141 Test 3

Front 1

1. Drug

Back 1

a. any chemical that affects the physiologic processes of a living organism.

Front 2

2. PHARMACOLOGY

Back 2

is the study of the science of drugs

Front 3

PHARMACOLOGY incorporates knowledge from a variety of areas including

Back 3

i. Absorption
ii. Biochemical effects
iii. Biotransformation
iv. Distribution
v. Drug History
vi. Drug Origin
vii. Excretion
viii. Mechanisms of action
ix. Physical and chemical properties
x. Physical effects
xi. Drug receptor mechanisms
xii. Therapeutic (beneficial) effects
xiii. Toxic (harmful) effects

Front 4

c. Pharmacology also incorporates several interrelated areas

Back 4

i. Pharmaceutics
ii. Pharmacokinetics
iii. Pharmacodynamics
iv. Pharmacotherapeutics
v. Pharmacognosy
vi. Toxicology

Front 5

PHARMACOGNOSY

Back 5

is the study of natural drug sources via plant, animal or mineral

Front 6

2. Plants

Back 6

i. alkaloids are the most active component in plants, reacts with acids to form a salt that is able to dissolve more readily in body fluids.

Front 7

b. Glycosides

Back 7

i. usually end in “-in”
ii. (digoxin).

Front 8

c. Gums

Back 8

i. give the products the ability to attract and hold water (seaweed extracts, seeds with starch).

Front 9

d. Resins

Back 9

Also acts as a local irritant or as a laxative and caustic agent.

chief source is Pine Tree sap.

Front 10

e. Oils

Back 10

i. classified as volatile or fixed.

Front 11

ii. Volatile oils

Back 11

1. peppermint, spearmint and juniper.

Front 12

iii. Fixed oils

Back 12

1. do not evaporate easily
2. castor oil, olive oil.

Front 13

3. Animals

Back 13

i. body fluids or glands can be drug sources

Front 14

b. Hormones

Back 14

i. insulin, steroids, etc.

Front 15

c. Oils and fats

Back 15

i. cod liver oil

Front 16

e. Vaccines

Back 16

i. flu, measles, mumps, hepatitis B, etc

Front 17

4. Minerals

Back 17

i. provide inorganic materials not available from plants and animals.
ii. Used as they occur in nature or are combined with other ingredients
iii. ( iron, iodine, Epsom salts).

Front 18

5. Synthetic Drugs

Back 18

a. laboratory researchers have used traditional knowledge along with chemical science for the development of drugs.
b. Most drugs produced today are made in laboratories.
c. DNA research is also producing drugs
i. (Human Insulin).

Front 19

two primary sources of drug information.

Back 19

i. U.S. Pharmacopeia and the National Formulary

Front 20

a drug will acquire 3 different names

Back 20

ii. Chemical name
iii. Generic name
iv. Brand or trade nam

Front 21

1. Pharmacutics

Back 21

a. is the study of how various dosage forms influence pharmacokinetics and Pharmacodynamics.

Front 22

b. Different dosage forms have

Back 22

different pharmaceutical properties.

Front 23

c. Dosage forms determine

Back 23

the ability of a drug to move into solution, called dissolution.

Front 24

i. Dissolution

Back 24

Actual breakdown of a dosage form occurs in the aqueous contents of the digestive tract.

2. Once dosage form disintegrates or is dissolved, it is free to enter into a solution as a solute particle and is more available to the body.

Front 25

Types of Drug Preparations

Back 25

a. Aqueous preparations
b. Alcohol preparations
c. Solid and semisolid preparations

Front 26

Types of Enteral Drugs

Back 26

a. Liquids, elixirs, syrups
b. Suspensions, solutions
c. Powders
d. Capsules
e. Tablets
f. coated tablets
g. enteric coated tablets

Front 27

Fastest drug preperation

Back 27

a. Liquids, elixirs, syrups

Front 28

g. enteric coated tablets

Back 28

i. Slowest
ii. Meant to be slow release.
iii. Cannot be crushed

Front 29

4. Routes

Back 29

a. Enteral
b. Parenteral
c. Topical

Front 30

a. Enteral

Back 30

i. All oral
ii. certain rectal

Front 31

b. Parenteral

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i. Sub Q
ii. Intra dermal
iii. Intramuscalr
iv. intravenous

Front 32

c. Topical

Back 32

i. Cream
ii. Transdermal patches
iii. Powders
iv. etc

Front 33

1. Pharmacokinetics

Back 33

a. is the study of how the body deals with a drug.

Front 34

What must be considered when determining the dosage

Back 34

route and timing of a drug dose pharmacokinetics of the drug must be considered.

Front 35

c. Pharmacokinetics includes:

Back 35

i. Absorption
ii. Distribution
iii. Metabolism
iv. Excretion

Front 36

2. Absorption

Back 36

a. is the movement of a drug from its site of administration into the bloodstream for distribution to the tissues.
b. a drug is not effective until it reaches the cells.

Front 37

3. Bioavailability

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a. is the term used to express the extent of drug absorption,

b. e.g. the enteral preparation of a drug is less bioavailable than the parenteral form of the drug.
i. When it is given orally or the allamentary canal less of it is absorbed (bioavailaliby) than a parenteral drug.

Front 38

4. Bioequivalent

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a. if 2 drugs have the same bioavailability and the same concentration of active ingredients they are said to be bioequivalent.

b. Absorbed into the body in the same way.

Front 39

5. Solubility:

Back 39

the ability of a drug to dissolve and form a solution

Front 40

a. The solubility of the administered drug must

Back 40

match the cellular environment of the absorptive site. Drugs must be in solution.

Front 41

c. Lipid solubility

Back 41

i. necessary for any drug that must cross the lipid rich cell membrane.
ii. Most cell membranes are lipid soluble.
1. Therefore most drugs are lipid soluble.
iii. It depends on the drugs chemical structure and is influenced by the cellular environment at the absorptive site.

Front 42

Drugs pass through a cell membrane in 3 ways:

Back 42

1) Through channels or pores.
Very few drugs pass this way.
2) Aid of a transport system
may require energy
this is not desired as it is inefficient
3) Direct penetration of a cell membrane
MOST COMMON and must be lipid soluble.

Front 43

7. Systems of Transport

Back 43

a. Filtration
b. Passive processes
c. Active processes
d. Facilitated diffusion
e. Pinocytosis

Front 44

a. Filtration

Back 44

i. Passage of drugs through the pores of the cell

Front 45

b. Passive processes

Back 45

i. diffusion, osmosis
ii. can be efficient but only over a very tiny distance
iii. from an area of high concentration to low concentration

Front 46

c. Active processes

Back 46

i. Active Transport
ii. Requires energy because its going from low concentration to high concentration

Front 47

d. Facilitated diffusion

Back 47

i. Uses another chemical to “facilitate” the movement of the medication

Front 48

e. Pinocytosis

Back 48

i. When the cell membrane engulfs the molecule.

Front 49

8. Factors which affect drug absorption

Back 49

a. Food in the stomach and intestines
i. Food will slow down absorption
b. Rate of blood flow to the stomach/intestines
i. Poor flow will slow absorption
c. Acidity of stomach, alkalinity of the intestines
d. G. I. motility

Front 50

9. First-Pass Effect

Back 50

i. ALL Oral Drugs are absorbed through the small intestine into the portal venous system that flows through the liver.
ii. The drugs are metabolized in the liver and some of the active drug will be inactivated or diverted before it can reach the general circulation and its intended site of action.

Front 51

iii. First-Pass reduces the bioavailability of a drug to

Back 51

less than 100%.

iv. Some drugs which undergo First-Pass may have a bioavailability of 50% or less.

Front 52

v. Dosage given for oral medication is much ______ than a parental dosage due to

Back 52

Higher,

First Pass effect

Front 53

b. Drug Routes that undergo First-Pass effects

Back 53

i. Hepatic artery
1. Goes through the portal artery
ii. Oral
iii. Portal Vein
1. Will have gone through the liver
iv. Rectal

Front 54

Drug routes that do not undergo First-Pass Effects (4)

Back 54

Buccal/sublingual
1. Absorbed directly into the capillary system
Parenteral
Topical, including some rectal drugs
Transdermal
Inhaled

Front 55

10. Distribution

Back 55

refers to the transport of a drug in the body by the bloodstream to its site of action.

Front 56

b. Three factors which determine movement of drugs throughout the body

Back 56

1) Blood supply
the areas with the best blood supply receive the drug first.
2) Ability to exit the vascular system.
3) Ability to enter into the cell.
All therapeutic effects take place in the cell

Front 57

11. Protein Binding

Back 57

a. Some portion of a drug binds to protein in the blood.

Front 58

i. The most common of these proteins in protien binding is

Back 58

albumin

Front 59

Protien binding in albumin

Back 59

1. There are receptor sites that the drug binds to and then does not get released and cannot produce its therapeutic effect.

Front 60

ii. Once a portion of a drug binds to protein in the blood it

Back 60

is not free to produce its desired effect.
iii. However, the unbound portion of a drug can produce the desired effect.

Front 61

b. When 2 or more drugs are competing for binding sites on protein molecules

Back 61

more of each drug is available to the cells and may cause a drug-drug interaction.

ii. Can produce a toxic effect due to the higher dosage level produced

Front 62

12. Volume of Distribution

Back 62

a. describes various areas where drugs may be distributed

Front 63

12. Volume of Distribution areas

Back 63

blood,
total body water,
body fat
other body tissues and organs.

Front 64

c. Water soluble

Back 64

i. highly water soluble drugs have a small volume of distribution and high blood concentration and tend to stay in the blood.
ii. Produces a very slow onset of action.

Front 65

highly fat soluble drugs

Back 65

have a large volume of distribution and low blood concentration because they are chemically repelled by the high water content of the blood.

Front 66

cell membranes are mostly

Back 66

lipid soluble and fat molecules pass through these membranes more easily.

Front 67

13. Blood Brain Barrier

Back 67

a. is a protective system of cellular activity that keeps many things away from the CNS
i. (foreign invaders, poisons).

Front 68

more likely to pass through the blood-brain barrier

Back 68

b. Drugs that are highly lipid soluble reach the CNS.

Front 69

c. Drugs used to treat diseases of the CNS must be

Back 69

highly lipid soluble to be effective

Front 70

1. METABOLI SM also referred to as

Back 70

BIOTRANSFORMATION.

Front 71

1. METABOLI SM

Back 71

b. Involves the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, or a more potent active metabolite.

Front 72

c. Liver is the most responsible for

Back 72

the metabolism of drugs
can occur in the plasma, kidneys and membranes of the intestines.

Front 73

2. Factors that alter metabolism

Back 73

3. genetic, diseases, medications, disease conditions.

Front 74

2. EXCRETION

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a. the elimination of drugs from the body whether they are active, metabolized or unchanged all drugs must eventually be removed from the body.

Front 75

b. The primary organs of excretion are

Back 75

the Kidneys.

Front 76

...also eliminate some drugs

Back 76

c. The skin, lungs, bile, feces, liver and the bowel

Front 77

3. Half-LIFE

Back 77

the time it takes for the drug levels to go from none to half of the original amount to be left in the body.
Used to determine the amount of time for a drug to be removed from the body.

Front 78

3. Half-LIFE is a measure of

Back 78

the rate at which drugs are removed from the body

Front 79

4. CUMULATION

Back 79

when a drug is taken in successive doses at intervals that are shorter than recommended or when the body is not able to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects.

Front 80

5. STEADY STATE

Back 80

a. the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed. Steady state is reached in approximately 5 half-lives of administered drug.

Front 81

6. CRITICAL CONCENTRATION

Back 81

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

Front 82

7. LOADING DOSe

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Drugs whose effects may be needed quickly have a recommended higher loading dose. Usually used for drugs that take a prolonged period to reach a critical concentration.

Front 83

8. MAINTENANCE DOSE

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after higher drug levels have been established with a loading dose, smaller doses of the drug are given to maintain the blood concentration of the drug.

Front 84

9. ONSET OF ACTION

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a. the time from drug administration to the first observable effect

Front 85

10. PEAK EFFECT

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a. is the time required for a drug to reach its maximum therapeutic effect. Peak level is the highest blood level of a drug.

Front 86

11. DURATION OF ACTION

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a. is the length of time that the drug concentration is sufficient to elicit a therapeutic response.

Front 87

12. TROUGH

Back 87

is the lowest blood level of a drug.

Front 88

13. DOSE RESPONSE CURVE

Back 88

b. When the relationship between the dose response is plotted as a graph, it is referred to as the dose-response curve.

Front 89

a. Dose

Back 89

i. is the exact amount of a drug that is administered in order to produce a specific effect.

Front 90

14. POTENCY

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is the measure of the strength or concentration of a drug required to produce a specific effect,
b. e.g. Morphine 10mg vs. Dilaudid 1mg.

Front 91

15. EFFICACY

Back 91

a. refers to the largest effect a drug can produce

Front 92

16. Factors influencing the body’s response to a drug;

Back 92

a. Weight
b. Age
c. gender
d. physiologic factors
e. pathologic factors
f. genetic factors
g. immunological factors
h. psychological factors
i. environmental factors
j. tolerance

Front 93

1. Pharmacodynamics

Back 93

a. is the study of what drugs do to the body and how they do it.

Front 94

2. Mechanism of Action or Therapeutic Effect

Back 94

a. can produce actions (therapeutic effects)

Front 95

several ways Therapeutic Effect a. can produce actions

Back 95

i. Can increase or decrease the rate at which a cell or tissue functions.
ii. can modify the strength of a cells function
iii. can not cause a cell to perform a function that is not a part of its natural function.

Front 96

3. Drugs exert their actions in three ways

Back 96

b. Agonist
c. Enzymes
d. Nonselective Interaction

Front 97

a. Receptors

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i. a drug binds to receptor sites on the cell and produce an action

Front 98

b. Agonist

Back 98

i. drug binds to receptor and produces a response

Front 99

Four types of Angonists

Back 99

Partial Agonist
Antagonist
Competitive agonist
non competitive agonist

Front 100

ii. Partial Agonist

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1. drug binds to receptor, response diminished compared with that elicited by an agonist.

Front 101

iii. Antagonist

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1. drug binds to receptor and produces no response. Drug prevents binding of agonists.

Front 102

iv. Competitive antagonist

Back 102

1. drug competes with agonist for binding site on receptor. If it binds, no response.
2. This is a reversible reaction.

Front 103

v. Noncompetitive antagonist

Back 103

1. binds to the receptor sites and blocks the effects of the agonist, non-reversible reaction.
2. Giving larger doses of the drug can not reverse its action.

Front 104

c. Enzymes

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i. are proteins that change the rate of chemical reactions without themselves being changed and without an external energy source.

Front 105

Enzymes catalyze

Back 105

nearly every biochemical reaction in a cell.

Front 106

iii. Drugs either enhance or inhibit a cells action through

Back 106

its interaction with the cells enzyme system.

Front 107

d. Nonselective Interaction

Back 107

affect cell membranes and various cellular processes which alter metabolic activities. These drugs can alter physically or chemically there cellular processes.

Front 108

1. PHARMACOTHERAPEUTICS

Back 108

a. is the study of the use of drugs in the treatment of disease.

Front 109

2. Assessment

Back 109

a. present drug therapy, prescribed drugs, OTC drugs. street/illicit drugs.

Front 110

3. Types of Drug Therapy:

Back 110

a. Acute
b. Maintenance
c. Supplemental
d. Palliative
e. Supportive
f. Prophylactic/Empiric

Front 111

4. Monitoring

Back 111

a. evaluation must be done to determine the patient’s clinical response to the drug.

Front 112

b. All drugs are potentially toxic and can have

Back 112

cumulative effects.

Front 113

5. Therapeutic Index

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i. the ratio of the drugs toxic level to the level that provides therapeutic benefits.

Front 114

ii. The safety of a drug is determined by

Back 114

the Therapeutic index

Front 115

b. Low-therapeutic index

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i. difference between the therapeutic dose and toxic dose is small.
ii. May cause an adverse reaction.

Front 116

6. Drug Concentration

Back 116

a. certain drug levels are associated with therapeutic responses and some drug levels are associated with toxic levels.

Front 117

7. Patient’s Condition

Back 117

a. concurrent diseases or other medical conditions may impact the patient’s response to drug therapy.

Front 118

8. Tolerance

Back 118

a. when the body becomes accustomed to a particular drug over a period of time, the response is decreased.

Front 119

9. Dependence

Back 119

a. occurs when an individual needs a drug to function normally, can be physiological (physical dependence) or psychological (addiction).

Front 120

10. Cross-Tolerance/Cross Dependence

Back 120

a. occurs when tolerance or dependence develops to different drugs which are chemically related,

Front 121

11. Withdrawal

Back 121

a. occurs when a drug is no longer administered to a dependent patient; barbiturates, benzodiazepines.

Front 122

c. The more drugs a patient receives

Back 122

the more likely that a drug interaction will occur, especially in the older adults.

Front 123

d. OTC medications and herbal remedies can

Back 123

interact significantly with prescribed medication.

Front 124

e. Drugs may inhibit absorption of other drugs

Back 124

across biologic membranes

Front 125

f. Combining one drug with another drug or with food can

Back 125

cause interactions that increase or decrease absorption, depending on the substances involved,

Front 126

drug-food interactions can result in

Back 126

toxicity or therapeutic failure

Front 127

i. If the rate of absorption is delayed

Back 127

, then the effects of the medication are delayed

Front 128

ii. Food can cause

Back 128

changes in the G.I. tract which may increase, decrease or stop absorption of medications.

Front 129

ii. Food can

Back 129

take longer for medications to reach peak levels

Front 130

c. Foods can increase

Back 130

absorption.
i. Peak effects can be heightened.

Front 131

i. Tetracycline

Back 131

1. should be taken on an empty stomach to be absorbed properly

Front 132

ii. Iron preparations

Back 132

1. will decrease absorption of calcium

Front 133

iii. Chocolate, spinach, and nuts

Back 133

1. will decrease absorption of calcium

Front 134

iv. Wheat bran, rolled oats and sunflower seeds

Back 134

1. will decrease the absorption of DIGOXIN. However, they lower cholesterol levels in the blood.

Front 135

v. Black licorice

Back 135

1. decreased the effects of anti-hypertension medications.

Front 136

2. Licorice taken with DIGOXIN may lead to

Back 136

irregular heart rhythms and cardiac arrest.

Front 137

3. Licorice and diuretics may cause

Back 137

potassium levels in the body to fall.

Front 138

vi. Grapefruit juice or the fruit

Back 138

1. can inhibit the metabolism of certain drugs, thereby raising their blood levels,

Front 139

3. Grapefruit affects

Back 139

the livers ability to metabolize a drug.

Front 140

vii. Orange juice

Back 140

1. should not be consumed with antacids that contain aluminum.

Front 141

viii. Leafy green vegetables high in Vitamin K

Back 141

1. should not be taken in great quantities while taking anticoagulant medications like Coumadin.

Front 142

ix. Cranberry juice and Coumadin when taken together

Back 142

1. increase bleeding

Front 143

x. Milk

Back 143

1. does not mix with some laxatives,

Front 144

xi. Regular soda and diet soda

Back 144

1. decreases the absorption of Calcium.

Front 145

xii. A combination of Monoamine oxidase (MAO) inhibitors (a family of antidepressants) and aged cheese, wines, yeast extracts, Chianti wine can

Back 145

can raise blood pressure to a life-threatening level.

Front 146

xiii. Theophylline (an asthma medication) + caffeine =

Back 146

excessive CNS stimulation.

Front 147

1. Charcoal broiled meats and smoking can decrease

Back 147

decrease theophylline levels reducing effectiveness.

Front 148

xiv. Potassium sparing diuretics (Spironolactone) + salt substitutes (main ingredient is KCL) =

Back 148

dangerously high potassium levels.

Front 149

b. Cancer drugs are being administered according to the patient’s

Back 149

circadian rhythms.

Front 150

a. Additive Effects

Back 150

i. when 2 drugs with similar actions are given together in smaller doses to produce an effect equal to one of the drugs at a higher dose. The 2 drugs are given in smaller doses thus avoiding a toxic reaction, but providing good pain relief;

Front 151

b. Synergistic Effects

Back 151

the response elicited by combined drugs is GREATER THAN the effect of each drug given separately. Two antibiotics may be given to fight infection more effectively than one antibiotic,

Front 152

c. Antagonistic Effects

Back 152

i. a drug inhibit the effect of another drug,

Front 153

d. Incompatibility

Back 153

i. occurs when 2 parenteral drugs or solutions are mixed together and results in chemical deterioration of one or both drugs,

Front 154

1. Adverse Drug Events (ADE)

Back 154

a. any reaction to a drug that is not expected.
b. A broad term to describe and adverse outcome of drug therapy in which a patient is harmed due to internal (body) or external (staff errors) factors.

Front 155

MOST COMMON ADE

Back 155

IS A MEDICATION ERROR

Front 156

1. Adverse Drug Events (ADE)

Back 156

e. any reaction to a drug that is unexpected and occurs at therapeutic dosages. Less predictable and may or may not be preventable.

Front 157

f. There are 4 general categories of ADR:

Back 157

i. Pharmacologic reactions
ii. Hypersensitivity (allergic) reactions
iii. Idiosyncratic reactions
iv. Drug Interactions

Front 158

2. MEDWATCH PROGRAM

Back 158

a. Food and Drug Administration Program that monitors and assesses the incidence of adverse reactions. Reports can be faxed to 1-800-FDA-0178.

Front 159

3. Pharmacologic Reaction

Back 159

a. a drug used to treat a disease may be more effective than desired,

Front 160

4. Hypersensitivity (allergic) Reactions

Back 160

an allergic reaction
involves the patient’s immune system which can result in a mild rash to anaphylaxis,

a life-threatening reaction with airway constriction cause by bronchospasms, tachycardia and cardiovascular collapse which may result in death.

Front 161

iii. Always check for allergies...

Back 161

before administering any drug to a patient.

Front 162

1. A person cannot be allergic to a drug

Back 162

that they have never taken, but they can have cross allergies within the same drug class.

Front 163

b. Cross Sensitivity

Back 163

i. sensitivity to one group of drugs may cause a cross sensitivity to another group of drugs that are chemically similar,

Front 164

call for help immediately if

Back 164

i. if a patient begins to exhibit signs of anaphylaxis after receiving a medication maintain the airway

Front 165

ii. Symptoms of anaphylaxis may include:

Back 165

1. rapid onset, sweating, feeling of apprehension, tightness in throat, bronchospasms, tingling in mouth, face or throat, itching, weakness, loss of consciousness.
5. Idiosyncratic Reaction

Front 166

5. Idiosyncratic Reaction

Back 166

a. is an unexpected and unpredictable reaction to a drug. It is a genetically determined abnormal response to a drug,

Front 167

6. Iatrogenic Reaction

Back 167

a. Unintentional adverse effects that occur during treatment.

Front 168

7. SIDE EFFECTS

Back 168

a. are expected, well-known reactions resulting in little or no change in the patient’s management.
b. The presence of side effects may not be a reason for the prescriber to stop a medication.
c. Side effects generally disappear with time.

Front 169

8. TOXIC EFFECTS

Back 169

a. may threaten life.
b. It can result from a single ingestion of a large amount of a drug such as an overdose.
c. If a patient is exhibiting toxic effects of a medication, DO NOT administer the next scheduled dose and notify the prescriber.

Front 170

9. Teratogenic

Back 170

a. drug induced birth defects.

Front 171

10. Mutagenic

Back 171

a. drugs can cause genetic mutation by changing a cell’s DNA.

Front 172

11. Carcinogenic

Back 172

a. some drugs have cancer causing effects.

Front 173

a. Cytotoxic Reaction

Back 173

i. the drug attached to a cell site is perceived as an antigen and is attacked by antibodies in the blood destroying the cell.

Front 174

a. Cytotoxic Reaction symptoms

Back 174

1. >hives, rash, difficulty breathing, increased B/P and HR, dilated pupils, diaphoresis, “panic” feeling, and respiratory arrest.

Front 175

b. Serum Sickness Reaction

Back 175

i. appears 2-3 weeks post ingestion of a drug
1. ->fever, rash, joint pain, and ENLARGED SPLEEN

Front 176

c. Delayed Allergic Reaction

Back 176

i. occurs several hours after exposure and involves antibodies that are bound to specific white cells

Front 177

Delayed Allergic Reaction signs and symptoms

Back 177

1. -> rash, hives, swollen joints, edema of the face and limbs.

Front 178

d. Erythema Multiforma

Back 178

i. a rash that is usually caused by an immune response to drugs.
ii. It may express itself on the skin in “multiforme” ways, including macules, papules, blisters, and hives.

Front 179

13. ASSESSMENT

Back 179

a. The nurse is responsible for checking all clinical responses to medication, both positive and negative, document and report to prescriber.

Front 180

pregnant woman should not

Back 180

1. no medication, including OTC or herbal remedies, other than those prescribed by the physician

Front 181

2. In some cultures certain herbs ____ be taken by the pregnant woman because it is the norm for the culture.

Back 181

May

Front 182

ii. Breast Feeding

Back 182

1. drugs may cross into breast milk and impact the infant. If breast feeding a mother should take medications only on the advice of the physician.
b. Elderly

Front 183

b. Elderly life span considerations

Back 183

i. Polypharmacy
ii. Physiologic changes
iii. Pharmacokinetics – absorption, distribution, metabolism, excretion
iv. Problematic medications

Front 184

16. Controlled Substance Schedule is in place to

Back 184

a. Strengthens law enforcement authority.

Front 185

16. Controlled Substance Schedule

Back 185

C-I – highest abuse potential
C II – high abuse potential
C- III – less than C-I
C-IV – less than C-III
C-V – less than C-IV

Front 186

a. OXYCONTIN

Back 186

ii. First marketed in 1997
iii. Fastest growing drug of abuse
iv. It is a slow release tablet
v. Abusers chew it or crush it to snort or inject the powder

Front 187

18. NEW DRUG DEVELOPMENT

Back 187

a. Before drugs can be approved for marketing, their efficacy and safety must be tested in animal and human population studies

Front 188

a. Informed Consent

Back 188

i. for Volunteers
ii. careful explanation of purpose of a study.
iii. describes procedures used and risks involved.
iv. Informed volunteer’s uninformed or coerced subjects.

Front 189

a. standards and scope of practice are well defined by

Back 189

i. Federal
ii. State
iii. Local
iv. Institutional policies and procedures

Front 190

21. Ethical Practice

Back 190

a. Autonomy
b. Beneficence
c. Confidentiality
d. Justice
e. Nonmaleficence
f. Veracity

Front 191

22. Cultural Considerations

Back 191

a. the US is a country of tremendous cultural diversity. Drugs are frequently prescribed as a major part of the treatment process.

Front 192

23. Ethnopharmacology

Back 192

a. examines the effects of drugs on specific ethnicities

Front 193

24. Drug Polymorphism

Back 193

a. refers to the effect of patient’s age, gender, size, body composition and other characteristics on pharmacokinetics.

Front 194

25. Cultural Assessment

Back 194

a. health beliefs
b. folk remedies
c. home remedies
d. usual response to illnesses
e. religious practices
f. dietary habits
g. OTC treatment

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a. Common classes of meds. involved in serious errors

Back 195

i. Antibiotics
ii. Anticoagulants
iii. Anti-diabetic drugs
iv. Anti-neoplastic drugs
v. Cardiovascular drugs
vi. CNS drugs
vii. Vaccines
viii. Elderly – most dangerous drugs
ix. digoxin, warfarin, insulins

Front 196

a. Patient education is required of all nurses’ by

Back 196

each state Nurse Practice Act.

Front 197

b. General teaching/learning principles

Back 197

i. patient centered
ii. assess readiness to learn
iii. patient’s ability to learn
iv. literacy level
v. use of pictures, demonstrations, return demonstrations
vi. interpreters for non-English speaking patients
vii. family support
viii. keep it simple
ix. repetition
x. resources for up to date information

Front 198

28. Patient/Family Teaching of Medications

Back 198

a. name, dose, action of drug
b. timing of administration
c. specific OTC drugs or alternative therapies
d. specific comfort or safety issues
e. safety measures
f. specific points about drug toxicity
g. specific warnings about drug discontinuation

Front 199

29. Discharge Teaching

Back 199

a. follow institutional policies
b. do not assume that adequate teaching has occurred
c. begin discharge teaching as soon as possible
d. minimize distractions
e. evaluate teaching
f. use social service and/or discharge planner for follow-up
g. document
h. document teaching/learning strategies

Front 200

1. OTC meds. account for __________
of all medications used in US.

Back 200

60% of all medications used in US.

Front 201

2. Americans spend approx ______ annually on OTC drugs

Back 201

$20 billion dollars

Front 202

____ of Americans take at least one OTC drug every ____

Back 202

3. 40%
2 days

Front 203

4. the average home medicine cabinet contains approx

Back 203

24 OTC preparations

Front 204

5. With most illnesses, initial therapy consists of

Back 204

self-care, including self medication with an OTC drug.

Front 205

_____ as many illnesses are treated by the consumer using an ________

Back 205

6. Four times
OTC drug than by visiting a physician

Front 206

a. Categories of abused substances

Back 206

i. uploads
ii. stimulants
iii. depressants

Front 207

a. DIGOXIN

Back 207

primarily for the treatment of heart failure. Increases the force of contraction which increases cardiac output and slows the heart rate allowing more time for the ventricles to fill with blood.

Front 208

DIGOXIN side effects

Back 208

most common is bradycardia

Front 209

DIGOXIN half-life

Back 209

is 36-48 hours

Front 210

DIGOXIN has a ______ theraputic index

Back 210

v. Narrow therapeutic index -> toxicity, high alert status

Front 211

Nursing interventions for Digoxin

Back 211

vii. Nursing – monitor apical rate before giving. Less than 60 hold and call physician.
viii. Electrolytes – monitor potassium levels.
ix. Blood Chemistry – BUN, Creatinine

Front 212

11. Diuretics

Back 212

a. Classified according to site of action in the kidneys. Remove excess fluid from the body.

Front 213

c. Loop diuretics

Back 213

most potent, used mainly for CHF and renal disease, monitor electrolyte especially KCL, e.g. Furosimide (lasix).

Front 214

Potassium sparing diuretics work by

Back 214

removes excess fluid while preserving KCL,

e.g. Spironolactone.

Front 215

e. Thiazides

Back 215

cheapest and most commonly used. Long half-life. Dosing generally once a day, e.g. Hydrochlorothiazide (HCTZ)

Front 216

11. Diuretics Indications

Back 216

control B/P

Front 217

12. Laxatives Indications

Back 217

– prevention and treatment of constipation and bowel preparation for radiologic or endoscopic procedures.

Front 218

Laxatives Contraindicated in

Back 218

persistent abdominal pain, n/v of unknown cause especially with fever and signs of acute abdomen.

Front 219

c. Laxatives should be for

Back 219

for short term use only. Long term use can lead to decrease bowel tone and dependency.

Front 220

k. Types of laxative

Back 220

l. bulk forming
m. osmotic
n. salines
o. Emollients (stoolsofteners)
p. stimulants

Front 221

COMMON LABORATORY TESTS

Back 221

1. hemoglobin
2. hematocrit
3. RBC’s
4. WBC’s
5. Platelets
6. Glucose
7. Albumin
8. Sodium
9. Potassium
10. Chloride
11. Renal
12. BUN
13. Creatinine