Pharm One Final 2 - ADME pharmokinetics

Question 1

What are ADVERSE REACTIONS?

Answer 1

UNINTENTIONAL
UNEXPECTED
UNDESIRABLE

Range from mild to severe.
Always STOP a drug if they are having and
ADVERSE REACTION

Question 2

If a drug with a half-life of more than 24 hours is prescribed to be given more than once a day, should the nurse question the health care provider?

True or False.

Answer 2

True

Question 3

Patients with kidney disease may have fewer protein-binding sites and are at a risk for drug toxicity.

When drug metabolism is reduced excess drug accumulation can occur and cause toxicity.

These are examples of:
Pharmacokinetics or
Pharmacotherapeutics

Answer 3

PharmacoKINETICS

Question 4

A drug NOT bound to a PROTEIN is an active drug

True or False

Answer 4

True

Question 5

Which of these three items can change ABSORPTION?

Modifying gastric emptying times
Changing gastric pH
Forming drug complexes

Answer 5

All three

Question 6

What is drug TOXICITY?

Answer 6

Drug levels that exceed the therapeutic range
and INCREASE ADVERSE EFFECTS.

If a drug is TOXIC always stop it.

Question 7

Four Factors that can cause Drug TOXICITY?

Answer 7

• Excessive Dose - accidental or intentional
• Disease - commorbities
• Age
• Genetics

Question 8

What is an AGONIST DRUG?

Answer 8

Agonist ACTIVATE receptors and produce a DESIRED response.
Examples:

• Nicoderm/Smoking patch is an AGONIST at nicotine receptors.
• Heroin, oxycodone, methadone, hydrocodone, morphine, and opium are full AGONISTS at opioid receptors.

-Tylenol and Morphine together - Agonistic effect
They work together, block pain receptor.

Question 9

What is an ANTAGONIST drug?

Answer 9

A drug that prevents receptor activation.
It BLOCKS the receptor site.

-Narcan and Heroin

Question 10

List examples of ANTAGONIST DRUGS -

Answer 10

• Beta BLOCKERS antagonists for receptor sites for Epi and NorEpi
• FAMOTIDINE (Pepcid) is an antagonist (H2 Blocker) that competes with histamine for H2 receptor sites in the stomach. It can decrease amount HCL acid produced.
• PROTAMINE is an antagonist to HEPARIN, when given IV. It will bind to HEPARIN and form an inactive complex.
• VITAMIN K is an antagonist to Warfarin.
• NALOXONE is an antagonist to morphine sulfate.

Question 11

What are the 3 considerations for

GERIATRIC DRUG DOSES?

Answer 11

Not so quick to give meds with elderly

Body Weight
Lab Results (Liver and Kidney)
Comorbid Health problems

lower doses

Question 12

Geriatric Drug Doses

What conditions might cause the dose to be LOWERED?

Answer 12

1. Decease in Bodyweight
2. Decrease in Kidney Function (BUN/Creatinine,) GFR)
3. Decrease in Body Water
4. Diminishing Hepatic Clearance
5. Diuretics - volume depletion
6. Bleeding from anti-coagulants
7. GI Irritation

Question 13

List 6 Problems with Geriatric drug administration.

Answer 13

1. Lack of coordinated care
2. Recent hospital D/C
3. Self-treatment
4. Several comorbidities
5. Sensory and physical changes.
6. Cognitive impairment

Question 14

Geriatric Drug Administration

Name an important consideration in adding a medication

Answer 14

Will the medication cause additional medical problems?

Risk/Benefit ratio

Question 15

PHARMOCOKINETICS - ADME -GERIATRICS

A = Absorption Issues

Answer 15

Geriatric ADME ABSORPTION

1. GI changes -Everything SLOWS down
   (Decrease in SM surface area, gastric emptying, gastric acid, gastric blood flow)
2. Swallowing difficulties
3. Poor nutrition
4. Feeding Tubes

Slower absorption

Question 16

PHARMOCOKINETICS - ADME -GERIATRICS

D= Distribution

Answer 16

GERATIRIC

1. Decline in muscle.
2. Increase in fat so lipid soluble drugs stored longer with prolonged action. (TOXICITY)
3. Reduced albumin, so decreased protein binding, and increased free drugs, which increases TOXICITY.

MORE fat, LESS protein - INCREASED TOXICITY

Question 17

PHARMOCOKINETICS - ADME -GERIATRICS

M=Metabolism

Answer 17

GERATRIC ADME METABOLISM

LIVER

1. Decreased hepatic blood flow (LIVER) and enzyme activity.
2. Prolonged Half-Life (TOXICITY)

Less blood
Less enzymes
Takes longer to metabolize

Question 18

PHARMOCOKINETICS - ADME -GERIATRICS

E= Excretion

Answer 18

Geriatrics. ADME. EXCRETION

1. Decreased renal function.
2. Prolonged Half-Life
3. Elevated drug levels.

TOXICITY

Question 19

PharmacoDYNAMICS - -GERIATRICS

Where are effects most frequently found

Answer 19

CV and CNS

Question 20

PharmacoDYNAMICS - -GERIATRICS

What receptors are reduced?

Answer 20

• Dopaminergic
• Cholinergic
• Adrenergic

Question 21

PharmacoDYNAMICS - -GERIATRICS

How is the brain affected?

Answer 21

1. Less blood flow to the brain

2. BBB is more permeable