pharm exam 2

Pharmacodynamics

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