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148 Cards in this Set
- Front
- Back
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What is pharmaceutic phase?
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When the drug becomes a solution so it can cross the biologic membrane
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True or False: When a drug is administered subQ, IM, IV, there is no pharmaceutic phase.
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True
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What is disintegration?
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Breakdown of the tablet into smaller particles
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What is dissolution?
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It is the dissolving of the smaller particles in the GI fluid before absorption
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True of False: Drugs in liquid form are more readily available for GI absorption than are solids.
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True
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Are drugs disinegrated andd absorbed faster in acidic fluids with a pH of 1 or 2 or akaline fluids?
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Acidic fluids
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True of False: Young people and older adults have more gastric acidity.
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False, young people and older adults have less gastric acidity
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Because of the lower amount of gastric acidity in young people and older adults, is drug absorption faster or slower?
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Drug absorption is slower
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Should enteric coated drugs be crushed? Why or why not?
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No, they should not be crushed because doing so alters the place and time of absorption
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Where do enteric coated drugs disintegrate?
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In the akaline environment of the small intestine
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What is pharmacokinetics?
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Is the process of drug movement to achieve drug action
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What are the four phases of pharmacokinetics?
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Absorption, Distribution, Metabolism and Eliminiation or Excretion
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What is absorption?
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The movement of drug particles from the GI tract to body fluids by passive absorption, active absorption or pinocytosis
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What is pinocytosis?
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A process by which cells carry a drug across their membrane by engulfing the drug particles (e.g like a sponge)
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Do water soluable drugs need a carrier?
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Yes
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True or False: Food has no impact on drug absorption.
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False, food can speed up or slow down absorption, as such for patient teaching it is important to know if a drug should be taken with our without food.
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Which drugs are absorbed faster? lipid soluble and non-ionized drugs or water soluble and ionized drugs
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Lipid soluble and non-ionized drugs
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True or False, drugs administered by these routes do not pass through the GI tract or liver: parenteral drugs, eyedrops, eardrops, nasal sprays, respiratory inhalants, transdermal drugs and sublingual drugs
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True
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Names some other conditions that can effect drug absorption.
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Blood flow, pain, stress, hunger, fasting, food and pH affect drug absorption
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Is drug absorption faster or slower in muscles with more blood vessels or those with fewer blood vessels?
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With more blood vessels like the deltoids.
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What is the process called when the drug passes to the liver first?
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First-pass or hepatic first pass
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What is bioavailability?
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It is the perecentage of the administered drug does the reaches the systemic circulation.
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What is the percentage of bioavailability for the IV route?
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100%
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When does bioavailability occur?
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After absorption and hepatic drug metabolism
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True or False: A decrease in liver function or a decrease in hepatic blood flow can increase the bioavailabilty of the drug, but only if the drug is metabolized by the liver.
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True
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What is distribution?
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The process by which the drug becomes available to the body
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What are the three factors that influence distribution?
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Blood flow, body tissue affinity and the protein-binding effect
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To which protein do most drugs bind?
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Albumin
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What are free drugs and why is this important?
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Free drugs are not bound to a protein, as such they are active and can cause a pharmacolgic response
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True of False: As the free drug in the circulation decreases, more bound drug is released from the protein to maintain the balance of the free drug
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True
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What can occur when two highly protein bound drugs are given concurrently?
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Drug accumulation or drug toxicity, as the drugs are competing for binding sites, causing more free drug to be released into circulation
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What can occur when protein levels are low?
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Can result in drug overdose because they are fewer protein binding sites, causes more free drug to be available
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What is the primary site of drug metabolism?
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The liver, but drugs can be metabolized in both the GI tract and the liver
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Are most drugs lipid or water soluble?
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Lipid soluble, page 6, Chapter 1
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What is the half-life of a drug?
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Is the time it takes for one half of the drug concentration to be eliminated
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How is the half-life of the drug expressed?
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t1/2
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True or False: Liver diseases such as cirrhosis and hepatitis alter drug metabolism.
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True
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If a client takes 650 mg of aspirin and the t1/2 is 3 hours, how much of the drug is eliminated in 3 hours?
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325 mg
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What is considered a short half-life for a drug
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4-8 hours
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What is considered a long half-life for a drug?
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24 hours or longer
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True or False: When a drug has a long half-life, it takes several days for the body to completely eliminate the drug
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True
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What is the main route of drug elimination?
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Through the kidneys (urine)
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True or False: Protein bound drugs cannot be filtered through the kidneys
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True
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What is the test called to determine renal function?
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Creatinine clearance
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What is creatinine?
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It is a metabolic by-product of muscle that is excreted by the kidneys
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True or False: Lower creatinine values are expected in women and older adults
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True, because both women and older adults have less muscle mass
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What are considered normal creatinine clearance levels?
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85 to 135 ml/min
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True or False: Because of low creatinine levels in older adults drug dosage may need to be increased?
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False, low creatinine levels in older adults would require that drug dosage be decreased
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What is pharmodynamics?
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The study of drug concentration and its effects on the body
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What are the types of drug responses?
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Primary and secondary
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Cranberry juice can inhibit the elimination of what OTC drug?
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Aspirin
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What is the primary effect
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It is desirable, it is what the drug is treating
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True or False: The secondary effects of a drug are always desirable
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False, they can be both desirable or undesirable
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True or False: An example of a drug with a primary and secondary effect is Benadryl
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True, Benadryl is an antihistamine whose primary effect is to treat the symptoms of allergy and has a secondary effect to depress the CNS causing drowsiness
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What is dose response?
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Dose response is the relationship between the minimal versus the maximal amount of the drug dose needed to produce the desired drug response
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What is maximum efficacy?
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Maximum drug effect
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True or False: Onset of action is the amount of time it takes to reach the maximum effective concentration after a drug is administered.
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False, onset of action is the amount of time it takes to reach the minimum effective concentration (MEC)
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What is peak action?
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Peak action occurs when the drug reaches the highest blood or plasma concentration
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True or False: Duration of action is the length of time the drug has pharmacologic effect
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True
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True or False: A time response curve evaluates the three parameters of drug action: on-set, peak and duration
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True
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What is the receptor theory?
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Drugs act through receptors by binding to the receptor to produce a response or to block or prevent a response
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What are the four receptor families?
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Kinase linked receptors, Ligand-gated ion channels, G-protein coupled receptor systems and nuclear receptors
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True or False: The activity of many drugs is determined by the ability of the drug to bind to a specific receptor
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True
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True or False: The better the drug fits at the receptor site the more biologically active it is
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True
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What is an agonist?
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Drugs that produce a response
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What is an antagonist?
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Drugs that block a response
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True or False: Most receptors are under the cell membrane
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True
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True or False: A betablocker is an antagonist
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True
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What are non-specific drugs?
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Drugs that affect various sites and have properties of non-specificity
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What are non-selective drugs?
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Drugs that affect various receptors or have properties of non-selectivity
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What are the four (4) categories of drug action?
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1) stimulation or depression, 2) replacement, 3) inhibition or killing of organisms and 4) irritation
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True or False: The length of action depends on the half-life of the drug
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True
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True or False: Drugs with a short half-life are given several times a day
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True
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What is the therapeutic index?
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An estimate of the margin of safety of a drug through the use of ratio that measures the effective dose (ED) in 50% of persons or animals and the lethal dose in 50% of animals
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True or False: The closer the TI ratio is to one (1) the greater the danger of toxicity
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True
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True or False: Drugs with a low TI have narrow margin of safety
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True
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True or False: The therapeutic range of a drug concentration in plasma should be between the minimum effective concentration in the plasma for obtaining desired drug action and the minimum toxic concentration
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True
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What is a peak drug level?
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This is the highest plasma concentration of drug at a specific time and indicates the rate of absorption
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What is the trough drug level?
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Is the lowest plasma concentration of a drug and it measures the rate at which the drug is eliminated
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True or False: Trough levels are drawn immediately before the next dose of the drug is given, regardless of the route of administration
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True
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True or False: Peak and trough levels are requested for drugs that have a narrow therapeutic index
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True
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What is a loading dose?
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A large initial dose of a drug given when immediate drug response is desired
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What are side effects?
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Side effects are physiologic effects not related to desired drug effects
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True or False: All drugs have side effects
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True, all drugs have side effects both desirable and undesirable
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True or False: Side effectcs result mostly from drugs that lack specificty
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True
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How do adverse reactions differ from side effects?
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They are more severe than side effects
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What is drug toxicity?
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When the drug levels exceed the therapeutic range
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What is pharmacogenetics?
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The scientific discipline studying how the effect of drug action varies from a peredicted drug response because of genetic factors or hereditary influence
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What is tolerance?
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Tolerance is a decreased responsiveness to a drug over the course of therapy
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What is tachyphylaxis?
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It is a rapid decrease in response to a drug; an "acute tolerance".
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What is the palcebo effect?
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Is the psyhcological benefit from a compound that may not have the chemical structure of a drug effect.
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What are the nurses' six rights of drug administration?
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1) the right to a complete and clear order, 2) the right to have the correct drug route and dose dispensed, 3) the right to access information, 4) the right to policies to guide safe medication administration, 5) the right to administer medications safely and to identify problems, and 6) the right to stop, think and be vigilant when administering medications
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What are the five rights of drug safe drug administration?
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1) the right client, 2) the right drug, 3) the right dose, 4) the right time and 5) the right route
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What are the five additional rights?
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1) the right assessment, 2) the right documentation, 3) the client's right to education, 4) the right evaluation, and 5) the client's right to refuse
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True or False: Two forms of identification are required prior to the administration of the medication
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True
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True or False: A telephone order (TO) or verbal order (VO) for medication must be cosigned by the prescribing healthcare provider within 24 hours
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True
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What are the components of a drug order?
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1) date and time the order is written, 2) drug name (generic preferred), 3) drug dosage ,4) route of administration, 5) frequency and duration of administration, 6) any special instructions for withholding or adjusting dosage, 7) physician or other health care providers signature or name if TO or VO, 8) signature of licensed practitioners taking TO or VO
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True of False: Nurses are legally liable if they give a prescribed drug and the dosage is incorrect or the drug in contraindicated for the client's health status
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True
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What is PRN?
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As needed
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What is PO?
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by mouth
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True or False: A nurse should check the drug label two(2) times before administration
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False, a nurse should check a drug label three (3) times before administration
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What is a black box warning?
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This the FDA strongest labeling requirement, warning health care providers of risks associated with certain drugs
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True or False: For all medications, it is safe to flush them down the toilet to dispose of them
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False
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What are the five (5) FDA pregnancy catergories?
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A, B, C, D, and X
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Which of the FDA pregnancy categories means a risk to a human fetus has been proven, and the risk outweighs the benefit and the drug should be avoided during pregnancy?
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X
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What FDA category means there is no risk to a human fetus?
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A
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What is the Nurse Practice Act?
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The laws that each state has regarding drug administration by nurses
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What is misfeasance?
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Negligence, giving the wrong drug or drug dose that results in the client's death
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What is nonfeasance?
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Omission; omitting a drug dose that results in the client's death
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Malfeasance
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Giving the correct drug but by the wrong route that results in the client's death
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Each drug may have several names; what are they?
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A chemical name, a generic name and a brand name
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True or False: Some generic drugs have inert fillers and binders that may result in variations of drug effectiveness
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True
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True or False: According to the ANA Code of Ethics for Nurses, the nurse safeguards client's rights, safety, dignity and health care. The nurse seeks consultation, accepts responsibility and demonstrates competency in nursing care
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True
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True or False: Drugs included in the USP-NF have met high standards for therapeutic use, client safety, quality, purity, strength, packaging safety, and dosage form, and will have the initials USP following their official name
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True
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True or False: For controlled substances, there must be a countersign of all discarded or wasted medications
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True
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What schedule of controlled drugs has the highest abuse potential that have accepted medical use?
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Schedule II
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What are the schedules of controlled substances?
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I- high potential for abusee, no accepted medical use
II-high potential for abuse, accepted medical use, can lead to strong physical and psychological dependency III - medically accepted drugs; potential abuse is less than that for schedules I and II. May cause dependence. IV - Medically accepted drugs. May cause depedence V - Medically accepted drugs. Very limited potential for dependence |
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What is drug interaction?
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The altered or modified action or effect of a drug as a result of interaction with one or more other drugs
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What is an adverse drug reaction?
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An undesirable drug effect that ranges from mild untoward effects to severe toxic effects
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What is drug incompatibility?
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Is a chemical or physical reaction that occurs among two or more drugs in vitro. In other words, the reaction occurs between two or more drugs within a syringe, IV bag, or any other artifical environment outside of the body
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What are pharmacokinetic interactions?
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Are changes that occure in the absorption, distribution, metabolism and excretion of one or more drugs
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True of False: When a person takes two or more drugs at the same time, the rate of absorption of one or both drugs can change
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True
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What are the three ways one drug can block, decrease, or increase the absorption rate of another drug
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1) By decreasing or increasing the gastric empyting time
2) By changing the gastric pH 3) By forming drug complexes |
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True or False: A significant increase in the serum albumin level because of liver disease or poor nutritional status can increase the free amount of highly protein bound drugs, making more drug available to exert its pharmacologic effect
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True
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True or False: It is impossible for one drug to increase the metabolism of another drug by stimulating liver enzymes
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False, one drug can increase the metabolism of another drug by stimulating liver enzymes
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True or False: Smoking can effect drug metabolism
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True, in the case of theophylline, used to treat COPD, smoking can increase hepatic activity and increase theophylline clearance
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True or False: Two or more drugs that undergo the same route of excretion may compete with one another for elimination from the body
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True
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Provide an example of a drug interaction
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Tetracycline and antacids; may prevent the absorption of tetracycline
Oral contraceptives and antibiotics Anticoagualants and anticonvulsants |
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True or False: The following are behaviors to avoid during medication administration
* do not be distracted when preparing medications * do not give drugs poured by others * do not pour drugs from containers with labels that are difficult to read or whose labels are partially removed or have fallen off * do not transfer drugs from one container to another * do not pour drugs into the hand * do not give drugs for which the expiration date has passed * do not guess about drugs and drug doses. Ask when in doubt * do not use drugs that have sediment, are discolored, or are cloudy (and should not be) * do not leave medications by the bedside or with visitors * do not leave prepared medications out of sight * do not give drugs if the client says he or she has allergies to the drug or drug group * do not call the client's name as the sole means of identification * do not give the drug if the client states the drug is different from the drug he or she has been receiving. Check the order * do not recap needles. use universal precautions. * do not mix with large amount of food or beverage or foods that are contraindicated |
True
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What is additive drug effect? Provide an example.
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Is the sum effect of two drugs, when two drugs with similar action are administered.
Beta-blocker and a diuretic in treating hypertension |
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True or False: Addivitive effects can be desirable or undesireable
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True
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What is synergistic drug effect or potentiation? Priovide an example
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When two or more drugs are given together, one drug can potentiate, e.g. clinical effect is substantially greater on another.
Demerol and Phengran |
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What is antagonistic drug effect? Provide an example
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When two drugs that have opposite effects are administered together, each drug cancels the effect of the other.
In the case of morphine overdose, naloxone is given as an antagonist to block the narcotic response |
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True or False: Food is known to increase, decrease or delay drug absorption
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True
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What is drug-induced photosensitivity?
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A skin reaction that is caused by exposure to sunlight
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What are the two types of photosensitvity reactions?
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photo-allergy and phototoxicity
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True or False: There has been an increase in the use of OTC products
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True
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What is polypharmacy and why is it an issue?
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Polypharmacy is having multiple prescribers and multiple pharmacies
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True or False: The use of OTC may mask symptoms thereby making diagnosis more complicated
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True
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True or False: The client's healthcare provider or pharmacist should be consulted before OTC preparations are taken
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True
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True or False: Inactive ingredients in OTC medications may result in adverse reactions
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True
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What are four important points associated with herbal therapy for consumer and health care provider education?
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1) Do not take herbs if pregnant or attempting to become pregnant
2) Do not take herbs if nursing 3) Do not give herbs to infants and young children 4) Do not take a large quantity of any one herbal prepartation additional tips: 5) results from conventional medicines may come faster 6) Safety, efficacy and dosage are important; thus multiple reliable sources should be consulted |
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What herb is known as the "herb of endurance" and is reported to lower cholestrol and trigylceride levels, decrease blood pressure and reduce the clotting capability of blood?
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Garlic
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This herb is know to boost the immune system and is used to treat headache, stomach problems and digestive disorders including motion sickness. Long-time use for relief of nausea is validated by modern research.
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Ginger
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This herb is not effective when used by individuals with moderate to severe depression.
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St. John's Wort
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This herb is known as a popular immune system enhancer, but should be avoided by those with HIV, AIDS and TB. It is also used by Native Americans to treat snakebites.
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Echinacea
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This herb may help with chronic fatigue syndrome and to relieve heartburn, but is contraindicated in those with hypertension.
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Licorice
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This root promotes sleep and muscle relaxation, and is an antieplileptic, antidepressant, and antipsychotic. Consumers need to be aware of potential liver damage.
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Kava
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