UNMC Pharmacology exam 1 2021

what is the pharmacologic classification of aspirin?

-NSAID -salicylate

what is therapeutic drug monitoring?

-Results used by health care provider to keep drug dose within predetermined range •Peak and trough levels

what are some processes of pharmacokinetics?

-absorption -distribution -metabolism -excretion

drugs are carried by blood and tissue fluids to which sites of the body?

-action sites -metabolism sites -excretion sites

what substances interact with opiates?

-alcohol -antihistamines -barbiturates -benzodiazepines -monoamine oxidase inhibitors

describe what all occurs in general anesthesia

-analgesia: block sensation of pain -relaxation: relieve anxiety -hypnosis: unconsciousness to block awareness - loss of reflexes: block reflexes that interfere with procedure

what is the therapeutic classification of ibuprofen?

-analgesic -anti-inflammatory -antipyretic

how do opiates effect the brain?

-can cause daytime sedation or sleepiness -chronic painkiller use is associated with a higher risk of major depression

what are the mechanisms of action for naloxone hydrochloride (narcan)?

-does not cause an action, prevents action -knock opioid receptors -blocks opioid receptor

what are some factors that affect rate and extent of drug absorption?

-dosage form, route of administration -administration site, blood flow, GI function -the presence of food or other drugs

what are characteristics of an ideal drug?

-effectively treats, prevents, or cure's patient's condition -produces rapid and predictable responses -taken conveniently -inexpensive -no interaction

what are the most frequent med errors?

-errors in patient assessment -inaccurate prescribing -errors in administration

other examples of DMARDS (TNF blockers)

-etanercept (Enbrel) -Infliximab (remicade) -abataceot (orencia)

what are the different types of parenteral routes?

-intravenous (IV) administration -intramuscular administration -intradermal -subcutaneous

what is efficacy?

-maximum response produced by drug -compares desired therapeutic effect of two drugs

what is a nurses responsibilities when it comes to medication?

-monitoring patient's condition before and during drug use -evaluating drug effects -teaching patient about self administration -conducting medication reconciliation

what are examples of strong opioid agonists?

-morphine -methadone -meperidine -fentanyl -oxymorphone -hydromorphone

how do opiates effect the digestive system?

-opiate induced slow digestion can lead to constipation -can lead to nausea and vomiting

what are the three opioid classifications?

-opioid agonist -mixed opioid agonist-antagonists -opioid antagonists

what are the ways a drug is excreted?

-renal excretion -pulmonary excretion -glandular secretion -fecal and biliary excretion

what are the 5 drug rights?

-right patient -right drug -right dosage -right route -right time

what are the three classes of NSAIDs?

-salicylates -ibuprofen and ibuprofen like agents -Cyclooxygenase-2 (COX-2) inhibitors

what are the types of oral drugs?

-tablets and capsules -enteric-coated -extended release -sublingual (SL) -Buccal

what are the different types of topical medication routes?

-transdermal -ophthalmic route -otic -intranasal -rectal -vaginal

describe the uses of benzodiazepines?

-treat anxiety -induce amnesia -PO for minor procedures -IV for general

how long does it take for midazolam to induce anesthesia

1-2 minutes

How much stronger is fentanyl than morphine?

100x

what is the max time you can use propofol in an infusion?

12 hours

how long does it take for midazolam to wear off?

2-6 hours

what is the dose limit on acetaminophen?

3-4 grams

how many phases does the FDA's clinical investigation involve?

4

what is the max time you can use propofol in a syringe?

6

How many branches does the FDA have?

7

What are the FDA pregnancy risk categories?

A- no risk B- no effect in animals, no human studies available C-animal show risk, human studies not available D-definite fetal risk X-absolute fetal risk, not to be given

how do you treat a ibuprofen over dose?

Administration of activated charcoal and nasogastric suction

what are some trade names for ibuprofen?

Advil, Motrin

what are salicylates used for?

Analgesic (fever reducer) Antipyretic (lower fever) Antiflammatory Antiplatelet (81mg)

what is the therapeutic classification of Adalimumab (humira)

Antirheumatic drug, antimalarial

what is the Pharmacologic classification of Alendronate (Fosamax)?

Bisphosphonate, bone resorption inhibitor

what is the mechanism of action for adalimumab (humria)

Blocks inflammatory activity of TNF (tumor necrosis factor-a protein that leads to cell inflammation)

what are the pharmacologic classifications of celecoxib?

COX-2 inhibitor NSAID

what are the mechanisms of action for celecoxib?

Celecoxib selectively inhibits the enzyme COX-2. It inhibits prostaglandin synthesis to reduce inflammation. This action relieves pain and inflammation in the joints and smooth muscle tissue.

what is a receptor?

Cellular molecule to which a medication binds to produce its effects

what is the pharmacologic classification of adalimumab (humira)

Disease-modifying antirheumatic drug

what are the contraindications/ precautions of celecoxib?

Do not use with Chronic Kidney Disease or Significant Cardiac History •Do not combine with anticoagulant or antiplatelet drugs, alcohol, corticosteroids or other NSAIDs•

what is the black box warning for adalimuab (humria)

Due to anti-inflammatory properties patients at risk for serious infections and malignancies

what is gout?

Form of acute arthritis caused by accumulation of uric acid crystals in joints and other body tissues •May be primary (genetic causes) or secondary (caused by diseases or drugs) •Treated with drugs that decrease joint pain and lower uric acid levels

what is a loading dose?

Higher amount given to "prime" bloodstream

what is the mechanism of action of ibuprofen?

Inhibits COX-1 and COX-2, which block prostaglandin synthesis and modulate T-cell function

what are the Mechanism of action of Alendronate (Fosamax)?

Inhibits osteoclast-mediated bone resorption to minimize loss of bone density

what are the adverse effects of propofol?

Injection-site pain,Respiratory depression,Apnea,Hypotension,Propofol infusion syndrome (PRIS)

what is the therapeutic effect and use for celecoxib?

Long term NSAID use (Rheumatoid Arthritis, Osteoarthritis)

what are the side effects of ibuprofen?

Most frequent: GI side effects, from indigestion to GI Bleeding•Large doses and chronic use can cause kidney problems

what is the pharmacologic classification of Ibuprofen?

NSAID

describe nonopioids

NSAIDS, centrally acting agents, or acetaminophen; used for mild to moderate pain

what is nonspecific inflammation is treated with?

NSAIDs and cotricosteroids

what is an example of an opioid antagonist?

Naloxone

oxycodone + acetaminophen=

Percocet

what are the adverse effects of celecoxib?

Potential for GI side effects (although less than non selective NSAIDS) •It may increase the risk of serious and potentially fatal cardiovascular thrombotic events, MI, and stroke. •This risk may increase with duration of use and in patients with cardiovascular risk factors.

what are the advantages of local anesthetics

Relief provided without: ◦CNS depression◦ Respiratory depression ◦Nausea and vomiting ◦Tremors ◦Anxiety

what are the adverse effects of midazolam?

Respiratory depression,Apnea,Drowsiness, fatigue,Slurred speech,Tremor,Hypotension,Cardiovascular collapse

what are the adverse effects of fentanyl?

Respiratory depression◦Peak 5-15 minutes after dose◦Outlasts analgesia Apnea Muscle rigidity Bradycardia Hypotension Nausea and vomiting Constipation

what schedule is fentanyl?

Schedule II

what schedule is morphine sulfate?

Schedule II, high abuse potential

What regulatory agency is responsible for ensuring drugs and medical devices are safe and effective?

U.S. Food and Drug Administration

what is the pharmacologic classification of allopurinol

Xanthine oxidase inhibitor

Which principle best describes what the nurse is expected to understand when administering medication to a client? a.The pharmacotherapeutics for all of the medications b. The most common side effects of the drug's prototype c.The trade and generic names for all of the medications d. The cost of the drug therapy from different drug manufacturers

a

the nurse is preparing medications for a group of clients. another nurse begins telling the nurse about her recent engagement. what is the best action by the first nurse? a. tell the second nurse that the conversation is distracting and must cease while meds are being prepared b. ask the second nurse to help administer the med so they can have more time to talk c. continue to prepare the medication for administration and pretend to listen to the first nurse d. stop preparing the med until the first nurse has finished talking about her engagement

a

what is cytochrome P450 (CYP)?

a hepatic (liver) microsomal enzyme, metabolizes many drugs

what is the Beers criteria?

a list of drugs that should be avoided by the elderly

what is ketorolac?

a powerful analgesic with minimum anti-inflammatory actions; lacks the serious adverse effects associated with opioids (respiratory depression, tolerance, dependence, abuse potential)

Chemical names are assigned to each drug. What are the major reasons for why nurses usually do not use the chemical names of drugs?(Select all that apply.) a.They are usually not brief or easy to remember. b. They are often difficult to pronounce. c.There is no standard for assigning names. d. They do not explain the nature of the drug. e. There is only one chemical name for each drug.

a, b

A patient who is experiencing no symptoms of a low calcium level asks why calcium is important. How should the nurse respond? (Select all that apply) .a. "Calcium is needed to keep the nervous system working properly." b. "Calcium is used by the body to make the muscles move." c. "Calcium is used in the blood to help with clotting." d. "Calcium maintains the normal respiratory rate." e. "Calcium is needed to control blood glucose levels."

a, b, c

when teaching a patient about a new medication, what information should be included? (select all that apply) a.side effects that can be expected b. which adverse effect to report to the healthcare provider c. the drug's therapeutic action d. name of the drug manufacturer

a, b, c

A new nurse makes a medication error. Which statements by the nurse manager foster a safe environment in which nurses will report medication errors?(Select all that apply) .a. "Many of us have made a medication error in our careers. The most important issue is to identify why the error occurred." b. "I know you could not feel any worse than you already do. We need to discuss how this error happened and how we can prevent it from happening again." c. "It's really good that your patient is okay and did not suffer any harmful effects of this error. We should discuss why this error occurred and how it can be prevented in the future." d. "Because you are a new nurse, we should sit down and discuss the procedure you followed to see what you could have done to prevent this error." e. "We need to sit down as soon as possible and write up an incident report describing everything you did incorrectly that caused this error."

a, b, c, d

the nursing instructor teaches the student how medication errors can occur. which common causes of errors will the instructor discuss? (select all that apply) a. the nurse administers the incorrect drug b. the nurse miscalculates the med dose c. the nurse misinterprets a healthcare providers orders d. the nurse does not check the clients identification band

a, b, c, d

which statements regarding the role of the U.S. food and Drug administration (FDA) are true? ( select all that apply) a. the FDA is responsible for ensuring the security of human drugs b. the FDA ensures the availability of effective drugs c. the FDA takes action against any supplement that is deemed to be unsafe d. the FDA facilitates the availability of safe drugs

a, b, c, d

A client says to the admitting nurse, "Why do you need to know the names of all the over-the-counter supplements I take? They aren't drugs." Which responses by the nurse are the most appropriate?(Select all that apply) a. "The admitting physician needs to know everything you are taking." b. "You're right. I'm not sure why the admitting paperwork asks for this information. Would you mind listing them anyway?" c. "The law requires us to keep a list of over-the-counter drugs and supplements that you are taking." d. "It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs."

a, d

A patient who is admitted to the medical unit for monitoring notices the arthritis medication does not look like the one used at home and asks the nurse about the different appearance. Which response by the nurse is the most appropriate? (select all that apply) a. "This is a different brand from the one you use at home, but it will give you the same pain relief." b. "Your healthcare provider feels we can safely substitute this drug for the drug you use at home." c. "This generic drug is the one we have on formulary in the pharmacy. It has the same ingredients as the one you use at home." d. "This is what we have in the pharmacy. Go ahead and take it for now and let me know if it doesn't relieve the pain." e. "The medications in the hospital often do not look like the ones you get from the pharmacy."

a,b,c

what are the four phases of pharmacokinetics that a drug goes through?

absorption, distribution, metabolism, and excretion

define a opioid agonist

activate mu and kappa receptors, bind to an opioid pain receptor in the brain, cause an analgesic response (reduction of pain sensation)

how do you treat a celecoxib over dose?

administer activated charcoal and nasogastric suction

what is the ophthalmic route

administer on or around the eyes

what is the otic route?

administered in the ears

describe nasogastric and gastrostomy tube medications

administered through device, liquid form, same process as those given PO

what is the intranasal route?

administered through the nose

after what age are adverse effects similar to adults

age 1

what is potency?

amount of drug needed to produce a specified effect

what is the therapeutic classification of tramadol?

analgesic

what is the therapeutic classification of celecoxib?

anti-inflammatory

what is a fever treated with?

antipyretics

What is a drug?

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

What are the amide local anesthetics?

articaine, bupivacaine, dibucaine, lidocaine, mepivacaine, prilocaine, ropivacaine

what was the first generation salicylate?

aspirin

example of an NSAID

asprin and ibuprofen

A patient has been prescribed acetaminophen and has been instructed by the nurse not to take any over-the-counter (OTC) cough or cold medications without first checking with the healthcare provider or pharmacist. What is the rationale for this instruction? a.There could be an increased risk for bleeding in the stomach and within other organs of the body. b.Cough medications and other OTC drugs could contain acetaminophen, so inadvertent overdose could occur. c.There is an increased risk for Reye's syndrome. d.No one should be taking more than one medication for pain.

b

For which client would the nurse anticipate the use of a local anesthetic? A. A client undergoing a umbilical hernia repair. B. A client needing stitches for a scalp laceration. C. A client scheduled for a repeat cesarean section. D. A client scheduled for a laparoscopic appendectomy.

b

Nursing students must memorize the generic names of drugs. What is the primary reason that generic names are used by healthcare providers over chemical and trade names? a.A drug can have more than one chemical and trade name. b. There is only one generic name for each drug. c.The trade names do not reflect the action of the drug as the generic name does. d. Nursing students should learn both the generic and trade names to avoid confusion with clients.

b

The nurse is following the guidelines established by the American Academy of Pediatrics when administering medications to a pediatric patient. Which nursing action is included in the guidelines?A.Verify drug orders after medication administration B.Check medication calculation with another professional C.Confirm the client's identity before administering the first dose of the shift D.Remember that all medication ordering and dispensing systems are the same in all facilities

b

The trade name for a drug is usually selected to be short and easy to remember. What is the reason the nurse does not use the trade name for a drug? a.There are no trade names for combination drugs. b. A drug can have more than one trade name. c.The trade name will expire and no longer be used. d. A company might change the trade name for a drug.

b

Which statement by the nurse would be part of a "best plan" to teach a client about general anesthesia? A. "An intravenous agent to induce sleep is usually all that is required." B. "An intravenous agent will be used first to induce sleep, then an inhaled agent will be used." C. "An inhaled agent is used to induce sleep, followed by an intravenous agent to promote relaxation." D. "An inhaled agent needs to be followed by an intravenous agent if the inhaled agent is not adequate."

b

nursing students must memorize the generic names of drugs. what is the primary reason that generic names are used by healthcare providers over chemical and trade names? a. a drug can have more than one chemical and trade name b. there is only one generic name for each drug c. the trade names do not reflect the action of the drug as the generic name does d. nursing students should learn both the generic and trade names to avoid confusion with clients

b

the nurse administers an evening medication to the client in the morning. the medication did go to the correct client. what is the nurses best course of action at this time? a. notify the healthcare provider to ask if any further action needs to be taken b. notify the healthcare provider about the error and complete an incident report c. tell the evening nurse to hold the evening dose just for tonight and complete an incident report d. call the pharmacy and change the medication administration time to the morning

b

The nurse is teaching a client the importance of taking the medication as prescribed. Client teaching is guided by the nurse's knowledge of which principles of pharmacokinetics?(Select all that apply.) a. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the bloodstream before it can be distributed throughout the body. b. A drug may be exposed to several physiologic processes while en route to target cells. c. Liver enzymes may chemically change the drug. d. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug.

b,c,d

What are the ester local anesthetics?

benzocaine, chloroprocaine, procaine, tetracaine

define a mixed opioid agonist-antagonist

bind to a pain receptor, cause a weaker neurologic response than a full agonist, also called partial agonist or mixed agonist, work on one receptor but block or have no effect on another

what is the mechanism of action of midazolam

binds to GABA receptors in the brain, intensifies the effects of GABA

define an opioid antagoni

block mu and kappa receptors, reverse the effects of these drugs on pain receptors, bind to a pain receptor and exert no response, also known as competitive antagonists

what does a calcium channel blocker do?

blocks heart calcium channels

what does an angiotensin-converting enzyme inhibitor do?

blocks hormonal activity

what does an adrenergic antagonist (or blocker) do?

blocks physiologic reactions to stress

what are the different ways you can give fentanyl as pain management?

buccal film or tablet, transmucosal lozenge, intranasal spray, transdermal patch

what routes will not go through the first pass effect?

buccal, sublingual, rectal, parenteral, topical

examples of opioid agonist-antagonist

butorphanol, nalbuphine

Pharmacotherapy is a critical intervention for many conditions, and a key part of nursing intervention. Which statement best describes pharmacotherapy? a.The study of medicine and drug therapy b. The application of natural substances to cure diseases c.The application of drugs for the prevention and treatment of disease and human suffering d. Understanding the difference between trade and generic medications

c

The clinic nurse will immediately alert the healthcare provider when which category X medication is identified on a recently diagnosed pregnant client's chart? A.Insulin B.Phenytoin C.Methotrexate D.Acetaminophen

c

Which rationale explains why anticonvulsants and antidepressants have an exaggerated effect in older adult clients? A.Increased intestinal transit time B.Increased rate of hepatic metabolism C.Declining efficiency of the blood-brain barrier D.Increased binding to plasma proteins such as albumin

c

the nurse explains to a student nurse that side effects differ from averse effects in which way? a. adverse effects cause permanent damage b. side effects are usually more serious than adverse effects c. side effects are predictable at therapeutic levels d. adverse effects are only dose related

c

the nurse is teaching a class about over-the-counter (OTC) medications at a senior citizen center. which statement by a participant indicates the teaching was effective? a."OTC medications are safe, as long as we dont take them at the same time as our prescription medications" b. "OTC medications are safe; otherwise, they would require a prescription" c. "we should not take any OTC medication without first calling our primary healthcare provider because these medications can interact with other prescriptions or products" d. "we must read all the label directions before taking any OTC medications"

c

what pregnancy category are DMARDS in?

c

how do opiates effect the respiratory system?

can cause respiratory depression, which can slow breathing and result in death

what are. drug to drug interactions?

can inhibit, enhance, or change the therapeutic effect of a drug

what are serious adverse drug effects?

can result in death, hospitalization, or disability, can cause congenital abnormalities, and life threatening events

what three systems do opioids effect the most?

central nervous system, Respiratory system ,and gastrointestinal

what are examples of mild opioid agonists?

codeine hydrocodone

how are opioids used as anesthesia?

combined with other medications to produce deep anesthesia

besides pain relief what are opiates used for?

cough center suppression, and treatment of diarrhea

Bioavailability of a drug can be affected by many factors. Which factor does not affect the bioavailability of a drug? a.Inert ingredients b. Rate of absorption c.Safety margin d. Tablet compression

d

The nurse is creating a teaching plan for a client on the cardiac unit and is researching the medications the client is currently taking to understand how each drug produces its effects in the body. To find this information, the nurse looks up which classification for each medication?a.Therapeutic b. Respiratory c.Disease d. Pharmacologic

d

When a drug is ordered for a client, what is the nurse responsible for knowing and understanding about the drug? a.Name, intended use, special considerations, and adverse effects b. Drug classification, contraindications, adverse effects, gender considerations, and cost of therapy c.Drug classification, contraindications, special considerations, and severity of adverse effects d. Name, intended use, effects, contraindications, special considerations, and adverse effects

d

the client and his wife receive the same medication for hypertension. The wife asks the nurse why she is receiving a higher dose of the medication. which response by the nurse is the most appropriate? a."you have a greater percentage of body fat, so you need more medication" b. "females have a higher metabolism, so you need more medication" c. "your hormones are different from your husbands, so you need more medication" d. "everyone is unique and responds differently to medications"

d

what pregnancy category is midazolam?

d

What is CYP450 inhibitor?

decreases metabolism causing increased level of drug (grapefruit juice)

decreased gastric tone and intestinal motility, results in ________ gastric emptying

delayed

define what distribution means in regard to drugs

describes how drugs are transported throughout the body

what are examples of volatile liquids used for anesthesia?

desflurane, enflurane, isoflurane, sevoflurane

describe extended release drugs

designed to dissolve slowly for longer duration of action (DO NOT CRUSH)

what conditions cause neuropathic pain?

diabetes, herpes zoster, acute trauma, cancer, autoimmune

what does a vasodilator do?

dilates peripheral blood vessels

describe buccal medications

dissolve in the cheek

what is an over-the -counter drug?

does not require authorization from health care providers

what is the Therapeutic classification of Alendronate (Fosamax)?

drug for osteoporosis and paget's disease

what are two types of drug interactions

drug to drug and drug to food

what is the first pass effect?

drugs absorbed from the stomach and small intestine travel to liver, where they may be inactivated before reaching the target organs

define the enteral route of absorption

drugs enter the GI tract (enteron= of the digestive tract )

what are scheduled drugs?

drugs with high potential for dependence or are frequently abused, sale and distribution are highly restricted, 5 categories

what is a chemical name?

each drug has only one, its provides a clear and concise meaning of the nature of the drug, is often difficult to pronounce, standard nomenclature established by IUPAC

what do you use to treat a midazolam overdose?

flumazenil

what is an example of an anti-seizure drug?

gabapentin (neurontin)

describe enteric-coated medication

hard, waxy coating to resist strongly acidic stomach contents (DO NOT CRUSH)

drugs absorbed faster from areas of the body where blood flow is ______

high (small intestine, lungs)

describe schedule 2 drugs

high potential for abuse, have accepted medical use but use may be severely restricted/refills are not usually permitted; Ex: opioids (codeine, fentanyl, methadone, morphine, oxycodone), cocaine

higher heart rate causes _______ drug distribution

higher

increased pulmonary blood flow causes ________ absorption of respiratory medications

higher

describe schedule 1 drugs

highest potential for abuse, no current acceptable medical use/no prescription may be written; Ex: heroin, LSD, marijuana

what are some ways med errors occur?

human factor inadequate communication confusing labels packaging drug names

what are drug allergies caused by?

hyperresponse of body defenses

what are the averse effects of alendronate (Fosamax)?

hypocalcemia, GI irritation

how is rheumatoid arthritis treated?

includes analgesics, anti-inflammatory drugs, corticosteroids, and disease-modifying antirheumatic drugs. •NSAIDs •Acetaminophen •Disease-modifying antirheumatic drugs (DMARDs) •Goals of RA pharmacotherapy are to manage inflammation, reduce pain, and maximize physical abilities

increased renal blood flow causes ______ elimination

increased

what causes increased permeability of the blood brain barrier?

inflammation

what is the mechanism of action of inhalation anesthetics?

inhibit flow of sodium into neurons, delay nerve impulses, activate GABA receptors

how is osteoarthritis treated?

is treated with a combination of analgesics and nonpharmacologic therapies. •Acetaminophen •NSAIDs •Goal of pharmacotherapy is to reduce pain and inflammation and to minimize disability

where does opium come from?

it is extracted from unripe poppy plant seeds

describe the fetal-placental barrier

it prevents harmful substances from passing from mother's blood stream to fetus. some substances can pass such as alcohol, cocaine, caffeine, and some prescriptions

describe the blood-brain barrier

it protects the brain from pathogens and toxins, it makes it difficult for drugs to pass to the brain, lipid soluble drugs are able to cross

what is a maintenance dose?

keep concentration within therapeutic range

if a drug has a long half life it will be given ______ frequently

less

What is a generic name?

less complicated than the chemical name, easy to memorize, many organizations use generic names to describe and identify

what types of drugs cross the placenta easier?

lipid soluble drugs, nonionized drugs

describe local anesthesia?

loss in sensation in immediate area, no loss of consciousness

describe regional anesthesia

loss of sensation in body region, no loss of consciousness

describe general anesthesia?

loss of sensation through whole body, loss of consciousness

describe a schedule 4 drug

low risk, similar restrictions to a schedule 3 drug; Ex: diazepam, tramadol

what does a diuretic do?

lowers plasma volume

describe a schedule 5 drug

lowest risk for abuse, similar controls to schedule 3 and 4; Ex: cough medicine with codeine, antidiarrheal meds with small amounts of opioids

what is an agonist?

makes the body do something, mimic the action of endogenous substances

why might a drug be a prescription rather than an over the counter drug?

may be addictive, too harmful for self-administration, used for complex conditions

what is the pharmacologic classification of tramadol?

mixed opioid-nonopioid analgesic

what are the therapeutic effects and uses of tramadol

moderate pain off label uses; neuropathic pain, restless leg syndrome

describe a schedule 3 drug

moderate risk for abuse, five refills allowed in a 6 month period; Ex: anabolic steroids, ketamine, codeine, hydrocodone, barbiturates

if a drug has a short half life it will be given ______ frequently

more

describe tablets and capsules

must dissolve before drug is available for absorption, slow onset time

how do you treat a tramadol overdose?

naloxone

what is a trade/brand name?

name that is given by the pharmaceutical company marketing the drug, attempt to be short and easy to remember

what are opiates?

natural substances obtained from opium, include morphine and codeine

where does morphine sulfate come from?

naturally occurring alkaloid derived from the opium poppy

in what age group is the blood brain barrier not fully developed?

neonates

what is an example of anesthesia gas?

nitric oxide

What does NSAID stand for?

non-steroidal anti-inflammatory drug

what are supplements?

not tested by FDA, herbal drugs and dietary supplements

describe the mechanism of action for morphine sulfate

occupies mu and kappa receptor sites in brain and dorsal horn of spinal cord that alter release of afferent neurotransmitters; alters perception of and emotional response to pain

what are combination drugs?

opioid and nonopioids

what routes of medication will undergo the first pass effect?

oral (PO) and gastrostomy tube (NG,OG)

oxycodone slow release=

oxycontin

what are some risks of over the counter drugs?

patient may not choose proper medications, no assistance from the health care provider, may interact with other drugs, foods, or herbal meds

what is a prescription drug?

patient must receive authorization to receive the drug

what is chronic pain?

persistent or recurring, lasts 3-6 months, often difficult to treat

what are side effects?

predictable, occur at therapeutic doses, distinguished from adverse effects by severity

what is the big difference between a generic drug and a trade name drug?

price! generic drugs are cheaper

What is a partial agonist?

produce weaker action than endogenous substances

aspirin blocks the synthesis of what hormone and how?

prostaglandins by inhibiting enzyme cyclooxygenase (COX)

what is the drug class of naloxone hydrochloride (narcan)?

pure opioid antagonist

what do corticosteroids do?

reduce inflammatory swelling, pressure on brain, spinal cord, spinal nerves

what are the common side effects of opiates?

respiratory depression, drowsiness, constipation, urinary retention, nausea, vomiting, itching, pupil constriction

oxycodone alone =

roxicodone

Describe MAC anesthesia.

sedated but responsive, can be minimal, moderate, or deep

describe the use of propofol

sedative-hypnotic, IV anesthetic, immediate onset, duration 10-15 minutes, antiemetic effect

what are some side effects naloxone hydrochloride (narcan)?

severe pain, abrupt withdrawal symptoms

what does the presence of food due to drug absorption?

slows it

if you are hypersensitive to which foods, you should not use propofol?

soy and eggs

what is neuropathic pain?

steady burning, electric shock, "pins and needles"

what is an antagonist?

stop the body from doing something or reverse drug, prevent action of endogenous substances

what is acute pain?

sudden onset, usually subsides once treated

what are opioids?

synthetic drug with morphine like activity, can be natural or synthetic

what is pharmacotherapy?

the application of drugs for prevention of treatment of suffering

where is the primary site of drug metabolism?

the liver

what is the pharmacologic classification?

the mechanism of the drug or how the drug produces its effects in the body

define absorption

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

where does most drug absorption occur?

the small intestine

define pharmacodynamics

the study of how a drug affects an organism (what the drug does to the body)

define pharmacokinetics

the study of how the organism affects the drug (what the body does to the drug)

what is pharmacology?

the study of medicine

what is a CYP450 inducer?

they increase rate of metabolism breaking down more drug

what is a drug half life?

time until the concentration is decreased by half

what is the primary goal of pain management?

to reduce pain to a level that allows the patient to continue normal daily activities

what are opioids used for?

to treat severe pain

describe sublingual (SL) medication

under the tongue, wait till it fully dissolves

what are adverse drug effects?

undesirable and possibly harmful actions that occur secondary to a medication

describe adjuvant analgesics

used to treat chronic pain that is neuropathic in nature (antidepressants, anticonvulsants)

describe the preimplantation stage

weeks 1-2, no blood supply with mother, "All or none" period

describe the embryonic stage

weeks 3-8, maximum sensitivity to teratogens, structural malformation and spontaneous abortion

describe the fetal stage

weeks 9-40, maximal transfer of substances, slowed growth or impaired organ function

what is a therapeutic classification?

what is being treated by the drug

how do you treat acetaminophen over dose?

•Acetylcysteine (Mucomyst) •Must be administered within 8 hours of overdose •Overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity

describe Nalbuphine (nubain)

•Agonist at kappa receptors •Weak antagonist at mu receptors •IV, IM, subcutaneous routes •Moderate to severe pain •Preanesthesia or anesthesia adjunct •Not a scheduled drug

what is the minimum effective concentration of a drug?

•Amount of drug required to produce a therapeutic effect

what are some drugs that are known for producing cancer risks?

•Antineoplastics •Immunosuppressants •Hormone and hormone antagonists

what are some forms of drug toxicity?

•Bone marrow toxicity •Cardiotoxicity •Dermatologic toxicity/Phototoxicity •Hepatotoxicity •Nephrotoxicity •Neurotoxicity •Ototoxicity •Skeletal muscle and tendon toxicity

what are the contraindications/ precautions of allopurinol

•CKD or impaired hepatic function •Peptic ulcers

what are the serious adverse effects of acetaminophen?

•Causes liver toxicity at high doses •Max dose: 4 gm/day, if no liver disease•Many recommend max dose of 2600mg •#1 cause of liver failure in the U.S. •Acute acetaminophen poisoning •Long-term ingestion of large doses also causes nephropathy •Acute hepatic failure - Metabolized almost completely by liver

what are carcinogenic drugs?

•Damage DNA, leading to mutation •Effects may not be seen for years

describe intravenous (IV) administration

•Directly to bloodstream •Fastest onset but also most dangerous

what are the contradictions/ cautions of ibuprofen?

•Do not use with peptic ulcer disease (PUD) •Caution with cardiac disorders •Do not combine with anticoagulant or antiplatelet drugs (increased bleeding) •Combined with alcohol or corticosteroids increases chances of PUD•

what is the mechanism of action for tramadol?

•Drug and one of metabolites bind to mu receptor •Weak opioid agonist activity •Inhibits norepinephrine and serotonin reuptake in spinal neurons•Inhibits transmission of pain impulses

describe intramuscular (IM) administrations

•Drugs directly into large muscles •Tissue can receive larger volume of drug. •More rapid onset of action

what are some ways that the absorption of drugs vary in geriatric patients?

•Gastric pH increases, medications dissolve more slowly •Decreased blood flow to GI tract, delays absorption and distribution •Slowed motility, increases time for absorption, increases N&V

what are the therapeutic effects and uses of allopurinol

•Gout and its complications •Prevents recurrent nephrolithiasis due to calcium oxalate stones in patients with elevated uric acid levels

what are some ways that distribution of drugs differ in pediatric patients?

•High proportion of water, dilutes water-soluble meds •Low body fat, lipid-soluble meds stay in blood •Immature liver, more "free" meds in blood •Underdeveloped blood brain barrier, adverse CNS effects

what are some serious adverse effects of aspirin?

•Hypersensitivity reaction •GI bleeding •Thrombocytopenia •Hemolytic anemia •Nephrotoxic effects •Hepatotoxicity •Tinnitus and hearing loss with high doses - sign of toxicity

what are some ways that the distribution of drugs vary is geriatric patients?

•Increased fat proportion, lipid-soluble meds stored longer •Less body water, water-soluble meds are more concentrated •Reduced liver function, more "free" meds in blood •Inefficient blood-brain barrier, greater risk of CNS effects

what are some ways that absorption of drugs varies in pediatric patients?

•Increased gastric pH, may slow or speed up absorption •Slow gastric emptying, increase absorption in stomach and slow absorption in intestines •Low blood flow to skeletal muscle, slow erratic absorption IM •Weak muscle contractions, slow absorption IM •Thin skin, increased absorption of topical meds

what is the toxic concentration of a drug?

•Level of drug that results in serious adverse effects

what is the mechanism of action for acetaminophen?

•MOA for pain unclear. We know it acts centrally in the CNS by inhibiting COX, but has no effects on COX in the peripheral tissues •Fever reduced direct action on the heat regulating center of the hypothalamus causing blood vessels to dilate, sweating and dissipation of heat.

describe intradermal and subcutaneous administration

•Major difference is depth of injection. •Dermis contains more blood vessels •Subcutaneous route delivers drugs to deepest layers of skin. •Eg. Insulin, heparin

what are the therapeutic effects and uses of aspirin?

•Mild to moderate intensity pain, inflammation, fever •Prevention of thromboembolic event •Stroke prophylaxis in patients with history of TIAs or persistent or paroxysmal atrial fibrillation •MI prophylaxis •Suspected coronary thrombosis •Off-label use to prevent colorectal cancer

what is the therapeutic classification of aspirin?

•Nonnarcotic analgesic •Antipyretic •Antiplatelet

what are the therapeutic classifications of acetaminophen?

•Nonopioid analgesic •Antipyretic

what are some ways a nurse can prevent adverse effects?

•Obtain a thorough medical history •Assess patient and diagnostic data •Prevent medication errors •Monitor pharmacotherapy carefully• Know all drugs taken by the patient •Be prepared for unusual drug effects •Question unusual orders •Teach clients about adverse effects

what are some symptoms of hyper calcemia?

•Palpitations •Metallic taste •Headache

what is the pharmacologic classification of acetaminophen?

•Para-aminophenol derivative

what are some drug classes that are most likely to cause allergic reactions?

•Penicillin and related antibiotics •Radiologic contrast media with iodine-insulin• NSAIDs •Sulfonamides •Cancer chemotherapy agents •Preservatives •Certain antiseizure drugs

what are the adverse effects of ketorolac?

•Peptic ulcers, •GI bleeding or perforation •Prolonged bleeding time •Renal impairment

what are teratogens?

•Potential to cause birth defects

what is the therapeutic range of a drug?

•Range where the drug produces its desired therapeutic action •After peaking, drug plasma level falls due to excretion

what are the therapeutic effects and uses of ibuprofen?

•Relief of fever and mild to moderate pain associated with chronic symptomatic RA and osteoarthritis •Myalgia, headache, dental pain, and dysmenorrhea

what are some adverse effects of aspirin?

•Stomach irritation •Heartburn •Nausea/Vomiting/Diarrhea

what are the therapeutic effects and uses of ketorolac?

•Use should be short term and restricted to managing acute pain of moderate to severe intensity •Not indicated for chronic pain or for minor aches and discomfort •The usual indication is postoperative pain, for which ketorolac can be as effective as morphine •Use should be no longer than 5 days or a set number of doses per facility protocol due to the risk of gastrointestinal, cardiovascular and renal complications

what are the therapeutic effects and uses of acetaminophen?

•Used to relieve pain and to reduce fever•Has no anti-inflammatory properties •Not an NSAID•Does not cause GI bleeding or ulcers •Often combined with opioid analgesics to reduce opioid requirements

what are some adverse effects of tramadol?

•Vertigo/Dizziness/Headache• Nausea/Vomiting •Constipation •Lethargy •Respiratory depression •Possible physical dependence

what are some advantages to using opioids as anesthesia?

◦Immediate onset when given IV ◦Short duration of action, less than 60 minutes

what is propofol infusion syndrome (PRIS)?

◦Metabolic acidosis, liver dysfunction, rhabdomyolysis, hyperkalemia, acute kidney injury, cardiac dysfunction

what are some disadvantages to using opioids for anesthesia?

◦Respiratory depression, muscle rigidity