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Pharmacotherapeutics > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Assessment of a Drug

A

Drug’s action, signs/symptoms of allergic reaction, adverse effects, contraindications, dosages/routes, drug incompatibilities, antidotes

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2
Q

Compliance

A

Implementation or fulfillment of a prescriber’s or caregiver’s course of treatment or therapeutic plan

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3
Q

Adherence

A

Perceived as implying more collaboration and active role between patient and provider

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4
Q

Prescription must include:

A
  1. Patient’s name
  2. Date the drug order was written
  3. Name of drug
  4. Drug dosage
  5. Drug dosage frequency
  6. Route
  7. Prescriber’s signature
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5
Q

NURSING DRUG DIAGNOSES

A
  1. Deficient knowledge
  2. Risk for injury
  3. Noncompliance
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6
Q

Drug Outcome Identification

A

ULTIMATE GOAL IS THE SAFE, THERAPEUTIC, AND EFFECTIVE MEDICATION ADMINISTRATION

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7
Q

Side Effects vs. Adverse Effects

A

Side effects are not life-threatening

Adverse effects can be life-threatening

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8
Q

SIX RIGHTS OF MEDICATION ADMINISTRATION

A
  1. Right drug
  2. Right dose
  3. Right time
  4. Right route
  5. Right patient
  6. Right documentation
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9
Q

Three Types of Nursing Interventions

A
  1. Drug administration
  2. Provision of comfort measures
  3. Patient/family education
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10
Q

Evaluation of Drugs

A

Monitor fulfillment of outcomes and patient’s therapeutic response

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11
Q

Drugs have three different names…

A
  1. Chemical name (chemical composition)
  2. Generic name (used in most official drug lists)
  3. Trade name (drug’s registered trademark)
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12
Q

Pharmaceutics

A

Study of how various dosage forms influence the way the drug affects the body

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13
Q

Pharmacokinetics

A

Study of what the body does to the drug

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14
Q

Pharmacodynamics

A

Study of what the drug does to the body and involves drug-receptor relationships

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15
Q

Phases of Drug Activity

A
  1. Dose of formulated drug
  2. Pharmaceutical phase (disintegration of dosage form)
  3. Pharmacokinetic phase (absorption, distribution, metabolism, excretion)
  4. Pharmacodynamic phase (drug-receptor interaction)
  5. Effect
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16
Q

Pharmacotherapeutics

A

Focuses on the clinical use of drugs to prevent/treat diseases and defines principles of drug actions

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17
Q

Pharmacognosy

A

Study of natural drug sources

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18
Q

Pharmacoeconomics

A

Economic aspects of drug therapy

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19
Q

Absorption

A

Movement of a drug into the bloodstream

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20
Q

Bioavailability

A

Extent of drug absorption

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21
Q

First-Pass Effect

A

Drugs absorbed by the intestines must pass through the liver before circulation
Oral drugs decrease bioavailability
IV drugs skip first-pass effect

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22
Q

Enteral Route

A

Drug is absorbed into circulation via mucosa of stomach/intestines

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23
Q

Sublingual Route

A

Goes under the tongue and is absorbed rapidly due to vascularization and bypassing the liver (same as buccal route)

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24
Q

Parenteral Route

A

Fastest absorption, most commonly an injection
Intradermally, subcutaneously, intramuscularly, and intravenously
Bypasses the first-pass effect

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25
Q

Topical Route

A

Delivers a uniform amount of drug over a long period of time

Avoids first-pass effect (except for rectum)

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26
Q

Distribution

A

Transport of a drug by the bloodstream to its site of action

Areas of rapid distribution are heart, liver, kidneys, and brain

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27
Q

Drug molecules not bound to plasma proteins…

A

Go to the site of action

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28
Q

Drugs bound to proteins…

A

Are inactive

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29
Q

Hydrophilic Drugs (Water-Soluble)

A

Smaller volume of distribution and high blood concentrations

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30
Q

Lipophilic Drugs (Fat-Soluble)

A

Higher volume of distribution and low blood concentrations

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31
Q

Metabolism

A

Biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite

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32
Q

Excretion

A

Primary organ is the kidneys, but liver and bowel play roles

Drugs metabolized by the liver are polarized and water-soluble, making elimination easy

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33
Q

Half-Life

A

Measure of the rate at which the drug is eliminated from the body
Most drugs have 5 half-lives

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34
Q

Onset

A

Time required for the drug to elicit a therapeutic response

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35
Q

Duration

A

Length of time drug concentration is sufficient to elicit a therapeutic response

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36
Q

Peak Level

A

Highest blood level

If peak is too high, toxicity may occur

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37
Q

Trough Level

A

Lowest blood level

If trough is too low, drug may not produce a response

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38
Q

Pharmacodynamics

A

Drugs exert actions through receptors, enzymes, and nonselective interactions

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39
Q

Receptor

A

Reactive site on a cell surface
Drug binds to receptor and causes a pharmacologic response
Drug with the greatest affinity will elicit the greatest response

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40
Q

Enzyme Interactions

A

Drugs inhibit (more common) or enhance (less common) the action of a specific enzyme

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41
Q

Nonselective Interactions

A

Main targets are cell membranes and other cellular processes

42
Q

Contraindication

A

Any patient condition that makes the use of a medication dangerous

43
Q

ACUTE THERAPY

A

Involves more intensive drug treatment in those with rapid onset illness to sustain life or treat disease

44
Q

MAINTENANCE THERAPY

A

Prevents progression of a disease or condition

Used for chronic conditions

45
Q

SUPPLEMENTAL THERAPY

A

Supplies the body with a substance needed to maintain normal function

46
Q

PALLIATIVE THERAPY

A

Improves quality of life and provides relief

47
Q

SUPPORTIVE THERAPY

A

Maintains the integrity of body functions while recovering from illness or trauma

48
Q

PROPHYLACTIC THERAPY

A

Drug therapy to prevent illness

49
Q

EMPIRIC THERAPY

A

Drug administration when a certain pathologic condition has a high likelihood of occurrence

50
Q

Therapeutic Index

A

Ratio of a drug’s toxic level to the level that provides benefits
Low index means small difference between therapeutic and toxic dose, small chance of adverse effects
High index has a greater likelihood of causing adverse effects

51
Q

Physical Dependence

A

Physiological need to avoid withdrawal symptoms

52
Q

Psychological Dependence

A

Addiction, desire for the euphoric effects
Also known as addiction
Common with benzodiazepines, opioids, and amphetamines

53
Q

Addictive Effects of Drug Interactions

A

Typical when two drugs with similar actions are used

54
Q

Synergistic Effects of Drug Interactions

A

Occur when two drugs enhance each other’s effects

55
Q

Antagonistic Effects of Drug Interactions

A

When two drugs lessen each other’s effects

56
Q

Incompatibility of Drug Interactions

A

Most common with parenteral drugs

Occurs when solutions are mixed together and chemically deteriorate

57
Q

External ADE

A

Errors by caregivers or malfunctioning equipment

58
Q

Internal ADE

A

Patient misuses medicine or takes with alcohol

59
Q

Medication Error

A

Preventable situation where a “Six Rights” is violated

60
Q

Medication Use Process

A

Prescribing
Dispensing
Administering
Monitoring

61
Q

Idiosyncratic Reaction

A

Occurs unexpectedly, genetically induced

62
Q

Drug-Induced Teratogens

A

Drugs that cross the placenta

63
Q

AGONIST

A

Drug binds to receptor and there is a response

64
Q

ANTAGONIST

A

Drug binds to receptor and there is no response

65
Q

Drug Therapy During Pregnancy

A

First trimester is usually the period of greatest danger of drug-induced developmental defects
Third trimester is the period most likely for drug transfer due to increased blood flow to the fetus, fetal surface area, and increased free drug in mother’s circulation

66
Q

Drug Properties that Influence Transfer Across Placenta

A

Drug’s chemistry, dosage, and concurrently administered drugs

67
Q

Chemical Properties that Influence Transfer Across Placenta

A

Molecular weight, protein binding, lipid solubility, and chemical structure

68
Q

Drug Therapy During Breastfeeding

A

Drug levels in breastmilk are usually lower than those in maternal circulation
Primary drug characteristics include fat solubility, low molecular weight, and high concentration

69
Q

Absorption in Neonatal/Pediatric Patients

A

Gastric pH is less acidic
Gastric emptying is slowed
Reduced first-pass effect due to immature liver
Intramuscular injections are faster and irregular

70
Q

Distribution in Neonatal/Pediatric Patients

A

Low fat content, high water content
Decreased protein binding due to immature liver
Immature blood-brain barrier, more drugs enter the brain

71
Q

Metabolism in Neonatal/Pediatric Patients

A

Decreased levels of microsomal enzymes due to liver

Older children may have increased metabolism

72
Q

Excretion in Neonatal/Pediatric Patients

A

GFR, tubular secretion, and reabsorption are decreased

Decreased perfusion to kidneys leads to decreased renal function, concentrating ability, and excretion of drugs

73
Q

Information Needed to Calculate Pediatric Dosages

A

Drug order
Patient’s weight in kilograms
Pediatric dosage as per manufacturer
Information regarding dosage forms

74
Q

Characteristics of Pediatric Patients that Affect Drug Dosages

A 
Thin and permeable skin
Decreased stomach acid
Decreased mucus barriers in the lungs
Decreased regulation of body temperature
Immature liver and kidneys
75
Q

Information Needed to Correct Pediatric Dosages

A
  1. Determine weight in kilograms
  2. Use the current drug reference to determine the usual dosage range per 24 hours in mg/kg
  3. Determine dose parameters by multiplying weight by minimum and maximum daily doses of the drug
  4. Determine total amount of drug to administer per dose per day
  5. Compare drug dosage with calculated safe range
76
Q

Cardiovascular Systems of Older Adults

A
  1. Decreased CO = Decreased absorption and distribution

2. Decreased blood flow = Decreased absorption and distribution

77
Q

GI Systems of Older Adults

A
  1. Increased pH = Altered absorption

2. Decreased peristalsis = Delayed gastric emptying

78
Q

Livers of Older Adults

A

Tested by AST and ALT

  1. Decreased enzymes = Decreased metabolism
  2. Decreased blood flow = Decreased metabolism
79
Q

Renal Systems of Older Adults

A

Tested by serum creatinine and BUN

  1. Decreased blood flow = Decreased excretion
  2. Decreased function = Decreased excretion
  3. Decreased GFR = Decreased excretion
80
Q

Absorption of Older Adults

A

Increased pH

Decreased gastric emptying and blood flow

81
Q

Distribution of Older Adults

A

Increased fat

Decreased water and protein binding sites

82
Q

Metabolism of Older Adults

A

Decreased microsomal enzymes and liver blood flow

83
Q

Excretion of Older Adults

A

Decreased GFR and nephrons

84
Q

Drug Polymorphism

A

Effect of a patient’s age, gender, size, and body composition on the pharmokinetics of drugs

85
Q

C-I

A 
High abuse potential
No medical use
Severe dependency potential
Only dispensed with approved protocol
Examples: heroin, marijuana, LSD
86
Q

C-II

A 
High abuse potential
Accepted medical use
Severe dependency potential
Dispensed with written prescription only
Examples: codeine, cocaine, morphine, oxycodone, amphetamine
87
Q

C-III

A

Less abuse potential than C-II
Accepted medical use
Moderate dependency potential
Dispensed with written or oral prescriptions
Examples: codeine, pentobarbital rectal suppositories

88
Q

C-IV

A

Less abuse potential than C-III
Accepted medical use
Limited dependency potential
Dispensed with written oral prescriptions
Examples: phenobarbital, benzodiazepines, meprobamate

89
Q

C-V

A

Less abuse potential than C-IV
Accepted medical use
Limited dependency potential
Dispensed with written prescription or OTC

90
Q

Common Errors

A 
Misdiagnosis
Patient misidentification
Lack of patient monitoring
Wrong-site surgery
Medication errors
91
Q

DRUGS COMMONLY INVOLVED IN MEDICATION ERRORS

A

CNS drugs
Anticoagulants
Chemotherapeutic drugs

92
Q

Categories of Medication Errors

A
  1. No error, but the potential to make an error was there
  2. Medication error with no harm
  3. Medication error with harm
  4. Medication error that results in death
93
Q

Prevention Strategies

A
  1. Multiple systems of checks and balances
  2. Prescribers must write legibly
  3. Authoritative resources must be consulted if unclear
  4. Nurses need to check medications three times
  5. “Six Rights” must be followed
94
Q

Reporting Errors

A

Errors must always be reported
Provide only factual information
Note any observed changes

95
Q

Medication Reconciliation

A

Involves verification, clarification, and reconciliation

96
Q

Verification

A

Collection of the patient’s medication with a focus on medications currently used

97
Q

Clarification

A

Professional review of this information to ensure its appropriateness

98
Q

Reconciliation

A

Further investigation of any discrepancies and changes in medication orders

99
Q

Patient and Family Education

A

CORNERSTONE OF DRUG THERAPY

100
Q

Domains of Learning

A

Cognitive (learning new things)
Affective (how you feel about it)
Psychomotor (how to perform)

101
Q

Evaluation of Patient Education

A

VALIDATE WHETHER LEARNING HAS OCCURRED

Pharmacotherapeutics (37 decks)

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