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136 Cards in this Set

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What is a pharmacopeia?
A medical reference summary that indicates standards of drug purity, strength and direction of synthesis.
The difference between therapeutic classification and pharmacologic classification is that therapeutic classification refers to a drug's _______
Therapeutic classification refers to a drug's USE.
The client is to receive sublingual nitroglycerin to treat chest pain. The nurse tells the client that a sublingual drug:

a. works by dissolution.
b. enters the blood stream directly.
c. takes several hours to be effective.
d. are toxic to the liver.
Sublingual drugs enter the blood stream directly.
Drugs that are given via the enteral route of administration utilize which system for delivery?
Enteral route = via the digestive system
A client who has kidney disease may have problems with which phase of drug movement?

a. Metabolism.
b. Excretion.
c. Distribution.
d. Absorption.
a. Metabolism (Liver)

b. EXCRETION (KIDNEYS)

c. Distribution (Blood/Lymph)

d. Absorption
Pediatric and geriatric clients may have altered sensitivity to drug therapy. This is due to:

a. reduced enzyme activity.
b. increased metabolic rates.
c. inactive life styles.
d. high percentage of body fat.
reduced enzyme activity
Which of the following will have the greatest effect on drugs excreted by the respiratory system?

a. High first pass effect.
b. Binding to plasma proteins.
c. Good blood flow to lung capillaries.
d. Drug solubility.
Good blood flow to lung capillaries.
Which of the following would cause a drug to be absorbed more quickly?

a. Large surface area of membrane.
b. Reduced binding to plasma proteins.
c. Reduced body temperature.
d. Presence of food in the digestive tract.
a. Large surface area of membrane.

b. Reduced binding to plasma proteins.
If the client is taking a drug with a short half-life you explain this by stating that half-life is the time it takes ________________.
to remove half of the drug from the general circulation.
A drug with a short half-life will be excreted quickly or slowly?
Quickly.
Disulfiram (Antabuse) is used to treat what?
Alcoholism.
When advising a client who has heart disease not to smoke, you know that the rationale is that nicotine causes the heart to __________.
accelerate its rate.
Client teaching regarding methylphenidate (Ritalin) would include which of the following:

a. methylphenidate (Ritalin) should be taken at bedtime to avoid insomnia.
b. if the child is over active it is ok to give an extra dose.
c. children on methylphenidate (Ritalin) should not eat chocolate.
d. there are no interactions between methyphenidate (Ritalin) and OTCs.
Children on methylphenidate (Ritalin) should not eat chocolate.
The following is true about the effects of sympathetic nervous system stimulation.

Heart rate will ________, pupils will ________.
Heart rate will increase, pupils will dilate.
Adrenergic drugs may have which of the following "fight or flight" side effects?

a. Tachycardia and Hypotension.
b. Hypertension and Bradycardia.
c. Cardiac arrhythmias and Bradycardia.
d. Cardiac arrhythmias and Hypotension.
Hypertension and Bradycardia.
Atropine is used in pre-operative clients to achieve what?
Decreased secretion of mucus membranes.
In what condition would the administration of atropine be contraindicated?
Glaucoma.
The primary use of beta 1 blockers is to treat:
Hypertension
Prior to starting any anticholinergic drug the nurse should assess the client for what?
Difficulty urinating.
The parasympathetic nervous system produces which of the following?
a. Rest and relaxation response.
b. Fight or flight response.
PARASYMPATHETIC = Rest and Relaxation

SYMPATHETIC (Sympathetic to situation) = Fight or Flight
When giving intravenous barbiturates you would monitor the client for ___________.
Respiratory depression.
Epilepsy is a condition characterized by:

a. high blood pressure and vasoconstriction.
b. abnormal discharges within the brain.
c. proteinuria and edema in the brain.
d. tremors, confusion and disorientation.
abnormal discharges within the brain.
Which of the following types of seizures occur most often in children?

a. Atonic.
b. Myclonic.
c. Absence.
d. Complex partial.
Absence.
All three categories of seizure drugs work by effecting:

a. nutrient and mineral balance.
b. rate of glucose metabolism.
c. protein levels.
d. coagulation factors.
nutrient and mineral balance.
When caring for a client who is taking phenytoin (Dilantin) you would include which of the following interventions in your plan of care?

a. Good pulmonary care.
b. Assessment for depression.
c. Attention to oral hygiene.
d. Monitoring for conjunctivitis.
Attention to oral hygiene.
One of the major side effects of antipsychotic drugs is extrapyramidal effect. Which of the following are symptoms of this?

a. Tremors and involuntary repetitive movements.
b. Diarrhea and abdominal cramping.
c. Lethargy and Bradycardia.
d. Insomnia and increased muscle tone.
Tremors and involuntary repetitive movements.
Which of the following symptoms would be found in a client with Parkinson's disease?

a. Bradykinesia and flaccidity of muscles.
b. Tremor, muscle rigidity and weakness.
c. Hyperkinesis and rigidity of muscles.
d. Spasticity and bradykinesia.
Tremor, muscle rigidity and weakness.
Symptoms of Parkinson's disease are thought to be caused by which of the following?

a. Destruction of the neurotansmitter dopamine.
b. Autoimmune effect on ACTH receptor sites.
c. Increase production of dopamine.
d. An inability to utilize dopamine.
Destruction of the neurotansmitter dopamine.
The focus of anti-parkinson drug therapy is to:

a. produce extrapyramidal effects.
b. stimulate release of acetylcholine.
c. decrease breakdown of dopamine in the limbs.
d. restore balance of dopamine and acetylcholine in the brain.
restore balance of dopamine and acetylcholine in the brain.
Clients with Alzheimer's disease have which of the following changes in brain function?

a. Loss of cholinergic brain function.
b. Hyperactive cholinergic brain function
c. Increased dopamine loss.
d. Breakdown of cells in the cerebellum.
Loss of cholinergic brain function.
formulary
lists of drugs and drug recipes commonly used by pharmacists
pathophysiology
the study of diseases and the functional changes occurring in the body as a result of diseases
pharmaceutics
the science of preparing and dispensing drugs
pharmacology
the study of medicines, the discipline pertaining to how drugs improve the health of the human body
pharmacotherapeutics
treatment of diseases by the use of drugs
Four stages of approval for therapeutic and biologic drugs
1. Preclinical investigation

2. Clinical investigation

3. Submission of a New Drug Application (NDA) with review

4. Post-marketing surveillance
Stage 1 of new drug approval process by FDA
Pre-clinical investigation- basic scientific research involving laboratory culturing and animal testing to determine drug dosage effectiveness and potential adverse effects.
Stage 2 of new drug approval process by FDA
Clinical investigation- involves CLINICAL PHASE TRIALS (longest part of drug approval process). Clinical pharmacologists perform tests on volunteers and large groups of selected clients with certain diseases. Scientists and practitioners establish drug doses and identify adverse effects. Clinical investigators address concerns such as drug-drug interactions, drug-other disease interactions, effectiveness between one type of client and another, etc.
Stage 3 of new drug approval process by FDA
Submission and review of New Drug Application (NDA)- Clinical Phase III trials and more animal testing may continue if needed. If NDA approved - move to stage 4. If NDA rejected- process stops until concerns are addressed.
Stage 4 of new drug approval process by FDA
Post-marketing surveillance- PURPOSE: to check for any new harmful effects that may appear when the drug is used in a larger and more diverse population. If serious adverse effects appear, drug is recalled.
Division of FDA responsible for regulation of therapeutic Rx and OTC drugs
CDER- Center for Drug Evaluation and Research
Division of FDA responsible for regulation of use of Biologics
CBER- Center for Biologics Evaluation and Research
Biologics
Chemical Agents that produce biological responses within the body; they are synthesized by cells of the human body, animal cells, or microorganisms. Ex: Hormones, vaccines, animal products.
Three drug classifications
TRADITIONAL DRUGS- chemically-produced, synthesized in a laboratory.

BIOLOGICS- naturally-produced, made by the body's cells & microorganisms, associated with the bloodstream (ex: hormones, vaccines, animal products)

NATURAL/ALTERNATIVE THERAPIES- extracted from a natural source (ex: herbs, vitamins, minerals)
Bioavailability
The ability of a drug to reach the bloodstream and its target tissues
Chemical Name
Strict Chemical Nomenclature used for naming drugs, established by the International Union of Pure and Applied Chemistry (IUPAC)
Combination Drug
A drug product with more than one active generic ingredient
Controlled Substance
Drug whose use is restricted by the Comprehensive Drug Abuse Prevention and Control Act
Generic Name
Nonproprietary name of a drug, assigned by the government
Pharmacological Classification
Organization of drugs on the basis of their MECHANISM OF ACTION. (Ex: diuretics [cause diuresis] calcium channel blockers, sympatholytics [block stress-related activity], vasodilators, etc)
Mechanism of Action
The method in which a drug exerts its therapeutic effects
Therapeutic Classification
Organization of drugs on the bases of their THERAPEUTIC USEFULNESS. (Ex: anticoagulants, antihypertensives, antidysrhythmics, antianginals, antihyperlipidemics)
Trade name
Proprietary (owner) name of a drug assigned by the manufacturer; aka BRAND name or PRODUCT name
Physical Dependence
Altered physical condition caused by the nervous system's adaptation to repeated drug use- person experiences physical signs of discomfort (withdrawal) when drug is no longer used.
Psychological Dependence
Strong, compulsive feeling of need to continue drug use; little or no signs of physical discomfort with discontinuance of drug.
Scheduled drugs
Drugs that are classified according to their potential for abuse.
Schedule I Drugs
Schedule II Drugs
Schedule III Drugs
Schedule IV Drugs
Schedule V Drugs
SCHEDULE I- highest potential for abuse, little to no therapeutic value (ex: heroin, LDS, marijuana),

SCHEDULE II- high potential (ex: morphine, cocaine, methadone)

SCHEDULE III- moderate potential (ex: anabolic steroids, codiene, hydrocodone [Vicodin]

SCHEDULE IV- lower potential (ex: Valium, Xanax)

SCHEDULE V- lowest potential (ex: OTC cough meds with codeine)
Enteral route
Drug administration through the gastrointestinal tract.
Parenteral route
Drug administration through the a way other than the digestive tract (usually injection).
Intraarterial route
Method of parenteral drug delivery where drugs are injected into the arterial circulation.
Intradermal route
Method of parenteral drug delivery where drugs are injected into the dermis of the skin.
Intraperitoneal route
Method of parenteral drug delivery where drugs are injected into the abdominal cavity.
Intrathecal route
Method of parenteral drug delivery where drugs are injected into the spinal subarachnoid space.
Topical route
Drug administration by which drugs are placed directly onto the skin and mucous membranes.
Hypodermis is _______
HYPODERMIS is directly under the epidermal layer of skin. (SubQ injections)
Dermis is _______
DERMIS is the layer of skin lying immediately under the epidermis, consists of papillary and reticular layers. (Intradermal injections)
Subarachnoid space is _______
SUBARACHNOID SPACE is the space between the pia mater and the arachnoid, containing the cerebrospinal fluid. (Intrathecal injections)
Transmucosal route
Method of topical drug delivery where drugs are applied directly to mucosal membranes, including the nasal and respiratory pathways and reproductive openings.
Transdermal route
Method of topical drug delivery, usually by a patch, where drugs are absorbed across the layers of the skin for the purpose of entering the bloodstream.
Solubility is _________
Dissolution is _________
SOLUBILITY is the ability to dissolve or mix.

DISSOLUTION is the dissolving process of solid drug preparations; the longer it takes for drugs to dissolve, the more delayed their onset of action.
Epidural route
Method of parenteral drug delivery where drugs are injected into the space overlying the dura mater.
Dura mater is _____

(Subdural space is _____)

Arachnoid membrane is _____

(Subarachnoid space is _____)

Pia mater is _____
DURA MATER is the outermost of the meninges covering the spinal cord and brain.

(Subdural space is the space between the dura mater and the arachnoid membrane.)

ARACHNOID is the intermediate membrane of the meninges that enclose the brain and spinal cord.

(Subarachnoid space is the space between the arachnoid membrane and the pia mater, containing the CSF.)

PIA MATER is the innermost of the meninges covering the spinal cord and brain.
Viscosity
Thickness of a liquid
Types of ENTERAL drug administration
ORAL (PO)- by mouth

BUCCAL- Across membranes of the mouth (cheek)

SUBLINGUAL (SL)- under the tongue

RECTAL (PR)- by suppositories or enema
Types of PARENTERAL drug administration
IV
IA
IC

Card 1 of 3
INTRAVENOUS (IV)- into the venous circulation

INTRA-ARTERIAL (IA)- into the arterial circulation

INTRACORONARY (IC)- into the coronary circulation
Types of PARENTERAL drug administration
SQ
ID
IM
Intraosseous

Card 2 of 3
SUBCUTANEOUS (SQ)- under the skin; into the hypodermis

INTRADERMAL (ID)- into the dermis of the skin; intracutaneous

INTRAMUSCULAR (IM)- into the muscles

INTRAOSSEOUS- into the bone
Types of PARENTERAL drug administration
Epidural
IT
IP
Intrasynovial

Card 3 of 3
EPIDURAL- into the space overlying the dura mater

INTRATHECAL (IT)- into the spinal subarachnoid space

INTRAPERITONEAL (IP)- into the abdominal cavity

INTRASYNOVIAL- into the joint
Types of TOPICAL drug administration

Transcutaneous
Transdermal

Card 1 of 2
TRANSCUTANEOUS- Across the skin

TRANSDERMAL- Across the dermis
Types of TOPICAL drug administration

Transmucosal
Opthalmic
Otic
Vaginal
Intrauterine

Card 2 of 2
TRANSMUCOSAL- across mucous membranes

OPTHALMIC- onto membranes of the eyes

OTIC- onto membranes of the deeper ear

VAGINAL- onto membranes of the vagina

INTRAUTERINE- onto membranes of the uterine lining
Agonists
Drugs that are capable of binding with receptors in order to induce a cellular response
Antagonists
Drugs that block the response of another drug
Biotransformation
The metabolism or chemical conversion of drugs from one form to another that may result in increased or decreased activity
Blood-brain barrier
An anatomical structure that prevents some substances from gaining access into the brain
Blood-placental barrier
An anatomical structure that prevents some substances from moving into the bloodstream of the fetus
Blood-testicular barrier
An anatomical structure that prevents some substances from entering male reproductive tissue
Absorption
The process of moving a drug across body membranes
Distribution
The process of transporting drugs through the body
Efficacy
The effectiveness of a drug in producing a more intense response as its concentration is increased
Enterohepatic
recirculation
Recycling of drugs and other substances by the circulation fo bile through the intesting and liver
Excretion
The process of removing substances from the body
First-pass effect
The initial metabolism in the LIVER of an (enteral) drug absorbed from the GI tract, rendering it less bioavailable before it reaches systemic circulation through the bloodstream.

Parenteral drugs bypass liver which prevents first-pass effect.
Half-life
The time it takes for one-half of the original amount of a drug in the body to be removed; a measure of the rate at which drugs are removed from the body.
Synergistic effect
A drug interaction that results from combined drug effects that are greater than the effect achieved if the drugs were given alone.
Contraindication
Any symptom or circumstance that makes treatment with a drug unsafe or inappropriate
Iatrogenic
hazard
Any potential or actual patient harm that is caused by errant actions of health care staff members
Onset of Action
Time it takes for a drug to elicit a therapeutic response
Peak effect
Time it takes for a drug to reach its maximum therapeutic response in the body
Receptor
The structural component on the outer surface of a cell to which a drug binds in a dose-related manner in order to produce a response.
Rate of Elimination
The amount of drug removed from the body during a specified period of time.
Prodrugs
Drugs that become more active after they are metabolized; an inactive drug form that is converted to an active metabolite by various biochem rxns in the body (often more readily absorbable than its active metabolite).
Potency
The power or strength of a drug at a specified concentration or dose.
METABOLITE

Active Metabolite

Inactive Metabolite
METABOLITE- A chemical form of a drug that is the product of one or more biochemical metabolic rxns involving the parent drug.

ACTIVE METABOLITES- metabolites that have pharmacologic activity of their own, even if the parent drug is inactive

INACTIVE METABOLITES- lack pharmacologic activity and are simply drug waste products awating excretion from the body
Parent Drug
The chemical form of a drug that is admin to the body before it is metabolized by the body's biochem rxns into its active or inactive metabolites.

A parent drug that is not pharmacologically active itself is a PRODRUG.
Substrate
A substance (ex: drug or natural biochemical in the body) on which an enzyme acts
Therapeutic
index
The difference between the minimum therapeutic and toxic concentrations of a drug. If the therapeutic index is narrow, the range btw the therapeutic and toxic drug concentrations is small.
Enzyme
A protein molecule that catalyzes one or more of a variety of biochem rxns.
Duration of Action
The length of time that a drug concentration in the blood or tissues is sufficient to elicit a therapeutic response
Palliative
Therapy
Aka Comfort care, used in the end stages of an illness when all possible therapy has failed.

Ex: high-dose opioid analgesics in end-stage cancer
Ex: O2 in end-stage pulmonary disease
Supportive
Therapy
Recovery care, maintains the integrity of body functions while pt is recovering.

Ex: Fluids & electrolytes to prevent dehydration in an influenze pt with vomiting & diarrhea
Polypharmacy
The use of many different drugs in tx of a pt who may have one to several health problems.
PREGNANCY Category A
Studies indicate no risk to the human fetus.
PREGNANCY Category B
Studies indicate no risk to the animal fetus; information is not available for humans.
PREGNANCY Category C
Adverse effects reported in animal fetus; information is not available for humans.
PREGNANCY Category D
Possible fetal risk in humans reported. However, considering potential benefit vs. risk may warrant the use of these drugs in pregnant women.
PREGNANCY Category X
Fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs should not be used in pregnant women.
Fetus is at greatest risk during
the ____ trimester because ____.

The greatest percentage of maternally absorbed drugs gets to the fetus during
the ____ trimester because ____.
First; The fetus undergoes rapid cell proliferation during this time and the skeleton, muscles, limbs, and organs are developing at their most rapid rate.

Last; Drug can most easily cross the placenta due to enhanced blood flow to the fetus, increased fetal surface area, and an increased amount of free drug in the mother's circulation.
5 Rights of
Medication
Administration
Right PATIENT
Right DRUG
Right DOSAGE
Right ROUTE
Right TIME

(6th Right for Parenterally Administered Meds: Right LOCATION)
ETHICAL PRINCIPLES

Beneficence
Beneficence- Duty of a healthcare provider to actively promote GOOD and best serve the patient.
ETHICAL PRINCIPLES

Justice
Justice- Duty of a healthcare provider to be fair or equal in one's actions; includes the fair distribution of resources for the care of the pt and determination of when to treat.
ETHICAL PRINCIPLES

Nonmaleficence
Nonmaleficence- Duty of a healthcare provider to do no harm to a client; includes avoiding doing any deliberate harm while rendering care.
ETHICAL PRINCIPLES

Veracity
Veracity- Duty of a healthcare provider to tell the truth; includes telling the truth with regards to placebos, investigational new drugs, and informed consent.
Amphetamines
Drugs that stimulate the central nervous system
Enuresis
Urinary incontinence
Narcotic
Agent that produces insensibility or stupor (narcosis); applies most commonly to the opioid analgesics
Somatic pain
SOMATIC PAIN originates from skeletal muscles, ligaments, and joints.
Visceral pain
VISCERAL PAIN originates from organs and smooth muscles.
Superficial pain
SUPERFICIAL PAIN originates from the skin and mucous membranes.
Central pain
CENTRAL PAIN results from any disorder that causes CNS damage.
Acute pain
ACUTE PAIN is SUDDEN in onset, usually subsides when treated, and typically occurs over less than a 3-month period.
Chronic pain
CHRONIC PAIN is PERSISTENT or RECURRING pain that is often difficult to treat, and typically lasts longer than 3 months.
Neuropathic pain
NEUROPATHIC PAIN results from a disturbance of function or pathologic change in a nerve.
Vascular pain
VASCULAR PAIN results from a pathology of the vascular or perivasscular tissues.
Referred pain
REFERRED PAIN occurs in an area away from the organ of origin.
Psychogenic pain
PSYCHOGENIC PAIN is psychologic in nature but is truly real pain in terms of actual pain impulses that travel through nerve cells.
Pain threshold
PAIN THRESHOLD is the level of stimulus that results in the perception of pain.
Pain tolerance
PAIN TOLERANCE is the amount of pain a patient can endure without it interfering with normal function.