Pharmacology Exam 1

Clinical pharmacology

The study of drugs used to treat, diagnose, or prevent disease.

Therapeutic effect

The intended clinical benefit or good effect of a medication.

Adverse effect

An unintended, undesirable response at a usual dose.

Toxic effect

Harm caused by excessive exposure or impaired clearance.

Chemical name

Name based on the drug's chemical structure, usually seen when a drug is still in trials.

Generic name

Shorthand version of the chemical name.

Brand name

Brand-specific name of a medication.

Drug class

A category or family of drugs with related characteristics.

Mechanism of action

How the medication works.

Indication

The condition or reason the medication is used.

Contraindication

A condition in which the medication should not be used.

Black box warning

A warning for significant risk factors and higher-risk events.

Nursing priorities

Assessments and labs, black box warnings, and patient teaching.

Medication study framework

Identity → action → nursing priorities.

Identity

Chemical name, generic name, brand name, and drug class.

Action

Mechanism of action, indications, adverse effects, and contraindications.

Nursing medication priorities

Assessments/labs, black box warnings, and patient teaching.

Notice, interpret, prioritize, plan

Clinical thinking used for safe medication decisions.

Most important adverse effects to study

The most common, most dangerous, and most actionable effects for nursing care.

Controlled substance

A regulated medication with potential for abuse, addiction, or dependence.

OTC medication

A medication available without a prescription that can still have adverse effects and safety risks.

Schedule I

Highest restriction.

Schedule II

High restriction.

Schedule III

Moderate restriction.

Schedule IV

Lower restriction.

Schedule V

Lowest scheduled risk.

Controlled-substance nursing responsibilities

Verify storage/access requirements, document administration and wasting precisely, and assess for misuse, diversion, and patient safety risks.

Current pregnancy labeling

Patient-centered risk information including risk summary, clinical considerations, and supporting data.

Current lactation labeling

Information about drug in human milk, effects on the infant, and effects on milk production.

Fertility considerations

Potential effects on fertility, pregnancy testing, and contraception.

ADME

Absorption, distribution, metabolism, and excretion.

Absorption

How the drug enters circulation.

Distribution

Where the drug travels in the body.

Metabolism

How the drug is transformed.

Excretion

Elimination of the drug from the body.

Pharmacokinetics

What the body does to the drug.

Route and absorption

The route affects how quickly the medication begins working and whether first-pass metabolism is bypassed.

Oral route

Common and generally safe; absorption is affected by stomach acidity, food, blood flow, and first-pass metabolism.

IM route

Medication is injected into muscle and absorbed into capillaries.

Subcutaneous route

Medication is deposited under the skin and slowly absorbed into circulation.

IV route

Fastest onset because the medication directly enters the venous system and skips absorption.

Distribution factors

Blood flow, protein binding, and barriers.

Protein binding

Only unbound drug can readily leave plasma and act on tissues.

Tightly protein-bound drugs

Generally remain in the body longer and have a longer duration of action.

Protein-binding competition

Drugs competing for binding sites can alter effectiveness or cause toxicity.

Blood-brain barrier

Protective barrier that limits drug entry into the CNS.

Lipid-soluble drugs and the BBB

Lipid-soluble drugs can pass through the blood-brain barrier more readily.

First-pass effect

An oral drug enters portal circulation, passes through the liver, and then reaches systemic circulation.

P450 enzymes

Hepatic enzymes involved in drug metabolism.

P450 induction

Speeds metabolism of drugs.

P450 inhibition

Slows metabolism of drugs.

Half-life

The time required for the amount of drug in the body to decrease by half.

Near-complete drug clearance

Usually occurs after about 5-7 half-lives.

Major routes of elimination

Kidneys and liver; drugs may also leave through skin, saliva, lungs, bile, and feces.

Impaired elimination

Increases drug accumulation and toxicity risk.

Why the same dose can affect different patients differently

Age, weight, sex/gender, genetics, organ function, disease state, immune response, psychological factors, tolerance, accumulation, interactions, and environment.

Recommended medication dose basis

Doses are commonly based on a 150-pound person.

What is more important than simply giving the recommended dose?

The patient's serum drug level and clinical response.

Very young patients

Have immature organ systems that can affect medication response.

Very old patients

Have functional decreases in organs that can affect medication response.

Physiological factors

Fluids/electrolytes, hydration, and sleep/wake rhythms.

Pathological factors

Disease, GI function, liver function, renal function, and cardiovascular disorders.

Psychological factors

Placebo effect and compliance.

Drug interactions

Drug-drug, drug-food, and drug-herb interactions.

Drug allergy

An immune response in which antibodies develop after exposure to a drug.

Allergic reaction

Can include rash, hives, and swollen joints.

Anaphylactic reaction

Can include rash, hives, difficulty breathing, hypertension, dilated pupils, panic feeling, tachycardia, and respiratory arrest.

Stomatitis

Inflammation of mucous membranes that can result from a direct toxic drug reaction and is not necessarily an allergic reaction.

Drug-induced skin damage

Rash, hives, and Stevens-Johnson syndrome.

Drug-induced microbiome damage

Disruption of normal flora can lead to superinfection.

Drug-induced bone marrow damage

Decreased platelets, white blood cells, or red blood cells.

Important skin red flag

New rash plus mucosal symptoms requires urgent escalation.

Hepatotoxicity

Drug-induced liver injury.

Hepatotoxicity findings

Fever, malaise, nausea/vomiting, jaundice, and abdominal pain.

Hepatotoxicity labs

AST, ALT, and bilirubin.

Nephrotoxicity

Drug-induced kidney injury.

Nephrotoxicity findings

Rising BUN/creatinine, altered urine output, fatigue, and edema.

Overdose

Exposure that exceeds the body's ability to metabolize or eliminate the medication.

Nursing response to overdose

Stabilize the patient, identify the medication and timing, provide emergency treatment, and use reversal agents/antidotes when available.

Normal blood glucose

70-110 mg/dL.

Normal potassium

3.5-5.0 mEq/L.

Hypoglycemia symptoms

Fatigue, drowsiness, hunger, anxiety, headache, cold clammy skin, shaking, incoordination, increased HR/BP, numbness or tingling around the lips/mouth/tongue, confusion, rapid shallow respirations, seizure, and coma.

Hyperglycemia symptoms

Fatigue, polyuria, polydipsia, Kussmaul respirations, restlessness, polyphagia, nausea, hot flushed skin, and fruity breath.

Hypokalemia symptoms

Weakness, tingling, cramps, nausea/vomiting/diarrhea, decreased bowel sounds, irregular weak pulse, orthostatic hypotension, and disorientation.

Hyperkalemia symptoms

Weakness, cramps, diarrhea, tingling, slow HR, low BP, decreased urine output, and difficulty breathing.

Sensory/neuro adverse effects

Blurred vision, color changes, corneal injury, tinnitus, hearing loss, confusion, delirium, insomnia, dizziness, hyperreflexia/hyporeflexia, and seizures.

Anticholinergic effects

Dry mouth, dry eyes, constipation, urinary retention, and tachycardia.

Teratogenic

Having potential congenital effects on a developing fetus.

Nursing response to an adverse effect

Recognize → hold if indicated → assess → notify → treat → document.

Nursing process

Assess → Diagnose → Plan → Implement → Evaluate.

Every vital sign is an example of what?

ANS output.

Central nervous system

Brain and spinal cord.

Peripheral nervous system

Nerves outside the CNS.

Somatic nervous system

Voluntary nervous system controlling skeletal muscle.

Autonomic nervous system

Involuntary nervous system controlling organs and glands.

Sympathetic nervous system

Fight-or-flight system.

Parasympathetic nervous system

Rest-and-digest system.

Autonomic tone

Both sympathetic and parasympathetic systems continuously operate, with organ function reflecting whichever tone is dominant.

Sympathetic origin

Thoracolumbar spinal cord, T1-L2.

Sympathetic fibers

Short preganglionic and long postganglionic.