Pharm - FINAL (Cumulative)

previous material

Properties of an Ideal Drug

The Big 3

• Effectiveness

• Safety (cannot produce harmful effects even if admin in very high doses)

• Selectivity (elicits only the response for which it is given)

  • ideally = localized effect

What is the most important property of a drug?

Effectiveness

What other drugs should you not take if you are taking a potassium-sparing diuretic?

other drugs that raise K

What are normal K+ levels?

3.5-5.0 mEq/L

What foods should you avoid if taking potassium-sparing diuretics?

• potassium rich foods

• salt substitutes

What drug properties enhance patient adherence?

• ease of administration

• a simple generic name

How to promote patient adherence to medications?

teach the pt WHY they are taking the drug and the SYMPTOMS of the medication

How does albumin affect drug distribution?

drugs attach to albumin → can’t reach site of action (not effective) → therapeutic failure

What are pharmacokinetic changes regarding drug therapy in older adults?

• Absorption: slowed

• Distribution: less albumin → DRUG ACCUMULATION

• Metabolism: slowed, prolonged effects → DRUG ACCUMULATION

  • requires less frequent dosing

• Excretion: declined → DRUG ACCUMULATION

What test should you use to assess the renal function of older adults? Why?

Creatinine clearance

• serum creatinine is influenced by lean muscle mass (variable at older age)

• creatinine levels may be normal even though kidney function is greatly reduced

Pharmacokinetics

What is the path/movement of drug distribution?

blood → interstitial space of tissues → cells

What are 3 major factors that determine drug distribution?

• blood flow to tissues, adequate BP

• ability of drug to exit the vascular system

• ability of drug to enter cells

Pharmacokinetics

• the movement of drugs through the body

• what the body does to the drug

What lifestyle changes can a pt make if they have hypertension?

• maintenance of potassium and calcium intake

• sodium restriction (lowers BP)

• DASH diet

• alochol restriction

• aerobic exercise

• smoking cessation

Beta2 Agonists

• SABA

• LABA

What are factors that cause individual variation in drug responses?

• pathologic variables → diminished function of kidneys (excrete) & liver (metabolize)

• physiologic variables (age, sex, weight)

• genetic predisposition (can alter the metabolism of drugs → unique/uncommon interactions)

• drug interactions

• PMHx

• drug interactions (mult drugs interacting with e/o)

What much a LABA always been taken with?

glucocorticoid

What is the therapeutic levels of Theophylline?

10-20mcg/mL

What are s/sx of Theophylline plasma levels between 20-25mcg/mL?

n/v, diarrhea, insomnia, restlessness

**generally very sick

What are s/sx of Theophylline plasma levels above 30 mcg/mL?

severe dysrhythmias (v fib) and convulsions

**heart becomes affected

What should the nurse do when a pt is experiencing theophylline toxicity?

• STOP theophylline

• activated charcoal together with a cathartic

• dysrhythmias respond to lidocaine

  • IV diazepam may help control seizures

Anticholinergic Drugs (Bronchodilators)

• Ipratropium

• Tiotroprium

Onset of therapeutic effect of ipratropium

• therapuetic effects begin within 30 secs

• reach 50% of max in 3 mins

• persist ~6 hrs

Onset of therapeutic effect of tiotroprium

• therapeutic effects begin about 30 mins after inhalation

• peak in 3 hrs

• persist ~24 hrs

• reaches a plateau after 8 consecutive days

What is a half-life?

What is the dosing interval of a drug with a short half-life? Long-half life

the time required for the amount of drug in the body to decrease by 50%

short half-life → short dosing interval

long half-life → long dosing interval

How many half lives does it take for a drug to leave the body?

4

What is the normal range for digoxin?

0.5-0.8 ng/mL

What are signs of digoxin toxicity?

• visual disturbances → halos around lights

• n/v, diarrhea

Nursing considerations for digoxin administration

• check HR before administration

• hold & notify provider if levels are above range

Antihistamine pharmacodynamics

block H1 receptors to PREVENT action of histamine at these sites

Basic mechanisms by which neuropharmacological agents act

• sites of action

• steps in synaptic transmission

• effects of drugs on the steps of synaptic transmission

What is one of the most desirable qualities a drug can have?

selectivity

• can alter a disease process while leaving other physiologic processes largely unaffected (↑ processes affected = ↓ selective)

Stimulant Laxatives

• Bisacodyl [Dulcolax]

• Senna

• Castor oil

What drug helps with opioid-induced constipation?

stimulant laxatives

How do stimulant laxatives work?

Stimulate the intestinal muscles to contract → increased bowel movements

What are adverse effects of nitroglycerin?

• headache

• orthostatic hypotension **make sure pt is sitting when taking

• reflex tachycardia

What o

life-threatening hypotension

Nursing considerations for discontinuing nitro

discontinue gtt SLOWLY

How do you administer emergency nitroglycerin?

1. take 1st dose, wait 5 mins

2. if no sx resolution, take 2nd dose and call 911

3. take 3rd dose is still no sx resolution

How should you store nitrates?

• light sensitive, original container

• dry

• room temp

What is the common ending for benzodiazepine drugs?

“-pam”

Sx of benzodiazepine oral overdose (toxicity)

• drowsiness

• lethargic

• confusion

Sx of benzodiazepine IV toxicity

• profound hypertension

• cardiac arrest

• respiratory depression (moderate unless combined with other CNS depressants)

**life threatening reactions

Pharmacologic effects of benzodiazepines

CNS depressant

• reduce anxiety

• promote sleep

• induce muscle relaxation

What is the antidote for benzodiazepine toxicity?

FLUMAZENIL

I “flu” in my mercedes “benz”

Extrapyramidal symptoms (EPS)

(serious movement disorders)

• pseudoparkinsonism

• acute dystonia

• akathisia

• tardive dyskinesia

What atypical antipsychotic (SGA) would a pt use only if 2 other psychotics have been tried and failed?

Clozapine

What is the pneumonic for anticholinergic side effects?

• can’t SEE

• can’t PEE

• can’t SPIT

• can’t SHIT

What is the normal plasma levels of Lithium?

0.8-1.4 mEq/Lin the treatment of bipolar disorder.

What drug class does Lithium belong in?

mood stabilizers

What drug class does Fluoxetine belong in?

SSRI

At what time of the day should you take Fluoxetine?

morning (can cause insomnia)

Side effects of fluoxetine

• withdrawal syndrome

• teratogenesis

• sexual dysfunction

• weight gain

• bleeding disorders

• insomnia

What should be done if serotonin syndrome is suspected?

d/c drug immediately

What are the two potassium sparing diuretics?

• Spironolactone (aldosterone antagonists)

• Triamterene (nonaldosterone antagonists)

Adverse reactions to potassium sparing diuretics

• hyponatremia (increased secretion of sodium)

• hyperkalemia

• benign and malignant tumors

• endocrine effects

• hypotension

What are the role of spacers for inhalers?

increases delivery of drug into the lungs

What drugs are bronchodilators?

• SABA & LABA

• Theophylline

• Ipratropium & Tiotropium

1. How long should you wait in between puffs when using a MDI?

2. Between puffs if using 2 different meds/inhalers?

1. at least 60 sec

2. 3-5 mins

What is the preferred method of administering inhalation drug therapy?

nebulizers

• better absoption than MDI

• preferred when in the hospital

Is ipratropium a fast or slow acting anticholinergic drug?

faster acting

• often administered w/ albuterol

• relieves broncospasm

Is tiotropium a fast or slow acting anticholinergic drug?

slower acting

• will take about ~1 week before seeing full benefits

What drug do you administer when managing an acute severe exacerbation of asthma?

albuterol

How would you manage an acute severe exacerbation of asthma?

• admin albuterol immediately (PRIORITY)

• in the meantime:

  • sit pt up 90 degrees

  • supplemental O2

  • nebulized ipratropium

How would you manage a COPD exacerbation?

• treat cause to treat exacerbation

• SABAs

• systemic glucocorticoids (for inflammation)

• antibiotics

• supplemental O2 (maintain sat of 88% to 92%)

Pharmacodynamics

what the drug does to the body

What drugs are used for allergic rhinitis?

• glucocorticoids

• antihistamines (oral and intranasal)

• sympathomimetics (oral and intranasal)

What is the first choice drug to prevent rhinitis?

intranasal glucocorticoidsare the first-line treatment.

When is it best to take intranasal glucocorticoids for seasonal rhinitis?

2-3 weeks before allergy season (before onset of sx)

What is the preferred route of administration for allergy drugs?

intranasal

What drugs are used for coughs?

• antitussives

• expectorants

Pharmacodynamics of antitussives

supress cough

Pharmacodynamics of expectorants

make cough more productive (stimulates flow of secretions)

What is an example of an expectorant drug for cough?

Guaifenesin

What are examples (2) of opioid antitussive drugs for cough?

• Codeine

• Hydrocodone

What are examples (2) of non-opioid antitussive drugs for cough?

• Dextromethorphan

• Benzonatate

H1 Antagonists

1st gen vs. 2nd gen

1st generation

• highly sedating (“i am so tired by 1am”)

2nd generation

• less sedation than 1st gen (“i always get a second wind at 2”)

Therapeutic uses of antihistamine drugs

• mild allergy

• severe allergy (sx management only)

• motion sickness

• insomnia

• common cold

Therapeutic use of drugs for diabetes mellitus

• prevent long term complications

• tighten blood glucose control

• control blood pressure and blood lipids

What are the basic mechanisms by which neuropharmacological agents act?

• sites of action (axons vs synapses)

• steps in synaptic transmission

• effects of drugs on the steps of synaptic transmission

Axonal conduction

conducting an action potential down the axon of the neuron

Synaptic transmission

information is carries across the gap between the neuron and the postsynaptic cell

What happens to the receptor activation when there is a block in reuptake?

increased receptor activation (more available)

Steps in synaptic transmission

1. transmitter synthesis

2. transmitter storage

3. transmitter release

What drug is contraindicated with nitroglycerin? Why?

Sildenafil

severe hypotension

What is the application procedure for transdermal contraceptive patches?

put on once a week for 3 weeks, followed by 1 week off (to permit normal menstruation)

Adverse effects of the transdermal contraceptive patch

• breast discomfort

• headache

• local irritation

• nausea

• menstrual cramps

What location should you avoid placing a transdermal contraceptive patch? Why?

breast (risk for breast cancer)

What is the application process of a vaginal contraceptive ring?

• one ring inserted each month

• left in place for 3 weeks, then removed

• withdrawal bleeding occurs during ring-free week

• new ring inserted 1 week later

What should you do if a vaginal contraceptive ring is expelled in the following time frames:

• < 3 hrs

• > 3 hrs

• < 3 hrs → wash with warm water and reinsert

• > 3 hrs → wash and reinsert AND use backup contraception for 7 days

What oral drugs can be taken for erectile dysfunction?

• sildenafil

• tadalafil

What priapism?

What drug is it an adverse effect for?

an erection lasting longer than normal

• seek medical attention if erection lasts > 4 hrs

Sildenafil

Sildenafil vs. Tadalafil (difference in timing aspect of med)

sildenafil → HAS timing aspect, peaks in 1 hr

tadalafil → DON’T need to time, effects last up to 36 hrs (“long acting viagra”)

What drugs are used to treat PUD?

Histamine 2 receptor antagonists

What ending do H2 receptor antagonist drugs have in their name?

-dine

How do H2 receptor antagonists work?

promote healing by suppressing secretion of gastric acid

What are H2 receptor antagonists used to treat?

gastric and duodenal ulcers

What is an example of a H2 receptor antagonist drug? What are its adverse effect?

Famotidine [Pepcid]

• condusion

• hallucinations

• CNS depression (lethargy, somnolence)/excitation (restlessness, seizures)

• increased risk of pneumonia (d/t elevation of gastric pH)

What are 3 antidiarrheal agents?

Which ones are opioids and which ones are non-specific antidiarrheals?

• Diphenoxylate [Lomotil] → opioid

• Loperamide [Imodium] → opioid

• Subsalicylate [Pepto-Bismol] → nonspecific antidiarrheal

What is a notable adverse effect of Subsalicylate [Pepto Bismol]?

may blacken stools and tongue

• don’t confuse with GI bleed and worry