Pharmacology Quiz 1

Pharmacokinetics

drug movement through the body to reach sites of action, metabolism, and excretion; What the body does to the drug

Pharmacodynamics

 Study of what the drug does to the body; Reactions between living systems and drugs; drug actions on target cells and the resulting alterations in cellular biochemical reactions and functions.

Absorption

The process that occurs from the time a drug enters the body to the time it enters the bloodstream to be circulated.

Distribution

Transport of drug molecules within the body; after a drug is injected or absorbed into the bloodstream, It is carried by the blood and tissue fluids to its sites of action, metabolism, and excretion.

Metabolism

When drugs are altered from their original form into a new form by the body; usually in the liver

Excretion

Elimination of a drug from the body; effective excretion requires adequate functioning of the circulatory system and the organs of excretion (kidneys, bowel, lungs, and skin)

Agonist

 A Drug that produces effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances.

Antagonist

A Drug that inhibits cell function by occupying receptor sites

Antidote

Substance that relieves, prevents, or counteracts the effect of a poison

Hypersensitivity

Immune mediated reaction to a drug

Serum drug level

Laboratory measurement of the amount of a drug in the blood at a particular time

Serum half-life

Laboratory measurement of the amount of a drug in the blood at a particular time.

Loading dose

Dose larger than the regular prescribed daily dosage of a medication; used to attain therapeutic blood leve

Maintenance dose

Quantity of drug that is needed to keep blood levels and or tissue levels at a steady state or constant level

Nephrotoxicity

A Toxic or damaging effect of a substance on the kidney; potentially serious because kidney damage interferes with drug excretion, causing drug accumulation and increased adverse effects.

Adverse effects

An undesired harmful effect resulting from a medication or other intervention such as surgery

Blood-brain barrier

A Barrier in the central nervous system that is composed of capillaries with tight bonds that act as a barrier to prevent passage of most ions and molecular weight compounds like some drugs from getting into the blood that goes to the brain.

• The barrier protects the CNS and can make drug delivery to the neurons more difficult. In neonates, the blood-brain barrier is poorly developed so drugs and other chemicals easily affect the CNS in young infants

Body surface area

The Surface of a human body expressed in square meters. This is used to ensure the therapeutic window for medication and avoid adverse medication effects

Total body water

The amount of water within the body (both intracellular and extracellular)

• The amount of water in the intracellular and extracellular compartments plus in the GI and urinary tracts,

• Adults: total body water is 60%, and in newborns, it is approximately 80%

• Meaning that water-soluble drugs like atenolol and penicillin are diluted easily and readily moved into intercellular tissue making serum drug concentrations lesser→ meaning that higher doses of water soluble drugs may be needed for newborns

Age-related changes

Physiologic events due to increasing age, which then affect drug responses

• Age-related physiologic changes of the liver affect the metabolism of medications; when you get older, your liver begins to shrink and have less metabolism. Also, the kidneys' GFR decreases and excretion is limited.

Polypharmacy

The use of several drugs during the same period

• Brings about greater risk as often older adults, especially with impaired mental status are not able to correctly remember or make proper medication schedules

Beer criteria

A list of potentially inappropriate medications for geriatric patients and recommendations for lowering certain doses to avoid problems and to attune medications to the diminished kidney function.

Muscarinic Agonists

Medications that mimic the effects of acetylcholine by activating muscarinic receptors, a type of cholinergic receptor

Bethanechol Muscarinic agonist

• Therapeutic action: contracts bladder muscles to allow urine to flow

• Indications: treat/prevent urinary retention

• SE: Excessive salivation, increased secretion of gastric acid, abdominal cramps, diarrhea

• Adverse effects: Hypotension and bradycardia

• Nursing Education: Muscarinic receptors are in the heart, exocrine glands, smooth muscles, and eyes; account for therapeutic action and side effects

Muscarinic Antagonists: also known as anticholinergics

medications that block the effects of acetylcholine on muscarinic receptors

Atropine: Muscarinic Antagonist

• Therapeutic action: blocks muscarinic receptors throughout the body 

• Indications: bradycardia, decrease in secretions before intubation and surgery, pupil dilation for eye exam

• SE/Adverse Effects: Hot, Dry, Blind, Red, Mad

• Nursing/education: Report symptoms above, sip fluids, sugar-free lozenges/gum for dry mouth

Tiotropium

• Therapeutic Action: Decreased incidence and severity of bronchospasm.

• Long acting

• SE: Insomnia, blurred vision, red eyes, difficulty peeing, faster heartbeat, difficulty swallowing

Ipratropium

• Short acting anticholinergic bronchodilater: relaxes muscles around airways, reducing spasms and airflow.

• Dry mouth, nausea, dizziness, difficulty breathing.

Cholinesterase Inhibitors

Used for myasthenia gravis

Neostigmine/pyridostigmine: Cholinesterase inhibitors

• Therapeutic Action: Prevent degradation of acetylcholine

• Side Effects: respiratory depression that cant be managed with drugs– requires mechanical ventilation (cholinergic crisis)

  • Pneumonic SLUDGE

Adrenergic agonists: Epinephrine

• Therapeutic action: fight or flight

• Indications: anaphylaxis, cardiac arrest (code blue), delayed absorption of local anesthetics.

• Adverse effects: Hypertensive crisis, dysrhythmias, angina, hyperglycemia.

• Nursing Education: Autoinjectors for anaphylaxis require immediate Emergency medical treatment due to rapid activation and must be given IV or IM

Dopamine

• (adrenergic agonist/ vasopressor)

  • Therapeutic Action: increases blood pressure and protects kidneys

  • Indications: shock (all types)

  • Adverse effects: Hypertensive crisis, dysrhythmias, angina, hypergllycemia

  • Nursing education: given only in ICU via continuous infusion because of rapid inactivation

Nonselective beta-adrenergic antagonist (beta blocker): Propranolol

• Indications: hypertension, “stage fright”, low doses anxiety

• Side effects: Hypotension

• Adverse Effects: bronchoconstriction, caution with asthma, bradycardia, heart failure, reflexive tachycardia, reduced cardiac output

• Nursing education: masks hypoglycemia in people with diabetes

Cardioselective adrenergic antagonist (beta blocker): Metoprolol

• Indications: hypertension, “stage fright”, low doses anxiety

• Side effects: Hypotension

• Adverse Effects: bronchoconstriction, caution with asthma, bradycardia, heart failure, reflexive tachycardia, reduced cardiac output

• Nursing education: masks hypoglycemia in people with diabetes

Short-acting beta agonist (SABA): albuterol

• Purpose:Rescue inhaler for acute bronchospasm, fast onset; relaxes smooth muscle

• Common side Effects monitoring: tremor, nervousness, palpitations

• Adverse effects: stop medication and call provider: severe hypersensitivity reaction, severe tachycardia, chest pain

Long-acting beta-agonists (LABA): salmeterol

• relaxes muscles around the airways to help them open up and make it easier to breathe

  • Purpose: maintenance inhaler, not for acute symptoms

  • Common side effects: tachycardia, headache

  • Adverse effects: severe hypersensitivity reaction, use without inhaled corticosteroid (risk of asthma-related death)

Formoterol (LABA)

• Purpose: Long-term control, fast onset compared to salmeterol.

• Common side effects: tachycardia, headache

• Adverse effects: severe hypersensitivity reaction

Methylxanthines: Theophylline(rarely used; need to know)

• Purpose: used together with other medicines to treat symptoms of asthma, bronchitis, and other lung diseases

  • Rarely used; use careful monitoring of drug levels

• Side effects: GII upset, restfullness

• Adverse Effects: Severe hypersensitivity reaction. Toxicity: seizures, arrhythmias (has a narrow therapeutic window)

Short-acting muscarinic/anticholinergic (SAMA): ipratropium 

• SAMA’s are medications called short-acting muscarinic antagonists that work by blocking acetylcholine, which constricts the muscles around the airways. Helps to relax these muscles and open up airway

• Purpose: Used for acute bronchospasm, slower onset than SABA

• Side effects: dry mouth, cough

• Adverse Effects: severe hypersensitivity reaction.

Long-acting muscarinic/anticholinergic (LAMA): tiotropium Long Acting Muscarinic antagonists.

• Purpose: Maintenance inhaler for COPD not for acute relief

• Side effects: dry mouth, constipation

• Adverse effects: Severe hypersensitivity reaction

Corticosteroids (inhaled): beclomethasone

• Beclomethasone

  • Purpose: Maintenance therapy for asthma after 

  • Side Effects: Oral candidiasis (thrush), hoarseness

  • Adverse effects: severe hypersensitivity reaction

Fluticasone: (inhaled)

• Purpose: Daily use for asthma control, rinse mouth after use

• Side effects: Thrush, hoarseness

• Adverse Effects: severe hypersensitivity reaction

Corticosteroids (systemic): prednisone

• Purpose: Short-term burst for exacerbations

• Side effects: weight gain, mood changes, hyperglycemia

• Adverse effects: severe hypersensitivity reaction

1st generation antihistamine: diphenhydramine (Benadryl)

• Purpose: short term usee for allergies or sleep aid

• Side effects: sedation, dry mouth, dizziness

• Adverse effects: severe hypersensitivity reaction, paradoxical reaction, severe drowsiness causing unsafe situations

2nd generation antihistamine: loratadine

• Purpose: Non drowsy option for seasonal allergies

• Side effects: mild drowsiness headache

• Adverse effects: severe hypersensativity

Leukotriene mediator antagonist: montelukast

• Purpose: maintenance therapy for asthma, allergic rhinitis

• Side effects: Headache, GI upset

• Adverse effects: severe hypersensitivity reaction, neuropsychiatric events (rare but serious)

Mast cell stabilizer: cromolyn

• Purpose: preventative treatment not for acute attacks

• Side effects: Throat irritation, cough

• Adverse effects: severe hypersensativity