EXAM 4: NUR 210/ NUR210 (LATEST 2023/ 2024) PRINCIPLES OF PHARMACOLOGY EXAM| QUESTIONS AND VERIFIED ANSWERS| GRADE A

EXAM 4: NUR 210/ NUR210 (LATEST 2023/ 2024) PRINCIPLES OF PHARMACOLOGY EXAM| QUESTIONS AND VERIFIED ANSWERS| GRADE A “Types of viruses - CORRECT ANSWER Flu Herpes Hepatitis A, B, & C" "Most antivirals and antibiotics have what SE - CORRECT ANSWER GI distress" "Nitrofurantoin SE - CORRECT ANSWER turns urine rust/brown" "Urinary analgesic - CORRECT ANSWER Phenazopyridine" "Phenazopyridine use - CORRECT ANSWER does not get rid of infection relieves symptoms" "Phenazopyridine SE - CORRECT ANSWER red-orange urine and secretions" "inherent resistance - CORRECT ANSWER Ability of the host to resist the disease independent of antibodies" "acquired resistance - CORRECT ANSWER bacterial resistance to a drug to which they were previously taking for long periods of time" "When should C & S be done? - CORRECT ANSWER prior to starting antibiotic" "Macrolide antibiotic - CORRECT ANSWER Azithromycin" "Antacid administration with macrolides - CORRECT ANSWER 2 hr before or after macrolide dose" "Azithromycin use - CORRECT ANSWER -STI -Chlamydia -when pts are allergic to PCN/cephalosporins for stronger bacterial infections" "Azithromycin SE - CORRECT ANSWER blurred vision headache drowsiness fatigue photosensitivity" "Azithromycin ADR - CORRECT ANSWER Superinfection tinnitus hepatotoxicity (liver)" "Azithromycin contraindications - CORRECT ANSWER hepatic/renal dysfunction heart issues TYLENOL" "Azithromycin nursing interventions - CORRECT ANSWER monitor for liver enzymes & for s/s of liver issues" "Glycopeptide antibiotic - CORRECT ANSWER Vancomycin" "Vancomycin use - CORRECT ANSWER MRSA serious infections" "Vancomycin IV caution - CORRECT ANSWER give slowly to prevent redman syndrome" "Vancomycin SE - CORRECT ANSWER chills dizziness GI distress Thrombophlebitis (central IV)" "Amoxicillin contraindications - CORRECT ANSWER allergy to other PCN or cephalosporins decrease effect with acidic fruits/juices" "Penicillin antibiotic - CORRECT ANSWER Amoxicillin" "Amoxicillin use - CORRECT ANSWER bacterial infections" "Amoxicillin ADR - CORRECT ANSWER C. diff associated diarrhea" "Fluoroquinolones antibiotics - CORRECT ANSWER Ciprofloxacin Levofloxacin" "Ciprofloxacin & Levofloxacin use - CORRECT ANSWER severe infections" "Ciprofloxacin & Levofloxacin ADR - CORRECT ANSWER SJS tendon rupture nephrotoxicity hepatotoxicity" "Bisacodyl ADR - CORRECT ANSWER dependence hypokalemia" "Bisacodyl contraindiciations - CORRECT ANSWER if you have an electrolyte imbalance DO NOT GIVE" "Bisacodyl nursing interventions - CORRECT ANSWER use only as needed with water" "Metabolic acidosis - CORRECT ANSWER pooping "pooping out your ass"" "Metabolic alkalosis - CORRECT ANSWER vomiting" "Antiulcers - CORRECT ANSWER antacid famotidine pantoprazole sucralfate" "Antacid - CORRECT ANSWER Magnesium (Mg) hydroxide/aluminum hydroxide" "Famotidine (Pepcid) use - CORRECT ANSWER treat peptic ulcers & GERD" "Famotidine (Pepcid) MOA - CORRECT ANSWER reduce gastric acid" "Famotidine (Pepcid) contraindications - CORRECT ANSWER tale 30 mins before any other drugs" "Pantoprazole MOA - CORRECT ANSWER reduce gastric acid" "Pantoprazole contraindication - CORRECT ANSWER Take 30 mins before any other drug" "sucralfate MOA - CORRECT ANSWER coats the ulcer" "Sucralfate contraindications - CORRECT ANSWER take 1-2 hours before any other drug" "Erythropoietin stimulating agent - CORRECT ANSWER epoetin alpha" "epoetin alpha SE - CORRECT ANSWER injection site reaction" "epoetin alpha BB warning - CORRECT ANSWER if hemoglobin over 11: hx MI, stroke, patient with cancer, increased risk of embolism have an increased risk of death with this drug" "epoetin alpha use - CORRECT ANSWER treats anemia" "epoetin alpha MOA - CORRECT ANSWER produces RBC" "Granulocyte colony stimulating factor - CORRECT ANSWER filgrastim" "filgrastim MOA - CORRECT ANSWER increases WBC to help prevent infection" "Male hormone - CORRECT ANSWER testosterone" "testosterone use - CORRECT ANSWER hypogonadism - delayed puberty" "Sexual dysfunction - CORRECT ANSWER sildenafil" "sildenafil MOA - CORRECT ANSWER increases blood flow to penis" "sildenafil use - CORRECT ANSWER erectile dysfunction" "sildenafil caution - CORRECT ANSWER do not take nitroglycerin within 24 hrs of this drug" "Benign prostatic hyperplasia (BPH) - CORRECT ANSWER Tamsulosin" "Tamsulosin MOA - CORRECT ANSWER Relaxes muscles in prostate" "Tamsulosin use - CORRECT ANSWER Improves symptoms associated with BPH" "Tamsulosin ADR - CORRECT ANSWER orthostatic hypotension" "Tamsulosin therapeutic symptoms - CORRECT ANSWER not dribbling increased urine flow" "Menopause (HRT) - CORRECT ANSWER conjugated estrogen" "Which abx can cause tendon rupture? - CORRECT ANSWER Fluoroquinolone: cipro" "Which abx causes bradycardia - CORRECT ANSWER Fluoroquinolone: Cipro" "Which abx cause crystalluria - CORRECT ANSWER Sulfamethoxazole; Crystalluria" "Which abx is contraindication for anemia - CORRECT ANSWER sulfamethoxazole" "Which abx is advise to avoid during 3rd Trimester - CORRECT ANSWER sulfamethoxazole" "Nystatin is administered - CORRECT ANSWER topical" "How is fluconazole administered? - CORRECT ANSWER PO or IV" "What medication can cause peripheral neuropathy - CORRECT ANSWER Metronidazole" "What can Metronidazole treat - CORRECT ANSWER H.Pylori or GU" "What can Metronidazole cause - CORRECT ANSWER Metal taste" "Which medication can cause Gingival hyperplasia - CORRECT ANSWER Acyclovir" "If a patient is allergic to milk, which medication should be concern about - CORRECT ANSWER acyclovir" "What medication turns urine brown/red - CORRECT ANSWER nitrofurantoin" "What is nitrofurantoin used for? - CORRECT ANSWER Acute or Chronic UTI" "What medication reliefs S/S of UTI - CORRECT ANSWER PhenAZOpyridine" "Phenazopyridine cause what color to urine - CORRECT ANSWER Orange-Red" NSAID ketorolac (Toradol) TUCA - CORRECT ANSWER T: Decrease pain, Decrease Inflammation, Decrease Ocular Itching U: Mild-Moderate pain (short-term), decrease ocular itching in seasonal allergies C: Prego (3T), hypersensitivity, asthma, hepatic disease, peptic ulcer disease, CV bleeding, breastfeeding, hypovolemia A: MI, Stroke, hepatitis, GI bleeding, hepatic failure, angioedema, seizures" "NSAID naproxen (Aleve) TUCA - CORRECT ANSWER T: Decrease pain, Decrease Inflammation U: Mild-moderate pain, osteoarthritis, rheumatoid arthritis, gouty arthritis, primary dysmenorrhea, tendinitis, bursitis myalgia, ankylosing spondilitis, dental pain, JRA C: Prego (2T/3T), hypersensitivity to NSAIDs & salicylates A: MI, Stroke, GI bleeding, hepatotoxicity" "NSAID ibuprophen (Advil) TUCA - CORRECT ANSWER T: Decrease pain, Decrease Inflammation, decrease fever U: Rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, dental pain, musculoskeletal disorders, fever, migraine, patent ductus arteriosus C: Hypersensitivity to NSAIDs & salicylates, asthma, severe renal/hepatic disease, avoid IV after 30 wk prego A: MI, Stroke, GI bleeding, Blood dyscrasias, cardiac dysrhythmias, nephrotoxicity, anaphylaxis" "Glucocorticoids methylPRESDNISolone (Solu-Medrol) TUCA - CORRECT ANSWER T: Decrease inflammation U: Severe inflammation, shock, adrenal insufficiency, MS, management of acute spinal cord injury, collagen disorders C: Hypersensitivity, intrathecal use, neonates A: HTN, embolism, thrombophlebitis, GI hemorrhage, pancreatitis" "Glucocorticoid dexamethasone (Decadron) TUCA - CORRECT ANSWER T:Decrease inflammation, suppresses normal imune response U: Infammation, allergies, neoplasms, cerebral edema, septic shock, collagen disorders, TB, meningitis, acute exacerbation of MS C: Psychosis, hypersensitivity to corticosteroids, fungal infections, AIDS, glaucoma, ocular infection, child <2ys A: CNS depression, seizures, heart failure, thromboembolism, GI hemorrhage" "Glucocorticoid budesonide (Pulmicort) TUCA - CORRECT ANSWER T: Prevents inflammation U: Rhinitis, prophylaxis for asthma, Crohn's, Uncerative colitis C: hypersensitivity, status asthmaticus A: epistaxis, respiratory infection, bronchospasm, sinusitis" "Glucocorticoid predniSONE (Deltasone) TUCA - CORRECT ANSWER T: Decrease inflammation, decrease adrenal insufficiency U: Severe inflammation, neoplasms, MS, derm disorders, collagen disorders C: hypersensitivity A: Thrombophlebitis, embolism, GI hemorrhage, pancreatitis" "NSAID celecoxib (CeleBREX) TUCA - CORRECT ANSWER T: Decrease pain, decrease inflammation U: Acute and chronic rheumatoid arthritis, osteoarthritis, acute pain, primary dysmenorrhea, ankylosing spondylitis, JRA C: Prego (3T), hypersensitivity to salicylates, iodides, other NSAIDs, sulfonomines A: MI, Stroke, CHF" "Sulfonomides sulfisoxazole (Gantrisin) TUCA - CORRECT ANSWER T: Broad antimicrobial spectrum against gram positive and gram negative organisms U: acute, chronic and recurrent UTI, acute otitis media, used in treatment of conjuctivitis, chloroquine-resistant trains of malaria C: History of hypersensitivity to sulfonomides or salicylates, advanced kidney or liver disease, intestinal and urinary obstructions A: NVD, aplastic anemia, goiter, hypoglycemia" "Sulfonomides trimethoprim-sulfamethoxazole TMP-SMZ (Bactrim, Septra) TUCA - CORRECT ANSWER T: severe complicated UTI's due to most strains of Enterobacteria Ceae, gram negative and gram positive bacteria U: bacterial infections of middle ear, urine, respiratory, and intestinal, a certain type of pneumonia (pneumocyctitis) C: Hypersensitivity to TMP-SMZ, sulfonomides or biosulfites, megaloblastic anemia due to folate deficiency, infant <2mo A: toxic epidermal necrosis, NVD, hepatitis, allergic myocarditis, kidney failure, photosensitivity, aplastic anemia (rare)" "Sulfonomides sulfasalazine (Azulfidine) TUCA - CORRECT ANSWER T: Antiinflammatory and immunomodulatory properties effective in controlling S&S of uncerative colitis and RA, reduces clostridiun and E. Choli in the stools U: Ulcerative colitis and mild enteritis, RA, C: sensitivity ot sulfasalazine, sulfonomides and salicylates, <2yr, intestinal and urinary track obstruction A: NVD, bloody diarrhea, rash, liver injury" "Sulfonomides phenazopyridine hydrochloride (Pyridium) TUCA - CORRECT ANSWER T: topical analgesic, anesthetic on urinary track mucosa *treats only symptoms and not underlying disease U: UTI, used with antiinfective, symptomatic relief of urinary burning C: hypersensitivity, renal insufficiency, hepatic disease, uremia A: hepatic and renal toxicity, anaphylaxis" "Sulfonomides nitrofuantoin (Furandantin) TUCA - CORRECT ANSWER T: Active against variety of gram negative and gram positive micro-organisms U: Pyelonephritis, pyelitis and cystitis caused by susceptible organisms C: significant impairment of kidney function, G6PD deficiency, prego (at term) A: peripheral neuropathy, hepatic necrosis, anaphylaxis, exfoliative dermatitis" "pharmacokinetics - CORRECT ANSWER Pharmacokinetics is the process of drug movement to achieve drug action. The four processes are absorption, distribution, metabolism (or biotransformation), and excretion (or elimination) *the affect the body has on the drug" "pharmacodynamics - CORRECT ANSWER Pharmacodynamics is the study of the way drugs affect the body. Drug response can cause a primary or secondary physiologic effect or both. The primary effect is desirable, and the secondary effect may be desirable or undesirable *the affect the drug has on the body" "Nursing process ADPIE - CORRECT ANSWER Assessment nursing Diagnosis Planning Implementation (nursing interventions) Evaluation" "drug interaction - CORRECT ANSWER is defined as an altered or modified action or effect of a drug as a result of interaction with one or multiple drugs" "adverse drug reaction - CORRECT ANSWER is an undesirable drug effect that ranges from mild untoward effects to severe toxic effects, including hypersensitivity reaction and anaphylaxis." "Drug incompatibility - CORRECT ANSWER is a chemical or physical reaction that occurs among two or more drugs in vitro. In other words, the reaction occurs between two or more drugs within a syringe, IV bag, or other artificial environment outside of the body." "Drugs that are highly protein bound - CORRECT ANSWER include the anticoagulant warfarin, anticonvulsants such as phenytoin and valproic acid, gemfibrozil (antihyperlipidemic), most nonsteroidal antiinflammatory drugs (NSAIDs), sulfisoxazole (sulfonamide), glyburide (antidiabetic), and quinidine (antidysrhythmic). Warfarin (Coumadin) is 99% protein-bound, allowing only 1% to be free drug. If 2% to 3% of warfarin is displaced from albumin binding sites, the amount of free warfarin would be 3% to 4% instead of 1%. This action has the potential to increase the anticoagulant effect of warfarin; excess bleeding may result." "Pharmacodynamic interactions - CORRECT ANSWER are those that result in additive, synergistic, or antagonistic drug effects." "additive effect - CORRECT ANSWER and is the sum of the effects of the two drugs (can be either good or bad)" "synergistic effect - CORRECT ANSWER When two or more drugs are given together, one drug can potentiate or have a synergistic effect on another. In other words, the clinical effect is substantially greater than the combined effect of the tw" "antagonistic effects - CORRECT ANSWER When two drugs that have opposite effects, or antagonistic effects, are administered together, each drug cancels the effect of the other. In other words, the actions of both drugs are nullified." "photosensitivity - CORRECT ANSWER A drug-induced photosensitivity reaction is a skin reaction caused by exposure to sunlight. It is caused by the interaction of a drug and exposure to ultraviolet A (UVA) light, which can cause cellular damage" "Subjective data - CORRECT ANSWER Subjective data are symptoms described by and apparent to the patient." "Objective data - CORRECT ANSWER Objective data are signs that are measured and detected by another person (the nurse)" "nursing diagnosis - CORRECT ANSWER A nursing diagnosis is made based on the analysis of the assessment data. Abnormal data collected during the assessment serve as the defining characteristics (for an actual problem) or risk factors (for a high risk for a problem) to support the appropriate nursing diagnosis. More than one applicable nursing diagnosis may be generated. The registered nurse formulates nursing diagnoses and uses them to guide the development of a care plan" "agonists - CORRECT ANSWER Drugs that produce a response are called agonists" "antagonists - CORRECT ANSWER drugs that block a response are called antagonists" "Absorption 1. direct penetration of the membranes 2. channels and pores 3. transport systems - CORRECT ANSWER the movement of a drug from its site of administration to the blood How do drugs cross membranes?" "1. Direct penetration of the membranes - CORRECT ANSWER - use by MOST drugs - most drugs to large to pass thru channels and pores - most drugs lack transport systems - drugs must be lipid soluble to be able to penetrate cellular membranes = lipophilic drugs" "2. channels and pores - CORRECT ANSWER only very small ions such as potassium and sodium can pass through cell membranes" "3. transport systems - CORRECT ANSWER - are carriers that can move drugs from one side of the membrane to the other - are selective" "Movement of drugs across membranes - CORRECT ANSWER -drugs must cross membranes (pass through cells) to enter the blood from their site of administration - drugs must then leave the blood (vascular systems) to get to their SITE OF ACTION - drugs must then cross membranes again to be metabolized and excreted" "pharmacokinetic phase: Absorption - CORRECT ANSWER process that occurs between the time a drug enters the body and the time it enters the bloodstream to be circulated - Rate of absorption -> depends on the formulation of drug (tablet, liquid, etc.) - Amount of absorption -> how effective drug will be absorbed Major determinants of rate of absorption: - blood flow -> higher blood flow, the faster the drug is absorbed - lipid solubility -> higher lipid soluble drugs faster than drugs whose lipid solubility is low - pH -> acidity of the stomach can break down the drug" "what is the first-pass effect? - CORRECT ANSWER affects amount of drug absorbed - the metabolism of a drug by the liver BEFORE it reaches systemic circulation - is the % of the drug that is broken down in the liver - "bioavailability" : the fraction of administered drug that actually reaches systemic circulation - IV bioavaiability= 100% - oral bioavailability will vary" "Three Routes of Absorption - CORRECT ANSWER 1. Enteral 2.Parenteral 3. Topical" "Enteral route of absorption - CORRECT ANSWER Defined by the way of GI tract (oral/gastric mucosa, small intestine, rectum) - any drug given via GI tract - EC (enteric coated): intended to break down in the small intestine NOT the stomach --> must undergo the "first pass effect" - PO --> portal circulation --> must undergo the first pass effect - SL, buccal, rectal --> absorbed into highly vascular tissue under tongue or in the rectum (by passes liver so little to NO first pass effect)" "Enteral routes of absorption - CORRECT ANSWER EC PO SL, buccal, rectal" "Parenteral route of absorption - CORRECT ANSWER SQ, IM, IV, intrathecal (into special cord), epidural (into spine) IV fastest route (NO barriers to absorption- absorption instant, complete, and irreversible) - most common route" "Topical (transdermal) route of absorption - CORRECT ANSWER application of meds to body surfaces - skin, eyes, ears, nose, lungs" "important - CORRECT ANSWER all meds given PO have some first pass effect" "Routes of administration Affected by: - CORRECT ANSWER - dosage form (ie, liquid vs tablet)- liquids absorbed faster - route (ie, IV vs PO) - IV fastest action - GI function: solubility and stability of the drug gastric emptying time coatings on the drug itself pH food" "oral administration preparations - CORRECT ANSWER Tablets: 1. chemical equivalent 2. bioavailability Enteric-coated -dissolves in intestine instead of stomach -absorption is variable Capsules - filled with granules or liquid (liquid absorbed faster) Sustained Release (SR) - drug released slowly by tiny spheres that contain the actual drug. Can take fewer doses. - Also CR (controlled release) and ER (extended release)" "pharmacokinetic phase: Distribution - CORRECT ANSWER - the movement of the drug through the body - process by which drug molecules LEAVE the blood stream and are transported by body fluids to site of action (EFC or cells of target tissue) - where drug produces its effects - depends largely on ADEQUACY OF BLOOD CIRCULATION - decreased blood flow = decreased distribution" "Blood Brain Barrier - CORRECT ANSWER cells in the capillary wall in the brain have very tight junctions that prevent drug passages (so drugs cannot go between them) - only drugs that have a transport system or are lipid soluble can cross" "1. alcohol 2. BBB not fully developed at birth - CORRECT ANSWER what can cross the BBB?" "- abcesses - tumors - CORRECT ANSWER blood flow is decreased by:" "What is the protein binding effect? - CORRECT ANSWER TEMPORARY storage of drug molecule allows drug to be available for longer period of time. - drug ratio of bound to unbound (free) molecules varies - binding is REVERSIBLE; very rapid process GOAL: maintain STEADY free drug concentration = STEADY STATE Only the UNBOUND drug is ACTIVE active = free to exert an effect" "protein binding effect - CORRECT ANSWER Drugs circulate in plasma either bound or unbound to protein (usually albumin) - bound drug molecules are pharmacologically inactive ( too large to diffuse through the membrane of the blood vessel) - bound drugs become a drug reservoir/storage depot Expressed in % - ex: drug is 50% protein bound - so..only 50% is active or able to exert effect" "albumin - CORRECT ANSWER the most abundant PLASMA PROTEIN - low levels = less protein for drugs to bind to - a LARGE molecule and ALWAYS remains in the blood stream - drugs bind to protein - limited number of binding sites - drug particles much smaller than albumin - unbound drug can pass through cell membrane" "Binding - CORRECT ANSWER - reversible - limited number of binding sites - some drugs have more ability to "bind" than others" "Coumadin - CORRECT ANSWER drug that is very highly protein bound (97-99%)" "Hypoalbuminemia - CORRECT ANSWER means that more free drug is available for distribution to tissue site b/c or no binding sites to be "bound" or inactive--> possibility of overdose - malnutrition or liver disease can cause" "normal serum albumin levels - CORRECT ANSWER 3.5 - 5.5 g/dl" "Drug-drug interactions may occur - drugs compete for protein binding site -> causing more free drug to be released into circulation - increased free drug many cause drug toxicity - CORRECT ANSWER what happens when 2 highly protein-bound drugs are given concurrently?" "decreased b/c less binding sites for the drug to bind to - could lead to toxicity - CORRECT ANSWER Thomas's labs come back and his albumin level is 2.0 g/dl. Considering his albumin level is low, his does of treatment may need to be?" "Pharmacokinetic phase: Metabolism or Biotransformation - CORRECT ANSWER - method by which drugs are inactivated or biotransformed - this new structure is called a METABOLITE - LIVER is major site of drug metabolism (converts fat-soluble drugs into water soluble metabolites) - KIDNEY can then excrete the metabolite" "Pharmacokinetic phase: Metabolism or Biotransformation- FIRST PASS PHENOMENON - CORRECT ANSWER happens during pharmacokinetic phase metabolism. - liver function test (LFT)- important serum/blood value for the nurse to monitor - normal aspirate aminotransferase = 0 -35 u/L - normal alanine aminotransferase= 4 - 36 u/L" "AST= 0-35 u/L ALT = 4-36 u/L - CORRECT ANSWER what are normal AST and ALT levels on a liver function test" "CYP450 system - CORRECT ANSWER drug metabolism via what system?" "Cytochrome P450 - CORRECT ANSWER a FAMILY of enzymes that metabolize drugs in the liver - about 1/2 of all drugs on the market are metabolized by this system" "drug drug interactions - CORRECT ANSWER what can occur when drugs which are metabolized by the SAME isoenzyme are take concurrently?" "Clinical Significance of P450 system - CORRECT ANSWER - some drugs are inducers of the P450 system - some drugs are inhibitors of the P450 system - Inducers speed up metabolism and so increase the breakdown and elimination of the drug - Inhibitors would slow down the metabolism of the drug" "speed up metabolism and so increase the breakdown and elimination of the drug = less therapeutic effect - CORRECT ANSWER what do inducers do" "slow down the metabolism of the drug = increase buildup and increase risk for toxicity - CORRECT ANSWER what do inhibitors do?" "grapefruit juice - CORRECT ANSWER a known P450 inhibitor increasing the risk for drug toxicity - can dramatically increase the blood levels or certain drugs - NEVER take ANY medication with this" "Pharmacokinetic phase: Excretion - CORRECT ANSWER Elimination of a drug from the body - kidney converts lipid soluble drugs into hydrophilic drugs that it can excrete Kidney is the major site of this - with kidney disease/dysfunction there is a decrease in this... so drugs can build up and cause toxicity" "Pharmacokinetic phase: Excretion: Renal labs - CORRECT ANSWER - blood urea nitrogen (BUN) and creatinine are other very important lab values for the nurse to monitor in this stage" "8-23 mg/dl - CORRECT ANSWER normal BUN level?" "0.6 - 1.2 mg/dl - CORRECT ANSWER normal creatinine level?" "Elimination: Half Life: Serum half - life (T 1/2) - CORRECT ANSWER time required for the serum concentration of a drug to decrease by 50% - varies, some drugs it it minutes others it may be a week or more - ex: a patient taking a drug with T 1/2 of 1 week stops taking the drug - it will wake about 4 weeks for the drug to be gone from his system" "4-5 half lives - CORRECT ANSWER it takes about how may half lives for a drug to reach a 'steady state'? *the goal*" "4-5 - CORRECT ANSWER it takes about how many half lives for a drug to be eliminated from the body?" "steady state - CORRECT ANSWER "intake of drug EQUALS amount metabolized/excreted" half life determine dosing internal ex: QD, QID" "Around the Clock Dosing (ATC) - CORRECT ANSWER used to create a 'steady state' - usually take about 4 doses to achieve steady state" "onset of action - CORRECT ANSWER LATENT period -> time it takes for the drug to elicit a therapeutic response" "peak effect - CORRECT ANSWER time it takes for a drug to reach its maximum therapeutic response" "duration of action - CORRECT ANSWER time that drug concentration is sufficient to elicit a "therapeutic response"" "maximize therapeutic range - CORRECT ANSWER drug dosing goal?" "3. Pharmacodynamic Phase - CORRECT ANSWER What the drug does TO the body - drugs may increase, decrease, replace, inhibit, destroy, protect, irritate to create a response - drugs exert multiple rather than single effects on the body ( some desired some not)" "Example of drug exerting multiple rather than single effects on the body (desired or not) - CORRECT ANSWER metaproterenol (Alupent) - dilates bronchial passages - the MOA - the therapeutic effect - it may also produce tracycardia or palpitations as adverse effects" "pharmacodynamics: Receptor Theory of Drug Action - CORRECT ANSWER - receptors are proteins located on surfaces of cell membranes - special chemicals in the body that drugs interact with to produce effects (hormones, neurotransmitter, other molecules) - when drug molecules bind with receptor molecules --> resulting drug-receptor which --> initiates physiochemical reactions that stimulate/activate OR inhibit normal cellular function -agonistic (stimulates) - antagonistic ( inhibits)" "Two types of receptors - CORRECT ANSWER - agonist - antagonist" "agonist receptor - CORRECT ANSWER a drug that has the ability to initiate a desired therapeutic effect by binding to a receptor ex: isoproterenol (Isuprel) = beta adrenergic agonist -> it binds to beta receptors and causes vasodilation" "antagonist receptor - CORRECT ANSWER a drug that produces its action not by stimulating receptors but by preventing other, natural substances from stimulating receptors ex: ranitidine (Zantac) = H2 antagonist - blocks release of gastric acid - diphenhydramine (Benadryl) = H1 antagonist - blocks action of histamine to decrease allergic reaction - propanol (Inderal) = beta adrenergic antagonist - blocks action of epinephrine (slow HR)" "note - CORRECT ANSWER when a receptor is blocked by a antagonist, the receptor cannot carry out its normal function" "drug responses do not always involve receptors - CORRECT ANSWER - some drugs act through simple physical or chemical interactions with small molecules ex: of receptor less drugs - Antacids - magnesium sulfate" "antacids - CORRECT ANSWER receptor less drug - neutralize gastric acidity by DIRECT chemical interactions with stomach acid" "magnesium sulfate - CORRECT ANSWER receptor less drug - is a powerful laxative that acts by retaining water in the intestinal lumen through an osmotic effect" "Adverse drug reactions (ADR) aka side effects - CORRECT ANSWER defined by the WHO as " any noxious, unintended, and undesired effect that occurs at normal drug doses - range from annoying (drowsiness, nausea, itching, rash) to life threatening (respiratory depression, neutropenia, liver damage, hemorrhage, anaphylaxis) - most common in elderly and very young - patients over the age of 50 account for nearly 50% of all reactions - also high risk in the very ill and pts receiving multiple drugs - increase # of drugs = increase ADRs" "mild ADRs - CORRECT ANSWER GI upset drowsiness pruritus rash" "severe ADRs - CORRECT ANSWER neutropenia (low WBC) heptaocellular injury (liver damage) cardiac dysrhythmias anaphylaxis hemorrhage" "what drugs are worrisome? Narrow therapeutic index (NTI) vs wide therapeutic index medications - CORRECT ANSWER therapeutic index is the measure of relative safety of drug - NTI have a ratio of lowest concentration at which clinical toxicity commonly occurs - therapeutic levels checked to insure the medication is dosed effective...want enough to be effective while avoiding toxicity" "black box warning - CORRECT ANSWER - required by the FDA for drugs that are especially dangerous - is the strongest safety warning a drug can carry and still remain on the market - the boxed warning must appear prominently on: the package insert the product label any magazine or other ad" "ADRs / Medication Errors - CORRECT ANSWER Med erros are the major cause of morbidity and mortality - over 2 million serious ADRs annually - 100,000 deaths annually - fourth leading cause of death Med errors can be made by many people- physicians, pharmacy, clerical staff, nursing" "Process to prevent errors - CORRECT ANSWER 1. restrict high alert drugs and medication routes 2. practice drug differentiation. Use the "tall-man" lettering for look alike drug names 3. use forcing functions (computerized systems for adm meds) 4. make patient info readily accessible 5. standardize and simplify 6. apply reminders 7. include the patient in therapy" "high alerts medications: ISMP identified these drugs to most likely cause serious harm and death: - CORRECT ANSWER - insulin (anti diabetic) - heparin (anticoagulant) - opioids (pain mgt.) - injectable potassium chloride (IV KCL)- dilute always - neuromuscular blocking agents - chemotherapy drugs" "Types of Drug interactions? - CORRECT ANSWER Drug-Drug - may be intended, unintended, increased risk with polypharmacy (>10 meds) and narrow therapeutic index drugs Drug-Food Drug-Herb Drug- Disease" "How can the nurse minimize drug interactions? - CORRECT ANSWER - minimize # of drugs the patient receives - take a thorough drug history - reconcile meds - be extra vigilant in monitoring when patient is taking drugs with a narrow therapeutic index" "Drug-drug interaction: interactions that increase therapeutic effects (Good) - CORRECT ANSWER Additive effects Synergism/ potentiation Interference Displacement" "Additive effects - CORRECT ANSWER interaction that increase therapeutic effects - two drugs with similar MOA are taken (1+1=2) - 2 antibiotics to treat a complicated infection" "Synergism/ potentiation - CORRECT ANSWER interaction that increase therapeutic effects - two drugs with different MOA; results in combined drug effects that are greater than those that could have been achieved if either drug was given alone (1+1=3) - Coumadin and ASA" "interference - CORRECT ANSWER interaction that increase therapeutic effects - interference by one drug with metabolism/elimination of a second drug can result in increased effects of second drug (CYP 450) and of decrease effects of first drug" "displacement - CORRECT ANSWER interaction that increase therapeutic effects - displacement of one drug from plasma protein binding sites by a second drug: increase effects of displaced drug" "drug-drug interactions: interactions that decrease therapeutic effects - CORRECT ANSWER -antidote -decreased intestinal absorption of oral drugs -activation of drug metabolizing enzymes in liver called enzyme inducers -increased excretion occurs when urine pH is changes/renal reabsorption is blocked" "antidote - CORRECT ANSWER interactions that decrease therapeutic effects - a drug given to antagonize the toxic effects of another drug ex: NARCAN is the antidote for morphine overdose" "decreased intestinal absorption of oral drugs - CORRECT ANSWER interactions that decrease therapeutic effects ex: activated charcoal given for drug overdose" "activation of drug metabolizing enzymes in liver called enzyme inducers - CORRECT ANSWER interactions that decrease therapeutic effects - increased metabolism rate of drug (cytochrome P450 system)" "TRUE. need to be careful when giving drugs to young and old - CORRECT ANSWER true/false age and gender have a significant impact on a medications pharmacokinetics (ADME)" "Variable affecting drug action (pharmacokinetics) - CORRECT ANSWER - age - body weight - genetic and ethnic characteristics - gender - pathologic conditions - psychologic considerations" "Drug Therapy in Children - CORRECT ANSWER 1. drug therapy is guided by age, WEIGHT, level of growth and development, at age 12 handle drugs similar to adults) 2. choice of drug is often restricted 3. safe therapeutic dosage ranges less well defined 4. PO when possible 5. IM in infants - thigh muscle 6. keep al meds childproof containers out of reach, and not referred to as candy" "children physiologic characteristics and pharmacokinetic consequences - CORRECT ANSWER - increased thinness/permeability of skin (enhanced absorption) - immature BBB - increased % of body water - altered protein binding until 1 year - decreased GFR glomerular filtration rate (decreased excretion rate ->toxicity) - decreased activity of liver drug metabolizing enzyme systems in neonates/infants --> increased risk for toxicity (slower) - increased activity of liver drug metabolizing enzyme systems in children --> increased risk for drug drug interactions" "Guidelines for Drug Therapy in Older Adults - CORRECT ANSWER - physiologic age (functional) more important than chronological age - in older adults, drug induced symptoms are commonly mistaken for a new disease or worsening of existing disease - 20% of people aged > 65 take at least 10 meds (polypharmacy) increased risk for ADR - use non drug measures when possible - long term therapy at home (large lettering, magnifying glass, open containers?, written schedules, enlist friends and family) - if patient develops new symptoms- ALWAYS consider possibility of ADRs at the CAUSE of the symptoms - renal and liver impairment" "reason of polypharmacy? - CORRECT ANSWER - multiple HCP - herbal therapy - OTC drugs - discontinued prescribed drugs - try to reduce eliminating or changing drugs and altering doses" "older adults PHYSIOLOGICAL characteristics and pharmacokinetic consequences - CORRECT ANSWER - hepatic changes: drugs metabolized more slowly - GI changes: decreased absorption of oral drugs - cardiac and circulatory changes: impaired circulation - decreased distribution of drugs - renal changes: drugs excreted less completely - decreased production of CYP 450 enzymes - increased risk for drug interactions - can decrease up to 30% in elderly" "Beers Criteria - CORRECT ANSWER a list of potentially inappropriate medications that should NOT be used in adults 65 years and older . - the goal is to improve care of older adults by reducing exposure to potentially inappropriate medications - 30% of hospital admissions in elderly patents may be linked to drug-related problems or drug toxic effects" "ADRs have been linked to preventable problems in the elderly such as: - CORRECT ANSWER - depression - constipation - falls - immobility - confusion - hip fracture" "mechanism of action - CORRECT ANSWER MOA" "CYP 450 enzyme system - CORRECT ANSWER important in metabolism of drugs" "bioavailability - CORRECT ANSWER the fraction of the drug that is absorbed. affected by the first pass affect" "IV IM inhalation transdermal sublingual all do not pass through the liver - CORRECT ANSWER first pass effect of various routes all 100%?" "first pass effect - CORRECT ANSWER all po drugs have what?" "first pass effect - CORRECT ANSWER varies depending on the drug composition?" "- chemical properties of the drug (lipid soluble faster absorbed than water soluble) - rate affected by size of the drug - gastric pH - blood flow - contact time in the absorption surface (severe diarrhea vs gastroparesis) - CORRECT ANSWER factors affecting the rate of absorption (how quickly the drug is absorbed?" "- route (IV = 100% vs oral) - first pass effect -chemical stability - protein binding - blood brain barrier - CORRECT ANSWER factors affecting amount of absorption (efficiency- how much of the drug is absorbed)?" "absorption - CORRECT ANSWER the transfer of a drug from its site of administration to the bloodstream?" "passive diffusion - CORRECT ANSWER drug moves from a region of high concentration to one of lower concentration. does not involve a carrier" "facilitated diffusion - CORRECT ANSWER does not require energy, can be saturated, and may be inhibited" "active transport - CORRECT ANSWER involves specific carrier proteins that cross the membrane. energy dependent. moves drugs against concentration gradient (low to high)" "endocytosis and exocytosis - CORRECT ANSWER transport drugs of exceptionally large size across the cell membrane. involves engulfing of a drug molecule by the cell membrane and transport into the cell by pinchingg off the drug filled vesicle. and opposite, cells secrete many substances by a similar vesicle formation process." "Anti-viral - CORRECT ANSWER Acyclovir" "Acyclovir use - CORRECT ANSWER to prevent replication for herpes virus" "Acyclovir SE - CORRECT ANSWER crystalluria caution w/ electrolyte disorder" "Acyclovir caution - CORRECT ANSWER nephrotoxicity seizure disorder" "Acyclovir teaching - CORRECT ANSWER increase fluid intake get up slowly (orthostatic htn)" "Anti-fungal (local) - CORRECT ANSWER Nystatin" "Nystatin (topical) use - CORRECT ANSWER athlete's foot" "Nystatin (oral) use - CORRECT ANSWER oral candidiasis (thrush) vaginal candidiasis (yeast infection)" "superficial fungal infections - CORRECT ANSWER oral candidiasis (thrush) vaginal candidiasis (yeast infection) tinea pedis (athletes foot)" "systemic fungal infections - CORRECT ANSWER Lungs CNS abdomen" "Opportunistic fungal infections - CORRECT ANSWER immunocompromised patient superinfection steroids chemotherapy" "Anti-fungal (systemic) - CORRECT ANSWER fluconazole" "fluconazole route - CORRECT ANSWER Oral, IV, vaginal, topical" "fluconazole use - CORRECT ANSWER -systemic fungal infections -immunosuppressed pts to prevent yeast infection" "fluconazole nursing interventions - CORRECT ANSWER -culture PRIOR to medication - monitor LFTs" "Urinary antiseptic - CORRECT ANSWER Nitrofurantoin" "Nitrofurantoin use - CORRECT ANSWER acute and chronic UTIs" "Nitrofurantoin teaching - CORRECT ANSWER -Notify MD if there are signs of superinfection -rinse mouth (stains teeth) -urine turns rust/brown" "Vancomycin ADR - CORRECT ANSWER nephrotoxic ototoxic redman syndrome" "redman syndrome SE - CORRECT ANSWER rash to face, neck, back and chest htn tachycardia wheezing sometimes itching" "Vancomycin nursing interventions - CORRECT ANSWER peak & trough hearing test renal test" "Tetracycline antibiotic - CORRECT ANSWER Doxycycline" "Doxycycline use - CORRECT ANSWER infections acne" "Doxycycline SE - CORRECT ANSWER stomatitis GI distress photosensitivity discoloration of permanent teeth" "Doxycycline ADR - CORRECT ANSWER superinfection hepatoxicity sjs" "Doxycycline contraindications - CORRECT ANSWER decreases effects of oral contraceptives children under 8 pregnant women" "Doxycycline teaching - CORRECT ANSWER -use another form of birth control -avoid milk, iron, antacids" "Aminoglycoside antibiotic - CORRECT ANSWER Gentamicin" "Gentamicin use - CORRECT ANSWER serious infections" "Gentamicin SE - CORRECT ANSWER ototoxicity superinfection nephrotoxicity" "Gentamicin nursing interventions - CORRECT ANSWER peak and trough baseline hearing test" "Sulfonamides antibiotic - CORRECT ANSWER trimethoprim/sulfamethoxazole" "Trimethoprim-sulfamethoxazole use - CORRECT ANSWER both drugs together cause bacteria resistance to develop much more slowly -uti -mrsa -alternative to penicillin" "Trimethoprim-sulfamethoxazole SE - CORRECT ANSWER photosensitivity" "Trimethoprim-sulfamethoxazole ADR - CORRECT ANSWER hypoglycemia crystalluria" "Trimethoprim-sulfamethoxazole caution - CORRECT ANSWER diabetes" "Trimethoprim-sulfamethoxazole teaching - CORRECT ANSWER sun precautions" "Trimethoprim-sulfamethoxazole topical use - CORRECT ANSWER burns sometimes skin ulcers" "Amoxicillin SE - CORRECT ANSWER tongue discoloration stomatitis glossitis" "Antibiotics - CORRECT ANSWER Metronidazole Cephalosporins Amoxicillin Azithromycin Vancomycin Doxycycline Gentamicin Ciprofloxacin Levofloxacin Trimethoprim-sulfamethoxazole" "Metronidazole teaching - CORRECT ANSWER NO alcohol reaction: facial flushing, sweating, severe HA, slurred speech" "Metronidazole use - CORRECT ANSWER GI (H. Pylori) GU (STIs)" "Metronidazole SE - CORRECT ANSWER Superinfection-(C.diff / thrush) dark urine metallic/bitter taste GI distress" "Cephalosporins use - CORRECT ANSWER bacterial infections" "Cephalosporins SE - CORRECT ANSWER GI upset dizziness/ vertigo headache" "Cephalosporins ADR - CORRECT ANSWER superinfection nephrotoxicity" "Cephalosporins teaching - CORRECT ANSWER Report symptoms ADR of yeast infection no citric juices" "Cephalosporins administration - CORRECT ANSWER IV over 30 mins IM mixed w/ solution" "Gastrointestinal antiemetics - CORRECT ANSWER promethazine ondansetron metoclopramide" "promethazine SE - CORRECT ANSWER dizziness (anticholinergic) DRYYYY" "promethazine ADR - CORRECT ANSWER EPS respiratory distress" "ondansetron SE - CORRECT ANSWER headache dizziness" "metoclopramide MOA - CORRECT ANSWER increases GI emptying" "metoclopramide use - CORRECT ANSWER POST OP helps with peristalsis" "metoclopramide SE - CORRECT ANSWER high doses can cause sedation & diarrhea" "Gastrointestinal antidiarrheal - CORRECT ANSWER diphenoxylate with atropine" "diphenoxylate with atropine use - CORRECT ANSWER diarrhea" "diphenoxylate with atropine MOA - CORRECT ANSWER slows gastric motility" "diphenoxylate with atropine caution - CORRECT ANSWER paralytic ileus with long term use monitor bowel sounds" "Gastrointestinal laxative - CORRECT ANSWER Bisacodyl" "Bisacodyl use - CORRECT ANSWER constipation" "HRT: conjugated estrogen (test answer) - CORRECT ANSWER Test answer: Taking these hormones are going to increase your risk for breast cancer & endometrial cancer" "HRT: conjugated estrogen use - CORRECT ANSWER minimize menopause symptoms" "Osteoporosis (oral bisphosphonate) - CORRECT ANSWER alendronate" "alendronate use - CORRECT ANSWER Prevention and treatment of osteoporosis very long half life!" "alendronate teaching - CORRECT ANSWER -Take on empty stomach with 8 ounces of water and sit upright for 30 minutes -Wait 30 minutes after ingestion to eat, drink or take other medications" Pencillin is family with which abx - CORRECT ANSWER Cephalosprins" "Side/Effect advise effect of PCN - CORRECT ANSWER Tongue discoloration, C.diff SJS" "What should you not have with PCN - CORRECT ANSWER Citrus fruit juice" "What does PCN and Cephalosprin decrease - CORRECT ANSWER anticoagulant- Warfarin" "What is side effect of cephalosporin - CORRECT ANSWER Dizzy, vertigo and nephrotoxic" "What important Nurse intervention for cephalosporin - CORRECT ANSWER Increase fluids and monitor I&O" "What does majority medication does abx reduce effects of - CORRECT ANSWER Birth control" "What is the MOA for Macrolide (Azithromycin) - CORRECT ANSWER Inhibits protein synthesis" "What is Macrolide - CORRECT ANSWER Azithromycin" "What antibiotic cause Tinnitus- ototoxicity - CORRECT ANSWER Azithromycin, vancomycin, gentamicin" "What abx causes photosensitivity and hepatotoxicity - CORRECT ANSWER Macrolide (Azithromycin); doxycycline" "What abx requires to take 1 hr before or 2 hr after meal, no fruit juice - CORRECT ANSWER Azithromycin" "How to you administer Vancomycin - CORRECT ANSWER Oral or IV Slowly" "Which abx causes thrombophlebitis - CORRECT ANSWER Glycopeptides-Vancomycin" "Which abx requires Peak & Trough - CORRECT ANSWER Vancomycin; aminoglycosied (gentamicin)" "Which abx causes Red Man Syndrome - CORRECT ANSWER Vancomycin (Glycopeptides)" "Which abx may request Creatine Clearance - CORRECT ANSWER Vancomycin" "What abx cause discoloration permanent to teeth - CORRECT ANSWER Tetracycline: doxycycline" "Which abx you should not take with dairy due to the inhibits of absorption of med - CORRECT ANSWER Tetracycline: doxycycline" "which abx decrease K+ levels - CORRECT ANSWER Tetracycline: doxycycline" "which abx requires empty stomach and no dairy - CORRECT ANSWER Tetracycline: doxycycline" "Which abx has a blood dyscrasia AVR - CORRECT ANSWER Aminoglycoside:Gentamicin; Cipro" "Aminoglycoside is what abx - CORRECT ANSWER Gentamicin" "glycopeptides is what abx - CORRECT ANSWER vancomycin" "Medication rights 5+5 - CORRECT ANSWER (1) the right patient the (2) right drug (3) in the right dose via (4) the right route at the (5) right time. **Experience shows that five additional rights are essential to professional nursing practice: (1) right assessment, (2) right documentation, (3) patient's right to education, (4) right evaluation, and (5) patient's right to refuse." "OTC medication - CORRECT ANSWER over-the-counter (OTC) drugs—drugs that are obtainable without a prescription" "cyclooxygenase COX - CORRECT ANSWER is the enzyme responsible for converting arachidonic acid into prostaglandins and their products. This synthesis of prostaglandins causes inflammation and pain at a tissue injury site. There are two enzyme forms of cyclooxygenase: COX-1 and COX-2. COX-1 protects the stomach lining and regulates blood platelets, and COX-2 triggers inflammation and pain" "Prostaglandins - CORRECT ANSWER (chemical mediators) have many effects: vasodilation, relaxation of smooth muscle, increased capillary permeability, and sensitization of nerve cells to pain." "The five characteristics of inflammation - CORRECT ANSWER "the cardinal signs of inflammation" 1-redness 2-swelling (edema) 3-heat 4-pain 5-loss of function." "Inflammation - CORRECT ANSWER a response to tissue injury and infection. When the inflammatory process occurs, a vascular reaction takes place in which fluid, elements of blood, leukocytes (white blood cells [WBCs]), and chemical mediators accumulate at the injured tissue or infection site. The process of inflammation is a protective mechanism in which the body attempts to neutralize and destroy harmful agents at the site of injury and to establish conditions for tissue repair" "Infection - CORRECT ANSWER caused by microorganisms and results in inflammation, *but not all inflammations are caused by infections" "NSAIDs - CORRECT ANSWER are aspirin and aspirin-like drugs that inhibit the enzyme COX, which is needed for the biosynthesis of prostaglandins." "salycilates - CORRECT ANSWER Aspirin comes from the family of salicylates derived from salicylic acid. Aspirin is also called acetylsalicylic acid (ASA) after the acetyl group used in the composition of aspirin" "COX1 and COX2 - CORRECT ANSWER two enzyme forms of cyclooxygenase, symbolized as COX-1 and COX-2. COX-1 protects the stomach lining and regulates blood platelets, promoting blood clotting. COX-2 triggers pain and inflammation at the injured site." "NSAID herbal alert - CORRECT ANSWER Dong quai, feverfew, garlic, ginger, and ginkgo may cause bleeding when taken with nonsteroidal antiinflammatory drugs (NSAIDs)" "Immunosuppressives - CORRECT ANSWER are used to treat refractory rheumatoid arthritis (arthritis that does not respond to antiinflammatory drugs). In low doses, selected immunosuppressive agents have been effective in the treatment of rheumatoid arthritis" "Immunomodulators - CORRECT ANSWER treat moderate to severe rheumatoid arthritis by disrupting the inflammatory process and delaying disease progression. Interleukin (IL-1) receptor antagonists and tumor necrosis factor (TNF) blockers are two groups of drugs classified as immunomodulators." "Gout - CORRECT ANSWER is an inflammatory condition that attacks joints, tendons, and other tissues. It may be called gouty arthritis. The most common site of acute gouty inflammation is at the joint of the big toe. Gout is characterized by a uric acid metabolism disorder and a defect in purine (products of certain proteins) metabolism, which results in an increase in urates (uric acid salts) and an accumulation of uric acid (hyperuricemia) or an ineffective clearance of uric acid by the kidneys." "The therapeutic range - CORRECT ANSWER The therapeutic range (therapeutic window) of a drug concentration in plasma is the level of drug between the minimum effective concentration in the plasma for obtaining desired drug action and the minimum toxic concentration (the toxic effect)" "Side effects - CORRECT ANSWER Side effects are physiologic effects not related to desired drug effects" "Adverse reactions - CORRECT ANSWER Adverse reactions are more severe than side effects. They are a range of untoward effects (unintended and occurring at normal doses) of drugs that cause mild to severe side effects, including anaphylaxis (cardiovascular collapse)" "Toxic effects, or toxicity - CORRECT ANSWER Toxic effects, or toxicity, of a drug can be identified by monitoring the plasma (serum) therapeutic range of the drug" "Tolerance vs. tachyphylaxis - CORRECT ANSWER Tolerance refers to a decreased responsiveness over the course of therapy. In contrast, tachyphylaxis refers to a rapid decrease in response to the drug" "A placebo effect - CORRECT ANSWER A placebo effect is a psychological benefit from a compound that may not have the chemical structure of a drug effect" drug response - CORRECT ANSWER the intensity of the drug response is directly related to the concentration of the drug at the SITE OF ACTION Goal is to: - maximize the beneficial effects- concentration high enough for desired response - minimize harm- avoid to high a concentration" "Three phases of drug action - CORRECT ANSWER 1. pharmaceutic phase (dissolution) 2. pharmacokinetic phase (drug moving through the body) 3. pharmacodynamic phase (what the drug does to the body)" "1. pharmaceutic phase - CORRECT ANSWER the drug goes into solution - Dissolution: the process by which a drug goes into solution and becomes available for absorption - must be dissolved before it can be absorbed - most absorption takes place in the small intestine" "2. pharmacokinetic phase: four processes - CORRECT ANSWER "what the BODY does to the drug" - absorption - distribution - metabolism/ biotransformation - exertion" "pharmacokinetic phase: Absorption - CORRECT ANSWER (small intestine) the movement of a drug from its site of administration into the blood" "pharmacokinetic phase: Distribution - CORRECT ANSWER drug moves from blood --> cell membrane" "pharmacokinetic phase: Metabolism/biotransformation - CORRECT ANSWER lipid soluble metabolite (liver) --> a water soluble metabolite" "pharmacokinetic phase: Excretion - CORRECT ANSWER water soluble metabolite (kidneys)" "liver - CORRECT ANSWER breaks down the drug" "kidneys - CORRECT ANSWER excretes the drug" "Pharmacokinetic phase movement process - CORRECT ANSWER orally --> stomach --> SI --> bloodstream --> site of action --> liver (broken down) --> kidneys (excreted) IV --> bloodstream --> cite of action --> liver --> kidneys" "drugs crossing the cell membranes phospholipid cell layer - CORRECT ANSWER -drugs must be LIPID SOLUBLE in order to pass through the membrane - WATER SOLUBLE drugs penetrate the cell membrane through channels and pores"