Term
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Definition
to go into solution
disintegration-to break down
dissolution-dissolve into a liquide |
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Term
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Definition
| the time it takes the drug to dissintigrate and dissolve(faster in acidic fluids) |
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Term
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Definition
| the study of what happens to the drug from the point of administration to the point of elimination |
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Term
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Definition
| movement from the site of administration to the bloodstream |
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Term
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Definition
| Movement from the bloodstream to the site of action |
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Term
| Metabolism/biotransformation |
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Definition
| enzymatic alteration of the drug structure. Liver is the primary site |
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Term
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Definition
| the process in which drugs and metabolites are excreted from the body. primary site is the kidneys also via bile, sweat, and breast milk. |
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Term
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Definition
passive
active
pinocytosis
channels/pores |
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Term
| lipid soluble + nonionized(noncharged)= |
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Definition
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Term
| water soluble + ionized (charged)= |
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Definition
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Term
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Definition
| must go through the liver TWICE |
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Term
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Definition
| the percentage of the administered drug that reaches the systemic circulation/blood stream |
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Term
| The most bio-availability= |
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Definition
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Term
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Definition
the process by with the drug becomes available to body fluids and tissues
The transport of the drug from the blood stream to the receptors/site of action |
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Term
| Distribution is influenced by |
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Definition
*Blood Flow (needs good blood supply)
*Affinity to the tissues (vol. water sol. vs. fat sol.,distribution sites i.e blood-brain barrier)
*Protein binding-albumin |
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Term
| Drugs not bound to protein are called |
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Definition
| free drugs-they are the ones that are ACTIVE |
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Term
| What affects the excretion rate? |
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Definition
Acidity of urine
Kidney dz
decreased blood flow to the kidneys |
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Term
| What is the most accurate test to determine renal function? |
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Definition
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Term
| What are the normal values for Creatinine clearance? |
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Definition
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Term
| if the values of Creatinine clearance are low, what can be expected with drug doses? |
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Definition
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Term
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Definition
| Time required for the serum concentration of a drug to decrease by 50% |
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Term
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Definition
evenly distributed concentrations of blood in the blood plasma
administration rate=elimination rate
*dependent on half-life
Note:the longer the half-life, the longer to reach a steady state. |
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Term
| The minimum effective concentration (MEC) |
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Definition
| the least amt for the drug to begin being effective |
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Term
| The MEC must be met in the blood before? |
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Definition
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Term
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Definition
| A large initial dose administered to achieve a rapid MEC |
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Term
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Definition
| how long it takes for the drug to start working (starts MEC) |
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Term
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Definition
| begins when the drug starts producing a response and ends when it stops. |
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Term
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Definition
| the effects of the drug on the body(Mechanism of action) |
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Term
| Drugs produce actions in 3 ways |
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Definition
*Receptor interactions (the better the fit, the better the response)
*Enzyme interactions(alters specific enzyme actions or responses)
*Non-selective interactions(physically interfere with or chemically alter cellular structures or processes) |
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Term
| Drugs that produce a response |
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Definition
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Term
| drugs that block a response |
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Definition
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Term
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Definition
| drugs that affect a particular receptor site vs. affecting various receptor sites |
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Term
| Selective vs. non-selective |
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Definition
| targeting specific receptors vs. affecting various receptors |
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Term
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Definition
highest plasma concentration
indicates rate of absorption |
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Term
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Definition
lowest plasma concentration of drug
indicates the rate of elimination
drawn immediately before next dose |
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Term
| to determine both peak and trough a _______ is required |
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Definition
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Term
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Definition
| desired outcomes for the drug (therapeutic response) |
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Term
| Adverse Drug Reactions (ADR) |
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Definition
| unexpected, unintended, undesired or excessive response to a drug given at therapeutic doses. |
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Term
| A TRUE allergy to a medication involves? |
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Definition
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Term
Neonatal/pediatric considerations:pharmacokinetics
*Absorption |
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Definition
Gastric PH LESS ACIDIC
Gastric emptying is SLOWED
IM absorption FASTER and IRREGULAR |
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Term
Neonatal/pediatric considerations:pharmacokinetics
*Distribution |
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Definition
The younger the person the greater the total body water TBW which means fat content is lower
decreased level of protein binding
immature blood brain barrier-more drugs enter the brain |
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Term
Neonatal/pediatric considerations:pharmacokinetics
*Metabolism |
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Definition
Liver is immature, does not produce enough microsomal enzymes needed to breakdown the meds=toxicity
older children may have an increased metabolism requiring higher doses than infants. |
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Term
Neonatal/pediatric considerations:pharmacokinetics
*Excretion |
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Definition
Kidney immaturity affects GFR & tubular secretion
Decreased perfusion rate of the kidneys may reduce excretion of drugs |
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Term
| Factors affecting pediatric drug dosages |
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Definition
*skin is thin and permeable
*Stomach lacks acid to kill bacteria
*lungs have weaker mucus barriers
Body temp less well regulated and dehydration occurs easily
Liver and kidneys are immature impairing drug metabolism and excretion |
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Term
| Methods of dosage calculations for pediatric pt. |
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Definition
| Age alone is NOT save-must get accurate body weight (mg/kg) |
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Term
| Medication administration for the pediatric pt: Safety Issues |
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Definition
*lack of research done in children
*therapeutic dosage ranges may be unclear
*long-term effects of drugs may be unknown
*CAREFUL calculations and administration is essential |
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Term
| The elderly pt considerations |
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Definition
Polypharmacy-1 in 3 pt. take 8 meds a day
*more meds, more side effects, more potential interactions.
Over 40% use OTC meds |
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Term
| Physiologic changes in the Elderly pt |
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Definition
Aging organs cause potential for drug accumuation and toxicity
*cardiovascular
*Gastrointestinal
*Hepatic
*Renal |
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Term
Geriatric considerations:pharmacokinetics
*Absorbtion |
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Definition
*decreased gastric PH
*slowed gastric emptying
*decreased blood supply to GI tract |
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Term
Geriatric considerations:pharmacokinetics
*Distribution |
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Definition
*TBW % is lower
*Fat content increased
*Decreased production of proteins by the liver resulting in decreased protein binding of drugs and increased circulation of free drugs=toxcicity |
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Term
Geriatric considerations:pharmacokinetics
*Metabolism |
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Definition
*Aging liver produces fewer microsomal enzymes, affecting drug metabolism (must decrease the dose)
*Reduced flow to the liver |
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Term
Geriatric considerations: pharmacokinetics
*Excretion |
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Definition
*Decreased GFR
*Decreased # of intact nephrons |
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Term
| TOP 3 problematic meds for the elderly pt: 1/3 of ALL ED visits by the elderly are due to side effects of the following 3 drugs: |
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Definition
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Term
| Principles of drug therapy for the elderly |
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Definition
*give smallest effective dose "start low, go slow"
*teach them about their meds(hearing aids/glasses in needed)
*Teach someone close to them
*Help them with ways to remember to take their meds
*Emphasize safe storage |
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Term
|
Definition
Asprin
Ibuprofen (motrin)
Celecoxib (Celebrex)
NOT TYLENOL |
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Term
| NSAIDS are divided into two groups |
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Definition
|
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Term
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Definition
| inhibits COX-2 production (Celebrex) |
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Term
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Definition
inhibits both COX-1 and COX-2 production
EX. Motrin and asprin |
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Term
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Definition
| pain (without damaging the stomach lining) |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| prostaglandins that cause inflammation |
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Term
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Definition
| made by the body during stress or injury and sends info to the brain->brain says you are in pain. |
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Term
| If you block prostaglandins |
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Definition
| there will be no info to the brain=no pain |
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Term
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Definition
| work in the periphery by blocking action of cyclooxygenase (COX) thereby decreasing the synthesis of prostaglandins and the inflammatory response. |
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Term
| The goal is to block COX-2 because |
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Definition
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Term
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Definition
*GI upset/bleeding
*Na & water retention leading to edema
*Nephrotoxicity
*Bleeding and bruising
*Cardiac arrythmias, heart attack, stroke
*Hepatotoxicity
*Tinnitus/Hearing loss (Asprin)
*Hypersensitivity |
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Term
| Non-Salicylate NSAID toxicity |
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Definition
**Not usually as serious as ASA toxicity
*drowsiness
*paresthesia
*Aggression
*Seizures
*GI-N&V, GI bleeding
*H/A, dizziness
*Cerebral edema, death |
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Term
| All NSAIDS are contraindicated for pt who are |
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Definition
| hypersensitive to any one specific NSAID |
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Term
| Who else should not use NSAID's? |
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Definition
Any pt. with:
*peptic ulcer disease
*GI or other bleeding disorder
*impaired renal function
*certain CV conditions
*ASTHMA |
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Term
| Adverse reaction to ASA or NSAID within 1-2 hrs of injestion |
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Definition
| *Dyspnea, sinusitis and nasal congestion |
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Term
| Salicylate (ASA) toxicity |
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Definition
*tinnitus/hearing loss (most common cause of chronic toxicity)
*increased HR
*Dimness of vision
*Drowsiness
*Confusion
*N/V & diarrhea
*Sweating/thirst
*Hyperventilation
*Hypo or hyper glycemia |
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Term
| Salicylate (ASA) toxicity TX: |
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Definition
***NO ANTODOTE***
*Reduction or discontinuation of ASA
*Gastric lavage
*dialysis in severe cases |
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Term
| TX of non-Salicylate NSAID toxicity |
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Definition
*Emesis with gastric lavage
*Admin of activated charcoal
*Supportive/symptomatic tx
**Hemodialysis is of NO value** |
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Term
| Acetaminophen (Tylanol) indications: |
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Definition
| mild to moderate pain relief and fever reduction |
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Term
| Acetaminophen (Tylanol) side effects: |
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Definition
*Anorexia
*N&V
*rash
*hepatotoxicity at high doses (greater than 4gm/day) |
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Term
| Tylenol and Nursing Implications |
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Definition
*Moniter for hepatotoxicity
*Teach pt. to monitor all OTC and prescription meds for inclusion of acetaminophen as an ingredient
*Alcoholics should use another category of analgesic. |
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Term
|
Definition
| acetylcysteine (Mucomyst) taken PO or IV |
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Term
|
Definition
|
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Term
|
Definition
| Loading dose + 2 doses ver a period of 21 hrs |
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Term
|
Definition
3,250 mg/day (reg. strength)
3,000mg/day (extra strength) |
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