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110 Cards in this Set
- Front
- Back
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Define Pharmacology and discuss the use of drug therapy |
study of drugs or chemicals that alter functions of living organisms
prevent, diagnose or cure diseases or disease processes to relieve symtoms |
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Sources of drugs (6) |
1. plants (morphine) 2. animals (insulin used to be made from pork) 3. minerals (iron) 4. synthetic (standardized, consistent, less likely to cause allergic reaction 5. semi-synthetic (some antibiotics) 6. biotechnology (manipulate DNA/RNA and recombine genes)
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How are drugs classified? |
by their effect on the body and their therapeutic use |
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What is a prototype? give 2 examples |
individual drugs that represent an entire group of drugs. Usually the first drug developed in the group and standard for newer versions.
ex) Morphine prototype for opiates and analgesics
ex) Penicillin prototype for antibacterials |
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What is a generic drug? give two examples |
Drug related to the chemicals of trade name drug that is always spelled in all lower case
name suggests the drug group. Ex) "-cillin" tells us it is an antibacterial drug Ex) acetaminophen = Tylenol Ex) ibuprofen = Advil
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What is a Trade name drug? Give one example |
Name designated and patented by the manufacture after having been developed by the manufacture
Ex) Paxil |
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Name two drugs that went from RX to OTC |
Pepcid and Zantac |
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Pure Food and Drug Act |
Establish the standards and requirements for drug labeling |
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Durham-Humphrey Amendment |
designated drugs that must be prescribed by a doctor and dispensed by a Pharmacist |
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Comprehensive Drug Abuse Prevention and Control Act, Title II, Controlled Substance Act, categories of controlled substanes |
Regulates the distribution of narcotics, categorizes it (Schedule I-V) by usefulness and its potential for abuse. |
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Schedule I definition and give examples |
Not approved for medical use, high abuse potential, not used for healthcare
ex) Heroin, LSD, Marijuana |
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Schedule II definition and give examples |
Used often in healthcare but has high abuse potential
Ex) codeine, morphine, oxycontin, cocaine, barbituates |
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Schedule III definition and give example |
less potential for abuse but may lead to dependence
ex) anabolic steroids |
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Schedule IV definition and give examples |
Little potential for abuse
ex) Diazepam, valium, lorazepam, Ambien |
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Schedule V definition and give example |
Contain moderate amounts of controlled substances
ex) cough medicine with codeine or hydrocodone in it |
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Orphan Drug Act |
Manufactures get decreased taxes and competition for creating drugs that treat serious disorders affecting only a small portion of population |
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Who oversees the drug approval process and what do they do? |
The FDA insures the safety and effectiveness of drugs by starting with animals then moving to the 4 phases of human studies |
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Phase I - Healthy People - what happens? |
determines dosages, routes of administration, absorption, excretion and metabolism.
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Phase II - Few subjects with target disease - what happens? |
looks at their responses compared to phase I people |
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Phase III - Large double blind study - what happens? |
placebo controlled study completed |
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Phase IV - FDA evaluates and monitors - what happens? give examples |
Drug is marketed for use but manufacture must monitor and report affects because many adverse affects may come to light later on.
ex) Vioxx - for pain but caused heart problems ex) Baycoll - statin but caused rhabdo |
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What does QSEN stand for and what do they do? |
'Quality and Safety Education for Nurses' Project
study of HC systems by focusing on the needed knowledge, skills and attitude required for future nurses. "What needs to be taught to nurses so they will be safe administers of medicine?"
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Where did the National Patient Safety Goals originate what does it do? |
Came from Joint Commission
Hospitals pay to be accredited and must implement strategies to enhance safety
Ex) No more abbreviations
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High Alert Medications |
Drugs that if used in error can cause significant harm |
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FDA Pregnancy Categories - hard to do research or logistical and ethical reasons |
A - no fetal risk B - animal studies show no risk but no adequate study on humans C- potential risk but drug may be used. Animal studies do show fetal toxicity but benefit outweighs risk D - evidence of fetal risk but potential benefit to mother may be acceptable. Used only in very serious situations. X - Fetal risk outweighs any benefit |
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What is Pharmacokinetics and what are the steps? |
Drug movement through the body
1. Absorption 2. Distribution 3. Metabolism 4. Excetion |
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Tell me about the Absorption step |
-its the time from when the drug enters the body to when it enters the blood stream -Things that effect: dosage, form, administration, blood flow to area, GI function, food -Administration: IV, SC, IM, PO, SL, Transdermal, inhalation |
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Tell me about the Distribution step |
-Transport of drugs through the bloodstream to the site of action -Drugs form compound with albumin which acts as a carrier for drug, only freed drug proteins have effect on body - this allows for drugs to be released as needed (lowers toxicity and more consistent blood flow) - drugs that are "highly bound" have long duration of action Nurse implication: patients with hypotension, low albumin, brain disorders and those preg/breastfeeding |
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Other name for plasma proteins |
Albumin |
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Tell me about the metabolism step |
- when drugs are biotransformed (inactivated in body) -liver enzymes transform drug into the water soluble metabolites so kidneys can excrete |
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Enzyme induction |
drugs that stimulate liver cells to produce larger amounts of drug metabolizing enzymes |
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Enzyme inhibition |
occurs with concurrent administration of 2+ drugs that compete for the same metabolizing enzymes |
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First pass effect |
Drugs that are extensively meabolized in the liver and only part of it reaches systemic circulation - drugs that have a "large first pass" may need to be given in higher dosage to treat problem |
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Tell me about the Excretion step |
-elimination of drug from body either unchanged through bowel (if taken PO) or as metabolites in urine |
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Serum Drug level |
measurement of amount of drug in blood -figures out outset, peek and duration of drug action |
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Serum half-life |
time of concentration of drug to decrease by 50% -determines rate of metabolism |
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What is Pharmacodynamics? |
The biochemical alterations made on target cells by drugs |
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What is receptor theory and what are the various ways it can work? |
drugs chemically bind with protein receptors on cell surface -it can increase/decrease intracellular activity, change membrane permeability, change synthesis and release neuro hormones -Agonist - speeds up function (epinephrine) -Antagonist - slows function |
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4 Variables that affect drug actions |
1. Dosage 2. Route 3. Diet 4. Drug-drug interactions |
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How does dosage affect drug action? |
-can be low or too high (toxicity)
Example) too little of anti-seizure drug can actually cause seizure |
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How does route affect drug action? |
-IV takes between 3-30 minutes to take affect, PO takes between 30-60. |
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How does diet affect drug action? |
-slows the affect in most cases -need to eat 2+ hours before and 1+ hour after However, not all: Example) Zetia needs to be taken with food |
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What kind of food can Coumadin (blood thinner) not be taken with? |
Too much leafy greens cause drug not to work |
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What kind of food are those on statins not allowed to eat? |
grapefruit |
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What 4 affects does drug-drug interactions have on drug affect? |
1. Additive - drugs that have similar action cause more effect when together (ex. Alc and sedative) 2. Synergism - drugs with different actions cause more effect when together (Tylenol and codeine) 3. Interference -when one drug disrupts the metabolism/excretion of other drug 4. Displacement - when one drug takes over the binding site of the other drug thus increasing effect of displaced drug. -ex) Don't give aspirin with Coumadin |
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What are 5 patient related variables? |
1. Age 2. Body weight 3. Genetic/ethnic 4. Gender 5. Psychological |
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Hematologic |
bleeding |
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Idiosyncrasy |
unexpected reaction when given drug first time |
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Teratogenicity |
causing abnormal fetal development |
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What are the 8 administration responsibilities designed for patient safety? |
1. Drug 2. Dose 3. Patient identification 4. Route 5. Time 6. Reason 7. Documentation 8. Legal order |
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What 8 things must be on legal order? |
1. Name of patient 2. drug 3. dose 4. route 5. frequency 6. date 7. time 8. Signature of prescriber (paper or electronic) |
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5 Techniques to eliminate medication errors |
1. CPOE - "computerized provider order entry" 2. Bar coding - scan patient wristband, medication and own nursing ID 3. Point of care - lab testing done sight on scene 4. Not using abbreviations 5. Medication reconciliation - medication (RX and OTC) from patient |
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What do antimicrobials do? |
inhibit cell walls inhibit protein synthesis disrupt cell membrane inhibit reporduction inhibit cell metabolism or growth |
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Bactericidal vs Bacteriostatic |
Killing bacteria vs. inhibiting bacterial growth |
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Prophylactically |
given to patient prior to medical procedure as prevention |
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What are the kind of antibacterial meds? |
1. Penicillin 2. Cephalosporins 3. Carbapenems 4. Aminoglycosides 5. Tetracyclines 6. Sulfonamides/urinary agents 7. Floroquinolones 8. Macrolides 9. Vancomycin 10. Drugs for TB |
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Penicillin G/Amoxicillin (Penicillin G, Amoxicillin) |
Class: Antibacterial Type: penicillin Principle: attack gram+ bacteria (resistance growing b/c overuse may require higher dose) Use: strep, pneumonia, endocarditis (used prior to dental work), menigitis Adverse: rash b/c could cause anaphylaxis next time Nurse imp: allergic reaction, patient have empty stomach |
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Zosyn (Zosyn) |
Class: Antibacterial Type: penicillin Principle: attack gram- bacteria/anaerobic organisms Use: extended spectrum to treat nosocomial infections Adverse: rash b/c could cause anaphylaxis next time Nurse imp: allergic reaction, patient has empty stomach
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Kefzol (cephalexin) |
Classification: Antibacterial Type: Cephalosporins (1st generation) Principle: broad spectrum gram +/- by inhibiting cell walls Use: surgical prophylaxis Adverse: GI symptoms Nurse implication: structurally similar to penicillin so be aware about allergies, not taken much anymore because has to be taken 4/day and patient compliance low.
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Cefotan (cefoxetan) |
Class: Antibacterial Type: Cephalosporin (2nd generation) Principle: broad spectrum gram+/- by inhibiting cell walls Use: surgical prophylaxis used 60 mins prior to procedure Adverse: GI symptoms Nurse imp: structurally similar to penicillin so be aware of patient allergies |
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Rocephin (cefriaxone) |
Class: Antibacterial Type: Cephalosprorin (3rd generation) Principle: broad spectrum gram+/- by inhibiting cell walls Use: gonorrhea Adverse: GI symptoms Nurse imp: structurally simular to penicillin so be aware of patient allergies |
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Maxipime (cefeprime) |
Class: Antibacterial Type: Cephalosporin (4th generation) Principles: broad spectrum gram +/- by inhibiting cell walls Use: wide variety of bacterial infections Adverse: GI symptoms Nurse imp: structurally similar to penicillin so be aware of patient allergies
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Teflaro (ceftatoline) |
Class: Antibacterial Type: Cephalosporin (5th generation) Principles: broad spectrum gram+/- by inhibiting cell walls Use: MRSA Adverse: GI symptoms Nurse imp: structurally similar to penicillin so be aware of patient allergies |
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Primaxin (imipenem cilastatin) |
Class: antibacterial Type: Carbapenems Principle: inhibit cell wall synthesis Use: staph, ecoli Adverse: seizures, cross sensitivity to penicillin Nurse imp: for use w/ acutely ill hospitalized patient with complicated body cavity/tissue infections |
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Streptomycin (Streptomycin) |
Class: antibacterial Type: Aminoglycosides Principle: inhibit gram- protein synthesis Use: active resistant TB Adverse: nephrotoxic, ototoxic Nurse imp: always given IM due to toxicity, take blood trough levels to prevent renal toxicity
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Nebcin (tobramysin) |
Class: antibacterial Type: Aminoglycosides Principle: inhibit gram- protein synthesis Use: wide variety of antibacterial infections Adverse: nephrotoxic, ototoxic Nurse imp: never give PO due to toxicity, take blood trough levels to prevent renal toxicity |
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Garamysin (gentamicin) |
Class: antibacterial Type: Aminoglycosides Principle: inhibit gram- protein synthesis Use: meningitis, endocarditis Adverse: neprotoxic, ototoxic Nurse imp: given IM or IV to preven toxicity, take blood trough levels to prevent real toxicity |
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Sumycin (tetracycline HCL) |
Class: antibacterial Type: Tetracyclines Principle: gram +/- bacteria Use: H pylori, chlamydia, PID (pelvic inflammatory disease), acne, syphilis Adverse: renal failure, teeth yellowing Nurse imp: lots of resistance but can be used in patients with penicillin allergy, must be 8yrs+, no expecting mothers |
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Cipro (ciprofloxacin) |
Class: Antibacterial Type: fluoroquinolones Principle: interferes with enzymes required for DNA synthesis Use: respiratory, GI and GU infections Adverse: GI symptoms Nurse imp: |
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Bactrim (trimethoprim/sulfamethoxozole) |
Class: Antibacterial Type: Sulfonamides/urinary agent Use: UTI Adverse: N/V/D, allergic reaction |
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Pyridium (phenazopyridine) - urinary aseptic |
Class: antibacterial Type: sulfonamides/urinary agents Use: UTI burn/urgency Adverse: doesn't get rid of UTI, only treats symptoms, turns pee orange Nurse imp: usually taken with Bactrim |
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Silvadene (silver sulfadiazine) |
Class: Antibacterial Type: sulfonamide Use: topical burns Nurse imp: ointment |
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E-mycin (erythromycin) |
Class: antibacterial Type: macrolides Use: wide variety of bacterial infections Adverse: GI symptoms Nurse imp: not used widely b/c must be used 4 times/day |
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Zithromax (azithromycin) |
Class: antibacterial Type: Macrolides Use: staph, strep, gonorrhea, chlamydia Adverse: GI symptoms Nurse imp: very popular b/c only needs to be taken 1/day for 5 days |
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Vancocin (vancomycin) |
Class: antibacterial Type: vancomycin Principle: gram+ organisms Use: severe infections, MRSA, given PO only for clostridium difficile Adverse: ototoxicity, nephrotoxicity Nurse imp: poorly absorbed in GI, give IV but watch for "red man syndrome" will go away if rate slowed, watch blood levels
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Flaygl (metronidazole) |
Class: Antibacterial Type: metronidazole Principle: anaerobic organisms Use: intraabdominal, gyn, trichomoniasis Adverse: dizziness, HA, GI, metallic taste Nurse imp: No ETOH (alc) for for 24 hrs prior and 36 hrs after |
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Drugs for TB (tubercle bacilli) |
Principle: usually bacteria in bone, brain, kidney Adverse: liver and renal impairment Nurse imp: drugs 95% effective when taken with strict adherence and in combination, also prevents resistance. -direct observe therapy: low compliance with these drugs so some patients must go into to HC facility to be observed taking drugs -need to moitor liver, culture sensitivity, CXR findings, no ETOH!!!!
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Name the 4 TB drugs |
1. INH (isoniazid) - used by latent TB patient as prophylaxis 2. Rifadin (rifampin) 3. Tebrazid (pyrazinamide) 4. Myambutol (ethambutol) |
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Tamiflu (oseltamivir) |
Classification: Antiviral Principle: inhibit replication of virus Use: influenza A or B Adverse: bronchospasm Nurse imp: need to start within 2 days of symptoms (useless after that), caution with asthmatic patients |
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Zovirax (acyclovir) |
Classification: Antiviral Principle: inhibit viral DNA replication Use: IV, PO and topical for genital herpes lesions and pain Nurse imp: not a cure, just for symptoms. resistance growing. |
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Drugs for HIV/AIDS |
Classification: Antiviral Principle: early/regular treatment decreases viral load Use: to prolong quality/quantity of life Nurse imp: complex/inexpensive combo of drugs, resistance is starting, patient usually treated using 2 NRTIs and a protease inhibitor
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Name the 4 HIV/AIDS drugs |
1. AZT (zidovadine) - Nucleoside reverse transcriptase inhibitor 2. Sustiva (efavirenz) - non-nucleoside reverse transcriptase inhibitor 3. Invirase (saquinavir) - protease inhibitor 4. Fuzeon (enfuvirtide) fusion inhibitor |
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Fungizone (amphotercin B) |
Classification: Antifungal Principle: disrupt cell membrane Use: Given IV to patients with life threatening fungal infection Adverse: temp neprotoxic, chilling, HA, N/V, pain Nurse imp: prior to use patient needs to be given acetaminophen, antihistamine and pain med |
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Mycostatin (nystatin) |
Classification: Antifungal Principle: disrupt cell membrane Use: topical for mouth/vaginal infections |
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Diflucan (fluconazole) |
Pretty much the same as Fungizone but not as many adverse symptoms |
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Lamisal (terbinafine) |
Classification: Antifungal Principle: disrupt cell membrane Use: Ringworm (use topically), Toe fungus (PO) Nurse imp: PO treatment for toe fungus is a long treatment process |
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Nix (permathrin) |
Classification: Antiparasitic Use: head lice (pediculosis), itch mite (scabies) Nurse imp: instruct patient about personal hygiene, environment cleanliness, foreign travel precautions, food handling, condom use |
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Vermox (mebendazole) |
Classification: Antiparasitic Use: Pin worms (enterobiasis) Nurse Imp: instruct patient about personal hygiene, environment cleanliness, foreign travel precautions, food handling, condom use |
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How long do live vaccines last? give example |
-They are lifelong
-chicken pox |
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How long do attenuated vaccines last? give examples |
-a few years, they require boosters
-flu, tetanus |
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Toxid |
substance containing antigens that are modified and inactivated |
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Serum sickness |
-occurs when patient gets repeated serums of immunizing drugs -edema of face, tongue, throat. fever, flushing -treated with antihistamines
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How long should a female avoid pregnancy after receiving a rubella and varicella vaccine? |
3 months |
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Vaccine adverse reporting system |
need to report when any dangerous or unusual reaction occurs to a vaccine |
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Sandimmune (cyclosproine) |
Classification: immunosupressant Principle: inhibits T-lymphocytes Use: IBS, Arthritis, prevents organ rejection after transplant Adverse: tremors, NA, oral candida, seizures, HTN, nephrotoxicity Nurse imp: females should not get pregnant during or up to 12 weeks after tx, need to take at the same time everyday with meals, use spoon provided for consistency, keep refrigerated, mix with juice and drink immediately, use glass container, use hygiene after use |
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Remicade (infliximab) |
Classification: tumor necrosis Principle: alpha blocker, decreases inflammation Use: rheumatoid arthritis, Crohn's disease Adverse: HA, dizziness, fatigue, anxiety, fever, rash Nurse imp: don't breastfeed, watch for blood in stools, watch for TB (can activate latent TB), other infections, anaphylaxis, patient may take acetaminophen or diphenhydramine prophylactically |
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Name the 5 types of Antineoplastics and what is the goal of these? |
1. Antimetabolites 2. Plant Alkaloids 3. Alkylating agents 4. Anti-tumor antibiotics 5. Interferons
-To kill percentage of cells and let patients immune system do the rest |
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Rheumatrex (methotrexate) |
Classification: Antineoplastic Type: Antimetabolites Principle: cell-cycle specific, prevent cancer cell DNA formation Use: cancer, rheumatoid arthritis Adverse: bone marrow suppression, mucositis, GI ulceration, alopecia Nurse imp: avoid alc, aspirin, sunlight, secreted in kidneys, watch WBC and platelet counts, use soft toothbrush |
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5-FU (flurouracil) |
Classification: antineoplastic Type: Antimetabolite Principle: cell-cycle specific, prevent cancer cell DNA formation Use: cancer Adverse: bone marrow suppression, mucositis, GI ulceration, alopecia Nurse imp: drink lots of water, use soft toothbr. |
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Oncovin (vincristine) |
Classification: antineoplastic Type: plant alkaloids Principle: cell-cycle specific, stop mitosis Use: Hodgkins, ALL (acute lymphoplastic leuk.) Adverse: nerve toxicity due to extravasation, toxic to some patients with preexisting hepatic problems, alopecia, mucositis Nurse imp: administer into good vein, have central line or use port-a-cath going into subclavian vein, start anti-emetics before and during tx, ensure patient eats, risk of bleeding |
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extravasation |
when drugs "leak" out of veins and into tissues |
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Cytoxan (cyclophosphamide) |
Classification: Antineoplastic Type: Alkylating agent Principle: cell cycle non-specific Use: wide variety of malignancies Adverse: cystitis, bone marrow suppression Nurse imp: take on empty stomach, increase fluids |
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What were Alkylating agents first developed from? |
Mustard Gas |
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Platinol (cisplatin) |
Classification: Antineoplastic Type: Alkylating agent Principle: cell cycle non-specific Use: solid and hematological cancers Adverse: N/V, nephrotoxic, ototoxic Nurse imp: check renal function, patient will need lots of fluids!!! |
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Adriamycin (doxorubicin) |
Classification: Antineoplastic Type: Anti-tumor antibiotic Principle: cell-cycle specific, block DNA/RNA transcription Use: leukemia, breast, lung, ovary cancer Adverse: bone marrow suppression, GI upset, cardiotoxicity, tissue necrosis with IV infiltrate, alopecia Nurse: turns urine red, SOB, check for edema, excreted in bile, increases with impaired hepatic function |
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Roferon-A/Intron-A (interferon alfa 2a/2b) |
Classification: Antineoplastic Type: interferon Principle: reprograms virus to not grow so rapidly and makes T-cells more cytotoxic Use: hairy cell leukemia, kaposi's sarcoma, chronic hepatitis Adverse: flu-like, depression, suicide, photosensitivity Nurse imp: read label carefully (often dosed in mu), refrigerate, don't shake bottle |
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What are the 3 types of adjunct treatment drugs and what do they do? |
1. Hematopoietic 2. Colony stimulating 3. Interleukins
-they assist primary antineoplastic drug |
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Epogen (epoetin alfa) |
Classification: Adjunct treatment drug Type: Hematopoietic Principle: increases RBCs Use: renal failure, cancer, HIV Adverse: HTN, banned in sports, N/V/D Nurse imp: won't give until hemoglobin is <12, check blood counts, blood pressure |
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G-CSF/Neupogen (filgrastium) |
Classification: Adjunct treatment drug Type: Colony stimulating Principle: promotes the growth of granulocytes Use: patients with low WBC Adverse: bone pain, redness at injection Nurse imp: give 24 hrs after chemo, instruct patient to avoid potential infections |
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Proleukin (aldesleukin) |
Classification: adjunct treatment drug Type: interleukins Principle: activate cell immunity, inhibit tumor growth, prevent rapid growth in malignant cells Use: renal cancer, melanoma, HIV, Kaposi sarcoma |
