Pharmacology Final (NURS 305-Liberty University)

What are the three most important characteristics of a drug?

Effectiveness

Safety

Selectivity

What is THE most important characteristic of a drug?

Effectiveness

Effectiveness

When a drug elicits the response it is intended to do

Safety

A drug that cannot produce a harmful side effect

NOTE: There is no completely safe drug

Selectivity

A drug only elicits the response it was intended to, there are no side effects

NOTE: There is no truly selective drug, all drugs have side effects

Every medication is a...

double-edged sword

Therapeutic objective

Maximum benefit with minimum harm

NOTE: This is also the goal of nursing

Six main rights of medication administration

1. Right medication/drug

2. Right dose

3. Right patient

4. Right route

5. Right time

6. Right documentation

What should be monitored for any drug?

-vital signs

-oxygen saturation

-mental status

-observing and reporting side effects

- managing side effects

- patient/family education

When should trough levels be drawn?

30 minutes before next med administration

Agonist analogy

Key opens the lock and opens the door

Antagonist analogy

Key is put in the lock and gets stuck but does not open the door

How are drugs rated for pregnancy?

Either A, B, C, D, or X

Pregnancy category A

Safest

Pregnancy category C

Animals show risk

Pregnancy category D

Shown to have risk in human

Only take if benefits outweigh the risks

Pregnancy category X

Risk always outweighs the benefits

How are all drugs rated related to abuse potential?

Schedule I-V

Schedule I drug

Highest abuse potential and not approved for medical use

Ex: Heroin, Marijuana, LSD

Schedule II drugs

High abuse potential

Ex: Opioids

Schedule III drugs

Less abuse potential

Combination drugs

Ex: Codeine+Tylenol

Schedule IV drugs

Mild physical or psychological dependence

Medically indicated

Ex: Benzodiazapines

Schedule V drugs

Medically accepted

Limited dependency potential

Ex: OTC's

Pharmacokinetics

What the body does to the drug

4 processes affecting pharmacokinetics

ADME

Absorption

Distribution

Metabolism

Excretion

Absorption

Time from entry into the body until entry into blood stream

Distribution

How the drug is carried through the body

Metabolism

What happens to the drug once absorbed?

Ex: Fist pass effect

Excretion

How the body gets rid of the drug

Ex: Kidney, liver, bowels, sweat, etc.

Serum half life

How long it takes for the blood level of a medication to decrease by 50%

How long does it take for a drug to achieve a steady state?

4-5 half lives

Lethal dose

A dose that will kill 50% of animals tested

Effective dose

A dose that produces a predefined response in 50% of those tested

Therapeutic index measures

A drug's safety

If a drug has a small/narrow therapeutic index is it safe or not safe?

Not safe

If a drug has a large/broad therapeutic index is it safe or not safe?

Safe

6 types of drug-drug interactions

1. Additive

2. Synergistic

3. Interference

4. Displacement

5. Antagonism

6. Incompatibility

Additive effect

1+1=2

Synergistic effect

1+1=3

Interference

One drugs slows or accelerated the metabolism or excretion of anoth

Displacement

Two drugs competing for binding sites

Antagonism

Two drugs cancel the effects of the other

Incompatibility

Physical interaction of two drugs that interfere with the effects of at least one of the drugs

Adverse effects of drugs are dependent on...

Dosage

Age

Medical history

Therapeutic index

Drug-drug interactions

Allergic reactions

Occurs with the second dose of the drug because of prior sensitization of the immune system

Ranges from mild itching to anaphylaxis

Idiosyncratic reaction

Unusual, unexpected reaction to medications usually a results of genetic predisposition

Iatrogenic

A disease caused by drugs; almost identical to naturally occurring diseases

Ex: Anti-psychotics may cause Parkinson-like symptoms

Carcinogenicity

The ability of a drug to cause cancer

3 most common medication errors

Confusing patient name

Illegibly written prescription

Wrong route (IM instead of IV)

Narrow spectrum vs broad spectrum abx

Narrow spectrum is specific for a certain organism

Broad spectrum covers many organisms and is useful when you don't know the cause of infection

Penicillins MOA

Inhibit cell wall synthesis

Penicillins are the drug of choice for what?

Pneumonia and meningitis

Infections caused by sensitive gram+ cocci and bacilli

Strep. pharyngitis

Empiric therapy

Treatment of an infection before specific culture information has been positively identified

Types of drugs for allergic rhinitis?

Anti-histamines

Glucocorticoids

Sympathomimetics (decongestants)

Cromolyn

Anticholinergics

Antileukotrienes

H2 antagonists treat what?

Gastric and duodenal ulcers

H1 antagonists treat what?

Allergic reactions

Do antihistamines relieve nasal congestion?

No

Why would 2nd generation antihistamines be better than 1st generation?

2nd generation does not cause drowsiness

What ending do antihistamines share?

-ine

Ex: Diphenhydramine, Cetrizine, Loratadine, Fexofenadine

1st generation antihistamines can cause what main adverse effect?

Drowsiness (CNS depression)

What is the most effective/first line drug for seasonal/perennial rhinitis?

Intranasal glucocorticoids

How long does it take for an intranasal glucocorticoid to start working?

2-3 weeks

What kind of inhibitor is Cromolyn?

Mast cell inhibitor

Cromolyn is best when given when?

Prophylactically 2-3 weeks before allergies begin

How long should someone take a decongestant for?

3-5 days maximum or they risk rebound congestion

What kind of medicine is pseudoephedrine and phenylephrine?

Decongestants

What medication for asthma is an anticholinergic? What does it do?

Ipratropium

Decreases secretions

What are the two opioid antitussives?

Codeine and Hydrocodone

What medication is an expectorant?

Robitussin (Guaifenesin)

First and #1 management of STEMI is what?

MONAB

What makes up MONAB?

Morphine

Oxygen

Nitrates

Aspirin

Beta blockers

Which patient would be a candidate for thrombolytic therapy?

A patient with a massive pulmonary emboli

A patient comes in with a STEMI. When does he have to be in the cath lab by? Thrombolytic therapy?

Cath lab- Within 90 minutes

Thrombolytic therapy- within 30 minutes

Choose one or the other-not both

What four drugs will be taken indefinitely post-MI?

Beta-blocker

ACE inhibitor

Statin

Anti-platelet/anti-coagulant

What is the most common condition to occur post-MI?

Ventricular dysrhythmias

Three antiplatelets for cath lab?

A -grel drug (Clopidigrel, tricagrelor, prasugrel)

Abciximab

Aspirin

Thrombolytic drugs end in what?

-teplase

ACE inhibitors end in what?

-pril

Beta-blockers end in what?

-lol

How to treat hemophilia?

Replace the clotting factor

Hemophilia A is missing what factor?

VIII (8)

A sounds like 8

Hemophilia B is also known as what?

Christmas disease

Hemophilia B is missing what clotting factor?

IX (9)

B-9 (benign)

Desmopressin is used for what?

Prevents bleeding in mild hemophilia A

Name a prokinetic drug and what it's used for?

Metaclopramide (Reglan)

Increase gastric motility and rate of gastric emptying for decreased N/V post-op/radiation

Name a serotonin receptor antagonist and why it's used?

Odansetron (Zofran)

To decrease N/V associated with chemo and operations

Name a phenothiazine and why it's used?

Promethazine (Phenergan)

N/V associated with chemo and post-op

Name two corticosteroids used for N/V after chemo?

Dexamethasone and methylprednisolone

Substance P/neurokinin1 antagonists do what and name one?

Prevents nausea and vomiting

Ex: Aprepitant (Emend)

Contraindications for laxative use

Individuals experiencing unknown abdominal/bowel pain

Acute surgical abdomen

Fecal impaction or bowel obstruction

Habitual use

Use with caution in pregnancy and lactation

5 main types of laxatives

Bulk-forming

Surfactants

Irritant/stimulant

Lubricant/osmotic

Lactulose

Bulk forming laxative example, group, and how it works?

Psyllium

Methylcellulose

Group 3

Fluid is key! It's softens and enlarges the mass

Surfactant laxative example, group, and how it works?

Docusate

Group 3

Increases water and electrolytes in intestine

Irritant/stimulant laxative example, group, and how it works?

Bisacodyl and Senna

Group 2

Stimulates peristalsis and decreases absorption of water and electrolytes

Lubricant/Osmotic laxative example, group, and how it works?

Magnesium hydroxide and Polyethylene glycol (Miralax)

Group 1

Retains water and promotes MAJOR peristalsis

Lactulose laxative group and why to take it?

Group 1

Decreases ammonia and is used for constipation and HEPATIC ENCEPHALOPATHY

Aggressive factors of PUD?

H. pylori, NSAIDs, acid, pepsin, smoking

Treatment for PUD includes what 3 drugs and lasts how long?

Amoxicillin

Clarithromycin

PPI or H2 blocker

10-14 days

What is the big problem with PPI's?

Polypharmacy- usually don't need it out of the hospital but doctors don't know why they're on it so they continue their prescriptions

What patient can't take a PPI?

A patient on HIV drugs