pharm exam 2

Pharmacodynamics

The study of what the drug does to the body

Pharmokinetics

the method by which drugs are absorbed, distributed, metabolized, and eliminated or excreted by the body

loading dose

use of a higher dose than what is usually used for treatment to allow the drug to reach the critical concentration sooner

critical concentration

The amount of a drug that is needed to cause a therapeutic effect

Distribution

movement of drugs by the circulatory system to the site of action

protein binding

Many drugs bind to proteins in the blood and go inactive. They reactivate when levels of that drugs, in the body, decrease. This creates a prolonged effect (CR, LA, ER)

blood brain barrier

highly lipid soluble drugs are more likely to pass through and reach CNS

first pass effect

The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.
DRUG IS NOT EFFECTIVE
may need higher dose PO

factors influencing drug effect

Weight
Age
Gender
Physiological Factors
Pathological Factors
Genetic Factors
Immunological Factors
Psychological Factors
Environmental Factors
Drug Tolerance
Cumulative Effect

oral drugs are best in an

empty stomach - usually

superinfection

overgrowth of normal microbiota that is resistant to antibiotics
- fever , diarrhea, vaginal discharge
*antifungal meds
may need to DC drug responsible

Hypersensitivity

an exaggerated response by the immune system to a particular substance

Anaphalactic reaction

an immediate, severe reaction to a substance to which an individual is allergic that can be life threatening

symptoms of Anaphalactic reaction

hives rash difficulty breathing, high bp, anxious

treatment of Anaphalactic reaction

epinephrine

cytotoxic reaction

- Antibodies attack antigens bound to cell receptors, leading to cell death
- Blood dyscrasias, elevated liver enzymes, decreased renal function
- shown on CBC - decreased hematocrit and WBC
DC drug
*notify hcp

delayed allergic reaction

This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells.
DC drug
*notify hcp

Loop Diaretics

can cause hypokalemia bc it can cause low potassium levels

serum sickness reaction

This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug

symptoms serum sickness reaction

rash, hives, swollen lymph nodes
DC drug
*notify hcp

Anticholinergic drugs

drugs that interrupt or reduce the function of the parasympathetic system

Anticholinergic effects

dry mouth
constipation
photophobia
blurred vision
Tachycardia

cell nucleus

A part of the cell containing DNA and RNA and responsible for growth and reproduction

cell membrane

lipoprotein structure
the semipermeable membrane surrounding the cytoplasm of a cell.

lipoproteins of cell membrane

phospholipids, glycolipids, cholesterol
can have receptor sites via proteins - reacts with specific chemicals

identifying markers

- surface antigens
- important in the role of cellular immunity
- histocompatibility proteins that allow for self-identification
- the body's immune system recognizes these proteins and acts to protect self-cells and to destroy non-self cells

channels

Pores in the membrane that allow passage of specific substances, such as ions

Cytoplasm

Site of cellular metabolism

mitochondria

ATP production

endoplasmic reticulum

production of protein, phospholipids and cholesterol

Golgi apparatus

A system of membranes that modifies and packages proteins for export by the cell

Lysosomes

An organelle containing digestive enzymes

Diffusion

Movement of molecules from an area of higher concentration to an area of lower concentration.

Osmosis

Diffusion of water through a selectively permeable membrane

facilitated diffusion

Movement of specific molecules across cell membranes through protein channels

active transport

Energy-requiring process that moves material across a cell membrane against a concentration difference

Endosytosis

occurs when the cell membrane invaginates and engulfs material to bring it into the cell

Exocytosis

a process by which the contents of a cell vacuole are released to the exterior .
hormones, neurotransmitters, and enzymes are excreted thru this

G0

a resting phase in which a cell is not preparing for the cell division cycle

G1

Cell growth and gathering phase

S phase

The synthesis phase of the cell cycle;
DNA has DOUBLED

G2 phase

Last substances are gathered for division
produces mitotic spindeles

m phase

mitosis and cytokinesis
cell division occurs, produce 2 identical daughter cells

primary actions

overdose, extension of the desired effect

secondary action

Undesired effects produced in addition to the pharmacologic effect

Hypersensitity

an exaggerated response by the immune system to a particular substance

drug allergy

formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug
- anaphylactic
- cytotoxic
- serum sickness
-delayed reactions

hydrocortisone

stop itching

stomatitis

sores in the mouth and tongue
inflammation of mucous membranes
*nystatin - coats mouth

blood dyscrasia

bone marrow suppression
fever chills weakness
- protective isolations, monitor CBC

assesing for liver injury

fever, jaundice, change in urine color or stool, elevated liver enzymes
DC med

assesing renal injury

change in urinary pattern, High BUN and creatine levels
- notify hcp may DC meds

poisoning

overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions

hypogylcemia

fatigue, drowsiness, hunger, anxiety, headache
- restore glucose

hypergycemia symptoms

fatigue, polyuria, polydipsia, nausea, THIRTSY
- admin. insulin to decrease glucose level

Hypokalemia

deficient potassium in the blood
- replace serum K+ level

Hyperkalemia

excessive potassium in the blood
- monitor cardiac rhythm, lower K+ levels

ocular damage

visual changes, blurring of vision, color vision changes
- monitor, DC as appropriate

auditory damage

- Assessment Findings: Dizziness, ringing in the ears (tinnitus), loss of balance, and loss of hearing
- Interventions: Monitor for hearing loss; discontinue medication as appropriate if a decrease in hearing is noted on assessment.

General CNS effects

Assessment: altered level of consciousness

Interventions: prevent injury

atropine- like (antichollergenic) effect

dry mouth, urinary retention , blurry vision
- sugarless losange, have pt void beofre admin

parkinson like syndrome

muscle trmors, change in gait
- DC med

nueroleptic malignant syndrome-

nero symptoms - fever, muscle rigidity
- DC as appropriate , check pupils

teratogenicity

Any drug that causes harm to the developing fetus or embryo
- advise woman possible effects on baby
- weight benefits and risk
-NURSE BABY FIRST THEN TAKE MEDS

narrow spectrum

effective against few organisms

broad spectrum antibiotics

affect a broad range of gram-positive or gram-negative bacteria

anticfective therapy

reduction of the population of invading organism

preventing drug resistance

limit drug use, proper drug use, narrow range antibiotics, multiple drug treatments

sensitivity testing

evaluation of pathogens obtained in a culture to determine the anti-infectives to which the organisms are sensitive and which agent would be appropriate for treatment of a particular infection

combination therapy

The administration of two or more antimicrobial medications simultaneously to prevent the growth of mutants that might be resistant to one of the antimicrobials
- smaller dosage of each drug

Prophalaxis

preventative treatment

Kernicterus

billirubin in CSF

gram postive

stain purple; thick peptidoglycan

gram negative

pink, more complex cell wall structure

beta lactam

Penicillins
Cephalosporins
Carbapenems
Monobactams

Aminoglycides drug names

amikacin
gentamycin
neomycin
streptomycin
tobramycin

Aminoglycosides MOA

inhibit bacterial protein synthesis
rapidly absorbing via IM
Primarily against aerobic gram(−) infections
Poorly absorbed from the GI tract
cross placenta but not BBB

Neomycin

Aminoglycoside
Given PO for preop bowel cleanse

Pharmacotherapeutics for aminglycosides

- gram neg. bacteria
noscociomal infections
UTI
CNS infection
eye infection

Aminoglycosides drug interactions

Synergistic with cephalosporins/penicilins.
Avoid combining with diuretics. neuromuscular blockade (succylcholine) to avoid inc. muscle relax. and resp. distress
toxicity to kidneys
warfarin - increase risk of bleeding
loop diuretic- inc. risk ototoxicity

Nursing Considerations aminoglycides

- allergy history
- baseline vitals
- asses drig interac.
rotate IM sites
gentamycin- draw blood after 1 hour

Penicilins MOA

MOA
-Bactericidal
-Bacterial infection caused by susceptible organisms
-More effective in gram +
-rapid cell destruction

Pharmokinetics of penicilin

absorbed thru duodenum and jejunum
factors that effect - acidity, presence of food in gi
- well distributed in body
liver inactivates metabolites

pencillins that can be used regardless of food intake

amoxicilin
penicillin V
augmenten

Pharmacotherapeutics penicilin

wide spectrum of antimicrobial activity
given IM when cannot be given PO
Penicilin g. - insoluble - IM

penincilin drug interactions

probenicid -increase plasma concentration of pen.
- methotrexate toxicity
- tetracyclines reduce effect
hormonal contraceptives decreased
- decrease vitamin K - increase bleeding
-hypo/hypernatremia
penicillin can inactivate amino-glycosides an dincrease its own functions

adverse reactions penicilin

hypersensitivity
serum sickness
drug fever
rash
oral candidis
diarhea
lethargy

nursing consid. penicilin

- allergy history
obtain c&s
vitals
monitor platelet count
clarify route
dont mix another drug with iv

cephalosporins MOA

broad spectrum
- Bactericidal
- used to treat wide range of bacterial infections.
- Gram + or gram-, the new the more gram-
- Cross sensitivity to penicillin (1%)
- Administered IV or IM bc many not absorb thru GI tract

1 Gen Cephalosporins

cefazolin, cephalexin
gram positive

2 Gen Cephalosporins

cefaCLOR, cefoteTAN
CROSS BBB
gram neg

3rd generation cephalosporins

ceftriaxone, cefotaxime, ceftazidime
CROSS BBB
for influenza, streptococci, vatarhalis

4th generation cephalosporins

-Cefepime
-Use: gram-negative organisms, and gram-positive organisms.

5th generation cephalosporins

- ceftaroline
*** only cephalosporin that covers MRSA
PENETRATE CSF

Pharmokinetics cephalosporins

-parenterally
1st and 2nd gen arent well distributed thru CNS
- not metalobolized at all - excreted thru kidneys unchnged

Drug interactions cephalosporins

dont mix with alcohol
uricosurics- relives gout drug can reduce kidneys ability to excrete cephalosporins.
proton pump - pepcid can decrease effect

nursing consideration cephalosporins

warfarin may need to be adjusted'
hypersensitivity is most common
monitor renal and platets
do not admin to a pt with penicilin allergy

Tetracylines

bacteriostatic
vibramycin and minocycline
- effective against gram neg and pos

Tetracylines MOA

Bacteriostatic inhibitor of protein synthesis
broad spectrum
CROSS PLACENTA
excreted in feces
enterohepatic recirculation - drug is reabsorbed

pharmacotherapeutucs Tetracylines

rocky mountain spotted fever
q fever
lyme disease
acne
anthrax