NR 293 pharm exam 1 Questions and answers + rationales

pharmacokinetics

the study of what the BODY does to the drug

pharmacodynamics

the study of what the DRUG does to the body

First pass effect-

the drug being metabolized by the liver

bioavailablility

the amount of the drug that is actually available after being metabolized

protein binding

drug needing to bind to protein inorder to move through out the body

peak

the time it takes for the drug to reach its maximum therapeutic response

onset

the time it takes for the drug to elicit a therapeutic response

duration

the time a drug concentration is sufficient to elicit a therapeutic response without giving additional doses

half life

the time it takes for one half of the original amount of drug to leave the body(measure of rate fo the drug leaving the body)

therapeutic index

lethal dose divided by therapeutic dose

trough

lowest blood level

peak level

highest blood level

agonist

drug binds to the receptor and there is a response

antagonist

drug binds to the receptor but there is no response,

*antagonist prevent agonist to bind to receptors(attach but dont activate)

acute therapy

examples: allergic reaction, someone who is coding

maintenance therapy

wont cure but it will prevent complications

ex) BP meds, insulin

supplemental therapy

hormones, vitamins, insulin

palliative therapy

providing utmost comfort for patient near death

supportive therapy

maintains the integrity of body functions while the patient is recovering from illness or trauma.

ex) provision of fluid while electrolytes to prevent dehydration in a patient with influenza who is vomiting and has diarrhea, and administration of fluids, volume expanders, or blood products to a patient who has lost blood during surgery

prophylactic therapy

prevention

empiric therapy

based on clinical probabilities. it involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on patients initial presenting symptoms.

ex)common: use of antibiotics active against the organism most commonly associated with a specific infection before the results of the culture and sensitivity reports are available

additive effect

combining 2 meds to reduce the dosage of another

synergistic effect

drug interactions that make the effect of a combination of drugs similar actions greater than just one

antagonistic

a drug that binds to and inhibits the activity of 1 or more receptors in the body.

AKA inhibitors

incompatibility

the characteristic that causes two parenteral drugs or solutions to undergo a reaction when mixed or given together that results in the chemical deterioration of at least one of the drugs

macrolides "thromycin"

prevent protein synthesis within bacterial cells

both bacteriostatic and bactericidal

"thromycin" indication

strep infections

mild-moderate URI and LRI

syphilis and lyme disease, gonorrhea, chlamydia, mycoplasma,

clarithromycin combination with omeprazole: active ulcer disease associated with H.pylori

"thromycin" adverse effects

GI effects, primarily with erythromycin

N/V, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia

azithromycin and clarithromycin: fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration

"thromycin" nursing implications

highly protein bound: severe interactions with other protein bound drugs

high incidence of GI upset, many drugs are taken after a meal or snack

"cyclines"

bacteriostatic

bind to Ca+ and Mg+ and Al+ ions to form insoluble complexes

*dairy products, antacids, and iron salts reduce oral absorption

"cycline" indications

wide spectrum

gram- and gram+, protozoa, mycoplasma, rickettsia, chlamydia, lyme disease,acne, others

"cycline" adverse effects

strong affinity to calcium

discoloration of teeth and tooth eneamel in fetus and children. or nursing infants

may retard skeletal development if taken during pregnancy

alterations in intestinal flora may result in:

superinfection, diarrhea, pseudomembranous colitis, vaginal candidiasis, gastric upset, enterocolitis, maculopapular rash

"cycline" nurisng implications

avoid milk products, iron prep, antacids bc of the chelation and drug-binding that occurs

take all meds with 6-8 oz of fluid- prefer water

bc of photosensitivity, avoid sunlight and tanning beds

aminoglycosides:Gentamycin

poor oral absorptin, no PO forms (except neomycin)

very potet antibiotics with serious toxicities

bactericidal; prevent protein synthesis

kill mostly gram- bacteria; some gram+

aminoglycosides indications

used to kill ecoli, proteus spp, klebsiella, serratia

poorly absorbed through GI, given parenterally

aminoglycosides: adverse effects

serious: nephrotoxicity and ototoxicity

must monitor drug levels to prevent toxicity

minimum inhibitory concentration

others: headache, paresthesia, fever, superinfection, vertigo, skin rash, dizziness

quinolones "floxacin"

AKA flouroquinolones

excellent oral absorption

absorption reduced by antacids

bactericidal

"floxacin" indications

complicated urinary tract, respiratory, bone and joint, GI, skin and sexually transmitted infections

"floxacin" adverse effects

insomnia, depression, convulsions

thrush, increased liver function studies

prolonged QT intervals

rash, urticaria, flushing

fever, chills, blurred vision, tinnitus

**BLACK BOX WARNING: increased risk of tendonitis and tendon rupture**

vancomysin (vancocin)

treatment of choice for MRSA

oral vancomysin- antibiotic-induced colitis (cdiff) and fro treatment of staph. enterocolitis

may cause ototoxicity adn nephrotoxicity

MUST MONITOR BLOOD LEVELS TO ENSURE THERAPEUTIC LEVELS AND PREVENT TOXICITY

toxic level: > 20 mcg/ml(trough)

redmans syndrom(flushing/itcihng of head, neck,face and upper trunk, antihistamine may be orders to reduse those effects) and hypotension are common with rapid infusion

clinaycin(cleocin)

used for chronic bone infections, GU infections

**FDA BLACK BOX WARNING: cdiff associated diarrhea**

metronidazole (flagyy)

used for anaerobic organisms, protozoal infections

contraindications: alcohol use within 3 days , pregnancy 1st

trimester

*avoid alcohol 24 hours before first dose and 36 hours after last dose*

nitrofurantonin (microdantin)

primarily used for UTIs

drug concentrates in the urine, use carefully if renal function is impaired

may cause fatal hepatotoxicity

antiviral (non HIV)

used to treat infections cause by viruses other than HIV

influenza

HSV, VZV

CMV

hepatitis A,B,C

antiretroviral drugs

used to treat infections caused by HIV, the virus that causes AIDS

inhibit viral replication

antiretroviral adverse effects

vary with each drug

healthy cells are often killed also, resulting in serious toxicities

acyclovir(zovirax)

used to suppress replications of HSV 1,2, VZV

drug of choice for treatment of initial and recurrent episodes of these infections

oral, topical, parenteral forms

ganciclovir (cyovene)

used to treat infection with cytomegalovirus(CMV)

oral and parenteral forms

CMV retinitis

opthalmic form surgically implanted(vitrasert)

bone marrow toxicity

oseltamivir (tamiflu)

zannamivir (relenza)

active against influenza A and B

reduce duration of illness

oseltamivir: causes N/V

zannamivir: causes diarrhea, nausea and sinusitis

treatment should begin within 2 days of influenza symptoms onset

chemotherapy

treatment of cancer

antineoplastic drugs

2 groups: CCNS &CCS(some drugs have characteristics of both)

narrow therapeutic therapy index

drug resistance

combination of drugs

harmful to rapidly growing cells

*harmful cancer cells

*healthy normal human cells

**hair follicles

**GI tract cells

**bone marrow cells

Chemo terms

dose limiting adverse effects

*GI tract and bone marrow

alopecia

emetic potential

myelosuppression

*BMS

*BMD

targeted drug therapy

nadir

lowest amount of WBC

common with chemo

extravastion

burning from inside out due to chemotherapy

***nursing implications

chemotherapy

baseline CBC

follow specific admin guidelines

remember all rapidly dividing cells(normal and cancerous) are affected

*mucous membranes

*hair follicles

*bone marrow components

monitor for and prevent: infection, bleeding,

Anemia

may result if SEVERE fatigue

antiretrovirus'

opportunistic infections

HIV and AIDs

protozoal, fungal, viral: CMS disease, HSV infections, bacterial-opportunistic neoplasias

HIV wasting syndrome

major weight loss,, chronic diarrhea, chronic fever

antiretroviral drugs HAART

includes at least 3 meds "cocktails"

all meds work in different ways to reduce the viral load

goal: find the regimen that will best control the infection with a tolerable adverse effect profile

med regimens charge during the course of illness

zidovudine

antiretroviral

given to HIV- infected pregnant women and new born babies to prevent maternal transmission

dose limited adverse effect: bone marrow suppression

other examples of antiretroviral

enfuvirtide(fuzeon)

indinavir(crixivan)

maraviroc (selzentry)

nevirapine(viramune)

raltegravir(isentress)

tenofovir(viread)

isoniazid(INH)

antitubercular

metabolized in the liver through acetylation- watch for "slow acetylators"

used alone or in combination with other drugs

contraindicated with liver disease

used for the prophylaxis and treatment of TB

***peripheral neuropathy- pyridoxine

***hepatotoxicity

rifampin

antiTB

red-orange discoloration of body fluids

MDR/MDX-TB

prevention of MDR-TB

amphotericin B

antifungal-systemic infections

aphotericin B adverse effects

cardiac dysrhythmias

neurotoxicity,tinnitus, visual disturbances, hand or feet numbness, tingling or pain, convulsions

renal toxicity, potassium loss, hypomagnesemia

pulmonary inflitrates

fever, chills, headache, hypotension, GI upset, anemia

fluconazole

N/V diarrhea, stomach pain

increased liver enzymes

use with caution in patients with renal and liver dysfunction

-azoles

imidazoles and triazoles: ketoconazole, fluconazole, itraconazole, voriconazole,

inhibit fungal cell cytochrome p-450 enzymes, resulting in cell membrrane leaking

results:altered cellular metabolism and fungal cell

nystatin

N/V anorexia, diarrhea, rash

needs to be dissolved slowly and steady

cisplatin(pantinol)

alkylating drugs

alter the chemical structure of the cells DNA

alkylating drugs

adverse effects

gi tract, myelosuppression, alopecia

nephrotoxiciy, peripheral neuropathy, ototoxicity,

*hydration can prevent nephrotoxicity

cyclophosphamide(cytoxan)- hemorrhagic cystitis

extravasation causes tissue damage and necrosis

cytotoxic antibiotics (doxorubicin)

natural substance produced by the mold streptomyces

active in all phases of cell cycle, blockade of DNA

EX) daunorubicin, bleomycin

cytotoxic antibiotics

adverse effects

all can produce done marrow suppression, except bleomycin

hair loss, N/V

pulmonary fibrosis and pneumonitis(bleomycin)

liver, kidney and cardiovascular toxicities

heart failure- cardiomyopathy(daunorubicin)