Pharmacology Chapter 1-5

Front 1

Pharmacology Definition

Back 1

the study of drugs that alter functions of living organisms

Front 2

pharmacotherapy

Back 2

the use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes

Front 3

medications

Back 3

drugs given for therapeutic purposes

Front 4

basis of drug classifications (3)

Back 4

effect on body systems
therapeutic uses
chemical characteristics

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prototype

Back 5

first drug in a group, sets the standard by which all other drugs in the group are measured (penicillin for antibs, morphine for analgesics, etc.)

Front 6

generic name

Back 6

related to the chemical or official name of the drug (amoxicillin)

Front 7

trade name

Back 7

designated and patented by the manufacturer - amoxil, trimox, zoloft, etc.

Front 8

patents

Back 8

required for drugs, have a time limit, generic versions of the drug can be made after the patent expires

Front 9

high costs of drug therapy driven by:

Back 9

research, availability of ingredients, high consumer demand (think viagra)

Front 10

prescription drug requirement

Back 10

prescription signed by someone with a DEA#

Front 11

drug approval process

Back 11

4 phases of testing and clinical trials, then FDA approval

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phase 1 clinical trials

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15-20 healthy volunteers - watching absorption, metabolism, excretion, toxicity

Front 13

phase 2 clinical trials

Back 13

50-100 people with disease

Front 14

phase 3 clinical trials

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10-15,000 people with disease - do benefits outweigh the risks? Leads up to the FDA approval.

Front 15

Phase 4 clinical trials

Back 15

following FDA approval, goes on for 15 years, drug is marketed for use with continued data collection for safety - this is the phase nurses are constantly directly involved in.

Front 16

Requirements for OTC drugs

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fda approves based on:
6th grade level comprehension of instructions
can consumer accurately self-diagnose?
is drug effective when used as recommended?
is drug safe when used as instructed?

Front 17

strategies to study pharmacology

Back 17

concentrate on therapeutic classifications
keep a reference handy
use own words in notes/cards
understand how drug works in body - applies to rest of class

Front 18

local effects of drugs

Back 18

effects only locally, such as sunscreen, ben-gay, lidocaine - exactly where placed

Front 19

systemic effects of drugs

Back 19

travels through multiple body systems

Front 20

can a client experience systemic effects of local drugs and local effects of systemic drugs?

Back 20

yes, for instance, if lidocaine is placed near an open wound, it could enter the bloodstream and have a systemic effect.

Front 21

where can you look up info on medications?

Back 21

pdr, online (epocrates, medlineplus.gov), textbook

Front 22

Modern medicines are mostly

Back 22

synthetic products made in labs

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controlled drugs are

Back 23

scheduled according to medical use and potential for abuse

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OTC Drugs vs. their prescription versions

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often differ in indications for use and recommended dosage

Front 25

with a new drug, the FDA is responsible for

Back 25

evaluating the drug for safety and effectiveness

Front 26

pharmacokinetics

Back 26

absorption, distribution, metabolism, excretion

Front 27

absorption

Back 27

process occurs from the time the drug enters the body to the time it enters the bloodstream

rate determines onset of action

Front 28

first-pass effect

Back 28

when a drug is given orally, it is absorbed from the GI tract and carried to the liver for metabolism via portal circulation - some of the drug is metabolized in the liver

Front 29

distribution

Back 29

drugs carried by blood and tissues to sites of action, metabolism and excretion

to heart, liver and kidneys - fast, to muscle, fat, organs, skin - slower

Front 30

protein binding

Back 30

drugs that bind to protein can be longer lasting or slow release. they are only released from their protein binding when the serum level is low. only free or unbound portion of drug can act because of size.

Front 31

metabolism

Back 31

breaking down a drug into its useable form

Front 32

drugs mainly metabolized by

Back 32

liver, kidneys

most by cytochrome P450 enzymes in liver - liver toxicity a risk (grapefruit juice)

Front 33

other metabolism sites

Back 33

blood, lungs, and GI mucosa

Front 34

prodrugs

Back 34

these are metabolized and THEN they become active -

most drugs are metabolized to inactive metabolytes

Front 35

what happens if 2 drugs compete for protein-binding sites?

Back 35

one drug will be displaced due to lack of adequate binding spots and therefore have a higher serum level - could be a big problem

Front 36

some drugs that are highly protein bound:

Back 36

warfarin
diazepam
sulfonamides

Front 37

effect of long term malnutrition on protein binding meds

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more drug circulates in blood due to lack of binding sites, increases serum level, has a stronger effect on the patient

Front 38

excretion requirements

Back 38

good circulation system
properly functioning kidneys, bowels, lungs and skin

Front 39

MEC

Back 39

minimum effective concentration - minimum serum level required for drug to have pharmacologic effect on cells

Front 40

duration of action

Back 40

time taht the serum blood levels are above the MEC

Front 41

toxic concentration

Back 41

excessive levels of a drug - either from one overdose, repeated doses, or slow metabolism of properly administered doses

Front 42

serum half-life

Back 42

amount of time required for blood serum level of a drug to decrease by 50%

Front 43

pharmacodynamics

Back 43

the action of a drug on a cell

Front 44

receptor theory

Back 44

primarily agonists and antagonists (agonists stimulate a cell to do its function, antagonists block a cell from doing its function) this is how antidotes work

Front 45

nonreceptor actions

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environmental changes like acid environment, osmolality

third agents such as vit. D

metal chelating agents (combine with drug and bind it)

Front 46

drug related variables

Back 46

dosage, routes of administration, drug-diet interactions (grapefruit juice), drug-drug interactions

Front 47

enteral

Back 47

oral administration

Front 48

parenteral

Back 48

injected administration

Front 49

client related variables

Back 49

age, pregnancy, body weight, genetic and ethnic characteristics, gender, pathologic conditions, psychological conditions (placebo)

Front 50

neonate

Back 50

immature organ development - liver and kidneys.

Front 51

infant

Back 51

liver function and blood-brain barrier still immature

Front 52

children

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increased metabolism of some drugs

Front 53

older adults

Back 53

GI, cardiac, liver and kidney status alter pharmacokinetics - impaired kidney and liver function greatly increase risk of adverse drug events

Front 54

drug tolerance/cross-tolerance

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body gets used to a drug eventually. cross-tolerance is getting used to related drugs

Front 55

adverse effects

Back 55

*any* undesired response to a drug

Front 56

therapeutic effects

Back 56

any desired response to a drug

Front 57

drug toxicity

Back 57

caused by excessive amounts of a drug and may cause permanent damage

Front 58

drug overdose treatments

Back 58

antagonists (antidotes), altering of environments, supportive measures

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pregnancy drug category A

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studies indicate no risk to human fetus

Front 60

pregnancy drug category B

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studies indicate no risk to animal fetus; info in humans not available

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pregnancy drug category C

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

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pregnancy drug category D

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possible fetal risk in humans reported' however, considering potential benefits v. risk may, in selected cases, warrant the use in pregnant women.

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pregnancy drug category X

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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.

Front 64

5 Rights of Medication Administration

Back 64

right drug
right dose (including decimal)
right client
right route of administration
right time (when was last meal?)

Front 65

RN Legal responsibilites for medication admin

Back 65

expected to have sufficient drug knowledge to recognize and question erroneous orders

responsible to CMAs and LPNs whom they are supervising

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LPN legal responsibilities for medication admin

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can give medications

Front 67

medication errors caused by:

Back 67

illegible writing
similar-sounding drugs
pharmacist filling script
nurses w/ inadequate knowledge or not following 5 rights
client's OTC or polypharmacy
distraction or interruptions

Front 68

medication orders require

Back 68

clients full name
generic and/or trade name
dose
route
frequency
date, time, sig of prescriber
refills -- scheduled medications (schedule II not refillable)

Front 69

drug preparations and dosage forms

Back 69

liquids
tablets and capsules
suppositories
transdermal (patch)
pump delivery systems (insulin)

Front 70

routes of administration

Back 70

oral (enteral)
topical
parenteral - intradermal, subcutaneous, intramuscular, or intravenous

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critical pathway

Back 71

measurable path to healing

Front 72

herbal and dietary supplements are a major concern because

Back 72

no regulation

Front 73

goals

Back 73

must have an intended outcome in order to use a drug

Front 74

drug selection and dosage

Back 74

best drug, least side effects, individualized dosage

Front 75

drug therapy in children

Back 75

dosage based on weight
oral route preferred
for IM administration, use thigh
childproof containers
never refer to it as candy!

Front 76

drug therapy in older adults

Back 76

physiological funtionality is more important than the age of the client
assess drug hx and OTC use
give smallest effective dose for shortest effective duration
smallest number eff. dose (long-acting drugs)
start low, go slow
inc. nonpharmacological treatments
assess for limitations in home use
assess drug effectiveness and any reactions to meds

Front 77

drug therapy in kidney impairment

Back 77

high risk for drug accumulation - impaired metabolism
monitor renal status:
- increased BUN (blood, urea, nitrogen
-increased serum creatinine
-decreased urine output

Front 78

drug therapy in liver impairment

Back 78

high risk for drug accumulation
monitor liver status:
-bilirubin
-albumin
-alt and ast (liver enzymes)

Front 79

drug therapy in critical illness

Back 79

aggressive treatment
multidrug regimens
r/o multiorgan failure
most meds IV
dosage requirements vary hugely
timing essential - around clock
weigh clients'
evaluate lab values frequently

Front 80

drug therapy in home care

Back 80

short or long term drug therapy
many drugs admin by pt or family member
review drugs and OTC w/ client
assess home environ. for pot. safety hazards
eval. for expected response and side effects

Front 81

basic unit of the central nervous system

Back 81

the neuron (glia support and nourish the neurons)

Composed of cell body, dendrite and axon.

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nerve fiber

Back 82

an axon together with a myelin sheath

Front 83

neurotransmittors

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chemicals that carry messages from one neuron to another or from a neuron to body tissue like heart or skeletal muscle

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afferent neuron

Back 84

conducts sensory impulses towards the brain or spinal cord

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efferent neuron

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neuron that conducts motor impulses away from the brain or spinal cord

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synapses

Back 86

microscopic gap between neurons in a chain. can be electrical or chemical. neurotransmitter release and removal occurs here

Front 87

receptors

Back 87

proteins embedded in the cell membranes of neurons. a neurotransmitter must bind to receptors to exert an effect on the next neuron in the chain

Front 88

cholinergic neurotransmitter system

Back 88

uses acetylcholine, found in CNS and ANS.

In CNS, associated with level of arousla, memory, motor conditioning, and speech.

Front 89

dopaminergic neurotransmitter system

Back 89

uses dopamine, found in substantia nigra, the midbrain and the hypothalamus.

Front 90

GABA-ergic

Back 90

uses GABA

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Noradrenergic

Back 91

uses norepinephrine

Front 92

serotonergic

Back 92

uses serotonin

Front 93

amino acid neurotransmitters

Back 93

aspartate, glycine, glutamate