Pharmacology Block One

Front 1

What is the single biggest reason behind why nurses get sued?

Back 1

medications

Front 2

Where did the word "Pharmacology" come from? What does it mean?

Back 2

the Greek word "pharmakon" which means drug or poison

Front 3

What is Pharmacology?

Back 3

the study of drugs or chemicals that alter the functions of living organisms

Front 4

What is the technical definition of Pharmacology?

Back 4

the study of biochemical and physiological aspects of drug action and drug effect.

Front 5

What are the six biochemical/physiological aspects of drug action and effect?
Which is most important?

Back 5

absorption, distribution, metabolism, elimination, toxicity, and mechanism of action.
Mechanism of action is most important.

Front 6

Are drugs only those medications purchased OTC or with an Rx?

What are some examples of drugs?

Back 6

No

OTC's, Rx's, Caffeine, alcohol, food additives, cosmetics

Front 7

Define what a drug is.

Back 7

any chemical that can affect a living process.

Front 8

What is drug therapy?

Back 8

the use of drugs to prevent, diagnose, or cure disease processes, OR
to relieve the signs and symptoms of an underlying disease process when no cure is possible (symptom control and increased quality of life is the goal in this case)

Front 9

What is clinical pharmacology?

Back 9

the study of drugs in humans

Front 10

What three qualities would the ideal drug have?

Back 10

Effectiveness, safety, and selectivity

Front 11

What is the most important property of drugs?

Why?

Back 11

Effectiveness

Because if the drug is not effective, it's not useful, no justification for giving it exists
i.e. antibiotics for viral infections

Front 12

A drug which elicits the response for which it has been administered would be considered _____________

Back 12

Effective

Front 13

what is the definition of a "safe" drug?

Do they exist?

Back 13

one that cannot produce harmful effects, even if administered in very high doses for a very long time.

No

Front 14

How can we reduce the chances of producing an adverse effect from a drug?

Back 14

by proper drug selection and administration (nothing is 100%)

Front 15

All drugs have the ________ to cause ____________.

Back 15

ability
injury

Front 16

what is a normal and predictable side effect for narcotic analgesics?

Back 16

respiratory depression

Front 17

what are some of the side effects that cancer chemotherapy can produce?

Back 17

Pancytopenia:
anemia
thrombocytopenia - not enough platelets
leukopenia - low level of white blood cells

Front 18

A drug that has its only response as that for which it is given would be considered _______________.

Back 18

Selective

No such thing as a 100% selective drug.

Front 19

why is it that there is no such thing as a 100% selective drug?

Back 19

because all drugs cause side effects

Front 20

what is the therapeutic objective of drug therapy?

Back 20

to provide the maximum benefit with the minimum harm

Front 21

who are the players in the system of checks and balances regarding drug admin?

Back 21

Prescriber
Pharmacy
RN
Patient

Front 22

Drug reactions should be _________ not merely __________ ___.

Back 22

anticipated
responded to

Front 23

How long does it take before a brand name drug can be made generic?

Back 23

17 years (until their patents are lost)

Front 24

what is the first question you should ask a pt?

If yes, what's the next question?

Back 24

1. are you allergic to any drugs?

2. what happens when you take that drug?

Front 25

what does a Type I hypersensitivy reaction look like?

Back 25

Massive release of histamines cause:
1. vasodilation = drop in BP, cardiovascular shock
2. vascular leak syndrome = localized swelling (most dangerous in larynx= resp. distress)
3. bronchoconstriction = resp. distress

Front 26

what is the first step in the mechanism of a Type I hypersensitivity rxn?

Back 26

Initial exposure to an allergen (Ag), where the Ag is presented to a B cell, and the B cell makes an inappropriate amount of IgE antibodies

Front 27

what is the second step in the mechanism of a Type I hypersensitivity rxn?

Back 27

If enough IgE antibodies are produced, they find their way to the mast cells and basophils, where the Fc portion fits into a receptor on the mast cell.

Front 28

what is the final step in the mechanism of a Type I hypersensitivity rxn?

Back 28

a second or subsequent exposure to the Ag occurs: - the Ag binds to the IgE molecules that had previously bound to the mast cells causing degranulation of the vasoactive amines of the mast cell. (release massive amount of histamine)

The histamines search out the H-1 receptors found on the smooth muscle of bronchioles (cause bronchoconstriction)

Histamine also causes vasodilation and increased vascular permeability, decreasing BP

Front 29

Type I Hypersensitivity Reactions can develop how fast and where?

Back 29

within seconds

locally and or systemically

Front 30

Type I Hypersensitivity Reactions are always mediated by what?

Back 30

IgE

Front 31

What type of cells are the major players in Type I Hypersensitivity Reactions

Back 31

Mast cells and basophils

Front 32

where do mast cells reside

Back 32

everywhere but especially in the upper and lower respiratory tracts and near blood vessels. skin and GI tract

Front 33

what is the term for hives?

Back 33

uticaria

Front 34

whether you have an allergic reaction or not to an allergen is all based upon what?

Back 34

genetics

Front 35

what is a normal response to a drug?

Back 35

it depends upon your population and the inherent biologic variability based upon physiological differences between "special populations"

Front 36

Why is a fetus considered a "special population"?

Back 36

b/c a fetus has no mechanism for metabolizing or eliminating drugs from the body - the kidney and liver are not functioning fully

Front 37

what does decreased hepatic function do to a drug's effect?

Back 37

it increases the potential drug effect because of decreased biotransformation

Front 38

what does decreased renal function do to a drug's effect?

Back 38

it increases drug effect because of decreased elimination of the active drug.

Front 39

what stage of fetal development is not susceptible to teratogenesis?

Back 39

the first two weeks

Front 40

most major congenital anomalies occur in what stage of fetal development

Back 40

weeks 3 - 8

Front 41

what are the pregnancy categories for drugs?

Back 41

A Remote risk of fetal harm
B slightly more risk than A
C Greater risk than B
D Proven risk of fetal harm - benefits of drug may be acceptable despite the risk
X Proven risk of fetal harm - the risk harm outweighs any potential benefit.

Front 42

define "teratogen"

Back 42

a drug or substance that can cause mental or physical defects in a developing fetus.

Front 43

what pregnancy category does every statin drug fall into

Back 43

Category X

Front 44

Most sensitive time for developing birth defects, gross malformations biochemical and behavioral abnormalities is when?

Back 44

during the first trimester.(most organogenesis is happening)

Front 45

always do what before administering drugs to a woman of child-bearing age

Back 45

check a urine pregnancy test or serum test

Front 46

children are not small adults, always dose based on ________ Until when?

Back 46

Weight mg/kg

until 16 years old or a certain BMI

Front 47

neonates are considered "special population" because?

Back 47

immature liver and kidneys

Front 48

why is it important to know that the amount and distribution of body water changes with age?

Back 48

b/c many drugs are dissolved in the body water and body water acts as the metabolic solute for chemical reactions to take place

Front 49

as a child ages tissue mass increases how?

Back 49

skeletal growth and muscle development

Front 50

what is special to consider the elderly population?

Back 50

the hepatic and renal function is in a state of decline b/c of age.

decreased GI motility
Decreased cardiac output
altered central nervous system
Increased fat to muscle ratio (so lipid soluble drugs stay in body fat longer)

Front 51

what effect does aging have on drug duration of action?

Back 51

increased duration of action to medicine

Front 52

what's the rule of thumb for giving meds to elderly

Back 52

Start out slow, and increase slowly.

Front 53

what does the Joint Commission say about Medication reconciliation?

Back 53

you must document all medications you're give AND go through all the other medications other providers have prescribeed. This list must be part of the medical recordds

Front 54

We want a drug to have a ____________ action, then be ______________, and finally, _____________.

Back 54

therapeutic
metabolized
eliminated

Front 55

In order for a drug to be effective each time it is administered, it must be standardized according to

Back 55

agreed-upon federal (USP/NF) guideline or formulations

Front 56

what does USP
and NF stand for

Back 56

U.S. Pharmacopia
National Formulor

Front 57

each drug is given three separate names:

Back 57

1. chemical name
2. generic name
3. Trade name

Front 58

whenever possible, you should use which name for orders and charting?

Back 58

the generic names

Front 59

who adopts the generic names?

Back 59

the US Adopted Names Council.

Front 60

Describe a schedule I controlled substance (CI)

Back 60

No accepted medical use in the U.S. i.e. LSD, heroine

Front 61

describe a schedule II controlled substance

Back 61

Highest potential for abuse - must present with original rx in person at pharmacy, no refills. Rx must have lic.# and DEA # i.e. morphine

Front 62

describe a schedule III or IV controlled substance

Back 62

high potential for abuse, rx can be phoned in, refilled 5x's or until 6 months is up, then must be re-written i.e. codeine

Front 63

describe a schedule V controlled substance

Back 63

abuse potential exists but is the least abused of controlled substances i.e. Robitussin AC
Refilled 5x's or until 6 months is up

Front 64

what is the pharmacokinetic impact of aging related reduced long and short term memory

Back 64

increased risk of unintentional noncompliance

Front 65

what is the pharmacokinetic impact of aging related reduced visual acuity

Back 65

increased risk of drug errors b/c of poor vision

Front 66

what is the pharmacokinetic impact of aging related decreased cardiac output

Back 66

decreased biotransformation and excretion of drugs, resulting in increased circulation time

Front 67

what is the pharmacokinetic impact of aging related altered peripheral vascular tone and reduced baroreceptor activity

Back 67

exaggerated effects of antihypertensives and diuretics.

Front 68

what is the pharmacokinetic impact of aging related increased adipose tissue

Back 68

altered distribution and increased concentration of fat-soluble drugs in adipose tissue; some drugs reach greater peak concentrations with longer half-lives.

Front 69

what is the pharmacokinetic impact of aging related decreased body water

Back 69

drier mucous membranes may cause drugs to stick to the oral cavity and cause irritation; increased water-soluble drug concentration in bloodstream

Front 70

what is the pharmacokinetic impact of aging related decreased enzymatic activity in liver

Back 70

altered biotransformation and detoxification processes; biotransformation time is lengthened and both parent drug and active metabolites exert effects for extended periods; drug toxicity may occur more rapidly

Front 71

What are the seven Rights of Drug Administration?

Back 71

The Right Drug
The Right route
The right dose
The right time
The right patient
The right to refuse
The right documentation

Front 72

What do you need to know beyond the seven Rights of Drug Administration?

Back 72

You MUST know that this is the right drug for a particular condition, given the patient's history

Front 73

Who can prescribe drugs that you can take a written or oral medication order from?

Back 73

MD, DO, DDS, DPM, NP, CMN, PA's are legally authorized to diagnose, treat and prescribe medications

Front 74

who can give medications?

Back 74

RNs, LPNs (IV only with cert), pharmicists, medical students, EMTs, paramedics, respiratory therapists, nursing students under direct supervison on doc or RN

Front 75

how many components are there to a drug order?

Back 75

8 in person
9 (when RN takes verbal or over the phone oders)

Front 76

Name the components of a drug order.

Back 76

1. date order is written
2. time order is written
3. drug dosage
4. route
5. frequency
6. duration
7. indication
8. prescriber's signature
9. RN signature (if telephone or verbal)

Front 77

what are the types of drug orders?

Back 77

1. routine
2. prn
3. single order
4. stat order
5. protocol order

Front 78

what is a protocol order

Back 78

drug admin on a sliding scale: if ______, then this amount.

Front 79

what is "PRN"?

Back 79

"Prorenata"
Means "as needed"

Front 80

How quickly should a Stat order be administered?

Back 80

between 1 - 10 minutes max

Front 81

what are the components of a drug history

Back 81

Drug use, past and present
Responses to drug use
Attitudes toward drug use
Storage of drugs
Identify - (factors warranting cautious us or avoidance of a drug, risk for adverse rxns, phys & psych rxn previously, financial issues, compliance issues)

Front 82

Name the abbreviations that are officially on the "do not use" list.

Back 82

U - use "unit"
IU - use "international units"
Q.D., QD, qd, q.d. - use "daily"
Q.O.D., QOD, q.o.d., qod - use "every other day"
trailing zeros - use 5 mg, not 5.0 mg
lack of leading zeros, use 0.5 mg, not .5 mg
MS - use "magnesium sulfate" or "morphine sulfate"
MSO4 or MgSO4 - write out name in full

Front 83

Define Side Effect

Back 83

a nearly unavoidable secondary drug effect produced at therapeutic doses

Front 84

Define Toxicity

Back 84

an adverse drug reaction caused by excessive dosing
OR in everyday parlance:
any servere adverse drug rxn, regardless of the dose

Front 85

Define Allergic Reaction

Back 85

an immune response which occurs after to a prior sensitization of the immune system to the allergen/drug

Front 86

Define idiosyncratic effect

Back 86

an uncommon drug response resulting from a genetic predisposition.

Front 87

Define iatrogenic disease

Back 87

a disease produced by a physician (or drugs)
Nearly identical to idiopathic (naturally occurring) diseases

Front 88

What is the term for a state in which the body has adapted to drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued?

Back 88

Physical Dependence

Front 89

What is the term for the ability of certain medications and environmental chemicals to cause cancers

Back 89

carcinogenic effect

Front 90

what is the term for a drug-induced birth defect?

Back 90

teratogenic effect

Front 91

what is the term for the ability to cause severe liver damage

Back 91

hepatotoxic

Front 92

what is the most common reason for withdrawing an approved drug from the market?

Back 92

hepatotoxicity

Front 93

how do drugs damage the liver?

Back 93

as some drugs undergo metabolism in the liver, they are converted to toxic products that can injure liver cells

Front 94

What is an ADR?

Back 94

adverse drug reaction

Front 95

about what percentage of all new drugs have serious ADRs that are not revealed ddruing Phase II and III trials

Back 95

50%

Front 96

when administering newly released drugs, what should you do?

Back 96

Be alert for unusual symptoms, even if not described in the literature

Front 97

if you suspect a drug of causing a previously unknown ADR, you should report the effect to whom?

Back 97

MEDWATCH
the FDA Medical Products Reporting Program
www.fda.gov/medwatch

Front 98

what is a medication error?

Back 98

any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the healthcare professional, patient, or consumer

Front 99

who makes medication errors?

Back 99

workers in the pharmaceutical industry, people in healthcare delivery sstem, patients and family members

Front 100

Name the 13 types of medication errors.

Back 100

wrong: patient, drug, route, time, dose (over, under, extra, omitted), dosage form, diluent, strength/concentration, infusion rate, technique (i.e. inappr. tablet crushing), duration of treatment. Also deteriorated drug error (expired drugs)

Front 101

what are the three categories of medication error causes?

Back 101

human factors
communication mistakes
name confusion

Front 102

examples of human factors in medication errors: most common?

Back 102

1.performance deficits (most common) ie. admin drug IV instead of IM
2.knowlege deficits
3.miscalculation of dosage

Front 103

examples of miscommunication in medication errors

Back 103

poor handwriting
oral and written orders misunderstood
use of zeros and decimal points