Name at least 3 concerns for a patient who is taking an OTC medication.
1) mask the signs and symptoms of an underlying disease 2) OTC’s and prescription drugs can interact with one another 3) taking prescription meds and OTC’s incorrectly can result in an OVERDOSE *make sure patient tells you all drugs they’re taking including vitamins, diet pills, etc.
What does pharmacokinetics concern itself with?
-movement of drugs throughout the body after administration -i.e: metabolism, distribution, excretion
Define critical concentration in relation to pharmacokinetics.
-amount of drug needed to cause a therapeutic effect
Define dynamic equilibrium in relation to pharmacokinetics.
-the actual concentration that a drug reaches in the body
Why is an initial loading dose given for some medications?
-given for drugs that take a long time to be absorbed (long half life) -b/c of medication’s properties it would take a long time to reach a therapeutic effect so a higher dose is initially given
Name 4 things dynamic equilibrium is affected by.
1) absorption 2) distribution 3) metabolism/biotransformation 4) excretion
What organ of the body is responsible for biotransformation of a drug?
-liver
The liver sometimes excretes a large concentration of a drug before it even reaches systemic circulation. What is this known as?
-first pass effect
Define half-life and what is it affected by?
-the time it takes for the amount of a drug in the body to decrease its concentration by half -affected by: absorption, distribution, metabolism, excretion
There are 5 different types of drug dosages. Name them.
1) loading 2)therapeutic 3)maintenance 4)toxic 5)lethal
What are the 8 rights of medication administration.
1) right patient 2)right medication 3)right dosage 4)right time 5)right route 6)right reason 7)right approach 8)right documentation
What is the difference between an adverse effect and a side effect?
-adverse: harmful and undesired -side:mild and possibly expected
An anaphylactic reaction is a response to an…?
-an allergy
During an anaphylactic response, what does the body do?
-forms antibodies -produces histamine which results in hives, rash and breathing difficulties
How is an anaphylactic response medically treated?
-p/t given epinephrine
If a patient uses an epi-pen to treat an anaphylactic response, what should they do immediately after?
-seek medical attention
Define pharmacotherapeutics and what do they focus on?
-branch that uses drugs to treat, prevent and diagnose disease -focus: effect of drug on body and body’s response to drug
Drug therapy depends on several patient related factors. What are they?
-severity of condition -urgency of condition -prognosis of patient
What are the 5 stages of drug approval and briefly states what happens in each?
1) pre clinical: animals 2) phase 1: human volunteers 3) phase 2: informed clients with disease 4) phase 3: tested in market 5) phase 4: surveyed in large population
Ideally a drug should have selective toxicity. What is that?
-kills only microbial cells but not the hosts cells
What piece of legislation gave the government power to control the labeling of drugs?
-Pure Food and Drug Act 1906
What 2 pieces of legislation began to categorize drugs based on their addictiveness?
-Harrison Narcotic Act 1910 - Controlled Substance Act 1970
What piece of legislation banned to sale of drugs that had not been thoroughly tested?
-food, drug and cosmetic act 1938
What piece of legislation was passed in an attempt to control misleading industry claims?
-Dietary Supplement Health and Education Act 1994
What is the difference between schedule I drugs and schedule II drugs and give examples within each category?
-I: no accepted medical use ex: heroin, LSD -II: high abuse potential, severe dependence ex: narcotics, amphetamines, cannabis
What is the difference between schedule III drugs and schedule IV drugs? Give examples.
-III: less abuse potential, moderate dependence ex: sedatives, nonamphetamine stimulants -IV: limited dependence ex: antianxiety agents
What are the only acceptable categories of drugs to give to a pregnant woman?
-A -B
In order from fastest to slowest, rate the routes of drug administration?
1) parenteral (IV) 2) percutaneous (IM) 3) enteral (PO) 4) transdermal, topical
K+ levels.
-3.5 to 5.0 mEq/L
St. John’s wort most famously interacts with oral contraceptives by making them…?
-useless
1 quart –> pint
2 pints
1 pint–> ounces
16 oz
1 oz–> cc’s
30cc’s
30cc’s –> mL
30 mL
1 tsp—> mL
5 mL
1 kiloliter—> liters
1000 liters
1 hectoliter—> liters
100 liters
1 dekaliter—> liters
10 liters
1 kilogram—> grams
1000 grams
1 hectogram—> grams
100 grams
1 dekagram—> grams
10 grams
60 drops or gtts–> mL
1 mL
100 mg–> mL
1 mL
/ss–>
0.5
roman numerals 10, 50, 100
-10: X -50: L -100: C
What 3 drugs use 65 mg per grain as their conversion factor rather than the traditional 60 mg per grain?
-tylenol -aspirin -acetometaphin
What is another name for the sympathetic nervous system?
-adrenergic system
What is another name for the parasympathetic nervous system?
- cholinergic system
Adrenergic neurotransmitters act on what chemical?
-norepinephrine
Cholinergic neurotransmitters act on what chemical?
-acetylcholine
What is acetylcholine?
-primary neurotransmitter released at cholinergic receptors
What receptors does acetylcholine act on?
-muscarinic receptors (visceral organs) -nicotininc receptors (contraction)
What is norepinephrine?
-primary neurotransmitter released in the adrenergic system
What receptors does norepinephrine act on?
-beta 1 and beta 2 -alpha 1 and alpha 2 -dopamine
Name 5 things the parasympathetic system is responsible for once activated.
1) stimulates flow of saliva 2) slows heartbeat 3) stimulates peristalsis and secretion 4) stimulates release of bile 5) contracts bladder
Name 8 things the sympathetic system is responsible for once activated.
1) dilates pupils 2) inhibits flow of saliva 3) accelerates heartbeat 4) dilates bronchi 5) inhibits peristalsis and secretion 6) converts glycogen to glucose 7) secrets adrenaline and noradrenaline 8) inhibits bladder contraction
The alpha 1 adrenergic receptor does what in order to cause what?
- constricts blood vessels, iris and urinary bladder -opens up airways to treat nasal congestion, control superficial bleeding, delay absorption of anesthetics
The alpha 2 adrenergic receptor acts on what in order to cause what?
-acts on nerve membranes to decrease levels norepinephrine - Lowers blood pressure and heart rate to treat hypertension, treats glaucoma
The beta 1 adrenergic receptor acts on what in order to cause what?
-acts on cardiac tissue to increase heart rate -stimulates heart rate to treat heart failure, cardiac arrest and shock
The beta 2 adrenergic receptor acts on what in order to cause what?
-acts on lungs, blood vessels and bronchi -produces bronchodilation
Dopamine the adrenergic receptor acts on what in order to cause what?
-stimulates norepinephrine release from nerve endings and adrenal glands -in order to increase renal flow, increase cardiac output and elevate BP
What does an agonist drug do?
-stimulates or mimics
A cholinergic agonist does what?
-mimics the parasympathetic nervous system
What is another word for a cholinergic agonist?
-parasympathomimetic
If a cholinergic agonist is direct acting, what does that mean?
- messes with the receptor sites by binding to cholinergic receptors
If a cholinergic agonist is indirect acting, what does that mean?
-messes w/ acetylcholine levels by allowing build up at receptor sites so that body produces a bigger response
Dopamine (Intropin) acts by doing what and when is it used?
-acts on target organs to create a sympathetic response -used to treat hypotensive shock, bronchospasm, asthma
When giving a patient Dopamine (Intropin) what should you as a nurse watch out for?
- arrthymias -hypertension -palpations -angina -dyspnea
What medication is used to diagnose myasthenia gravis?
- Edrophonium (Tensilon, Enlon)
What medication would you expect to prescribe to a patient with myasthenia gravis?
-Pyridostigmine (Regonol, Mestinon) -acetylcholinesterase inhibitor (blocks acethylcholine from being broken down)
Anticholinergic drugs like Atropine act by doing what?
- competitively block acetylcholine receptors at their muscarinic sites
What should you watch out for when giving anticholinergic drugs like Atropine to a patient?
- photophobia -palpitations -tachycardia *sympathetic system side effects
When giving a patient a beta blocker such as Propranolol or Atenolol, what should you teach a patient?
-do not take with NSAIDS -taper off dosage
Ginseng most famously masks the symptoms of….?
-hypoglycemia in diabetics
How do alpha agonists like Phenylephrine and Clonidie act?
- stimulate alpha receptors
The alpha agonist Phenylephrine (Neo-Synephrine) acts on what receptor to produce what?
-alpha 1 -constricts topical vessels in the nose
The alpha agonist Clonidine (Catapres) acts on receptor to treat what?
-alpha 2 -used to treat hypertension
What should you teach a patient to watch out for when taking an alpha agonist like Phenylephrine or Clonidine?
- monitor BP at home