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