Pharmacology midterm Flashcards

Terms Definitions
What is dissolution and what inhibits it?
It is when a drug in solid for disintegrates into small particles to dissolve into a liquid. Food and some drugs inhibit it
What is absorption? What inhibits it?
Process of a drug getting ready for absorption. INHIBITS: pain, stress. fatty, hot, and solid foods slow down gastric emptying times
How are lipid soluble drugs absorbed?
The only one to be absorbed readily through the GI tract
How are water soluble drugs absorbed?
they need a carrier or an enzyme or a protein to pass through a membrane
When there are large molecules to go through the GI membrane, do ionized or nonionized drugs pass through?
What for of drug is absorbed rapidly from the GI tract?
nonionized and lipid soluble are faster than water soluble and ionized drugs
What is passive absorption?
Does not require energy. Occurs mostly by diffusion.
What is active absorption?
requires energy and a carrier like an enzyme or a protein.
What is pinocytosis?
a cell carries it across the membrane by engulfing it
What is the effect of laxatives and narcotics on absorption?
Laxatives SHORTEN the time the drug is IN the GI tract which decreases absorption. Narcotics decrease peristalsis, increasing the time the drug is in the GI tract.
What do Protein binding drugs bind to? Does this make the drug readily available?
albumin. NO. The drug bound to albumin is inactive because it is not available to receptors. FREE DRUGS are the only drugs available for use.
What is bioavailability? Which rout has the greatest and least bioavailability?
The % of administered drug that reaches the systemic circulation. Greatest= IV, Least= PO
What is Hepatic first pass?
Process in which a drug does not go directly into the systemic circulation following ORAL absorption but passes from the intestinal lumen to the live first via the portal vein.
What are trough levels?
the lowest plasma concentration of a drug
what are peak levels?
the highest plasma concentration of a drug
What is MEC?
Minimum Effective Concentration: the therapeutic minimum. If it is BELOW this it does not work.
What is MTC?
Maximum effective concentration. AKA: MTC= Minimum Toxic Concentration). Too high of a drug level that results in toxicity
What is an agonist?
a drugs that mimics a chemical in the body
What is an antagonist?
2 drugs are combined that have opposite effects. They decrease or negate each other.
What is a synergistic reaction?
Potentiation. The effect of COMBINED drugs from DIFFERENT categories is greater than either of the drugs by itself.
What is the formula for BSA?
square root of weight(lbs) x height(inches) / 3131 OR square rood of KG x CM / 3600
What is an additive effect?
the sum of the effect of two drugs from the SAME category
What is a cumulative drug effect? What can cause it?
the body is unable to metabolize and excrete one dose of a drug before the next dose is given. Liver and Kidney damage can cause this.
What is drug interation?
drug's interaction is altered or modifies action or effect of drug as result of interaction with one or more other drugs.
What is drug Incompatibility?
THIS HAPPENS OUTSIDE THE BODY. The drugs mix in the IV and clog it or cause undesirable effects.
Where does Drug Interaction happen?
Inside the body
What is a loading dose?
initial large dose of a drug to rapidly achieve the minimum effective concentration
What effects are always undesirable?
Adverse reactions
What tests should be done especially for the elderly when taking drugs?
liver and kidney function tests
What is Creatinine clearance?
the most accurate test to determine renal function.
What is the normal level for urine creatinine?
85-135 ml
What is the normal serum creatinine levels?
80-130 ml
What is another name for right education?
Informed consent
Name the 5+5 rights?
patient, drug, dose, route, medication, assessment, documentation, education, evaluation, refuse
What does Enteral Route mean?
Oral, Sublingual, eye drops, ear drops, inhalation, suppositories, topical
What is the parenteral route?
any route other than enteral route. Usually done by a needle. SQ, IM, IV, ID
How do you pull an ear when administering ear drops for a child? An adult?
Child: down and back <8; adult: up and back
What must you have with you when administering ear drops?
Cotton ball to keep drug in, tissue. Try to have them keep it in for a minute
What temperature should ear drops be?
body temp
What patient teaching should be done when applying eye ointment?
They need to expect blurry vision. Try to do it at night.
What equipment must you have when applying eye drops?
tissue, gloves, sterile gauze
Why would you use a transdermal patch?
Has fewer adverse reactions, creates a controlled release of meds for systemic effect. Reduces risks of toxicity.
What do you label the patches with?
date, time, initials
When must you take off a transdermal patch?
Prior to MRI to avoid skin burns
What is the difference between a topical route and a transdermal route?
Topical route acts ON the skin but is not ABSORBED through the skin
name 4 forms of a topical drug:
Creams, liquids, suppositories (rectal/vaginal), solids/tablets dissolved in mouth
What size of needle do you need for an ID injection?
3/8-5/8", 25-27 gauge
What size of needle is needed for SQ injection?
1/2-5/8", 25-27 gauge
How much can you inject for a SQ injection?
0.1-1.5 ml
What three drugs are used for SQ?
heparin, insulin, allergy meds
When doing a SQ injection when must you never aspirate?
insulin and heparin
what size of needles are needed for IM injections?
1-1.5", 18-23 gauge
How much can you inject into a pt with IM?
1-3 mL.
How much medication can you inject Deltoid?
Which IM site is preferable with peds?
vastus Lateralis
What drug needs a Z-track? Where can it be injected?
Iron Dextran. DG and VG
What must you never do with sublingual drugs?
chew or crush them
How much drug is the limit for children when injecting IM?
1 mL
How are trade and generic drugs written?
Generic is lowercase. Trade is capitalized.
What is a One time order?
a drug is given only once and then D/C
What is the NPA?
Nurse practice act. It is individualized for each state.
what is misfeasance?
negligence. wrong dose or wrong drug
what is nonfeasance?
omission of drug
what is malfeasance:
right drug, wrong route
What are schedule I drugs?
NOT APPROVED FOR MEDICAL USE. High abuse potential. Heroin, Marijuana
What are schedule II drugs?
High abuse potential with sever dependancy. ACCEPTED MEDICAL USE. Narcotics
What are schedule III drugs?
Less abuse potential but potential for moderate dependence. Tylenol w/ codiene.
What are schedule IV drugs?
Less abuse potential than schedule III. sedatives, anxiety agents, nonnarcotic analgesics, diazepam, Valium
What are schedule V drugs?
Very limited dependency and abuse potential. SMALL amount of narcs for antidiarrheals and antitussives. (Codiene in cough syrup)
What are schedule VI drugs?
Marijuana. Limited medical use.
What are category 1 drugs?
FDA category. drugs are safe and effective
What are Category 2 drugs?
FDA category. drugs to be either unsafe or ineffective. Need to be reformulated or removed from market.
What are category 3 drugs?
FDA category. Drugs that don't have enough data to make safe.
Can OTC drugs be dangerous?
YES! Drug-Drug interactions,
What are physiologic risks for children r/t drugs?
Children are made of 70% water (neonates and infants) so they require higher doses for water soluble drugs until age 2. Decreased body fat=decreased fat soluble drugs. less albumin=decrease dose of protein bound drugs until age 2. metabolism is decreased d/t decreased liver enzymes. Older children have increased metabolism=more dose. BEFORE 9 months: decreased kidney capacity and increased accumulation of drug. Evaluate for dehydration and drug overlapping
What physiologic risks for elderly r/t drug administration?
decreased body water=decrease water soluble drugs. Increased body fat= increase fat soluble drugs. loss of protein= decrease protein binding drugs. Decreased metabolism d/t decreased hepatic BF and liver size. Reduced elimination because of DECREASED CARDIAC OUTPUT and BF.
What 3 tests evaluate medication excretion?
BUN, Serum creatinine, creatinine clearance
What are two ways to calculate drug dosages for children?
Body weight (Kg) and BSA
What vitamins are fat soluble?
How are fat soluble drugs metabolized?
slowly. can be stored in the fat tissue, liver, and muscle in significant amounts.
How are fat soluble drugs excreted?
In the urine at SLOW rate.
What two fat soluble drugs can be toxic overtime?
A and D
What vitamins are water soluble?
B complex and C
Are water soluble drugs usually toxic?
No unless in extreme amounts.
Where are water soluble vitamins stored?
They are not stored in the body so you need to take them consistently
Where are water soluble drugs excreted?
Readily in the urine.
Do water soluble vitamins bind to proteins?
Where is Thiamine found?
Vitamin B1. enriched bread and cereals, yeast, liver, pork, fish, milk, lentils,
What food is Riboflavin found in?
Vitamin B2. Milk, enriched breads and cereals, liver, lean meat, eggs, almonds, soy, leafy greens
Where are B-6 vitamins found?
lean meat, leafy green, whole grains, yeast, bananas, salmon, soy beans, nuts and seeds, carrots
Where do you find Vitamin B-12?
Liver, Kidney, fish, milk, eggs, chicken, turkey
What slows the absorption of iron?
food, anti acids
what increases absorption of iron?
Vitamin C
Describe how iron should be taken when PG?
You must increase the intake of iron when PG but you should stay away from it during the first tri because megadoses are contraindicated because of possible teratogenic effects. Large amounts are needed during the other 2 tris
What happens if there is an OD of vitamin C?
Crystalluria when taken with aspirin or sulfonamides. It can cause a false negative occult test and false positive sugar in the urine.
What is the cause for deficiency of Folic acid?
It can effect the development of CNS and NTD like spinal bifid a or anencephaly (Lack of brain mass formation).
What does folic acid do?
DNA synthesis and cellular division
What is are the two divisions of the PNS?
somatic (automatic), Autonomic (involuntary)
What are the two divisions of the Autonomic nervous system?
Sympathetic (Adrenergic) and Parasympathetic (Cholinergic)
What is doxapram?
Dopram, it is an analeptic
What is caffeine used for?
COPD or to stimulate for drug overdose
What is Ritalin?
for ADHD to increase attention span and cognitive performance.
What does Provigil do?
What part of the brain do anorexiants act on?
Why are amphetamines used only for short term?
Because it has a high physical and psychological abuse and addiction potential d/t euphoria and alertness
How often do you give meds for ADHD and when do you give it?
2x/day and at breakfast and luck
what are SE of ADHD drugs?
restlessness, tachycardia, insomnia, hypertension, anorexia, tremors and irritability
What is a sedation med?
causes a calming effect and relaxes to allow rest. Does not affect consciousness. It is usually given during the day
what is a hypnotic drug?
produces sleep and given at night. It is a short term use drug because it can cause dependency and you want to taper off of it.
What must you not take with hypnotics?
What are SE of Hypnotics?
Causes Natural sleep. hangover, dependance, tolerance, excessive depression, respiratory depression, REM rebound, hypersensitivity
What medication would be used as an antidote for the sedative/hypnotic group benzodiazepines?
What is Provigil given for?
What does Provigil do?
IT is an amphetamine that stimulates the release of neurotransmitters (dopamine and norepinephrine) from the brain and sympathetic system.
What do amphetamines cause?
Euphoria and alertness
name 8 nonpharmalogic ways to fall asleep:
warm bath, warm drinks, appropriate room temp, clean and dry linens, decreased loud noises, decrease naps, arise at a specific time of day, avoid copious amounts of fluid
What is balanced anesthesia?
a combination of drug used for general anesthesia.
what does balanced anesthesia do?
minimizes cardiovascular problems, decreases amount of anesthesia needed, reduces N/V, minimizes organ function and decreases pain
what is the first stage of anesthesia?
Analgesia= begins with consciousness and ends with loss of consciousness. speech is difficult. Induction stage
What is the second stage of anesthesia?
What is the third stage of anesthesia?
Surgical. Surgery is done during this stage. Anesthesia deepens, respirations go shallow and respiratory rate is increased. Nitrous Oxide is used here.
What is the fourth stage of anesthesia?
Medullary Paralysis= BAD! Toxic. CODE BLUE.
Where is the spinal put in?
What block is used for PG women?
Saddle block. Epidural
What drugs are given preoperatively and why?
Cholinergic blocking- decrease respiration secretions. Antiemetics= decrease N/V post op. Muscle relaxants. anti anxiety
Name two Local anesthetic agents and examples.
Esters: Amides:
What is Dilantin used for?
grand mal, status eptilepticus, physcomotor.
What is given during status eptiepticus before dilantin?
What is the therapeutic and toxic ranges of dilantin?
10-20 mcg/mL; 30-50 mcg/mL
What are side effects of Dilantin?
HA, diplopia, confusion, dizziness, sluggish, decreased coordination, slurred speech, N/V, hypertension/
What is the most serious type of seizure and how is it treated?
Status Eptilepticus: Valium always first.
What is Luminal used for and 3 side effects:
Status Eptilepticus, grand mal, partial seizures. Confusion, depression, irritablity
Who is valporic acid contraindicated for?
Children under 12, PG, and liver disease
What are benzodiazepines classified as?
anti anxiety, sedative/ hypnotics.
What medication is used for benzodiazepine OD?
Name 8 drug name categories for sympathetic nervous system:
Adrenergics, adrenergic agonists, adrenomimetics, sypathomimetics, parasympatholytics, anticholinergic, cholinergic antagonists, cholinergic blocking
name 8 drug name categories for parasympathetic systems?
Cholinergic, Parasypathomimetics, cholinomimetic, cholinergic agonists, sympatholytics, adrenolytics, adrenergic blockers, adrenergic antagonists
What are direct acting drugs?
directly stimulate adrenergic receptors (Epinephrine and norepinephrine)
What are Indirect acting drugs?
Stimulate the release of norepinephrine from terminal nerve endings (Amphetamine)
What are mixed acting drugs?
Stimulate the adrenergic receptor sites and stimulates the release of norepinephrine from the terminal nerve endings. (ephedrine)
What are Direct acting drugs for parasympathetic system?
act on receptors to activate a tissue response
What are indirect acting drugs for parasympathetic NS
Inhibit the action of the enzyme AChE by forming a chemical complex. IT permits ACh to persist and attach to the receptor
What are the receptor sites for the sympathetic nervous system?
Adrenergic nerve fibers. Alpha, Beta or both
What are the neurotransmitters of the SNS?
Where does epinephrine come from?
The adrenal gland
What receptor does the receptor site of alpha 1 do in the SNS?
Increase all the fight or flight
What does alpha 2 receptors do?
vasodilatation, hypotension, decrease GI motility and tone
What does beta1 do?
Increase HRa
What does beta 2 do?
bronchodilation, dopaminergic: renal, mesenteric, coronary and cerebral arteries.
What receptor site of the SNS has the greatest effect on blood pressure?
Alpha 1
What are the receptor sites for the ParaNS
Muscarinic, Nicotinic
What does muscarinic receptors do?
stimulates smooth muscle, slow heart rate
what do Nicotinic receptors do?
Neuromuscular= affect skeletal muscles
What are the neurotransmitters for the ParaNS?
Acetylcholine, Acetylcholinesterease
What are the most common side effects to antihistamines?
drowsiness, dizziness, fatigue, disturbed coordination, skin rashes,
What are the most common Side effects of anticholinergics?
Dry mouth, decreased perspiration, blurred vision, tachycardia, constipation, urination retention
What causes Parkinson's?
Imbalance in neurotransmitters. Increased ACh and decreased dopamine
What 5 drugs treat parkinson's?
Carbidopa/levodopa, MAO-B and COMT inhibitors, Dopamine agonists, Anticholinergic.
What does carbidopa do for Levodopa?
it stops the enzyme turning Levodopa to dopamine in the PNS so more can get to the brain and so you need less drug and there are not a lot of S/E
What do MAO-B inhibitors do?
prevent dopamine breakdown
What do COMT inhibitors do?
prevent dopamine receptor inhibitors.
Why are dopamine agonists given and what do they do?
The given for people who cannot tolerate levodopa. It readies dopamine receptors.
What do ANticholinergics do to help parkinson's?
decreases AhC. it causes rigidity but has minimal effect on bradykinesia.
What is an example of an anticholinergic?
Cogentin for parkinsons
What does Carbidopa/Levodopa do?
stimulates dopamine receptors
What do you give for MG overdose/ insufficient dosing?
Cholinesterase inhibitor
Why are muscle relaxants prescribed?
Decrease pain and increase ROM. Decrease muscle tone and involuntary movement w/o loss of voluntary motor function.
what are S/E of muscle relaxants?
mild sedation, reduction of anxiety and tension, alters pain perception
What are S/S of MS?
Diplopia, weakness in the extremities or spasticity
What drugs are used for MS?
Prednisone (glucocorticoids), ACTH adrenocorticotropic hormone
What are the actions of prednisone?
it suppresses inflammation and the normal immune response
What does ACTH do?
stimulates the adrenal cortex to secrete cortosol
What is Cytoxan used for?
treat CHRONIC progressive MS symptoms. It is an immunosuppressant.
What are S/E of Cytoxan?
pulmonary fibrosis, myocardial fibrosis, homorrhagic cystitis, leukopenia, N/V
Name two anticholinergic drugs
Cogentin, Norflex
What is the action of Anticholinergics?
Parasympatholytics that inhibit the release of Acetylcholine
What are uses of Anticholinergics?
reduce the rigidity and some tremors that are characteristic of parkinsonism but have a minimal effect an bradykinesia
What are some contraindications of anticholinergics?
Glaucoma, GI disturbances, GU obstruction, Prostatic hypertrophy, MG
What medication is used for Alzheimer's?
AChE inhibitors
What drug is used for Alzheimer's?
What stimulates the CTZ and vomiting centers?
Impulses from drugs, toxins, vestibular center in the ear. VC: odor, tast, gastric mucosal irritation, stimulated by ACh
What are causes for diarrhea?
foods(Spicy/spoiled), fecal impaction, bacteria and virus, laxative abuse, malabsorption, stress/anxiety, bowel tumor, inflammatory bowel disease
name three antidiarrheals?
opiates, somatostatin analog, adsorbents.
What is the action of opiates r/t GI?
decrease intestinal motility
What is an opiate?
Anything that decreases the CNS
What are 3 drugs for diarrhea?
Imodium, kaopectate, pepto-bismal
What do adsorbents do for the GI?
to coat the wall of the GI, absorb bacteria or tocin that is causing diarrhea.
How must you administer bulk forming laxatives?
with 8 oz of water or it will cause obstruction.
What do bulk forming laxatives do?
It draws water into the intestine.
Do bulk laxatives cause dependency?
name 3 bulk forming laxatives
Metamucil, FiberCon, Citrucel
what are osmotic laxatives?
It draws water into the intestine and it promotes peristalsis.
What are 3 examples of osmotic laxatives?
Fleet enema, MOM, Mag, Citrate
Name 4 complications of osmotic laxatives:
electrolyte imbalances, hypotension, weakness, dehydration
What are Emollient laxatives?
Wetting agents. Creates barrier between feces and colon to prevent reabsorption of fecal fluids. It decreases straining
What is an example of an Emollient laxative?
What do Stimulant laxatives do?
Irritate the sensory nerve endings
name 3 stimulate laxatives:
senna, dulcolax, castor oil
name 3 S/E of stimulant laxatives:
abdominal cramps, electrolyte imbalances
What are Peptic ulcers caused by? IS it only in the stomach?
an user that is in the stomach caused by hepersecretion of HCL and pepsin which breaks down the GMB. It is 10x more frequent. NO it is also in the Esophogus or duodenum
What are 6 predisposing factors for peptic ulcers?
stress, hyper motility of stomach, incompetent sphincters, genetics, environmental, bacteria (H pylori), drugs
What are nonpharmacologic Tx for GERD?
avoid smoking/alcohol, weight loss, avoid hot and spicy and greasy foods, raise the head of bed and not eat before bedtime.
What are 4 complications of GERD?
Barrett's esophagus, bronco spasms, esophageal ulcer, stricture
What is Barrett's esophagus?
change in lining that can increase risk of cancer.
Name 5 GERD drugs:
Zantac, Prilosec, Prevacid, Prontonix, Nexium
What is H-pylori?
gram - bacillus linked with development of peptic ulcers
How do you test for H-pylori?
breath test, biopsy or lab work (blood and stool)
What is the treatment for H-pylori?
2 antibiotics used in a 14 day treatment
What is the class of medication for Cytotec?
Prostaglandin analogue.
What is the purpose of Cytotec?
prevent and treat peptic ulcers for those on high doses and long term therapy of NSAIDS and ASA.
What does Cytotec do physiologically to the body?
suppresses the gastric acid and increases cytoprotective mucus and the GI tract
What do you use for longterm use of drugs for GI bleeds?
What is carafate?
Pepsin inhibitor. It protects gastric mucosa. IT combines with preteens to form a viscous substance that covers the ulcer and protects it from acid and pepsin
What do PPI;s do?
suppress gastric acid secretions by inhibiting the "pumping" action in the parietal cells. IT blocks the final step of acid production and inhibits gastric acid up to >90%.
Name 5 examples of PPI's:
Prilosec, Prevacid, Aciphex, Prontonix, Nexium
What MG med helps to Dx it?
Tesilon: improves symptoms in 5-10 minutes
What class of drugs is used to treat MG?
Mestinon. Give it every 3-6 hrs
How does Mestinon work?
It transmits neuromuscular impulses by preventing destruction of ACh
What must you teach a client about MG drugs?
Take drugs as prescribed so they can work. Wear an identification bracelet. Report any recurrent symptoms. Take drug before meals for good drug absorption, but if you have Nausea than take with food.
What are the S/S of AChE inhibitor insufficient or OD?
muscle weakness, dyspnea, dysphagia
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