Pharm Final

What are the four main pharmacokinetic (PK) phases?

What are the four main pharmacokinetic (PK) phases?

absorption

distribution

metabolism

excretion

Absorption

movement into the bloodstream

Distribution

movement from blood into tissue and cells

Metabolism

change in drug shape/structure (liver)

Excretion

movement out of body (kidneys)

Pharmacodynamics

agonists - activate receptors

antagonists - block receptors

partial agonists - partially activate

How does protein binding affect the distribution and action of a drug in the body?

occurs when older adults have reduced serum albumin levels

drugs bump into these molecules and get stuck and stays stuck = inactivated

What is the first-pass effect, and how does it influence the bioavailability of a drug?

whenever the drug is administered orally, enters the liver, and suffers extensive biotransformation to such an extent that the bioavailability is reduced

What are the key steps in the nursing process when administering medications?

assessment = data, drug allergies, adverse effects

analysis (nursing diagnosis) = med errors, safety, careplans

planning = setting goals and interventions

implementation = after goals

evaluation = if plan is working, teaching,

List at least three patient identifiers that should be used when giving medications to ensure patient safety.

name, birthdate, medical record number

When should medication reconciliation be performed?

each time a pt transfers from one level of care to another

What are the common signs and symptoms of anaphylaxis, and how can it be managed in an emergency situation?

nausea, vomiting, difficulty breathing, low BP, loss of consciousness, stop infusion, epinephrine

Describe the typical anticholinergic effects of certain medications and provide examples of drugs that may cause these effects.

cant see

can pee

cant spit

cant shit

Anticholinergic drugs that may cause the 4c effect

What are the risk factors for drug-induced hepatotoxicity, and how can it be detected?

jaundice (anorexia, upper ab. pain, n/v/d, dark urine, inc need for sleep, clay colored stool, ecchymosis and encephalopathy)

AST and ALT

Explain the signs of CNS depression and the potential consequences of overdosing on CNS depressant drugs.

stop breathing, risk of falls, the brake pedal

What is orthostatic hypotension, and how can it be managed?

moving from horizontal to vertical position, gravity pulls blood to lower extremities

change positions slowly, hydration, support socks

Define polypharmacy and explain its potential risks, particularly for elderly patients.

elderly patient’s take a lot of medications and depending on the interaction the drug levels can be come too high or low

How do age-related changes in pharmacokinetics affect drug absorption, distribution, metabolism, and excretion in geriatric and pediatric patients?

geriatrics = reduced serum albumin levels affect distribution, liver and kidney declines affect metabolism and excretion

pediatrics = BBB more sensitive (distribution), liver and kidney not fully matured

Explain the purpose of the Beers Criteria

helpful resource that specifies which drugs are most dangerous to older adults and provides a succinct rationale

Structure and function of a neuron

dendrites = receives signal

action potential = electrical charge fired down axon

axon = sends signal

axon terminals = secretes neurotransmitters

synapse =gap where action potentials causes vesicles to empty their NTs

postsynaptic terminal

Explain the role of synapses in neuronal communication.

gap where action potentials causes vesicles to empty their NTs

Neurotransmitter diffusion

NT enter synapse + float away in CSF, becomes inactive

How to terminate a signal

release, reuptake, degradation

Neurotransmitter reuptake

presynaptic terminal has pumps that suck NTs back inside presynaptic terminal where they are recycled for future use

Neurotransmitter degradation

enzymes break apart NTs (end in ace)

Explain the mechanism of action (MOA) of selective serotonin reuptake inhibitors (SSRIs)

first line for depression

block serotonin reuptake (inc. serotonin)

What is the typical time frame for antidepressants to start showing their full therapeutic effects?

1-4 weeks

Discuss the potential increased risk of suicidal thoughts and behaviors associated with using antidepressants, particularly in certain age groups.

pediatrics have an inc risk because of sudden mood elevation

when initiating drug therapy

What precautions should be taken when prescribing and monitoring patients on antidepressant therapy to minimize the risk of suicide?

Why are TCAs considered to have a higher risk of overdose compared to other classes of antidepressants?

cause fatal heart dysrhythmias

What are the therapeutic effects of benzodiazepines, and what are their main indications for use?

they work faster v antidepressants (help GABA = dec activity involved with anxiety + alertness)

treats anxiety, insomnia, muscle spasms, seizure disorders, and reducing alcohol withdrawal symptoms

Describe the common adverse effects of benzodiazepines

CNS depression = slurred speech, dizziness, ataxia (unsteady gait), memory difficulties

fall risk

highly addictive + withdrawal is unpleasant

short term use

Discuss the risk for addiction and dependence associated with benzodiazepine use, including the factors that may increase this risk

highly addictive so avoid:

opioids + alcohol

long term use

Identify common drug interactions involving benzodiazepines and describe their potential consequences

do not take other CNS depressants or could cause slurred speech, dizziness, ataxia, and memory difficulties

Compare and contrast the mechanism of action of benzodiazepines and Z-drugs (e.g., zolpidem, zaleplon, eszopiclone

Z drugs = activate benzodiazephine1 receptors in the brain to make you sleepy

less likely to cause dependence and addiction

What are the risk factors for developing lithium toxicity, and how can they be minimized during lithium therapy?

maintaining consistent amounts of sodium

avoid excess exercise

hydration

Explain the relationship between sodium levels and lithium levels in the body, and how sodium intake or balance changes can affect the risk of lithium toxicity.

too much sodium = low lithium

not enough sodium = high lithium

What lowers lithium levels

high sodium

pregnancy

drug interactions (caffeine, theophylline, mannitol)

What raises lithium levels

low sodium

sweating, dehydration (excessive exercise)

drug interactions (thiazide, loop diuretics, ACE, ARBs, NSAIDs, metronidazole, tetracyline)

dec renal function (aging)

Describe the common signs and symptoms of lithium toxicity.

SCAN

Sedation

Course hand tremors

Ataxia

Nausea

What is the relationship between clozapine use and the risk of neutropenia, and why is this side effect of particular concern?

destroys WBC = severe infections that spreads through bloodstream

Compare and contrast the typical side effect profiles of FGAs and SGAs, including the risks of extrapyramidal symptoms (EPS), metabolic side effects, and tardive dyskinesia

First generation antipsychotics side effects

extrapyramidal syndrome (akathisia, acute dystonia, parkisonism, tardive dyskinesia)

neuroleptic malignant syndrome

photosensitivity

inc risk of death (elderly w/ dementia psychosis)

Second generation side effects

extrapyramidal syndrome

metabolic syndrome

agranulocytosis

black box warning = same as first gen

Discuss the importance of regular follow-up and growth monitoring in children receiving ADHD medications, including the assessment of height, weight, and overall growth patterns

weight loss + growth suppression = take meds during or after meals

What strategies can be employed to minimize the risk of insomnia in patients taking ADHD medications?

do not take late in the day

Explain the relationship between nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of gastrointestinal (GI) bleeding

can cause damage to the stomach’s lining (gastric mucosa) = GI bleeding

Explain the importance of limiting the use of ketorolac to a maximum of 5 days

inc risk of GI bleeds

Describe the precautions and strategies that can be employed to minimize the risk of GI bleeding in patients taking NSAIDs, such as co-administration of gastroprotective agents.

ketorolac = taken with meds to protect the stomach

take with food/milk or a med that dec stomach acid

monitor kidney function

take smallest effective dose for shortest time

How can NSAIDs contribute to kidney injury?

they can be nephrotoxic

Discuss the importance of increasing fiber intake and maintaining adequate hydration in patients taking opioid

can cause constipation bc bowel motility slows down

What is the role of naloxone in the management of opioid toxicity, and how does it work as an antidote?

antidote for opioid toxicity

kicks off opioids off receptors and blocks them from reattaching

Describe the signs and symptoms of opioid toxicity, and explain when naloxone should be administered.

CNS depression

miosis (small pupil)

itching, nausea, vomiting

What is the main indication for drugs like tizanidine?

muscle spasms due to injury/surgery and spasticity due to cerebral palsy, spinal cord injury, or multiple sclerosis

List the common adverse drug reactions associated with donepezil use, including gastrointestinal and cardiovascular.

cholinergic effects (urinary frequency, nausea, diarrhea = 4Cs opposite)

bradycardia (inc risk for falls)

dont take with anticholinergics

Discuss the limitations of donepezil therapy in altering the overall progression of Alzheimer's disease, and explain why it is considered a symptomatic treatment rather than a disease-modifying therapy

does not stop or slow disease progression just treats symptoms

What should you assess before administering oral medication to someone who has myasthenia gravis?

assess a person’s swallowing ability

Describe the symptoms of overmedication (cholinergic crisis) in patients with myasthenia gravis, including the key signs and symptoms related to excessive acetylcholine stimulation.

SLUDGE + killer Bs

Salivation

Lacrimation

Urination

Diaphoresis/diarrhea

GI cramping

Emesis

Bradycardia, bronchospasm, bronchorrhea (watery sputum)

Antidote for cholinergic crisis

atropine

What are the key clinical parameters and outcomes used to evaluate the effectiveness of levodopa in the treatment of Parkinson's disease?

levodopa = converted to dopamine

Explain the purpose of carbidopa when it is co-administered with levodopa in the treatment of Parkinson's disease

carbidopa prevents levopoda from getting converted to dopamine before BBB, keeps the dosage for levedopa lower (prevents adverse effects)

What is the generally accepted therapeutic level range for phenytoin when used for seizure control?

10-20

Describe the risk factors for phenytoin-induced gingival hyperplasia and the precautions that can be taken to minimize this side effect.

can cause enlargement of the gums (gingival hyperplasia) and clients should practice good dental hygiene

What is the relationship between angiotensin-converting enzyme inhibitors (ACEIs) and the risk of angioedema?

angioedema is an adverse effect of ACEIs (less than 1% develops)

if happens once, client should NEVER take an ACEI again

What alternative antihypertensive medications can be considered for patients who develop a cough related to ACEI use?

angiotensin 2 receptor blockers (ARBs)

List the main contraindications for the use of beta-blockers (BBs) in clinical practice.

bradycardia and hypotension

blood sugar regulation = hard to notice BS drop symptoms

bronchoconstriction

depression

erectile dysfunction

What diuretic can cause tinnitus?

furosemide

Describe the primary indication of mannitol as an osmotic diuretic

treat cerebral edema

Discuss the risk of hypokalemia with diuretic use, and describe the strategies that can be employed to minimize this risk.

kidneys can excrete too much potassium

eating potassium rich foods (yellow/orange foods)

What is the generally accepted therapeutic range for digoxin?

0.5-2

NEVER go above 2

What parameters and clinical assessments should be performed before administering digoxin to a patient?

check pulse for 60 secs + apical pulse = less than 60 or change in rhythm hold dose and notify provider

Stable angina

partial coronary artery blockage

no pain @ rest

pain w/ physical or emotional distress (o2 demands inc)

Unstable angina

plaques in coronary artery suddenly ruptures

happen whenever

can progress to heart attack

Variant (prinzmetal’s) angina

coronary artery spasms

at rest or sleeping

List the common side effects associated with the use of nitrates.

orthostatic hypotension

h/a

Describe the appropriate timing and administration of sublingual (SL) nitroglycerin for the management of acute angina episodes, including the recommended dosing intervals and when to seek medical attention

take at start of pain

let is dissolve under tongue

no relief after 5min, call 911 and take another

after another 5min, if pain persists take another and call 911

3 tabs within 10mins

be 8 hrs drug free

Purpose of anticoagulant therapy (blood thinners) in patients with atrial fibrillation.

reduces likelihood of blood clots forming in heart

Describe the common and potentially serious adverse drug reactions (ADRs) associated with long-term amiodarone use.

lung problems (pulmonary fibrosis)

liver issues

thyroid problems

eye problems

List the common and potentially serious adverse effects of statins.

hepatotoxicity

myopathy + rhabdomyolysis (muscle cells die, myoglobin + creatine kinase into the bloodstream, damaging the kidneys)

Describe the signs and symptoms of myopathy in patients taking statins, and explain the importance of monitoring for this potential adverse effect during statin therapy

muscle aches and pains

patients should report unexplained muscle aches so watch BUN levels for kidney failure

Explain the laboratory monitoring parameters and recommended frequency for patients receiving heparin and warfarin therapy.

warfarin = INR 2-3 , genetics and diet can impact

heparin = aPTT 0.6-10, heparin induces thrombocytopenia

What is the antidote for enoxaparin and heparin?

protamine sulfate

Describe the proper technique for administering subcutaneous heparin and enoxaparin injections, including site selection.

in the love handles area of the abdomen

softy pinch to create small fat bulge

dont try to get air bubble out of enoxaparin

Describe the importance of auscultating breath sounds after administering a respiratory treatment, such as a bronchodilator or nebulizer therapy, and explain how this assessment helps evaluate the effectiveness of the treatment.

can cause broncho relaxation

Describe the potential effects of albuterol on heart rate, and explain the underlying mechanism responsible for this effect.

tachycardia, palpitation, muscle tremors, and restlessness = drinking too much coffee

Importance of rinsing the mouth after using inhaled glucocorticoids.

cause oral candidiasis or thrush

First generation antihistamine use

sleepy effect

allergic reactions, nausea, cough, insomnia, itching

prescribed for extrapyramidal symptoms

Second generation antihistamine use

no sleepy (do not easily cross BBB)

selective

longer half-life

allergic rhinitis

How do nasal decongestants like pseudoephedrine work?

activate alpha 1 receptors = nasal vasoconstriction in nasal mucosa

Identify the most serious adverse effect associated with the use of insulin therapy

hypoglycemia

weight gain

Effects of unmanaged diabetes

cause damage to tiny blood vessels, damage the retinas, nerves, and kidneys

Describe the signs and symptoms of hypoglycemia and discuss the importance of prompt recognition and management in patients receiving insulin therapy

cold and clamy

crucial to know onset, peak, and duration

Compare the onset of action and duration of commonly used insulins.

aspart lispro = rapid acting

regular = short

NPH = intermediate acting

glargine = long acting

Describe the key clinical parameters and laboratory tests used to evaluate the effectiveness of levothyroxine therapy in patients with hypothyroidism.

dec if levels are low and inc if levels are high

TSH levels monitored and at 0.5-5

List the common adverse reactions associated with levothyroxine (hypoth) therapy.

insomnia

hyperthyroid symptoms

Identify the primary causes of peptic ulcer disease (PUD).

certain medications (NSAIDS)

stress

tobacco and alcohol use

List the main indications for the use of proton pump inhibitors (PPIs) and histamine-2 receptor blockers (H2 blockers).

to treat peptic ulcers

Describe the main indications for the use of docusate.

constipation (mild form of laxative) de

Discuss the potential dangers and risks associated with the overuse of stimulant laxatives.

dec bowel tone, making problems worse

chronic use can lead to electrolyte imbalances