Term
| Absorption, distribution, metabolism, and excretion |
|
Definition
|
|
Term
| Science that studies the effects of drugs within a living system and about the knowledge of the pharmacokinetic properties |
|
Definition
|
|
Term
| Biochemical and physical effects and mechanism of action |
|
Definition
|
|
Term
| Science of harmful effects |
|
Definition
|
|
Term
| Clinical indications, prevention, diagnosis, and treatment of a living organism |
|
Definition
|
|
Term
|
Definition
|
|
Term
| No accepted medical use, high abuse potential |
|
Definition
|
|
Term
| Accepted medical use, but high potential for abuse and/or dependence |
|
Definition
|
|
Term
| Less abuse potential, moderate dependence possible |
|
Definition
|
|
Term
| Lower abuse potential with limited dependence |
|
Definition
|
|
Term
| Low abuse potential, limited dependence, may require prescription or may be OTC |
|
Definition
|
|
Term
| Sole legal drug enforcement agency in US |
|
Definition
|
|
Term
| In Colorado, MDs and PAs can order which schedules of drugs? |
|
Definition
|
|
Term
| When can a nursing student take a verbal order for a medication? |
|
Definition
|
|
Term
| Who is legally responsible if the doctor writes an order for the wrong drug and the nurse gives it? |
|
Definition
| ALWAYS THE NURSE. THE NURSE IS ALWAYS WRONG :) |
|
|
Term
| 5 Areas in Patient Teaching in Drug Therapy |
|
Definition
- Oral followed by written material
- Reason for use
- How to take it (frequency, dosage, what to avoid)
- Possible adverse reactions
- When to call or return to providor
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|
|
Term
| Pregnancy category with adequate studies and no fetal risk |
|
Definition
|
|
Term
| Pregnancy category with adequate animal studies and no well-controlled studies in pregnant women |
|
Definition
|
|
Term
| Pregnancy category with adverse fetal effects in animal studies, but benefits may be acceptable in humans despite risks |
|
Definition
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|
Term
| Pregnancy category with human fetal risk, but benefits may be acceptable despite risks |
|
Definition
|
|
Term
| Pregnancy category with known animal and human fetal abnormalities, and should not be used in pregnant women |
|
Definition
|
|
Term
| 7 Drugs Considered Safe During Pregnancy |
|
Definition
- Tylenol
- Anti-asthmatics
- Heparin
- Insulin
- Anti-emetics
- Aldomet, Digoxin
- Selected Antibiotics
|
|
|
Term
| Elderly constitute 12% of the US population but use ____% of the nation's prescribed drugs |
|
Definition
|
|
Term
| 4 Principle Factors Underlying Drug Problems in Elderly |
|
Definition
- Altered pharmacokinetics
- Multiple and severe illnesses
- Multiple-drug therapy
- Poor adherence
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|
|
Term
| Drug list that identifies drugs with a high likelihood of causing adverse effects in the elderly |
|
Definition
|
|
Term
| Elderly (mostly) patients taking multiple drugs |
|
Definition
|
|
Term
| Polypharmacy makes it more likely to have what? |
|
Definition
| Drug-to-drug interactions |
|
|
Term
| As many as ______% or more of elderly patients fail to take their medications as prescribed |
|
Definition
|
|
Term
| Nonadherence can result in what two things? |
|
Definition
- Therapeutic Failure (underdosing)
- Toxicity (overdosing)
|
|
|
Term
| Is therapeutic failure or toxicity more common in the elderly? |
|
Definition
| Therapeutic Failure (90%) |
|
|
Term
| 4 Contributing Factors to Unintentional Nonadherence |
|
Definition
- Forgetfulness
- Failture to comprehend instructions
- Inability to pay for drugs
- Use of complex regimens
|
|
|
Term
| 3 Contributing Factors to Intentional Nonadherence |
|
Definition
- Patient belief that the drug is simply not needed in dosage prescribed
- Unpleasant side effects
- Expense
|
|
|
Term
| Factors that Contribute to Poor Adherence in the Elderly |
|
Definition
- Multiple chronic disorders
- Multiple Rx medications
- Multiple doses/day for each med
- Multiple prescribers
- Cahnges in regimen
- Cognitive or physical impairment
- Living alone
- Recent discharge from hospital
- Low literacy
- Inability to pay for drugs
- Personal conviction drug is unnecessry or dosage is too high
- Presence of side effects
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|
Term
| A drug that has strict prescribing and availability criteria because of its potential for addiction or abuse |
|
Definition
|
|
Term
|
Definition
|
|
Term
| 3 Steps in Case of Medication Error |
|
Definition
- Inform supervisor and provider STAT
- Complete incident report (not filed in patient chart)
- Provider typically informs patient/family of error
|
|
|
Term
| How to Report a Medication Error |
|
Definition
| Medication Errors Reporting (MER) Program |
|
|
Term
| "What the body does to the drug" |
|
Definition
|
|
Term
| "What the drug does to the body" |
|
Definition
|
|
Term
| What does ADME stand for? |
|
Definition
- Absorbed into body fluids
- Distributed to sites of action or storage
- Metabolized or biotransformed
- Excreted from body
|
|
|
Term
| What physiochemical properties affect ADME? |
|
Definition
- Drugs are typically weak acids or weak bases
- Acids are absorbed in acidic stomach
- Bases are absorbed in alkaline intestine
|
|
|
Term
| What chemical properties affect ADME |
|
Definition
- Ionized (polar) form is usally water soluble
- Non-ionized (nonpolar) form is more lipid soluble
|
|
|
Term
| Which form is more apt to cross cell membrane, ionized or non-ionized? |
|
Definition
|
|
Term
| Are most weak bases polar or nonpolar? |
|
Definition
|
|
Term
| Process involving movement of drug molecules from site of entry into the circulating fluids |
|
Definition
|
|
Term
| 5 factors that affect absorption |
|
Definition
- Absorbing surface
- Blood flow to site of administration
- Ionization (ionized solutions don't cross cell membrane easily)
- Stability of drug in the acid/alkaline environment
- pH of local environment enhances or retards absorption
|
|
|
Term
| How are water-soluble drugs absorbed in the GI tract? |
|
Definition
| Must first be dissolved in water |
|
|
Term
| What 3 factors that affect absorption can be changed? |
|
Definition
- Alcohol in stomach (changes dissolving)
- Nicotine (lowers plasma enzymes and can increase or decrease metabolism)
- Caffeine (increases stimulation including gastric motility)
|
|
|
Term
| What environmental impact changes absorption? |
|
Definition
|
|
Term
| When a medication error is reported, where is the information forwarded? |
|
Definition
- FDA
- ISMP
- Product Manufacturer
|
|
|
Term
| What kind of drugs are most likely to cross the blood-brain barrier? |
|
Definition
| Nonpolar/Non-ionized (more lipid soluble) |
|
|
Term
| Heat, cold, massage, vasoconstriction, and vasodilation affect what? |
|
Definition
|
|
Term
| Transport from bloodstream to body tissues and site of action |
|
Definition
|
|
Term
| Easier than absorption and more rapid |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Allow drug accumulation to occur |
|
Definition
|
|
Term
| Drug that is available to body at cellular level |
|
Definition
|
|
Term
| Reservoir drug that becomes free slowly |
|
Definition
|
|
Term
| Drugs attach mainly to this protein |
|
Definition
|
|
Term
| How does low albumin affect drug distribution? |
|
Definition
| The drug is used up faster, because there is more free drug, which makes it more toxic to cell. It might need to be given more frequently and in lower doses. |
|
|
Term
| The process of chemically altering a drug for use or inactivating a drug into a metabolite that can be excreted |
|
Definition
|
|
Term
| What kind of drug can be metabolized? |
|
Definition
|
|
Term
| Inactive substance that must be converted to an active form |
|
Definition
|
|
Term
| Liver Phases in Metabolism |
|
Definition
- Phase I - Oxidation
- Phase II - Conjugation
|
|
|
Term
| Where O2 attaches to molecule in liver |
|
Definition
|
|
Term
| In liver when another chemical group attaches to the drug and changes it into a different compound or more polar, making it excretable by the kidney |
|
Definition
|
|
Term
| Portal circulation from the GI tract that is only in effect for oral/enteral drugs |
|
Definition
|
|
Term
| For many drugs ___% is gone in the first pass |
|
Definition
|
|
Term
| 2 ways to bypass first pass effect |
|
Definition
- Increase Dose
- Increase Frequency
|
|
|
Term
| Enzyme system in the liver involved in drug metabolism |
|
Definition
| CYP450 Cytochrome Enzyme System |
|
|
Term
| How many channels and isoenzymes involved in CYP450? |
|
Definition
| 12 channels with several subchannels and 50 isoenzymes |
|
|
Term
| How many channesl are typically used in CYP450? |
|
Definition
|
|
Term
| What percent of drugs go through only 6 channels of CYP450? |
|
Definition
|
|
Term
| How does CYP450 affect drug metabolism? |
|
Definition
| If more than 1 drug competes for the same channel, there can be competition to get through |
|
|
Term
| What is the most common type of CYP450 drug? |
|
Definition
|
|
Term
| How do inhibitors affect drug-drug interactions in CYP450? |
|
Definition
- Slows metabolism
- 2nd drug accumulates toxic levels
|
|
|
Term
| How do inducers affect drug-drug interactions in CYP450? |
|
Definition
- Drugs stimulate production of enzymes
- Increases rate of metabolism
- Clears 2nd drug out of the system faster
|
|
|
Term
| Can a drug be an inducer and inhibitor at the same time? |
|
Definition
| Yes, it can inhibit one channel and induce another |
|
|
Term
| 8 factors that affect metabolism |
|
Definition
- Age
- Nutrition status (especially protein status)
- Liver disease
- Presence of other drugs
- Alcohol (induces CYP2E1)
- Smoking (induces CYP1A)
- Change in fluid levels and hormone interactions
- Time of day (circadian rhythms)
|
|
|
Term
| Metabolism can affect ___ of drug and may require adjustment of dosage and freqency |
|
Definition
|
|
Term
| Process by which drugs and metabolites are removed from the body |
|
Definition
|
|
Term
| Most important route of excretion |
|
Definition
|
|
Term
| How are water-soluble drugs excreted? |
|
Definition
|
|
Term
| How are lipid-soluble drugs excreted? |
|
Definition
| Reabsorbed by teh tubules and re-enter systemic circulation. Must leave the body via other routes, or get another chance at becoming water-soluble during liver processing. |
|
|
Term
| 5 Excretion Sites (other than kidneys) |
|
Definition
- GI Tract (bile, feces)
- Lungs (volatized in intact form)
- Sweat and Salivary Glands
- Mammary Glands (breast milk)
- Hemo-dialysis (Filters the blood)
|
|
|
Term
| In mechanisms of drug action, _____ or _____ are not the determing factor for creating a response |
|
Definition
| Volume or Weight (compare typical doses of each druginstead) |
|
|
Term
| How do generic drugs affect bioavailability? |
|
Definition
| The drug does not have to be evenly distributed throughout the tablet, and this can be an issue when splitting pills |
|
|
Term
| Time from administration to first appearance of drug effect |
|
Definition
|
|
Term
| Time from administration to peak effect of drug |
|
Definition
|
|
Term
| Time from first to last measurable effect |
|
Definition
|
|
Term
| Lowest plasma concentration that still produces an effect |
|
Definition
| Minimum Effective Concentration |
|
|
Term
| The maximum ability of a drug to initiate biologic activity as a result of binding |
|
Definition
|
|
Term
| Maximum strength per mg of drug |
|
Definition
|
|
Term
| Accumulation of doses to keep fairly constant concentration (what is taken in replaces what is eliminated) |
|
Definition
|
|
Term
| Proteins on the surface of cell membranes which, when stimulated, create a response |
|
Definition
|
|
Term
| Chemical attraction to binding |
|
Definition
|
|
Term
| Drugs which bind with receptors and produce and effect |
|
Definition
|
|
Term
| Agonists have affinity and ______ |
|
Definition
|
|
Term
| Drugs which interact with receptors but do not create a response |
|
Definition
|
|
Term
| Antagonists have affinity but ______ |
|
Definition
|
|
Term
| Some portion of the drug combines with some molecular structure on teh cell membrane, producing a biological effect |
|
Definition
| Drug-receptor Interaction |
|
|
Term
| Enzyme combines with drug instead of the normal substrate molecule |
|
Definition
|
|
Term
| Interaction that produces a more general effect on cell membranes |
|
Definition
| Nonspecific Drug Interaction |
|
|
Term
| The amount of time it takes to reduce the amount of unchanged drug by 50% |
|
Definition
|
|
Term
| How does a short t 1/2 affect dosing? |
|
Definition
| Short t 1/2 means more frequent dosing or larger dosing so it lasts longer |
|
|
Term
| Dose needed for drug to be effective for 50% of population |
|
Definition
|
|
Term
| Lethal dose for 50% of population |
|
Definition
|
|
Term
| The ratio between the lethal dose and the dose needed for an effect |
|
Definition
|
|
Term
|
Definition
| LD/ED (Lethal Dose/Effective Dose) |
|
|
Term
| What TI shows the greatest danger? |
|
Definition
| The closer to 1, the greater the danger |
|
|
Term
| The time when dosing is effective by not toxic |
|
Definition
| Therapeutic Window (Therapeutic Range) |
|
|
Term
| What happens with twice the dose half as often? |
|
Definition
| High fluctuations in blood levels, could be from ineffective to toxic in peaks and troughs |
|
|
Term
| What happens with half the dose twice as often |
|
Definition
| Low blood levels, could be below min effective concentration and min inhibition concentration |
|
|
Term
| 80% of drugs are given this way |
|
Definition
|
|
Term
| Nasogastric or gastric tube or rectal administration |
|
Definition
|
|
Term
| Administration using SC, IM, IV, intrathecal, epidural, other fluids |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Skin, eyes, ears, nose administration |
|
Definition
|
|
Term
| 1-2 hours after oral delivery or 30 minutes after IV delivery |
|
Definition
|
|
Term
| Residual amount right before next delivery |
|
Definition
|
|
Term
| Another term for steady state |
|
Definition
|
|
Term
| A constant dose given at regular intervals to produce blood concentrations at relatively constant levels |
|
Definition
|
|
Term
| How many t 1/2 does it take to reach a steady state? |
|
Definition
|
|
Term
| Large initial dose to bring blood levels to desired concentration |
|
Definition
|
|
Term
| Amount needed to achieve desired therapeutic response |
|
Definition
|
|
Term
| How much drug is present over repeated dosing |
|
Definition
|
|
Term
| Decreased response that occurs after repeated drug administration |
|
Definition
|
|
Term
| Physical or psychological cravings for a drug |
|
Definition
|
|
Term
| An abnormal response thought to be related to genetic enzymatic deficiencies |
|
Definition
|
|
Term
| When drug effects are modified by another substance |
|
Definition
|
|
Term
| How does drug competition for protein binding affect concentrations and effects of drugs? |
|
Definition
| The drug with a greater affinity for binding will have more drug reservoir and less free drug. The 2nd drug will have more free drug, which could lead to toxicity or greater effects (unintended) of the 2nd drug and fewer effects of the bound drug. |
|
|
Term
| Unexpected, undesired, excessive response to a medication that leads to harm, disability, hospital stay, etc. |
|
Definition
|
|
Term
| 4 Types of Adverse Drug Effects |
|
Definition
- Dose-related (toxic) Reactions
- Drug-drug and Drug-food Interactions
- Hypersensitivity (allergic reactions)
- Idiosyncratic Reaction
|
|
|
Term
| Can be an allergic or non-allergic reaction |
|
Definition
| Hypersensitivity Reaction |
|
|
Term
| Symptoms of allergic reactions |
|
Definition
- Urticaria (hives)
- Pruritis (itching)
- Bronchospasm
- Wheezing
- Vomiting
- Diarrhea
- Anaphylaxis
|
|
|
Term
| Timing of allergic reaction |
|
Definition
| Minutes to hours after exposure |
|
|
Term
| Timing of non-allergic hypersensitivity reaction |
|
Definition
| 2 days to 3 weeks after exposure |
|
|
Term
| Symptoms of non-allergic hypersensitivity reaction |
|
Definition
- Hemolytic anemia
- Glomerulonepthritis
- Lymphadenopathy
- Thrombocytopenia
- Neutropenia
- Arthralgia
- Toxic epidermal necrolysis
- Steven's Johnsons symdrome
|
|
|
Term
| 4 Types of Drug-drug Interactions |
|
Definition
- Potentiation
- Interference
- Displacement
- Antagonism
|
|
|
Term
| Drugs with similar actions cause an additive effect |
|
Definition
|
|
Term
|
Definition
| Coumadin and aspirin taken together cause excessive bleeding |
|
|
Term
| One drug accelerates or slows the metabolism or excretion of another drug through the CYP450 system |
|
Definition
|
|
Term
|
Definition
| Eythromycin taken with Digoxin elevates blood levels of digoxin and with coumadin elevates blood levels of coumadin |
|
|
Term
| Two drugs compete for protein binding sites |
|
Definition
|
|
Term
|
Definition
| One drug wins and is bound to protein, while the other is free in higher levels in the body |
|
|
Term
| One drug decreases the effectiveness of another drug because of divergent actions |
|
Definition
|
|
Term
|
Definition
| Oral ketoconazole is absorbed in an acidic environment. H2-receptor antagonists or proton pump inhibitors decrease acidity in stomach, changing the effectiveness of ketoconazole. |
|
|
Term
| Effect of Grapefruit Juice and CYP System |
|
Definition
| Grapefruit juice inhibits CYP450 by binding to an isoenzyme and decreasing the first pass effect. This allows less medication to be metabolized, leading to more drug circulating in the body. This can increase the therapeutic and toxic effects of the drug. (especially with calcium blockers) |
|
|
Term
| MAOs can't be taken with what food? |
|
Definition
| Tyramine (hypertension and intracranial bleeding) |
|
|
Term
| Oral anticoagulants can't be taken with what food? |
|
Definition
| Vitamin K (antagonistic effect) |
|
|
Term
| Tetracycline can't be taken with what food? |
|
Definition
| Dairy Products (cause the antibiotics to not be absorbed) |
|
|
Term
| Iron taken with what food causes an increase in absorption? |
|
Definition
|
|
Term
| If the doses of IV and oral meds are different, why is the duration of action the same? |
|
Definition
| Impact at cellular level is the same |
|
|
Term
| Why do we know so little about gender differences in drugs? |
|
Definition
| Until recently, most studies were conducted on men |
|
|
Term
| What is the gender difference with digoxin? |
|
Definition
| When used to treat heart failure, may increase mortality in women, while having no effect on mortaility in mend |
|
|
Term
| What is the gender difference with alcohol? |
|
Definition
| Alcohol is metabolized more slowly by women than men. So, if a man and woman drink the same amount (based on weight), the woman will become more intoxicated. |
|
|
Term
| What is the gender difference in opioid analgesics? |
|
Definition
| They are more effective in women than men, so lower doses can be used in women |
|
|
Term
| What is the gender difference with quinidine? |
|
Definition
| It causes greater QT interval prolongation in women. As a result, women are more likely to develop torsades de pointes, a potentially fatal cardiac dysrhythmia |
|
|
Term
| When do you administer pain medication? |
|
Definition
| Before pain reaches it peak to maximize effectiveness |
|
|
Term
| Anesthetics work by depressing the ______ |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Anesthetic on small body region, procedural area |
|
Definition
|
|
Term
| Anesthetic that causes state of unconsciousness, used for surgery |
|
Definition
|
|
Term
| Anesthetic used on larger body region that targets nerves |
|
Definition
|
|
Term
| Reduce undesirable effects of anesthesia, reduce apprehension |
|
Definition
|
|
Term
|
Definition
- Inhalation (gas/liquid)
- IV Agents
|
|
|
Term
| Anesthetic can be given _____ or _____ |
|
Definition
|
|
Term
| Involves a combination of drugs, each with a specific effect |
|
Definition
|
|
Term
| Stages of General Anesthesia |
|
Definition
- Stage 1 - Analgesia
- Stage 2 - Excitement
- Stage 3 - Surgical Anesthesia
- Stage 4 - Medullary Paralysis
|
|
|
Term
| Stage of anesthesia with loss of consciousness |
|
Definition
|
|
Term
| Stage of anesthesia where reflexes are still present and they may be exaggerated |
|
Definition
|
|
Term
| Stage of anesthesia that can be toxic and involve respiratory arrest and vasomotor collapse |
|
Definition
| Stage 4 Medullary Paralysis |
|
|
Term
| Stage of anesthesia with increasing depth of anesthesia, affect on respiration, loss of reflexes, flaccidity, and lower body temperature |
|
Definition
| Stage 3 Surgical Anesthesia |
|
|
Term
| Inhalation anesthetic used by dentists |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Why is nitrous oxide a popular drug? |
|
Definition
| High analgesia but with low anesthesia |
|
|
Term
| 3 volatile inhalation anesthetics that can be mixed with O2 or nitrous |
|
Definition
- Halothane
- Isoflurane
- Ethrane
|
|
|
Term
| Are IV anesthetics used alone? |
|
Definition
|
|
Term
| The exception to the clear IV rule |
|
Definition
|
|
Term
|
Definition
| Profound respirations and hypotension |
|
|
Term
| What is the allergy risk with propofol? |
|
Definition
|
|
Term
| Why does propofol cause an increased risk of bacterial infection? |
|
Definition
| Thicky and sticky, which makes it hard to flush the IV line and bacteria love living in that environment |
|
|
Term
| Use propofol with caution in what two conditions? |
|
Definition
|
|
Term
| In spinal anesthesia, patients can awake with _____, which might be suggestive rather than causative |
|
Definition
|
|
Term
| Headaches in spinal anesthesia usually only occur with larger __________ |
|
Definition
|
|
Term
| How long is bedrest with spinal anesthesia? |
|
Definition
|
|
Term
| After spinal anesthesia, release will not happen until what happens? |
|
Definition
|
|
Term
| Stabilizes or elevates threshold of excitation of nerve cells, prevents depolarization and transmission of nerve impulses |
|
Definition
| Regional and Local Anesthetics |
|
|
Term
| What is the effect of local and regional anesthetics? |
|
Definition
| Loss of sensation without skeletal muscle involvement |
|
|
Term
| Affects distal nerve endings |
|
Definition
|
|
Term
| Topical anesthetic with short duration |
|
Definition
|
|
Term
| Topical anesthetic with long duration |
|
Definition
|
|
Term
|
Definition
- Fingers
- Ears
- Nose
- Toes
- Ohs
|
|
|
Term
| Local anesthetics mixed with ____ can cause ischemia |
|
Definition
|
|
Term
| Local anesthetics can be mixed with what for dual action? |
|
Definition
|
|
Term
| How often do you take VS during recovery from anesthesia? |
|
Definition
| Every 15 minutes or sooner |
|
|
Term
| What two areas are critical to monitor with anesthesia patients? |
|
Definition
|
|
Term
| What drug can be given for shivering after surgery? |
|
Definition
|
|
Term
| What 3 drugs are most commonly used in balanced anesthesia? |
|
Definition
- Barbiturates (for induction)
- Neuromuscular Blocking Agents (for muscle relaxation)
- Opioids and Nitrous Oxide (for analgesia)
|
|
|
Term
| Index of inhalation anesthetic potency |
|
Definition
| MAC (Minimum/Median Alveolar Concentration) |
|
|
Term
| How is it suspected inhalation anesthetics work? |
|
Definition
| Selctive alteration of synaptic transmission |
|
|
Term
| 6 Adverse Effects of Inhalation Anesthetics |
|
Definition
- Respiratory/Cardiac Depression
- Sensitization of the Heart to Catecholamines
- Malignant Hyperthermia
- Aspiration of Gastric Contents
- Hepatotoxicity
- Toxicity to Operating Room Personnel
|
|
|
Term
| Most Significant Adverse Effect of Spinal Anesthesia |
|
Definition
|
|
Term
| 2 categories of analgesic meds |
|
Definition
|
|
Term
| Narcotics act on which nervous system? |
|
Definition
|
|
Term
| Non-narcotics act on which nervous system? |
|
Definition
| Peripheral (PNS) - Voluntary and Autonomic |
|
|
Term
| A drug that produces a response |
|
Definition
|
|
Term
| A drug that produces a partial response |
|
Definition
|
|
Term
| A drug with mixed effects on receptors |
|
Definition
|
|
Term
| Difference between tolerance and addiction |
|
Definition
- Tolerance - body builds up a tolerance to the drug and increasing amounts must be used to produce THERAPEUTIC effect
- Addiction - person requires increasing amounts for RECREATIONAL effect and would change lifestyle to procure it
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Term
| Why is tolerance to respriratory depression good? |
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Definition
| When higher doses of drug are needed, the risk remains relative |
|
|
Term
| Why are higher doses needed with physical dependence and addiction? |
|
Definition
| Dopaminergic reward system never reaches original high |
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|
Term
| 2 Life-threatening Side Effects of Narcotics |
|
Definition
- Respiratory Depression (increase in CO2 levels, decrease in respirations)
- Decrease in Blood Pressure
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|
Term
| 3 Interventions with Narcotic Side Effects |
|
Definition
- Bag Valve Mask and Supplemental O2
- Reversal Drugs
- Protect Airway (suction and positioning)
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|
Term
| Narcotic Overdoe Symptoms |
|
Definition
- Pinpoint Pupils
- Bradypnea (less than 8 respirations)
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Term
| Opiates increase the effects of what 5 meds? |
|
Definition
- Alcohol
- Sedatives
- Hypnotics
- Antipsychotic Meds
- Muscle Relaxants
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Term
| Drug for overdose of narcotic |
|
Definition
- Narcotic Antagonist
- Example - Narcan (Naloxone)
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|
Term
| How does a narcotic antagonist work? |
|
Definition
- Blocks receptor site and displaces narcotic
- These drugs have a higher affinity to the opiate receptor site thanthe narcotic taken
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|
Term
| How does the t 1/2 of narcan affect dosing? |
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Definition
| Usually shorter than t 1/2 of narcotic, so the dose must be repeated |
|
|
Term
| What is an off-label use of Lomotil? |
|
Definition
|
|
Term
| What is an off-label use of Codeine and hydromophone? |
|
Definition
| Antitussive (effective, but have abuse potential) |
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|
Term
| What is an off-label use of Dextromethorphan? |
|
Definition
| Antitussive (chemically related to opiates, but few effects other than antitussive, so it's in a lot of OTC cold meds) |
|
|
Term
| What is an opioid-like analgesic that is synthetic, but binds to mu receptors and has an effect on moderate to severe pain? |
|
Definition
|
|
Term
| When is tramadol contraindicated? |
|
Definition
| Patients with narcotic dependence or addiction |
|
|
Term
| What doees NSAID stand for? |
|
Definition
| Nonsteroidal Anti-inflammatory Drugs |
|
|
Term
| How do NSAIDS reduce pain? |
|
Definition
- Inhibiting chemical mediators
- Inhibit prostoglandins by interacting with cyclooxygenase
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|
|
Term
| NSAIDS are not only analgesics, but also ________ |
|
Definition
|
|
Term
| NSAIDS work by inhibiting what? |
|
Definition
|
|
Term
| Most famous COX1 inhibitor |
|
Definition
|
|
Term
|
Definition
- Inhibition of platelet aggregation
- Antipyretic
- Anti-inflammatory
- Don't need to use opioids
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|
|
Term
|
Definition
- Gastric ulcers that can bleed to death
- Gastritis issues
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|
|
Term
| Aspirin decreases the stickiness of platelets for how long? |
|
Definition
7 days (the entire life of the platelet)
this effect is permanent. Will not have the proper effect of platelets until new ones are formed.
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|
|
Term
| Aspirin helps to prevent what 2 things? |
|
Definition
- Colon Cancer
- Prophylaxis of recurrent MI or stroke
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|
|
Term
| What dose of aspirin is taken for MI and stroke prevention? |
|
Definition
|
|
Term
| Why is aspirin never given to children? |
|
Definition
|
|
Term
| What age should never be given aspirin? |
|
Definition
|
|
Term
| Can alcohol and aspirin be mixed? |
|
Definition
|
|
Term
| Drug-drug Interactions of ASA |
|
Definition
- Heavily Protein-bound
- Anti-coagulants
- Alters pH (metabolic acidosis)
- Gastric Irritation
- Alcohol
|
|
|
Term
| Symptoms of mild toxicity of ASA |
|
Definition
- Tinnitus
- Headache
- Dizziness
- Drowsiness
- Confusion
- Paresthesias
- Ventilatory Stimulation
- GI Distress
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|
|
Term
| Symptoms of Salicylate Poisoning |
|
Definition
- Alterered respirations (increased, then depression)
- Altered fluid/lytes and acid-base balance (alkalosis to acidosis)
|
|
|
Term
| What is the antidote to ASA poisoning? |
|
Definition
|
|
Term
| What is the treatment for ASA poisoning? |
|
Definition
- The sooner the better
- Can give something basic, like Sodium Bicarb
- Ventilatory support
- Correct acid-base imbalance
- Hasten excretion
- Watch for GI bleeding
- Expect effects of severe anticoagulation
- Renal failure if already renal insufficiency
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|
|
Term
|
Definition
|
|
Term
| Are other NSAIDS salicylates? |
|
Definition
| No, but share many common side effects |
|
|
Term
| Side effects of Ibuprofen |
|
Definition
- Sodium and water retention
- Caustic to stomach and intestinal lining
- Massive GI bleeds
- Renal damage
|
|
|
Term
| What is the effect of NSAIDS on muscle injuries? |
|
Definition
| In a strain, it had no greater effect than a placebo, and in animal studies it delayed healing |
|
|
Term
| What is the effect of NSAIDS on contusions? |
|
Definition
| No studies in humans, but equivocal at best or slow adaptation to training |
|
|
Term
| What is the effect of NSAIDS on ligament injuries? |
|
Definition
| Beneficial if it promotes a little bit of mobilization, but can be detrimental if it promotes too much mobilization and you overdo it |
|
|
Term
| What is the effect of NSAIDS on bone injuries? |
|
Definition
| Marked association between non-union and delayed healing (it inhibits ossification after hip fracture and total hip replacement) |
|
|
Term
|
Definition
|
|
Term
| Most famous COX2 inhibitor |
|
Definition
|
|
Term
| How is a COX2 inhibitor different from a COX1? |
|
Definition
- No anti-inflammatory action
- Does not inhibit platelet aggregation
- Rare gastric irritation
- Not likely to cause bronchioconstriction in patients allergic to ASA
- Fewer drug-drug interactions
- No risk of Reye's
|
|
|
Term
| Just 1 tablet of COX2 inhibitor celecoxib can increase CV risk for how long? |
|
Definition
|
|
Term
| How does celecoxib increase risk of CV effects? |
|
Definition
- It does not suppress platelet aggregation, because it doesn't block COX1
- It blocks COX2, which can cause increased vasoconstriction
- The combination of these two increase the likelihood of vessel blockage once thrombosis has begun
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|
|
Term
| Treatment for overdose of tylenol |
|
Definition
- Give N-acetylcysteine (Mucomyst)
- It interacts with toxic metabolite and protects liver cells
- Best if given within 10-12 hours after ingestion
|
|
|
Term
|
Definition
|
|
Term
| Symptoms of Tylenol overdose within 12-24 hours |
|
Definition
- GI Cramping
- Nausea
- Vomitting
|
|
|
Term
| Symptoms of Tylenol overdose on 2nd day |
|
Definition
- No obvious signs
- Relief
- Urine output drops
- Hematuria
- Pain in upper right quadrant
|
|
|
Term
| Symptoms of Tylenol overdose at 3-5 days |
|
Definition
| Irreversible Hepatic Necrosis |
|
|
Term
| T 1/2 of single dose of ASA |
|
Definition
|
|
Term
| Is there physical dependence risk with ASA? |
|
Definition
|
|
Term
| Does ASA work for visceral pain? |
|
Definition
|
|
Term
| 3 main classes of opioid receptors |
|
Definition
|
|
Term
| Responses to this receptor include analgesia, respiratory depression, euphoria, sedation, physical dependance, decreased GI motility |
|
Definition
|
|
Term
| Responses to this receptor include analgesia, sedation, and decreased GI motility |
|
Definition
|
|
Term
| Pure opioid agonists activate which receptor(s) to produce analgesia and other effects? |
|
Definition
|
|
Term
| How do agonist-antagonist opioids pentazocine, nalbuphine, and butorphanol affect mu receptors? |
|
Definition
|
|
Term
| How do agonist-antagonist opioids pentazocine, nalbuphine, and butorphanol affect kappa receptors? |
|
Definition
|
|
Term
| How do agonist-antagonist opioid buprehorphine affect mu receptors? |
|
Definition
|
|
Term
| How do agonist-antagonist opioid buprehorphine affect kappa receptors? |
|
Definition
|
|
Term
| How do pure opioid antagonists affect mu and kappa receptors? |
|
Definition
| Antagonists that do not produce analgesia or any other effect of agonists, but instead work to reverse respiratory and CNS depression |
|
|
Term
| Which antagonist is used to treat opioid-induced constipation? |
|
Definition
|
|
Term
| Routes of administration for morphine |
|
Definition
- Oral
- IM and SubQ
- IV
- Epidural and Intrathecal
|
|
|
Term
| Strong opioid analgesic with 100x potency of morphine (not remifentanil) |
|
Definition
| Fentanyl (Sublimaze, Duragesic, Fentora, Actiq, Ionsys) |
|
|
Term
| Routes of administration of fentanyl |
|
Definition
- Parenteral
- Transdermal
- Transmucosal
- Buccal Tablets
|
|
|
Term
| The first needle-free patient-activated system for on-demand delivery of analgesia |
|
Definition
| Transdermal Iontophoretic System (Ionsys) |
|
|
Term
| About 10x more potent than morphine |
|
Definition
|
|
Term
| About 1000x more potent than morphine |
|
Definition
|
|
Term
| Similar to fentanil, in that it is 100x more potent that morphine |
|
Definition
|
|
Term
| How does meperidine differ from morphine? |
|
Definition
- Short t 1/2
- Interacts adversely with a number of drugs
- Accumulation of toxic metabolite
|
|
|
Term
| Oral med similar to morphine with a long duration of action, but may cause a fatal dysrhythmia |
|
Definition
| Methadone (Diskets, Dolophine, Methadose) |
|
|
Term
| Drug similar to morphine that is no better that other strong opioids, but has a very high abuse potential, so it is banned in the US |
|
Definition
|
|
Term
| What is the limiting factor with codeine? |
|
Definition
| Dose remains low to prevent side effects, which means pain relief achieved safely is quite low |
|
|
Term
| Codeine provides pain relief equivalent to how much ASA or Tylenol? |
|
Definition
|
|
Term
| Moderate to strong opioid frequently abused through snorting, crushing, IV, etc. |
|
Definition
|
|
Term
| This pain reliever is only available in combination with other meds (usually ASA and Tylenol) |
|
Definition
|
|
Term
| Prototype for Agonist-Antagonist Opioid |
|
Definition
|
|
Term
| Tylenol can not be taken with what 2 drugs? |
|
Definition
- Alcohol (can cause fatal liver damage)
- Warfarin (can accumulate to dangerous levels and increase risk of bleeding)
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|
|
Term
| Topical Local Anesthetics |
|
Definition
Lidocaine
Tetracaine
Cocaine |
|
|
Term
|
Definition
| Drugs that produce unconciousness and a lack of responsiveness to al painful stimuli |
|
|
Term
| Injectible Local Anesthetics |
|
Definition
Nerve Block
Shorter procedures: lidocaine or mepivacaine
Longer procedures: bupivacaine
IV Regional: Lidocaine w/o epi
Epidural: lidocaine or bupivacaine
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|
|
Term
|
Definition
| Drugs that do not reduce conciousness and they blunt sensation only to a limited area |
|
|
Term
| How do local anesthetics work? |
|
Definition
| Stop nerve conduction by blocking sodium channels in the axon membrane |
|
|
Term
| 2 classes of local anesthetics |
|
Definition
ester-type anesthetics: (procaine) occasionally cuase allergic reactions and are inactivated by esterase in the blood
amide-type anesthetics: (lidocaine) rarely cause allergic reactions and are inactivated by enzymes in the liver |
|
|
Term
| Types of General Anesthetics |
|
Definition
Inhalation Anesthetics
Intravenous Anesthetics
|
|
|
Term
|
Definition
| Refers speciically to loss of sensibility to pain |
|
|
Term
|
Definition
| Refers not only to loss of pain but to loss of all other sensations as well (eg, touch, temp, taste) |
|
|
Term
Minimum Alveolar Concentration
(MAC) |
|
Definition
As the minimum concentration of drug in the alveolar air that will produce immobility in 50% of patients exposed to a painful stimulus.
Low MAC = high potency |
|
|
Term
|
Definition
| Th use o a combination of drugs to accomplish what we cannot achieve with one anesthetic alone |
|
|
Term
| Classifications of Inhaled Anesthetics |
|
Definition
|
|
Term
|
Definition
Opioids
Barbituarates
Benzodiazepines |
|
|
Term
|
Definition
| Patient Controlled Analgsia |
|
|
Term
|
Definition
| electronically controlled infusion pump that can be activated by the patient to deliver a preset bolus dose of an opioid, which is delivered though an indwelling catheter |
|
|
Term
|
Definition
| Delivers opioid (fentanyl) through transdermal dosage not a pump |
|
|
Term
| Most common drug used in a PCA pump |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Epinephrine effects on vessels in anestetics |
|
Definition
vasoconstrictor: decreases local blood flow and delays systemic absorption of anesthetic
Prolongs anesthesia and reduces risk of toxicity |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Drugs to reduce nausea and vomiting |
|
|
Term
| 3 Phases Drugs go Through |
|
Definition
Pharmaceutical
Pharmacokinetic
Pharmacodynamic |
|
|
Term
|
Definition
Absorbing
Distributing
Metaolizing
Excreting |
|
|
Term
|
Definition
| The chemical and physiologic changes that the drug causes |
|
|
Term
3 Phases of Action
Pharmaceutical Phase |
|
Definition
| Dissolves or disintegrates |
|
|
Term
3 Phases of Action
Pharmacokinetics |
|
Definition
|
|
Term
3 Phases of Action
Pharmacodynamics |
|
Definition
| Interaction with receptors |
|
|
Term
Pharmaceutical Phase
How does the dissolution rate of a drug effect the rate of the compound crossing the cell membrane? |
|
Definition
| The faster the dissolution rate the quicker the compound crosses the cell membrane |
|
|
Term
| What type of drugs absorb better in the stomach? |
|
Definition
|
|
Term
| What type of drugs absorb better in the intestine? |
|
Definition
|
|
Term
| What does rate of absorption depend upon? |
|
Definition
| When the drug becomes bio-available to exert it's action. It has to fit into the specific receptor. |
|
|
Term
| Factors that affect absorption |
|
Definition
- ionization - ionized solutions don't cross membranes easily
- stability of the drug in acid / alkaline environment
- pH - local environment enhances or retards diffusion of acid/base drugs
|
|
|
Term
| Outside Factors that impact absorption |
|
Definition
- Alcohol in the stomach (changes dissolving)
- Nicotine (lowers plasma enzymes and can increase or decrease metabolism)
- Caffeine (increases stimulation including gastric motility)
|
|
|
Term
| 3 Drug Storage Environmental Impacts |
|
Definition
- Temperature - store at toom temp, some need refrigeration
- Light sensitivity - some are light sensitive and need to be storeed in dark color containers
- air/humidity sensitive - some require tight sealed containers
|
|
|
Term
| 5 Routes of Administration |
|
Definition
- Oral (80% of drugs - swallowed, buccal, sublingual)
- Enteral (nasogastric or gastric tubes, rectal)
- Parenteral (SC, IM, IV, intrathecal, epidural, other fluids)
- Pulmonary (gasses, mist)
- Topical (skin, eyes, ears, nose)
|
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| pH upper portion of small intestine |
|
Definition
|
|
Term
| Blood-brain barrier, what type of drugs can cross and why? |
|
Definition
| Lipid soluble because BBB is heaby in lipids composition |
|
|
Term
| Where do pulmoary drugs have to reach to be effective? |
|
Definition
|
|
Term
| What effects percutaneous absorption? (topical) |
|
Definition
- massage (enhances)
- heat (can increase)
- sweat or friction (can wash away)
- capillary system not intact
|
|
|
Term
| 3 things distriution of drug depends upon |
|
Definition
- permeability of capillaries to drug molecule
- cardiac output
- regional blood flow
|
|
|
Term
| Drug Reservoirs (in general) |
|
Definition
accumulation of drug occurs
- attach to items: plasma protein binding and tissue binding
Creates a reservoir, is reversible
- as more free drug is metabolized, more bound molecles become unbound
- must be free to work
|
|
|
Term
| Barriers to drug distribution |
|
Definition
blood-brain barrier - only lipid soluble
placental barrier - limited protection |
|
|
Term
|
Definition
| process of chemically altering a drug for use or inactivating a drug into a metabolite that can be excreted |
|
|
Term
| Only a __________ drug can be metabolized |
|
Definition
|
|
Term
|
Definition
| inactive substance that must be coverted into an active form |
|
|
Term
|
Definition
Phase I: Oxidation
Phase II: Conjugation |
|
|
Term
| What happens in liver Phase I? |
|
Definition
| Oxidation: O2 attaches to molecule |
|
|
Term
| What happens in liver phase II? |
|
Definition
Conjugation
another chemical group attaches to the drug
changes it into adifferent compound or more polar makingit excretable by the kidney |
|
|
Term
|
Definition
| Most oral/enteral drugs lose ~90% in first pass through the liver. Oral/enteral drugs must be given in higher doses and more often to get effective amount of drug into system for prolonged amount of time. |
|
|
Term
|
Definition
- 12 channels with several subhannels with 50 isoenzymes
- 90% of drugs go through only 6 of the channels
|
|
|
Term
| Why would CYP450 effect drug, if 2 or more drugs are taken at same time? |
|
Definition
90% of drugs go through 6 of the 12 channels. So if they have the same receptors, the one that gets there first wins and the other is slow to metabolize and toxic lvels of the drugs accumulate
Watch drug-drug interactions!!! |
|
|
Term
|
Definition
chromic exposure to one drug may get more enzymes produced
(drug doesn't last as long as it did initially) |
|
|
Term
| Intentional use of interactions |
|
Definition
Drugs given on purpose together because of reactions.
ie. drug 1 and drug 2 are given together. They fight for the same receptors. Drug 1 will win and this will allow drug 2 to take longer to metabolize. Without drug 1, drug 2 will metabolize too quickly and will not be effective.
|
|
|
Term
| 9 Factors Affecting Metabolism |
|
Definition
- age
- nutritional status (especially protein)
- liver disease
- presence of other drugs (compete for enzymes or toxic effect on liver cells)
- Alcohol
- Smoking
- fluid levels
- hormone interactions
- time of day
|
|
|
Term
| Most important route for excretion of drugs and metabolites |
|
Definition
|
|
Term
| What type of drugs do the kidney's not eliminate? |
|
Definition
| Lipid soluble - they are reabsorbed b tubules and reenter the systemic circulation. Leave body via other routes or get another chance at becoming water soluble during liver processing |
|
|
Term
| How does urine pH effect excretion of drugs? |
|
Definition
- Urine pH varies between 4.6-8.2
- weak acids more readily excreted in alkaline urine
- Weak bases are more readily excreted in acidic urine
|
|
|
Term
| Other than the kidney, name 5 sites for excretion of drugs |
|
Definition
- GI tract
- Lungs
- Sweat/salivary glands
- Mammary glands
- Hemodialysis
|
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