Pharmacology Exam One

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Pharmacology
Chapters 1-12, 18, 19, 53-57
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1

Pharmaceutic phase

DISSOLUTION

is the fist phase of drug action

2

In the pharmaceutic phase the drug becomes a solution so that it can:

Cross the biological membrane

3

Which form of drug is the most rapidly absorbed from the GI Tract?

Liquid Suspension

Drugs need to be in a solution so that they are absorbed

4

pharmacokinetics

is the process of drug movement to achieve drug action.

Absorption--> distribution --> metabolism-->and excretion

5

Protein- based drugs are destroyed by the

small intestine by digestive enzymes

such as insulin and growth hormones

6

According to your text a drug that is NOT highly protein bound would be:

Freely distributed to the extravascular tissue

7

The route for drug absorption that has the greatest bioavailability is:

Intravenous

8

Passive absorption

occurs mostly by diffusion (movement from higher concentration to lower). With the process of diffusion, the drug does not require energy to move across the membrane.

9

Active absorption

requires a carrier such as an enzyme or protein to move the drug against a concentration gradient. Energy is required.

10

Pinocytosis

is a process by which cells carry a drug across their membrane by engulfing the dug particles.

11

drugs that are lipid soluble pass

pass rapidly through GI membranes. The GI membrane is composed mostly of lipid and protein, so drugs pass easily.

12

Water-soluble drugs need a

Carrier.

either enzyme or protein to pass through the membrane

13

Large particle pass through a cell membrane if the are

Non ionized (have no positive or negative charge).

*weak acid drugs such as aspirin are less ionized in the stomach, and they pass through the stomach lining easily and rapidly.

14

Drugs that are lipid soluble and nonionized are absorbed ____ than water-soluble and ionized drugs

FASTER

15

The process in which the drug passes to the liver first is called

FIRST- PASS EFFECT, or hepatic first pass

16

Bioavailability

is the subcategory of absorption. It is the percentage of administered drug dose that reaches the systemic circulation.

17

The serum half-life of a drug is the time required:

After absorption for half of the drug to be eliminated

18

T.C. has liver and Kidney disease. He is given a medication with a serum half-life of 30 hours. You expect the DURATION OF ACTION of this medication to:

Increase

19

Free drugs

(drugs not bound to protein) are active and can cause a pharmacologic response. The portion of the drug that is bound is inactive because it is not available to receptors.

As free drug in the circulation decreases, more bound drug is released from the protein to maintain the balance of free drug.

20

When two highly protien bound drugs are given concurently

they compete for protein-binding sites, thus causing more free drug to be released into the circulation.

21

Primarily ___ is what protein binding drugs bind to

albumin

22

For elimination through the Kidneys to be possible, a drug must:

Be Water-Soluble

23

Creatinine is normally excreted in urine as metabolic waste. However in a renal disorder you would expect the blood creatinine level to be:

Increase

24

Metabolism

body inactivates or bio transforms drugs. Primary site is the liver. Most drugs are inactivated by liver enzymes and are then converted or transformed by hepatic enzymes to inactive metabolites or water-soluble substances for excretion.

25

A large % of drugs are lipid soluble; thus the liver metabolizes the lipid-soluble drugs substances to______

water-soluble substance for renal excretion

26

factors affecting ABSORPTION

  • route
  • preparation
  • dosage
  • digestive motility
  • digestive enzymes
  • blood flow at administration
  • lipid solubility
  • degree of ionization
  • pH of local environment
  • drug-drug, drug-food interactions
27

Cytochrome P450 is a

family of isozymes responsible for the biotransformation of several drugs.

  • enzyme induction
  • enzyme inhibition

Drug metabolism via the cytochrome P450 system has emerged as an important determinant in the occurrence of several drug interactions that can result in drug toxicities, reduced pharmacological effect, and adverse drug reactions. Recognizing whether the drugs involved act as enzyme substrates, inducers, or inhibitors can prevent clinically significant interactions from occurring.

28

Prodrugs

converted from inactive form to active

29

Most drugs are excreted by the kidneys..other routes include?

Kidney = #1

bile, feces, lungs, saliva, sweat, and breast milk

30

Acidic urine promotes the elimination of _____ & alkaline urine promotes elimination of ______

weak based drugs

weak acid based drugs

31

Pharmacodynamics

is the study of the way drugs affect the body.

Drug response can cause a primary or secondary physiologic effect or both. The primary is desirable, the secondary effect may be desirable or undesirable.

32

Dose response =

the relationship between the minimal vs the maximal amount of drug needed to produce the desired affect.

33

Onset of action

is the time it takes to reach the minimum effective concentration after a drug is administered.

34

Peak action=

occurs when the drug reaches its highest blood or plasma concentration

35

Duration of action=

the length of time the drug has a pharmacologic effect

36

drugs act through receptors by ?

binding to the receptor to produce (INITIATE) a response or to block (PREVENT) a response

The better a drug fits at the receptor site, the more biologically active the drug is.

37

agonist drugs

drugs that produce a response

38

antagonist drugs

drugs that block a response

39

Cholinergic receptors pg.8

are located in the bladder, heart, blood vessels, stomach, bronchi, and eyes.

A drug that stimulates or blocks the cholinergic receptors affects the anatomic sites of location.

40

Categories of Drug Action

1. stimulation or depression

2. replacement

3. inhibition or killing of organisms

4. irritation

41

The biological activity of a drug is determined by the:

Fit of the drug at the receptor site

42

A mechanism of drug action that does not involve a receptor or enzyme such as a cancer drug is:

Nonspecifc

43

Drugs that attach but do not elicit a response are called:

Antagonists

44

Knowledge of drug potency does NOT enable us to predict whether a potent drug is more or less toxic. The valid indicator that measures the margin safety of the drug is its:

Therapeutic Index

45

Drugs with narrow therapeutic ranges such as digoxin (0.5-2 ug/ml), require plasma/serum drug level monitoring _____ to avoid drug toxicity.

At periodic Intervals

46

After drug administration, the highest plasma/serum concentration of the drug at a specific time is called:

Peak Level

47

Prior to administration of a medication, the nurse should check a drug reference book to obtain the following pertinent data for:

1. Protein-binding effect

2. Half-Life

3. Therapeutic Range

48

A time response curve evaluates three parameters of drug action, which does NOT include:

Therapeutic Range

49

When immediate drug response is desired, a large initial dose is given to rapidly achieve an MEC in the plasma.

Loading Dose

50

Peak drug levels

indicate the rate of absorption of the drug

highest concentration of a drug

51

trough drug levels

indicate the rate of elimination of the drug

lowest concentration of a drug

52

drugs with a high therapeutic index have a

wide margin of safety and less danger of producing toxic effects

53

Side effects and adverse reaction

are physiologic effects not related to desired drug affects.

Adverse reaction are more severe than side effects.

54

Tolerance

refers to a decreased responsiveness over the course of therapy.

55

Absorption, Distribution, Metabolism(biotransformation), Excretion of drugs by the body

Pharmacokinetics

56

Biochemical and Physical effects of drugs and mechanism of drug actions

Pharmacodynamics

57

Name given by United States Adopted Name Council

Generic (NONPropietary) Name

58

Celeste =

Hoe

59

Lety=

card image

(no comment)

60

Pregnancy Category A

No risk to fetus

61

Pregnancy Category B

no risk to animal fetus but information in humans is unavailable

62

Pregnancy Category C

Adverse effects in animal fetus, in humans is unavailable

63

Pregnancy Category D

Possible fetal risk in humans reported, however potential benefit may in selected cases may warrant use of drug

64

Pregnancy Category X

Fetal Abnormalities reported and positive evidence of fetal risk in humans is available from animal/human studies. Never should be taken by pregnant women.

65

Therapeutic action of drug

Risk Vs. Benefit

Benefits

66

Side Effects/ Adverse reactions or contraindication

Risk Vs. Benefit

Risk

67

prevention of disease through vaccine

Prophylactic (Drug Therapy)

68

Drug bound to protein, cause inactive drug action/response

Protein bound drug

69

Not bound to protein causing pharmacologic response that is active.

Free Drug

70

As it decreases, more bound drug is released from protein

Free drug

71

Time it takes for one half concentration to be eliminated

Half-Life

72

Drug reaches highest blood/plasma concentration

Peak Action

73

length of time drug has pharmacologic effect

Duration of Action

74

Medication given on time.

Given at Correct time.

Lab aware of tests.

Set up blood draw

Responsibilities of Nurse obtaining Peak And Trough

75

Indicate Time of highest plasma concentration & Rate of absorption.

Peak

76

Time of lowest plasma concentration & Rate of Elimination

Trough

77

IV, IO

ET, INHALATION

SL, RECTAL, BUCCAL

IM

SQ

PO

ROUTES of Drug Admin. in ORDER OF RAPID ABSORPTION

78

"RIGHT" Medication Administration check list

right drug

right dose

right time

right route

right patient

79

What Nurse listens to from pt as they list symptoms

Subjective Data

80

What Nurse Observes

Objective Data

81

Dissolution of the drug

Pharmaceutic

82

Effect of drug action because of hereditary influence

Pharmacogenetic

83

4 processes of drug movement to achieve drug action

Pharmacokinetic

84

Effect of drug action on cells

Pharmacodynamic

85

Drug that block a response

Antagonist

86

Drug that produces a response

Agonist

87

Drug absorbed by diffusion

Passive Absorption

88

Which type of drug passes rapidly through the GI Membrane?

Lipid-Soluble and nonionized

89

What Affects a drug absorption?

Hypotension, Pain, Stress

90

Two drugs given together cancels the effect of each other

Antagonistic Effect

91

Adrenergic agonist affect the..

sympathetic nervous system

92

Sympathomimetics affect the ...

sympathetic nervous system

93

Adrenergic receptors are typically found where in the body?

effector cells of muscles, such as the heart, bronchiole walls, gastrointestinal tract, urinary bladder, and ciliary muscle or the eye.

94

What does and Alpha ONE receptor do?

increases force of heart contraction; vasoconstriction increases blood pressure; mydriasis (dilation of pupils) occurs; decreases secretion in salivary glands; increases urinary bladder relaxation and urinary sphincter contraction.

95

What does an Alpha TWO receptor do?

Inhibits release of norepi; dilates blood vessels; produces hypo-tension; decreases gastrointestinal motility and tone.

96

Beta ONE receptors do?

Increases heart rate and force of contraction; increases renin secretion, which increases blood pressure.

97

Beta TWO receptors do?

dilates bronchiloes; promotes gastrointestinal and uterine relaxation; promotes increase in blood sugar through glycogenolysis in liver; increases blood flow in skeletal muscles

98

alpha-adrenergic receptors are located in

blood vessels, eyes, bladder, and prostate

99

alpha 2 receptors are located in the

the postganglionic sympathetic nerve endings.

100

Beata 1 receptors are located in the

kidney but primarily the heart

101

beta 2 receptors are found mostly in the

smooth muscles of the lung and gastrointestinal tract, the liver, and the uterine muscle.

102

Schedule I

heroin, hallucinogens (LSD, marijuana[except when prescirbed with cancer treatment], mescalin, peyote, psilocybin.)

*high potential for drug abuse not accepted medical use.

103

Schedule II

*high potential for drug abuse. Accepted medical use. Can lead to strong physical and psychological dependency

ex: demerol, morphine, hydrocodone, methadone, oxycodone

104

What schedule is cocaine?

schedule II

105

schedule III

*Medically accepted drugs.Potential abuse is less that that of schedule I and II. May cause dependence.

106

Schedule IV

*Medically accepted drugs. May cause dependence.

107

Schedule V

*Medically accepted drugs. Very limited potential for dependence.

(codeine in cough preparations)

108

What is the nurses role in administering controlled substances?

  • account for all controlled drugs
  • keep a special controlled-substance record for required information.
  • countersign all discarded or wasted medication;wastage must be witnessed.
  • ensure that documentation and drugs on hand match.
  • keep all controlled drugs in a locked storage area
109

misfeasance

negligence; giving the wrong drug or drug dose that results in the patient's death.

110

nonfeasance

omission; omitting a drug dose that results in the patient's death

111

Malfeasance

giving the correct drug but the wrong route that results in the patient's death

112

How do you know a generic drug is just as effective?

*it is given an "A" rating

generic drugs have the same active ingredients as brand name drugs but are usually less expensive because manufacturers do not have to do extensive testing; these drugs were clinically tested for safety and efficacy by the pharmaceutic company that first formlated the drug.

113

Pharmacogenomics

refers to the general study of all the different genes that determine drug behavior.

114

an enzyme system either induces or inhibits the action of substrates. Induction or inhibition of a substrate accounts for the variations in drug metabolism in individuals and groups.

Cytochrome P-450 enzyme system

115

Poor metabolizers of antidepressants, antipsychotics, cardiovascular agents, and isoniazid, which can lead to toxicity

people of european descent

116

Many have diminished therapeutic, effects from beta blockers, ACE inhibitors, and warfarin sodium

People of African descent

117

drug interaction

as an altered or modified action or effect of a drug as a result of interaction with one or multiple drugs.

118

Pharmacokinetic interactions

are changes that occur in the absorption, distribution, metabolism or bio-transformation, and excretion of one or more drugs

119

One drug can block, decrease, or inccrease the absorption of another drug. It can do this by?

  1. by decreaseing or increasing gasric emptying time
  2. by changing the gastric pH
  3. by forming drug complexes
120

Category I - over the counter drugs

drugs judged to be safe and effective

121

Category II- OTC

drugs judged to be unsafe or ineffective; these drugs should not be included in nonprescription products

122

Category III- OTC

drugs for which there is insufficient data to judge safety or efficacy

123

drug misuse

indiscriminate or recration use of a chemical substance or its use for purposes other than those for which is intended.

124

drug abuse

drug use inconsistent with medical or social norms

125

How do you define addiction

a compulsive, uncontrollable craving for and dependence on a substance to such a degree that cessation causes severe reactions

126

what is tolerance

the need for a larger dose of a drug to obtain the original euphoria.

Decreased effect of a substance that results from repeated exposure. It is possible to develop cross-tolerance to other substances in the same category

127

what is craving for a drug

subjective need for a substance, usually experienced after decreased use or abstinence. Cue-induced craving is stimulated in the presence of situations previously associated with drug taking.

128

Withdrawal syndrome

Constellation of physiologic and psychologic responses that occur when there is abrupt cessation or reduced intake of a substance on which an individual is dependent or when the effect is counteracted by a specific antagonist

129

Metabolism of Alcohol?

  • Absorption into the blood stream--> primarily in small intestine-->some in stomach.
  • Metabolized by the liver
  • Excreted-->Urine --> breath 5%-->sweat (smell drunk)
130

Alcohol Pharmacology

  • CNS depressant
  • Affects various neurotransmitter systems
  1. gaba, glutamate, dopamine, opioid
  2. enhances the inhibitor effects of GABA on its receptor
131

Alcohol toxicity ..what happens?

  • cant communicate
  • irregular/slow heart rate
  • hypothermia
  • respiratory depression
  • coma
  • death

*dangerous in combo with other depressants

132

Physiological effects of Cocaine

  • lasts 1-2 hours
  • increased energy and motor activity
  • increased heat rate and BP
  • euphoria
  • decreased appetite
  • mental alertness
  • increased body temp
  • dilated pupils
133

Cocaine toxicity looks like?

  • rapid heart beat
  • hallucinations
  • paranoid delusions
  • tremors and convulsions
  • respiratory failure
  • heart attack or heart failure
  • stroke
134

Physiological effects of Meth

  • similar to cocaine
  • irritability and aggression
  • anxiety and or paranoia/nervousness
  • increased wakefulness
  • tremors/convulsions
  • decreased appetite
  • insomnia
  • high BP and heart rate
135

Meth toxicity ?

  • neurotoxic : serotonergic neurons and dopaminergic neurons
  • Permanent psychosis
  • hyperthermia
  • kidney failure
  • coma
  • stroke
  • heart attack
136

Aloe Vera

externally used for treatment of minor burns, insect bites, and sunburns. (fresh is better)

Some success with the treatment of dandruff, oily skin, and psoriasis.

Taken internally, aloe vera is a powerful laxative.

Menstrual flow is increased with small doses.

137

Garlic: what is it good for?

detoxifies body and increases immune function; decreases platelet aggregation; increases HDL and decreases cholesterol and triglycerides.

Caution: with prescription anticoagulants because of increased fibrinolysis and decreased platelet aggregation

SE: heartburn, flatulence, gastric irritation, decreased RBC, dizziness, diaphoresis

138

Ginkgo biloba

Antioxidant; peripheral vasodilation and increased blood flow to CNS, reduces platelet aggregation.

Uses: allergic rhinitis, Alzheimer's, anxiety/stress, dementia, vertigo, poor circulation, altitude sickness. Erectile dysfunction.

139

Role of the nurse when it comes to educating about herbal therapies

  • obtain history
  • risks vs benefits
  • purchase
  • storage
  • potential interactions
  • Do not give to: pregnant or nursing..infants or young children
140

Pharmacodynamics in the pediatric pt

  • differences in body composition
  • variability in body water,fat, protein amounts
141

Pharmacokinetics in the pediatric pt

  • immaturity of organs and systems
  • greatest effect in newborns and infants
142

Absorption and the pediatric pt

  • reduced gastric acidity
  • irregular gastric emptying
  • thinner skin- topicals easily absorbed
143

Distribution in the pediatric pt

  • more body water= less drug concentration
144

Metabolism in the pediatric pt

higher metabolic rates

145

Excretion in the pediatric pt

immature kidneys

146

Pharmacokinetics in the geriatric pt (absorption, distribution, metabolism, excretion)

  • Absorption: decreased acidity, motility, and blood flow.
  • Distribution: decreased protein binding sites and body water. Increased body fat
  • Metabolism: decreased liver function
  • Excretion: decreased kidney function
147

Pharmacodynamics in the geriatric pt

  • decreased receptors
  • decreased affinity
  • Altered response to drugs R/T CNS changes
  • decreased compensatory response
  • higher risk for ADR (?)
  • May need lower dose
  • may need higher dosing intervals
148

The geriatric pt and Cardiac glycosides

careful monitoring

149

the geriatric pt and Anticoagulants

warfarin highly protein bound---> albumin levels are low= high free drug

*close monitoring

150

The geriatric pt and GI drugs

  • Anit-ulcer agents--AVOID TAGAMET
  • laxatives

TAGAMET= CAUTION: not good for the older adult..it interacts with every other drug

151

Are home health aide allowed to give medication?

legally home health aids may only assist with medications the patient customarily self-administers.

152

What happened to the babies that were born after mom took THALIDOMIDE for morning sickness?

card image
153

Herbal use and pregnancy

card image

Moms need to be managed on how they can affect the body

154

Iron and pregnancy

need more RBC= higher blood volume

-dark leafy greens, fortified meats.

-begin in the 2nd trimester

-take on empty stomach

-main issues include constipation, dark stools, nausea.

-Relief: fiber and water

155

Folic acid and pregnancy (vitamin B9 & folate)

  • help prevent against neural tube defects
  • should start taking a few months before conseption
  • 400-800mcg
  • can be found is fortified cereal, broccoli, bread...
156

What is Tocolytic therapy?

  • drug therapy to decrease uterine muscle contraction
  • #1 use is calcium antagonist magnesium sulfate
  • calcium channel blockers prevent influx of calcium ions, resulting in relaxation of the myometrium

Moral of the story: if you limit the available calcium= interrupt uterine contractions= additional time for fetal maturation & delay delivery