Terms in this set (138)
"Pharmacokinetics" includes the basic processes of:
Absorption, Distribution, Metabolism, Excertion
Drug enters the body
Movement of a drug from the site of administration to body fluids
Reaches it's site of action
Drug movement from the blood to the interstitial space of tissues and from there into the cells.
Also called "biotransformation". alteration of a drug structure accomplished by enzymes
exits the body
Movement of the drug and their metabolites out of the body.
Pass easily through the GI system
Water soluble medications
require a carrier to pass through the GI membrane (active absorption)
lipid soluble medications
absorb easily through the GI membrane because the GI membrane is composed mostly of lipids
First Pass affect
The process in which a drug passes first through the liver after absorption.
Percentage of the administered drug dosage that reaches the blood stream (systemic circulation)
oral drugs always <100%, therefore increased dosage.
The time it takes for one-half of the drug concentration to be eliminiated.
When two drugs are given together that are both "highly protein-bound" drugs, the pateint is at greater risk of drug accumulation (drug toxicity).
It is only the "free" drug (drug not bound to protein) that will be able to create a pharmacologic response.
Blood Brain Barrier
Only drugs that are lipid Soluble or have a carrier can pass.
Stronger barrier then fetal-placental barrier
According to Table 1-1 in your textbook, the normal half-life of Ibuprofen is 2-4 hours. Which one of the following is a true statement regarding the administration of 400mg of Ibuprofen
Normally, the nurse would expect that 50% (200mg) of the Ibuprofen would remain in the patient 2-4 hours following administration.
The time that it takes following administration for a drug to reach it's highest blood concentration
Drugs that blocks a response
Secondary effect of the drug. Always undesirable.
Adverse drug reaction from excessive dosing of the drug
An estimate of the margin of safety of a drug.
Drug that creates a response
A decrease in the responsiveness of the drug over the course of therapy.
Predictable secondary effect of the drug. Can be desirable or undesirable.
Psychological benefit of a drug despite no chemical drug effect
is thinner and more porous, absorption will most likely be enhanced
Distribution in children
Until the age of 2 years, the pediatric patient typically requires higher doses of "water-soluble" medications to achieve therapeutic levels, than do older children or adults. The need for higher doses in this age group is because of the increase in body fluid proportion.
Infants and neonates have less albumin and thus fewer protein receptor sites available than older patients. This leads to a decrease in the dosges needed in young patients to achieve a therapeutic level.
"dose per unit of weight"
a medication dose may be determined based on the patients' weight in kilograms. frequently used for kids.
Nursing thoughts for kids
Toddlers may react violently to medication administration. The nurse may use creative strategies such as imagination through play therapy to successfully administer the medications.
Allowing the pre-school aged child some level of choice and control will enhance cooperation wiht medication administration.
defined as the administration of many drugs together. This is a common occurrence in the older adult. ***can lead to problems such as confusion, falls, malnutrition, renal and liver dysfunction and nonadherence.
Physiological changes in older adults
Decrease in hepatic enzyme function thus reducing and slowing metabolism of medications.
Decrease in cardiac output leading to a decrease in drug delivery to tissues.
Decrease in blood flow to the kidneys thus a decrease in glomerular filtration. This leads to a decrease in medication excretion.
Assessing and monitoring kidney function in the older adult
With the older adult patient, the serum creatinine level may be within normal values even though there is a decrease in renal function.
One way to assess kidney function is to monitor urine output.
Creatinine clearance is an indicator of glomerular filtration.
a factor in nonadherence
Cost of medication esp in older adults
When a nurse gives the wrong medication or dose to a client and the client is dies, the offense is
Omission of a drug that results in death.
Giving correct drug via the wrong route results in death
The Food and Drug Administration Modernization Act.
granted financial incentives to do pediatric research on existing drugs.
The nurse knows that the act that provides for the privacy of client's health information is called
Are Generic Drugs approved by the FDA? If so, what criteria does the FDA use to say that a Generic Drug is equivalent to the original agent?
If the serum concentration falls within 80 - 125% of the brand drug, it is considered equivalent
Drugs pass from site to site in the body by
Directly penetrating the membrane
With the assistance of a carrier
what are the 6 rights of medication administration
Drug category A
No risk to fetus
Drug category B
Assumed little or no risk. Adverse effect on animals may have been evident but not in humans
Drug category C
Adverse effect on animals, but not adequate studies on humans
Drug category D
Risk to human fetus, has been proven. Used in life threatening conditions. Risk versus benefit of the drug must be determined.
Drug category X
Drug should be avoided during pregnancy.
A protein that transports a variety of drugs "out" of the cells. For example, it transports drugs out of the cells of the brain and kidneys, so they can be eliminated.
Can "lipid soluble" drugs easily penetrate the membranes?
Yes. The membranes are primarily composed of lipids so the lipid soluble agents dissolve into the lipid membranes.
Can "water soluble drugs easily penetrate the membranes?
No. Water soluble drugs will repel from the membranes. They need a carrier to cross.
Cannot pass through the membrane--charged--bouncing all over-spastic.
Can pass through the membrane, no charge
How does a drug become ionized
Asprin weak acid will become ionized if in an alkaline environment.
How long does it usually take for drugs administered by the IV route to be absorbed?
IV drugs are already there! They don't have to absorb.
Elixirs and syrups
Will absorb fasted then pills or tablets
Drugs are absorbed faster in sites where blood flow is high
Deltoid gets more blood then gluteal
small amount of blood vessels compared to muscles
Fast Absorption-increases blood vessels
sublingual, buccal and rectal medications
If a patient has diarrhea, and takes an oral medication such as Ibuprofen. Will the diarrhea affect the absorption of the medication?
Hypermotility of the GI tract will pass the medication through the GI tract before it has an adequate amount of time to absorb.
If a patient takes an oral medication, then exercises. She/he runs on the treadmill and lifts weights. Will this exercise effect the absorption of the oral medication?
Exercise will decrease blood flow to the stomach
Blood will be shunted to the peripheral muscles
Your patient is taking this medication. She asks you what the "sr" means that is written on the pill. What will you tell her
Sustained Release capsule
Morphine (narcotic analgesic) is a drug that is administered both by mouth and by intravenous administration. Would you expect:
The oral dose would be higher than the intravenous dose
Why are abscesses difficult to treat with antibiotics?
No blood supply to the inner mass of an abscess
have a huge blood supply to the outer edges, but very little blood supply to the core
Why are brain tumors difficult to treat
due to the blood brain barrier
Warfarin (Coumadin) is a highly protein bound drug (99%). If Coumadin is administered to a person who is malnourished elderly or liver disease, he/she will most likely:
Get too much of an effect from the Warfarin
After absorption, which of the following drugs must first pass through the portal vein/liver before it enters the general circulation?
Elixir or syrup (cough syrup)
First pass effect
All oral drugs go through the liver via the portal vein first
certain drugs are partially or completely inactivated on the first pass--little to no effect.
Ibuprofen is highly protein bound (98%). The portion that is protein bound is:
Inactive, and has no therapeutic effect
While attached to the protein, can the drug be eliminated via the kidneys
The protein is too large to exit the vascular system and will not be eliminated via the urine
If you are caring for a patient with cirrhosis of the liver, you can expect that the physician will prescribe (higher/lower) doses of medications
Because it will metabolize/become inactive slower
How do you define the "half-life" of a drug
Time it takes for a medication to decrease concentration in the plasma by one-half
What factors would prolong the half-life of a drug?
Liver, kidney, cardiac problems
Every drug has side effects
Unpredicted immune response, mild to severe
Purtitus-itching of the skin
rhinitis-swelling and clear drainage from the nose
wheezing-constriction of the smooth muscles surrounding the bronchioles
Unpredictable, client overracts ot underreacts to a drug
Narcan is given for an overdose of narcotics. This drug has which one of the following effects?
Tetracycline should be administered with food (dairy esp)to decrease gastric upset.
Tetracycline won't absorb if given with food or antacids
MAO inhibitors such as Marplan should not be administered with Tyramine rich foods such as Cheese or wine
Will lead to hypertensive crisis
Drugs that decrease cardiac output, will cause an increase in elimination of other drugs. Therefore the client will have a decrease in the blood concentration of the other drug
Decrease cardiac output will lead to decrease in renal perfusion and decrease in drug elimination.
A patient is taking Benadryl and complains of drowsiness. This reaction is most likely
Drugs absorbed from all sites along the GI tract must pass first through the liver via the portal vein before distributed throughout the body.
Tricky!! If administered via oral mucosa or rectum, they won't enter the liver first)
Enteric Coated Drugs"
Resist disintegration in the gastric acid of the stomach. Disintegration occurs in the small intestine where the environment is more alkaline.
Should the nurse ever crush or break an enteric coated pill?
If the patient takes a Tums (antacid), before they take an enteric coated pill, will that effect absorption?
Yes. The enteric coated pill will most likely now absorb in the stomach
Drugs that are "sympathomimetics" work by:
mimic the sympathetic system
central nervous system
brain and spinal cord
peripheral nervous system
2 Divisions of PNS
Somatic Motor System voluntary. skeletal muscles
Autonomic Nervous system-involuntary. controls heart, respiratory system, smooth muscles, GI and glands.***
2 divisions of Autonomic Nervous System
Sympathetic nervous system-flight or fight. adrenergic. main neurotransmitter-norepinephrine
Parasympathetic nervous system rest and digest Cholinergic or muscarinic. mail neurotransmitter-acetylcholine.
Lungs broncioles dilate
Heart rate increases
Blood vessels constrict
Bladder, GI and uterus relax-flight or fight emergency-not a good time to have a baby or potty.
Lungs-broncioles, eye constrict
Blood vessels dilate
heart rate decreases
GI-increased parastalsis, and secreations
Rest and digest
respond to norepinephrine and epinephrine
located on the blood vessels and causes vasoconstriction
controls vasoconstriction of alpha 1--like a dimmer switch.
1-heart, location heart-primarily
also kidney-release of renin into the blood
increase heart contraction and rate
2-lungs-pirmarily located in the lungs
also in uterus-relaxes smooth muscles
dilates arterioles in the heart, lungs, and skeletal muscles
increases blood glucose
GI motility decrease
liver-increase blood glucose
A sympathomimetic drug that causes bronchodilation, effects which one of the following adrenergic receptors?
Alpha 1 receptor agonists
used for vaso constriction, treatment of nasal congestion, to stop bleeding
A sympathomimetic drug that causes vasoconstriction, effects which one of the following adrenergic receptors
A sympathomimetic drug that causes increased force of cardiac contraction and increase in heart rate, effects which one of the following adrenergic receptors?
Alpha 2 agonist
used to treat HTN
careful with old-may lead to othrostatic HTN
adverse effects of alpha 1 activation
Bradycardia-reflex responding to HTN
necrosis at IV infiltration into tissues
Beta 1 activation
treatment of cardiac arrest caused by asystole
treatment of heart failure
treatment of shock
increases HR, force of contraction and cardiac output.
adverse effects of Beta 1
tachycardia and dysrhythmias
angina pectoris-increased cardiac oxygen demand poor profusion to heart
O2 demand is > then O2 supply
Beta 2 activation
Treatment of asthma-broncodilation
treatment of pre-term labor-relaxes smooth muscles.
Adverse effects of Beta 2
promotes breakdown of glycogen into glucose-problem for DM
may require increased insulin dosages.
A sympathomimetic drug that causes uterine relaxatation, effects which one of the following adrenergic receptors?
The nurse administers a drug that stimulates the beta 1 and beta 2 receptors, Isoproterenol (Isuprel). What will this do to the oxygen consumption and oxygen demand of the heart?
It will increase consumption and demand. The heart will have to work harder and faster
Will stimulation of the sympathetic system cause an (increase/decrease) in the blood glucose level?
Which adrenergic receptor is responsible for the rise in the blood glucose level?
It would make most sense to use a (alpha 1 agonist/alpha 1 antagonist) to treat hypertension.
Alpha 1 antagonist
Which type of Adrenergic agent should be used to treat Peripheral Vascular Disease (Raynaud's disease?
alpha 1 antagonist
Which Adrenergic Receptor is responsible for Prostate Contraction?
Which type of Adrenergic Drug would decrease Prostate Contraction?
alpha 1 blocker/antagonist
Name a drug that is a Alpha 1 Blocker that is good for clients with BPH as well as hypertension?
causes relaxation in bladder neck and prostatic capsule
watch out for orthostatic HTN
An IV is infusing with Epinephrine. The nurse notices that the IV has infiltrated. What might be a concern of the nurse regarding the infiltration with epinephrine?
What would be the treatment of choice for this client regarding an infiltrated IV with Epinephrine in the tissues?
Alpha 1 Blocker (Phentolamine)
The nurse is administering an Alpha 1 Blocker. Side effects might include:
The nurse is preparing to administer Atenolol. The nurse knows that any drug name that ends in "lol", is:
The primary reason(s) that a beta blocker would be given is for treatment of: (Select all that apply)
Therapeutic effects of the beta adrenergic blockers result from blockage of the beta 1 receptor
decrease cardiac contraction
decreases the velocity or the impulse conduction through the AV node.
adverse effects of beta 1 blockers
reduced cardiac output
adverse effects of beta 2 blockers
inhibition of glycogenolysis-insigigicant for patients w/out DM
selective beta 1 blockers
drug of choice for pt's with lung issues or DM
does not affect the broncioles or glucose levels
Adverse Effects of non-selective Beta Blockers would include (Select all that Apply)...
Propranolol (Inderal) is:
Nonselective beta blocker
Metoprolol (Lopressor) is:
beta 1 blocker selective
major uses of cholinergic drugs
stimulate GI tone
decrease HR and BP
increased salivary and bronchial secretions
Adverse effects of parasympathomimetics
increased muscle tone (nor nicotinic)
abdominal cramping and diarrhea
Relieves urinary retention
The nurse administers bethanechol to a pt, the patient has idiosyncratic reaction and displays a full range of cholinergic/muscarinics side effects these include
inhibits acetylcholine action
increased pulse rate
decreased GI motility
relaxation of bronchi
dilation of pupils
preop medication decrease salivary and maintain HR
dilate pupils for eye exam
antidote for cholinergic overdoses-nerve agent bioterrorism
adverse affects of anticholinergics
increased intraocular pressure
Oxybutin ditropan (bed pan)
uriniary tract antispasmodic
treats overactive bladder
used for incontinence
used for overactive bladder only
motion sickness and eye exams
used for asthma, COPD, and rhinitis
used for IBS