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Pharm Exam 1 Key Terms/Topics

Terms in this set (140)

Drug or Medication
any substance that is take to:
1. Prevent 2. Cure
3. reduce symptoms of a medical condition
4 roles of the nurse (in relation to pharmacology)
1. KEEP THE PATIENT SAFE!!
2. Administering the drug
3. Assessing the effects of the drugs
4. Teaching the patient about the drugs
Goal of drug therapy
Maximum benefit with minimum harm
-always weigh the risks vs. the benefits to using a medication
Ideal medication is:
1. Safe 2. Effective 3. selective
Characteristics of an Ideal Drug
Effectively treats, prevents, cures patient's condition
Produces rapid, predictable response at relatively low doses
Produces no adverse effects
Can be taken conveniently (by mouth)
Characteristics of an Ideal Drug (Continued)
Can be taken infrequently and for a short length of time
Inexpensive and easily accessible
Quickly eliminated by body after beneficial effect produced
Does not interact with other medications or food
Drug Naming: Generic name
The harder to pronounce name assigned by USAN, can have different brand names associated
-indicates drug groups (like -cillins)
Drug Naming: Brand name
Developed by the company to "market" the medication.
Prescription Drugs
written and overseen by a healthcare provider
-Drugs may be addictive
-drugs may be to harmful for self-administration
-treat complex conditions
Advantages of Prescription
-Health care provider can examine and diagnosis patient.
-Maximize therapy
-Patient teaching
-Patient follow-up
Over-the-Counter Drugs
drugs that can be obtained from a store or pharmacy without a prescription
-patient may treat themselves
-must carefully follow direction
Risks of Over-the-Counter Drugs
-No drug is without risk.
-Patient may not choose proper medications
-May interact with food, herbals, prescription, or other OTC drugs
-May be ineffective or harmful
Drug Schedules
Drugs with high potential for dependence or that are frequently abused are categorized into schedules.
-Sale and distribution are highly restricted
Schedule V, Schedule IV, Schedule III, Schedule II, Schedule I
What are the the 5 drug schedules rating from lowest abuse potential to the highest abuse potential?
Drug Schedule I (examples)
Heroin, GHB, LCD, marijuana, MDMA, mescaline, methaqualone, methcathinone, peyote, & psilocybin
Drug Schedule II (examples)
Potent opioids (codeine, fentanyl, morphine), amphetamine, cocaine, methamphetamine, methylphenidate, PCP, short-acting barbiturates
Drug Schedule III (Examples)
Anabolic steroids, buprenorphine ketamine, lower dose codeine, hydrocodone, & intermediate-acting barbiturates
Drug Schedule IV (Examples)
Benzodiazepines, long-acting barbiturates, meprobamate, pentazocine, tramadol, & zolpidem
Drug Schedule V (Examples)
Cough medicines with codeine, antidiarrheal medicines with small amounts of opioids
Pharmacokinetics
The study of how the organism affects the drug
-what the BODY does to the drug
Pharmacodynamics
The study of how the drug affects the organism
-what the DRUG does to the body
Absorption, Distribution, Metabolism, Excretion
What does "ADME" stand for?
Absorption
Absorption is the process of moving a drug from the site of administration to the bloodstream.
-Primary factor for determining onset of drug action
-Oral administration is preferred method
1. Dosage form, route of administration
2. Administration site, blood flow, GI function
3. The presence of food or other drugs
What are the factors that affect rate and extent of drug absorption?
1. Enteral 2. Parenteral 3. Topical 4. Inhalation
What are the 4 main routes of administration?
1. oral 2. sublingual/buccal 3. Rectal
4. Gastrostomy tubes
4 types of enteral administration
Parenteral
Injections
1. vaporization 2. Gas inhalation 3. Nebulization
Different types of Inhalation administration
1. tablets and capsules 2. Oral liquid
3. Enteric coating 4. extended release
Types of Oral medication
Sublingual (SL) and Buccal Routes
-Medications kept in mouth
-Not subjected to stomach acid or first-pass effect
-If multiple medications ordered, administer oral ---medications first, then sublingual preparations.
-Place buccal medications in cheek.
Nasogastric and Gastrostomy tubes
-Medications administered through devices
-Usually liquid form
-Solid drugs that are crushed tend to clog tubes.
-Do not use sustained release medications.
-Drugs exposed to same processes as those given PO
First Pass Effect
Drugs absorbed from the stomach and small intestine travel to liver, where they may be fully or partially inactivated before reaching target organ(s)
Oral (PO) & Gastrostomy Tubes (NG, OG)
Which routes undergo the first pass effect?
Topical Route
Applied to skin, mucous membranes
-local effects
-some given for slow release systemic effects
1. Intravenous (IV) 2. Intramuscular (IM)
3. Intradermal & subcutaneous
What are 3 types of parenteral administration?
1. GI tract environment. 2. Blood flow to the absorption site. 3. Drug interactions. 4. surface area
4 factors that affect absorption
Bioavailability
-Percent of drug administered that actually enters the systemic circulation
Distribution
how drugs are transported throughout the body.
Blood & tissue fluid
How are drugs carried through the body?
-Action sites
-Metabolism sites
-Excretion sites
Blood & Tissue fluid carry the drug to where?
Blood Brain Barrier
Barrier to distribution, protects brain from pathogens and dangerous drugs making it difficult to pass
Metabolism
A process that changes the activity of a drug and makes it more likely to be excreted.
The Liver
What is the primary site for metabolism?
Prodrugs
Medications that require metabolism to produce therapeutic actions
Have no pharmacological activity without the metabolism of the liver
Hepatic (liver) microsomal enzymes
Cytochrome P450 (CYP): An enzyme that metabolizes many drugs
-Drugs that inhibit CYP450 generally put the patient at risk for drug toxicity
Excretion
Removal of a medication from the body
Grapefruit juice
An example of a CYP450 inhibitor is?
Kidney
What is the primary organ in excretion?
Urine, Lungs, Sweat, Saliva, Breastmilk, feces
Drugs are excreted in?
-Dose reduction for patients with renal impairment (renal dose)
-Some drugs undergo reabsorption after renal filtration
-Drug excretion dependent on urine pH
Renal Excretion (primary site)
-Gases and volatile liquids
-Most excreted unmetabolized
-Respiratory rate and blood flow affect excretion
Pulmonary Excretion
-Saliva, sweat, breast milk
-This is why patients can taste and smell some drugs
Glandular Secretion
Interpatient Variability
Individuals have different responses to drugs (therapeutic response)
-Therapeutic index
-Dosing considerations (Dose‒response relationships)
-Drug receptor interactions
Therapeutic responses are related to:
Therapeutic range or Therapeutic Index
-The range where the drug produces its desired effect
-Describes the drug's margin of safety.
Amount of drug required to produce a therapeutic
What is minimum effective concentration (MEC)
Toxic Concentration
Level of drug that results in serious adverse effects
narrow therapeutic window
Difference between minimum effective dose and toxic dose may be narrow
Receptors
Most drugs produce their actions by activating or inhibiting specific cellular receptors.
Agonist
make the body do something, mimicking natural ligand
Antagonist
Prevent action
Agonist + Antagonist
a diminished response
Therapeutic range or Therapeutic Index
-The range where the drug produces its desired effect
-Describes the drug's margin of safety.
-Narrow therapeutic window describes small difference between effective and toxic dose
Dosing Considerations
The therapeutic response of most drugs depends on their concentration in the plasma
-Loading Dose
-Maintenance Dose
-Dose often determined based on Drug half-life
Short half-life
Drugs are given more frequently for which kind of half-life?
Long half-life
Drugs are given less frequently for which kind of half-life?
Factors to medication errors
human factors, inadequate communication, or confusing labels, packaging, or drug names.
HUMAN factors
Most medication errors are caused by what factors?
-Errors in patient assessment
-Inaccurate prescribing
-Errors in administration
What are some of the most frequent errors?
-Extend length of hospitalization
-Increase medical costs for patient, agency
-Create legal challenges
-Kill the patient
What are some consequences of medication errors?
Right patient, right drug, right dosage, right route, right time
What are the 5 rights of medication administration
Strategies for reducing medication errors
-Assess factors that might interfere with drug administration.
-Minimize factors that contribute to medication errors.
-Be aware of stressful situations and distractions.
Black box warning
Strictest warning provided by FDA. Reasonable evidence of a serious or life threatening hazard associated with the drug.
-Antidepressants: Suicidal Ideation
-Depo Provera (injectable birth control): Bone Loss
-Fluoroquinolones (antibiotics like Cipro): Tendon rupture
What are some examples of black box warning?
1. increased gastric pH (less acidic) 2. Delayed gastric emptying 3. low blood flow to skeletal muscles (in infants) 4. thin, highly permeable skin
What are some absorption variables for pediatric patients?
1. decreased gastric pH (more acidic due to increased hydrochloric acid production) 2. delayed gastric emptying 3. increased blood flow
What are some absorption variables for pregnant patients?
1. Increased pH (less acidic) 2. Delayed gastric emptying 3. Decreased in blood flow
What are some absorption variables for geriatric patients?
-Enhances absorption of acid-labile drugs (drugs that are easily broken down in acid)
-Slows absorption of weak acids
-Stabilizes by age 2 or 3
Increased Gastric pH
-Keeps drug in stomach longer
-Increases absorption of drugs absorbed across stomach lining
-Decreases absorption of drugs absorbed in intestine
Delayed Gastric Emptying
-Slow, erratic absorption of drugs administered IM or subcutaneous
-IM injections avoided if possible
Low Blood Flow to Skeletal Muscle in Infants
Lotions and topical drugs absorbed more rapidly
Skin of Infants thin, Highly Permeable
1. Small amounts of plasma proteins creating more "free drug"
2. Underdeveloped brain barrier
3. Decreased blood flow
4. Immature liver function
What are some Distribution Variables for pediatric patients?
1. Higher concentration of "Free Drug" in plasma so more drug molecules available to transfer across the placenta.
2. Increased blood flow
What are some distribution variables for pregnant patients?
1. Higher concentration of water-soluble drugs due to decreased total-body water. More "free drug"
2. Fat soluble drugs stored in fat tissue.
3. Increased permeability of the blood-brain barrier
What are some distribution variables for geriatric patients?
1. significantly slower in children
2. Immature liver & hepatic cytochrome enzyme
3. Allow sufficient time for metabolic handling of the drug to avoid toxicity
What are some metabolism variables for pediatric patients?
1. Metabolism is pharmacokinetic factor least affected by pregnancy
2. Placenta and fetal liver contribute to overall drug metabolism (increasing metabolism of some drug)
What are some metabolism variable for pregnant patients?
1. Metabolism slow, or even incomplete (usually just slow)
2. Liver function declines
3. Decreased drug binding to plasma proteins
What are some metabolism variable for geriatric patients?
-Sometimes this means a slow rate of breakdown
-Other times it means the inadequate breakdown causes too much medicine to pass into the system
Slower or inadequate metabolism
3 to 5 years of age
Metabolic rate reaches adult levels at what age?
1. Immature renal system
2. Risks of drug toxicity and toxicity to kidney
What are some excretion variables for pediatric patients?
1. Enhance renal systems
2. Increased elimination which may mean need for dosage adjustment
What are some excretion variables for pregnant patients?
1. Renal function declines
2. Risks of drug toxicity and toxicity to kidney
What are some excretion variables for geriatric patients?
-More drug hanging around= increased risk for drug toxicity
-Drugs hanging out around the kidney too long can mean toxicity to kidney tissues
Slower or inadequate excretion
child's age, height, weight, maturational state, and body surface area (BSA)
Dosage calculations should consider what items for pediatric dosing?
Double-checked
All critical care medications should be?
Teratogens
Substances, organisms, or physical agents that cause a permanent abnormality in structure or function, growth retardation, or death to embryo or fetus
Breastmilk
Where are most medications excreted to during pregnancy/post-pregnancy?
A-X categories (A,B,C,D,X)
How does the FDA rate medications for pregnancy?
1. Intrauterine fetal death 2. Physical malformations 3. Growth impairment 4. Behavioral abnormalities
5. Neonatal toxicity
What are some potential fetal consequences of teratogens?
First trimester
Which trimester poses the greatest risk for adverse effects due to organogenesis and rapid development?
Even with small concentrations (less than 3%), effects in infants can be serious
Adverse drug effects during lactation
A list of potentially inappropriate medications
-Drugs that have a high risk of causing adverse drug reactions
-Use of these drugs should be avoided or closely monitored.
Beers Criteria
1. Visual impairment 2. Hearing impairment 3. Functional impairment 4. Cognitive dysfunction
What are some barriers to medication adherence in elderly?
-Overuse, underuse, or erratic use
-May be accidental or deliberate
-Self-adjusting dose is common.
-Splitting doses to make expensive medication last longer
Drug misuse in older adults
Use of multiple medications to treat patients.
-Increases risk of drug interactions and adverse effects
-Encourage patients to have providers share care plan.
-Encourage patient to use the same pharmacy so pharmacist can catch drug interactions.
Polypharmacy
1. Sudden change in mental status 2. Rapid weight loss
3.Dehydration 4. Restlessness 5. Anorexia
6. Changes in fluid balance, retention
7. Changes in bowel habits
8. Functional status change in any system
Medications may cause what adverse effects in elderly adults?
Medications that relieve pain without causing loss of consciousness.
Analgesics
Sudden onset, usually subsides once treated
Acute Pain
-Persistent or recurring, Lasts 3 to 6 months
-Often difficult to treat
-Issues of tolerance/physical dependence with medication use
Chronic Pain
1. Non-opioid 2. Opioid 3. Adjuvant
What are some types of Analgesias?
-Non addicting
-Antipyretic effects (fever reducing)
-Work well alone for mild pain
-Combined with opioids- enhance analgesic effects
Non-opioid
An adjuvant analgesic is a medication that is not primarily designed to control pain but can be used for this purpose.
-Some examples of adjuvant analgesics are medications like antidepressants and anticonvulsants.
Adjuvent
Strong opioid -- weak opioid -- non-opioid
What is the order of pain medications for acute pain?
non-opioid -- weak opioid -- strong opioid
What is the order of pain medications for chronic pain?
-Acetaminophen is the drug of choice
-Caution with concentration
-Careful dosing based on weight
-Ibuprofen also ok
-Alternate between acetaminophen and Ibuprofen for fever and or pain
Treating pain in pediatric patients
-American Geriatric Society
-Acetaminophen should be initial consideration, unless contraindicated
-Caution with NSAIDs
-Caution with narcotics
-More likely to cause side effects
-Older adults may be afraid of addiction
-Educate
-Beers Criteria
Treating pain in geriatric patients
1. Acetaminophen (Tylenol). 2. Ibuprofen (Advil, Motrin)
3. Aspirin (ASA) 4. Ketorolac (Toradol)
5. Celecoxib (Celebrex)
5 different non-opioids medications
-Non-opioid analgesic for mild to moderate pain
-No anti-inflammatory effects
-Reduces fever
-Decreases opioid requirements
-Safe, and often first option for both children and the elderly
Acetaminophen (Tylenol)
-Metabolized almost completely by liver
-Causes liver toxicity at high doses
-#1 cause of liver failure in the U.S.
-Antidote: Acetylcysteine (Mucomyst)
-Must be administered within 8 hours of overdose
Acetaminophen (Tylenol)
-MOA: Prevent COX enzymes from releasing prostaglandins that cause pain, fever and inflammation
-Efficacy is similar amongst NSAIDs
-Differences in potency, time of onset, & duration of action
NSAIDS
1. vasodilation in kidney 2. platelet aggregation
3. protect mucosa in stomach
Prostaglandin effects by COX-1 enzymes (Positive)
1. Inflammation at site of injury
2. Pain sensation, fever in the brain
Prostaglandin effects by COX-2 enzymes (Negative)
-A good Initial choice for acute pain due to cost & safety
-Anti inflammatory
-Antipyretic
-Good for arthritis
-Hard on kidney in large doses
-GI irritation and bleeding
Ibuprofen (Advil)
-COX-2 specific Inhibitor
-Selectively inhibits cyclooxygenase-2
-Less GI irritation
-Less platelet effects than other NSAIDS
Celecoxib (Celebrex)
-Effective as acetaminophen for acute pain at similar doses
-Worse side effect profile than acetaminophen
-Anti-inflammatory, Antipyretic, Analgesic, Anti-platelet
-Administer w/food to decrease GI upset burn, bleeding, tinnitus
-Do not give aspirin to children
Aspirin
-Start with non-opioid medications like acetaminophen, ibuprofen, aspirin
-Non pharmacological interventions like rest, relaxation, stress reduction
-Treat underlying cause (such as sinus infection)
-Migraine
-Sumatriptan (Imitrex)
Medications for Headache
1. Sinus 2. cluster 3. Tension 4. Migraine
what are the 4 types of headaches?
1. Agonist 2. Agonist-Antagonist
3. Antagonist (nonanalgesic)
What are the three classifications of opioid based on their actions?
-WHO ladder: Moderate Pain and Beyond
-Pain management best practices with opioids
Use of opioid drugs
-Main use: to alleviate moderate to severe pain
-Often given with adjuvant analgesic drugs to assist primary drugs with pain relief and reduce need for opioid
-Opioids are also used for:
-Cough center suppression, Treatment of diarrhea,
Balanced anesthesia
Indications for Opioid Analgesics
-CNS depression
-Leads to respiratory depression
-Most serious adverse effect
-Nausea and vomiting, Urinary retention, Diaphoresis and flushing, Pupil constriction (miosis), Constipation, Itching
Side effects of Opioid Analgesics
-Known drug allergy
-Severe asthma or COPD
-Use with extreme caution in patients with:
-Respiratory insufficiency
-Elevated intracranial pressure
-Morbid obesity or sleep apnea
-Paralytic ileus
-Pregnancy
Contraindications of Opioid Analgesics
-Central Nervous system depressants like:
-Alcohol
-Benzodiazepines (meds like Xanax or Valium)
-Antihistamines that make you sleepy like Benadryl
Interactions of Opioid Analgesics
-Baseline respiratory rate, Assess pupils, Constipation, Risk for falls in elderly population, Be prepared to administer Narcan
Nursing Implications of Opioid Analgesics
Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, confusion, PAIN and associated symptoms
Opioid withdrawal manifests as:
-If RR <9 bpm (or is declining and known opioid exposure) consider naloxone (Narcan)
-Failure of the drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose.
Naloxone (Narcan
-A common physiologic result of chronic opioid treatment
-Result: larger dose is required to maintain the same level of analgesia
Physical Tolerance
Physiologic adaptation of the body to the presence of an opioid
Physical Dependence
A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief
Psychological Dependence
-Drug overdoses now kill more people than car accidents
-Prescription opioid addiction has reached crisis proportions.
-From the 1990's until recent years, opioids have been overprescribed
-Opioids are highly addictive.
-Opioids have a small margin of error for safety
What is Opioid Crisis Factor?
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