume, and regional blood flow change distribution and metabolism
  • Drug excretion rates may increase
  • Pre-implantation period: 1-2 weeks of 1st trimester, teratogen either causes death of the embryo or has no effect
  • Embryonic period: 3-8 weeks, period of maximum sensitivity to teratogens
  • Fetal period: 9-40 weeks or until birth, medications have prolonged duration of action
  • Pregnancy categories: A,B,C,D,X (X is the worst)
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11
Q 
ADRs
Adrenergic agents (Sympathomimetics) (phenylephrine (neo-synephrine))
A

tachycardia, hypertension, dysrhythmias, CNS excitation and seizures, dry mouth, nausea and vomiting, anorexia

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12
Q 
ADRs
Anticholinergic agents (benzotropine mesylate (Cogentin))
A

dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, glaucoma

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13
Q 
ADRs
Cholinergic agents (Parasypathomimetic)(miniopress))
A

profuse salivation, sweating, increased muscle tone, urinary frequency, bradycardia

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14
Q

ADRs

Salicylates (Aspirin)

A

with high doses may cause GI distress and bleeding, may increase action of oral hypoglycemic agents

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15
Q

ADRs

Vancomycin

A

nephron/ototoxicity, peak/trough with the 3rd dose, Red Man Syndrome

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16
Q 
ADRs
Hydantoins phenytoin (Dilantin)
A

CNS depression, gingival hyperplasia (soft bristle tooth brush), skin rash, cardiac dysrhythmias, hypotension

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17
Q

ADRs

Succinylcholine

A

malignant hyperthermia (fast rise in temp. and severe muscle contractions), (Dantrolene Sodium is the preferred tx)

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18
Q

ADRs

Glucocorticoids (Corticosteroids) (Prednizone)

A

adrenal gland suppression, hyperglycemia, mood changes, cataracts, peptic ulcer disease, osteoporosis and “masking infections”, Cushing’s Syndrome as a result from long term therapy

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19
Q

ADRs

Aminoglycosides (Gentamicin)

A

ototoxicity, nephrotoxicity

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20
Q

ADRs

Fluoroquinolones (Cipro)

A

may cause tendon inflammation/irritation/rupture

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21
Q

ADRs

Rifampin

A

can turn body fluids orange

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22
Q

Penicillin injections

A

highest allergy incidence, observe pt for 30 minutes after dose, given IM because it has a poor oral absorption rate

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23
Q

Dilantin

A

given IV deserves caution because it can cause tissue damage, do not use hand veins, it may also cause a severe rash

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24
Q

Tylenol

A

liver damage with high doses

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25
Epoetin alfa
gental rotation of vial, subQ route, given for side effects and not for the cancer itself
26
KCI
always give medication while pt is upright to prevent esophagitis, do not crush tablets or allow pt to chew, dilute liquid forms before giving orally or through NG tube, never administer IV push or in concentrated amounts, be careful to avoid extravasation and infiltration
27
Food/drug interactions | Metronidazole
Disulfiram like effects with alcohol
28
Food/drug interactions | PCNs
decrease the effectiveness of OCPs, aminoglycoside antibiotics
29
``` Food/drug interactions Valporic acid (Depakote) ```
alcohol, phenobarbital and phenytoin
30
Food/drug interactions | Tetracyclines
OCPs, dairy products interfere with absorption
31
Food/drug interactions | Spironolactone (Aldactone)
hawthorne, ammonium chloride, aspirin, digoxin, potassium supplements, ACE inhibitors, angiotensin-receptor blockers (ARBs), antihypertensives
32
Anticholinergics
Inhibit parasympathetic impulses. Suppressing the parasympathetic division induces symptoms of flight-or-fight response
33
Naloxone (Narcan)
pure opioid antagonist, blocking both mu and kappa receptors. Used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected
34
Antibiotics
encourage compliance to prevent possibility of antibiotic resistance, monitor for allergies because of the high allergenicity, clients who are allergic to one have a high chance of being allergic to others (PCNs)
35
Acetaminophen
avoid alcohol because of the possibility of liver toxicity with high doses
36
Spirituality
Incorporates the capacity of love, to convey compassion and empathy, to give and forgive, to enjoy life, and to find peace and fulfillment in living. The spiritual life overlaps with components of the emotional, mental, physical, and social aspects of living
37
Potassium rich foods
Bananas, white beans, dark leafy greens, yogurt, fish, avocado
38
Who is the father of Pharmacology
John Jacob Abel
39
What are the 3 types of drugs
Synthetic Biologic Herbal
40
Why is it important to ask patients if they are taking Herbal medication
Because you can never be sure how much they are taking
41
Who regulates medications in the US
FDA
42
How long and how many phases are there in the approval process of a drug
``` 4 phases: Preclinical (1-3 yrs) Clinical (2-10 yrs) Review of new drug Postmarking ```
43
What is an ADR
Allergic: non-life threatening Anaphylactic: life threatening
44
Name 2 ways drugs are categorized
Therapeutic | mechanism of action
45
What is a prototype drug
A model drug that is well understood, has known action and adverse effects
46
Which class of controlled substances are considered highest risk of abuse potential
Class 1
47
What age groups commonly require further caution when administering drugs
Pregnant and breastfeeding young and elders any age with chronic health issues
48
Which pharmacokinetic elements change during pregnancy
Metabolic rates
49
Which period of pregnancy is considered at highest risk for teratogenic exposure/consequence
Embryonic period: 3-8 weeks
50
Which FDA category of drug poses the lowest risk when consumed by a pregnant woman
Cat A
51
How are medication doses commonly calculated
by weight in kg/mg
52
Where is a consistent area to inject medications in the pediatric population
vastus lateralis in the thigh
53
Which age group is known for polypharmacy
older adults
54
Describe some important nursing teaching interventions for the older adult group
Making sure that they understand how to take medications
55
What are 2 types of immune modulators
stimulator | suppressor
56
Which vaccine type deserves extra caution when administering
Live vaccinations
57
What are 2 types of biologically developed cytokines
Interferons | Interleukins
58
Why are immunosuppressants given
To suppress the immune system so that it doesn't attack a foreign substance (organ transplant, autoimmune disorder, various inflammatory disorders)
59
When taking Cyclosporines, what specific nursing advice should be given
Don't drink grapefruit juice
60
What is inflammation
Non-specific defense with a goal of containing injury or destroying invading pathogen
61
Name 2 classes of anti-inflammatory drugs
NSAIDs | Glucocorticoids
62
What is the common mechanism of action for anti-inflammatory drugs
prevent prostaglandins (pain messages)
63
What is the FDA black box warning for IBU
Contraindicated in use for tx of preoperative pain in the setting of coronary artery bypass graft surgery due to potential for stroke or MI
64
Which NSAID can cause Reye's syndrome in the pediatric population
Aspirin
65
Is Tylenol considered a NSAID
No, it is used for tx of fever and pain but it is not an anti-inflammatory
66
What are causes for bacterial mutation
- Not taking medications as prescribed - Taking medications for the wrong infection - Partial tx - Nonsocomial infections
67
Which class of drugs is commonly associated with ototoxicity
Aminoglycosides
68
Why are patients often non-compliant with tx of TB
pts often times don't experience symptoms till the TB becomes active and with the medications they have a lot of symptoms
69
Cyclosporine (Neoral, Sandiummune)
- Immunosuppressant-inhibits helper T cells -Tx of: organ transplants, Crohns disease, ulcerative colitis ADRs: Oliguria, HTN, tremors, gingival hyperplasia -Interactions: phenytoin, phenobar, carbamazepine, rifampin, azoles, ACE inhibitors, NSAIDs, macrolides, GRAPEFRUIT JUICE
70
ADRs of vaccinations
site tenderness low grade fever fatigue dizziness
71
Interferon alfa-2b (Intron A)
- Immunostimulant- normal cell protectors, WBC enhancement-better defense - Tx: Cancers and viral infections - ADRs: flu-like symptoms, depression/suicidal ideation, hepato/neurotoxicity - Interactions: Zidovudine (hematologic toxicity)
72
PCNs
- Tx: G+ cell wall inhibitors - cillin in the name - high allergenicity profile - Interacts with OCP
73
Cephalosporins
- Tx: G+ (1st gen.), G- (3rd gen), cell wall inhibitors - cef, kef - Caution in PCN allergic pts - Disulfiram-like effect with ethos - Interacts with cumadin
74
Tetracylines
-Tx: G+/-, ribosome function inhibition -cycline -Teratogenic -bone growth stunting, tooth staining -binds with minerals do not give with dairy
75
Macrolides
- Tx: G+/-, ribosome function inhibitor - mycin - drug interactions: cyclosporin, anticonvulsants, cumin - oral table dissolves with acid, NO JUICE!
76
Aminoglycosides
- Tx: G+/-, protein synthesis inhibitors - micin, mycin - ototoxic/nephrotoxic - serum levels of drug often drawn for therapeutic benefit/toxicity - interacts with many drugs (ampho B) - peak/trough levels with 3rd dose
77
Fluoroquinolones
- Tx:G+/-, bacterial DNA enzyme inhibitor - oxacin - no use in pediatric puts - binds with minerals (no dairy/multivitamins - FDA black box warning: tendon inflammation
78
Sulfonamides
- Tx: G+/-, folic acid inhibitors - sulfa - drug interactions: coumadin, phenytoin - causes urine crystals - caution in: megablastic anemic pts, hx of kidney diseases due to crystals
79
Metronidazole
- Tx: anaerobic/non-malarial protozoans - Flagyl - Disulfiram-like effects with alcohol consumption - common metallic taste in mouth
80
Clindamycin-not an amino glycoside or macrolide
- Tx: G+/-, bacterial protein synthesis inhibitor - cleocin - Associated with Antibiotic Associated Pseudo-membranous Cellulitis (AAPMC)
81
Linezolid
- Tx: MRSA (G+) - Zyvox - Causes thrombocytopenia - caution in pots taking SSRIs- HTN crisis!
82
Quinupristin Dalfopristin
- Tx: VRE - Synercid - Risk for hepatotoxicity and pseudo-membranous colitis
83
Vancomycin
- Tx: G+ - big gun, use in sepsis, severe infection or resistance concerns - Vancocin - Ototoxicity/Nephrotoxicity - Red Man Syndrome- decrease rate of infusion
84
What are the 4 drugs for the tx of TB
- Isoniazid (INH) - Rifampin - Pyrazinamide - Ethambutol
85
What drugs are used for malaria
chloroquine | primaquine
86
Is tx for HIV a single or multi drug regime
multi
87
What is the goal of HIV tx
Reduce HIV RNA copies in the blood - Increase lifespan - Higher quality of life - Decreased risk of transmission from mother to child
88
What are common labs to measure HIV status
-CD4 count -HIV RNA assays -amylase (assess for pancreatitis) -CBCs -lipid levels LFT (liver function test)
89
What is the function of interferon therapy when treating a viral infection
Reprogram infected cells to inhibit replication
90
Which antineoplastic drugs have the risk of secondary malignancy following tx
Alkylating agents and Antitumor Antibiotics
91
What is a unique ADR to the alkylating agents
secondary malignancy
92
When taking hormone/hormone antagonist drugs, what type of side effects can the patient expect
menopausal symptoms for both men and women
93
What are some ADRs of diphenhydramine
- drowsiness, occasionally paradoxical - CNS stimulation and excitability - Anticholinergic effects: dry mouth, tachycardia, mild hypertension, photosensitivity
94
When using steroid inhalers, how long does it take to observe positive effects
2-3 weeks
95
What is a hallmark ADR of cyclophosphamide (cytoxan)
hemorrhagic cystitis
96
What beverage should a pt taking theophylline, a xanthine bronchodilator avoid
caffine
97
Name 2 LABA drugs
Salmeterol | Arfomoterol
98
Name 2 SABA drugs
Albuterol | Xopenex
99
What device is used to administer MDIs
a spacer
100
When comparing drowsiness effects with antihistamines, which generation has the highest drowsiness
1st generation
101
What is the antidote for benzos
Flumazinone
102
How long does a patient need to wait before starting Buspar when discontinuing an MAOI
14 days because hypertensive crisis may result
103
What time of day should an SSRI be taken and why
take in the morning because can cause sleep disturbances
104
How do SSRIs work
Selectively inhibit serotonin reputake, allowing more serotonin to stay at the junction of the neurons
105
4 common effects from SSRIs
``` weight gain GI bleeding sexual dysfunction diaphoresis tremor nausea fatigue ```
106
when taking an SSRI when should a patient expect therapeutic results
up to 4 weeks
107
What is the enzyme required for HIV to replicate itself
Protease
108
Which drugs are used to treat influenza and when are they used
- Tamiflu, Relenza | - Must be used within the 1st 48 hours and only for high risk groups

Pharmacology (18 decks)

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