pharm exam 2

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134 Terms

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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