The MIDDY! Flashcards
(205 cards)
1
Q
the time it takes for half the drug concentration to be eliminated from the body
A
Half life
2
Q
What measures the rate drugs are removed from the body
A
Half life
3
Q
Also known as:
what the BODY does to the DRUG
A
PharmacoKINETICS
4
Q
What are the 4 processes of pharmacokinetics
A
Absorption
Distribution
Metabolism
Excretion
5
Q
What is the movement of a drug from the site of administration, into the blood stream
A
Absorption
6
Q
What is the movement of the drug into the cells
A
Distribution
7
Q
The method by which drugs are inactivated (biotransformed) by the body
A
Metabolism
8
Q
Where does metabolism primarily occur?
A
The liver
9
Q
Biotransformation refers to which pharmacokinetic process?
A
Metabolism
10
Q
What refers to the elimination of a drug from the body?
A
Excretion
11
Q
What factors affect absorption?
A
GI Function
Route
Dosage
Lipid Solubility
Blood Flow
Surface Area
(GI.R.D.L.B.S)
Gee I. Really. Dont. Like. Bull. Shit.
12
Q
What factors affect distribution?
A
Protein Binding
Blood Flow to the tissues
Solubility
(P.B.S)
PBS “distributes” (broadcasts) TV shows
13
Q
What is the INITIAL biotransformation (metabolism) of a drug that produces altered pharmacologically active molecules?
A
First Pass Effect
14
Q
What is the most common route of excretion?
A
Urine
15
Q
What is the rate at which drug molecules disappear from the circulatory system?
A
Clearance
16
Q
What enzyme system is key to liver metabolism
A
The P450 system
17
Q
Drugs circulate in the plasma either bound or unbound to plasma proteins
A
Protein binding
18
Q
What protein contributes to most of the the body’s protein binding
A
Albumin
19
Q
Drugs given by what route may be extensively metabolized before reaching the systemic circulation.
Give an example.
A
PO
Nitroglycerin
(First pass effect)
20
Q
What INCREASES metabolism and excretion
A
Inducers
21
Q
What are 2 examples of inducers
A
Tobacco
St. John’s Wort
There was a TOBACCO farmer named St. JOHN who’s pregnant wife had to be INDUCED while on the farm!! 😨
22
Q
Clearance is affected by factors such as ______.
A
Gender
23
Q
What DECREASES metabolism and excretion
A
inhibitors
24
Q
What are 2 examples of inhibitors
A
Benadryl
Grapefruit
Ben was a Grapefruit. Idk make it work lol
25
Drugs given by what route, bypass the liver and prevent first pass effect
IV
IM
IN
subcut
ntg
inhaln
mucosa
transdermal
26
When 2 highly protein bound drugs displace one another this is called
Displacement
They fight for protein binding
27
What is highly selective and nearly impermeable
The blood brain barrier
28
When bound to a protein, a drug is unable to pass through what? (causing it to have no effect)
Capillary walls
- because when the drug molecule is bound to a protein, the bound drug molecule is so big that it can’t fit passed the capillary wall. Thus, it can’t make it to the target cell to have an effect until the molecule becomes unbound
29
What causes drug molecules to become free from their protein bonds
When these bonds dissolve
- a drop in serum drug level
30
What do you call drug molecules that are not protein bound?
Active
31
Drugs administered by what route take longer to be absorbed?
Orally
32
Which route of med administration is absorbed more rapidly;
Enteral or Parenteral?
Parenteral
33
Which liquid meds are absorbed the fastest?
Elixirs
Syrups
34
Which type of oral medication is absorbed the slowest?
Enteric coated
35
Drugs cause their effects by interfering with what system?
The enzyme cascade system
36
Think about it:
Liver damage causes what?
Higher levels of ACTIVE drug
More Toxicity
37
What labs do you monitor for liver damage?
ALT
AST
Albumin
Total Protein
38
What do you assess for with liver damage?
Jaundice
Enlarged liver
Ascites
39
The liver changes drugs from ______ soluble to _______ soluble?
From FAT soluble to LIQUID soluble
40
The kidneys can only excrete drugs when they are _____ soluble?
Liquid
41
Think about it:
Kidney diseases cause what?
Decreased effectiveness of drug excretion
Increased risk for adverse drug reactions
42
What are 2 major modes of drug clearance?
Hepatic metabolism
Renal excretion
43
Who’s gonna rock this middy?!
You!
Lol keep going!
44
What labs do you monitor for Renal diseases?
BUN
Cr
Medication Drug Levels
45
Constipation does what to drug contact time?
Leading to what kind of effects?
It increases drug contact time (poop traffic)
Because there’s a poop blocking the way 💩🚧
Leading to increased drug effects / toxicity ☣️
46
In regards to ABSORPTION
Explain Geri’s gastric mobility
Slow gastric mobility- unpredictable rates of absorption
💡 Geri is an old woman. And everything about Geri low or slow
47
In regards to ABSORPTION
How is Geri’s gastric pH?
High
Less acidic
(More alkaline)
48
In regards to ABSORPTION
How is Geri’s peristalsis?
Slow
49
In regards to ABSORPTION
How is Geri’s blood flow in her GI tract?
Reduced
(Low/slow)
50
The attraction between albumin and drug is represented by what?
Percentages
51
PROTEIN BINDING:
89% and above is considered to
Highly bound
52
PROTEIN BINDING:
60-89% is considered to be:
Moderately bound
53
PROTEIN BINDING:
Less then 30% is considered to be:
Low bound
54
Nutritional status effects what?
(think liver)
Protein binding
55
A patients diet needs to have?
Adequate protein
56
In regards to DISTRIBUTION:
Geri’s blood brain Barrier is?
Less effective
57
In regards to DISTRIBUTION:
Geri’s Lean body mass is:
Decreased
58
In regards to DISTRIBUTION:
Geri’s total body water content is:
Reduced
59
In regards to DISTRIBUTION:
Geri’s protien binding sites are?
And why?
Reduced
Due to aging liver
60
In regards to DISTRIBUTION:
Geri’s fat content is:
INCREASED!
Remember Geri also put on some lbs with age 😅
61
In regards to METABOLISM:
Geri’s liver?
Decreased in size/mass
62
In regards to METABOLISM:
Geri’s liver blood flow?
Decreased
63
In regards to METABOLISM:
Geri’s overall metabolism is?
Decreased
64
In regards to EXCRETION:
Geri’s renal filtration rate is?
Decreased
65
In regards to EXCRETION:
Geri’s renal blood flow is?
You guessed it
Decreased
66
In regards to EXCRETION:
Geri’s nephron levels are?
Decreased
67
Aging leads to a greater incidence of
Toxicity
68
What is the USP-NF?
United States Pharmacopoeia National Formulary
69
What does the USP-NF do?
Sets high drug standards used in the US
70
How often is the USP-NF standards revised?
Every 5 years
71
What kind of agency is the USP?
NOT a Government agency
72
The USP does what?
The Federal Government does what?
The USP reviews meds and sets standards
The FEDs enforce and control those standards
73
The time it takes to reach minimum effective concentration
(MEC)
Onset
74
The time it takes to reach highest blood or plasma concentration
Peak
75
The length of time the drug has pharmacological effect
Duration
76
Where the drug is at highest level concentration
Peak
77
Where the drug is at lowest level concentration
Trough
78
Thick, sugary liquid- PO med
Syrup
79
Clear, Liquid- PO med
Elixir
80
Suspension solutions, usually oily
Emulsion
81
What liquid PO meds absorb 2nd fasted to Syrups and Exlixirs
Emulsions
82
TID
3 times a day
83
BID
2 times a day
84
What time is breakfast
0800
85
What time is lunch
1200
86
What time is dinner
1700
87
1 tsp= x mL
5 mL
88
3 tsp = x tbsp
1 tbsp
89
1 tbsp= x mL
15 mL
90
1 oz = x tbsp
2 tbsp
91
1 oz = x mL
30 mL
92
1 cup = x oz
8 oz
93
1 cup = x mL
240 mL
94
1 pint = x cups
2 cups
95
1 pint = x oz
16 oz
96
1 quart = x pint
2 pint
97
1 quart = x oz
32 oz
98
1 quart = x cups
4 cups
99
1 gallon = x quarts
4 quarts
100
1 gram = x milligrams
1000
101
1 kilogram= x grams
1000 grams
102
1 kilogram = x lbs
2.2 lbs
103
1 milligram = x micrograms
1000
104
1 liter = x mL
1000 mL
105
1 mL = x cc
1 cc
106
1 grain (gr) = x mg
60 mg
107
Who can prescribe meds?
HCPs:
NP
PA
MD
Dentist
Dermatologist
NP,PA,MD,D,D
108
Drug names that are capitalized
Trade/ Brand name
109
Drug names that are lower case
generic
110
Drug names that sound alike
Trade/Brand names
111
Drugs that are usually more expensive
Trade/ Brand names
112
Drugs that have the “circled R” symbol
Trade/ brand
113
Drugs that are more affordable
Generic names
114
What are core pt variables
Culture
Health status
Inherited traits
Life span
Diet
Life style
Environment
Habits
Gender
C.H.I.L.D. L.E.H.G
(Child leg) 🤷♂️
115
The desired, therapeutic effect of the drug
Pharmacotherapeutics
116
What the BODY does to the DRUG
The change that occurs to the DRUG when it is inside the BODY
Pharmacokinetics
117
What the DRUG does to the BODY
The effects of the DRUG on the BODY
Pharmacodynamics
118
Conditions under which the drug must be carefully monitored
Precautions
119
Conditions under which the drug should not be used at all
Contraindications
120
Effects that may occur when the drug is given along with another drug, food, or substance
Drug interactions
121
The unintended and usually undesired effects that may occur with the use of the drug
Adverse/ side effects
122
Basic teaching to pt and family
Reason for prescription
Adverse effects
Intended effect
Drug name
R.A.I.D
you want to raid the room to teach the pt
123
Digoxin toxicity s/s
Visual disturbances (seeing Halos, usually blue/green)
Bradycardia
Anorexia
Abdominal pain
n/v
124
Established official standards and requirements for accurate labeling
1906
Pure Food Drug acts
125
Strengthened 1906 law, prohibiting fraudulent therapeutic claims of drug effectiveness
1912
Shirley Amendment
Shirley sure was a fraud
And had 12 kids
126
Required that drugs must meet standards of purity and strength; labeling requirements established- penalties for fraudulent claims and misleading labels
1938
Food, Drug, and Cosmetics Act
127
FDA was established and charged with enforcing the law; gave FDA control over drug safety
1938
Food, Drug, and Cosmetics Act
128
Designated that drugs must be prescribed by a licensed HCP and dispensed by a pharmacist
1951
Durham-Humphrey Amendment
These guys were both pharmacists who liked to hump 🤷♂️
And they were both 51 years old
129
Increased control on drug safety; more extensive testing on new drugs; manufacturers must prove safety and efficiency;
1962
Kefauver-Harris Amendment
130
Authorized FDA to establish official names for uniformed nomenclature; gave federal authority to standize drug names
1962
Kefauver-Harris Amendment
131
Regulated distribution of narcotics and categorized narcotics according to therapeutic usefulness and potential for abuse
1970
Comprehensive Drug Abuse Prevention and Control Act
132
Updated and replaced all previous narcotic laws
1970
Comprehensive Drug Abuse Prevention and Control Act
133
Required inclusion of women and minorities in NIH funded research studies
1993
NIH Revitalization Act
134
Established federal law that regulates OTC sale of ephedrine, pseudoephedrine, and phenylpropanolamine due to their use in manufacturing methamphetamine
2005
Combat Methamphetamine Epidemic Act
135
By way of the intestines
Enteral
136
By way OTHER THAN the intestines
Parenteral
137
High protein bound drugs have _______ duration
Longer
138
Low protein bound drugs have _______ duration
Shorter
139
High protein bound drugs have _______ affinity to proteins
High
140
Low protein bound drugs have _______ affinity to proteins
Low
141
What happens to normal cell function, when a single step in the enzyme cascade function is blocked?
The normal cell function is disrupted
142
How can we maximize therapeutic results of drugs
Administer drug in a way that promotes absorption
Administer drug at the appropriate time
Monitor lab values
143
How can we minimize adverse effects of drugs
Allergies
Discontinue or withhold if needed
Administer safely
Monitor pt and labs
Contraindications
Assessment to detect onset of adverse effects
Report adverse effects
techniques: crushing pills, etc
A.D.A.M. C.A.R.T.
144
7 rights of drug administration
Right patient
Right drug
Right dose
Right route
Right time
Right reason -6
Right documentation -7
145
How many time do you check the 5 rights before administering
3x
When pulling meds
After pulling meds
Before administration
146
7 Elements of a medication order
Pt name
Drug name
Drug dose
Drug route
Drug frequency
Provider signature
Date and time ordered
147
How much air do you draw into the syringe before drawing from a vial
Equal to the amount of liquid you are drawing out of the vial
148
Electrolytes to check for digoxin
K
Mag
Ca
149
Electrolytes to check for flurosemide
Na
Cl
Ca
K
Mag
150
Electrolytes to check for enoxaparin
None
151
Electrolytes to check for insulins
Glucose
152
Time frame to give meds
0900-2200
153
How long before or after the scheduled time may you administer medication
30 min before or after the scheduled time
30 min before meals or after meals is best unless indicated otherwise
154
Where do you administer enoxaparin
Subcut
Love handles
(Lateral abdomen)
155
How do you know if digoxin working?
Decreased severity of HF
Increase in cardiac output
156
How do you know if furosemide is working?
Urine output
Decreased BP
Decreased edema
157
What do you assess for with digoxin?
Apical pulse for 1 before administration
- to make sure HR is above 60 BPM
Electrolyte/dig levels
BUN/Cr
ALT/AST
Input & output
158
What do you assess for with furosemide?
Daily weight
Input & output
SBP > 100
Electrolyte levels
BUN/Cr
ALT/AST
159
Refers to the progressive increase in the pre-meal or night time insulin dose, based on pre-determined blood glucose ranges
Sliding scale
160
What approximates daily insulin requirements
Sliding scale. Insulin regimens
161
When using a sliding scale, how should you regulate your carbohydrate intake with each meal?
Eat the same amount of carbohydrates at each meal
162
Which insulins are you able to mix?
Regular and NPH
163
When mixing insulins, which insulin do you draw up first?
Regular
164
Where is the best site to administer insulin
Abdomen
Must rotate sites
165
Why must you rotate insulin sites?
Lipodystrophy: condition when fat either breaks down or builds up under the skin; causing lumps or indentations that can interfere with insulin absorption
166
What must you do when giving an insulin that is a HIGH ALERT med
Have another nurse check!
167
Subcut needle size
25-30 G
3/8 - 1 inch (most common 3/8- 5/8)
168
IM needle size
20-25 G
5/8-1.5 inch
169
Drugs should be ordered by what name?
generic
170
What categorizes drugs by the disease state that they are used to treat
Therapeutic classification
171
Categorizes drugs based on the drugs mechanism of action (MOA)
Pharmacological classification
172
What kind of environment do drugs love?
Acidic environments
173
What are the stages of tablet breakdown
Tablet > disintegration > dissolution
174
How many half lives are needs to achieve steady state?
4-5 half lives
175
BETA 1 receptors are located in the _______.
Heart
176
BETA 2 receptors are located in the ________.
Lungs
177
Calcium channel receptors are located in the _____.
Heart/ blood vessels
178
Drugs ending in __pine do what
Slow the movement of calcium into the heart and blood vessels
179
What is the difference between the effective dose and the therapeutic dose?
Therapeutic index
180
What is located between the peak and trough, an average range
Therapeutic index
181
Unusual response to a drug and may be the opposite of what is anticipated
Idiosyncratic response
182
Response specific to an individual person and sometimes has genetic cause
Idiosyncratic response
183
Study of drugs that alter functions of living organisms
Pharmacology
184
Pharmacology include what 3 aspects
Pharmacotherapy
Pharmacodynamics
Pharmacokinetics
185
Theory that describes the way drugs exert their effects by binding with receptors
Receptor theory
186
Binding either stimulates or inhibits normal cell functions (agonist vs. antagonist)
Physiochemical reaction
187
Changes in the permeability of cell membrane to one or more ions
May open or close ion channels (calcium channel antagonists -pine)
188
Modify the synthesis, release, or inactivation of
Neurohormones that regulate physiologic processes (acetylcholine, norepi):
Direct acting vs. indirect acting drugs
189
Nonreceptor drug actions
- Anti acids: act chemically
- Drugs structurally similar to nutrients required by the body: Interfere with normal cell function
Osmotic diuretics: increase osmolarity
Metal chelating agents: combined with toxic metals to be more readily excreted
190
How is the PNS subdivided
Somatic nervous system (voluntary)
Autonomic nervous system (involuntary)
191
s/s of SNS and PSNS
SNS: fight or flight
PSNS: rest and digest
192
Identify neurotransmitters of the sympathetic nervous system
Norepinephrine
193
Identify neurotransmitters of the parasympathetic nervous system
Acetylcholine
194
What is the function of norepinephrine
Increases HR
Increases BP
195
What is the function of Acetylcholine
Contracts muscles
Dilates blood vessels
Slows HR
196
What are the receptors of the sympathetic nervous system
Adrenergic receptors
197
What are the receptors of the PSNS?
Cholinergic receptors
198
Are adrenergic receptors agonists or antagonists?
Agonist receptors
199
Are cholinergic receptors agonists or antagonists?
Antagonist receptors
200
What is the function of adrenergic receptors?
Bring about the effects of SNS
201
What is the function of cholinergic receptors?
Bring about the effects of the PSNS
202
Variables that effect drug action?
Dosage- serum drug level
Route
Drug-diet
Pt related variables
203
What are pt related variables
Age
Race
Culture
Weight
Genetics
Gender
Preexisting conditions
Psych factors
Pg2craw
204
What drugs have adverse effects
All drugs
205
Strongest warning from the FDA
Black Box Warning
