pharm test 1 Flashcards
(175 cards)
1
Q
effectiveness
A
does what it is intended to do
2
Q
safe
A
safety cannot be assured
3
Q
selectivity
A
would do only what it is intended to do
4
Q
therapeutic objective
A
max benefit
min harm
5
Q
agonist
A
activates receptor sites by binding w/ them
binds & creates change (mimics something in body)
6
Q
agonist examples
A
dobutamine MIMICS nor-epi
insulin
morphine (opioid)
7
Q
antagonist
A
- prevent receptor activation (prevents event)
- inhibit action of endogenous substances & drugs (inhibits action)
- have no effects of their own on receptors (don’t cause response)
- prevent agonist from doing job (prevent effects of drug)
8
Q
non-receptor drugs
A
chemically neutralize
9
Q
non-receptor drug examples
A
antacid (neutralize acid)
magnesium sulfate (laxative)
-pulls water out=stool
10
Q
pharmacokinetics
A
what body does to drug?
11
Q
ADME (pharmacokinetics)
A
Absorption
Distribution
Metabolism
Excretion
12
Q
absorption
A
enters body –> reaches blood stream
13
Q
factors affecting absorption
A
route
-IV, IM, subQ, PO
form
-liquid»_space; tablet
14
Q
distribution
A
drug carried throughout body (transport)
15
Q
factors affecting distribution
A
protein binding
blood-brain barrier
16
Q
phenytoin
A
protein bound drug
17
Q
metabolism
A
drug absorbed into body
18
Q
where does metabolism usually take place
A
liver
fat –> water soluble = renal secretion
19
Q
hepatic microsomal enzyme system
A
cytochrome P450 system
-system that metabolizes
20
Q
therapeutic consequences of metabolism
A
- faster renal excretion
- drug inactivation
- increased therapeutic action
- activation of prodrug (cover to help get to intestines)
- increase/decrease of toxicity
21
Q
first pass effect
A
oral med pass first through liver –> mostly metabolized = small portion available
-given sublingual instead
22
Q
nitroglycerin
A
given sublingual (absorbed through mouth)
23
Q
excretion
A
getting drug out of body
24
Q
where does excretion take place
A
mostly through kidneys
could be:
-bowel
-lungs
-skin
25
how would you check pt's renal status
BUN, GFR
26
serum half life
time for the blood level of a med/drug to decrease by 50%
4-5 half-life cycles before steady state
27
half-life example:
half-life = 3 hr
how long until steady state
12 hours
28
lethal dose
does that will kill
29
effective dose
dose that produces a predefined response
30
therapeutic indec
measure drug safety
ratio of LD - ED
31
large index
LD & ED are far apart
safe
32
small index
LD & ED are close
dangerous
33
drug prototype
chemical name (long name)
34
generic name
usually class specific
professional name
(need to know generic)
35
trade name
branded or trademark name
(pt usually knows)
36
pharmacodynamics
how drug influences target cells & subsequent changes in body's biochemical reactions
-what drug does to body
37
interference
one drug inhibits/induces metabolism or excretion of another
38
displacement
two drugs compete for binding site on albumin
-2 protien bound = 1 kicked off
39
antagonism
effects of two drugs cancel each other out
-key hole
40
incompatibility
physical interaction of two drugs interfere with effect of at least one
41
food interactions
- dairy products
- certain antibiotics
- foods containing vitamin k
- grapefruit juice
42
drug + empty stomach
1 hour before
2 hours after
43
side effects depend on:
- dose
- therapeutic index
- age
- medical history
- drug-drug interactions
44
allergic reaction
penicillin
NSAIDs
sulfa drugs
45
idiosyncratic reaction
bad response to med
46
iatrogenic
medication causes disease
47
teratogenic effects
drug induced birth defect
48
toxicity
nausea/vomiting
anemia/abnormal bleeding
damage to liver
damage to kidneys
49
reporting medication errors
assessment
determine interventions
complete incident report
notify person in charge
follow protocol
50
schedule I substances
not approved for medical use
high risk for abuse
51
schedule I examples
heroin
LSD
marijuana*
52
schedule II
medical use
high risk for abuse
53
schedule II examples
opioids (morphine, codeine)
54
schedule III
combination drugs
lower risk for abuse
55
schedule III examples
tylenol #3= tylenol + codeine
56
schedule IV
medically indicated
mild physical/psychological dependence
57
schedule IV examples
benzodiazepines (diazepam)
choral hydrate
phenobarbital
58
schedule V
medically accepted
limited dependency
59
schedule V examples
lomotil
cough syrup w/ codiene
60
schedule # drugs
lower # = higher risk for abuse
61
Before administering a medication, what does the nurse need to know to evaluate how individual pt variability might affect the pt's response to the med? (Select all that apply)
a. chemical stability of med
b. family medical history
c. pt's age
d. ease of administration
e. pt's diagnosis
b. family medical history
c. pt's age
e. pt's diagnosis
62
which patient's are @ increased risk for adverse drug events? (Select all that apply)
a. 2-month-old infant taking med for gastroesophageal reflux disease
b. 7-year-old female receiving insulin for diabetes
c. 23-year-old female taking antibiotic for first time
d. 40-year-old male who is intubated in the ICU & taking antibiotics & cardiac meds
e. 80-year-old male taking meds for COPD
a. under 1
d. more drugs
e. over 70
63
pt who has cancer reports pain as "burning" & "shooting" alternating w/ feelings of numbness & coldness. what med will be given
duloxetine (cymbalta)
64
what is preferred for pt w/ persistent pain
scheduled dosing around the clock
65
opioids shouldn't be used
chronic pain
66
pain threshold
point where it becomes painful
67
pain tolerance
point when pain becomes too much
(finally take/do something)
68
pain tolerance is decreased by:
repeated exposure to pain
fatigue
anger
fear
sleep deprivation
69
physical dependence
body's reaction
ex: no coffee --> headache
70
addiction
behavior pattern
71
initial reaction of physical dependence
about 10 hours after last dose
yawning, rhinorrhea, sweating
72
later reaction of physical dependence
violent sneezing
weakness
nausea/vomiting
diarrhea
abdominal cramping
bone & muscle pain
muscle spasm & kicking movements
73
how long does physical dependence last if untreated
7-10 days
74
what moderates pain
nor-epi & seratonin
75
where do nor-epi & seratonin moderate pain
medulla & pons
76
acute pain
less than 6 months
somatic, visceral, referred
77
acute somatic pain
connective tissue, muscle, bone, & skin
78
acute visceral pain
internal organs & abdomen
79
referred pain
present in area removed or distant from point of origin
80
somatic pain feeling
sharp & localized or dull & non-localized
81
acute somatic pain responds best to
*TYLENOL & OPIOIDS*
acetaminophen
corticosteroids
NSAIDs
opiates
local anesthetics
ice
massage
82
visceral pain responds to
*OPIOIDS*
corticosteroids
NSAIDs
83
analgesics
relieve pain w/out causing loss of consciousness
84
opioids
most effective pain relievers available
85
drugs for acute pain
morphine & other opioid agonists
acetaminophen
86
morphine & opioids
moderate --> severe pain
oral, IV, transdermal
87
morphine & opioids for - moderate pain
codeine or codeine/acetaminophen
hydrocodone or hydrocodone/acetaminophen
88
morphine & opioids - severe pain
morphine
oxycodone
89
chronic pain
over 6 months
significant behavior & psychological changes
90
types of chronic pain
central
non-neuropathic
neuropathic
psychogenic
91
central chronic pain
CNS lesion or dysfunction
migraine (headache)
92
central pain treatment
treat cause
medications
93
non-neuropathic pain
myofascial (chronic) pain syndromes
fibromyalgia (muscle pain)
myositis (inflammed muscles)
myalgia (sore muscles)
muscle strain
94
non-neuropathic drug choices
NSAIDs
TCAs
serotonin reuptake inhibitors
95
neuropathic pain feeling
burning & tingling sensation
96
neuropathic pain
trauma or disease to nerves
diabetic neuropathy (nerve damage due to diabetes)
post-herpetic neuralgia (lasting pain from shingles)
deafferentation pain (pain loss due to sensory input)
97
management strategy (ABCDE)
Ask about pain regularly
Believe pt/family in reports of pain
Choose pain control appropriate for pt
Deliver interventions in timely, logical, coordinated fashion
Empower pts/families (allow pts to control treatment)
98
drugs for neuropathic pain
anti-epileptics:
- pregabalin
- gabapentin
antidepressant:
- TCAs
- duloxetine (cymbalta)
99
three families of peptides
enkephalins
endorphins
dynorphins
100
peptides severe
neurotransmitters
neurohormones
neuromodulators
101
pure opioid agonists
*agonist: MU & KAPPA*
morphine
codeine
meperidine
102
MU antagonist & KAPPA agonist
pentazocine
nalbuphine
butorphanol
103
MU agonist & KAPPA antagonist
buprenorphine
104
pure opioid antagonists
*MU & KAPPA*
naloxone
naltrexone
105
morphine
moderate to severe pain
(not used to treat anxiety)
binds to MU
106
morphine adverse effects
respiratory distress
constipation (need laxative)
orthostatic hypotension
urinary retention
euphoria/dysphoria
sedation
miosis (pinpoint pupils)
intracranial pressure (ICP)
birth defects
107
morphine shouldn't be given to...
pt w/ head trauma (ICP)
pregnant women (birth defect)
pt w/ impaired pulmonary function (asthma, emphysema, kyphoscoliosis, chronic cor pulmonale)
108
pharmacokinetics of morphine
not very lipid-soluble
doesn't cross blood-brain barrier easily
small fraction of dose reaches site of analgesic action
109
what schedule is morphine
schedule 2
110
precautions of morphine
decreased respiratory reserve (COPD), head injury, pregnant, labor & delivery
111
morphine toxicity
classic triad
- coma
- RD
- miosis
112
morphine toxicity treatment
ventilatory support
naloxone (narcan) --> blocks receptors
113
mild to moderate pain
codeine (generic)
hydrocodone (vicodin)
oxycodone (oxycontin)
meperidine (demerol)
114
moderate to severe pain
morphine
hydromorphone
oxymorphone
levorphanol
fentanyl
methadone
115
codeine dose
parenteral:
- 120
oral:
- 200
116
hydrocodone dose
oral:
- 30
117
oxycodone dose
oral:
- 20
118
meperidine dose
parenteral:
- 100
oral:
- 400
119
morphine dose
parenteral:
- 10
oral:
- 30
120
hydromorphone dose
parenteral:
- 1.5
oral:
- 7.5
121
oxymorphone dose
parental:
- 1
122
levorphanol dose
parenteral:
- 2
oral:
- 4
123
fentanyl dose
parental:
0.1-0.2
124
methadone dose
parenteral:
10^b
oral:
3-5^b
125
fentanyl
100x potency of morphine
chronic pain
126
five formulations in three routes
parenteral (sublimaze)
transdermal (duragesic)
transmucosal
127
parenteral
*sublimaze*
surgical anesthesia
128
transdermal
*duragesic*
- patch
- iontophoretic system
129
transmucosal
lozenge on stick (Actiq)
buccal film (onsolis)
buccal tablets (fentora)
sublingual tablets (abstrail)
130
alfentanil & sufentanil
1000x more
131
remifentanil
10,000x more
animal tranq.
132
meperidine
short half-life
can't use for longer than 48 hours
133
methadone
long half-life
treatment for pain & opioid addicts
134
hydromorphone (dilaudid)
10x more patent than morphine
less nausea than morphine
135
1.5 mg of hydromorphone IV = ??? morphine IV
10 mg
136
codeine
schedule 2
pain & cough suppression
137
what precent of codeine converts to morphine in liver
10%
138
when can't pt convert codeine to morphine in liver
lack 2D6 pathway
139
oxycodone
long-acting analgesic
140
hydrocodone
no max dose unless combined w/ tylenol or ibuprofen
141
dosing guidelines
- pain assessment
- dosage determination
- dosing schedule
- avoiding withdrawal
142
pure opioids max dose?
no ceiling dose
143
when should opioids be administered
on fixed schedule
144
patient-controlled analgesia
PRN
pt gives own dose
145
opioid antagonists
block effects of opioid agonists
146
uses of opioid antagonists
opioid overdose (opioid- induced constipation)
reverse post-operative opioid effects
manage opioid addiction
147
pure opioid antagonist meds
naloxone (narcan)
methylnatrexone (re listor)
alvimopan (entereg)
naltrexone (revia, vivitrol)
148
naloxone (narcan)
reverse opioid overdose (titrated cautiously)
reverse post-operative opioid effects
reversal of neonatal RD (labor & delivery)
149
methylnatrexone
treat opioid-induced constipation
(laxative isn't working)
150
non-opioid centrally acting analgesics
tramadol (ultram): suicide risk
clonidine (duraclon)
ziconotide (prialt)
dexmedetomidine (precedex)
151
tramadol
schedule 4
increase nor-epi & serotonin in brain (blocks uptake)
used for suicide
152
clonidine
neuropathic pain
hypotension
rebound hypertension
bradycardia
153
after surgery, a pt has morphine prescribed for postoperative pain. it is most important for the nurse to make which assessment?
a. RR
b. HR
c. pain level
d. constipation
a. RR
154
a post-operative pt who has an IV infusion of morphine has a RR of 8 breaths/min & is lethargic. which as-needed (PRN) medication should the nurse administer to pt?
a. methadone (dolophine)
b. nalbuphine (nubain)
c. tramadol (ultram)
d. naloxone (narcan)
d. naloxone (narcan)
155
nociceptive pain patho
injury to tissues
somatic & visceral
156
neuropathic pain patho
injury to peripheral nerves
responds poorly to opioids
157
ongoing evaluation
reassess frequently
evaluate after sufficient time
be alert to new pain
158
barriers to assessment
inaccurate reporting by pt
under-reporting by pt
language & cultural barriers
159
drug therapy
non-opioid analgesics
opioid analgesics
adjuvant analgesics
160
step 1: analgesic ladder
mild to moderate
- non-opioid
- NSAID & acetaminophen
161
step 2: analgesic ladder
more severe pain
- opioid analgesic
- oxycodone
- hydrocodone
162
step 3: analgesic ladder
severe pain
- morphine
- fentanyl
163
cancer pts avoid
meperidine (demerol)
164
routes of administration
oral
rectal
transdermal
IV or sub Q
IM
intraspinal
intraventricular
PCA
165
breakthrough pain
transient episodes of pain
give PRN
166
adjuvant analgesics
complement effects of opioids
amitriptyline (elavil)
give w/ opioid
167
types of adjuvant analgesics
antihistamines
- hydroxyzine (vistaril)
glucocorticoids
bisphosphonates
168
physical interventions
heat
cold
massage
exercise
TENS
169
psychosocial interventions
relaxation & imagery
cognitive distraction
peer support groups
170
older adults
heightened drug sensitivity
under-treated: believed to...
- insensitive to pain
- tolerate pain well
- highly sensitive to opioid side effects
171
young children
asses & treat verbal/non-verbal
172
a pt w/ cancer complains of bone pain rates 8/10. which medication should the nurse administer?
a. ibuprofen (motrin)
b. acetaminophen (tylenol)
c. hydromorphone (dilaudid)
d. meperidine (demerol)
c. hydromorphone (dilaudid)
173
which is the priority of care in the pt w/ moderate to severe pain from cancer?
a. prevention of addiction & physical dependence
b. adequate pain relief w/ opioid medication
c. avoid constipation by increasing dietary intake
d. using TENS or massage to treat cancer pain
b. adequate pain relief w/ opioid meds
174
the nurse instructs a pt w/ cancer pain about taking opioids. which statement, if made by pt, indicates understanding about instructions?
a. i can expect drug to cause serious side effects
b. i will develop an addiction to pain medication
c. if the drug no longer works, the dose can be increased
d. i should not take medication until pain is severe
c. if drug no longer works, dose can be increased
175
a pt who is an opioid abuser is diagnosed w/ bone cancer. if the pt complains of severe bone pain, it is most important for the nurse to administer which medication?
a. potent non-steroidal anti-inflammatory drugs
b. adequate doses of opioids
c. frequent doses of non-opioids
d. regular doses of an opioid agonist-antagonist
b. adequate doses of opioids
