NURS 2004 Pharmacology Midterm

Any chemical that can effect the living processes

The study of drugs and their interactions with living systems

Use of drugs to diagnose, prevent or treat disease, or prevent pregnancy

Name of the chemical composition of a drug

Name of a drug as assigned by the united states “adopted name council” (same names used in Canada)

Proprietary name of a drug chosen by the company

1. They do not modify existing functions in the body (They DO NOT change the body)

2. They exert their functions on multiple systems (Side effects)

3. They interact with molecules which are normal points of control of physiological processes (how they work)

Benefits must always outweigh the risk of a drug

1. Use single action drugs when possible

2. Start with lowest dose

3. Individualize treatment to the patient

4. Monitor the effects (positive and negative)

Assessment

Diagnosis

Planning

Implementation

Evaluation

Take a medical history

Identify possible risks for the patient (allergies, genetics…)

Observe the appropriateness of a prescribed drug (dangers, risks…)

Identify which interventions should be implemented

Conduct the 10 rights and 3 checks

Assess the patients capacity for self-care

1. Right Patient

2. Right Medication

3. Right Dose

4. Right Time

5. Right Route

6. Right Assessment

7. Right Evaluation

8. Right Education

9. Right to Refuse

10. Right Documentation

1. When you get the medication

2. When you’ve drawn your medication

3. At the bedside BEFORE giving the medication

Implement non-drug therapies as well

Verify satisfaction with the drug

Observe adverse reactions / interactions

The movement of drugs throughout the body

The molecular effect of drugs on the body (what the drug does when it gets to where it needs to go)

1. Pharmacokinetics (absorption, distribution, metabolism excretion)

2. Pharmacodynamics (drug receptor interaction)

1. Drug absorption

2. Drug Distribution

3. Drug metabolism

4. Drug secretion

1. Through the cell membrane

2. Through channels / ports

3. With the aid of transport systems

1. Rate of dissolution

2. Surface area

3. Blood flow to admission site

4. Lipid solubility

5. pH

Lower dose, because there are more free radicals to bind to sites

Higher dose, because there are less free radicals (they’re all binding to proteins)

The chemical changing of a drug

Liver function

Lifestyle (substance abuse)

Diseases

When the liver absorbs a medication, and reduces the amount of drug that reaches the bloodstream

1. Glomerular Filtration

2. Passive tubular reabsorption

3. Active tubular secretion

No

Less nephrons, meaning less filtration sites

Duration and intensity of drugs can increase

Breast milk, bile, lungs, sweat and saliva

How long it takes for a drug to start taking effect

Point in time where a drug is working best - when the highest dose is in the blood

How long a drug has a therapeutic effect on the body

Optimal range for medication concentration in the blood plasma, which falls between Minimum effective concentration and Toxic concentration

Attains quicker therapeutic action, and is followed by lower maintenance doses to maintain a therapeutic drug plasma concentration

The time required for the amount of drug in the body to decrease by 50%

Longer, because it takes more time for the drug to leave the body

Shorter, because to maintain therapeutic levels, more doses would need to be administered as it leaves the body quickly

6.25mg

The maintained level of a drug in the blood plasma after repeatedly administering doses. This means the amount of drug excreted is equal to that of the administered dose.

4

1. A drugs half life

2. Dosing frequency

3. Plasma drug levels

4. Dosage amount

5. Rate of absorption

6. Route

7. Patient’s metabolism

8. Excretion of the drug

The relationship between the administered dose and the intensity of the response produced.

To identify the minimal amount of drug needed to get the maximum response

The largest effect that a drug can produce (no longer any more effective if we add more drug)

The amount of drug that needs to be in the blood plasma to have an effect on the body

Efficacy: How well one dose works in a patient

Potency: How much drug is needed for the effect of the drug to become beneficial

Medication that has molecules which bind to, and activate receptors to mimic the action of the body’s own regulatory molecules

Medication that has molecules which block receptor activation that happens in the body’s own regulatory mechanisms

Yes, taking more than one medication (even if not prescribed) can lead to drug interactions

No, some drug interactions can be desired

Caffeine, nicotine, alcohol, recreational drugs

Sulbactam and Ampicillin

Aspirin and Warfarin

1. Direct chemical / physical interactions (eg., mixing)

2. Pharmacokinetic interactions (one drug alters the concentration of another)

3. Pharmacodynamic interactions (One drug alters the effect of another)

4. Combined toxicity

No, you should never administer a precipitate

1. Drugs that elevate gastric pH

2. Laxatives (if absorbed in intestines)

3. Drugs that suppress peristalsis (giving more/less time for absorption)

4. Drugs that induce vomiting (IV or injection would be more preferable in this case)

5. Drugs that absorb other drugs

6. Drugs that reduce regional blood flow

Competition for protein binding sites

Transmembrane protein that transports a wide variety of drugs OUT of cells

1. Intestinal epithelium (absorption in the intestine)

2. Placenta (drug export from placental cells to maternal cells)

3. Blood brain barrier (drug export from cells of brain in the capillaries into the blood)

4. Liver (blood export from liver into bile)

5. Kidney Tubules (drug export from renal tubular cells into urine)

1. Minimize the amount of drugs a patient is taking

2. Take a thorough drug history

3. Be aware of possible “hidden” drug use

4. Adjust dosage as metabolizing inducers or protein binding drugs are added

5. Adjust the timing of administration

6. Monitor for signs of early toxicity

Inhibits drug metabolism (When you cant metabolize a drug there is more in the blood)

Approximately 1 hour BEFORE the meal (DIFFERENT FOR INSULIN!!!)

Approximately 2 hours AFTER a meal

Yes, nearly everything in the body can interact with medications in the body. Herbal medicine interactions are just as likely as drug interactions

Any reaction to a drug that is an undesired effect (excludes excessive dosing). These effects range from annoying to life threatening

Young patients and the elderly

Low neutrophil count which leads to increased risk of infection

The degree of sensitization of the immune system - not the drug dosage (Immune response DOES NOT occur at first exposure, because you NEED to create antibodies FIRST)

No, a patients sensitivity can change over time

An uncommon drug response resulting from a genetic predisposition (usually brief)

Develops over long term use of certain drugs where the body had adapted to drug exposure where the drug is needed to function properly

Results when drug use is discontinued

Addiction: Withdrawal from drugs with phycological component of dependance

Abstinence syndrome: Withdrawal of drugs with physical component of dependance

Cancer causing

Remember benefit MUST outweigh the risk

Drug-Induced birth effect (or miscarriage)

Drugs that are converted to toxic products that injure liver cells (VERY important to monitor for liver failure - jaundice, dark urine, light colored stools, vomiting, abdominal discomfort)

Measure of time required for the ventricles to repolarize after each contraction

The ability of some drugs to prolong the QT interval on ECGs

Only ever give ONE QT DRUG at a time

1. Body weight and composition

2. Body surface area

3. Age

Kidney disease causes poor kidney function, which means increased toxicity (blood-drug levels)

Liver disease causes poor metabolic activity, which means increased blood toxicity

pH changes can alter absorption, distribution, metabolism, and excretion of drugs

7.35 - 7.45

Decreased responsiveness to a drug (caused by receptor changes) as a result of repeated drug administration

1. Pharmacodynamic tolerance (less sensitive to drug presence

2. Metabolic tolerance (accelerated drug metabolism)

3. Tachyphylaxis (caused by repeated dosing over a short time)

The extent to which a drug becomes completely available to its intended biological destination(s).

The study of how genes affect individual drug responses

1. Failure to take medication as prescribed

2. Drug interactions

3. Diet

Erosion of the gut wall

When any region is exposed to acid’s pepsin

The lesser curvature of the stomach and the duodenum

Abdominal pain after a meal or on an empty stomach

Abdominal pain relieved by food or antacids

Weight loss or poor appetite

Bloating, nausea, poor appetite

Gastrointestinal bleeding (in severe cases) resulting in vomit in blood, or stool

Prostaglandins, which stimulate mucus production and vasodilation while suppressing secretion of gastric acids

Peptic ulcer disease

1. Antibiotics

2. Anti-secretory agents

3. Mucosal protectants

4. Antacids

5. Histamine (H2) receptor antagonists

Prevents stimulation of the H+ receptors, decreasing acid concentration, and production of gastric acid. Usually given PO.