pharm final

know some NSAIDs & antigout drugs

what is pharmacology?

study or science of drugs

what is pharmacokinetics?

study of what the body does to the drug (ex: absorption, distribution, metabolism, excretion)

what is pharmacotherapeutics?

clinical use of medications to prevent or treat illness

defines principles of drug actions (ex: cellular processes that change in response to the drug)

drugs are organized into classes

what is absorption?

movement of medication from the injection site into the bloodstream

what is albumin?

most common protein

carries the majority of protein-bound drugs

what does decreased production of proteins by the liver cause?

decreased protein-binding of drugs & increased circulation of free drugs

what is the first pass effect?

a large portion of a drug is chemically changed into inactive metabolites by the liver

causes small bioavailability

do oral drugs have a high first pass effect?

yes

do transdermal drugs have a high first pass effect?

no

what is prophylactic therapy?

treatment to prevent an infection

what are some examples of prophylactic therapy?

antihistamines before giving vancomycin to prevent red man syndrome

tamiflu for a patient who has been exposed to the flu

what is empiric therapy?

treatment of an infection before knowing what it actually is, based on what is most likely happening

what are some examples of empiric therapy?

giving antibiotics for a UTI before tests come back to confirm

how do medications generally affect pediatric patients?

the liver & kidneys are immature, causing impaired drug metabolism & excretion

how do medications generally affect older adult patients?

decline in organ function, causing increased risk for adverse effects & toxicity

the number of intact nephrons is decreased, causing less acidic gastric pH & increased fat content

usually on multiple medications a once (polypharmacy)

what should be assessed when administering medications to patients in general?

age

allergies & dietary habits

sensory, cognitive, & motor-skill deficits

financial status & limitations

list of health-related care providers

list of medications, existence of polypharmacy, & self-medication practices

lab results

history of smoking & alcohol use

risk situations related to drug therapy (beers criteria)

what is the common perception of questions in african cultures?

asking personal questions of someone you just met is considered intrusive & improper

what is the common perception of eye contact in african cultures?

direct eye contact is considered rude

what are some biological variations of people of african descent?

keloid formation, sickle cell anemia, lactose intolerance, skin color

what is the common perception of respecting others in asian cultures?

have high respect for others, but especially authority figures

what is the common perception of hand-shaking in asian culture?

usually are not comfortable shaking hands with the opposite sex

what are some biological variations of people of asian descent?

many drug interactions, lactose intolerance, skin color, thalassemia (deficient hemoglobin)

what is the common perception of expressing feelings in hispanic cultures?

expressing negative emotions is considered impolite

what is the common perception of eye contact in hispanic cultures?

avoiding eye contact is considered attentive & respectful

what is the common perception of touching in hispanic cultures?

considered acceptable between two people in a conversation

what are some biological variations of people of hispanic descent?

lactose intolerance, skin color

what is the common perception of tone of voice in native american cultures?

speaking in a low tone of voice is common

what is the common perception of touch in native american cultures?

light touch of a person’s hand is preferred over a firm handshake

what are some biological variations of people of native american descent?

lactose intolerance, skin color, cleft uvula problems

of the cultures reviewed, which are present-oriented?

african, asian, & native american

what do most medication errors occur from?

breakdown in medication use system

do most medication errors occur because of individual error?

no

which drugs are most commonly involved in severe medication errors?

CNS drugs, anticoagulants, & chemotherapeutic drugs

what are some issues that contribute to errors?

organizational issues

education system issues

sociological factors

use of abbreviations

what are some interventions that can be use to emphasize safety & prevent errors?

using two patient identifiers

not administering medication if you did not draw up or prepare yourself

minimizing verbal or telephone orders

never assuming

using generic names

requiring a second nurse to administer high-risk medications

what is some patient education that should be included with analgesics?

notify physician with signs of allergic reaction or adverse effects

don’t use other medications without checking with the provider

what is prophylactic therapy for pain management?

medicate before the pain becomes severe to provide adequate analgesia

is pain management purely pharmacological interventions?

no

what are some adverse effects of opioid analgesics?

constipation (can be prevented with increased fluid, fiber, exercise, etc.)

orthostatic hypotension (instruct patient to change positions slowly)

respiratory depression (contact physician immediately)

what are some contraindications for morphine?

use of CNS depressants or severe respiratory conditions

what is an example of a nonopioid analgesic?

acetaminophen

what is status epilepticus?

multiple seizure occur with no recovery between them

what can status epilepticus cause?

hypotension, hypoxia, brain damage, or death

is status epilepticus an emergency?

YES

what is required after status epilepticus?

usually lifelong AED therapy

what can long term use of phenytoin cause?

gingival hyperplasia, acne, hirsutism, & dilantin facies

is phenytoin protein-bound?

highly

what should be monitored with phenytoin?

serum albumin levels (if low, toxicity can occur)

what is gabapentin used for?

neuropathic pain, adjunct to help with seizures

what do beta blockers usually end in?

olol

what do beta blockers do? (MOA)

reduce transmission of impulses in the heart, which lowers heart rate & blood pressure

what should patients do when taking beta blockers?

take radial pulse for a full minute & notify provider if pulse is less than 60 bpm

what is an example of a beta blocker?

metoprolol

what are beta blockers used for? (indications)

HTN, HF, dysrhythmia

what is a contraindication of beta blockers?

asthma

what are the adverse effects of beta blockers?

bradycardia & hypotension

what should be monitored with beta blockers?

BP & HR

what do ACE inhibitors usually end in?

pril

what is an example of an ACE inhibitor?

lisinopril

what is the first line cardiac drug for non-black people?

ACE inhibitors

what are ACE inhibitors used for? (indications)

HTN, HF

which cardiac drugs have renal protective effects?

ACE inhibitors

what are the adverse effects of ACE inhibitors?

fatigue, dizziness, mood changes, **dry cough**, hyperkalemia, **angioedema**

what are calcium channel blockers used for? (indications)

HTN, dysrhythmia, raynaud’s phenomenon

what are contraindications of calcium channel blockers?

acute MI, AV block, hypotension

what are the adverse effects of calcium channel blockers?

hypotension, palpitations, constipation, dyspnea

what can all anti-dysrhythmic drugs cause?

dysrhythmias

what is classified as hypertension for patients 60 or older?

greater than 150 systolic __or__ greater than 90 diastolic

what is classified as hypertension for patients younger than 60 or with chronic kidney disease or diabetes?

greater than 140 systolic __and__ greater than 90 diastolic

which cardiac drugs should be used first for african american people?

thiazides or CCBs

which NSAID has an antiplatelet effect?

aspirin

which patients should aspirin not be given to?

patients with renal dysfunction

what is aspirin used to treat?

MIs, thromboembolic events, prophylaxis

what is one of the first drugs given in the ER?

aspirin

what are some factors that predispose a patient to digoxin toxicity?

**hypokalemia**, use of pacemaker, hepatic dysfunction, hypercalcemia, dysrhythmia, hypothyroidism, respiratory conditions, renal disease, & increased age

which diuretics can be used in patients with cardiac conditions?

furosemide (monitor potassium)

what can potassium imbalance cause?

cardiac dysrhythmias

what is the normal range for potassium?

3\.5-5

can all forms of lidocaine be given IV?

no, forms with epinephrine need to be used as a local anesthetic

which dysrhythmias is lidocaine strictly used for?

ventricular arrhythmias

what are the adverse effects of lidocaine?

bradycardia, blurred vision, mood swings, dizziness, drowsiness, **twitching** (from blockage of sodium channels)

does nitroglycerin have a high first pass effect?

yes

what is the most important drug used for angina?

nitroglycerin

what are some contraindications of nitroglycerin?

severe anemia, closed-angle glaucoma, hypotension, severe head injury, **use of erectile dysfunction drugs (slidenafil)**

what are the adverse effects of nitroglycerin?

tolerance, reflex tachycardia, postural hypotension

what does metformin do?

decreases production of glucose by the liver

decreases intestinal absorption of glucose

increases uptake of glucose by the tissue

what are the adverse effects of metformin?

GI upset, metallic taste, lactic acidosis

what is the first line drug for diabetes?

metformin

is metformin used for type 1 DM?

no

what are the contraindications of metformin?

renal or hepatic disease

what is a normal creatinine level?

0\.6-1.2

what are some rapid-acting insulins?

lispro, aspart, glulisine

what are some short-acting insulins?

regular

what are some intermediate-acting insulins?

NPH

what are some long-acting insulins?

detemir

how should insulins be drawn up?

insulin needles

clear before cloudy (prevents contamination)

what is an adverse effect of all antibiotics generally?

c. diff

what do quinolones end in?

floxacin

what are some examples of quinolones?

ciprofloxacin, levofloxacin