Pharmacokinetics Flashcards
(138 cards)
1
Q
What are the 4 parts of pharmacokinetics?
A
- Absorption
- Distribution
- Metabolism
- Excretion
2
Q
What is drug absorption defined as?
A
the movement of a substance from its site of administration, across body membranes to circulating fluids
3
Q
What is drug distribution defined as?
A
The transportation and holding areas of the drug in the body, until it reaches its site of action
4
Q
What is drug metabolism defined as?
A
biological transformation ‘biotransformation’ chemically converting a drug to a form that is more easily removed from the body
5
Q
What is drug excretion defined as?
A
the process of eliminating the drug from the body
6
Q
During Absorption, the presence of food will _______ the drugs potential drug effect.
A
Decrease
7
Q
During distribution, the displacement of drug from plasma protein binding site _______ the potential drug effect.
A
Increases
8
Q
Decreased excretion _____ the potential drug effect.
A
Increases
9
Q
Increased excretion ____ the potential drug effect.
A
Decreases
10
Q
What factors affect drug absorption?
A
Whether it is taken with food.
Digestive motility
Blood flow
Route of administration
11
Q
What is a Loading Dose?
A
An initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose.
(a drug with a long half-life may take a longer time to achieve it’s status- sometimes a loading dose is given).
12
Q
What is the difference between a Adverse effect and a Side effect?
A
Adverse= an undesirable and potentially harmful action caused by the administration of the medication.
Side= types of drug effects that are predictable and that may occur even at therapeutic doses. They are less serious than adverse effects.
13
Q
What is the most common adverse effect of medication?
A
Nausea and vomiting. Headaches and changes in blood pressure.
14
Q
What does Dose Dependent mean with regard to adverse effects?
A
As the drug dose increases, the risk of adverse effects also increases.
15
Q
How do you minimize/prevent adverse drug effects in clients?
A
Educate them on difference between side and adverse effects.
Understanding the drugs that are being taken.
16
Q
Why would a drug be approved and given to clients if it was known to cause cancer?
A
Risk Benefit Ratio- determination of whether the risks from a drug outweigh the potential benefits received by taking the medication.
17
Q
What are Teratogens?
A
Drugs that cause birth defects (e.g. alcohol).
18
Q
What are the three primary classes of drugs that increase the risk of acquiring cancer?
A
- Antineoplastics (work to eliminate cancer cells).
- Immunosuppressants (dampen the immune system).
- Hormonal agents
19
Q
What are the signs and symptoms of neurotoxicity?
A
Depression, mania, sedation, behavioural changes, suicidal feelings, hallucinations and seizures.
20
Q
What are the treatment options for neurotoxicity?
A
Medications (corticosteroids, antidepressants).
Therapy
Lifestyle changes- healthy eating, exercise.
21
Q
What are the signs and symptoms of hepatotoxicity?
A
Jaundice, itching, and easy bruising.
22
Q
What are the signs and symptoms of nephrotoxicity?
A
Swelling, foamy urine, weight gain, fatigue, decreased urine output, high BP, blood in urine.
23
Q
How do we prevent nephrotoxicity?
A
Providing proper hydration, monitoring urinary values, and adjusting doses appropriately for clients with renal impairment.
24
Q
What are the signs and symptoms of cardiotoxicity?
A
Excessive fatigue, cough, SOB, weight gain or peripheral edema.
25
What are the signs and symptoms of bone marrow toxicity?
Fatigue, bleeding, and infections.
26
What are the signs and symptoms of skeletal muscle toxicity?
Muscle weakness, muscle pain, difficulty swallowing, dehydration.
27
What is a Idiosyncratic reaction?
An adverse drug effect that produces unusual and unexpected symptoms that are not related to the pharmacological action of the drug.
28
What is the nurse's role in drug administration?
1.Obtain medical history (including allergies).
2.Thoroughly assess the client and all diagnostic data- e.g. underlying hepatic or renal impairment that will affect the way the drug is handled by the body.
3.Prevent medication errors.
4.Monitor pharmacotherapy carefully- monitor client signs and symptoms regularly.
5.Know the drugs.
6.Be prepared for the unusual.
7.Question unusual orders.
8.Teach clients about adverse effects and the difference between allergic reactions.
29
What is the difference between potency and efficacy?
Potency= how strong the medication is.
Efficacy= how efficient it is at creating a therapeutic effect.
30
What drug is more critical for assessment one with a narrow therapeutic index or one with a larger therapeutic index?
Narrow.
31
What is a Antagonist?
Blocks a receptor. It can be competitive, noncompetitive or functional (slows drug absorption).
32
What is a Agonist?
A drug that produces a response that mimics the effect of an endogenous regularly molecule.
33
What is a Partial Agonist?
A medication that produces a weaker or less effective response than an agonist.
34
What organ is the main site of drug metabolism?
Liver
35
Other than the liver, where can drug metabolism also occur?
The kidneys, intestinal mucosa, lungs, plasma and placenta.
36
What factors affect the distribution of a drug?
Blood flow
Drug solubility
Tissue storage
Protein binding
Special barriers
37
What are areas of rapid distribution in the body?
Highly vascularized, or sites with a large blood volume (e.g. heart, liver, kidneys, brain).
38
What are areas of slow distribution in the body?
Less vascularized, less blood volume (e.g. muscle, skin)
39
What are the areas of slowest distribution?
Less vascularized, least blood volume. (e.g. bone, fat).
40
What is Half-Life?
the time it takes for half of the original amount of the drug in the body to be eliminated.
41
Which medication would you give more frequently- one with a short half-life or one with a long half-life? Why?
Short half-life because it is moving quicker through the body.
42
Explain the non-pharmacological management of angina pectoris.
Primarily focuses on lifestyle modifications:
Large meals should be avoided.
Quit smoking
Limit salt and saturated fats.
Maintain ideal body weight.
Limit or abstain from alcohol.
Maintain blood glucose levels.
Physiotherapy
Counselling- manage stress
43
What is the difference between Beta1 receptors and Beta2 receptors?
Beta 1= primarily on the heart.
Beta 2= located primarily on smooth muscles of bronchioles and blood vessels.
44
How does grapefruit juice interact with some drugs?
Can increase or decrease the breakdown of some blood pressure, cholesterol-lowering, and organ transplant medicines
45
What is the main neurotransmitter in the PSNS?
Acetylcholine
46
What are the indications and uses of cholinergics?
Promotion of bladder motility, GI motility and treatment of glaucoma.
47
What are the two primary ANS neurotransmitters?
1. Norepinephrine
2. Acetylcholine
48
What 4 possible actions are autonomic drugs classified as?
1. Stimulating the SNS.
2. Inhibiting the SNS
3. Stimulating the PSNS
4. Stimulating the PSNS
49
What are Anticholinergics?
Drugs that block the actions of acetylcholine in the PSNS.
(PS is decreased and the S is increased).
50
What are the types of adrenergic receptors?
Alpha 1 and 2
Beta 1 and 2
51
What are some common side effects of adrenergic drugs, like epinephrine, include?
Anxiousness, dizziness, restlessness, headaches, nausea.
52
TRUE OR FALSE: Administering two adrenergic agents together may precipitate severe cardiovascular effects such as tachycardia or hypertension.
True
53
What are Adrenergic Antagonists?
Bind to adrenergic receptors but inhibit or block stimulation of the SNS. They have the opposite effect of adrenergic agents.
54
What are examples of conditions that are treated by alpha 1 adrenergic agonists?
Nasal congestion, hypotension and mydriasis.
*** constriction
55
What are examples of conditions that are treated by alpha 2 adrenergic agonists?
Hypertension
56
What are examples of conditions that are treated by beta 1 adrenergic agonists?
Cardiac arrest, heart failure and shock.
*** increases contractility and heart rate.
57
What are examples of conditions that are treated by Beta 2 adrenergic agonists?
Asthma- relaxation of bronchial smooth muscle.
*** dilation and relaxation
58
Explain the advantages of selective beta antagonists versus non-selective beta antagonists.
Selective beta antagonists, compared to non-selective beta antagonists, have the advantage of primarily targeting heart beta-1 receptors, leading to fewer side effects like bronchoconstriction in patients with respiratory conditions like asthma, while still achieving the desired effects on heart rate and blood pressure, making them preferable for patients with co-occurring medical issues.
59
What is the difference between selective beta antagonists versus non-selective beta antagonists?
Selective beta-agonists only target beta-receptors in certain parts of your body (beta 1 receptors in the heart).
- affect the heart rate and how hard it works.
Nonselective beta-agonists target all of your beta-receptors.
- affect blood vessels throughout the body.
60
Describe and compare the Somogyi phenomenon and morning hyperglycemia (Dawn) along with preventative measures for both.
Somogyi Effect- rapid decrease in blood glucose usually in the night. The body responses and this stimulates the release of hormones that elevate blood glucose epinephrine, cortisol, and glucagon. This results in a hyperglycemic blood glucose in the morning.
- Way to avoid this: avoid carbohydrates at bedtime, adjust your dose of medication or insulin, use an insulin pump to administer extra insulin during early-morning hours.
Dawn Phenomenon- between 4-8AM blood glucose levels rise due to naturally produced cortisol and growth hormone.
- Prevention: eat earlier, track blood sugar.
61
When is Levemir insulin typically given?
At bedtime
62
Which Insulin would you give if you wanted it to start working quickly?
Rapid-acting
63
What is the normal range of insulin?
4-7 mmol/L
64
What are important client education points regarding Insulin administration?
1.The importance of monitoring their blood sugar levels.
2.Educate when and how to administer the insulin.
3.Educate them about hypoglycemia- the signs and symptoms.
4.Always have sugar with them if they become hypoglycemic.
5.Know what to do when they have hyperglycemia.
6.Keep insulin at room temperature unless they are storing it for a long period of time.
7.Be sure to be using an insulin syringe.
8.They need to be wearing a medical alert bracelet.
65
What are types of pharmacotherapy used for Type I Diabetes?
Rapid, Short, Intermediate and Long Acting Insulin
66
What are types of pharmacotherapy used for Type II Diabetes?
Oral Anti-hyperglycemics including biguanides, alpha-glucosidase inhibitors, incretin enhancers.
67
What is the action of Alpha-glucosidase inhibitors?
Interferes with carbohydrate breakdown and absorption; acts locally in the GI tract with little systemic absorption.
68
What is the action of Biguanides?
Decreases production and release of glucose from the liver; increases cellular uptake of glucose; lowers lipid levels
69
What is the action of Incretin enhancers?
Slows the breakdown of insulin keeping it circulating in the blood longer; slows the rate of digestion.
70
What is Metformin's class?
Biguanides
71
What is the role of Metformin?
Helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver.
72
What is the action of Sulfonylureas?
Stimulates insulin release from pancreatic islet cells; decreases insulin resistance.
73
What are some effects of sulfonylureas?
Cause cause hypoglycemia, GI disturbances, rash.
74
What are the actions of Sitagliptin?
Increases glucose after meals.
75
What are adverse effects of Sitagliptin?
Headache, diarrhea, nasopharyngitis, upper respiratory tract infection. allergic skin reactions and anaphylaxis.
76
What are the therapeutic effects and uses of Glyburide?
Lowers blood glucose levels in patients with Type II diabetes.
77
What is the mechanism of action of Glyburide?
Stimulates release of insulin; increases sensitivity of peripheral tissues to insulin.
78
What are some adverse effects of Glyburide?
Nausea, vomiting, loss of appetite, photosensitivity, rash, reaction with alcohol.
79
What are some serious adverse effects of Glyburide?
Hypoglycemia, nausea and vomiting, aplastic anemia.
80
TRUE OR FALSE: Biguanides do not cause hypoglycemia or weight gain.
True.
81
What are some side effects of Biguanides?
Diarrhea
Nausea and vomiting
82
What is Insulin Overdose?
Receiving more insulin than your body needs.
83
What are some signs and symptoms of insulin overdose?
Fatigue
Confusion
Irritability
Anxiety
Sweating
Rapid heart rate
84
What are signs and symptoms of insulin underdose?
Pallor
Shakiness
Dizziness
Sweating
Weakness
Difficulty concentrating
85
What is the first drug choice for reducing blood lipid levels?
Statins
86
What is an example of a prototype Statin drug?
Atorvastatin
87
What is Atorvastatin's mechanism of action?
Inhibits HMG-CoA, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol. Lowers total LDL cholesterol and triglycerides.
Slightly increases HDL cholesterol.
88
What are adverse effects of Atorvastatin?
Gi complaints- intestinal cramping, diarrhea, and constipation.
Rash and heartburn.
Do not take with grapefruit juice as it inhibits the metabolism of statins, allowing them to reach toxic levels.
89
Identify the process in reporting and managing medication incidents.
Nurse’s legal and ethical responsibility to document and report medication errors.
-Should be factual and objective
-Should include specific interventions implemented to promote client safety
-Record all names of individuals notified of error
-Failure to document could be interpreted as negligence
-Should follow agency-specific policies and procedures for reporting errors
Medication administration record (MAR) should contain information on given or omitted medications.
Medication incidents should be reported to Health Canada through MedEffect and through institute for Safe Medication Practices (ISMP).
-Quality improvement purposes, to ideally prevent incidents in the future.
90
What are some strategies for Reducing Medication Incidents
Follow nursing process
Assess all factors that might interfere with same drug administration
Minimize factors that contribute to medication errors
-Clarify orders
-Follow agency policies and procedures
Record on MAR immediately after administration
91
What are examples of high alert medications?
1. Insulin
2. Opiates and narcotics
3. Injectable potassium chloride (or phosphate) concentrate.
4. Intravenous anticoagulants (heparin)
5. Sodium chloride solutions above 0.9%
92
TRUE OR FALSE: The higher the therapeutic index, the safer the drug.
True.
93
Define median lethal dose.
The dose of a drug that will be lethal to 50% of a group.
94
What is a Therapeutic Index?
Ratio of a drugs median lethal dose to its median effective dose.
the range of doses at which a medication is effective without unacceptable adverse events. Drugs with a narrow TI (NTIDs) have a narrow window between their effective doses and those at which they produce adverse toxic effects.
95
What is Median Toxicity Dose?
A dose that will produce toxicity in 50% of the population.
96
TRUE OR FALSE: The higher the MOS, the safer the drug.
True.
97
What is Margin of Safety?
The amount of drug that is lethal to 1% of the population divided by the amount of drug that produces a therapeutic effect in 99% of the population.
98
Why is a higher therapeutic index safer?
there is a larger gap between their effective and toxic concentrations. For these types of drugs, it is acceptable to administer a dose that surpasses the minimum required dose to achieve the intended therapeutic effect.
99
TRUE OR FALSE: Grapefruit juice can increase or decrease how the body breaks down statin-based cholesterol medications
True.
100
TRUE OR FALSE: Salt can increase the amount of fluid in the body, which can make a medication dose less effective
True.
101
TRUE OR FALSE: An empty stomach enhances absorption.
True.
102
What is the Hepatic First Pass Effect?
a phenomenon of drug metabolism at a specific location in the body which leads to a reduction in the concentration of the active drug before it reaches the site of action or systemic circulation.
103
TRUE OR FALSE: When a drug is given parenterally it bypasses the liver, preventing the first-pass effect from taking place and more drug gets into the general circulation and reaches its target organ.
True.
104
What are examples of Enteral med administration?
Orally, rectally
105
What is the onset of rapid acting insulin?
10-15 minutes.
106
What is the peak of rapid acting insulin?
1-2 hours
107
What is the duration of rapid acting insulin?
3-5 hours
108
What is the onset of short acting insulin?
30 minutes
109
What is the peak of short acting insulin?
2-3 hours
110
What is the duration of short acting insulin?
6.5 hours
111
What is the onset of intermediate acting insulin?
1-3 hours
112
What is the peak of intermediate acting insulin?
5-8 hours
113
What is the duration of intermediate acting insulin?
Up to 18 hours.
114
What is the onset of long acting insulin?
90 minutes
115
What is the peak of long acting insulin?
N/A
116
What is the duration of long-acting insulin?
Lantus= up to 24 hours
Levemir= 16-24 hours
117
What are the primary symptoms of hypoglycemia?
Tachycardia, sweating, irritability, confusion and drowsiness.
118
TRUE OR FALSE: Insulin causes potassium to move into the cells and may cause hypokalemia?
True (and this can cause severe heart dysrhythmias).
119
What are some important points to educate a diabetic patient on with regard to insulin administration?
Instruct client to increase blood glucose monitoring when experiencing fever, nausea, vomiting, or diarrhea.
Check urine for ketones.
Check weight every day.
Monitor BP and pulse routinely.
Check blood glucose routinely.
Carry simple sugar with you.
Exercise can increase insulin demand.
120
What does DASH stand for?
Dietary Approaches to Stop Hypertension
121
Pharmacotherapy of Myocardial Infarction
Treatment Goals (based on different cases- not all of these medications are given):
*Restore blood supply to myocardium
oThrombolytics, organic nitrates
*Reduce myocardial oxygen demand
oBeta blockers (vasodilate and slow the heart down)
*Control MI‒associated dysrhythmias
oBeta blockers, calcium channel blockers
*Reduce post-MI mortality
oASA, ACE inhibitors
*Manage severe MI pain and anxiety
oAnalgesics
122
What are the benefits of enteral medications?
If the GI tract remains functional then it is preferred to use the enteral feeding route vs TPN.
-Enteral is less invasive and less risky.
-Lower chance of infection.
-Going through the GI tract (keeps the GI system active).
-Reduced cost (TPN is very expensive)
123
What are the drugs used to prevent and manage a CVA.?
anti-hypertensives, anticoagulants, thrombolytics, statins and antiplatelet like ASA.
124
What is the time frame to administer a thrombolytic post CVA?
Within 3 hours.
125
What are the two types of strokes?
1. Ischemic- blockage
2. Hemorrhagic- bleeding
126
Are the treatments for an ischemic and hemorrhagic stroke different?
Ischemic- tissue plasminogen activator (tPA), blood thinners (helps stop blood clots from forming, and antihistamines
Hemorrhagic- helps lower BP, stop bleeding, stop pain (antihypertensives, anticonvulsants, and clotting support medications)
127
Which medication when taken within 24 hours of a nitrate could cause life threatening hypotension and cardiovascular collapse?
Viagra® (sildenafil)
128
Why are blood glucose levels tested frequently with betablockers?
beta blockers can impact blood sugar levels and mask signs of low blood sugar.
129
Why is Heparin administered for about 3 days following an MI?
to prevent rethrombosis after successful thrombolysis
130
Why is pain control essential following an acute MI and what class of medications can be given to treat this?
Pain control is crucial after an acute myocardial infarction (MI) because severe chest pain can lead to increased anxiety, further stress on the heart, and potentially worsen the patient's condition; therefore, managing pain helps stabilize the patient and allows for proper medical interventions; the primary class of medications used for pain control in this situation are opioids, most commonly morphine when other options are not suitable
131
Why would beta blockers be used with caution in HF?
They can have a negative inotropic effect, meaning they can temporarily weaken the heart's ability to contract, potentially worsening symptoms in patients with already compromised cardiac function.
132
What is the goal of thrombolytic therapy in the treatment of an MI
to rapidly dissolve the blood clot blocking the coronary artery, restoring blood flow to the affected heart muscle, and limiting the size of the heart muscle damage by achieving reperfusion
133
Identify indications for pharmacotherapy with adrenergic antagonists.
The adrenergic antagonists are widely used for lowering blood pressure and relieving hypertension. These antagonists have a been proven to relieve the pain caused by myocardial infarction, and also the infarction size, which correlates with heart rate.
134
Why would you monitor the CPK level of someone taking a statin?
A healthcare provider would monitor the CPK (creatine phosphokinase) level of someone taking a statin because elevated CPK levels can indicate muscle damage, which is a potential side effect of statin medications, particularly when experiencing muscle pain or weakness
135
How long must you take Statins before you will see the results?
4 weeks.
136
How are statins administered? Can you take them if you are pregnant?
Statins are usually taken once a day, with or without food
You should take them at the same time each day.
Statins should be stopped during pregnancy.
137
Can Cholestyramine be taken at the same time as other meds? Why or why not?
Take this medication before a meal and/or at bedtime, and try to take any other medications at least 1 hour before or 4 hours after you take cholestyramine because cholestyramine can interfere with their absorption
138
