Pharm Test 1, Note Set 2

Front 1

T/F: Pharmokinetics are very important to study

Back 1

T: gives predicatbility to drug effects, guides dosing (amt, time, dose form), important for dealing w/ narrow safety ranges

Front 2

Minimum effective concentration (MEC)

Back 2

Lowest plasma concentration required to cause measurable response

Front 3

Onset of action

Back 3

When plasma levels reach MEC

Front 4

Peak

Back 4

Highest plasma concentration (greatest risk for toxic/adverse rxn at peak plasma concentration)

Front 5

Duration of action

Back 5

Time period when plasma concentration is above MEC

Front 6

Therapeutic index/range

Back 6

Ration between toxic dose and effective dose (Lethal dose (LD) in 50% of population, and Effective dose (ED) in 5% of population)
Close to 1, more narrow the index = greater the risk of toxicity
Narrow TI = monitor plasma drug levels and drug effects

Front 7

Half-life

Back 7

Time it takes after absorption, for 50% of drug to be eliminated
4-5 half-lives to eliminate 98% of drug
Half-life helps determine duration of action

Front 8

Multiple dosing

Back 8

Dose approximately every half-life in order to maintain steady-state blood levels (equilibrium between drug transfer in and out of plasma)
Takes 4-5 half-lives to reach steady state blood levels

Front 9

Loading doses

Back 9

Giving higher than maintenance doses in order to rapidly reach steady-state blood levels

Front 10

How are plasma drug levels monitored?

Back 10

Give drug on time
Draw blood, document: time drawn and time drug given, label/order correct test

Front 11

Peak and trough drug levels

Back 11

Ordered for drugs w/ narrow TI
At least 4 doses given (steady state reached)
Give drug on time and document
Draw blood at proper time
If dosing schedule interrupted talk w/ lab, MD, reschedule blood draw

Front 12

Peak

Back 12

Draw blood at peak of drug action

Front 13

Trough

Back 13

Draw blood immediately before next dose of drug

Front 14

Factors influencing pharmocokinetics

Back 14

Dose
Frequency
Condition of ADME
Drug dissolution
Route of admin

Front 15

Drug-receptor interaction theory

Back 15

Drugs interact w/ receptor in lock-and-key fashion; only certain keys fit certain locks

Front 16

Rate interaction theory

Back 16

Rate of binding determines type and intensity of response
Drug w/ greater affinity/concentration will attach to receptor more often = more intense response

Front 17

Agonist

Back 17

Combines w/ receptor = response

Front 18

Antagonist

Back 18

combines w/ receptor = inhibits agonist

Front 19

T/F: Pure antagonists are the same as antagonists.

Back 19

F: Pure have their own action

Front 20

Competitive antagonist

Back 20

Has higher affinity for receptor, can displace agonist AT receptor, can be OVERCOME by higher concentration of agonist

Front 21

Non-competitive antagonist

Back 21

Cannot be overcome by higher concentrations of agonist

Front 22

Additive drug interaction

Back 22

Combined effect of 2 similar drugs that act at same receptor

Front 23

Potentiation drug interaction

Back 23

Effect of one drug increased by the 2nd (absorption, concentration at receptor; decreased metabolism, slow excretion)

Front 24

Synergism drug interaction

Back 24

Combined effect greater than each drug alone

Front 25

Inhibition drug interaction

Back 25

Decrease in:
Effect
absorption
Concentration at receptor
Increase in:
metabolism
excretion

Front 26

Side effect drug rxn

Back 26

Any effect other than the primary therapeutic effect

Front 27

Adverse drug rxn

Back 27

Noxious, unwanted/unintended rxn occurring at "normal doses"

Front 28

Severe drug rxn

Back 28

Toxicity (may be d/t excessive dosing)

Front 29

T/F: No drug rxn is acceptable.

Back 29

F: weigh risk vs. benefit, doesn't necessarily require stopping the drug

Front 30

T/F: Allergies and hypersensitivity are the same thing.

Back 30

F: Hypersensitivity is any excessive rxn, allergies are histamine-mediated immune responses that require sensitization (state of hypersensitivity)

Front 31

Idiosyncratic effect

Back 31

Uncommon response, may be d/t genetic disposition

Front 32

Anaphylactic rxn

Back 32

Life threatening! S/S:
Edema at injection site
Anxiety/restlessness
Coughing/sneezing
Itching of throat/mouth/palms/soles of feet
Bronchospasm (wheezing)
Laryngospasm (stridor/airway compromise)
Vascular collapse (hypotension, tachycardic)

Front 33

Treatment of anaphylaxis

Back 33

Epinephrine 1 mg IV/ET (less severe 0.3-0.5 mg IM/sq)
Airway management (intubation, O2)
Antihistamine (Benadryl) IV
Corticosteroids (Solumedrol) IV
Fluid resuscitation
Vasopressors (dopamine)
<3 monitoring

Front 34

Hives (Urticaria)

Back 34

Wheals w/ pruritis (watch in mouth = AIRWAY!)
Tx: stop drug, antihistamines, corticosteroids

Front 35

Serum sickness (type III)

Back 35

Skin rashes, edema
Fever, joint pains (arthralgia)
Anaphylaxis if untreated!
Tx: stop drug, corticosteroids, NSAIDs, antihistamines

Front 36

Erythema multiformae

Back 36

Delayed rxn
Circular edematous lesions (bulls-eye lesions)
Necrosis of lesions = infection
Tx: stop drug, corticosteroids, wound care

Front 37

Steven-Johnson syndrome

Back 37

More severe form of eyrthema multiformae
Lesions involve MM and skin = can errode = PAIN!
Joint pain, fever, malaise
Tx: stop drug, symptom management, corticosteroids/antibiotics, wound care
Death from lesion infections can occur!

Front 38

Toxic epidermal necrolysis

Back 38

Severe form of erythema multiformae
Skin sloughs
Tx: stop drug, antibiotics/corticosteroids, wound care (isolation?)

Front 39

Photosensitvity

Back 39

Skin rxn = rash, sunburns easy
Tx: avoid sun exposure, clothing, sunscreen, client teaching to avoid sunburn

Front 40

T/F: the most common GI rxn is N/V

Back 40

T: take w/ food/milk if possible
Stop drug if necessary

Front 41

Diarrhea GI rxn

Back 41

May need to stop drug
Antibiotics: teach client to eat yogurt or Lactobacillus products
Pseudomembraneous colitis: C. diff overgrowth in gut (worsening diarrhea, mucous/blood stool = stop drug, tx)

Front 42

GI bleeding

Back 42

Drugs act as irritants = increase acid and/or affect blood clotting
Tx: stop drug, use gastric acid blocking agents
nonsteroidal anti-inflammatories, caffeine, corticosteroids

Front 43

Malabsorption syndrome

Back 43

Fat soluble vitamins

Front 44

Nephrotoxicity

Back 44

Reduced renal function = renal failure (acute/chronic)
Higher risk w/ existing renal disease
Monitor BUN, creatinine, UO
Maintain good hydration w/ pre-hydrate/Mannitol (EF solute)
Monitor therapeutic blood levels w/ high risk drugs

Front 45

Ototoxicity

Back 45

Tinnitus, vertigo, hearing loss
Tx: stop drug, hearing loss may be irreversible
Prevent: monitor, teach people symptoms
Drugs: aspirin, loop diuretics

Front 46

Encephalopathy

Back 46

Reduced LOC
Seizures
Risk greater w/ pre-existing neuro disease/injury
Tx: stop drug, manage symptoms

Front 47

T/F: behavioral changes can be a sign of a nuero rxn

Back 47

True

Front 48

Paradoxical rxn

Back 48

Opposite of expected therapeutic effects

Front 49

Etrapyramidal rxn

Back 49

Parkinsonian symptoms
Tx: stop drug, reduce dose, anticholinergic agents

Front 50

Arrhythmias

Back 50

Irregularities in cardiac rhythm

Front 51

Arrhythmogenic drugs

Back 51

may directly interfere w/ cardiac conduction or sensitize myocardium to epinephrine/norepinephrine
Drugs: stimulations, some anesthetics
Tx: stop drug, cardiac monitoring, treat dysrhythmias

Front 52

Myocardial toxicity

Back 52

Direct damage to myocardial tissue
Causes cardiomyopathy = lead to CHF
Tx: stop drug, montior <3 functions, symptom management
Drugs: lead, some antineoplastics, illicit drugs

Front 53

Cardiac vasoconstriction

Back 53

Cause reduced circulation to myocardium
MI if severe enough
Tx: stop drug, manage symptoms
Drugs: cocaine, meth

Front 54

Blood dyscrasias

Back 54

Dysfunction of blood forming organs

Front 55

Bone marrow depression

Back 55

Reduced: WBC, RBC, platelets

Front 56

Severe aplastic anemia

Back 56

lack of production of all cells

Front 57

Hemolytic anemia

Back 57

direct RBC distruction
Can cause renal failure if heme molecules clump in glomerulus
Tx: stop drugs, corticosteroids
WBC: Neupogen
RBC: O2, transfusion, epogen
platelets: safety, transfusion, Oprevelkin

Front 58

Hepatotoxicity-Toxichepatitis

Back 58

looks like viral form (elevated enzymes - ALT, AST, jaundice)
Tx: stop drug, corticosteroids
Drugs: Tylenol, antilipemic drugs

Front 59

Carinogenicity

Back 59

Ability to cause cancer
Dose related risk (higher dose, higher risk)
Drugs: antineoplastics, anabolic steroids
Prevent: minimize exposure

Front 60

Teratogenicity

Back 60

Ability to cause birth defects
Most risk in 1st trimester
TEACH! Avoid drugs throughout pregnancy - only w/ approval of HCP
Agents: many! alcohol, antineoplstics, anticonvulsants, etc.

Front 61

Teratogen Scale

Back 61

A = no harm, B, C = consider use carefully, D avoid, X absolutely not
If high risk exposure = US exams to assess for injury/malformation, counseling r/t malformation, implications for tx and/or decision to continue pregnancy

Front 62

Factors affecting adverse drug rxn

Back 62

Age (elderly, infants)
Gender (women higher chance, > w/ fat soluble drugs)
Race/genetic disposition (differences in metabolism, receptor reactivity
Hx of allergies/asthma
Current disease state
Drug related factors