Pharm II Exam 1

in vitro

"in glass" in Latin. It refers to experiments conducted outside of a living organism, usually in a lab.

in vivo

in humans

the Abigail Alliance

created to accelerate drug development and review for serious, life threatening diseases

misfeasance

negligence, wrong drug or wrong dose given

nonfeasance

omission, not giving a prescribed med

malfeasance

giving correct drug via wrong route

chemical name

describes the chemical structure of the drug

generic name

official, non-proprietary name for a drug, less expensive than brand name

brand/trade name

trademark name, always capitalized

the nurse identifies the act that provides for the privacy of patient health information as the

Health Insurnace Portability and Accountability Act, HIPAA

The Drug Regulation Reform Act

shortened the time in which new drugs could be developed and marketed

The Drug Relations Act

increased approval rate of the drugs used to treat AIDS and cancer

The FDA Modernization Act

controls new drug use and discontiued drugs

the nurses identifies the primary purpose of federal legislation in drug standards as

ensuring public safety

which situation regarding controlled substances requires the supervising RN to intervene?

controlled substances are locked awau from patients, and all staff members have keys for necessary access

the nurse is to administer a dose of furosemide (lasix). the nurse knows that Lasix is the ______ name of the drug

brand name

pharmacogentics

variations of the predicted response to a drug due to genetic factors

biologic variations in response to medication

pharmacogenomics

certain classes of meds have different effects in people whose genetics are a characteristic of a certain group

ex: people of asian descent may have a decreased response to a drug due to higher levels of CYP2D6 enzymes

nursing assessment

assess cultural and racial background

consider communication styles, social organizations, environmental controls

nursing planning

collaborate with patient to reduce high-risk health behaviors

nursing interventions

incorporate non-harmful traditional practices with biomedical prescriptions

nursing patient teaching

provide info in more than one form

include family and support people

nursing evaluation

patient correctly demonstrates understanding of prescriptive therapies and treatments

pharmacogenetic research has found that some African Americans

are less responsive to beta blockers and ACE inhibitors than European Americans

antihypertensive agents

the patient’s culture may influence the patient’s attentiveness to time. this may be of special concern to nurses when they teach patients about

the schedule of medicaton dosing

pharmaceutic phase includes

disintegration (smaller pieces)

dissolution (solution capable of crossing biologic membrane)

does the age of a patient have any impact on the pharmaceutic phase?

yes, drugs are disintegrated and absorbed faster in acidic fluids

young children and older adults have less gastric activity, so drug absorption is slower

why are some drugs adminstered with food and others on an empty stomach?

food in GI tract may interfere with dissolution and absorption of drugs and it may enhance absorption of drugs

some drugs irritate the gastric mucosa

ex: iron supplement taken alone bc it has binding effect and will effect absorption

ex: synthroid taken alone bc other meds cause it to have less bioavailability

pharmacokinetics

what the body does to the drug

absorption, distribution, metabolism, excretion

absorption

the movement of drug particles from the GI tract to body fluids

distribution

drug becomes available to body fluids and tissue

metabolism

body inactivates the drug) biotransforms

excretion

how the body gets rid of the drug

are water-soluble or lipid-soluble drugs absorbed faster?

drugs that are lipid-soluble because they can cross the cell membrane

bioavailability

what % of drug reaches systemic circulation

affected by drug form, route, food, other drugs, changes in metabolism

why do you need to know your patient’s health history?

absorption is reduced if there are fewer villi in the small intestine r/t disease, surgery, etc

why are lidocaine and some nitroglycerines not adminstered orally?

extensive first pass metabolism, most of the drug would be destroyed in given PO

warfarin and morphine also have first pass metabolism

first pass effect

passes throufh liver before systemic circulation, lower bioavailabilty

why is the dose of an oral med more than the dose of the same med given IV

bioavailability is less in the PO route, whereas IV drugs enter systemic circulation immediately

what factors affect bioavailability

drug form

route of administration

GI mucosa and motility

food and other drugs

changes in liver metabolism

what drug doesn’t have first pass effect

levofloxacin

same amount PO and IV

all floroquinilones are 100% bioavailable

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why can’t insulin be given PO

insulin and other protein based drugs are quickly destroyed by digestive enzymes in the small intestine

a digestive enzyme that metabolizes protein

protease from the pancreas

protein-bound drug vs free drug

protein-bound drugs are not free to be active

a patient has low protein levels, how might this affect drug distribution?

less protein means fewer binding sites which leads to more free drug which can result in drug toxicity

know your patients albumin and plasma protein

geriatric tend to have lower protein levels

what can cause lower protein levels?

advanced age

liver or kidney diseases

malnourishment

blood brain barrier

only lipid soluble drugs can pass

form of protection

can make treatment difficult, hard to distribute med

half-life

time it takes for half the drug to be eliminated

longer half-life results in less frequent doses

where are drugs metabolized

liver

sometimes GI tract

what has a longer half-life, klonopin or xanax?

klonopin, longer half-life, less frequent dosing

what organ is the main route of elimination

kidneys

other means are liver, feces, saliva, lungs, etc

how does decreased GFR affect excretion

leads to impaired/slower excretion

drug accumulation

common lab test to determine renal function

creatinine clearance

BUN

creatinine levels

pharmacodynamics

study of biochemical and physiological effects of drugs

what the drug does to the body

wellbutrin (zyban)

made as an antidepressant drug, side effect was smoking cessation, rebranded for smoking cessation

minoxidil

vasodilator used to treat HTN, side effect of hair growth lead to Rogaine drug

maximal efficacy

giving/taking more of a drug does not change its maximal effect

there is a point when a med does not provide more therapeutic value despite a larger dose

peak therapeutic value vs risk of side effects

onset

how soon the med takes effect

peak

when the drug reaches max effect

duration of action

how long the drug lasts

what’s an example of a med where it’s very important to know the onset, peak, and duration

opioids

insulins

what factors might affect onset of action?

route

food in stomach

pH of GI tract

other meds being taken

agonist

drugs that produce a response

promotes uptake, enhances another drug

ex: sulfonylureas

antagonist

drug that blocks a respinse

ex: histamine blockers, ACE inhibitors

nonspecific drug effect

drug acts on multiple receptors (same type of receptor) throughout the body

ex: cholinergic effect of urecholine, used to treat post-op urinary retention but well decrease HR, BP, etc

prochlorperazine (compazine) is a

anticholinergic agent

nonselective drug effect

drug acts on many different types of receptors

ex: epinephrine acts on Alpha1, Beta1, Beta2 receptors

ex: albuterol

four categories of drug action

stimulation or depression, narcotics, amphetamines, amaryl

replacement, synthroid, insulin, pancreatic enzymes

inhibition or killing of organisms, ABX

irritation, laxative

therapeutic index

measures the margin of safety of a drug

ratio of benefits to toxic effects

tachyphylaxis

rapidly diminishing repsonse to a drug that previously worked

loading dose

used when immediate drug respone is desired

large initial dose

ex: digoxin

side effects

physiologic effects not related to desired drug effects

can be desirable or undesirable

adverse reactions

more severe than side effects

always undesirable

must be reported and documented

toxic effects

identified by monitoring the plasma therapeutic range of the drug

toxic effects occur when drug levels exceed the therapeutic range

cytochrome P450 isozymes

isozymes responsible for the biotransformation of many drugs and other substances

tolerance

decreased responsiveness over the course of therapy

drugs that can cause tachyphylaxis

narcotics, barbiturates, laxatives, psychotropic agents

placebo effect

psychological benefit from a compound that may not have the chemical structure of a drug effect

have no pharmacologic activity

teratogens

drugs that cause birth defects

carcinogens

drugs that cause cancer

metabolites

end product of metabolism

true or false

the pharmacodynamic profile of a med is unchanged over the lifespan of a patient

true

what the drug does to the body

a patient have liver and kidney disease. he is given a med with a half-life of 30 hours. as compared to a healthy person, the nurse expects the duration of the half-life of this med to _____ in this patient

increase

when assessing older adults and those with renal dysfunction, the nurse knows that creatinine clearance is usually

decreased

a patient sustains significant burns to the skin and is experiencing fluid shift associated with edema in the fluid overload phase. the nurse would anticipate that this will interfere most with what phase of pharmacokinetics?

distribution

most drugs are metabolized in the

liver

ture or false

age and gender significantly impact a med’s pharmacokinetics

true

what the body does to the drug

polypharmacy

multiple meds

may cause confusion, multiple providers, ask about OTC and herbals

common issues in geriatric pharmacology

loss of protein-binding sites

decline in hepatic first-pass metabolism

drugs with prolonged half-life, decreased liver and kidnet function

changes result in more free drug, unmetabolized drug, inefficient excretion, leads to toxicity and adverse reactions

why are geriatric patients more likely to have an adverse reaction to vasodilator drugs

the sympathetic feedback does not occur quickly, can result in orthostatic hypotension

safety issue due to decreased BP

safe hypnotic for geriatrics

ramelteon (rozerem)

used to treat anxiety and insomnia

avoid diazapam (valium) and lorazepam (ativan)

want drugs with short half-life

what diuretics and antihypertensives are safe for geriatrics?

calcium blockers, ACE inhibitors, beta blockers

consider nonpharmacologic measures to reduce BP

what labs should be monitored with hydrochlorothiazide

potassium

can have an increased risk of electrolyte imbalances for older patients

what diuretics and antihypertensives are avoided in geriatrics?

alpha1 blockers (prazosin, terazosin) and alpha2 agonists (methyldopa, clonidine)

cause orthostatic hypotension

why is digoxin avoided in geriatrics?

most of digoxin is eliminated by the kidneys, which have decreased function in elderly

dig accumulation cna lead to bradycardia

what to consider with anticoagulants in geriatrics

warfarin (coumadin)

decreased serum albumin

risk for falls

drug/food interactions

risk of hemorrhage

monitor PT/INR and watch for signs of bleeding

what antibacterials are safe for geriatrics?

penicillins, cephalosporins, tetracyclines, sulfonamides

what antibacterials are not safe for geriatrics?

aminoglycosides, fluoroquinolones, vancomycin

these are excreted in urine and not given in patients older than 75yo

an older adult comes to the emergency department after taking cimetidine (tagamet). what is most important for the nurse to monitor the patient for?

confusion

what GI drugs are safe for geriatrics?

histamine blockers, famotidine (pepcid)