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158 Cards in this Set
- Front
- Back
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What are the three phases that oral drugs go through?
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1) pharmaceutic 2) pharmacokinetic 3) pharmacodynamic
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In what phase does a drug become a solution so that it can cross the biologic membrane?
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pharmaceutic phase
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What are the four processes of the pharmacokinetic phase?
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1) absoption 2) distribution 3) metabolism 4) excretion
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In what phase does a biologic or physiologic response result?
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pharmacodynamic
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What percentage of drugs are taken orally?
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80%
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What are the two pharmaceutic phases?
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1) disintegration 2) dissolution
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What are fillers and inert substances used in drug preparation generally called?
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excipients
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What is the breakdown of a tablet into smaller particles called?
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disintegration
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An infant's gastric secretions are high or lowers than adults?
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higher (alkaline)
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Penicillin is better absorbed in what pH environment?
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high pH (alkaline)
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What is the term for the dissolving of smaller particles in the GI fluid before absorption?
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dissolution
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What is the time it takes the drug to disintegrate and dissolve to become avilable for the body to absorb it called?
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rate limiting
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What type of drug is delayed on absorption?
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enteric-coated
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Which tablets or capsules should not be crushed?
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enteric-coated
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What are the three types of absorption?
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1) passive 2) active 2) pinocytosis
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What type of drugs are destroyed in the small intestine by digestive enzymes?
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protein based
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What type of absorption occurs by diffusion?
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passive
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What type of absorption requires a carrier such as an enzyme or protein to move the drug against a concentration gradient?
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active
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What type of absorption is a process by which cells carry a drug across their membrane by engulfing the drug particles?
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pinocytosis
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What type of absorption requires energy (ATP!)?
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active
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What GI membrane is mostly composed of what?
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lipids and protein
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What type of drugs pass rapidly through the GI membrane?
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lipid soluble drugs
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What type of drugs need a carrier to pass through the GI membrane?
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water soluble
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What pH of drugs pass through the stomach lining easily and rapidly?
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weak acidic
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What seven factors affect drug absorption?
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1) blood flow 2) pain 3) stress 4) hunger 5) fasting 6) food 7) pH
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What is the process called in which the drug passes to the liver first?
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first-pass effect or hepatic first pass
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What is the administered drug dose that reaches the systemic circulation called?
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bioavailability
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What is the bioavailability for oral drug routes?
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always less than 100%
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What is the bioavailability for IV drug routes?
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always 100%
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Oral drugs that have a high first-pass hepatic metabolism, may have a bioavailability of what percentage?
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20% to 40%
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Oral doses should be how many times larger than an IV dose?
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3 to 5 times
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What are the five things that affect bioavailability?
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1) the form of the drug 2) route 3) GI mucosa and motility 4) food and other drugs 5) changes in liver metabolism
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If a drug is metabolised by the liver, and there is a decrease in liver function, what does this do to the bioavailability of the drug?
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increases it
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What is the process by which the drug becomes available to body fluids and body tissues?
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distribution
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Drugs with a larger volume of drug distribution will have a longer half-life, thus their time in the body is increased or decrease?
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increase (they stay in the body longer)
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What do you call drugs that are not bound to protein?
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free drugs (WOO HOO!)
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What is the primary protein that binds with drugs?
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albumin
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There are 4 types of protein-bound drugs. Name them.
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1) highly-protein bound 2) moderately high protein bound 3) moderately protein-bound 4) low protein-bound
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What are the only drugs that can cause a pharmacologic response?
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free drugs (WOO HOO!)
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A low-protein level could lead to what?
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a drug overdose (due to an increase in the amount of free drug in the plasma)
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How is a drug dose prescribed?
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according to the percentage in which the drug binds to protein
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What percentage of the drug is bound in highly protein-bound drugs?
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89%
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What percentage of the drug is bound in moderately high protein-bound drugs?
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61%-89%
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What percentage of the drug is bound in moderately protein-bound drugs?
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30%-60%
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What percentage of the drug is bound in low protein-bound drugs?
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30%
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What protein do most anticonvulsants bind primarily to?
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albumin
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What protein do most antidisrhythmics bind to?
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globulins
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Patients with abnormally low serum-albumin levels that results in fewer protein-binding sites results in what negative effect?
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drug toxicity
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What demographic is likely to have hypoalbuminemia?
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older adults
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What type of client may have abnormally low serum-albumin levels?
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clients with liver or kidney disease, or those who are malnourished
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To avoid possible drug toxicity, what two things should you check before administering the drug?
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1) check the protein-binding percentage of the drug 2) check the client's plasma protein and albumin levels
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What two places can drugs be metabolized?
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GI tract and liver
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What is the primary site of metabolism?
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liver
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What is the time it takes for one half of the drug concentration to be eliminated called?
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half-life (t1/2)
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How does our body excrete lipid soluble drugs?
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the liver metabolizes them into water soluble substances for renal excretion
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What are some drugs transformed into that cause an increased pharmacologic response?
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active metabolites
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What negative result can occur from decreased metabolism rate?
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excess drug accumulation and drug toxicity
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What two things affect the half-life of a drug?
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metabolism and elimination
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What is the main route of drug elimination?
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through the kidneys (urine)
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Besides the kidneys, what are six other routes of drug elimination?
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1) bile 2) feces 3) lungs 4) saliva 5) sweat 6) breast milk
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What kind of drugs cannot be filtered through the kidneys?
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protein-bound drugs
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What pH of urine promotes elimination of weak acid drugs?
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alkaline
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What pH of urine promotes elimination of weak base drugs?
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acidic
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What does large quantities of cranberry juice do to the pH of urine?
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makes it more acidic
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The creatinine clearance test is most accurate for testing what?
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renal function
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What is a metabolic byproduct of muscle that is excreted by the kidneys?
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creatinine
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A decrease in renal GFR results in what changes in creatinine levels?
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an increase in creatinine in your blood and a decrease in creatinine in your urine (an increase in serum creatinine levels and a decrease in urine creatinine clearance)
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What is the normal creatinine clearance range?
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85-135 mL/min
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What could an older adult's creatinine clearance be?
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60 mL/min
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What three responses can a drug cause?
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1) primary 2) secondary 3) both
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Which drug effective is desirable?
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primary
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What is the minimal vs. maximal amount of a drug needed to produce the desired drug response called?
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dose response
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What is the time it takes to reach the minimum effective concentration after a drug is administered?
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onset of action
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What occurs when the drug reaches its highest blood or plasma concentration?
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peak action
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What is the length of time the drug has a pharmacologic effect for?
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duration of action
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What evaluates the onset of drug action, peak action, and duration of action?
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time-response curve
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Where are most receptors found?
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cell membranes
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Drug binding sites are primarily located on what four things?
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1) proteins 2) glycoproteins 3) proteolipids 4) enzymes
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What are the four receptor families?
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1) kinase-linked receptors 2) ligand gated ion channels 3) G-protein coupled receptor systems 4) nuclear receptors
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What is the site on the receptor at which drugs bind?
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ligand binding domain
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Where is the ligand-binding domain for kinase-linked receptors?
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on the cell surface
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Where does the drug activate the enzyme in the kinase-linked receptor?
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inside the cell
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What is the ligand-binding domain for ligand gated ion channels?
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the receptor on the cell membrane that opens a channel when bound
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How do ligand gated ion channels work?
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the gate opens bringing in sodium and calicum ions when the receptor on the cell membrane is bound
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What are the three components of the G protein-coupled receptor system?
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1) receptor 2) G-protein that binds with guanosine triphosphate (GTP) 3) the effector that is either an enzyme or an ion channel
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How does the G-protein coupled receptor system work?
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drug -> receptor -> G-protein -> effect
(each arrow also means activates) |
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Where is the ligand-binding domain for nuclear receptors?
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nucleus
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Which of the four receptor families takes longer for the activation of receptors?
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nuclear (because the receptors are activated through transcription factors)
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What are drugs that produce a response called?
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agonists
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What are drugs that block a response called?
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antagonists
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What does IC50 stand for?
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inhibitory concentration required to inhibit 50% of the maximum biological response
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Drugs that affect various sites are called what?
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nonspecific drugs (fits a specific receptor but receptor can be at ANY site ex: eyes, lungs, heart)
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Drugs that affect various receptors are called what?
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nonselective drugs
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The four categories of drug action are what?
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1) stimluation or depression 2) replacement 3) inhibition or killing of organisms 4) irritation
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What drug action is when the rate of cell activity or the secretion from a gland increases?
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stimulation
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What drug action reduces cell activity and function of a specific organ?
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depression
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What drug action substitutes essential body compounds?
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replacement
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What drug action interferes with bacterial cell growth?
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inhibition or killing of organisms
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What is the guide for determination of drug dosage intervals?
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half-life
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If there is a liver or renal impairment, what happens to the half-life of a drug?
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increases
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What estimates the margin of safety of a drug?
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therapeutic index (TI)
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The closer the therapeutic ratio is to 1, the greater the ____?
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danger of toxicity
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A high therpeutic index means what for the safety and toxic effects of a drug?
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more safe, less danger of toxicity
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What is the highest plasma concentration of a drug at a specific time?
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peak drug level
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What do peak drugs levels indiciate?
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indicates the rate of absorption
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What is the lowest plasma concentration of a drug called that measures the rate at which a drug is eliminated?
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trough drug level
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When are trough levels drawn?
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immediately before the next dose of a drug is given
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Peak levels indicate the rate of ______ of the drug and trough levels indicate the rate of _____ of the drug.
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1) absorption 2) elimination
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If peak or trough level is too high, what can occur?
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toxicity
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What is the large initial dose of a series of doses called?
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the loading dose
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What are physiologic effects not related to desired drug effects?
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side effects
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What is the difference between side effects and adverse reactions?
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adverse reactions are more severe
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What is the scientific discipline studying how the effect of a drug action varies from a predicted drug response due to genetic factors or hereditary influence?
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pharmacogenetics
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What is a decreased response over the course of therapy called?
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tolerance
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What is a rapid decrease in a response to a drug called?
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tachyphylaxis
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What is another phrase for tachyphylaxis?
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acute tolerance
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What is the psychological benefit from a compound that may not have the chemical structure of a drug effect?
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placebo effect
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What are the fourdrug categories that can cause tachyphylaxis?
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1) narcotics 2) barbiturates 3) laxatives 4) psychotropic agents
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If a drug is given by injection, what two phases is it only involved in?
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1) pharmacokinetic 2) pharmacodynamic
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Drugs in liquid form absorb faster or slower than those in solid form?
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faster
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What type of food would you not want to eat before ingesting an enteric-coated tablet and why?
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1) fatty food 2) decreases absorption rate
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If you give a drug with a long half-life more than once a day, what should you do?
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report to health care provider
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What type of drugs should you monitor the therapeutic range of?
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drugs that are more toxic or have a narrow therapeutic range
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If a drug is nephrotoxic, what should be assessed?
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creatinine clearance
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What is made based on the analysis of assessment data?
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nursing diagnosis
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Before information is presented to the client, what should first be assessed?
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readiness to learn
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When taking anti-fungal agents, what four lab tests should be monitored?
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1) liver enzymes 2) BUN 3) creatinine 4) electrolytes
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When providing an interpreter, what, when possible, should you consider?
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ethnic background and gender
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How should you check if an asian client understands instructions?
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repeat it back or do a demonstration
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When offering prescriptions, instructions, or pamphlets to asian or pacific islander clients, what should you do to show respect?
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use both hands
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To establish trust among hispanic/latinos or appalachains, what three things should you do?
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1) demonstrate interest in client's family and personal matters 2) hint at topics, don't give orders 3) solicit client's opinions and advice
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What kind of beverage should you discourage around the time of taking medications?
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alcohol
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What does smoking tobacco do to some medications?
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alters absorption
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To make sure that client has ingested medication/medication has been administered, what should you do?
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do not take your eyes off of pill until patient has swallowed medication (DO NOT ASSUME THEY TOOK IT...PEOPLE ARE CRAY)
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What are the nurses' six rights regarding safe medication administration?
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1) right to complete and clear order 2) right to have correct drug, route, and dose 3) right to access information 4) right to policies to guide safe medication administration 5) right to administer medications safely and identify system problems 6) right to stop, think, and be vigilant when administering medications
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What are the 5 traditional rights of safe drug administration?
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1) client 2) drug 3) dose 4) time 5) route
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What are the additional 5 rights essential to professional nursing practice of safe drug administration?
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1) right assessment 2) right documentation 3) client's right to education 4) right evaluation 5) client's right to refuse
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What 4 people can prescribe a medication?
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1) podiatrist 2) physician 3) licensed health care provider 4) dentist
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When receiving a telephone order or verbal order for medication, when should the order be co-signed by the prescribing health care provider?
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within 24 hours
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If a prescribed drug and the dosage is incorrect, or the drug is contraindicated for the client's health status, who is legally liable?
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the nurse who administered it
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When are the three times that a drug label should be checked?
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1) at the time of contact with the drug bottle/container or the prepackaged drug unit 2) before measuring the drug 3) after measuring the drug
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What is the dose prescribed within guidelines for drug administration and is related to the client's physical status including renal function?
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right dose
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What are the two most frequently used methods of drug distribution?
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1) stock drug method 2) unit dose method
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The method of drug distribution where drugs are dispensed to all clients from the same containers is called what?
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stock drug method
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The method of drug distribution where drugs are individually wrapped and labeled for single doses for each client is called what?
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unit dose method
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What kind of intervals should antibiotics be administered on?
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even intervals (2, 4, 6 hrs) so that therapeutic blood intervals are maintained
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Why do you adminster antiobiotics at even hour intervals?
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so that therapeutic blood intervals are maintained
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Why would you administer a medication sublingually?
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for venous absorption
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What do you call the route in which you administer medication through the nose, eyes, or ears?
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installation
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There are 8 types of routes for drug administration. Name them.
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1) oral 2) sublingual 3) buccal 4) feeding tube 5) sepository 6) topical 7) installation 8) inhalation 9) parenteral
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When is sterile technique required for medication administration?
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parenteral routes
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Documentation of the client's response to the medication is required for which types of medications?
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1) narcotics 2) non-narcotic analgesics 3) sedatives 4) antiemetics 5) medications that give unexpected reactions
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What is defined as any preventable event that may cause or lead to inappropriate medication use or harm to a patient?
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medication error
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Which system is the basis for the success of the use of barcoding?
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CPOE (computerized prescriber order entry)
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How should one dispose of prescription drugs?
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remove the drug from its original container and dispose of it in a sealed bag mixed with an undesirable substance such as kitty litter or coffee grounds
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For every 100 medication administration, there are how many medication errors?
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5
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Medications that you should not crush have which suffix?
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-er or -sr
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What are the classes/categories of high alert medications? (18)
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1) adrenergic agents 2) adrenergic antagonists 3) anasthetic agents 4) antiarythmics 5) antithrombotic agents 6) cardioplegic solutions 7) chemotherapeutic agnets 8) dextrose 9) dialysis solutions 10) epidural/intrathecal agents 11) hypoglycemics 12) inotropic medications 13) liposomal forms 14) moderate sedation agents 15) narcotics/opiates 16) neuromuscular blocking agents17) IV radial contrast agents 18) total parenteral nutrition solutions
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