Term
| Name the 3 phases PO drugs go thru |
|
Definition
Pharmaceutic (Dissolution)
Pharmacokinetic
Pharmadynamic |
|
|
Term
| What phase that PO drugs undergo will be surpassed when drugs are given subQ, IM, or IV? |
|
Definition
|
|
Term
When a PO drug disintergrates into small particles what phase is it in
(Number and Name) |
|
Definition
Phase I
pharmaceutic phase
(dissolution) |
|
|
Term
| Tablets are not 100% drug, what other components do they contain and why? |
|
Definition
| Fillers and Excipients are used to allow the drug to take on size and shape in order to enhance drug dissolution. |
|
|
Term
| What additive will be found in drugs such as penicillin and why? |
|
Definition
| Penicillin is poorly absorbed by the GI tract bc of gastric acid. K+ and Na are added to increase the absorbancy of the drug. |
|
|
Term
| Why do infants absorb more penicillin than adults? |
|
Definition
An infants gastric secretions have a higher PH.
(making it a more alkaline enviroment) |
|
|
Term
Disintergration and Dissolution are often confused.
Explain the difference. |
|
Definition
Disintergration is the breakdown of a tablet into smaller particles.
Dissolution is the dissolving of those smaller particles in th GI fluid before absorption. |
|
|
Term
|
Definition
| The time it takes the drug to disintergrate and dissolve in order to become available for the body to use it. |
|
|
Term
True or False
Drugs in liquid form are more rapidly available for GI absorption than solids. |
|
Definition
|
|
Term
To aid in disintergration and absorption what can you do when taking the drug?
Who would beneifit this most? |
|
Definition
Take the drug with a high acidic fluid (PH of 1 or 2) rather than alkaline fluids.
Very young and Elderly pt's have less gastric acidity. |
|
|
Term
True or False
Enteric Coated drugs resist disintergration in the gastric acid of the stomach. |
|
Definition
True
Disintergration of EC drugs takes place in the Alkaline enviroment of the small intestine, giving a delayed onset. NEVER crush EC pills or beaded capsule type pills. |
|
|
Term
| Disintegration and Dissolution happen in what phase? |
|
Definition
Phase I
Pharmaceutic Phase
aka
Dissolution Phase |
|
|
Term
| Name the 2nd Phase a PO drug will undergo? |
|
Definition
|
|
Term
| What is the basic concept of the pharmakinetic phase? |
|
Definition
| It is the process of drug movement to acheive drug action. |
|
|
Term
During the pharmacokinetic phase four processes occur.
Name them.
(Hint)
AD ME |
|
Definition
A: Absorption
D: Distribution
M: Metabolism
E: Excretion/Elimination |
|
|
Term
|
Definition
| The movement of drug particles from the GI tract to body fluids via passive absorption, active absorption, or pinocytosis. |
|
|
Term
| _________ absorption occurs mostly by diffusion, which means? |
|
Definition
Passive
The drug is moving from an area of higher concentration to lower concentration.
NO ENERGY IS NEEDED to get across the membrane |
|
|
Term
| In _______ absorption a carrier such as an enzyme or protien is needed to move the drug across the membrane. |
|
Definition
Active.
ENERGY IS REQUIRED. |
|
|
Term
| What is the name of the process within absorption that engulfs and carrys a drug across the membrane? |
|
Definition
|
|
Term
| GI membrane is composed mostly of __1____ and ___2___, therefore ____3_____. |
|
Definition
1. Lipid (fat)
2. Protien
3. There for drugs that are lipid soluble pass rapidly through the membrane (passive absorption) and Drugs that are water soluble need a carrier (Active absorption). |
|
|
Term
| What is a Non-Ionized particle? |
|
Definition
| It is a large particle that can pass through the membrane only bc it has no - or + charge. |
|
|
Term
| Give an example of a weak acid drug. |
|
Definition
Asprin.
Asprin is a weak acid drug and will pass through the stomach lining easily and rapidly. |
|
|
Term
| Give 2 examples of drugs that need a high acidic enviroment to acheive greater absorption. |
|
Definition
Calcium Carbonate
and
Antifungals. |
|
|
Term
| _________ will destroy penecillin G. Therefore _____ |
|
Definition
| Hydrochloric acid in the stomach will destroy Penecillin G, therefore, a large oral dosage of pene will be needed to offset what will be partially lost. |
|
|
Term
Give examples of ROUTES medications can be given which will NOT pass through the GI Tract or Liver.
(Hint P.E.E.T RN)
|
|
Definition
P: Parental Drugs
E: Eye Drops
E: Ear Drops
T: Transdermal
R: Resp. Inhalants
N: Nasal Sprays |
|
|
Term
Of the 4, which will be absorbed fast and which slow?
__ a. Lipid Soluble
__ b. water soluble
__ c. ionized drugs
__ d. non-ionized |
|
Definition
a. Fast
b. slow
c. slow
d. fast |
|
|
Term
| Blood flow, pain, stress, hunger, fasting, food, and PH are all examples of what? |
|
Definition
| Things that can affect drug absorption. |
|
|
Term
| Vasoconstricting drugs will do what to absorption? |
|
Definition
|
|
Term
Which IM injection site would produce faster absorption?
deltoids or gluteals. |
|
Definition
| deltoids bc there are more blood vessels. |
|
|
Term
| The process in which the drug passes to the liver first rather than the GI tract is called ___________? |
|
Definition
|
|
Term
| During oral absorption if a drug is not designed to go directly into systemic circulation...where would it go instead and how? |
|
Definition
It would pass from the intestinal lumen to the liver via the portal vein.
(First pass effect) |
|
|
Term
Some drugs may be metabolized to an inactive form when metabolized in the liver.
What else can happen to a drug in the liver? |
|
Definition
1. The inactive portion of the drug would be excreted, which would reduce the amount of active drug.
2. Some drugs are metabolized at all by the liver.
3. Others may be metabolized into what is known as a metabolite, which may be equally or more active that the original drug. |
|
|
Term
Name 4 examples of drugs that exhibit first pass effect.
(Hint)
L, M, N, w |
|
Definition
L: Lidocaine
M: Morphine
N: Nitroglycerins (some)
W: Warfin/coumadin |
|
|
Term
| The percentage of an administered drug dose that reaches the circulatory system ______________ |
|
Definition
|
|
Term
The bioavailabilty of PO drugs is ___ - ____ %.
IV Drug bioavailability is____%. |
|
Definition
1. 20-40%. Only 20 to 40 percent of an oral drug dose will reach systemic circulation.
2. 100%. |
|
|
Term
| Because of the siginifcant difference of bioavailabilty between oral and IV drugs, in which route would you expect the dose to be larger? |
|
Definition
| The oral dose would be larger bc only 20 to 40 percent of the drug dose will enter the circulatory system. Where 100% of the IV drug will be utilized. |
|
|
Term
| How much larger would you expect an Oral dose to be than a IV dose? |
|
Definition
|
|
Term
| Bioavailabilty is a subcategory of _________. |
|
Definition
|
|
Term
| If a drug is metabolized by the liver and the liver is compromised, what would this do to the bioavailability of the drug? |
|
Definition
| It will increase the bioavailabilty bc the liver wouldnt be metabolizing it. |
|
|
Term
There were 5 factors that we discussed in class that alter bioavailability of a drug.
Name them.
|
|
Definition
1. Drug Form
2. GI Mucosa and Mobility
3. Route of admin
4. Food and other drugs
5. Changes in Liver(disfunction) |
|
|
Term
Rapid absorption of oral drugs _________
bioavailabilty of the drug and can cause an __________ in drug concentration.
|
|
Definition
Increase
Increase
(This can cause drug toxicity) |
|
|
Term
| Slow absorption ________ bioavailability and causes _______ in drug concentration. |
|
Definition
|
|
Term
| The process in which the drug becomes available to body fluids and body tissues. |
|
Definition
|
|
Term
| Drug distribution is influenced by 3 things, name them. |
|
Definition
| Blood flow, the drug's affinity to the tissue, and the protien binding effect. |
|
|
Term
| All drugs must bind to a _______. |
|
Definition
|
|
Term
| Most drugs will bind to what protien? |
|
Definition
|
|
Term
| Drugs with a larger volume of drug distribution have a ______ half life |
|
Definition
|
|
Term
| Why must we be familiar with highly protien-bound drugs? |
|
Definition
| If two high protien bound drugs are given at the same time, they will compete for protien binding sites. If there arent enough protien binding sites the will be more free drug released into circulation. |
|
|
Term
| You just realized that a Pt has been taking 2 highly protien bound drugs for an extended time, what should you look for? |
|
Definition
| Possible drug toxicity due to accumulation in circulation caused by lack of protien binding sites |
|
|
Term
| What must the nurse take into consideration if a pt has low protien levels? |
|
Definition
| You must be aware that with low protien, the # of binding sites will also be decreased. Being said, more free drug will be in the plasma. This can cause overdose. |
|
|
Term
| Your pt has a low serum albumin level due to liver or kidney disease. What must you consider. |
|
Definition
| Since most drugs bind to the protiens, albumin or globulin, I would monitor the pt for drug toxicity being that there are fewer protiens available therefore fewer binding sites for the drug as well. More free drug would be forced left in the blood. |
|
|
Term
| The liver is the primarly site for ______ of a drug. |
|
Definition
|
|
Term
| The timeit takes for one half of the drug concentration to be eliminated is called ______. |
|
Definition
|
|
Term
| If a pt has kidney or liver dysfunction what would you expect would happen to the drugs said 'half-life' |
|
Definition
| The half life would be prolonged because LESS of the drug is being metabolized due to the kidneys and/or liver being compromised. This can cause drug toxicity due to drug accumulation. |
|
|
Term
| A short half life of a drug is considered to be ____ to ____ hrs. |
|
Definition
|
|
Term
| A long half life is considered to be ____ hrs or longer. |
|
Definition
|
|
Term
- Digoxin has a half life of _____ hrs, with a Pt who has Normal renal function)
Meaning: |
|
Definition
36.
Meaning it take the body 36 hours to completely eliminate the drug. |
|
|
Term
| The main route of drug elimination (not excretion which is different) is through the ________. |
|
Definition
|
|
Term
| The kidneys can NOT filter _______ drugs. |
|
Definition
| Protien bound drugs. The drug HAS to be RELEASED from the protien in order for the kidney to filter it. |
|
|
Term
The kidneys filter what kinds of drugs?
3 |
|
Definition
1. free unbound drugs (released from protien)
2. water soluble drugs
3. drugs that are unchanged |
|
|
Term
| Urine pH influences drug excretion. Normal urine pH varies from ___ - ___. |
|
Definition
|
|
Term
| If your pt's urine is pH is 3, therefore it is ______. |
|
Definition
|
|
Term
Acidic urine promotes excretion of ____ acid drugs.
|
|
Definition
|
|
Term
| Asprin is excreted rapidly in ______ urine. |
|
Definition
|
|
Term
| Your pt has come into the ED with an diganosis of Asprin Overdose. What would you expect an order for? |
|
Definition
| Sodium Bicarbonate because it will create a alkaline enviroment for urine, thus excreting the Asprin at a faster rate. |
|
|
Term
| Your pt is diagnosed with Asprin overdose, what would you AVOID giving the pt? |
|
Definition
| Any type of acidic drinks such as cranberry juice. Acidic urine inhibits elmination of asprin. You want the urine to be alkaline. |
|
|
Term
| Your pt is renally impaired and their glomerular filtration rate (GFR) is decreased. What would this do to drug excretion? |
|
Definition
|
|
Term
| The most accurate test to determine renal function is? |
|
Definition
| 24hr urine. Creatine Clearance. |
|
|
Term
| ________ is a metabolic byproduct of muscle that is excreted by the kidneys. |
|
Definition
|
|
Term
Normal Creatine Clearance is ___ to ___ ml/min.
What is the number for the elderly? |
|
Definition
85 to 135ml/min.
Elderly pts 60ml/min |
|
|
Term
| If your 35yr old pt has a creatine clearance of 60 you would expect their drug dose to be ______. |
|
Definition
|
|
Term
The study of drug concentration and its effects on the body.
_________________ |
|
Definition
|
|
Term
| When a pt is taking more than 8 drugs to inlcude scripts, herbs, OTC drugs it is called: |
|
Definition
|
|
Term
| To keep a polypharmacy pt safe you can: |
|
Definition
1. encourge pt to use same pharm.(BEST IDEA)
2.have pt take drugs to every dr visit.
|
|
|
Term
| The parasympathetics major nuero transmitter is |
|
Definition
|
|
Term
| Drugs that are cholergenic act off the the _______ nervous system. |
|
Definition
|
|
Term
| Every neuro transmitter has a transmitter that breaks it down. What breaks down acettycholine? |
|
Definition
|
|
Term
| If you you have a nuero mus disorder caused by a deficit of acetycholine, what are two ways you can increase acetycholine? |
|
Definition
1. Give a cholinestrase inhibitor. (blocks enzyme that breaks it down).
2. Give a cholerigic drug (acts like acetocholine) |
|
|
Term
blockers are aka as
________
|
|
Definition
|
|
Term
| Cholinergic blockers (antagonists) are called: |
|
Definition
|
|
Term
| a cholergic drug causes _______ constriction |
|
Definition
|
|
Term
| an anticholergenic drug causes pupil _________. |
|
Definition
|
|
Term
|
Definition
| constriction of the pupil |
|
|
Term
| If you were giving a cholingeric drug what would be the priority nursing assesment prior to giving the drug? |
|
Definition
Respiratory for ineffective airway clearance.
Blood pressure and heart rate bc they decrease them |
|
|
Term
| Pt is admitted with undiagnosed abdominal pain but has diarhea. If all you had available what would you give, cholernergic or anticholenergic? |
|
Definition
| Anticholnergic bc it decreases peristalsis. |
|
|
Term
| What is pilocarpine used to treat? |
|
Definition
glycoma
pilocarpine is a cholinergenic |
|
|
Term
| if you give a cholergenic drug would you want to keep the lights on or off? |
|
Definition
| off, to help the pupil dilate bc cholergenic drugs cause pupil constriction |
|
|
Term
| pilocarpine is a ______ drug and causes pupil _______. |
|
Definition
cholergenic.
constriction. |
|
|
Term
| What is the most critical pt teaching when giving pilocarpine? |
|
Definition
| Advise them they will be on the drug for the rest of their life. |
|
|
Term
Pt says my vision isnt getting better with pilocarpine, whats your response?
(this is critical teaching) |
|
Definition
| this drug does not make sight better, however it keeps it from getting worse. |
|
|
Term
|
Definition
| ones drugs who characteristics and actions can represent a group. |
|
|
Term
| Bethanechol is a _______ of a cholenergic drug |
|
Definition
|
|
Term
NEVER give bethanechol ______ or ______.
(p284) |
|
Definition
|
|
Term
| why would bethanecol be contraindicated in peptic ulcers? |
|
Definition
| because it increases gastric secretions. |
|
|
Term
| pepsinogen is a _______ enzyme in the stomach |
|
Definition
|
|
Term
| Treats urinary distention (ONLY non obstructive bladder) usually given post up, this drug also treats abdominal distention due to slow parastolisis/slow GI motility and gas build up |
|
Definition
|
|
Term
NOT given for bowel obstruction.
p.284 |
|
Definition
|
|
Term
(drug)
Causes increased secretions
frequent urination
miosis
p.284 |
|
Definition
|
|
Term
an adverse reaction of this bethanechol is:
p.284 |
|
Definition
1. orthostatic hypotension
Life threatening:
acute asthmatic attack |
|
|
Term
| The SA node is the _____ of the heart. |
|
Definition
|
|
Term
| __________ drugs can cause heart block |
|
Definition
cholergenic
Example:
bethanechol |
|
|
Term
| Using the nursng process, what would be a physical assement of a pt taking bethnechol? |
|
Definition
| you would need to palpate the bladder to confirm that it's firm/full of urine. |
|
|
Term
_________ is the antidote for cholinergic drugs?
what will you monitor after giving? |
|
Definition
Atropine.
heart rate (for increase). |
|
|
Term
page 285 and 345
a chronic dengenerative autoimmune neuromuscular disoder that causes receptor sites or be compromised or destroyed.
|
|
Definition
|
|
Term
(p.345)
Disease characterized by weakness and fatigue of skeletal muscles, difficulty swallowing, dysrathria (slurred speech)drooping eye lids |
|
Definition
|
|
Term
| Shorter half equals _____often you give drug |
|
Definition
|
|
Term
| A major reason for a a pt with myasthenia gravis to have myasthnic crisis would be? |
|
Definition
inadequate medications
(not taking the med correctly) |
|
|
Term
| Priority assesment of a pt with mysthenic crisis is: |
|
Definition
| respiratory rate bc paralysis of resp muscles can occur |
|
|
Term
SLUDGE
stands for:
This is an accronym for warning signs of a cholergenic crisis |
|
Definition
S: Saliva
L: lacrination (tearing)
U: Urinary frequency
D: Diarhea
G: GI symptoms (bloating)
E: Enurisis (bed wetting) |
|
|
Term
|
Definition
|
|
Term
| A pt taking a drug for myasthenis gravis should take it before or after meals? |
|
Definition
|
|
Term
| A priority pt goal when taking drugs for MG (myasthenia gravis) is: |
|
Definition
Pt will demonstrate patterns of regular breathing.
Know to take it before meals.
|
|
|
Term
| MORE ON CHOLINERGIS DRUGS IS ON PAGE 339, 345. |
|
Definition
|
|
Term
P.339
An incurable dimensia is marked by cognative disfunction:
__________ |
|
Definition
|
|
Term
p339
delerium is ______
where as dementia is ____. |
|
Definition
|
|
Term
p 339
the pathophysiolgy of this disease is the degeneration of the cholinergic nueron and deficiency in acetycholine.
What is the disease? |
|
Definition
|
|
Term
The class of drugs used to treat Alzheimers is _____.
|
|
Definition
| Acetycholinesterase inhibitors. |
|
|
Term
Aricept treats mild to moderate _____.
p.341 |
|
Definition
|
|
Term
| The idea behind drug therapy for Alzheimers is to ______. |
|
Definition
| slow ir down, bc theres no cure. |
|
|
Term
Excelon treats mild to moderate ______.
p341 |
|
Definition
|
|
Term
| Monitor a pt taking tacrine for _______. |
|
Definition
hepatoxicity.
(excessive bilirubin, yellow skin) |
|
|
Term
| Excelon is the alzheimers drug that does not cause ______. |
|
Definition
|
|
Term
p.347
This drug helps in diagnosing MG, it is direct acting, and mytosis resolves(?). |
|
Definition
|
|
Term
| Increased AP diameter is another way to say: |
|
Definition
|
|
Term
p288(table18-3)
Anticholinergic drugs _____ heart rate with large doses and ______ heart rate with small doses. |
|
Definition
increase with large
decrease with low. |
|
|
Term
__________ decrease GI motility.
(Drug class) |
|
Definition
|
|
Term
Why may a pt get a Antichlolinergic drug pre op?
What are adverse effects?
Life threat? |
|
Definition
bc it dries up resp secreations and decreases GI secretions.
Adverse: urinary retention/dry mouth.
Life threat:
|
|
|
Term
| An age related change that of the integumentary system that will effect a pt taking an anticholinergic drug |
|
Definition
urinary retention
heat stroke
hypothermia bc they decrease sweating mechism
|
|
|
Term
the BEERS list is:
Biggie on this list is!!!! |
|
Definition
a list of med contraindicated for older adults.
Anticholinergic |
|
|
Term
A major contraindication for Anticholinergic drugs in pts with glaucoma is:
p289 chart 18-2 |
|
Definition
|
|
Term
| Why not give an Anitcholinergic drug to a pt with MG? |
|
Definition
| Because it is only used during MG crisis. |
|
|
Term
| Why would it be contraindicated to give atropine (anticholinergic) to a pt showing signs of myocardial eschemia? |
|
Definition
| Because it increase cardiac work load. |
|
|
Term
| Drug/drug interactions with anticholinergic drugs include: |
|
Definition
| antidepressants, antihistamines. |
|
|
Term
Using the nursing process:
When giving a anticholinergic drug you must: |
|
Definition
Get baseline vitals (compare heart rate in case of tachycardia)
Assess urine output
Be familiar with pt's medical history. |
|
|
Term
Page 291
robinul
page 292 detrol
page 293 prototype |
|
Definition
|
|
Term
| Diarhea will never be a side effect of ANTIcholinergics, instead you'll see _____. |
|
Definition
|
|
Term
|
Definition
|
|
Term
p308
A drug that relieves anxiety is _______. |
|
Definition
|
|
Term
| a sleep inducing drug is a ________. |
|
Definition
|
|
Term
| Increasing the dose of a sedative will then make it a ________. |
|
Definition
|
|
Term
The primary ingredient in OTC antihistamines (using as sleep aid) is
___________. |
|
Definition
|
|
Term
Common side effects of sedative hypnotics are:
p309 table 20-1 |
|
Definition
| Hangover, REM rebound (vivid dreams), dependence, tolerance, escessive drugs, resp depression, |
|
|
Term
p310
The short acting barbiturates used to help induce sleep AND will cause the pt to awken early in the morning are _____ and ____. |
|
Definition
|
|
Term
| CNS depressants esp barbituartes will _______ the CNS system (resp,cardiac, vasometer) |
|
Definition
|
|
Term
| If you are taking a CNS depressant what must you NOT consume? |
|
Definition
|
|
Term
p.311
Contraindications with barbiturates include: |
|
Definition
Resp depression
fetal immaturity
nephrosis
severe hepatic disease |
|
|
Term
| *** There is _____ antidote for barbiturates*** |
|
Definition
|
|
Term
| If you have pt with cirosis of the liver, why would you think twice about giving a barbiturates? |
|
Definition
| The liver will lack the enzymes to break the drug down. |
|
|
Term
| A side effect/adverse effect that you commonly see in the older adult when giving a barbiturate is: |
|
Definition
|
|
Term
| A serious life threatening effect of a barbiturate is: |
|
Definition
|
|
Term
| The liver must function well in order for a drug to be _______. |
|
Definition
|
|
Term
______: the time it takes drug to reach min effective concentration.
____: Drug reaches highest blood or plasma concentration.
_____: The length of time the drug has a pharmacologic effect. |
|
Definition
|
|
Term
__________
states that drug concentration in plasma should be between the minimum effective concentration and minimum toxic concentration |
|
Definition
|
|
Term
Peak is the ______ plasma concentration of a drug at a specific time
where as
Trough is the _____ plasma concentration of a drug. |
|
Definition
|
|
Term
peak measures ______.
trough measures ______. |
|
Definition
|
|
Term
| When should you do a blood draw to see if a given drug has reached 'peak'. |
|
Definition
| At the prosed peak time of the drug (when is said to have reached its peak) |
|
|
Term
| When should you draw for trough levels? |
|
Definition
| Immediatly before the next dose is given to make sure it has been eliminated and to avoid toxicity. |
|
|
Term
| peak and trough are normally ordered when a pt is taking what kind of drugs? |
|
Definition
| drugs a narrow therapeutic index and hat are considered toxic. |
|
|
Term
| How could you determine if a pt is experiencing toxic effects or toxicity of a drug? |
|
Definition
| By monitoring the serum theraputic range of the drug. If the serum level is over the theraputic range, you have toxicity |
|
|
Term
______: decreased resposiveness over the course of therapy
where as
______: is the rapid decrease in the RESPONSE to the drug, aka 'acute tolerance' |
|
Definition
|
|
