NUR 2060 (Pharmacology) EXAM

NUR 2060 (Pharmacology) EXAM 1 What is pharmacology? - the study of drugs and their interactions with living systems What is pharmacotherapeutics? - the use of drugs to diagnose, prevent, to treat disease or prevent pregnancy What are the 3 main properties of an ideal drug? - 1. effectiveness (elicits response for which it's given) 2. safety (cannot produce harmful effects) 3. selectivity (only elicits response for which is given) Which schedule has the highest level of abuse potential? - Schedule I What is the difference between the chemical, generic, and trade names of a drug? - -Chemical= chemical structure of the drug -Generic= the official name of the drug -Trade= name given to the drug from the manufacture Which type of drug name starts in a lower case letter? - generic Which type of drug name starts as an UPPER case letter? - Trade/brand name What does a "local" route mean? - one area of the body (i.e. skin) What does a "systemic" route mean? - effects all over the body What does an "enteral" route mean? - drug given by mouth (oral/PO) What does a "parenteral" route mean? - drug that goes directly into the blood stream (i.e. IV, IM, Sub Q) What does a "mucous membrane application" route mean? - drug given via sublingual, buccal, inhalation, vaginal, and rectal What does a "topical" route mean? - drug given via dermal, transdermal, otic, and ophthalmic What are the seven "Rights" of medication administration? - right DRUG right DOSE right ROUTE right TIME right PATIENT right OF PATIENT TO REFUSE MEDICATION right DOCUMENTATION How are drugs classified? - 1. chemical structure/group (i.e. opiate) 2. action (an opiate receptor agonist) 3. site of action (CNS) 4. use (an analgesic) Are drugs endogenous or exogenous? - exogenous Drugs mimic endogenous or exogenous actions? - endogenous actions What is the term that describes how the drug MOVES though the body? - pharmacokinetics What is the term that describes how the drug WORKS in the body - pharmacodynamics What are the four basic processes of pharmacokinetics? - 1. absorption 2. distribution (blood) 3. metabolism (liver) 4. excretion (kidney) What effects absorption of a drug? - -blood flow -drug lipid solubility -pH and drug ionization -passive diffusion -pharmaceutical processing (coatings, and additives) What is bioavailability? - the portion or percentage of an administered dose of a drug that is absorbed and able to cause an effect What do drugs bind to to be carried throughout the body? - plasma protein binding (albumin) What would low plasma albumin levels cause? - Low levels of albumin would increase the level of that drug in the blood stream causing it to have a more profound/harmful effect on the patient T or F: a drug cannot pass through a membrane when it's bound to plasma albumin? - true; once unbound it is free to be used If a drug has a higher affinity to bind to plasma albumin, what happens to that drug and the other drug if given at the same time? - i.e. if you give warfarin and aspirin at the same time, aspirin has a higher affinity to bind to albumin which then will then increase the levels of warfarin in the blood stream (because aspirin is bound to all the albumin sites). The level of warfarin will increase and therefore more bleeding and thinning of the blood will occur. (this is why we typically don't give them together) What type of drugs can cross the blood-brain barrier? - only lipid soluble and non tightly bound What is another name for metabolism? - biotransformation What is the cytochrome P450 system? - a group of enzymes in the liver recognized and identified for their ability to breakdown drugs What are the first 3 families of the cytochrome P450 system known to do? - metabolize drugs (CYP1, CYP2, and CYP3) What is the "First Pass Effect"? - when drugs given PO move through the liver, breaking them down to some degree What is half-life? - the amount of time it takes 1/2 of a drug to get out of the system How many half-lives does it take to reduce a drug to an amount that is negligible? - 4 half-lives How many half-lives does it take to reach a plateau/steady-state in the blood stream? - 4 half-lives What is an agonist? - helps a process happen What is an antagonist? - blocks a process from happening What is efficacy? - a drug's ability to cause a response T or F: If a drug has a greater efficacy than another drug, this means it is better than the other drug - FALSE! efficacy is a drug's ability to cause a response. i.e. not everyone needs morphine for pain. It depends on how much of an effect we need for the patient's condition What is potency? - how much drug must be administered to elicit a desired response If a drug is known to be more potent than another, what does that mean? - If drug is more potent it does NOT mean its better, it only means a smaller dose is needed to elicit a response (pg.46) What is selectivity? - the drug only elicits the response it is given for What is simple occupancy theory? - drugs intensity is proportional to the number of receptors occupied What is affinity? - the strength of the attraction between a drug and its receptor What is high intrinsic activity? - drugs with high intrinsic activity cause intense receptor activation What is the Therapeutic Index and what kind of therapeutic index is safer? - a measure of a drug's safety; the larger the therapeutic index, the safer the drug. What is the distance called between the peak and the trough? - therapeutic range What are the possible negative effects if drugs are given together? - 1. incompatibility (physically with a precipitate or chemically inactivate each other) 2. change in absorption (decreased by laxatives, increased with constipation causing drugs) 3. alter protein binding (i.e. warfarin & aspirin) 4. biotransformation (inhibits enzymes, decreases metabolism, may increase levels) What is the purpose of a risk management program? - its designed to detect, evaluate, prevent and mitigate adverse drug events What is the purpose of the Risk Evaluation and Mitigation Strategies (RiskREMS)? - to minimize drug induced harm (benefits outweigh the potential harm); this act allowed the FDA authority to subject drugs to new risk identification and communication strategies in post marketing period What are components of REMS? - -medication guide -patient packet insert -elements to ensure safe use -laboratory test results -patients are monitored -enrolled in a registry What physiological changes in pregnancy that impact drug dosing? - 1. increased kidney clearance 2. increased liver metabolism 3. decreased GI tone/peristalsis T or F: All drugs cross the placenta>? - T Must always assume that all or some of the drug crosses the placenta What type of drugs have an easier time crossing the placenta? - lipid soluble What type of drugs have a difficult time crossing the placenta? - ionized, highly polar, or protein-bound drugs Why are NSAID's contraindicated in late pregnancy? - NSAID's are uterine suppressions What adverse reaction do prostaglandins affect on a pregnant women? - uterine stimulation (contraction) The effect of a teratogen is highly dependent on what? - when the drug was giving during the pregnancy Which stage of fetal development is most fragile to damages from teratogens? - embryonic What type of defects occur to a fetus if a teratogen is given during the fetal stage? - behavioral and developmental defects What are the stages of fetal development? - 1. Preimplantation (conception-2 weeks) 2. Embryonic (week 3- week 8) 3. Fetal (week 9-term) What are the pregnancy categories of drugs? - A, B, C, D, & X. (A being the least hurtful, and X contraindicated) What is the safest advice to give to breastfeeding mothers who take medications? - it's best to take medication after breastfeeding Why are children more sensitive to medication than adults? - immature organ system Discuss GI absorption in neonates/infants... - -may be increased or decreased -Gastric emptying prolonged and gastric ph is very low which leads to increased absorption of some (stomach, acid labile) -decreased of others (intestine) Describe absorption through IM injection in neonates/infants... - IM absorption is slow and erratic Describe transdermal absorption in neonates/infants... - Transdermal is rapid and complete (toxicity risk) Describe protein binding with giving drugs to neonate/infants... - 1. albumin levels are lower in neonates/infants 2. endogenous compounds (i.e. fatty acids, bilirubin) compete with drugs for available binding sites (increased free drugs in blood) Describe effects to blood brain barrier with giving drugs to neonate/infants... - immature CNS which increases susceptibility to drugs in the CNS Describe metabolism and excretion of drugs in neonate/infants... - metabolism and excretion is low so dosages are lower By what age are most organs approximate to maturity of adults? - 1 year old Pediatric drug-metabolizing capacity is markedly elevated until what age? How do you fix the doses in this population? - -2 years old, (then gradually declines) (p.90) -increase dose, or decrease interval (aka increase frequency) What is the most common method used to figure out a pediatric dosage? - body surface area (don't need to know formula) In geriatric patients, most drug sensitivity is related to... - organ system degeneration What is important to understand when dosing medication for geriatric patients? - individualization; monitoring them for desired and adverse reactions What are the age-induced drug responses? - -Absorption: slow rate and GI motility (decreased acidity pg.92) -Distribution: increased body fat, and decreased lean body mass, muscle, CO, water and albumin -Metabolism: decreased liver function (first-pass metabolism may be enhanced) -Excretion: decreased renal blood flow and GFR (most important cause of adverse drug reactions; drug accumulation) Describe fat soluble and water soluble drug distribution in geriatric patients... - -fat soluble drugs= long residual effects(?) -water soluble drugs= higher concentration due to low total body water What is the "Beer's List"? - "Beer's List" identifies 48 medications that should be avoided in older adults What are the defense factors for GI protection? - 1. mucus (barrier) 2. bicarbonate (neutralizes H+ ions) 3. blood flow (sufficient blood flow to the cells) 4. prostaglandins (stimulate secretion of mucus, bicarb, promote vasodilation, and suppress secretion of gastric acid) What are the aggressive factors that affect the GI protection? - 1. Helicobactor pylori (promotes ulcers) 2. NSAID's (inhibits biosynthesis of prostaglandins) 3. gastric acid (ulcer production) 4. Pepsin (enzyme that can injure unprotected cells) 5. smoking (weakens the sphincter and accelerates gastric emptying---increase acid in duodenum) What is the primary carcinogen for stomach cancer? - Heliobactor pylori What are risk factors for ulcers? - -H. pylori -smoking -ETOH -increase acid -decrease bicarb -stress -NSAID usage What is Zollinger-Ellison syndrome? - condition where there is hyper secretion of gastric acid; increased ulcer probability What are prevention/treatments for ulcers? - -eliminate H. pylori -avoid NSAID's and corticosteroids -avoid smoking and ETOH -eat 6 small meals/day -decrease stress What are the classes of antiulcer drugs? - -antibiotics -antisecretory agents (proton pump inhibitor and H2 receptor antagonists) -mucosal protectants -antisecretory agents that enhance mucosal defenses -antiacids Why do we give antibiotics in the cocktail for treatment of ulcers? - to treat H.pylori How many antibiotics are usually prescribed to treat H. pylori and why? - 2-3 antibiotics; to decrease resistance What is the regime for treatment of H. pylori infection? - -2-3 antibiotics -antisecretory agent (i.e. H2 antagonist or proton pump inhibitor) -14 day course is best What are some antibiotics that are useful for eradication of H. pylori? - -*amoxicillin -*bismuth (pepto; has antibacterial properties) -clarithromycin (Baxin) -*metronidazole (Flagyl) -tetracycline (Achromycin) What is the action of Histamine 2 receptor antagonists? - inhibit gastric acid secretion What are the uses of Histamine 2 receptor antagonists? - -H. pylori regime -decrease symptoms & prevent complication of PUD -prevent NSAID induced ulcers -maintenance and rescue -decrease heartburn -GERD -Zollinger-Ellison syndrome -aspiration pneumonitis Give medication examples of Histamine 2 Antagonists. - **((End in -dine))** i.e. -cimetidine (Tagamet) -ranitidine (Zantac) -famotidine (Pepcid) -nizatidine (Axid) What are some cautions when giving Histamine 2 antagonists? - -avoid antacids 1 hour before giving H2 antagonists -increased bleeding abnormalities -some risk of pneumonia with decreased acid in GI What is the action of a Proton Pump Inhibitor? - suppress gastric acid secretion (block the enzyme needed for acid formation) Give medication examples of Proton Pump Inhibitors. - **((end in -prazole))** i.e. -omeprazole (Prilosec) -esomeprazole (Nexium) -lansoprazole (Prevacid) -rabeprazole (Acifphex) -pantoprazole (Protonix) What are the uses for a Proton Pump Inhibitor? - -for active peptic ulcers -preferred prohylactic (not a rescue) -risks: fractures (due to osteopenia), pneumonia, acid rebound, intestinal infections **Don't use for more than 16 weeks!!** What is the action of a Mucosal Protectant? - local protectant action against acid and pepsin (adheres to surface and promotes healing, prevents injury for up to 6H) Give medication example(s) of a Mucosal Protectant. - sucralfate (Carafate) What are the uses of Mucosal Protectant medications? - -rescue and maintenance -pain relief of ulcers What are the nursing implications for Mucosal Protectants? - -may harden with enteral feedings -constipation -contains an aluminum (if antacid is needed, must wait 30 minutes post mucosal protectant given) -give on empty stomach What is the action of a Anti-secretory Mucosal Agent medication? - inhibits gastric acid secretion, promotes mucous production, and increases blood flow via vasodilation What is another name for an Anti-secretory Mucosal Agent? - Prostaglandin Give example(s) of Antisecretory Agents. - misoprostol (Cytotec) What are the uses/cautions of Antisecretory Agents? - -prevention of NSAID-induced ulcers -prophylaxis **CAUTION: do NOT use while pregnant! Prostaglandin causes uterine contraction!! What pregnancy category is misoprostol (Cytotec)? - Pregnancy category X (DO NOT TAKE WHILE PREGNANT!!) What are the actions of Antacids? - -neutralizes gastric acid (does NOT absorb acid or coat stomach; it bufferes the gastric pH only) At what pH is pepsin suppressed? - pH>5 Give medication examples of Antacids. - -calciumcarbonate (Tums) -magnesium hydroxide (Milk of Magnesia -aluminum hydroxide (Amphogel) **don't allow/recommend patients to ingest baking soda; it can cause electrolyte imbalances What are the uses of Antacids? - -acid indigestion -heartburn -reflux esophagitis -peptic ulcers -prevention of stress ulcers -pain from ulcers What are contraindication(s) of Antacid use? - renal dysfunction patients (except Antacids with aluminum in them i.e. aluminum hydroxide (Amphojel)) What are some adverse reactions with taking Antacids? - -constipation (Ca and Al containing meds) -diarrhea (Mg containing meds) *teach patients to balance meds to control these ADRs Which antacids have high acid neutralizing capacities (ANC)? - -magnesium hydroxide (Milk of Magnesia) -calcium carbonate (Tums) --Low ANC= aluminum hydroxide (Amphojel) What is magnesium hydroxide (Milk of Magnesia) often combined with and why? - aluminum; to decrease diarrhea What is the Antacid drug of choice? - magnesium hydroxide (Milk of Magnesia) What are medication examples of combination Antacids? - -Maalox -Mylanta -Gelusil What are the nursing implication of Antacids? - hx and pt. teaching: -H. pylori -medication -eating habits (bland diet) -smoking -ETOH -raise head of bed at night What are the uses of laxatives? - -tx of *constipation -prep for *surgery/diagnostic testing -decrease systemic absorption of ammonia (*poisoning) -soften the stool -increase stool volume -accelerate fecal passage What is the action of Bulk-Forming Laxatives? - absorb water into fecal contents and expand bulk of stool Give examples of Bulk-Forming Laxtives. - -*psycillium (Metamucil, Konsyl, Fiberal) -polycarbophil (Fibercon) What are the nursing implications of administering Bulk-Forming Laxatives? - **must be administered with 8oz of water (or will cause esophageal obstruction!) What is the action of Surfactant Laxatives? - lowers surface tension which increases water into the feces Give examples of Surfactant Laxatives. - -*docusate sodium (Colace) -docusate calcium (Surfak) What are the uses of Surfactant Laxatives? - -soften/lubricate hard feces -prevent constipation (doesn't treat it once its present) *take with 8oz of water What are the uses of Stimulant Laxatives? - -short term use in constipation -used on opiod-induced constipation Give medication examples of Stimulant Laxatives. - -*senna (Senokot) -bisacodyl (Dulcolax) What is the action of Stimulant Laxatives? - stimulate intestinal motility Which classification of laxatives are most often abused? - stimulant laxatives What are the side effects of giving Stimulant Laxatives? - -cramping, nausea, vomiting, diarrhea -don't take bisacodyl (Dulcolax) with milk or antacids--->will destroy pill coating -senna (Senokot) can turn urine brown or pink Give an example of a Osmotic/Saline Laxative. - -*magnesium hydroxide (Milk of Magnesia -lactulose (Cephulac) -polyethylene glycol (MiraLax) -*polyethylene glycol-electrolyte (Golytely, Half-Lytely) -sodium phosphate (Phospho-soda Fleet) What is the action of a Osmotic/Saline Laxative? - contains laxative salts that help draw water into the intestinal lumen; causing feces to swell and soften What are the uses for Osmotic/Saline Laxatives? - -short term constipation -prep for diagnostic tests and surgical procedures -decrease ammonia is hepatomegaly (lactulose/Cephulac) What are Lubricant Laxatives? - -soften and lubricate stool promotes peristalsis through local irritation (30 minutes) -i.e. mineral oil and glycerin suppositories What is a Chloride Channel Activator Laxative? - -*lubiprostone (Amitiza) -promotes secretion of chloride rich formula into bowl and enhances motility of sm. intestine -for chronic idiopathic constipation and constipating IBS -pregnancy category C What are the nursing implications when giving laxatives? - -assess bowel and laxative history -eating habits -potential causes -most administer at night for action in AM -teach pt. normal bowel habits and dangers of chronic use What are some non medicinal ways to prevent constipation? - -increase: fluids, dietary bulk, ambulation/exercise -consider use of coffee, tea, prunes, and pineapple Give examples of Serotonin Receptor Antagonists Antiemetic drugs. - **((end in -setron))** i.e. -*ondansetron (Zofran) -granisetron (Granisol, Kytril, Sancuso) -dolsetron (Anzemet) -palonosetron (Aloxi) What are the uses for Antiemetics? - -chemotherapy induced nausea/vomiting -postoperative nausea/vomiting What medication, when given with an antiemetic, will give a synergistic effect? - dexamethasone (steroid) What is the action of Phenothiazine Antiemetics? - blocks receptor in CTZ What are causes of nausea and vomiting? - -stimulation of chemoreceptor trigger zone (CTZ) -activation of vomiting centers (smell, sights, odors, inner ear, pain, etc.) -best if used BEFORE chemotherapy as preventative Give examples of Phenothiazine Antiemetics drugs. - -promethazine (Phenergan) -*prochlorperazine (Compazine) -*metoclopramide (Reglan) -Droperidol (or Haldol) What caution must you take, as a nurse, if giving Droperidol/Haldol for antiemetic effects? - Droperidol/Haldol is associated with fatal cardiac dysrhythmias What caution must you take, as a nurse, if giving promethazine (Phenergan) for antiemetic effects? - caution with children and risk for respiratory depression Discuss Antiemetics that help with motion sickness. - i.e. -*scopolamine (Transdermal Scop) -dimenhydrinate (Dramamine) -meclizine (Antivert) -it suppress nerve stimulation in the CNS -anticholinergic side effects: dry mouth, blurred vision, drowsiness, constipation, and urinary retention (in older men) What are causes of acute diarrhea? - -<72 hours -infection (E. coli) -GI disease -change in diet -nervousness and anxiety -allergic reaction -intoxication -side effect of medications What are causes of chronic diarrhea? - -malabsorption syndrome -inflammatory bowel disease -endocrine disorder What are the uses for antidiarrheals? - -symptomatic relief -decrease in number and volume of stools in patients with ostomies Give examples of Antidiarrheals. - -*bismuth subsalicylate (Pepto-Bismol) -*difenoxin/atropine (Motofen) -*diphenoxylate/atropine (Lomotil) -*loperaminde (Imodium) -activated charcoal -kaolin (Kaopectolin) What is a major side effect of opioids? - cause constapation by decreasing intestinal motility Why was atropine added to diphenoxylate (Lomotil)? - excessive doses of diphenoxylate could cause morphine like effects; atropine added to not allow for abuse What medications are useful in IBS (irritable bowel syndrome)? - -*dicyclomine (Bentyl)--->decreased GI motility -*alosteron (Lotronex) --->only approved for women What are antidiarrheal medications useful for patients with IBD: Ulcerative Colitis & Crohn's? - -*sulfasalazine (Azulfidine) -mesalamine (Rowasa) -olsalazine (Dipentum) What are cautions for giving antidiarrheal medications, specific to patient's with IBD? - -must monitor CBC What are the actions for antidiarrheal medications for IBD patients? - -decrease inflammation by decreasing prostaglandin synthesis -may also use steroids and immune modulator for same effect Discuss orlistat (Xenical, Alli). - -facilitates weight loss -decreases absorption of fat by blocking enzymes used to break down fat -must use low fat diet and supplement with fat soluble vitamins -if patient eats fats, will have diarrhea, greasy poop, and increased flatulence Discuss non amphetamines. - -suppress appetite by increasing norepinephrine in the brain -ADR's: increased alertness, decreased fatigue, increased nervousness, insomnia, tachycardia, hypertension, angina i.e. -diethylporpion (Adipex-P) -phentermine (Lonamin) Discuss sibutramine. - -sibutramine (Meridia) -for BMI>=30 -increased serotonin, norepinephrine, and dopamine in brain -is an appetite suppresant -withdrawn in 2010 due to cardiovascular, non fatal, risks What is the difference in dosage when giving a medication PO v.s parenterally? - PO needs a bigger/stronger dose due to the first-pass effect What special considerations are done when giving children oral medications? - -given with medicine cups, oral syringes (do not use with or for another medication) -squirt medicine into cheek What special considerations are done when giving children eye drops/ointment? - -make a pouch with the lower lid and place medication, 1 drop at a time, in this pouch -close eye for a few minutes What special considerations are done when giving children ear drops? - -shake well -for <3yrs, pull ear outward and down -for >3yrs, pull ear outward and up -keep child on side for 2 minutes What special considerations are done when giving children nose drops? - -clear nose of secretions -don't let squeeze dropper touch nostrils -keep head back for 2 minutes What special considerations are done when giving children suppositories? - -use pinky finger for children <3yrs -use index finger for children >=3yrs -insert 1/2-1 inch beyond sphincter -hold buttocks together for a few minutes -have child hold their position for 20 minutes What was the first Act for safety of medications? - FDA Cosmetic Act What is the most important consequence of drug metabolism as it relates to renal excretion? - it accelerates/promotes renal excretion by turning lipid soluble drug into water soluble drug for excretion What changes can drugs go through in metabolism via liver enzymes? - 1. accelerated renal excretions 2. drug inactivation 3. increased therapeutic action 4. activation of "prodrugs" 5. increased or decreased toxicity What is a prodrug? - a compound that is inactive when administered then undergoes activation via metabolism If a patient has poor renal function, what does this mean for the drug in the body? - drug may accumulate so patient may need to less of drug What is enterohepatic recirculation? - reabsorption of a drug from small intestine In pharmacokinetics what is it called when the rate of administration = rate of excretion? - steady state/ plateau What is an Idiosyncratic reaction? - unexpected or rarely seen, usually genetically related What is an ADR? - any undesired effect that occurs at normal dosages What is Pharmacogenomics? - variants based on heredity that effect pharmacokinetics and pharmacodynamics Why is it not appropriate to drink grapefruit juice while taking some types of medications? - Interferes with enzymes that break drugs down which increases concentration (statins, CA channel blockers) What are the two programs that report problems with medications? - Medwatch and USP Medication Errors Reporting Program 1 gm = ____gr (grain)? - 1 gm = 15 gr 1 mg = ____mcg? - 1 mg = 1,000 mcg 1 oz = ____TBSP = ____cc or mL? - 1 oz = 2TBSP = 30 cc or mL 1 mL = _____ gtts? - 1 mL = 15 gtts 1 kg = ____lbs? - 1 kg = 2.2 lbs 1 tsp = _____mL? - 1 tsp = 5 mL 1 TBSP = ______mL? - 1 TBSP = 15 mL H2 blockers - What types of drugs end in dine?