Intro To Pharm

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When sugar is added to improve the taste, the liquid is called

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syrup

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contains a drug in an alcohol solvent

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tincture

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When alcohol and aromatic flavorings are used, the liquid is called

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elixir

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prevents the drug from dissolving until it passes into the small intestine where the pH is less acidic.

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enteric coating

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Troches, also called

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lozenges

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Controlled substances are kept in

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double-locked cabinet and each dose dispensed must be properly documented

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Controlled Substances Schedule 1

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No accepted medical use; high potential for abuse (Heroin, LSD, marijuana)

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Controlled Substances Schedule 2

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Accepted medical use; high abuse potential; risk of psychological or physical dependence.

(Dilaudid, morphine, OxyContin, Ritalin)

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Controlled Substances Schedule 3

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Some appropriate medical uses; less abuse potential than Schedule I or II drugs; risk of psychological or physical dependence.

(Mixtures containing small amounts of controlled substances (e.g., codeine) Male sex hormones: androgens, anabolic steroids

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Controlled Substances Schedule 4

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Have appropriate medical uses; some potential for abuse; (Valium, Ativan,)

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Controlled Substances Schedule 5

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Some potential for abuse. Can be dispensed without prescription under certain regulations;

(buprenorphine, diphenoxylate plus atropine)

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refers to the movement of drug molecules in the body

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Pharmacokinetics

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Pharmacokinetics includes

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absorption, distribution, metabolism, and excretion of drugs (ADME)

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movement of a drug into the bloodstream from its site of administration

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Absorption

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Factors that affect drug absorption are

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1. fat and water solubility
2. ionization
3. pH
4. concentration (dose)
5. route of administration.

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oral route advantages

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1. Easy, convenient
2. no special skills required
3. usually least expensive
4. painless
5. safest (absorption can be prevented)

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oral route disadvantages

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1. Variable absorption,
2. some drugs inactivated by gastric acids or liver enzymes
3. may be irritating to gastrointestinal tract
4. requires patient cooperation

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Intravenous route advantages

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1. Rapid onset of action
2. more control over amount of drug delivered to the bloodstream
3. can be given in larger volumes of fluid
4. less local damage caused by irritating drugs

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Intravenous route disadvantages

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1. Most expensive route
2. requires special training
3. most dangerous (not readily reversed)
4. risk of fluid volume excess.
5. infection, embolism

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Intramuscular route advantages

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1. Can be used for poorly soluble drugs
2. drugs that are intended to be absorbed over time.

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Intramuscular route disadvantages

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1. Pain
2. inconvenience
3. requires special skill

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Percutaneous route advantages

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1. No special skills required
2. painless
3. rapid effects with sublingual, buccal, and inhalation routes;
4. transdermal route allows for slow absorption over time.

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Percutaneous route disadvantages

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1. Local irritation, especially with transdermal drugs

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transportation of a drug to the site of action by body fluids

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Distribution

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Factors that influence the rate and extent of drug distribution include

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1. Physical and chemical characteristics of the drug (ph and solubility)
2. Circulation to the intended site of action
3. Plasma protein binding:
4. Affinity for fatty tissue: drugs that are attracted to fat tissue are stored there and released slowly over time.

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the chemical reactions that alter foreign substances, including drugs, in the body

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Metabolism

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The ..... is the primary site of drug metabolism

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liver

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drugs such as central nervous system depressants, stimulate the liver to produce increased drug-metabolizing enzymes. Such drugs are known as

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liver enzyme inducers

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condition in which increasing amounts of the drug are needed to achieve the same effect.

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tolerance

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first-pass effect

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phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation

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four primary systems that affect the first pass effect of a drug are

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1. enzymes of the gastrointestinal lumen
2. gut wall enzymes
3. bacterial enzymes
4. hepatic enzymes

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The elimination of a drug from the body is called

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excretion

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primary organ of drug excretion

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kidneys

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secondary routes of drug excretion

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gastrointestinal (GI) tract, lungs, breast milk, and, to a small extent, saliva and sweat.

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interactions of drugs with cells and other body structures or components to produce characteristic effects.

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Pharmacodynamics

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based on the ability of drugs to attach to specialized regions of cells called receptors. (lock and key)

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receptor theory of drug action

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describes a drug’s ability to bind to a given receptor

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Affinity

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ability of a drug to produce an effect as a result of binding with a receptor

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Efficacy

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drug that produces a pharmacologic effect when it binds with a receptor.

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agonist (has both affinity and efficacy.)

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drug that combines with receptors without producing a pharmacologic effect or a drug that occupies receptor sites so that other drugs or chemicals cannot bind there.

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antagonist (sometimes referred to as “blockers” because they block the receptor sites.)

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Factors That Affect Drug Dosages and Actions

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1. body weight
2. age
3. gender
4. genetics
5. biologic rhythms
6. medical conditions
7. tolerance and cumulation
8. emotional state and beliefs about a drug

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body weight Affect Drug on Dosages

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larger people generally require greater doses of drugs than smaller people

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age Affect on Drug Dosages

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Young children have immature liver and kidney function so they may not metabolize or excrete the drugs efficiently. Some older people also have reduced liver and kidney function

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gender Affect on Drug Dosages

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higher proportion of fat in females, the effects of female hormonal cycles, females have not always been well represented in drug studies

pregnant women

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Genetics Affect on Drug Dosages

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presence or absence of specific drug-metabolizing enzymes is genetically based. People who lack a particular enzyme are unable to metabolize certain drugs. (

hypertension, whites respond better to beta-adrenergic blockers than African Americans. African Americans respond better to diuretics. )

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Biologic Rhythms Affect on Drug Dosages

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Patient responses to some drugs vary with biorhythmic cycles. For example, drugs given to promote sleep work better at the patient’s usual sleep time than at other times.

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Medical Conditions Affect on Drug Dosages

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Pathologic states can affect drug absorption, distribution, metabolism, and/or excretion. Examples of situations that influence drug effects include: liver/renal failure, Diarrhea

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Tolerance Affect on Drug Dosages

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Cross-tolerance occurs when the patient develops tolerance to one drug that causes tolerance to a second similar drug without previous exposure to the second drug.

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Drug Interactions Affect on Drug Dosages

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When two or more drugs are present in the body at the same time, there is a chance of drug interactions. Drug interactions can alter the effects of any of the drugs present.

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Psychological Factors Affect on Drug Dosages

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if the patient in pain lacks confidence that a given drug will be effective, it may indeed not work well for that person. On the other hand, belief that an agent will bring relief seems to enhance that effect.

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drug issues with older adults

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1. Polypharmacy: taking multiple drugs for multiple medical conditions
2. Limited financial resources
3. Hearing impairment: the pt. may not understand verbal instructions
4. Vision impairment
5. Cognitive impairment

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Drugs that cause abnormal embryonic or fetal development are said to be

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teratogenic

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drugs will have combined effects greater than either agent would have alone: may permit lower doses of each agent to be used, which achieves the goal with less risk of adverse effects from either drug.

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Synergism (working together) 1+1=2

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when the action of one drug is enhanced by the action of another drug ; interactions may be either beneficial or harmful.

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Potentiation 1+1=4

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The Five Rights

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1. Right drug

2. Right dose

3. Right time

4. Right route

5. Right patient

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Always read a drug label three times

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1. when you select the container
2. when you remove the dose from the container
3. when you replace the container.

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Follow oral drugs with a minimum of

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100 mL of fluid to help the drug reach the stomach and to facilitate absorption

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3 factors that affect distribution of a drug

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protein binding, blood flow, solubility

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controlled drugs are to be counted at least every

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8-12 hours

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pregnancy risk is highest in what trimester

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1st (1-12 weeks)

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pharmaceutic phase

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drug dissolves

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pharmacokinetic

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absorption, distribution, metabolism, and excretion of drugs (ADME)

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what type of drug name is listed on the pharmacopeia

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generic

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organization responsible for Medication Errors Reporting Program

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I.S.M.P. Institute for Safe Medication Practices

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Z-track method = what form of injection

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intramuscular

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when testing for allergies use what route

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Intradermal

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ventrogluteal site =

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hip

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vastus lateralis site =

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thigh

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steps of the nursing process

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assessment, analysis, planning, implementation, evaluation.

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assessment

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baseline collection of objective and subjective

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analysis

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ineffective self health management, deficient knowledge, noncompliance, anxiety

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planning

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set expected realistic outcomes, develop teaching plan

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implementation

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drugs, 6 rights, manage adverse reactions, family teaching

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evaluation

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evaluate teaching, drug effectiveness, expected outcomes

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how many hospital deaths occur from a drug calculation error

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1 in 10,000

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if 5 rights and 3 checks done an error will be caught ....

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95% of the time

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drug labels should always contain

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name, form, strength

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1 oz =

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2 tablespoons

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1g =

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1,000 mg

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generic name

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smaller print, often in parentheses, often under the trade name

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trade name

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often 1st, capitalized and has a registration symbol

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intradermal injection

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10-15 degree angle, inner part of forearm, upper back, hairless, small doses 0.1mL

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subcutaneous injection

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45 to 90.. 90 for bigger pts. ; 0.5 to 1 mL (more then 1mL split it or go IM); upper arms, upper abs(thin abs best)., upper thighs, back

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intramuscular injection

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90 degree... dart, aspirate for 5-10 seconds 1-3 mL per site; deltoid, hip, thigh(thigh more for kids) z-track method