Pharm review Ch. 1-7 (Exam 1)

over the counter drugs (risks)

Risks No drug is without risk. Patient may not choose proper medications. No assistance from health care provider May interact with foods, herbals, prescriptions, or other OTC drugs May be ineffective or harmful

contraindication

a factor in the patient's condition that makes the use of a medication or specific treatment dangerous or ill advised or impractical (example: a patient in renal failure would not benefit from diuretics could even be harmful..)

The conditions whereby the drug should be avoided are _______________

contraindications

buccal

crushed and spread over buccal mucosa

topical application (absorption)

delivers a more uniform amount of drug over a longer period of time, but the effects of the drug are usually slower in their onset and more prolonged in their duration of action.

chemical name

describes the drug's chemical composition and molecular structure.

Drugs use ___________ and _________ _________ to cross plasma membranes to reach their target cells.

diffusion, active transport

Because oral liquid formulations do not undergo ______________, they are absorbed __________ than tablets or capsules

dissolution, faster

The _____________ rate of a tablet or capsule is often the ______________ part of the absorption process of an oral medication.

dissolution, slowest

intravenous (absorption)

drugs given this way will bypass the liver. prevents the first pass effect from taking place, and therefore more of the drug reaches the circulation. IV injection delivers the drug directly into the circulation, where it is distributed throughout the body. 100% absorption most typical *most dangerous due to absorption rate & efficiency*

The nurse knows that governmental drug legislation requires the drug manufacturer to prove that a drug is both safe and:

effective

Some drugs are __________ __________ because the medications will irritate the stomach _____________ should they dissolve in the stomach

enteric coated, mucosa

A drug that moves into a cell along its concentration gradient utilizing a membrane carrier protein is using the process of __________ ___________.

facilitated diffusion

National Drug Code (NDC)

federal law requires unique identifier for each prescription drug (like your SS#) contains 3 groups of numbers to identify the product, manufacturer, and packaging

sublingual

given beneath the tongue

schedule II drugs

have current accepted medical use but must be severely restricted normally no refills are permitted (but there are exceptions) high abuse potential

schedule I drugs (include)

heroin, ghb, LSD, marijuana, MDMA, mescaline, methaqualone, methcathinone, peyote, psilocybin

Simple diffusion, or passive transport, is the movement of a chemical from an area of ___________ concentration to an area of ___________ concentration.

higher, lower

therapeutic classifications

how the drug is being used in treating a specific disease

anticoagulants

influence blood clotting

excretion involves the:

large intestine, kidneys, bladder

metabolism involves the:

liver

antihyperlipidemics

lower blood cholesterol

antihypertensive

lower blood pressure vasodilator

A description of how a drug works on its target organs and cells is called the ___________ __ _________

mechanism of action

simple diffusion (passive transport)

movement of a chemical from an area of higher concentration to an area of lower concentration

schedule I drugs

no currently accepted medical use, no prescriptions can be written highest abuse potential

an IV drug will move quickly by __________ diffusion from its region of ______ concentration (___________) to a region of ______ concentration (___________) to produce its action

passive, high, blood, low, tissues

Before any drug is administered, the nurse must obtain and process pertinent information regarding: (5 things)

patient's medical history physical assessment disease processes learning needs capabilities

Exclusivity

period of about 5 years when competing markets cannot sell generic version of drug The rationale for exclusivity: developing company needs time to recoup the millions of dollars in r&d costs involved in designing, and testing new drugs. Without this guarantee drug companies have little incentive to develop new drugs.

The drug research participant with a particular dis-ease is taking part in an investigative study to examine the effects of a new drug. Previously, this drug was tested using healthy volunteers. The next phase of the clinical trial investigation in which the patient will be participating is:

phase 2

schedule II drugs (include)

potent opioids, amphetamine, cocaine, methamphetamine, methylphenidate, PCP, short acting barbituates

trade name

proprietary name, given to the drug by the manafacturer

Carrier proteins that assist in active transport are sometimes called ___________.

pumps

a drug that is "biosimilar" has comparable effectiveness and safety to the _____ _____ _____

reference product drug

controlled drugs

regulated according to their abuse potential

antidysrhythmics

restore normal cardiac rhythm

Orphan disease

serious, rare diseases that affect fewer than 200,000 people in the US

Drug molecules that are small, nonionized, and lipid soluble will usually pass through plasma membranes by _________ ______________

simple diffusion

Drug molecules that are ________, ___________, and ______ __________ will usually pass through plasma membranes by simple diffusion

small, nonionized, lipid soluble

absorption takes place in the:

stomach, small intestine

pharmacology

study of medicines

adrenergic

sympathetic nervous system

describe enteric-coated tablets:

tablets may have a hard, waxy coating that enables them to resist acidity designed to dissolve in the alkaline environment of the small intestine.

bioavailability

the extent of drug absorption

absorption

the process of moving a drug from the site of administration to the bloodstream.

The oral route is considered one of the safest because:

the skin barrier is not compromised.

pharmacokinetics

the study of what actually happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. also includes the onset of action, the peak effect of a drug, and the duration of action.

pharmacodynamics

the study of what the drug does to the body. It involves drug receptor interactions. Receptors are usually specialized protein molecules on the outer surfaces of cells or within cells to which drug molecules bind to exert their effects.

Why are tablets coated?

to mask taste/odor improve appearance of tablets prevent medicament from atmospheric effects control the site of action of drugs (enteric coating) produce sustained released product

__________ ___________ are selective and only carry molecules that have specific structures

transport proteins

antianginals

treat angina

(true/false) The nurse should not crush tablets or open capsules unless the manufacturer specifically states that this is permissible.

true

intramuscular injection (absorption)

typically absorbed faster than drugs injected subcutaneously. Drugs directly into large muscles Tissue can receive larger volume of drug. absorbed over several hours. Absorption may be increased by applying heat to the injection site or by massaging the site (increases blood flow to area)

small molecules, such as ________, __________, and ______ may also enter through _______ __________ in the plasma membrane

urea, water, alcohol, open channels

The nurse knows that drugs that are subject to stricter regulations are those:

with a high potential for abuse or dependency

pharmacokinetics processes

*Absorption *Distribution *Metabolism *Excretion

Orphan drug act

1983 drug manufactures are now offered development grants, tax credits for clinical investigation expenses and 7 years of exclusivity to market orphan drugs fun fact: Over 700 medications have been approved as orphan drugs since the passage of this act.

(clinical trial investigation) Phase ______ relies on studying patients with the disease to be treated.

2

The nurse is looking up a drug that has been pre-scribed and wants to know the therapeutic classifica-tion for the drug. Which of the following would indicate a therapeutic classification? 1. Beta-adrenergic antagonist 2. Antihypertensive 3. Diuretic 4. Calcium channel block

2 (antihypertensive)

(clinical trial investigation) Phase _____ studies use large numbers of partici-pants with the condition being treated by the drug

3

The nurse is using a drug handbook to determine the indications for the drug furosemide (Lasix). The term indications is defined as the: 1. Way a drug works on the target organs. 2. Amount of the drug to be administered. 3. Conditions for which a drug is approved. 4. Reason that the drug should not be given

3 (Conditions for which a drug is approved.)

The nurse is reviewing the patient's medication record and does not recognize the medication, filgrastimsndz (Zarxio). Consulting a drug guide, the nurse finds it is listed as a "biosimilar" to filgrastim (Neupogen). Which of the following best describes the definition of a biosimilar drug? 1. It is another term for a "generic" drug when the two drugs exert similar biologic effects. 2. It is a drug that has similar effects on the body, but belongs in a different chemical and therapeutic classification. 3. It is a drug that is derived from living cells, such as yeast, and has comparable effectiveness and safety to the reference product drug. 4. It is a drug that is identical to the reference product drug and thus, does not require FDA approval.

3 (It is a drug that is derived from living cells, such as yeast, and has comparable effectiveness and safety to the reference product drug.)

(clinical trial investigation) Phase _____ is considered postmarketing surveillance after the drug has been approved.

4

creatinine range

0.5-1.2 mg/dL

(clinical trial investigation) Phase ______ studies use small groups of healthy participants.

1

A nurse notes that multiple patients had a reaction to the same medication, a drug that has been available for several years. Which action should the nurse take? (Select all that apply.) 1. File an Adverse Event Report with the FDA. 2. Note the reaction in the patient's chart. 3. Notify the healthcare provider who ordered the drug. 4. Wait until the FDA sends a notification of the drug's recall before informing the patient. 5. Compare each patient's reaction to determine if it is the same.

1, 2, 3

Which patient characteristics, if noted in the patient's medical record, would the nurse consider important information that may affect the physiologic response to various types of drug therapy? (Select all that apply.) 1. 82-year-old and female 2. Asian and obese 3. Past medical history of kidney disease 4. Mother and sister with diabetes 5. Has no medical insurance

1, 2, 3, 4

As a member of an interprofessional team, what key responsibilities does the nurse have to ensure effective pharmacotherapy? (Select all that apply.) 1. Monitoring the patient's condition before and during pharmacotherapy 2. Teaching the patient about self-administration and any required monitoring of drug effects 3. Ensuring that all drug and treatment options have been considered before beginning pharmacotherapy 4. Frequently conducting a medication reconciliation to verify current medications in use 5. Determining the ideal drug to be prescribed to the patient to treat the current condition

1, 2, 4

BUN (blood urea nitrogen) range

10-20 mg/dL

prototype

Compares all other medications in the class to the prototype

indications

Conditions for which a drug is approved All prescription drugs must have some degree of effectiveness. Every drug has at least one indication.

over the counter drugs

Do not require authorization from health care provider Clients may treat themselves. Must carefully follow directions No monitoring from health care provider needed

"ideal drug"

Drug that is both effective & safe, producing no side effects or adverse reactions; only a theoretical construct-

sublingual and buccal (absorption)

Drugs administered by this route are absorbed into the highly vascularized tissue under the tongue—the oral mucosa. Drugs are absorbed rapidly because the area under the tongue has a large blood supply. These drugs bypass the liver and are systemically bioavailable.

prescription drugs

Drugs that may be addictive Drugs that may be too harmful for self-administration Treat complex conditions Require skill to administer Patient must receive authorization to receive the drug.

scheduled drugs

Drugs with high potential for dependence or that are frequently abused Sale and distribution are highly restricted Placed in one of five categories called schedules

prescription drug (advantages)

Health care provider can examine and diagnosis patient. Maximize therapy Patient teaching Patient follow-up

supplements

Herbal and dietary supplements are not drugs. Not subjected to same regulatory process Can cause side effects and interact with medications Not tested by FDA for safety

pharmacological classification

How the drug acts A drugs mechanism of action More specific May use the drugs chemical name

factors affecting bioavailability

Inert ingredients Tablet compression Rate of absorption

nursing role in pharm

Knowledge of the drug Administering the drug Assessing the effects of the drug Teaching the patient about the drug

Substitution (generic for trade)

Laws vary by state Pharmacists may substitute generic for brand. Pharmacists may have to obtain approval from provider before substituting generic. Can be cost saving for patients Many pharmacies offer generic lists.

The nurse is asked by a family member: "They're giv-ing mom Motrin and she takes Advil. Hasn't the wrong drug been ordered?" The nurse will respond, knowing that:

Motrin and Advil are trade names for the same generic drug, ibuprofen

generic name

Only have one name (generic "diphenhydramine" is known as Benadryl by trade) shorter and simpler than chemical name often used in most official drug compendiums to list drugs lowercase lowercase lowercase

reclassification

Prescription drugs can be changed to over-the-counter drugs. Decision initiated by manufacturer or mandated by FDA High safety margin must exist

parenteral (absorption)

The parenteral route is the fastest route by which a drug can be absorbed, followed by the enteral and topical routes. form of med administration other than the GI tract. Most commonly it refers to injection by any method. Topical, transdermal, sublingual and buccal, IM are all considered to absorb this way

oral/enteral (absorption)

The presence of food or fluids ingested with the drug. The dosage formulation. The status of the absorptive surface. The rate of blood flow to the small intestine. The acidity of the stomach GI motility less than 100% absorption

drugs administered directly into blood vessels by IV or intra-arterial routes are not _______________ because they are placed directly in the _________________.

absorbed, bloodstream

___________________ is the process of moving a drug from the site of administration to the bloodstream.

absorption

The many processes of pharmacokinetics are grouped into four categories:

absorption distribution metabolism excretion

Absorption is the process of moving a drug from the site of ________________ to the ________________.

administration, bloodstream

clients less likely to correctly take drugs if the drug is:

annoying adverse effects inconvenient dosing schedule expensive

profile drug

another name for prototype of drug

drug

any substance that is taken to prevent, cure, or reduce symptoms of a medical condition.

The patient requests that a refill prescription of a Schedule II controlled substance be telephoned to the drug store. When responding to the patient, the nurse would consider which factor? Refills of Schedule II drugs:

are not permitted under Federal Law

When considering various drug therapies, the nurse knows that most drug testing and approval occurs with which population?

caucasian men

Like the original reference product drug, ____________ are derived from living cells, such as yeast or bacteria. They are not exact, duplicate copies of the original medication, but have comparable effectiveness and safety

biosimilars

distribution involves the:

bloodstream