Pharmacology Exam 1 Flashcards

What is the difference between a therapeutic effect vs a therapeutic objective?

Therapeutic Effect: Beneficial effect of a medication (opposite of adverse effects, which are harmful or unintended).

Therapeutic Objective: The ability for medications to protect from disease, help with symptoms, or prevent pregnancy. This is the goal of the therapeutic effect.

What is a prototype drug?

The first medication of its kind; it’s developed to be a “blank slate” for other medications representative of its mechanisms of action.

What is the difference between a generic name and a brand name?

Generic: A global, standardized medication name. There’s only one generic name for a medication. They’re in all lowercase, indicate the drug class in the suffix, and have consistent active ingredients. Used in clinical practice.

Brand: Names that are produced from pharmaceutical companies. There can be multiple names. These are capitalized and easier for patients to understand. They vary in active ingredients and may not have efficacy.

• This is important because incongruence between brand and generic names can lead to medication errors or overdose.

How do brand names contribute to medication errors?

1. Multiple brand names for a single drug.

2. Different active ingredients, even in the same “name” of drug.

3. Brand names differ between countries.

What are the properties of an “ideal” drug?

1. Effectiveness: The most important. When medications do what they’re supposed to do.

2. Safety: When medications have a reduced capacity to cause harm long-term. Not always avoidable.

3. Selective: The effect that elicits a desired response. Almost no drug is 100% selective.

   1. No drug is truly ideal due to cost, interactions, patient adherence, and side effects. The goal is therapeutic objective, or causing the most benefit with the least amount of harm.

What is the difference between scheduled, PRN, STAT, and standing orders?

Scheduled Order: Time critical medications are given within 30 minutes. Scheduled medications are given within 1 hour. Non-critical medications are given within 2 hours. If a medication comes more frequently than q4h, provide within 25% of the dosing time (15, 30, 45 minutes).

PRN: Given as needed after a patient meets a predetermined set of circumstances.

STAT: An order that takes priority over other orders.

Standing Order: A pre-approved order that allows medication administration prior to a specific set of circumstances.

What are the components of a medication order? Give an example.

Medication name, dosage, route, and frequency.

Exp: Potassium Chloride 20mg PO BID.

What are all of the routes of medication?

PO - Oral.

SL - Sublingual.

IM - Intramuscular.

IV - Intravenous.

SUBQ - Subcutaneous.

Rectal.

Vaginal.

Inhalant.

Topical.

Transdermal.

What are all of the frequency abbreviations?

q - Every.

AC - Before Meals.

PC - After Meals.

HS - At Bedtime.

What are the phases of clinical testing?

1. Pre-Clinical Testing: Completed over 1-5 years. Animals are tested to see the harm and benefits of medications.

2. Phase I: Phases 1-3 are completed over 2-10 years. Healthy volunteers are tested to check metabolism, pharmacokinetics, and drug effects of medications.

3. Phases 2 & 3: Patients are tested to analyze therapeutic effects, dosage range, safety, and effectiveness.

   1. Applications are given to the FDA for approval.

4. Phase 4: General public is surveyed indefinitely.

   1. Controls: Placebo; provides scientific baseline for drug effectiveness.

   2. Randomized: Equal chance of getting picked for certain groups at the beginning of the study for reducing confounding factors.

   3. Blinding: Groups are unaware of testing boundaries to reduce bias and confounding factors.

What are limitations of the drug approval process for women and children?

Women: Excluded from clinical trials due to risk of pregnancy, effects on the menstrual cycle.

Children: Excluded from clinical trials due to risk of adverse effects.

What is the difference between a leading and trailing zero? Other examples of documentation errors?

• Leading Zero: A lack of a zero in the tens place of a decimal number. “.5” can look like “5,” so you need to write “0.5” instead.

• Trailing Zero: An unnecessary zero in the tenths place of a whole number. “2.0” can look like “20,” so you need to write “2” instead.

• Unspecific Units: Using a non-measurable unit when describing a medication dosage. “cc” should not be replaced with mg/mL, because it doesn’t indicate the amount of medication per volume.

• Uncommon Abbreviations: Any deviations from the standard abbreviations. Using “u” instead of “units,” or "qd” instead of daily.

What are some common medication conversions?

Mass/Linear:

2.2lb = 1 kg.

1 ft = 12 in.

1 in = 2.5 cm.

Liquids:

1 tsp = 5 mL.

3tsp = 1 tbsp = 15mL.

2 tbsp = 1 oz = 30 mL.

0.5 cup = 4 oz = 125 mL.

1 cup = 8 oz = 250 mL.

What is the difference in action between polar ions and nonpolar medications?

Polar: Polar molecules themselves have uneven positive and negative charge, but they have an equal amount of protons and electrons. Ionization is not equal, and either has a positive or negative charge, depending on the gain or loss of electrons.

• These are water-soluble, so they cannot cross the plasma membrane easily. They can utilize channels and facilitated diffusion, or transport systems and active transport for travel.

Nonpolar: Nonpolar molecules that are uncharged.

• These are lipid-soluble, so they easily cross the plasma membrane. They often travel through direct penetration.

How are medications absorbed?

Absorption happens when medications travel until they reach the bloodstream:

• Dissolution Rate: More dissolution, more absorption. Drugs need to be dissolved before absorption.

• Surface Area: The larger the surface area, the quicker the absorption. This is why they are mostly absorbed in GI (villi, microvilli).

• Blood Flow: The higher the blood flow, the higher the absorption. Increase in concentration gradients, like in GI and skin.

• Lipid Solubility: The higher the lipid solubility, the higher the absorption. They can pass through plasma membranes.

• pH Partitioning: The higher the pH difference the higher ionization rates, the more absorption. The stomach and duodenum have low pH, absorbing acidic medications. The small intestine absorbs more alkaline medications.

• Bioavailability: The amount of medication available for use after absorption.

What are the different forms of medication absorption?

• IV: No barriers in absorption because of direct bloodstream access. This is rapid, controlled, and allows irritant drug usage. But, costly, inconvenient, and irreversible mistakes.

• IM/SUBQ: Only barrier is the capillary wall. Medications pass through muscle cells easily from big gaps. Can be rapid or slow absorption. Great for poorly soluble medications/depot preparations. Can be an inconvenience.

• SL:

• PO: Barriers are GI cells and capillary wall. Drugs can only pass through cells instead of going around them. Absorption depends on pH, solubility, emptying time, food, other drugs, and drug coatings. They pass through to the portal vein into the liver. They’re easier to do yourself and effects are more reversible, but can cause irritation and variable absorption.

What types of medications affect absorption?

Enteric-Coated (EC): Medications have coating so they don’t dissolve in the stomach, which helps stomach upset. Do not crush.

Sustained Release (SR, XL): Medication is located in little beads inside the medication.

Transdermal Patch:

How are medications distributed?

Distribution happens when medication moves from the bloodstream into cells:

• Blood Flow:

• Exiting Vascular System:

• Protein Binding:

• Entering Cells:

What is the difference in distribution between the blood-brain barrier and the placenta?

The blood-brain barrier

How are medications metabolized?

Metabolism happens when medications are altered by enzymes:

• P450 Enzymes:

  • Induction:

  • Inhibition:

  • Competition:

Why shouldn’t patients have grapefruit juice?

What is the first pass effect?

What are the consequences of drug metabolism?

What are normal AST and ALT levels?

How are medications excreted?

Medications are excreted through bile, urine, sweat, air, and other avenues. The most important organ for excretion is the kidney:

• Filtration:

• Passive Reabsorption:

• Active Secretion:

• pH Ionization:

  • This can be manipulated through

• Competition for Transport:

What are normal BUN and Creatinine levels?

What is the difference between affinity, efficacy, potency, and selectivity?

What is the difference between an agonist and an antagonist?

What factors make up the therapeutic range?

• Minimum Effective Concentration:

• Toxic Concentration:

• Half-Life:

How do nurses maintain medication safety?

What are the 6 rights of medication administration?

1. Right Person. Check charts, room numbers, scan wristbands, and verify name and DOB with the patient.

2. Right Medication. Check label and verify medication name and limit abbreviations.

3. Right Dose. Provide the prescribed dose, and double check with other member of care team. Double-check unit conversions; don’t be afraid of asking questions.

4. Right Route. Provide the prescribed route, and see if it’s appropriate for a patient.

5. Right Time. Check frequency of medication, and make checklists.

6. Right Documentation. Chart within a reasonable timeframe or in the room with the patient, and limit distractions. Provide patient education.