Pharmacotherapeutics Chapter 2 questions and answers.docx

  Chapter 2 - Correct Answers: Application of Pharmacology in Nursing Practice (Pharmacologic Principles) Pharmacologic Principles - Correct Answers: *DRUG*: Any chemical that affects the physiologic processes of a living organism *PHARMACOLOGY*: Study or science of drugs Drug Names - Correct Answers: *CHEMICAL NAME*: Describes the drug's chemical composition and molecular structure *GENERIC NAME (Nonproprietary name)*: Name given by the United States Adopted Names Council *TRADE NAME (Proprietary name)*: The drug has a registered trademark; Use of the name is restricted by the drug's patent owner (usually the manufacturer) 1. Pharmacologic Principles: PHARMACEUTICS - Correct Answers: *PHARMACEUTICS*: The study of how various drug forms influence the way in which the drug affects the body Dissolution: Dissolving of solid dosage forms and their absorption (Enteric-coated medication must NOT be crushed!) 2. Pharmacologic Principles: PHARMACOKINETICS - Correct Answers: *PHARMACOKINETICS*: The study of what the body does to drug [ ADME ] 1. Absorption 2. Distribution 3. Metabolism 4. Excretion ADME - Absorption - Correct Answers: *ABSORPTION*: The process of the drug moving from the site of administration to the bloodstream; Determines the onset of drug action *BIOAVAILABILITY*: The fraction of a dose of drug that is absorbed from its site of administration and reaches (in an unchanged form) the systemic circulation *FIRST PASS EFFECT*: The phenomenon by which a drug is metabolized - Gut wall absorption, then passed through the liver - The drug is greatly reduced before reaching systemic circulation - Oral = First Pass Effect - IV, Sublingual (under the tongue), Buccal (in the cheek) = Bypass the First Pass Effect + Absorbed straight into the blood stream Different Routes: 1. *ENTERAL ROUTE*: The drug is absorbed into the systemic circulation through the oral or gastric mucosa or the small intestine - Oral routes - Sublingual routes (under the tongue) = Faster than oral - Buccal routes (in the cheek) = Faster than oral - Rectal (can also be topical) 2. *PARENTERAL ROUTE*: By injection ⟶ By needle - Intravenous = Fastest delivery into the blood - Intramuscular - Subcutaneous - Intradermal - Intraarterial - Intrathecal - Intra Articular 3. *TOPICAL ROUTE*: Through the skin (cream, pastes, etc.) - Skin (includes transdermal patches) - Eyes - Ears - Nose - Lungs (inhalation) - Rectum - Vagina 4. *TRANSDERMAL ROUTE*: Usually through a patch through the skin ⟶ Slower way of absorbing medication 5. *INHALED ROUTE* ADME - Distribution - Correct Answers: *DISTRIBUTION*: Transport of a drug by the bloodstream to its site of action - The movement of the drug through the body - Determined by several factors including protein-drug binding (only the free drug can be distributed to the tissues) *Albumin* ⟶ The most common blood protein + Carries the majority of protein-bound drug molecules (stores the drug) - Protein-bound drugs = Don't have to be dosed as frequently - Releases when needed ADME - Metabolism - Correct Answers: *METABOLISM*: Also referred to as BIOTRANSFORMATION ⟶ Metabolism by the liver Biochemical alteration of a drug into... - an active metabolite - a less active metabolite - a more soluble compound - a more potent active metabolite (as in the conversion of an active prodrug to its active form) *PRODRUG*: Initially inactive; Requires the liver to activate it into its active form *CYTOCHROME P-450 ENZYMES*: (or simply P-450 enzymes) aka microsomal enzymes within the liver responsible for metabolizing drugs - Will eventually need to know the drugs that inhibit/induce CYP enzymes - Lipophilic = "fat loving" - Hydrophilic = "water loving" - Enzymes ADME - Excretion - Correct Answers: *EXCRETION*: Elimination of drugs from the body - The rate of excretion determines the drug blood level 1. Renal Excretion (Most) = Primary site of excretion is the kidney 2. Biliary Excretion = Involves active secretion of drug molecules or their metabolites from hepatocytes into the bile ⟶ The bile then transports the drugs to the gut, where the drugs are excreted Therapeutic Drug Monitoring - Correct Answers: The process of measuring drug levels to identify a patient's drug exposure and to allow adjustment of dosages with the goals of maximizing therapeutic effects and minimizing toxicity *HALF-LIFE*: Time required for half (50%) of a given drug to be removed from the body *STEADY STATE*: The time it takes for a drug to have a consistent concentration in the body - For most drugs = Usually requires four to five half-lives of the drug, given at regular intervals, to reach steady state The length of time until the onset and peak of action and the duration of action play an important part in determining the PEAK LEVEL and TROUGH LEVEL. If the peak blood level is too high, then drug TOXICITY may occur. *PEAK LEVEL*: Highest blood level of a drug - Generally don't check peak levels - Not always toxic but can be - Check 1 hour after the dose is given *TROUGH LEVEL*: Lowest blood level of a drug - When giving medications, usually go by trough levels - to help determine toxicity - We want to make sure that the concentration isn't too high to cause damage OR isn't too low to be ineffective - Checked 15 minutes before the next dose is given *TOXICITY*: Occurs if the peak blood level of the drug is too high *MINIMAL EFFECTIVE CONCENTRATION*: The lowest concentration of a drug at which it is still effective *Therapeutic Drug Monitoring* = Checking troughs and peaks 3. Pharmacologic Principles: PHARMACODYNAMICS - Correct Answers: *PHARMACODYNAMICS*: The study of what the drug does to the body - The mechanism of drug actions in living tissues - Therapeutic effect - Mechanism of action - Drug-receptor relationships - Enzymes 4. Pharmacologic Principles: PHARMACOGENOMICS - Correct Answers: *PHARMACOGENOMICS (PHARMACOGENETICS)*: The study of how genes affect a person's response to drugs 5. Pharmacologic Principles: PHARMACOTHERAPEUTICS - Correct Answers: *PHARMACOTHERAPEUTICS*: The clinical use of drugs to prevent and treat diseases - Defines principles of drug actions ⟶ The cellular processes that change in response to the presence of drug molecules - Drugs are organized into pharmacologic classes Terms to Know - Correct Answers: 1. *CONTRAINDICATIONS*: If a patient has a reason to not have a drug given to them ⟶ May have an adverse effect, worsening of a problem - Example: Don't want to give patient penicillin if they are allergic 2. *ACUTE*: Happening right now (past few days, weeks, months) - Example: Appendicitis vs. Diabetes (chronic) 3. *MAINTENANCE*: Implies receiving medication in regular intervals 4. *SUPPLEMENTAL (or REPLACEMENT)*: Giving medication to supplement what a patient is lacking - Example: Iron-deficiency = Give iron supplements 5. *PALLIATIVE*: To help ease symptoms, not to necessarily treat - Example: Cancer patient = Give pain medication, not treating the cancer 6. *SUPPORTIVE*: To relieve symptoms - Example: Patient has sepsis, has a fever = Give medication to treat their symptoms, not treating the problem 7. *PROPHYLACTIC*: Medication to prevent a problem; if at risk - Example: Someone is going to Africa, don't want to get malaria 8. *EMPIRIC*: Patient has symptoms, presumed they have a condition = Treat them for that presumed condition - Example: Burning urination... frequent = Presume that it is a UTI + give medication to treat Monitoring the Patient + Effects of the Drug - Correct Answers: *Therapeutic Action*: Monitor to make sure that the drug is working, in the concentration that it needs to be ⟶ Check blood pressure, etc. *Adverse Effects*: Any side effects/Unintended effects - from normally dosed medication - Example: Tylenol - Resulting in liver failure *Toxic Effects*: Too much medication *Therapeutic Index*: The measurement of the safety of the drug; Making sure that the drug is not toxic; The middle point between the Minimum Effective Concentration (MEC) and the Minimum Toxic Concentration (MTC) *Drug Concentration*: Amount *Patient Condition*: Patient's response to the drug Patient's Response to the Medication - Correct Answers: *TOLERANCE*: Decreasing response to repeated drug doses *DEPENDENCE*: Physiologic or psychological need for a drug *PHYSICAL DEPENDENCE*: Physiologic need for a drug to avoid physical withdrawal symptoms *PSYCHOLOGICAL DEPENDENCE*: Also known as addiction and is the obsessive desire for the euphoric effects of a drug Drug Interactions - Correct Answers: *Additive Effects*: Refers when two drugs are being used together. Results are additive vs. the two drugs being taken independently 1 + 1 = 2 *Synergistic Effects*: Combining drugs leading to an effect larger than expect 1 + 1 = 4 *Antagonistic Effects*: Combining drugs leading to an effect smaller than expect *Incompatibility*: No effect Adverse Drug Events - Correct Answers: *Adverse Drug Withdrawal Event*: Significant physical changes to discontinuing the administration of a drug *Medication Error*: Need to know the Six Rights to prevent medication error *Adverse Drug Reaction*: Adverse side effects Six Rights of Drug Administration - Correct Answers: 1. Right Drug 2. Right Dose 3. Right Time 4. Right Route 5. Right Patient 6. Right Documentation Medication Use Process - Correct Answers: The prescribing, dispensing, and administering of medications, and the monitoring of their effects. 1. Prescribing ⟶ Doctor 2. Dispensing ⟶ Pharmacists 3. Administering ⟶ Nurse 4. Monitoring ⟶ Nurse Adverse Drug Reactions - Correct Answers: Unexpected, unintended, or excessive responses to medications given at therapeutic dosages (as opposed to overdose) - *Pharmacologic Reaction* - *Hypersensitivity Reaction*: Allergic reaction - *Idiosyncratic Reaction*: Unexpected effect of a drug - *Drug Interaction* Other Drug Effects - Correct Answers: *Teratogenic*: Can cause harm to a fetus *Mutagenic*: Can cause mutations *Carcinogenic Effects*: Can cause cancer 6. Pharmacologic Principles: PHARMACOGNOSY - Correct Answers: *PHARMACOGNOSY*: The study of natural (vs. synthetic) drug sources Examples: plants, animals, minerals 7. Pharmacologic Principles: PHARMACOECONOMICS - Correct Answers: *PHARMACOECONOMICS*: The study of economic factors influencing the cost of drug therapy Cost-benefit analysis 8. Pharmacologic Principles: TOXICOLOGY - Correct Answers: *TOXICOLOGY*: The science of the adverse effects of chemicals on living organisms - Clinical toxicology deals specifically with the care of poisoned patients Chapter 2 Key Points - Correct Answers: - Nursing responsibilities with regard to drugs extend far beyond the Rights of Drug Administration - You are the patient's last line of defense against medication errors - Your knowledge of pharmacology has a wide variety of practical applications in patient care and patient education - By applying your knowledge of pharmacology, you will make a large contribution to achieving the therapeutic objective of maximum benefit with minimum harm - Application of the nursing process in drug therapy is directed at individualizing treatment, which is critical to achieving the therapeutic objective