pharm exam 2

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Pharmacodynamics

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Pharmacodynamics

The study of what the drug does to the body

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Pharmokinetics

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

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loading dose

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

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critical concentration

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

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Distribution

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

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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)

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blood brain barrier

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

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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

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factors influencing drug effect

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

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oral drugs are best in an

empty stomach - usually

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superinfection

overgrowth of normal microbiota that is resistant to antibiotics

  • fever , diarrhea, vaginal discharge *antifungal meds may need to DC drug responsible

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Hypersensitivity

an exaggerated response by the immune system to a particular substance

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Anaphalactic reaction

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

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symptoms of Anaphalactic reaction

hives rash difficulty breathing, high bp, anxious

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treatment of Anaphalactic reaction

epinephrine

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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

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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

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Loop Diaretics

can cause hypokalemia bc it can cause low potassium levels

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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

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symptoms serum sickness reaction

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

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Anticholinergic drugs

drugs that interrupt or reduce the function of the parasympathetic system

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Anticholinergic effects

dry mouth constipation photophobia blurred vision Tachycardia

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cell nucleus

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

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cell membrane

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

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lipoproteins of cell membrane

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

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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

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channels

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

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Cytoplasm

Site of cellular metabolism

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mitochondria

ATP production

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endoplasmic reticulum

production of protein, phospholipids and cholesterol

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Golgi apparatus

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

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Lysosomes

An organelle containing digestive enzymes

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Diffusion

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

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Osmosis

Diffusion of water through a selectively permeable membrane

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facilitated diffusion

Movement of specific molecules across cell membranes through protein channels

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active transport

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

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Endosytosis

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

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Exocytosis

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

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G0

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

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G1

Cell growth and gathering phase

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S phase

The synthesis phase of the cell cycle; DNA has DOUBLED

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G2 phase

Last substances are gathered for division produces mitotic spindeles

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m phase

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

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primary actions

overdose, extension of the desired effect

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secondary action

Undesired effects produced in addition to the pharmacologic effect

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Hypersensitity

an exaggerated response by the immune system to a particular substance

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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

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hydrocortisone

stop itching

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stomatitis

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

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blood dyscrasia

bone marrow suppression fever chills weakness

  • protective isolations, monitor CBC

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assesing for liver injury

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

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assesing renal injury

change in urinary pattern, High BUN and creatine levels

  • notify hcp may DC meds

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poisoning

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

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hypogylcemia

fatigue, drowsiness, hunger, anxiety, headache

  • restore glucose

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hypergycemia symptoms

fatigue, polyuria, polydipsia, nausea, THIRTSY

  • admin. insulin to decrease glucose level

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Hypokalemia

deficient potassium in the blood

  • replace serum K+ level

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Hyperkalemia

excessive potassium in the blood

  • monitor cardiac rhythm, lower K+ levels

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ocular damage

visual changes, blurring of vision, color vision changes

  • monitor, DC as appropriate

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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.

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General CNS effects

Assessment: altered level of consciousness

Interventions: prevent injury

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atropine- like (antichollergenic) effect

dry mouth, urinary retention , blurry vision

  • sugarless losange, have pt void beofre admin

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parkinson like syndrome

muscle trmors, change in gait

  • DC med

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nueroleptic malignant syndrome-

nero symptoms - fever, muscle rigidity

  • DC as appropriate , check pupils

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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

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narrow spectrum

effective against few organisms

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broad spectrum antibiotics

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

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anticfective therapy

reduction of the population of invading organism

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preventing drug resistance

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

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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

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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

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Prophalaxis

preventative treatment

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Kernicterus

billirubin in CSF

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gram postive

stain purple; thick peptidoglycan

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gram negative

pink, more complex cell wall structure

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beta lactam

Penicillins Cephalosporins Carbapenems Monobactams

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Aminoglycides drug names

amikacin gentamycin neomycin streptomycin tobramycin

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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

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Neomycin

Aminoglycoside Given PO for preop bowel cleanse

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Pharmacotherapeutics for aminglycosides

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

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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

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Nursing Considerations aminoglycides

  • allergy history

  • baseline vitals

  • asses drig interac. rotate IM sites gentamycin- draw blood after 1 hour

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Penicilins MOA

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

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Pharmokinetics of penicilin

absorbed thru duodenum and jejunum factors that effect - acidity, presence of food in gi

  • well distributed in body liver inactivates metabolites

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pencillins that can be used regardless of food intake

amoxicilin penicillin V augmenten

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Pharmacotherapeutics penicilin

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

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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

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adverse reactions penicilin

hypersensitivity serum sickness drug fever rash oral candidis diarhea lethargy

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nursing consid. penicilin

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

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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

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1 Gen Cephalosporins

cefazolin, cephalexin gram positive

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2 Gen Cephalosporins

cefaCLOR, cefoteTAN CROSS BBB gram neg

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3rd generation cephalosporins

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

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4th generation cephalosporins

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

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5th generation cephalosporins

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

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Pharmokinetics cephalosporins

-parenterally 1st and 2nd gen arent well distributed thru CNS

  • not metalobolized at all - excreted thru kidneys unchnged

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Drug interactions cephalosporins

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

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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

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Tetracylines

bacteriostatic vibramycin and minocycline

  • effective against gram neg and pos

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Tetracylines MOA

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

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pharmacotherapeutucs Tetracylines

rocky mountain spotted fever q fever lyme disease acne anthrax

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