NR293 exam 1 (solution guide) complete latest 2022.
NR293 exam 1 2022. - oral disintegration, buccal tablets, and oral soluble wafers - liquids, elixirs, and syrups - suspension solutions - powders - capsules - tablets - coated tablets - enteric coated tablets - Put in order from the fastest to the slowest rate of absorption: enteric coated tablet; suspension solutions; capsules; liquids, elixirs, and syrups; coated tablets; powders; tablets; oral disintegration, buccal tablets, and oral soluble wafers when they reach the small intestine - When do enteric coated tablets start working? When a drug: 1. Is destroyed by gastric acid 2. Causes gastric irritation or ulceration 3. When bypass of the stomach significantly enhances drug absorption - When are enteric coated tablets used? antagonist ; agonist - A drug that inhibits or blocks a cellular response is called an __________ and a drug that elicits or activates a reaction is called an _____________. first pass - proceeds directly from intestine to liver therapeutic effect - margin of safety of a drug unbound drug - free, active drug causing a pharmacological response absorption - movement of drug from site of administration into the bloodstream metabolism - biotransformation of a drug distribution - transport of drug by the bloodstream to its target site excretion - eliminates drugs from the body safety warnings - What are precautions? contraindication - a reason not to take a certain medical treatment due to the harm that it would cause the patient; RED FLAG examples: allergies or in pregnancy Trade name - What term describes the proprietary name for a medication? Pharmacokinetics: 1. absorption 2. disruption 3. metabolism 4. excretion - the study of what the body does to the drug 3 names. 1. The chemical name describes the drugs molecular structure 2. The generic name is often shorter and simpler than the chemical name and is used to identify the drug; may give a clue to what drug class 3. The trade or brand name is a proprietary name that is usually registered by the pharmaceutical company for the purposes of marketing. - How many names does a drug have? What are they? side effect - an effect other than the indicated use of the drug; not so serious; we expect them to happen; warn patient; things that can be dealt with adverse reaction - undesirable effect that is a direct response of the drug; dangerous and serious effects; may be fatal; we don't expect these things to happen; effects can last months to years toxic effect - serious adverse effects but in a toxic manner examples: - death - sepsis cummulative effect - if a drug is not excreted properly before repeated doses are given, build up may occur examples: - hearing loss - memory loss Step 1: Absorption - First the drug is administered through one of many possible routes, is collected and sent through the liver (first pass) for distribution to the body Step 2: Distribution - The drug is transported to the body using protein (usually albumin) Step 3: Metabolism - The drug is metabolized by the liver and the tissue Step 4: Excretion - The drug is sent to the liver an/or intestines to be cleared from the body - What is a drug's journey through the body? protein bound; free drug - What is it called when a drug is being carried by a protein (usually albumin) to assist with transportation throughout the body? What is it called when the drug is not being carried by a protein? unbound aka free drug = unpredictable and wild protein bound drug = predictable - If a drug does not have a protein attached to it, is it predictable or unpredictable? How about if a drug does have a protein attached to it? toxicity - What can too much free drug cause? enzymes - What helps the liver metabolize drugs? infants and older adults - Who has less enzymes? the liver - What organ metabolizes drugs? ALT and AST - What labs test for liver function? slow acetylators - this is an enzyme that breaks medication down slowly (metabolizes slowly) therefor, the patient needs a lower dose of medication half life - the time required for one half of a drug to be removed from the body; gauge to how long a drug may last the kidneys - Where are drugs excreted through? BUN and creatinine - What labs test for kidney function? fast acetylators - this is an enzyme that breaks medication down quickly (metabolizes fast) therefor, the patient needs a higher dose of medication Onset is the time it takes a drug to start working. Peak is the time it takes for a drug to reach it maximum effect. Duration is the time frame the patient is getting therapeutic effects. Termination is when the drug stops working. - toxic - When a drug level rises above a peak level, it is in the ___________ range. 5 - How many half life's does it take a drug to be eliminated from the body (steady state)? short half life = more often; drug leaves the body more quickly long half life = less often; drug stays in the body longer - If a drug has a short half life, will we dose the patient for often or less often? How about if a drug has a long hterm-18alf life? pharmacokinetics - the study of the process a drug goes through from the time of ingestion or injection until all of the parent drug and metabolites have left the body Pharmacodynamics - study of what the drug does to the body Pharmacotherapeutics - study of the use of drugs in treating disease; the goal or expected outcome of the drug Pharmacogenetics - the study of how genetics impacts drug metabolism The liver metabolizes the drug therefor some of the drug becomes deactivated. The remaining amount of the drug is called BIOAVAILABILITY. - What happens to a drug when it passes through the liver? IV because it does not pass through the liver, it goes straight into the bloodstream - What route of absorption has 100% bioavailability? desired therapeutic outcome should be established - What should be done before drug therapy is started? acute therapy - What type of therapy? Definition: someone is acutely ill and we are trying to help them with that illness Example: antibiotic, vasopressor maintenance therapy - What type of therapy? Definition: patient has a problem, we are trying to maintain it so it doesn't get worse Example: BP meds Supplemental/replacement therapy - What type of therapy? Definition: body is not making on its own or can't make anymore Example: insulin or iron if deficient palliative therapy - What type of therapy? Definition: drugs that comfort the patient when they have pain due to a condition that is not curable or treatable Example: morphine sulfate supportive therapy - What type of therapy? Definition: supporting one while they get better Example: IV fluids, tylenol and benadryl can help symptoms from the common cold but cannot cure it Prophylactic therapy - What type of therapy? Definition: prevention therapy Example: vaccines, prophylactic antibiotics, birth control Empiric therapy - What type of therapy? Definition: we think it's something based on clinical s/s but we aren't sure, we treat it based on how it looks and sounds toxic dose / effective dose - the ratio of the dose that produces the desired therapeutic effect to the dose that produces a toxic effect YES! They are easier to become toxic and fatal. The patient is more likely to have an adverse reaction. - Is frequent monitoring required when giving a drug with a small therapeutic range? it is harder for that drug to become toxic; less monitoring required; less likely to have an adverse reaction; most OTF medicines - What does a large therapeutic range mean? crystals can form and there will be a clot in the tubing - What can happen if you give two medications that are not compatible in the same IV tubing? 1. Drug properties: is it a protein drug? Soluble in lipids? What is the chemical makeup? 2. Fetal gestational age: first trimester is the most dangerous 3. Maternal factors: is moms liver and kidneys working? Does she have genetic issues? - What are factors that affect safety in drug therapy during pregnancy? Category A is the safest: no risk to the human fetus Category B and C: grey area Category D: **dangerous**; way risks and benefits -Mom's going to die -Mom needs chemo Category X: defects have been seen; never going to do it - drug therapy during pregnancy over the counter (otc) drugs - drugs that are available without a prescription for short term self-treatment of common minor illnesses they aren't fully developed yet and there are not enough studies done on babies to prove that the drug could be safe - Why don't we give babies up to 2 years otc medications? - overuse - can build a tolerance - can damage liver from Tylenol - can damage kidneys from ibuprofen - drug interactions - poly pharmacy - delaying treatment of the real problem - abuse - What are problems of otc medications? 3000mg/day; 2000mg/day - What is the max dose of tylenol per day for healthy adults? How about if they are elderly, have liver disease, or an alcoholic? additive effect - What drug interaction effect? 1+1=2; both drugs work like they should synergist effect - What drug interaction effect? 1+1>2; the drugs work better together than they do separately antagonistic effect - What drug interaction effect? 1+1<2; the drugs work against each other sulfunylureas - What oral diabetic drug class? - glipizide (Glucotrol) - glyburide (Diabeta Micronase) - glimepiride (Amaryl) MOA: stimulates release of insulin Adverse/side effects: hypoglycemia, weight gain, rash, and GI symptoms Contraindications: sulfa allergy, pregnancy, hypoglycemia, and limited calorie intake Nursing implications: - give 30 minutes before food, morning is best - monitor blood sugar - stop if insulin is started Notes: - can be used with metformin and other oral DM drugs - can be given to patients with renal failure Biguanides - what oral diabetic drug class? - metformin (Glucophage) MOA: improves insulin receptor sensitivity (does not increase insulin production); decrease sugar production in the liver Side effects: GI issues and metallic taste Adverse effects: lactic acidosis (rare but fatal) Interactions: iodinated radiologic contrast media (CT) increases risk of acute renal failure and lactic acidosis Contraindications: renal dysfunction and pregnancy Nursing implications: does not require routine monitoring Notes: - blood sugar does not need to be checked - first line drug for T2DM Glinides - What oral diabetic drug class? - repaglinide (Prandin) - nateglinide (Starlix) MOA: increases insulin secretion from pancreas Adverse/side effectS: weight gain and hypoglycemia Contraindications: - do NOT combine with sulfonylureas - hypoglycemia - pregnancy - if meal is missed - sulfa allergy Nursing implications: - take 30 minutes or LESS before meals - skipped meal = skipped dose Notes: - similar to sulfonylureas Thiazolidinediones - what oral diabetic drug class? - pioglitazone (Actos) MOA: regulates genes involved in glucose and lipid metabolism Side effects: weight gain, peripheral edema, and reduced bone density Adverse effects: hepatoxicity Contraindications: heart failure, pregnancy, and caution use in liver/kidney problems Interactions: other meds metabolized by CYP3A4 Nursing implications: - give once daily with or without food - monitor ALT/AST Notes: - only available though specialized manufacturer programs Alpha-glucosidase inhibitors - what oral diabetic drug class? - acarbose (Precose) MOA: blocks the enzyme alpha-glucosidase (found in the small intestine) which delays absorption of glucose Adverse/side effects: flatulence, abdominal pain, and elevated liver enzymes with high doses Contraindications: IBS, malabsorption issues, cirrhosis, DKA, and pregnancy Interactions: decreases bioavailability of digoxin, ranitidine, and propranolol Nursing implications: - take with first bite of every meal - take 3x/day; skipped meal = skipped dose Notes: - timing is very important!!!!! Sodium Glucose CoTransporter (SGLT2) Inhibitors - What oral diabetic drug class? - canaglifozin (Invokana) - dapaglifozin (Farxiga) - empagliflozin (Jardiance) MOA: SGCT2 inhibitors lower blood sugar by causing the kidneys to remove sugar from the body through urine Side effects: genital yeast infection, UTI, and increased urination Adverse effects: hypotension, hypovolemia, hyperkalemia, and increased LCL cholesterol Contraindications: moderate to severe kidney impairment, DKA, and pregnancy Interactions: rifampin decreases effectiveness of SGCT2 inhibitors Nursing implications: - give daily in the morning Notes: - reduces risk of CV event in T2DM (canaglifozin) - FDA WARNING FOR CLASS: risk for ketoacidosis, AKI - FDA WARNING FOR CANAGLIFOZIN (INVOKANA): risk for leg/foot amputation Thiazolidinediones —> pioglitazone (Actos) - What diabetic oral drug has a black box warning for heart failure? Alpha-glucosidase inhibitors —> acarbose (Precose) - For which diabetic oral drug is timing extremely important when giving? ** needs to be given at first bite of food Biguanides —> metformin (Glucophage) - What oral diabetic drug does not need to be closely monitored due to there being no risk of hypoglycemia? No. Skipped meal = skipped dose. Patient is at risk for hypoglycemia if does is given without food. Timing is very important!!!! - Should a nurse still administer a morning dose of acarbose (Precose) if their patient skipped breakfast? Sulfonylureas - What other diabetic oral drug should not be combined with Glinides? Morning time is the best time to take it. It should be taken 30 minutes before food. - When is the best time for a patient to be administered glipizide (Glucotorl)? Glinides —> repaglinide (Prandin) and nateglinide (Starlix) - What oral diabetic drug should be taken 30 minutes or LESS before food? metformin (Glucophage) - If a patient is showing prediabetic signs/symptoms, what oral diabetic medication would they potentially be prescribed? acute renal failure and/or lactic acidosis - If a patient taking metformin (Glucophage) forgets they are supposed to skip their dose the morning before a CT scan and for 48 hours after, what are they at risk for? - juice - rapid dissolve sugar tablets - honey - snack - What should you give a conscious patient who is hypoglycemic? - inject glucagon IM or subQ OR - inject dextrose in the IV - What should you give an unconscious patient who is hypoglycemic? analgesic drugs - What are drugs that relieve pain without causing unconsciousness? opioid analgesics - MOA: - agonist (reduction of pain sensation) OR antagonist (reverse effects of agonist drugs) Indications: - moderate to severe pain - cough supression - treatment of diarrhea - balanced anesthesia Commonly prescribed: - fentanyl - hydromorphone (Dilaudid) - Morphine sulfate Adverse effects: - CNS depression (sedation, disorientation, lightheadedness) - respiratory depression (hypotension and bradycardia) Side effects: - GI: nausea, vomiting, constipation - GU: urinary retention #Continues
Escuela, estudio y materia
- Institución
- Chamberlain College Of Nursing
- Grado
- NR 293 ADVANCED PHARMACOLOGY (NR293)
Información del documento
- Subido en
- 28 de julio de 2022
- Número de páginas
- 30
- Escrito en
- 2021/2022
- Tipo
- Otro
- Personaje
- Desconocido
Temas
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nr293 exam 1
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nr 293 exam 1
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nr 293 exam 1 guide
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elixirs
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put in order from the fastest to the slowest rate of absorption enteric coated tablet suspension solutions capsules liquids
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and syrups coa
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