Pharmacotherapeutics Quiz 1

Front 1

What are the 7 tips for studying pharmacology?

Back 1

1. Focus on classifications and prototypes
2. Compare newly encountered drugs with prototypes
3. Try to understand how the drug acts in the body (indications, side effects, contraindications)
4. Study major characteristics
5. Use your resources!
6. Write out drug info cards using your own words
7. Think about clinical application of the information

Front 2

What are 6 general questions we should ask about medications we are administering?

Back 2

1. What does the med do?
2 Why is the pt needing it?
3. What are the benefits?
4. What are the pt's primary problems?
5. What are the signs of the pt's issues that the medication is required?
6. Double check for ALLERGIES!!

Front 3

What are the 6 areas of clinical info we need to know concerning medications?

Back 3

1. Indication
2. Route (IV meds we need to know dilution, rate, and compatibility)
3. Adverse effects (side effects)
4. Contraindications (includes allergies)
5. Nursing considerations (implications) regarding administration info and assessment/monitoring
6. Action - what does the med do physically?

Front 4

What is pharmacodynamics?

Back 4

The study of Drug Action or the Mechanism of Action (which is mostly on receptors). These are three interchangeable names.

Front 5

What is efficacy?

Back 5

The ability of a drug to cause a desired effect or biological activity - drugs can't create a new function, they act on normal body chemicals.

Front 6

What are the 4 considerations regarding receptors and medications?

Back 6

1. Receptors bind with the natural body chemicals or drugs only if it is compatible with the receptor
2. Drugs bind with receptors on the cell surface or within the cell
3. Receptor specificity is the ability to bind only with compounds that have specific features
4. Receptor affinity is the strength with which the drug binds to the receptor

Front 7

How is high affinity and low affinity clinically important in drugs?

Back 7

High affinity drugs bind strongly with the receptors and can have affects even in low doses. Low affinity drugs are more likely to dissociate with the receptor or be bumped off by a high affinity drug.

Front 8

What are the two major drug actions when attaching to receptors and any subcategories or actions?

Back 8

A. They act like natural body chemicals to:
1. Open or close ion channels
2. Activate 2nd messengers within the cell
3. Stimulate usual cell function as an agonist
B. They block natural body chemicals by attaching to cell receptors so normal chemicals cannot attach - Antagonist

Front 9

What action within the cell do water-soluble hormones produce within the cell?

Back 9

The activate the 2nd messenger system

Front 10

What is the general explanation of undesirable responses to drugs?

Back 10

These are effects we don't want! Drugs have more than one action and attach to many receptors that have affinity for that drug, regardless of intended attachment to that receptor. This results in multiple actions that result in one of two actions - predictable and unpredictable responses.

Front 11

What are 7 categories of predictable responses of drugs?

Back 11

1. Side effects - unintended action, secondary effects
2. Adverse effects - undesirable side effect, may be harmful
3. Cumulative effects - the drug is not metabolized and excreted, so it accumulates in the body
4. Toxic effects - the drug dose increases in excess of the therapeutic range with adverse effects - can cause organ damage
5. Dependence - the drug is required or the person will feel physical symptoms of withdrawal - is predictable
6. Psychological dependence - the pt has a craving for the effects of the drug, but no physical dependence
7. Withdrawal - when the drug is no longer available and there is a physical dependence - Sx of withdrawal are usually the OPPOSITE from the drug effect

Front 12

What are the 3 categories of unpredictable responses to drugs?

Back 12

1. Drug allergy - can range from skin responses to anaphylaxis - drug needs to be d/c'd and not be given again. Prior to medicating, get a drug hx including sx related to perceived allergy
2. Idiosyncratic reaction - unpredictable, unintended rxn seen in the elderly and children that have no obvious cause
3. Iatrogenic reaction - condition caused by the drug therapy - ex. acne from the therapy

Front 13

What are drug interactions?

Back 13

A drug's effects on other drugs.

Front 14

What are the 3 types of antagonistic effects of drug-drug interactions?

Back 14

1. Drug #1 blocks the receptor drug #2 would use, causing drug #2 to have no action. Ex. Narcan (naloxone) for opioid overdose
2. Drug #1 can increase the metabolism of drug #2 - large amounts of alcohol makes microenzymes that metabolize narcotics and decrease sensitivity
3. Drug #1 can block absorption of drug #2 - ex. antacids increase stomach pH and some meds aren't absorbed - loss of therapeutic effects

Front 15

What are 3 general categories of drug-drug interactions?

Back 15

1. Antagonistic effects
2. Additive effects
3. Synergistic effects

Front 16

What are additive effects of drug-drug interactions?

Back 16

2 drugs that have different actions will have an additive effect when given together - gives a predictive therapeutic effect with extra effects and better effects - ex. diuretic and ACE inhibitor for HTN

Front 17

What are synergistic effects of drug-drug interactions?

Back 17

2 drugs given together create a greater-than-additive effect - one drug may have a minimal effect, but when combined with another, both will have greater effects

Front 18

What are the 3 reasons for seeking a synergistic effect from 2 drugs?

Back 18

1. It helps to displace a drug from protein binding sites to make it available
2. It can inhibit metabolic inactivation
3. It can create a decreased elimination of one of the meds

Front 19

What are possible consequences of a synergistic drug-drug interaction?

Back 19

It can result in unpredictable effects and make it so the therapeutic goal is not reached - ex. all CNS depressants when given with alcohol increase the depressant effect and can result in cessation of breathing and death

Front 20

What are the drug effects of antacids, ASA, diuretics, and mineral oil on nutrients?

Back 20

Antacids - increase gastric pH and chelates minerals so they are not available
ASA - damages gastric lining and inhibits brush border enzymes, like cyclooxygenase (COX), and decreases prostaglandin synthesis.
Diuretics - increase the excretion of nutrients
Mineral oil - inhibits the absorption of Vitamin D, K, and beta-carotene

Front 21

What does chelate mean?

Back 21

Any of a class of coordination or complex compounds consisting of a central metal atom attached to a large molecule, called a ligand, in a cyclic or ring structure.

Front 22

What is cyclooxygenase (COX)?

Back 22

An enzyme (EC 1.14.99.1) that is responsible for formation of important biological mediators called prostanoids, including prostaglandins, prostacyclin and thromboxane. Pharmacological inhibition of COX can provide relief from the symptoms of inflammation and pain. Non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, exert their effects through inhibition of COX. The names "prostaglandin synthase (PHS)" and "prostaglandin endoperoxide synthetase (PES)" are still used to refer to COX.

Front 23

What are prostaglandins?

Back 23

They are mediators and have a variety of strong physiological effects, such as regulating the contraction and relaxation of smooth muscle tissue.[1] Prostaglandins are not hormones, but autocrine or paracrine, which are locally acting messenger molecules. They differ from hormones in that they are not produced at a discrete site but in many places throughout the human body. Also, their target cells are present in the immediate vicinity of the site of their excretion (of which there are many).

Front 24

What are 2 effects food can have on drugs?

Back 24

1. Drug absorption is reduced or delayed by food, so the drug is absorbed best if given on an empty stomach - ex. ASA, digoxin, ibuprofen, PCN G&K - although food may be recommended TO reduce the action and inhibit destruction of mucosa
2. Drug absorption is enhanced by food - ex. erythromycin, diazepam, and chlorothiazide

Front 25

What is Pharmacokinetics?

Back 25

The study of 1. How drugs enter the body 2. How drugs are distributed to the intended site of action 3. How drugs are metabolized 4. How drugs are eliminated from the body

Front 26

What are the three routes of absorption of a drug?

Back 26

1. Enteral route - PO - preferred route
2. Parenteral route - using a needle to perforate the skin - IV, IM, SC (SQ)
3. Topical - absorbed through the skin or mucus membranes of the mouth or rectum

Front 27

What 3 things must be present in order to be able to give a drug PO?

Back 27

1. Pt must be able to swallow without aspiration
2. Pt must not be vomiting or have a significant risk of vomiting
3. GI tract must be able to absorb the drug - the villi must be intact

Front 28

What is dissolution?

Back 28

The breakdown of a drug in body fluid so it is dissolved and can get into circulation.

Front 29

What is bioavailability?

Back 29

The proportion of a drug that is available for systemic effects after being dissolved in the body or with water, alcohol, or oil.

Front 30

What does food do for bioavailability?

Back 30

It decreases dissolution and absorption

Front 31

What 4 things affect stomach acid and bioavailabilty?

Back 31

1. Some drugs are not stable in acid and are destroyed
2. People have differing amounts of stomach acid - the very old and very young have less
3. Acid degrades the strength of drugs
4. With less acid, less drug is degraded and more is available, so a lower dose is needed

Front 32

What makes ionic drug forms absorbable by cells?

Back 32

The pH in the stomach changes the charged particle to uncharged so it can be absorbed.

Front 33

Why can't some meds be given through the GI tract?

Back 33

Some are destroyed by pancreatic enzymes.

Front 34

What are the 4 forms of oral meds?

Back 34

1. Liquids - ready for absorption
2. Capsules - almost as fast as liquids
3. Sustained release tablets - SR, XR, CR - absorbed over 8-12 hours as various coatings come off
4. Enteric coated - protects capsule/tablets from stomach acid and comes off in the duodenum where the pH is increased

Front 35

Describe the 3 parenteral routes of drug administration?

Back 35

1. SC - subcutaneous - small amount is injected just under the skin - absorbs slowly
2. IM - intramuscular - larger amount is given and has faster absorption due to an increased blood supply
3. IV - intravenous - There is NO ABSORPTION here as it is already in circulation - allows blood levels to stay high and therapeutic, however there is a risk for bacterial infections or damage to the veins - there must be no particles in the solute injected

Front 36

What is chemical phlebitis?

Back 36

Some drugs irritate the vein and a clot forms - the long-term result is hardening of the vein.

Front 37

What creates the persistence of drugs in the blood?

Back 37

Drugs are either free in the plasma and available for use, or are bound to proteins, mostly albumin, and are released as drug concentrations in the blood are lowered. The longer the drug will bind, the longer DURATION OF ACTION.

Front 38

What are the 6 factors controlling the distribution of drugs in the body?

Back 38

1. High lipid solubility and low protein binding readily diffuse across the cell membrane - ex. anesthetics
2. Water-soluble drugs pass along the cell membrane with difficulty
3. High drug concentrations favor diffusion into tissues
4. High binding proteins creates less free drug in the plasma and slows diffusion into the tissues
5. Non-specific binding - ex. many drugs bind to albumin
6. Competitive binding can cause a drug with lower affinity to be bumped off of albumin - ex. warfan has a weaker affinity and is bumped off by ASA, thus creating more availability of free warfan

Front 39

What are the parts of the dose response curve?

Back 39

Administration, absorption, time for absorption to reach minimal effective concentration (threshold), absorption during therapeutic range, peak, elimination through therapeutic range, elimination through time of termination of action.

Front 40

What is half-life?

Back 40

The time it takes for plasma levels of a drug to decrease to half the concentration.

Front 41

What is the therapeutic index?

Back 41

The ratio between desired effects and lethal dose - given as a ratio indicating how close the therapeutic dose and lethal dose are - ex. digoxin

Front 42

What is a steady state concerning drug levels?

Back 42

You administer a drug 4 times in order to reach the therapeutic range and get the trough at the therapeutic minimum; then administer the drug to keep levels in the therapeutic range - ex. antibiotics, they need high levels

Front 43

What is a loading dose?

Back 43

Administering a large dose when you can't wait for the concentration to get to a therapeutic range due to a long amount of time required - ex. some meds take 7-50 days to reach therapeutic levels - ex. digoxin, heparin.

Front 44

What are the barriers to distribution?

Back 44

1. Blood-brain barrier prevents water soluble drugs from passing into the CNS due to tight endothelial cells covered by fatty glial cells - lipid solubles can pass
2. Placental barrier - Some drugs can cross this barrier, so care is needed when selecting drugs

Front 45

What is biotransformation?

Back 45

The primary organ is the LIVER, although the kidney and bacteria in the colon help out. This is where drugs are made water soluble to be excreted by the kidney. The liver adjusts the synthesis of enzymes according to how much drug is needed - ex. excessive alcohol makes microenzymes that metabolize narcotics
Some drugs are also converted to active metabolites in the liver so they can be used.
Liver disease decreases this availability and drugs can accumulate to toxic levels.

Front 46

What is the First Pass?

Back 46

Drugs absorbed in the small intestine are absorbed into the blood and travel to the portal vein and into the liver where they are metabolized, which decreases the amount available.

Front 47

What administration methods bypass the First Pass?

Back 47

IV, IM, rectal, and SL because they go directly to the target organ and not through the liver first.

Front 48

What is enterohepatic recycling?

Back 48

Drugs released in bile move into feces but are reabsorbed in the intestine - this keeps drugs in the body more and levels can become toxic

Front 49

Why is serum creatinine measured?

Back 49

Creatinine builds up from muscle breakdown at a constant rate, so it is used to evaluate renal clearance. If GFR is low, that would mean passive glomerular diffusion and active secretion into the renal tubules is down and the drug may accumulate in the body.

Front 50

What are special considerations concerning gastric issues and drug absorption with perinatal pharmacotherapeutics?

Back 50

The mother will have slow gastric emptying and slow intestinal transit, which would increase the absorption of lipid soluble drugs and increase their effect.

Front 51

How does N/V affect perinatal pharmacotherapeutics? What are the best ways to try to treat N/V when a mother is pregnant?

Back 51

Treatment with antacids for N/V will increase gastric pH so weakly basic drugs have increased absorption - ex. opioids. It is best to eat small, frequent meals, don't eat and then lay down, avoid tight clothing, and avoid antacids if possible. Treat N/V with a few crackers before arising in the am and avoid spicy or gas forming foods. Try to avoid antiemetics - only take them if nutrition and fluid balance are compromised.

Front 52

How does pregnancy affect the absorption of IM drugs? What happens with albumin during pregnancy?

Back 52

They are absorbed more quickly due to increased tissue perfusion and vasodilation.
During pregnancy, there is decreased albumin, thus creating more free drug available.

Front 53

How does pregnancy affect lipid soluble drugs? How does increased water weight affect drug action?

Back 53

Increased body fat means increased storage of lipid soluble drugs, which could lead to toxicity.
Increased total body water decreases peak concentration, thus decreasing the available drug for action.

Front 54

How does increased progesterone affect drug metabolism during pregnancy? What happens with GFR during pregnancy, and how does this affect drug concentrations?

Back 54

Increased progesterone increases liver enzymes which increase drug metabolism. This causes liver clearance to increase and reduces half-life of the drug.
GFR is increased during pregnancy, which causes excretion of drugs to increase.

Front 55

Does the placenta interfere with lipid soluble drugs crossing the barrier? What happens to the drugs?

Back 55

Lipid soluble drugs easily cross the placental barrier and will accumulate in the fetus - ex. opioids cross the barrier and can cause respiratory depression when the baby is born.

Front 56

Does the placenta interfere with water soluble drugs crossing the barrier? What happens with these drugs?

Back 56

Water soluble drugs cross the placental barrier, but are excreted in the urine of the fetus. However, the urine goes into the amniotic fluid and the fetus swallows it creating continued exposure to the drug.

Front 57

How does the mother having more total body water affect the fetus?

Back 57

More total body water in the mother allows for more free drugs in circulation that are able to cross the placental barrier.

Front 58

Does the fetal liver have any effect on drugs?
What happens with some drugs, such as tetracycline, concerning fetal tissues?

Back 58

The fetal liver has some ability to inactivate drugs and at birth the neonate's liver has to clear what drugs were given to the mother.
Some drugs bind permanently to fetal tissue. An example is tetracycline binding to the teeth and permanently staining un-erupted teeth.

Front 59

What is teratogenicity?

Back 59

This refers to drugs that interfere with embryonic/fetal development. 15-60 days after conception the major organs are being formed and it is the most critical phase for malformation. After the first trimester, drugs don't affect fetal structure, but can have toxic effects.

Front 60

How is lactated milk affected by some drugs and how should it be handled?

Back 60

Some drugs can end up in breast milk, so if the drug can harm the infant, breast feeding should be stopped during the administration of the drug.

Front 61

What are the consequences regarding sustained release drugs and breast feeding?
If a drug is given and the baby is breast feeding, how should this affect scheduling?

Back 61

Sustained released drugs should be avoided as they can get into breast milk and are not easily eliminated by the baby.
Schedule the mother to get the medication after breast feeding in order to minimize the infant's exposure.

Front 62

Regarding fat soluble drugs, what changes should be made in the infant's feeding schedule and why?

Back 62

The infant should be given formula at mid day since this is the time when breast milk contains the most fat.
Always watch for infant drug reactions!

Front 63

How are dosage calculations different in children?

Back 63

Body weight varies a lot in children, so dosages are calculated based on body surface area (BSA).

Front 64

How do dosages need to be changed in reference to the high water content in neonates?

Back 64

Neonates are around 80% water, so dosages may need to be relatively higher for some drugs to reach therapeutic levels.

Front 65

How is the newborn's GI system and liver different than others and what is the consequence?
How is pH different in a newborn and how does this effect drug absorption?

Back 65

A newborn's GI system and liver are immature and have less enzymes. Therefore, the drugs have a longer half-life and it takes longer for them to be metabolized.
A newborn's pH is higher, so acidic drugs are not absorbed as well.

Front 66

How is absorption via the skin different in newborns and why?
What response might babies and children have to medications?

Back 66

The skin more readily absorbs drugs because it is immature and permeable.
Infants and children may have paradoxical responses to medications.

Front 67

In regards to renal function, how is the structure and function different in neonates up to 6 months, and how does this affect drug excretion?

Back 67

The neonate has decreased amounts of renal tubules, shorter tubules, and decreased tubular blood flow. This creates an increased risk of toxicity due to decreased excretion.

Front 68

What happens to ICF in the elderly?
How are receptors affected in the elderly and how does this affect drug responsiveness?

Back 68

ICF in the elderly decreases due to a fluid volume deficit.
Receptors decrease with aging, resulting in a decreased cellular responsiveness to drugs.

Front 69

How are heart contractility and peripheral blood flow affected by aging and what is the result?
How are baroreceptors affected by age?

Back 69

Myocardial contractility decreases around 1% each year. Peripheral blood flow is decreased in the older adult due to decreased elasticity of the arteries, which results in increased systolic and diastolic BP. Baroreceptors are less sensitive, so there is an increase in orthostatic hypotension.

Front 70

How is GI motility, gastric pH, gag reflex, and esophageal emptying affected by aging? What are some consequences?

Back 70

GI motility is decreased, gastric pH is increased (decreased absorption of Vitamins B1 and B12, calcium, and iron), gag reflex is decreased and esophageal emptying is slowed (leads to a higher risk of aspiration and pneumonia).

Front 71

How are the liver and intestines affected as we age and what are the consequences?

Back 71

Blood flow to the liver and intestines is decreased. This results in a reduction in microsomal enzymes in the liver. Peristalsis in the intestines is slowed and nutrient absorption is decreased.

Front 72

How much is renal blood flow affected in the elderly and what is the result?
What happens to albumin levels?

Back 72

By the age of 90, renal blood flow has decreased by 50%! This results in decreased tubular resorption, which results in a decreased ability to concentrate urine.
Albumin levels can drop in the elderly (or anyone), which leads to increased free drug - watch the lab work!

Front 73

How is biotransformation, liver mass, muscle mass, GFR, and creatinine production affected by aging and what are the results?

Back 73

Biotransformation decreases 50% between the ages of 60 and 100 as liver mass decreases. Muscle mass also decreases, GFR decreases, and creatinine production decreases. The serum creatinine concentration does not go up as GFR decreases, which means drugs stay in the body longer with increased side-effects.

Front 74

What happens to CV compensatory mechanisms in the elderly and what are the consequences?

Back 74

CV compensatory mechanisms are less effective in the elderly. Drugs designed to increase BP are more profound due to the vagal reflex that decreases the HR are less effecient.

Front 75

What happens regarding K+ sparing diuretics and renal function in the elderly?

Back 75

Renal function is decreased, which causes the effects of K+ sparing diuretics to become enhanced. This can result in hyperkalemia.

Front 76

Why is hyperkalemia so dangerous?

Back 76

K+ plays a large role in maintaining membrane potentials in muscles and electrical potentials in nerve cells. If it is altered, one main effect is a change in the heart's rhythm that can progress to cardiac arrest and death.

Front 77

What happens to a neuromuscular blockade in the elderly?
How about autonomic adrenergic responses?

Back 77

Neuromuscular blockade is increased in the elderly.
Autonomic adrenergic responses are decreased in the elderly, so beta blockers increase toxicity.

Front 78

What is a neuromuscular blockade?

Back 78

It is the administration of a paralytic agent which acts of the neuromuscular junction in order to create temporary paralysis for surgery or other medical needs - ex. anesthesia

Front 79

What is the autonomic adrenergic response?

Back 79

?

Front 80

What happens with the neurotransmitters dopamine and acetylcholine in the elderly and what are the effects?

Back 80

Dopa and ACH decrease in the elderly, therefore extrapyramidal (Parkinson-type effects) effects of neuroleptics and Reglan (increased peristalsis)

Front 81

What kinds of responses can be seen in the elderly regarding sedatives/hypnotics/antianxiety drugs?

Back 81

Paradoxical responses can happen with these drugs and the result can be restlessness, disorientation, confusion, and balance disturbances.

Front 82

Poly pharmacy usually occurs as a result of multiple diseases. Then, side effects have to be treated, also. What three negative consequences (and sub information) result from poly pharmacy?

Back 82

1. Increased risk of adverse drug effects
2. Drug interactions:
a. Take 2 drugs, there is a 5-6% chance of interactions
b. Take 5 drugs, there is a 50% chance of interactions
c. Take 8 drugs, there is a 100% chance of interactions!
3. Decreased compliance by pt due to low funds, confusion, etc.

Front 83

What age and weight is the average dose based on?
What happens as body size/weight increases?

Back 83

The average dose is based on a person (usually male) of 150 pounds and age 20-60.
As body weight/size increases, drug concentration decreases - dosages may need adjustment.

Front 84

What is the termination of action regarding drugs?

Back 84

No drug effects are seen, but the plasma may still contain the drug.

Front 85

What is the trough level?

Back 85

It is the lowest plasma concentration just prior to the next dose. Trough blood draws need to take place 5 minutes before the next administration of a drug.