Pharm Test 1 P. 6-12

Front 1

controlled substance: schedule categories refers to the potential for

Back 1

dependency and abuse to occur

Front 2

category 1

abuse potential:
medical use:
dependency:

Back 2

high

none

severe (physical addiction can occur)

Front 3

category 2

abuse potential:
medical use:
dependency:

Back 3

high


accepted

severe physical and or psychologic
*these drugs can't be refilled*

Front 4

category 3

abuse potential:
medical use:
dependency:

Back 4

less than category 2

accepted

moderate/low physical or high pscyhologic

Front 5

category 4

abuse potential:
medical use:
dependency:

Back 5

less than 3

accepted

limited physical or psychologic

Front 6

category 5

abuse potential:
medical use:
dependency:

Back 6

less than 4

accepted

limited physical or pschologic = no real potential

Front 7

what category

heroin

Back 7

1

Front 8

what category


tylenol

Back 8

3

Front 9

what category

marijuana

Back 9

1

Front 10

what category

hydrocodone

Back 10

3

Front 11

what category

codeine

Back 11

2

Front 12

what category


vicodin

Back 12

3

and lortab

Front 13

what category

fentanyl

Back 13

2

Front 14

what category

valium

Back 14

4

diazepam

Front 15

what category

cocaine

Back 15

2

Front 16

what category


amphetamine

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2

Front 17

what category

lorazepam

Back 17

4

Front 18

what category

alprazolam

Back 18

4

Front 19

what category


propoxyphene

Back 19

4

Front 20

what categories have high potential for sedation to occur in the client

Back 20

2,3,4

Front 21

the intensity of the drug response is determinted by:

Back 21

the concentration at sites of action

Front 22

the primary determinant of the concentration is the:

Back 22

administered dose

Front 23

when administration is performed correctly, the dose that was given will bear a close relationshop to the:

Back 23

prescribed dose

Front 24

administration
-what are the 3 important determinants of drug responses

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dosage size
route
timing of administration

Front 25

administration

what are the 2 bullets under this category"

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because of poor patient adherence and medication errors by hospital staff, drugs are not always administered as prescribed

Front 26

administration

what can result from
-medication errors
-poor patient adherence (patient is not compliance)

Back 26

result may be toxicity or treatment failure

Front 27

pharmokinetics deteremines what:

what are the components of pharmokinetics?

Back 27

how much of an administered dose gets to the site of action

drug absorption
drug distribution
drug metabolism
drug excretion

Front 28

once a drug has reached its site of action, ____ processes determine the nature and intesnsity of the response

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pharmacodynamic

Front 29

what is thought of as the impact of the body on drugs?

what is thought of as the impact of drugs on the body?

Back 29

pharmacokinetics


pharmacodynamics

Front 30

what are the 3 categories under Pharmacodynamics

Back 30

-drug receptor interaction
-patients functional state
-placebo effects

Front 31

Pharmacodynamics

the initial step leading to a response is the:

what does this interaction result in?

Back 31

binding of a drug to its receptor

(the drug receptor interaction is followed by a sequence of events that ultimately results in a resonse)

Front 32

Pharmacokinetics and Pharmacodynamics

Characteristics unique to each patient can influence both of these processes and by doing so can help determine the patien's response to a drug. The sources of individual variation include (4)

Back 32

physiologic variables
pathologic variables
genetic variables
drug interactions

Front 33

sources of individual variation
-which variable (physiologic, pathologic, genetic)

diminished function of the kidneys

Back 33

pathologic variable

Front 34

sources of individual variation
-which variable (physiologic, pathologic, genetic)

age

Back 34

physiologic

Front 35

sources of individual variation
-which variable (physiologic, pathologic, genetic)

gender

Back 35

physiologic

Front 36

sources of individual variation
-which variable (physiologic, pathologic, genetic)

dminished function of the liver

Back 36

pathologic

Front 37

sources of individual variation
-which variable (physiologic, pathologic, genetic)

alters metabolism of drugs

Back 37

genetic variables

Front 38

sources of individual variation
-which variable (physiologic, pathologic, genetic)

weight

Back 38

physiologic

Front 39

sources of individual variation
-which variable (physiologic, pathologic, genetic)

can predispose the patient to unique drug reactions

Back 39

genetic variables

Front 40

Pharmacokinetics

what is the movement of a drug from its site of administration to the blood

Back 40

absorption

Front 41

Pharmacokinetics

what ist he movement of the drug from where you give it to the blood

Back 41

absorption

Front 42

Pharmacokinetics

the preparation of the drug plays an important role in the rate of absorption. examples are

-enteric coating dissolves where? (intestine or stomach)

Back 42

oral tablets, enteric coated, and sustained release preparations


intestine

Front 43

Pharmacokinetics

the amount of the medication absorbed determines:

Back 43

intensity

Front 44

Pharmacokinetics

the route of administration affects what:

ex: depot injection
-it's like giving someone a shot with yogurt.
what kind of drug is it?

Back 44

rate and amount of absorption

suspension and it takes the body awhile to absorb it so its a long acting drug

Front 45

Pharmacokinetics

the meds in your stomach are based upon the

Back 45

pH in our stomach (our stomach is acidic)

Front 46

for an oral tablet, drugs must pass through what kind of cels in order to be absorbed into the circulatory system?

Back 46

epithelial cells (GI tract is lined with them)

Front 47

surface area: is a major determinant

the (smaller or larger) the surface area, the (faster or slower) the absorption will be

Back 47

larger

faster

Front 48

what organ has the largest GI surface area and this is where the majoriry of oral medications are absorbed

Back 48

small intestine

absorbed in INTESTINE not the stomach

Front 49

how does lipid solubility affect absorption?

Back 49

how fatty is the product

-the fattier it is, it will slip into the cells and get in there

Front 50

what do they mean by pH partitioning?

Back 50

for example, aspirin.
the pH in your intestine is alkalotic (your stomach is acidic) and aspirin is an acid.

when the aspirin hits the small intestine and beacuse its an acid and the intestine is alkalotic, it will try everning itself out so it can pass through the wall

Front 51

the (lower or greater) the pH difference, the (faster or slower) the diffusion

Back 51

greater
faster

Front 52

what is the first-pass effect?


liver metbaolism may inactivate the drug..if so, the first pass effect:


what might have to be administered to achieve the desired effect:

Back 52

drugs absorbed by the small intestine are transported to the liver before being circulated to the rest of the body.

the liver may metabolize much of the drug before it enters circulation. when the blood hits the liver for the first time, there is an amount of medication that is inactivated. this mechanism is referred to as the "first pass effect"


lowers the amount of active drug released into systemic circulation


higher drug dosages

Front 53

first pass effect occurs mostly with what kind of medications

Back 53

PO (oral)

Front 54

enteral is administered by:
parenteral: administered by

Back 54

ingesting (give through mouth)

injecting with an injection

Front 55

routes of administration

po

Back 55

oral

Front 56

routes of administration

sl

Back 56

sublingual (under tongue)

Front 57

routes of administration

sc

Back 57

subcutaneous (beneath the dermis and into the subcutaneous tissue usually in the pts upper arm, thigh, or abdomen

Front 58

routes of administration

IM

Back 58

intramuscular

Front 59

routes of administration

IV

Back 59

intravenous

Front 60

routes of administration

top

Back 60

topical

Front 61

routes of administration

neb

Back 61

nebulizer

Front 62

routes of administration

inh

Back 62

inhaler

Front 63

routes of administration

supp

Back 63

suppository (rectum or vagina)

Front 64

routes of administration

trans

Back 64

transdermal patch

Front 65

oral products

tablets
-what does it consist of

Back 65

drugs plus binding product (cornstarch)

Front 66

oral products


enteric coated
-where does it dissolve?

they are employed for 2 purposes:

Back 66

coating that dissolves in the intestines

consist of drugs that have been coated with a material designed to dissolve in the intestine but not the stomach. they release their contents into the intestine, not stomach.


1) protect drugs from acid and pepsin in the stomach
2) protect the stomach from drugs that can cause gastric discomfort

Front 67

oral products

enteric coated
-increased variability when:
-dependent upon?

Back 67

-Increased variability on onset of response
-Dependent upon stomach emptying

Front 68

oral products

enteric coated
-we have enteric coated products to reduce:

Back 68

the potential of stomach ulcer development

Front 69

oral products

enteric coated

think of it as an M&M
-what does she mean by that

Back 69

candy coated outside is resistance to acid
-so you take the pill and it goes into the stomach but it doesn't do anything. it only dissolves in the intestine (alkaline enviornment)

Front 70

Oral agents – Sustained Release (extended release, controlled release, etc)
-what are they made up of?
-tell me about their absorption?

Back 70

Small spheres that dissolve at different rates (capsule with nerds)

-capsules filled with tiny spheres that contain the actual drug; the spheres have coatings that dissolve at variable rates. Because some spheres dissolve more slowly than others, drug is released steadily throughout the day. The primary advantage is that they permit a reduction in the number of daily doses.
-You can open nerd capsule, but you can’t crush the nerds.(can't crush them because you break the chemical coating which allows them to be SR) you can open the capsule and put them in applesauce


variable

Front 71

Oral agents – Sustained Release (extended release, controlled release, etc)

you can't break apart or crush because if you did, the drug would:

Back 71

be available at once (most deadly is nitroglycerin and narcotics like oxycotin)

Front 72

Sublingual
-where is it absorbed?
-what is the advantage?
-what happens with metabolism?

Back 72

•Absorbed through the oral mucosa
•Rapid absorption
•Drug bypass’s the liver
(works just as fast as an IV injection because of vascularity. it doesn't have to go through metabolism, it's 100% active under the blood stream.

Front 73

IM injections

“Depot” preparation means that the drugs

Back 73

absorb very slowly over an extended period of time

Front 74

IM injections

Types of Depots...
•DepoProvera -
•Pen G Benzathine -
•Lunelle -

Back 74

progesterone

penicillin

for birth control

Front 75

Subcutaneous: is similar to IM, but has a (slower of faster) absorption rate than the IM injection

Back 75

slower

Front 76

Depot injections--- like yogurt.

Use larger needle (what size guage) its going to hurt them..

•They are released over a (short or large) period of time

•what do they look like?

Back 76

20 guage or 18 guage)

larger

They are usually cloudy or white

Front 77

Considerations in IV administration
-what should you look for:
-evaluate for:
-palpate:
-listen to:

Back 77

-Look for swelling or erythemia
-Evaluate for blood return
-Palpate around the site and surrounding area for tenderness and swelling
-Listen to what you patient tells you.

-Redness is phlebitis
-Potassium burns in fluid

Front 78

What harm can an infiltrate do?

Back 78

vascular compression ---no blood supply.

Third spacing and necrosis can happen.

Front 79

How do you fix infiltrate?

Back 79

Heat.
Heat dilates.
It takes 2-3 hours but it will get better.
that allows circulation that can get blood to take fluid back in and you want to keep it warm.

Front 80

-Never push a drug in less than how long?

why?

Back 80

1 minute

Side affects can happen very fast

Front 81

When reconstituting your drug, make sure:

Back 81

it is completely dissolved or you could cause an embolism make sure they are completely dissolved.

Front 82

Distribution
-what is it?

Back 82

Transportation of the drug in the body by bodily fluids to its site of action (Transportation of drug in body to site of action)

Front 83

Distribution
-what is it influenced by:

Back 83

circulation, your plasma protein which is albumin, and blood brain barrier (need a transporter)

Front 84

Distribution
3 factors to consider:

Back 84

1. Blood flow
2. Exiting vascular system
3. Blood brain barrier

Front 85

Distribution
3 factors to consider
-Exiting vascular system
*drug must leave circulation:
*in the capillary beds, the drugs pass between:

Back 85

to be metabolized

the cells and into the intersitial space (drugs pass through the pores in the capillary wall)

Front 86

Distribution
3 factors to consider:
-Blood brain barrier
*very selective in which drugs may pass through*
therefore, the drugs must be __ or use a ___

Back 86

lipid soluble or use a transport system

Front 87

Distribution
3 factors to consider:
-Blood brain barrier

*barrier makes it difficult to treat what kind of problems:

so if it is an infection, use drugs that are:

Back 87

cerebral

lipid soluble

Front 88

Pharmacokinetics
-Placental drug transfer:

what passes through?

Back 88

whatever mom gets, baby gets.

Drugs that are lipid soluble and without a charge can pass through the placenta

Front 89

Pharmacokinetics
-Placental drug transfer:

drugs have the potential to cause numerous problems:

Back 89

birth defects
mental retardation
respiratory depression (narcs)
cardiac rhythm changes

Front 90

Pregnancy Safety Categories
A, B, C, D, X

adverse effects reported in animal fetus and information in humans is not available

Back 90

C

Front 91

Pregnancy Safety Categories
A, B, C, D, X

studies show no risk to the fetus

Back 91

A

Front 92

Pregnancy Safety Categories
A, B, C, D, X

possible fetal risk in humans reported

Back 92

D

Front 93

Pregnancy Safety Categories
A, B, C, D, X

considering potential benefit versus risk may warrant the use of these drugs in pregnant women

Back 93

D

Front 94

Pregnancy Safety Categories
A, B, C, D, X

studies indicate no risk to animal fetus and information in humans is not available

Back 94

B

Front 95

Pregnancy Safety Categories
A, B, C, D, X

fetal abnormalities reported and positive evidence of fetal risk in human is available from animal and human studies

Back 95

x

Front 96

Pregnancy Safety Categories
A, B, C, D, X

these drugs should not be used in pregnant women

Back 96

x

Front 97

Pregnancy Safety Categories
A, B, C, D, X

no potential of harm to fetus

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a

Front 98

Pregnancy Safety Categories
A, B, C, D, X

there's been animal testing, no human information but it's found to be safe for baby and infants

Back 98

b

Front 99

Pregnancy Safety Categories
A, B, C, D, X

don't give if yo don't have to

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c d x

Front 100

Pregnancy Safety Categories
A, B, C, D, X

100% contraindicated in pregnant women unless the women is drying and the only way to save her life is this drug. we will risk the fetus to save moms life.

Back 100

x

Front 101

Pregnancy Safety Categories
A, B, C, D, X

wight the risk vs benefit. where is the fetus in development and where is the mom in pregnancy

Back 101

c and d

Front 102

protein binding --think _______

Back 102

elderly because they don't eat properly

Front 103

what is the most abundant protein in the body

Back 103

plasma albumin

Front 104

tell me about protein
-small or large molecule?
-what can't it do?

Back 104

large

cannot pass out of the circulatory system

Front 105

protein binding can cause restriction of drug distribution. because albumin is too large to leave the bloodstream, drugs bound to albumin cannot leave either

drugs attached to protein are called:

Back 105

bound

Front 106

because albumin has few binding sites, there is significant competition for binding sites. what can this cause:

Back 106

decrease drug concentration and increase possibility for adverse reactions and toxicity (one drug can displace another from albumin causing the free conentration of the displaced drug to rise . by increasing levels of free drug, competition for binding can increase the intensitiy of drug responses and toxicity can result

Front 107

what is biotransformation

Back 107

enzymatic change in a drugs chemical structure

Front 108

What is the primary site of metabolism in the human body?

Back 108

liver

Front 109

what is Cytochrome P450

what does the metabolism?

Back 109

highly utilizated enzymatic system that is used to metabolize certain drugs

enzymes

Front 110

what is the most important secondary action of metabolism?

Back 110

the drugs conversion to a format that the kidney can excrete

Front 111

the most important consequence of drug metabolism is the promotion of:

Back 111

renal drug excretion

(the kidney which is the major organ of drug excretion, is unable to excrete drugs trhat are highly lipid soluble. so you have to convert lipid soluble drugs into more polar (less lipid soluble) compounds to make it possible for the kidney to excrete many drugs

Front 112

consequences of drug metabolism

inactivation of medication

Back 112

drug metabolism can converty active compounds into inactive forms

Front 113

consequences of drug metabolism

increase therapeutic action

Back 113

metabolism can increase the effectiveness of some drugs.

Front 114

consequences of drug metabolism

activation of prodrugs into active forms
-what is a prodrug

Back 114

a prodrug is a compound that is inactive as administered and then undergoes conversion to its active form within the body

Front 115

consequences of drug metabolism

-decrease toxicity when active forms are converted to inactive forms
-increase toxicity when inactive forms are converted to active forms

we have higher toxicity when ___ occurs



whats an example

Back 115

inactivation

tylenol. when you take it, it is inactivated but when the kidney metabolizes it, it metabolizes to whats known as an active metabolite (chemical) that chemical kills and harms liver cells