Pharm final exam review slides

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Undesirable, potentially harmful effects of medications

Adverse effects

Adverse effects can occur at both _______ and ________ doses

Both therapeutic and abnormal doses

True or false: not all prescriptions, OTCs, herbal remedies, and supplements have the potential for adverse effects.

False (all medications have the potential for adverse effects)

What is the hematologic condition of decreased erythrocyte, leukocyte, and/or thrombocyte production, caused by some drugs?

Blood dyscrasias

Predictable/anticipated (but still undesirable) effects of medications

Side effects

What distinguishes side effects from adverse effects?

Severity

Nursing teaching should include predictions of ________ side effects

Predictions of common side effects

Drug reactions that produce the opposite of the intended effects

Paradoxical reactions

Uncommon drug reactions often caused by genetic differences

Idiosyncratic reactions

What is the type of drug reaction due to stimulation of the immune system by the drug?

Hypersensitivity (allergic) reactions

Drug reaction that occurs due to patient overdose of the drug

Toxic reactions

Allergy-hypersensitivty reactions:
The body recognizes the drug as a _________
_______ and cellular ________ respond and are released by the body

The body recognizes the drug as a foreign invader
Histamine and cellular mediators respond and are release by the body

Allergy (hypersensitivity) reactions are especially dangerous when they occur in what part of the body?
(Bonus: why?)

The throat
(Swelling)

Pharmacodynamics:
The combined effect is greater than the sum of the individual agents (1+1>2)

Synergistic interaction

Pharmacodynamics:
The combined effects is equal to the sum of the individual agents (1+1=2)

Additive interaction

Pharmacodynamics:
One drug inhibits the ability of another drug to act (1+1<1)

Reducing (antagonist) interactions

What aspect of pharmacological administration (giving meds) needs to be adjusted for elderly patients?

Dosage (reduction)

What four aspects of pharmacokinetics become impaired in elderly patients?

Absorption
Distribution
Metabolism
Excretion

Four stages of pharmacokinetics

Absoprtion
Distribution
Metabolism (biotransformation)
Excretion (elimination)

Pharmacokinetics:
Drug transportation from the site of absorption (GI or bloodstream) to the site of action (body tissues)

Distribution

Factors affecting distribution (5)

Blood flow to tissues (perfusion)
Tissue storage (tissue-specific storage)
Obesity (lipophilic drugs)/edema (hydrophilic drugs)
Drug-protein binding (albumin)
Barriers (blood-brain-barrier, placenta)

Drug-protein complexes cannot cross the ________ membrane to reach target tissues

Capillary membrane

In order for a drug to reach its target tissues, it must be ______ and _______ (from drug-protein complexes)

Free & unbound

What type of drugs are distributed into/accumulated in adipose tissue?

Lipophilic drugs (obesity)

Lipophilic drugs are (more/less) active at the site of action but are (quickly/slowly) released from fatty tissue

Less active at the site of action but slowly released from fatty tissue

What type of drugs are distributed into and remain in interstitial solution?

Hydrophilic drugs (edema)

Refers to the amount of a drug that reaches the site of actions

Bioavailability

Factors affecting bioavailability:
First-pass _________ metabolism
__________ of the drug
Chemical _________
Formulation

First-pass hepatic metabolism
Solubility of the drug
Chemical stability
Formulation

The first-pass hepatic metabolism effects occurs much more often with (IV/oral) drugs than with (IV/oral) drugs

Occurs much more often with oral drugs than with IV drugs

Pharmacokynetics:
Process to change activity in a drug and make it more likely to be excreted
(Bonus: what is the other name for it?)

Metabolism
(Biotransformation)

Drug metabolism occurs primarily in what three organs?

Liver
Kidneys
Intestinal tract cells

What four components of drugs are changed during metabolism?

Chemical structure
Function
Activity
Toxicity

What type of drug has no pharmacological activities?

Prodrugs

Pharmacokynetics:
Process by which drugs and their metabolites are removed from the body

Elimination

What is the primary site of drug elimination in the body?

Kidneys

Drug elimination includes:
_______ filtration
_______ secretion
Partial _________

Glomerular filtration
Tubular secretion
Partial reabsorption

The drug elimination process must be careful considered in patients with what impairment?
(Bonus: why?)

Renal (kidney) impairment
(Drugs stay in the body longer, increasing the risk of toxicity)

How is the risk for toxicity avoided concerning drug elimination in renal-impaired patients?

Reduced drug doses are given

The therapeutic response of a drug most likely depends on _________ in the _______

Concentration in the plasma

The amount of a drug required to produce a therapeutic effect

Minimum effective concentration

The range in which a drug produces its desired effect (goal of drug administration)

Therapeutic range

The level of a drug that results in serious adverse effects

Toxic concentration

The length of time required for plasma concentration to decrease by 1/2 after administration

Plasma half-life (t1/2)

A drug has _______ concentration when it is administered at the same rate at which it is eliminated

Stable concentration

Repeated dosing (stable concentration) provides _______________

Provides plateau plasma level

Drugs have approximately ____ half-lives until excretion

Approximately 4 half-lives until excretion

Loose definition for what a specific drug does to the body

Pharmacodynamics

Pharmaco- = __________

"medicines"

-dynamics = ________

"change"

What are the two components of pharmacodynamics?

Drug mechanisms of action (MOA)
Effects of drug concentration on body response

Drug type that activates receptors to cause a response

Agonists

Drug type that binds to receptors to block a response

Antagonists

Bacteria that render usually-successful antibiotics ineffective, due to mutation and transfer of genetic material from the antibiotic to the bacteria

Superbugs

How are superbugs more superior than weaker bacterial strains?

Superbugs replicate while weaker strains are killed.

Two human contributions to antibiotic resistance

Unnecessary prescriptions for viral illness (overuse)
Incomplete course of therapy (reinfection)

Common side/adverse effects of antibiotics (5)

NVD
Hypersensitivity
Photosensitivity
Superinfections
Blood dyscrasias

How can NVD related to antibiotics be relieved? (2)

Avoid heavy meals
Prefer small, frequent meals (don't overload GI)

Antibiotic allergic reactions (5 symptoms)

Pruritus
Urticaria
Nervousness/anxiety
Shortness of breath
Swelling of lips/tongue

Itch (r/t hypersensitivity)

Pruritus

Hives (r/t hypersensitivity)

Urticaria

Life-threatening allergic response of acute inflammation, due to rapid release of inflammatory mediators throughout the body

Anaphylaxis

Anaphylaxis:
Laryngeal edema/bronchoconstriction decrease...

Oxygen intake

Anaphylaxis:
Vasodilation causes...(2)

Severe hypotension
Shock

Anaphylaxis:
Inadequacy of body to meet cellular/tissue/organ needs for oxygen/glucose is known as...(2)

Hypoxia/hypoglycemia

Rash in response to direct sunlight/lack of sunscreen/lack of protective clothing, caused by antibiotics

Photosensitivity

If a patient develops a photosensitive rash while taking an antibiotic, what should the nurse instruct the patient to do? (3)

Avoid direct sunlight and/or wear sunscreen & protective clothing
Notify the nurse or prescriber of any rash
Stop taking the medication until the rash is evaluated

Bacteria (such as C. diff.) that proliferates when normal flora are killed by antibiotics

Superinfection

Fungal infections such as vaginal yeast infections and black, hairy tongue are examples of...

Superinfections

Two (2) names for bone marrow suppression (common adverse effect of drugs)

Blood dyscrasias
Myelosuppression

Three "decreases" of blood dyscrasias (with associated conditions)

Decreased erythrocytes, causing anemia (weakness, pallor)
Decreased leukocytes, causing leukopenia (infection)
Decreased thrombocytes, causing thrombocytopenia (bruising/bleeding)

If a female tells the nurse that she is using BCPs while taking an antibiotic, what situation should the nurse advise the patient concerning?

Drug-drug interaction (antibiotic cancels out BCPs-pregnancy could occur)

Prior to administering an antibiotic, a nurse should perform what on/for the patient?

An assessment

The nurse's pre-antibiotic assessment should include...
History of ______ _____________
__________ (physical exam, vital signs, lab reports, pregnancy test if needed)
_________-_________ interactions (drug history)
_________ and ___________

History of drug allergies
Baseline
Drug-drug interactions
Culture and sensitivity

Aspect of initial assessment that determines causative pathogen of infection

Culture

Aspect of initial assessment that determines which antibiotics are effective against a causative pathogen

Sensitivity

Most common drug (antibiotic) allergy

Penicillin allergy

If penicillin is given parenterally at clinics/ER, the patient should be observed _______ minutes before leaving even if the patient has received penicillin before w/o reaction.

30 minutes

Administration of antibiotics such as penicillin with acidic fruit juices results in what?

Neutralization of the antibiotic (alkaline)

Natural, inexpensive penicillin; only works on Gram-positive infections

Penicillin G

Penicillins (2) developed for Gram-positive and some Gram-negative infections; one of the more broad-spectrum prototypes

Ampicillin
Amoxicillin

Extended-spectrum penicillin used against Psuedomonas

Carbenicillin

Antiobiotic widely prescribed for Gram-negative infections (structurally similar to penicillins)

Cephalosporins

How many generations of cephalosporins exist?

Four

1st generation of cephalosporins:
__________ (Keflex)

Cephaxelin (Keflex)

2nd generation of cephalosporins:
__________ (Ceclor)

Cefaclor (Ceclor)

3rd generation of cephalosporins:
__________ (Rocephin)

Ceftriaxone (Rocephin)

4th generation of cephalosporins:
__________ (Maxipime)

Cefepime (Maxipime)

Cephalosporins are more effective against gram-_________ and (aerobic/anaerobic) bacteria

Gram-negative
Anaerobic

Cephalosporins have a broader __________, longer __________, and better permeability to _______-_________ fluid with each new generation of the antibiotic.

Broader spectrum
Longer duration
Better permeability to cerebrospinal fluid

Cephalosporins interfere w/ the bacterial ______ _______, making them bacteriocidal.

Bacterial cell wall

Cephalosporins have an antabuse-like interaction w/ _________ for up to 72 hours, causing impaired consciousness.

Alcohol (avoid alcohol intake while taking cephalosporins)

Broad-spectrum antibiotic used against both Gram-positive/Gram-negative infections

Tetracyclines

Tetracyclines inhibit bacterial __________ synthesis by binding to the _____ ribosomal unit, thereby interfering attachment of _______ to ______ and terminating growing amino acid chains.

Inhibit bacterial protein synthesis; bind to 30s ribosomal unit; interfere with attachment of tRNA to mRNA

Does tetracyclines' interference with bacterial protein synthesis render them bacteriocidal or bacteriostatic?

Bacteriostatic

Tetracyclines bear a strong affinity for ________ to form insoluble complexes.

Calcium

Prototype tetracyclines (2)

Tetracycline
Doxycycline

Broad-spectrum antibiotic that can be either bacteriostatic or bacteriocidal

Macrolides

Macrolides inhibit bacterial _________ synthesis.

Protein synthesis

What drug is administered when a patient expresses an allergic reaction to penicillins?

Macrolides (broad spectrum)

Macrolides are most effective against Gram-_________ infections.

Gram-positive

When administered macrolides, patients should be encouraged to take the antibiotic (before eating/after eating).

Before eating (empty stomach)

The ______ coating of macrolides prevents GI irritation.

Enteric coating

___________-resistant strains are rather common, due to the drug's frequent use in the place of penicillin.

Macrolide-resistant strains

Prototype macrolide

Erythromycin

Antibiotic most often used to treat tuberculosis (TB) and often administered parenterally alongside other drugs

Aminoglycosides

Aminoglycosides are bacteriocidal by inhibiting bacteria _______ synthesis.
(Bonus: gram-positive or gram-negative bacteria?)

Protein synthesis
(Gram-negative)

When administered aminoglycosides, patients should be warned concerning what adverse effects? (2)

Nephrotoxicity; ototoxicity (dizziness [vertigo], hearing loss, tinnitus)

Prototype aminoglycoside

Gentamicin

When administering aminoglycosides, physicians should monitor the patient's urinalysis for urinary _______ and _____uria, as well as increased serum _____ and ___________.

Urinary casts; proteinuria; increased serum BUN; creatinine

Physicians must monitor the peak/trough levels of aminoglycosides for what reason?

The therapeutic range of aminoglycosides is very narrow (toxic level close to effective level).

Highest drug level in the blood

Peak level

At what time after administration should the peak level of the drug in the blood stream be examined?

15-30 minutes

Lowest drug level in the blood

Trough level

When should blood be drawn to monitor the trough level of a drug? Why?

No more than 30 minutes prior to the next infusion (to prevent toxicity w/next dose)

Which broad-spectrum antibiotic is traditionally used for UTIs? Why?

Sulfonamides (reach high concentrations in the kidneys)

Sulfonamides combine synergistically with __________, both of which are effective against UTIs.

Trimethoprim

Sulfonamides are bacteriostatic by inhibiting _____ _____ synthesis in bacteria.

Folic acid synthesis

Why are sulfonamides (sulfa drugs) effective against bacteria but harmless to humans?

Humans obtain enough folic acid from food to counter the disruption of folic acid synthesis by sulfa drugs.

Prototype sulfonamides (sulfa drugs):
___________ (Bactrim/Septra)

Sulfamethoxazole (Bactrim/Septra)

Widespread use of sulfa drugs against UTIs has led to what complication?

Strain resistance

Drugs for Influenza:
Best prevention

Annual vaccination

Drugs for influenza prophylaxis (prevention) (2):
__________ (Symmetrel)
__________ (Flumadine)

Amantadine (Symmetrel)
Rimantadine (Flumadine)

Influenza Drugs:
Use for ___-__________ individuals after confirmed outbreak.

"un-vaccinated" individuals

Drug for new, active influenza

Tamiflu (Oseltamivir)

How soon after onset of influenza symptoms should Tamiflu (Oseltamivir) be given?

Within 48 hours

Drugs for Hepatitis:
Best prevention via _______________.
(Bonus: for which two strains?)

Immunization
(Hepatitis A & Hepatitis B)

Drug for Hepatitis:
Prevention through _________________ (antibodies) for those with personal contact for ________ months (passive immunity)

Immunoglobulins
3

Drug for Hepatitis treatment

Interferon - "interferes" w/ virus infection (increases immune system)

HIV Infection:
HIV targets what?

The CD4 receptor on T4 (Helper) lymphocytes

T4 cells are part of what system?

Cell-mediated immune system

Loss of T4 cells due to HIV results in a vulnerability to develop _________ alongside HIV.

Develop infections (alongside HIV)

Therapeutic goals of anti-Hepatitis drugs:
Reduction of ____ in the blood
Increase _____ span
High quality of _____ (all things considered)

Reduction of HIV in the blood
Increase life span
High quality of life (all things considered)

Drugs for HIV (Antiretrovirals):
List 2 Reverse-Transcriptase Inhibitors

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Drugs for HIV (Anti-retrovirals):
__________ inhibitors (PIs)
__________ (entry) inhibitors

Protease inhibitors (PIs)
Fusion (entry) inhibitors

Drugs for HIV (MOA):
What do Reverse Transcriptase inhibitors do? (______________ [Retrovir, AZT])

They are able to make HIV lose the ability to replicate DNA.
(Zidovudine [Retrovir, AZT])

Protease inhibitors block the final assembly of new ___ and control the spread of ____ to uninfected cells.
(_________ [Crixivan])

They block the final assembly of new HIV and control the spread of HIV to uninfected cells.
(Indinavir [Crixivan])

Fusion inhibitors block the fusion of _____ to _____
(___________ [Fuzeon])

Block the fusion of HIV to CD4
(Enfuvirtide [Fuzeon])

What HAART?
What is the function of HAART?
What conditions does it affect? (2)

Highly-Active Antiretroviral Therapy
Aggressive therapy with multiple drugs.
HIV/AIDS

Haart: Simultaneous use of drugs from several ___________ to reduce probability of drug __________.

Several classes
Resistance

Antifungal agents (2)

Nystatin (candida albicans)
Miconazole (athlete's foot, jock itch)

Two (2) reasons for ineffective antifungal drug therapy

Incomplete full course
Reinfection

Systemic fungal infections might be deadly in...

Immuno-compromised people

List four immuno-compromised people:
______________ syndrome
Taking ________ therapy
Taking _________________ to fight __________ rejection
Debilitated, _____________ or otherwise poor health

Immunodeficiency syndrome (AIDS)
Taking cancer therapy
Taking immunosuppressants to fight transplant rejection
Debilitated, malnourished or otherwise poor health

Systemic antifungal agents (2)

Amphotericin
Fluconazole

Amphotericin & Fluconazole bind to __________ in fungal cell membranes, causing __________.

Ergosterol
Leakage

Intensive and extended fungal treatment causes what side effects? (12)
_______ and chills
______tension and ______cardia
_____/______ pain & _____ache
GI issues (2)
Three types of toxicity

Fever and chills
Hypotension and tachycardia
Muscle, joint pain, headache
Nausea and vomiting
Renal, neuro- and hepatic toxicity

Protozoa - Malaria:
Female Anopheles mosquito is the carrier of several species of ____________.

Plasmodium

Plasmodium is responsible for:

Malaria

Malaria is caused by infected ___________ __________.

mosquito bites

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