PHARM WEEK 1 INTRO TO MEDS Flashcards
(125 cards)
1
Q
Percocet vs. Percodan
A
Oxycodone (with acetaminophen) vs.
Oxycodone (with aspirin)
[both are pain meds]
2
Q
Hydroxyzine vs. Hydralazine
A
Antianxiety vs. antihypertensive
3
Q
Quinidine vs. Quinine
A
Antidysrhythmic vs. antimalarial
4
Q
Celexa vs. Celebrex
A
SSRI vs. NSAID (anti-inflammatory)
5
Q
Methods of Drug Distribution
STOCK
- advantages
A
Advantages:
- Always available
- Cost Efficiency
- in your place of work
6
Q
Methods of Drug Distribution
STOCK
-disadvantages
A
Disadvantages:
-More errors
- poured by many
- more drugs to choose
from
- may be a multi dose vial which is now discouraged especially liquid meds b/c of some outbreak of hepatitis
- Drug expiration may be
missed
7
Q
Methods of Drug Distribution
UNIT DOSE
- Advantages
A
Advantages:
- Fewer errors
- Saves time
- Correct dose without calculation
- Billed for specific # doses
8
Q
Methods of Drug Distribution
UNIT DOSE
-Disadvantages
A
Disadvantages:
- time delay to get drug
- if contaminated or damaged, not readily replaceable
9
Q
Computer Based Drug Administration (CBDA):
4
A
- Computerized Prescription Order System (CPOS)
- Bar Code Medication Administration
- Medication Administration Record (MAR & eMAR)
- Automation of Medication Dispensing Administration
10
Q
1 teaspoon = __ ml
A
5 ml
11
Q
1 Tablespoon (T) = __ ml = __ ounce (use a __ __ __ or __)
A
15 ml; 1/2 ounce
med measuring cup
syringe
12
Q
1 ounce = __ ml = __ T
A
30 ml ; 2T
13
Q
The art and science of preparing and dispensing drugs and medicines (packaging, pharmacies, oral vs. tablets vs. solution, gastric effects) =
A
pharmaceutics
14
Q
The quantitative study of how drugs are taken up and biologically transformed (“MOTION”), what the body does to the drug =
A
pharmacokinetics
15
Q
The quantitative study of drug “ACTION” - what the drug does to the body (how the med works and its chemical action) =
A
pharmacodynamics
16
Q
What are some contemporary issues in pharmacology? (4)
A
- drug approval process
- transcultural considerations
- drug interactions, OTC drugs, drug abuse
- herbal therapies
17
Q
Food & Drug Administration (FDA) passed which act?
A
1938 Food, Drug, and Cosmetic Act
18
Q
What does the FDA do?
A
Monitors, regulates, manufactures, and markets drugs
- testing
- labels
- packaging re: adverse effects
19
Q
1970 Controlled Substances Act: Schedule Categories of drugs (I - V)
A
I. High abuse potential, NO medical use (Heroin, LSD)
II. High abuse potential; ACCEPTED medical use (morphine - epidemic of opioid addiction)
III. Medically accepted;
20
Q
HIPAA (4)
- ___ act set standards for privacy of health information
- Limited access to patient info from ___
- __ __ __ with pharmacist
- All clients __ __ they received copy of privacy practices
A
- 2003
- pharmacy
- Private consult area
- sign statement
21
Q
Nurse practice acts __ __ __
A
vary by state
22
Q
NY/NJ law prohibits nurse from giving medication without:
A
a valid prescription from HCP
23
Q
Under the nurse practice acts, there are __ __ and __ __
A
criminal offenses
civil offenses
24
Q
Nurse practice acts: Civil Offenses include: (3)
A
- Misfeasance
- Nonfeasance
- Malfeasance
25
Misfeasance
negligence (wrong drug/dose) results in death
26
Nonfeasance
omission results in death
27
Malfeasance
correct drug by wrong route causes death
28
FDA Pregnancy Categories classify __ __ to __ . The categories are: (5)
drug risks; fetus
1. A
2. B
3. C
4. D
5. X
29
FDA Pregnancy Categories
| - Categories __ and __ are considered safe during pregnancy, especially in the 1st trimester
A & B
30
FDA Pregnancy Category A
Studies show no fetal risk
31
FDA Pregnancy Category B
No fetal risk in ANIMAL studies
| No risk assumed in humans
32
FDA Pregnancy Category C
Fetal risk in ANIMAL studies
| Weigh risk vs. benefit
33
FDA Pregnancy Category D
Established/ Proven FETAL risk
| Weigh risk vs. benefit if life-threatening
34
FDA Pregnancy Category X
Established/ Proven FETAL risk
Risk is > benefit
AVOID IN PREGNANCY
35
Phases of Human Clinical Drug Experimentation
| Phase I
Determines human drug dose in healthy subjects
36
Phases of Human Clinical Drug Experimentation
| Phase II
Demonstrate drug safety & efficacy in subjects with disease
37
Phases of Human Clinical Drug Experimentation
| Phase III & IV
Demonstrate drug safety & efficacy in wide client population and collect long term data
38
Phases of Human Clinical Drug Experimentation
| Phase V
Adding adverse events to a drug after the drug is widely used
Report any adverse events to the FDA
39
taking antidepressants can lead to __ because your __ __ increases due to weight gain
diabetes
blood sugar
40
The roles of the nurse in drug research (5 )
1. Client and family advocate
2. Liaison between client, health care provider, and research nurse responsible for specific protocol
3. informed consent
4. risk to benefit ratio
5. assess for therapeutic effects, side effects, and adverse reactions
41
Ethnopharmacology = the study of drug responses that may be __ to an individual owing to __, __ and __ phenomena
In other words,
__ + __ = ethnopharmacology
unique
social, cultural, biologic
anthropology + pharmacology
42
Pharmacogenetics = __ of the __ __ to a drug due to genetic factors
variations; predicted response
43
Which classes of antihypertensive agents do African Americans respond poorly to?
beta blockers
| ACE inhibitors
44
Asians have a greater sensitivity to which two drug classes ?
benzodiazepines
| anti-depressants
45
What 4 things make up transcultural nursing?
1. traditional health practices
2. complementary health practices
3. alternative health practices
4. mainstream health practices
46
What are traditional health practices?
Includes the use of teas, herbs, spices, special foods, and homeopathic remedies
Can produce neutral, beneficial, or deleterious effects
47
Giger and Davidhizar Transcultural Assessment Model
| - Nursing assessment (7)
1. culturally unique individual
2. communication
3. space
4. social organization
5. time
6. environmental control
7. biology variations (pharmacogenomics)
48
Drug interactions: Additive effects
sum of the effects
Two drugs with similar actions sum their effects (e.g., 1+1 =2)
May be desirable or undesirable
49
Drug interactions: Synergism or Potentiation
clinical effect is greater than simply the combined effect of the two
ex: 1 + 1 = 3
50
Drug interactions:
| Drug Interference
one drug increases or decreases the metabolism or excretion of another
51
Drug interactions: Displacement
one takes the place of another ; two drugs compete for binding sites on plasma proteins (e.g., albumin)
52
Drug interactions: Antagonism
one cancels the effect of the other (1+1 = 0)
Basis for antidotes to toxic effects of another drug or chemical
(e.g., Narcan in an opiates overdose - prevents opiates from binding to CNS receptor sites)
53
Drug interactions: Incompatibility
one cannot exist with the other
interaction of 2 drugs interferes w/ action of at least 1 drug
basis for drugs that bind/inactivate another toxic drug in GI tract
54
Examples of additive effects
Hydralazine (vasodilator) + Nitroglycerin (vasodilator) = Hypotension
(requires caution and patient knowledge)
Ask q's like :
1. What is the patient's bp?
2. What's their baseline bp?
3. Has patient taken both in the past?
Beta blocker + diuretic =
55
Examples of synergism or potentiation
Codeine + ASA = > pain relief
Ampicillin + Sulbactam (enzyme inhibitor which helps ampicillin enter the cell of the bacteria to fight infection) = > therapeutic effect
56
Drug interference examples
Cimetidine = med for ulcer, certain enzymes will be inhibited, may not be able to metabolize meds like coumadin = diminished effect of the med
Probenicid given in conjunction with penicillin allows the penicillin to stay in the body longer b/c probenicid slows renal excretion
57
Displacement examples
Anticoagulants & anti-inflammatory = > risk bleeding
58
Albumin binds to drugs so that you can carry it around in the body to the intended site. Active form of the medication =
when unbound to albumin, this is when the medication is working
you can overdose the patient without actually overdosing them!
59
Incompatibility examples
Magnesium in antacids + tetracycline = may impair absorption of tetracycline
Mixing different types of IV meds in the same tubing can cause crystalized drug and line occlusion
laxatives speed up peristalsis by increasing the speed - you have less chance for the drug to be absorbed
- try not give these with other meds
Morphine (opioid) - slows GI mobility - might have a greater effect of the drop, more likely to absorb more without actually giving a greater dose of the drug
60
Drug abuse =
drug use inconsistent with medical or social norms
- nurses and other HCPs at risk b/c
1. readily available
2. stress involved on the job
3. desensitization
61
Drug-Food Interactions
| Food __ most drug absorption
slows
62
Drug-food interaction exceptions:
| Tyramine foods + ?
Tyramine foods beer, wine, cheese, pickled herring, yogurt, liver and yeast extract) + MAO inhibitors = severe HTN
63
Drug-food interaction exceptions:
| Vitamin K-rich foods + ?
Vitamin K-rich foods (green leafy veggies, broccoli, bananas, fish) + warfarin (Coumadin) = decreased anticoagulation
64
Drug-food interaction exceptions:
| Dairy products + ?
Dairy products impair absorption of tetracycline
If you drink tetracycline with milk, it will decrease the plasma levels of the drug, therefore inhibiting absorption
65
Drug-food interaction exceptions:
| Grapefruit juice + ?
Grapefruit juice + calcium channel blockers = decrease bp and possible toxicity.
66
Some meds that must be taken with food:
beta blockers
Statin
Aspirin
67
Which med do you want to take on an empty stomach for better absorption?
Synthroid - given for hypothyroidism
68
Drug- lab values interactions:
__ __ or __ __ can affect certain drug therapies
Examples:
abnormal plasma; serum electrolytes
Examples:
Digoxin & low K+ or Mg++ or high Ca++
- may cause digitalis toxicity (nausea, diarrhea, H/A, blurred vision, bradycardia, ventricular dysrhythmias)
69
What are 7 cautions with use of OTC meds?
1. OTC drugs may cause delay in professional diagnosis and treatment 2. Symptoms may be masked
3. Be sure to read labels carefully
4. Consult health care provider before use
5. Inactive ingredients may cause adverse reactions
6. Potential for overdose
7. Risk for drug-drug interactions
70
OTC drugs and herbal therapies (4)
1. need to be aware of usage
2. may be beneficial
3. may have serious potential side effects
4. may interfere with prescription drug therapy
71
Common Herbal Remedies:
| Chamomile
GI complaints
72
Common Herbal Remedies:
| Echinacea
immune system enhancer
73
Common Herbal Remedies:
| Garlic
lower cholesterol and triglycerides,
74
Common Herbal Remedies:
| Ginger
boost immune system
75
Common Herbal Remedies:
| Gingko
improve memory
76
Common Herbal Remedies:
| Ginseng
decreases stress, boost energy, and digestion
77
Common Herbal Remedies:
| St. John's wort
antidepressant
78
What are the potential hazards of herbs:
| 4
1. lack of standards
2. largely unregulated by FDA
3. possible interactions with drugs
4. should NOT be used:
- if pregnant or nursing
- by infants or small children
- with chemotherapy
- in large quantities
79
Drug Action Phases:
| Pharmaceutic Phase
1. Drug becomes a solution so that it can cross the biologic membrane
* Drugs that are administered by subcutaneous, intramuscular or intravenous routes do not go through a pharmaceutic phase
80
Drug Action Phases:
| Pharmacokinetic Phase
1. Absorption
2. Distribution - protein binding
3. metabolism or biotransformation
4. excretion or elimination
81
Pharmacokinetics: Absorption of ORAL MEDS-
First Pass Effect
Drug passes through liver before entering systemic circulation;
Chemical and biological barriers in GI environ
82
Pharmacokinetics: Absorption of Oral Meds-
Bioavailability
% drug that reaches systemic circulation
In other words, the amount that goes into the bloodstream after being metabolized by the liver
PO drugs always
83
Pharmacokinetics: Distribution =
process by which drug becomes available to body fluids and tissues
84
Distribution: Protein Binding
Plasma protein bound drugs
Bound drug portion is inactive
Highly bound greater than 89%; less than 30% low protein bound
2 high protein bound drugs together can = toxicity
85
Distribution: Protein Binding
Free (unbound) drugs
Only free drugs are active
Hypoalbuminemia = excess free drug & can cause toxicity
86
Be aware of __ __ __ of all drugs taken by client
Check client's __ __ and __ levels
protein binding %
plasma protein & albumin
87
Distribution: Protein Binding
Blood Flow
Abscesses, exudates, glands, & tumors decrease distribution
abscesses and exudates don't have blood flow, no blood vessels
88
Distribution: Protein Binding
Body Tissue Affinity
Body Tissue Affinity: Some drugs accumulate in fat, bone, liver, muscle, & eye tissue (e.g., amiodarone (give for a-fib) – can cause lung toxicities)
89
Pharmacokinetics: Metabolism or Biotransformation
What is metabolism?
What is the primary site of drug metabolism?
When metabolism is decreased what happens?
Metabolism is the process by which the body inactivates or biotransforms drugs
Liver primary site of drug metabolism
-Liver enzymes convert or transform drugs to inactive metabolites or water-soluble substances for excretion
Liver diseases can affect metabolism (e.g., hepatitis, cirrhosis)
When metabolism is decreased,
-Excess drug accumulation can lead to toxicity
90
Metabolism: Half- life
time it takes for 1/2 drug concentration to be eliminated
metabolism affects 1/2 life
Liver dysfunction prolongs 1/2 life
By knowing drug's half-life, we can estimate time to reach biologic steady state
91
__ to __ half lives saturates biology system
What does saturating the biologic system mean?
3-5
the amount of drug taken in is the same amount that is excreted
92
__ are main route of drug excretion
Other routes include: (7)
Kidneys
1. liver
2. bile
3. feces
4. lungs
5. saliva
6. sweat
7. breast milk
93
Kidneys filter __ __ __, __-__ __, and __ __
1. free unbound drugs
2. water-soluble drugs
3. unchanged drugs
94
__ __ drugs can not be excreted via the kidneys
Protein bound
95
Urine pH
| Acid urine excretes __ __ __
weak base drugs
96
Urine pH
| Alkaline urine excretes __ __ __
weak acid drugs
97
We can manipulate the urine pH which is between __ and __ to help patient's body __ the drug
4 and 8
eliminate
98
what is the most accurate renal function test ?
```
creatinine clearance (Cr Cl)
this is a 12-24 hour urine collection
```
99
Creatinine is the
metabolic byproduct of muscle tissue that is excreted by kidneys
100
Less muscle mass = __ creatinine values (especially in __ and __)
lower;
| women; elderly
101
Normal Creatinine Clearance levels are between :
85 - 135 ml/ min
102
If CrCl is lower than the normal range, what would you do?
may need to decrease drug dose
103
Pharmacodynamic Phase
| -Primary physiologic effect
desirable
| - what drug was approved for
104
Pharmacodynamic Phase
| -Secondary physiologic effect
May be desirable or undesirable
| Example: Diphenhydramine (Benadryl) causes drowsiness
105
Pharmacodynamic Phase
| Dose response & maximal efficacy
Dose response is relation between minimum vs. max dose needed for desired effect
106
Pharmacodynamics
- Therapeutic Index
- Low =
- High =
Low: narrow margin of safety
High: wide margin of safety
107
Pharmacodynamics
Peak levels:
Time of highest plasma drug concentration & shows rate of absorption
-Drug peak blood work drawn at prescribed time
108
Pharmacodynamics
Trough levels:
Lowest plasma drug concentration & shows rate of excretion.
-Drug trough blood work drawn just before next dose of drug and should be documented
109
Pharmacodynamics
Loading dose:
large initial dose
110
Pharmacodynamics
Side effects
desirable and undesirable
111
Pharmacodynamics
Adverse reactions
- More severe than side effects
- Always undesirable
- Can be mild to severe
- Example: mild allergic reaction (mild hives) vs. severe such as anaphylaxis (CV collapse)
112
Pharmacodynamics
Toxic effects
likely to occur when drug levels exceed therapeutic range
113
Pharmacodynamics
Drug tolerance
Can occur due to frequent, repeated drug administration (e.g., opioids)
114
Pharmacodynamics
placebo effect
Psychological benefit from a compound without chemical structure of a drug effect
115
Pharmacodynamics: Receptor Theory
receptors found on cell membranes
ligand-binding domain is the site on the receptor in which drugs bind
116
Pharmacodynamics: Receptor Theory
What are the four receptor families ?
1. Kinase-linked receptors
2. Ligand-gated ion channels
3. G protein-coupled receptor systems
4. Nuclear receptors
117
Receptor Theory: Families
Kinase-linked receptor
ligand binding domain on cell surface
drug activates enzyme inside cell initiating effect
118
Receptor Theory: Families
Ligand-gated ion channels
drug spans cell membrane, ion channels (Na and Ca) open initiating effect
119
Receptor Theory: Families
G protein-coupled receptor systems
drug activates receptor which activates G-protein which activates effect
120
Receptor Theory: Families
Nuclear receptors
effect is achieved through in and through the functions of the cell nucleus by means of a transcription (reading and coding) process. Activation is prolonged in this receptor family.
121
Pharmacodynamics
Agonists
drugs that produce a response
122
Pharmacodynamics
Antagonists
drugs that block a response
123
Pharmacodynamics
Nonspecific/Nonselective drug effect
drugs that affect multiple sites/ receptors
124
Potentially Inappropriate Medications (PIM) in Older Adults
| 4
1. Beers Criteria
2. Meds to AVOID in older adults regardless of diseases or conditions
3. Meds considered potentially inappropriate when used in older adults with certain diseases or syndromes
4. Meds that should be used with caution
125
1970 Controlled Substances Act:
| Schedule Categories of Drugs
I. High abuse potential, NO medical use (Heroin, LSD)
II. High abuse potential; ACCEPTED medical use (morphine - epidemic of opioid addiction)
III. Medically accepted;
