Pharmacology quiz 1

Describe adequate preparation for class and recall the point distribution for assignments & assessments in NURS 300A.
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Terms in this set (56)
Florence Nightingale : we learn by oservation and experience, nature alone cures
A.T. Still: When every part of the machine is working properly then the body is in harmony and is as immutable as the lawas of gravity
St. Basil
Native American perspectives: Everything we have is provided by the earth
Absorption: process is which the drug gets from one place into the blood, routes: Oral, rectal, injections. In terms of clinical nursing scenarios a nurse would have to know what type of administration the patient needed to inform the best absorption method for the pt. IV for immediate release or ET release for lower chance of toxicity and less trips into the patient's room to administer drugs.
Distribution: movement of drugs from blood to other sites. A nurse needs to know which drugs are metabolized to ensure the safety of the patient and make sure the drugs reach where they need to be if the are hydrophilic or lipophilic to cross membranes and make it to their site of action.
Metabolism:enzyme induced change to the drugs chemical structure. ( activation or inhibition of the drug). TYpically occurs in the liver but secondary sites are brain, blood and kidney. A nurse needs to know how fast the drug is metabolized to ensure patient safety.
Excretion: The removal of drugs from the system (renal, fecal, exhalation, sweat)
Which is the predominant influence on increasing drug levels following an oral dose of a drug?AbsorptionWhich of these processes predominate after the peak drug level is achieved? (i.e., what processes cause the plasma drug level to go down?)DistributionExplain the pharmacokinetic factors that cause plasma drug levels to increase and then decrease after a dose of medication; compare the unique aspects when there is an absorption phase vs. intravenous administration of a drug.plasma drug levels increase due to the absorption in order to be available for the body to distribute them to their site of action. When there is an absorption phase less of the drug is available for distribution depending on which route of administrationDefine bioavailability and identify the two biggest contributors to the bioavailability of a drug.Bioavailability is the dose of the drug that makes it from the site of administration into the systemic circulation 2 biggest factors impacting bioavailability: 1. Extent to which drug is absorbed 2. 2. first pass effectDefine drug distribution and common areas to which a drug may distribute.Distribution: movement of drug from the blood to the site of action Common Areas: Brain, Liver, Kidney, Adipose tissueConsider that drugs can accumulate in different tissues/organs in the body.Drugs accumulate in the tissue and organs such as kidneys, liver, fat tissue, and have therapeutic and adverse effectsAlso consider that drug can "distribute" to plasma proteins but would then stay in the blood.Drugs that "like" to be in the blood are: Highly hydrophillic/ polar drugs move poorly/slowly across membranes Large drugs also move slowly across membranes Drugs that bind to RBC's or plasma proteins distribute outside the blood lessNote how saturation of proteins or competition for protein binding sites can increase amount of "free" (pharmacologically available) drug.Saturation and competition can bump off drugs that are bound to receptors causing them to be released into the bloodstream causing adverse effects of and can lead to toxicity.Relative to the time of absorption and distribution, when is the most appropriate time to retrieve a blood sample to measure a peak drug level.After the absorption and distribution phaseState the typical result of drug metabolism, also known as biotransformation.Drug metabolism changes the drugs chemical structure, leads to a change in the drug activityAlso note that drug biotransformation can lead to production of active and/or toxic metabolitesMetabolism can either increase or decrease drug toxicity depending on the metabolite formed is active/inactive and if they are excreted or not.Describe the importance of excretion of a drug from the body; describe the primary route of drug excretion, and some additional routes by which the drug may be excreted.Drug excretion is important to remove toxic materials out of the blood, primary route of excretion is through the renal system(kidney), additional routines may be fecal, exhalation, sweatRecall the "rule of thumb" for when a drug is "gone" from the body.After about 4 or 5 half-livesCalculate how much of a drug remains after 1, 2, 3, 4, or 5 half-lives1:50%, 2: 25%, 3: 12.5%, 4: 6.25%, 5: ~3%Likewise, what is the "rule of ;thumb" for reaching the "plateau drug level" (consistent drug levels with each repeated regularly scheduled dose)?4 Half-lifesConsider once a drug is administered, if it is ever truly gone from the body?It is relatively gone after 4/5 half lives or 4 to 5 daysDescribe exceptions to the rule of thumb regarding serum drug levels, response, and half-lives:Drugs with large volumes of distribution. Drugs that bind their receptor irreversibly. Drugs that have a "post dose" effect.Discuss the consequences of drug blood levels that fluctuate considerably or erratically between doses, and how this may affect patient response.The patientCapsules vs. tablets.Tablets are powdery, sometimes have film to hide smell, some can be split Capsules: Smooth, not split, capsule to hide smellcreams and ointmentsCreams: can be rubbed into the skin Ointments: are not absorbedSolutions and suspensions.Solutions: clear, homogenous, fully dissolves suspensions: heterogenous, particles, needs to be shakenConsider the type and amount of information that can be found on a stock bottle label or prescription drug label compared to the information found on the official FDA product labeling:The proscribing informationNote that all drug products have expiration or "beyond use" dates, whether the drug comes directly from the manufacturer (stock label), from the manufacturer through the pharmacy (pharmacy label), or if the product tis compounded by the pharmacy.Explain a pharmacokinetic reason and a "side effect" reason why some drugs may be available in extended release or delayed release forms, compared to immediate release forms.This extends the duration of action where you do not have to constantly administer results. One side effect would be having a toxic amount of drug in the bloodstream at one certain time.Recall at least 3 sets of 2 letters used to denote extended-release drugsER, LA,SR, XR, CDRecall at least 2 sets of 2 letters used to denote delayed-release drugs:EC, DRInspect a liquid before administration; and describe when not to administer and/or find more information first.For solutions: check expiration and beyond use date look for particulates observe for discoloration For suspensions: may settle this is normal think shampooLearn and recall the terminology for drug routes listed on the first page of this document.eternal- of the intestines (orally) Parenteral- other than enteral Injection (IV,IM) Transdermal, InhalationIdentify enteral vs. parenteral and other routes of administration.enteral of the intestines or gi tract (supository, oral) parental other than the gi tract (injection)Explain the purpose of FDA "boxed warnings" and describe their location within the "PIInform the public about important information about life threatening and severe effects.What is known well, and perhaps what is not known well about a drug, when it first reaches the market.FDA will determine what needs to be published on the label. The FDA inspects and regulates manufacturers. Decides if further research of a drug is needed.Consider what be less well known about:Orphan drugs: little incentive for trying to prevent rare disease, similar to Phase 2 study Fast-track drugs: Drug process to get it out sooner than latern Emergency use authorization drugs: Chemical warfare or pandemic, skips the FDA approvalCompare the purpose and size of Phase 1 and Phase 2 trial compared to Phase 3 clinical trials.Phase 1: to establish the maximum dose without reaching toxicity Phase 2: purpose is to find the target population, Phase 3: Find the adverse effects of the drug and what rate side effects occur.Explain the importance of these first 3 (bolded) properties of phase-3 randomized controlled clinical trials (RCTs):a. Randomized. So groups are equal and prevent allocation bias b. Controlled (a control group) sometimes the control group is the standard of care or a placebo control group. Placebo c. Blinded, and often "double-blinded."to ensure the pt and provider does not know who receives treatment and doesMore RCT properties that reduce the influence of chance and bias: (d) Prospective (e) Large sample sizes:prevents allocation biasDescribe the function of the data safety monitoring board during clinical research of drugsIndependent groups review what the results are in order to determine if the study is safe to continue for the research participants. To determine if it is ethical to continue the trial. They can stop a trial early and push it forward if the results are significant.Compare the regulation of non-prescription drugs (e.g., OTC ibuprofen) and other non-drug therapies available without a prescription (e.g., herbal supplements) with prescription/legend drugs. The FDA is unable to regulate the non-drug therapies, because they do not claim to cure anythingOTC drugs the pt needs to self diagnose and know there is an OTC medication. Need to be able to safely self medicate and read and follow instructions Sometimes they need to show photo IDDescribe how some legend drugs are categorized as "controlled substances" depending on "potential for abuse."Schedule 1- no medical purpose, potential for abuse leading to dependecy Schedule 2_ controlled substance available for prescription- highest for potential for abuse Schedule 3- high potential for abuse but less than 2 Schedule 4- potential for abuse but less than 3 Schedule 5- some potential for abuseDescribe the principle difference between a Schedule I controlled substance and other controlled substances.C-1- not accepted for medical purpose- heroin, ecstasy C-2- most tightly regulated, accepted for medical purpose, no refills- morphine, fentanyl, oxy C-3- steroids (testosterone) C-4- Codeine (cough syrup)Locate symbols on a drug package label that indicates it is Rx-only and whether it is a controlled substance.When it is Rx- only it will clearly state that is prescription only if it is controlled substance then it has to have a C and then an number (typically roman numeral)Consider the types of patient assessments related to medication use that are within a nurse's scope of practice (sources: textbook, Sherpath assignment, NURS 300AL, NURS 292L, NURS 207).Nurses can retrieve, dispose, inventory, and handle lockupdruga substance recognized by the library for medications, and is intended to have an effect on the body.What are the four important practices and modes of thought that science relies on to generate data, interpretations, conclusions, and practice recommendations?Skepticism, Critical Thinking, The Scientific Method, and Imagination.Describe the strength of recommendations produced in practice guidelines, and the level of evidence that supports the strength of various recommendations.A: Systemic review of high quality RCTs B: Systemic review of cohort studies. Individual low-quality RCT. Some case studies C: Case series (poor quality cohort and case control studies) D: Expert opinion. Scientist says. Not science.Define bioavailability and identify the two biggest contributors to the bioavailability of a drug.Bioavailability is the portion of a dose that makes it from the site of administration to the systemic circulation. The two biggest contributors to the bioavailability of a drug are the extent of absorption and the first pass effect and how well it can pass through metabolism.Consider that drug can accumulate in different tissues/organs in the body.Lipophilic drugs are distributed well but are also likely to accumulate in adipose tissues. Hydrophilic drugs are likely to accumulate in the blood.