Patho Test 1 (Redo)

Front 1

Definition of a drug:

Back 1

Alters process no change/ create new functions

Front 2

What is pharmacokinetics vs pharmacodynamics?

Back 2

Body to drug vs Drug to body

Front 3

What are the four steps in the nursing process?

Back 3

Assessment, analysis, planning, implementation, evaluation

Front 4

Which step of the nursing prcss is the following:

-Initiation and completion of specific nursing actions as defined by nursing diagnoses, goals, and outcome criteria

- Independent, collaborative, dependent

- Statements of interventions include frequency, specific instructions...

Back 4

Implementation

Front 5

Which step of the nursing process does the following example show:

- Data collection, review, and analysis

- Medication profile

Back 5

Assessment

Front 6

Which step of the nursing process does the following example show:

- Determining status of goals+outcomes of care

- Monitoring the ptnts response to drug therapy

- Clear, concise documentation of pre and post assessment

Back 6

Evaluation

Front 7

Which step of the nursing process does the following example show:

- Identification of goals and outcome criteria

Back 7

Planning

Front 8

Which step of the nursing process does the following example show:

- Identifies actual and potential client problem(s) based on review and interpretation of client data - nurse reviews relevant client data and determines what they mean

Back 8

Analysis

Front 9

Patho definitions:

__ = sequence of events; Abnormalities to clinical manifestation =

___ = cause of disease

Back 9

Pathology ; Pathogenesis : Etiology

Front 10

What are the manifestations (data gathered about disease) of disease and the nature of data for each?

Back 10

Symptoms (patients perception) ; Signs (examiners observation) ; Lab abnormalities, (test results) Radiographic abnormally (ie X-ray, CT, ultrasound)

Front 11

What is the difference between Structural vs Functional disease?

Back 11

Organic disease with structural changes / lesions within body vs without visible lesions at onset, physiologic change

Front 12

What are the three Exogenous causes of diseases vs Endogenous?

Back 12

Physical, chemical, microbiologic vs Vascular, immunologic, metabolic

Front 13

What is an idiopathic disease vs iatrogenic vs nosocomial?

Back 13

cause unknown vs adverse reaction vs acquired in hospital

Front 14

What are three routes of absorption?

Back 14

Enteral (drug absorbed into systemic circulation), Parental (into blood circulation), Topical

Hint 14

Enteral = oral, sublingual, buccal, rectal

Parental = IV, IM, ID, SQ

Topical = skin, eyes, ears, rectum, lungs

Front 15

Which route of absorption has no first pass effect?

Back 15

Parental

Front 16

For the following transport mechanisms identify which concentration it goes from and which drug characteristics are involved:

Passive diffusion, facilitated diffusion, active transport, endocytosis

Back 16

1. Passive = high to low ; hydrophobic + small

2. Facilitated = high to low with protein carrier ; hydrophilic + big

3. Active = low to high with ATP ; hydrophilic + big

4. Endocytosis = receptor mediated ; too large

Front 17

What factors decrease absorption? (5)

Back 17

pH (WA in alkaline + WB in acidic); dece blood flow; decr contact time; decr total SA; P glycoproteins

Front 18

What are the factors affecting bioavailability?

Back 18

solubility of drug (hydrophilic vs phobic), instability of environment (stomach and intestine, enzymes), first pass effect

Front 19

What factors increase distribution?(5)

Back 19

incr blood flow, incr capillary permeability, decr protein binding, incr solubility (small non polar hydrophobic, incr vol of distribution

Front 20

Metabolism aka ___ = biochem alteration of drug into what four forms?

Back 20

Inactive metabolite, more soluble compound, more potent metabolite, or less active metabolite

Front 21

What factors affect Phase 1 of biotransformation? (4)

Back 21

Polymorphism, polypharmacy, liver disease, age

Front 22

How does polymorphism affect biotransformation?

Back 22

Polymorphism = genetics of person = rapid metabolizers = [] of active drug decr = inactive incr = therapeutic effect decr = greater amount of drug req

Front 23

How does polypharmacy affect biotransformation?

Back 23

Polypharmacy seen with older adults. have CYP450 inducers = incr activity of enzyme = incr inactive = decr active

Front 24

Phase 2 biotransformation is when...

Back 24

already polar drug becomes even more polar = more water soluble and easier to excrete

Front 25

___ = when amount of drug being absorbed is same as amount being cleared when the drug isgiven continuously or repeatedly

Back 25

Steady state (takes 4-5 half lives)

Front 26

What are the 5 "focuses" of Pharmacodynamics?

Back 26

Drug receptor interactions ; Dose response relationship ; Potency and Efficacy; Drug activity profile ; Class of meds

Front 27

What are the two type of drug receptor interactions and what type of drug do they "accept"?

Back 27

Extracellular = hydrophilic, large, polar, charged vs Intracellular = hydrophobic, small, nonpolar, uncharged drugs

Front 28

What are the three types of Extracellular receptors?

Back 28

1. ligand gated ion channels 2. g protein coupled receptor 3. tyrosine kinase receptors

Front 29

A dose response relationship curve answeres what question?

Back 29

how much drug is needed to produce a therapeutic response

Front 30

Define potency vs efficacy:

Back 30

Potency = how much drug is req to have a therapeutic response (less needed = greater potency) vs Efficacy = max therapeutic response that drug is able to produce (related to # of drug receptor complexes formed)

Front 31

What things are part of the drug activity profile?

Back 31

Duration of action, Onset of action, Therapeutic index

Front 32

Drug activity profile definitions:

__ = time it takes for drug to meet min effective []

__ = ratio of min [] of drug that prdcs toxic effect and min [] that prdcs desired effect

__ = length of time drug exhibits therapeutic effect

Back 32

Onset of action ; Therapeutic index (narrow TI = high chance of side effect) ; Duration of action

Front 33

What are the classes of meds?

Back 33

Agonist drugs, antagonist drugs, irreversible receptor antagonists

Front 34

Classes of meds defn:

__ = covalent bonds, cant seperate from receptor

__ = mimic ligand receptor, same effect as endogenous ligand itself

__ = block receptors activation response. Has two types..

Back 34

Irreversible ; Agonist ; Antagonist (competitve = blocks ligand site vs non competitve = binds to site different from endogenous site)

Front 35

Part of Symptomatic disease are the following abbreviations, what do they stand for?

Dx; Hx; PE;

Back 35

Diagnostic, history; physical exam;

*most diagnoses can be made from ^^

Front 36

Diagnosing asymptomatic disease easrly reqs regular...? (3)

Back 36

Dental appts, well baby exam, physical exam

Front 37

When and who to screen for asymptomatic diseases depends on what three things?

Back 37

ØLikelihood of patient developing disease

ØAvailability of treatment

ØCost of screening test

Front 38

For potentional diseases what are the three methods of disease preventation?

Back 38

Lifestyle and behav changes, vaccination, public health improvements

Hint 38

Preventable diseases (ie smallpox, measles, whopping cough, periodontal disease)

Front 39

What is the difference between diagnostic test vs procedure?

Back 39

Test = analyze specimen removed from patient vs Procedure = manipulationof patient beyond that usually done during physical examination

Front 40

Clinical procedures involve a primary healthcare practitioner performing what type of procedure vs specialist?

Back 40

PHCP = common common tests (ie urinalysis,vaginal smears, and throat cultures) vs Specialist = manipulative procedures

Front 41

Radiological procedures defns:

__ = allow PE of internal structures without surgery

__ = depend on differing absorption propertiesof tissues as x-rays pass through them, Radiodense material leaves white shadow

__ = produces a dynamic x-ray image

__ = good for soft tissues and liquids

Back 41

Radiologic techniques; X ray; Fluoroscope; Ultrasound

Front 42

Radiological procedures defns:

__ = creates cross-sectional images of body, preferred for detecting acute processes and delineating deep-seatedlesion

__ = records tissue characteristics in tissueplanes, T1 = lipid vs T2 = water

__ = evaluates functional activity of anorgan, expensiveand exposes patient to radiation

Back 42

Computed tomography (CT); Magnetic resonance imaging (MRI); Nuclear medicine

Front 43

Anatomic Pathology Tests and Procedures defns:

__ = diagnosis of lesions in pieces of tissue removed from patient

__ = removal of small specimens

__ = removal of large specimens

__ = cells sloughed or scraped from bodysurfaces (ie cancer)

Back 43

Surgical pathology; Biopsy; Resection; Cytology specimens

Front 44

Anatomic Pathology Tests and Procedures defns:

__ = uses small-caliber needle to obtainspecimen

__ = postmortem exam of a body, imp teaching tool

_ = investigates accidental and criminaldeaths

Back 44

Fine-needle aspiration (FNA); Autopsy; Forensic pathology

Front 45

Clinical Pathology Tests and Procedures defns:

^ Branch of pathology that performslab tests on tissues and fluids

__ tests = evaluate organ function + detect specific abnormalities

__ = test for presence of Microbes, RBC/ WBC, chemical substances

__ = measurement of hemoglobin, counting of WBC and RBC

Back 45

Biochemical tests; Urinalysis; Complete blood count (CBC)

Front 46

Clinical Pathology Tests andProcedures defns:

__ = procurement,typing, testing, processing, storage, and administration of blood components

__ = detection of antigens and antibodies inblood and tissue and study of lymphocytes

__ = detecting pathogenic microorganisms and determining susceptibility

__ = more common. more rapid and give more sensitiveresults

Back 46

Transfusionmedicine; Immunopathology; Microbiology laboratory; Molecular tests

Front 47

Molecular diagnosis: determines __ of neoplasms or microorganisms

- involves sequencing DNA or RNA andcoupling it with a probe

- sequencing is done by a polymerase chainreaction (PCR)

Back 47

“molecular signature”

vs Pharmacogenomics: involves predicting patient’s response to particular drugstores on genetic makeup. Useful when treatment involves a drug notorious for eliciting an “idiosyncratic” response. Dangerous if therapeutic levels are exceeded

Front 48

Public Health Laboratories:

- established by governments to helpcontrol __

- perform many biological tests

- water testing also important to publichealth

- certain highly contagious diseasesrequire reporting to state authorities

Back 48

communicable diseases

Front 49

Who is responsible for Foodand Drugs Act + ControlledDrugs and Substances Act?

Back 49

Health Products Food Branch (HPFB) Inspectorate of Health Canada

Front 50

Who regulates acts which protect the Canadian consumer from potential health hazards and fraud or deception in the sale and use of foods, drugs, cosmetics, and medical device?

Back 50

Therapeutic Products Directorate (TPD)

Front 51

Which federal law governs the collection, use, and disclosure of personal information?

Back 51

Personal Information Protection and Electronic Documents Act (PIPEDA)

Front 52

Which act is the primary piece of legislation governingfoods, drugs, cosmetics, and medical devices? States that drugs must comply with official prescribed standards

Back 52

Canadian Food and Drugs Act

Front 53

Which act replaced the Narcotic Control Act and provides reqs for the control andsale of narcotics, controlled drugs, and substances of misuse?

Back 53

ControlledDrugs and Substances Act (CDSA)

* RCMP is responsible for enforcement ofthe CDSA

Front 54

The Marihuana Medical Access Program wasreplaced with what?

* Health Canada regulates the producers ofmarihuana for this purpose but is not involved in the decision-making process.

Back 54

Marihuana for Medical Purposes Regulations

Front 55

What is the primary purpose of Health Canada’s TPD?

Back 55

to protect patients and ensure drug effectiveness.

Front 56

Describe the size and the type of participants in the FourClinical Phases of Investigational Drug Studies

Back 56

1. small and healthy

2. large and volunteers with disease

3. large and patients followed by research centres

4. voluntary postmarketing studies by companies to know therapeutic and adverse effects

Front 57

What are the three areasof Potential Liability?

Back 57

Failure to assess or re evaluate ptnt; failure to ensure safety of ptnt; med error

Front 58

During pregnancy which three factors affect the fetus's safety?

Back 58

Drug properties, festal gestational age, maternal factors

Front 59

What is the major risk during the first trimester vs the third trimester?

Back 59

first: exposure of fetus to drugs + greatestrisk for drug-induced developmental defects vs third: drug transfer more likely

Front 60

What four drugcharacteristics increase the likelihood of drug transfer via breastfeeding?

Back 60

fat solubility, low molecular weight, nonionization, and high concentration

Front 61

Pharmacokinetics Children: Absorption

__ due to immature acid producing cells

__ due to slow / irregular peristalsis

__ due to immature liver and decr enzymes

__ decreases bioavailability

__ faster and irregular

Back 61

gastric pH less acidic; slowed gastric emptying ; reduced first pass elimination; reduced bile sale formation; intramuscular absorption faster and irregular

Front 62

Pharmacokinetics Children: Distribution

total body water differences result in __

greater total body water means __

__ due to decreased production of protein by liver

immature blood brain barrier means __

Back 62

increased distribution and dilution of water soluble drugs; lower fat content; decreased level of protein binding; more drugs enter the brain

Front 63

Pharmacokinetics Children: Metabolism

__ due to immature liver

older children have __ metabolism, req higher doses or more freq

other factors... (3)

Back 63

decreased microsomal enzyme; higher metabolism; liver enzyme prdctn, genetic diff, substances mom may have been exposed to during pregn

Front 64

Pharmacokinetics Children: Excretion

kidney immatiruity affects __ and __

decreased __ of kidneys may reduce excretion of drugs, decr kidney function, and decr concentrating ability

Back 64

glomerular filtration rate and tubular secretion; decr perfusion rate

Front 65

What 5 factors affect pediatric drug dosages?

1. thin and permeable

2. lack acid to kill bacteria

3. weak mucus barriers

4. less well regulated and easily dehydrated

5. immature, decr drug metablism and excretion

Back 65

Skin; Stomach; Lungs; Body temp; Liver and Kidney

Front 66

When calculating dosages for ped ptnts what units should weight and height be in?

Back 66

kg (not lbs) and cm (not in)

Front 67

What four issues in clinical drug use should be considered for older adults?

Back 67

Polypharmacy, non adherence, incr incidence of chronic illnesses, sensory and motor deficits

Front 68

Cardiovascular. What two physiological changes cause decr absorption and distribution?

Back 68

decr cardiac output and decr blood flow

Front 69

Gastrointenstinal. What physiological changes cause altered absorption? delayed gastric emptying?

Back 69

incr pH = altered absorption; decr peristalsis = delayed gastric emptying

Front 70

Liver. What physiological changes cause decr metabolism?

Back 70

decr enzyme production = decr metabolism

Front 71

Kidney. What physiological changes cause decr metabolism, decr excretion (3)?

Back 71

decr blood flow = decr metabolism; decr blood flow, decr kidney function, decr glomerular filtration rate = decr excretion

Front 72

Pharmacokinetics Older Adults: Absorption

__ due to decr ability of stomach to produce HCl

__ due to decr muscle tone and activity

__ due to decr cardiac output and perfusion

__ due to flattened villi

Back 72

gastric pH less acidic; slowed gastric emptying/ mvmnt throughout; decr blood flow to GI tract; absorptive surface of GI tract reduced

Front 73

Pharmacokinetics Older Adults: Distribution

lower total body water % = ?

increased fat content due to __

decreased prdctn of proteins by liver result in __ and __

Back 73

higher [] of water soluble drugs; decr lean body mass; decr protein binding of drugs and incr circulation of free drugs

Front 74

Pharmacokinetics Older Adults: Metabolism

aging liver produces __ affecting drug metabolism

reduced blood flow to liver results in decr metabolism which results in..

Back 74

fewer microsomal enzymes; decr metabolism = incr half life = drug accumulation

Front 75

Pharmacokinetics Older Adults: Excretion

decr glomerular filtration rate due to ___

decr number of __

Back 75

decr blood flow; intact nephrons

Front 76

What are the three categories in the Beers Criteria for Preventation of Adverse drug events?

Back 76

1. Potentially inappr drugs and classes in elderly

2. Potentially inappr meds to avoid with certain diseases

3. Meds to be used with caution in older adults

Front 77

Gene therapy is an experimental technique using geneticmaterial to treat or prevent disease. What are the three techniques?

Back 77

Replacing mutated gene with healthy copy of the gene; Introducing new gene into body to help fight a disease; Inactivating mutated gene thats functioning improperly

Front 78

What occurs duringgene therapy vs gene transfer?

Back 78

Gene therapy: segments of DNA are injected into the patient’s body vs Gene transfer: viruses are used

Front 79

Who oversees gene therapy research in Canada?

Back 79

Biologics and Genetic Therapies Directorate of Health Canada

Front 80

What is Pharmacogeneticsvs Pharmacogenomics?

Back 80

genetics: study of genetic variations in drug response + focuses on single-gene variations vs genomics: how genetics affect the body’s response to drugs+ individualized drug therapy

Front 81

What 3 things are part of MedicationReconciliation?

Back 81

Verification, clarification, and reconciliation