PHARM FINAL

what is bioavailability?

Portion of the drug that reaches the systemic circulation and is available to act

on body cells

which route of medication has the slowest bioavailability and why?

PO, due to the first-pass effect of the liver

which route of medication has the fastest bioavailability?

IV meds = 100% bioavailability

what is the intrathecal route?

directly through the CSF/spinal space

what is pharmacokinetics?

what the body does to the drug

what affects pharmacokinetics?

form of the drug; route given; health of the body/organ function; pH; action of enzymes; presence of food,alcohol other medications; circulation; metabolic rate

what two major organs are part of the pharmacokinetic processes?

liver and kidneys

what is the livers functions in metabolism?

LFTs, Anorexia, n/v, jaundice, decreased function = increased toxicity s/s, role of ETOH (primary metabolized in liver)

what is the kidneys functions in excretion?

BUN/CR, decreased function = increased toxicity s/s

what is first pass effect?

when a drug travels to the liver first to be metabolized before becoming active in the body, drug loses its effectiveness, includes degradation of the drug by the liver

what is a teratogenic effect?

medication effect results in a birth defect/deformity, usually caused by medications from pregnancy category D or X

what is an agonist?

turns on and promotes receptors

what is an antagonist?

turns off and blocks receptors

what are controlled substances (definition)?

medications regulated by the FDA due to their abuse potential

how does the system of scheduling work for controlled substances?

lower the schedule/number, the higher the risk for sedation, abuse, respiratory depression and addiction

what can you not combine with calcium channel medications?

grapefruit juice

what can you not combine with warfarin?

grapefruit juice & vit K foods

what can you not combine with MAOIs?

tyramine foods

what can you not combine with tetracycline?

dairy products

what is a photosensitivity reaction and examples of meds that can cause it?

drug-sun reaction, causing an exaggerated sunburn (fluoroquinolones, phenothiazines, tetracycline/doxycycline, sulfonamides, sulfonylureas, accutane)

what should you teach patients about when taking drugs that cause a photosensitivity reaction?

avoiding sun between 10 am – 4 pm and use protective clothing and sunscreen > 30 SPF

1 teaspoon = ? mL

5

1 tablespoon = ? mL

15

1 oz = ? mcg

1000

1 g = ? mg

1000

WBC levels

4,000 - 10,000/mm3

RBC levels

4.2 - 5.9 million/mm3

hemoglobin levels

12 - 18 g/dL

hematocrit levels

37 - 54%

platelet levels

150,000 - 450,000/mm3

BUN levels

6 - 20 mg/dL

creatinine levels

0.6 - 1.3 mg/dL

potassium levels

3.5 - 5 mEq/L

magnesium levels

1.5 - 2.5 mg/dL

what is an autoimmune disease?

disease produced when body “attacks” its own cells, thinking that the cells are foreign

what are examples of autoimmune diseases?

graves disease, lupus, MG, MS, RA, type 1 diabetes

why are immunizations given?

provide active immunity by stimulating the immune system to produce antibodies

what are side effects and normal reactions to immunizations?

warmth, redness, and inflammation at the site of injection, as well as flu-like symptoms; these effects do not preclude the patient from getting further doses

who should not receive immunizations?

have fever, are ill, are immunocompromised, are taking steroids, and/or are pregnant may not be able to receive them, especially “live” ones

what is a famous side effect of vincristine (oncovin)?

peripheral neuropathy (numbness, tingling, pain)

what is a famous side effect of cyclophosphamide (cytoxan)?

hemorrhagic cystitis (hematuria, dysuria)

what is a famous side effect of doxorubicin (adriamycin)?

cardiomyopathy (tachycardia, EKG changes, CHF)

what is a famous side effect of busulfan (myleran)?

pulmonary toxicity (fever, cough, dyspnea)

what does leucovorin (wellcovorin) do?

rescue med for chemo, an active form of folic acid that rescues normal cells from the adverse effects of methotrexate

what does mesna (mesnex) do?

rescue med for chemo, reduces the incidence of hemorrhagic cystitis with cyclophosphamide (cytoxan)

what are common side effects for steriods?

hyperglycemia, gi upset and bleeding, weight gain from fluid retention, mood swings, hirsutism, delayed wound healing

what do monoclonal antibodies (DMARDs/ MABs) cause?

immunosuppression

what does azathioprine (imuran) cause?

bone marrow supression

is methotrexate safe in pregnancy?

no

what is a low white count called?

leukopenia

what precautions and why for leukopenia?

neutropenic precautions due to risk of infection

what is low red count called?

anemia

what does anemia cause and what to do for it?

fatigue, pallor, decreased activity tolerance (needs rest periods)

what is low platelet count called?

thrombocytopenia

what does thrombocytopenia cause and what risks?

bruising, risk for bleeding (fall prevention)

what risks does epoetin (epogen) have?

hypertension and CV related events

what does a culture and sensitivity tell us?

allows us to avoid always having to use broad spectrum ABs, and thus, helps prevent future resistance

how do you infuse vancomycin (vancocin) IV and what to use?

use a pump and infuse it slowly to avoid hypotension (red man/red neck syndrome)

when do you draw a peak level in vanco?

30 min after drug infusion has finished

when do you draw a trough in vanco?

30 min before next dose is due

what kind of damage does fluoroquinolones cause?

cartilage/ tendon damage

are fluoroquinolones the first choice for uncomplicated UTIs and why?

NO due to damage to cartilage and tendons

what should a patient not take with tetracycline, when can they have this?

not take this with dairy, iron, or antacids; we make sure to separate them by two hours

what is the first-line drug to treat TB?

rifampin

what damage can rifampin cause?

liver damage, monitor LFTs

what does rifampin do to bodily fluids?

discolors them red-orange tint

what must you monitor with isoniazid (INH)?

liver and LFTs

what can acyclovir (zovirax) cause?

renal failure, seizures, stevens johnson syndrome

what to monitor when giving acyclovir (zovirax)?

kidney function tests

with anthelmintics, who is treatment recommended for?

whole household and close contacts

what should a patient avoid who’s taking metronidazole (flagyl)?

alcohol

what must you monitor in indinavir (crixivan)?

LFTs

when should someone take HIV meds?

consistently same time every day to decrease resistance

what is isotrentinoin (accutane, claravis) used for?

vitamin A drug used to treat severe nodular acne resistant to other treatments

how long does isotrentinoin (accutane, claravis) take to see effects?

8 - 12 weeks

what may isotrentinoin (accutane, claravis) cause?

suicidal ideation, monitor for depression

what are permethrins used for?

treat scabies and lice

what are common permethrins treatments?

elimite 5%

when are mydriatics contrindicated?

glaucoma because pupil dilation increases pressure in the eye

how should one make sure meds stay in the eye when administering glaucoma meds?

put pressure on inner canthus

what needs to be done when administering eye drops?

compress the nasolacrimal duct at the inner canthus for 60 seconds to keep the drops in the eye (prevent systemic absorption)

what happens to HR during hypocalcemia?

bradycardia

what does one need to do when administering alendronate (fosamax)?

remain upright for 30 min

what do SERMs increase the risk for?

DVT

are SERMs pregnancy category X meds?

yes

what with ibuprofen helps protect the stomach?

misoprostol (cytotec) may be taken concurrently to protect stomach

what is the toxic side effect (and what to watch for) when taking salicylates?

salicylism = dizziness, ringing in ears, decreased hearing, NVD

what to monitor for when taking acetaminophen (tylenol)?

s/sx of liver dysfunction (anorexia, nausea, vomiting, jaundice, and elevated liver enz) due to how its hard on the liver

what should patient avoid when taking acetaminophen (tylenol)?

alcohol

should those taking percocet take acetaminophen (tylenol)?

no, acetaminophen (tylenol) is the “cet” in percocet

how does colchicine (a gout med) treat an acute attack or be a low dose prophylaxis?

reducing inflammation

how is fibromyalgia typically treated?

mood medications, such as SSNRIs like duloxetine (cymbalta)

what are common adverse effects in ACE inhibitors?

COUGH (it is not dangerous but may be annoying to patient) and hyperkalemia

what to monitor for when taking ace inhibitors?

K levels

what can beta blockers cause?

difficulty breathing, bronchoconstriction, decreased exercise perfromance

when are beta blockers contraindictated?

in patients with existing lung disease (asthma and COPD)

what is a major adverse effect of hydrochlorothiazide (hydrodiuril)?

fluid and electrolyte loss

what are side effects of furosemide (lasix)?

tinnitus, photosensitivity, electrolyte depletion, hyponatremia and hypokalemia