PHARM Exam 1 AI Generated, but reviewed by me; (No specific Meds Mentioned)

Clinical judgment

The use of critical thinking and decision-making skills to safely administer medications and monitor patient responses.

Medication reconciliation during Recognize Cues

Review new drug orders and compare them with medications the patient has been taking at home to avoid omission, duplication, or drug interactions.

First step in health teaching

Build trust and assess the patient's readiness to learn.

What should be assessed before medication teaching?

Educational level, health literacy, motor skills, and abilities.

What should patients learn about medications?

Purpose, indications, dosage schedule, correct administration, food and fluid restrictions, storage, therapeutic effects, side effects, adverse effects, drug interactions, and adherence strategies.

Teach-Back: Triage

Focus on one topic at a time.

Teach-Back: Tools

Use a model or visual aid to help the patient understand.

Teach-Back: Take responsibility

Say, "I want to make sure I did a good job teaching," rather than "I want to make sure you understood me."

Teach-Back: Tell me

Have the patient explain the information back to make sure they understand it.

Teach-Back: Try again

Reteach the information if needed.

Comprehensive Drug Abuse Prevention and Control Act

A 1970 federal law that created a scheduling system for controlled substances.

Schedule I

Not approved for medical use and has high potential for abuse.

Schedules II through V

Approved for medical use with decreasing potential for misuse leading to psychological and/or physical dependence.

Chemical name

The name that describes a drug's chemical structure.

Generic name

The non-proprietary name for a drug.

Trade or brand name

The name chosen by the drug company and usually trademarked; a drug may have many brand names.

Generic vs trade-name drugs

The active ingredient is the same; the difference is the fillers, and they must be bioequivalent.

Bioequivalence

The comparison showing that generic and trade-name drugs have equivalent therapeutic effects.

A rating related to bioequivalence

Indicates a drug is considered therapeutically equivalent.

Pharmacokinetics

The movement of a drug through the body and what the body does to the drug.

ADME

Absorption, Distribution, Metabolism, and Excretion.

Absorption

The movement of the drug into the bloodstream after administration.

What affects absorption?

Route of administration, age, weight, and health status.

Enteral administration

Administration by mouth; approximately 80% of medications are given this way.

Dissolution

The time it takes for a drug to disintegrate into small particles and combine with liquid to form a solution.

Distribution

The movement of a drug from the circulation to body tissues.

What affects distribution?

Vascular permeability, cell membrane permeability, blood-brain barrier, placenta, blood flow, pH, and cardiac output.

Metabolism

The process by which the body chemically changes drugs into a form that can be excreted.

Primary site of drug metabolism

Liver.

Secondary site of drug metabolism

Kidneys.

P450 or cytochrome P450 system

The enzyme system used by the liver for drug metabolism.

What happens when drug metabolism is decreased?

Excess drug accumulation can occur and lead to toxicity.

Excretion

The elimination of drugs from the body.

Main route of drug excretion

Kidneys.

Prerenal conditions

Conditions such as dehydration or hemorrhage that decrease blood flow and glomerular filtration.

Intrarenal conditions

Conditions such as glomerulonephritis or chronic kidney disease that affect filtration, secretion, and reabsorption.

Postrenal conditions

Conditions such as prostatic hypertrophy, stones, or neurogenic bladder that obstruct urine flow.

Enteric-coated medications

Medications that resist disintegration in the stomach and pass into the small intestine where the coating dissolves and absorption occurs.

Can enteric-coated tablets be crushed?

No.

Can sustained-release capsules be crushed?

No.

Pharmacodynamics

The study of the effects of drugs on the body.

Primary drug effect

The desirable, intended response.

Secondary drug effect

An effect that may be desirable or undesirable.

Onset

The time for a drug to reach the minimum effective concentration.

Peak

The time when a drug reaches its highest blood concentration.

Duration of action

The length of time the drug exerts its therapeutic effect.

Agonist

A drug that activates receptors and produces a desired response.

Partial agonist

A drug that produces only moderate activity when binding to receptors and can also prevent receptor activation by other drugs.

Antagonist

A drug that prevents receptor activation and blocks a response.

Bioavailability

The percentage of an administered drug available for activity.

IV bioavailability

100%.

Oral bioavailability

Always less than 100% and varies based on absorption and first-pass metabolism.

First-pass metabolism

An orally absorbed drug travels through the portal vein to the liver, where some of the drug is metabolized to an inactive form and excreted, reducing active drug available.

Routes that bypass first-pass metabolism

Intravenous, intramuscular, subcutaneous, nasal, sublingual, and buccal routes.

Protein binding

The distribution of drugs into plasma where many drugs bind to plasma proteins.

Highly protein-bound drug

A drug that is 90% bound to protein.

Weakly protein-bound drug

A drug that is less than 10% bound to protein.

Free drug

The unbound portion of the drug that remains active and can reach its site of action.

What happens when two highly protein-bound drugs are given together?

They compete for protein-binding sites, increasing the free drug released into circulation.

Why can protein-binding competition cause toxicity?

More free drug is available in the bloodstream and can interact with tissue receptors.

Half-life

The time it takes for the amount of drug in the body to be reduced by half.

What affects half-life?

Liver and kidney function.

What happens to half-life when metabolism or excretion is impaired?

The half-life is prolonged.

Why is half-life important?

It helps determine how often a patient should receive a medication.

Peak drug level

The highest plasma concentration of a drug at a specific time.

What does a peak level indicate?

It provides information about drug absorption.

Typical oral peak level

Usually 2-3 hours after oral administration.

Typical IV infusion peak level

Usually 30-60 minutes after IV infusion.

What does a low peak indicate?

The minimum effective concentration has not been met.

Trough drug level

The lowest plasma concentration of a drug, drawn just before the next dose regardless of route.

Drug toxicity

When the drug exceeds the therapeutic range.

What can cause drug toxicity?

Overdose or drug accumulation.

Risk factors for drug toxicity

Disease, genetics, and age.

Side effects

Secondary effects of a drug that are expected.

Adverse drug reactions

Unintentional, unexpected effects that occur with normal dosages and are always undesirable.

Drug interaction

An altered or modified interaction or effect of a drug resulting from interactions with one or more other drugs.

Risk factors for drug interactions

Chronic health conditions, multiple medications, multiple healthcare providers, and multiple pharmacies.

Population at highest risk for drug interactions

Older adults because of polypharmacy and sometimes having multiple healthcare providers.

Pharmacodynamic drug interaction

An interaction involving additive, synergistic, or antagonistic drug effects.

Additive drug effect

Increasing the response beyond what the drug could do by itself.

Example of additive drug effect

Beta blocker and diuretic.

Synergistic drug effect

One drug has a synergistic effect on another, increasing the effect.

Antagonistic drug effect

One drug stops the effect of another.

Phytomedicine

Plants or herbs with therapeutic or healing properties that may be preventative or therapeutic.

Botanicals

A plant or plant part valued for medicinal or therapeutic properties.

How are herbal supplements classified?

As dietary supplements.

Do herbal supplements require FDA approval before being sold?

No.

What must herbal supplement manufacturers follow?

Good manufacturing practices to ensure consistent processing and quality.

What claims can herbal supplement companies make?

General health, structure/function, or nutrient-deficiency claims if supported by data or research.

What claims can herbal supplement companies NOT make?

They cannot claim a supplement diagnoses, treats, cures, or prevents a specific disease.

FDA disclaimer for supplement claims

"This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease."

How does FDA oversight of supplements compare with prescription drugs?

Dietary supplements have minimal FDA oversight compared with prescription drugs.

When does the FDA monitor supplements?

After they are on the market.

What can the FDA do if a supplement is unsafe?

Issue warnings, take action against the manufacturer or distributor, or require removal from the market.

What must herbal supplement labels include?

Product name, net quantity, Supplement Facts, complete ingredient list, and manufacturer's or distributor's name and address.

Reliable sources for herbal supplement information

National Center for Complementary and Integrative Health and the Office of Dietary Supplements.

Why should nurses ask about herbal supplements?

They can interact with medications and cause adverse effects.

Patients requiring extra caution with herbal supplements

Pregnant patients, breastfeeding patients, patients preparing for surgery, patients younger than 18, and patients older than 65.

Herbal monograph

An organized source of information about a specific herb that may include botanical and pharmaceutical information.

Important rule about herbal supplements

Natural does not mean safe.