Pharm - Quiz 1
definition of Toxicity:
the condition of producing adverse bodily effects due to poisonous qualities - common poisons & their antidotes - 1. acetaminophen - acetylcysteine 2. beta blockers - glucagon 3. opiates - naloxone 4. carbon monoxide - oxygen
definition of Peak Level: - Therapeutic Drug Monitoring
highest blood level! - levels are drawn immediately after the dose is administered - high plasma concentration of the drug at a specific time (measures absorption) - a LOW Peak means NO therapeutic effect is achieved
definition of Superinfection:
the process by which a cell that has previously been infected by one virus gets co-infected with a different strain of the virus, or another virus, at a later point in time - may be resistant to the antiviral drug or drugs that were being used to treat the original infection
definition of Dissolution: - Chapter 2 Vocabulary
the process by which solid forms of drugs disintegrate in the Gastrointestinal Tract and become soluble before being absorbed into the circulation
definition of the First-Pass Effect:
the process in which the drug passes to the liver first (hepatic first-pass) - effects Bioavailability because the liver deactivates or alters some or all of the drug - Parental and Topical (except rectal) are NOT affected by the first-pass
definition of Therapeutic Drug Monitoring: - Chapter 2 Vocabulary
the process of measuring drug levels to identify a patient's drug exposure and to allow adjustment of dosages with the goals of maximizing therapeutic effects and minimizing toxicity - Peak Level and Trough Level
definition of Drug Actions: - Chapter 2 Vocabulary
the processes involved in the interaction between a drug and body cells (e.g., the action of a drug on a receptor protein) - also called Mechanism of Action
if you were given a statement such as - "you are taking the patient's temperature. what part of the nursing process is that?":
assessment - performing a comprehensive assessment
Chapter 2 Review Questions - a drug that delivers 300mg has a half-life of 4 hours. how many milligrams of the drug will remain in the body after 1 half-life?:
150mg will remain after one half-life
list the Chemical, Generic, and Trade Names of Ibuprofen:
chemical name - (+/-)-2-(p-isobutylphenyl) propionic acid generic name - Ibuprofen trade name - Motrin, others
definition of Pharmacology:
study or science of drugs
definition of an Antagonist: - Chapter 2 Vocabulary
a drug that binds to and inhibits the activity of one or more receptors in the body - also called Inhibitors
definition of a Steady State: - Chapter 2 Vocabulary
the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose
Chapter 3 Review Questions - the physiologic differences in the pediatric patient compared with the adult patient affect the amount of drug needed to produce a therapeutic effect. the nurse is aware that one of the main differences is that infants have which of these factors?: A) increased protein in circulation B) fat composition lower than 0.001% C) more muscular body composition D) water composition of approximately 75%
water composition of approximately 75%
definition of an Agonist: - Chapter 2 Vocabulary
a drug that binds to and stimulates the activity of one or more receptors in the body
Chapter 1 Review Questions - a 77 year old man who has been diagnosed with an upper respiratory tract infection tells the nurse that he is allergic to penicillin. which is the most appropriate response by the nurse?: A) "many people are allergic to penicillin." B) "this allergy is not a major concern because the drug is given so often." C) "what type of reaction did you have when you took penicillin?" D) "drug allergies don't usually occur in older individuals due to built-up resistance to allergic reactions."
"what type of reaction did you have when you took penicillin?"
list & describe the steps of the Nursing Process:
1. Assessment - data collection, review, & analysis - medication profile 2. Planning - identification of goals and outcome criteria - Goals - objective, measurable, and realistic - Outcome Criteria - concrete descriptions of patient goals 3. Implementation - initiation & completion of specific nursing actions as defined by the nursing diagnosis, goals, and outcome criteria (includes patient education) - independent, collaborative, and dependent 4. Evaluation - occurs after the nursing care plan has been implemented - systematic, ongoing, and dynamic - includes monitoring the fulfillment of outcomes, as well as monitoring the patient's therapeutic response to the drug and its adverse effects & toxic effects
describe the Pregnancy Safety Categories:
1. Category A - NO risk to the human fetus 2. Category B - NO risk to the animal fetus - information for humans is NOT available 3. Category C - adverse effects reported in the animal fetus - information for humans is NOT available 4. Category D - possible fetus risk in humans reported - however, in selected cases consideration of the potential benefit vs risk may warrant use of these drugs in pregnant women 5. Category X - fetal abnormalities have been reported - positive evidence of fetal risk to humans is available from animal and / or human studies - these drugs are NOT to be used by pregnant women
describe the Pharmacologic Principles:
1. Pharmaceutics - the study of how various drug forms influence the way in which the drug affects the body 2. Pharmacokinetics - the study of what the body does to the drug 3. Pharmacodynamics - the study of what the drug does to the body 4. Pharmacotherapeutics - the clinical use of drugs to prevent and treat diseases (defines principles of drug actions) 5. Pharmacognosy - the study of natural (versus synthetic) drug sources (i.e., plant, animals, minerals) 6. Pharmacoeconomics - branch of economics that uses cost-benefit, cost-effectiveness, cost-minimization, cost-of-illness and cost-utility analyses to compare pharmaceutical products and treatment strategies
list the "Rights" of Medication Administration: - 5 Rights, 6 Rights, 9 Rights
1. Right Drug - ensure that the correct drug is given by checking the specific medication order 2. Right Dose - confirm that the dosage amount if appropriate for the patient's age & size 3. Right Time - routine medication administration times 4. Right Route & Form - confirm the appropriateness of the prescribed route while also making sure the patient can take / receive the medication by the prescribed route 5. Right Patient - checking the patient's identity 6. Right Documentation - documentation of information related to medication administration is crucial to patient safety 7. Right Reason or Indication - addresses the appropriateness in use of the medication to the patient 8. Right Response - refers to the drug and its desired response in the patient 9. Right to Refuse - right of the patient to refuse medications
Chapter 2 Review Questions - each statement describes a phase of pharmacokinetics. put the statements in order, with 1 indicating the phase that occurs first and 4 indicating the phase that occurs last: A) enzymes in the liver transform the drug into an inactive metabolite B) drug metabolites are secreted through passive glomerular filtration into the renal tubules C) a drug binds to the plasma protein albumin and circulates through the body D) a drug moves from the intestinal lumen into the blood system
1. a drug moves from the intestinal lumen into the blood system (D) 2. a drug binds to the plasma protein albumin and circulates through the body (C) 3. enzymes in the liver transform the drug into an inactive metabolite (A) 4. drug metabolites are secreted through passive glomerular filtration into the renal tubules (B)
describe the Barriers to Absorption: - Pharmacokinetics
1. blood flow 2. food in stomach 3. acidity of stomach (drugs are created to absorb in high acid so if stomach is buffered won't absorb) 4. absorptive surface of stomach (parietal cell condition) 5. dosage formulation-liquids are faster, and enteric coated slow to absorb
Chapter 3 Review Questions - the nurse is preparing to give an oral dose of acetaminophen (Tylenol) to a child who weighs 12 kg. the dose is 15 mg/kg. how many milligrams will the nurse administer for the dose?:
180mg - 12kg x 15mg/kg = 180mg - 1kg = 2.2 pounds -- a 10 pound baby weighs 4.5kg ; divide the number of pounds by 2.2 to determine kg
Chapter 2 Review Questions - the nurse is reviewing the various forms of topical medications. which of these are considered topical medications?: A) rectal ointment for hemorrhoids B) eye drops for inflammation C) sublingual tablet for chest pain D) inhaled medication for asthma E) intradermal injection for tuberculosis testing
A) rectal ointment for hemorrhoids B) eye drops for inflammation D) inhaled medication for asthma
Chapter 1 Review Questions - the nurse is reviewing data collected from a medication history. which of these data are considered objective data?: A) white blood cell count 22,000 mm^3 B) blood pressure 150/94 mm Hg C) patient rates pain as an "8" on a 10-point scale D) patient's wife reports that the patient has been very sleepy during the day E) patient's weight is 68 kg
A) white blood cell count 22,00 mm^3 B) blood pressure 150/94 mm Hg E) patient's weight is 68 kg
definition of Synergistic Effects: - Chapter 2 Vocabulary
drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drug given alone - 1 + 1 is greater than 2
Chapter 2 Review Questions - a patient has just received a prescription for an enteric-coated stool softener. when teaching the patient, the nurse should include which statements?: A) "take the tablet with 2 to 3 ounces of orange juice." B) "be sure to drink 6 to 8 ounces of water with the tablet." C) "avoid taking all other medications with any enteric-coated tablet." D) "crush the tablet before swallowing if you have any problems with swallowing." E) "be sure to swallow the tablet whole without chewing."
B) "be sure to drink 6 to 8 ounces of water with the tablet." E) "be sure to swallow the tablet whole without chewing."
Chapter 3 Review Questions - the nurse is preparing to administer an injection to a preschool-age child. which approaches are appropriate for this age group?: A) explain to the child in advance about the injection B) provide a brief, concrete explanation about the injection C) encourage participation in the procedure D) make use of magical thinking E) provide comfort measures after the injection
B) provide a brief, concrete explanation about the injection D) make use of magical thinking E) provide comfort measures after the injection
Chapter 1 Review Questions - the nurse is reviewing new medication orders that have been written for a newly admitted patient. the nurse will need to clarify which orders?: A) metformin (Glucophage) 100mg PO twice a day B) sitagliptin (Januvia) 50mg daily C) simvastatin (Zocor) 20mg PO every evening D) irbesartan (Avapro) 300mg PO once a day E) docusate (Colace) as needed for constipation
B) sitagliptin (Januvia) 50mg daily E) docusate (Colace) as needed for constipation
Chapter 1 Review Questions - the nurse is compiling a drug history for a patient. which questions from the nurse will obtain the most information from the patient?: A) "do you use sleeping pills to get to sleep?" B) " do you have a family history of heart disease?" C) "when you have pain, what do you do to relieve it?" D) "did you have the mumps as a child?" E) " tell me about what happened when you had an allergic reaction to penicillin." F) "what herbal products or over-the-counter medications do you use?"
C) "when you have pain, what do you do to relieve it?" E) "tell me about what happened when you had an allergic reaction to penicillin." F) " what herbal products or over-the counter medications do you use?"
Chapter 3 Review Questions - the nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. which factors puts the neonatal patient at risk with regard to drug therapy?: A) higher gastric pH B) increased peristalsis in the GI tract C) immature renal function D) reduced first-pass elimination in the liver E) decreased protein-binding of medications
C) immature renal function D) reduced first-pass elimination in the liver E) decreased protein-binding of meds - drug therapy can result in adverse effects and toxicity (drug properties, fetal gestational age, and maternal factors)
describe Cardiovascular Dysfunction:
Cardiovascular Disease is #1 in the US - drugs need a competent CV System for circulation, so if there is Cardiovascular Dysfunction the other body systems don't work well either - think it through: medication will not be as effective if there is Cardiovascular or Renal Dysfunction - LOW Cardiac Output = LOW Absorption and Distribution - LOW Blood Flow = LOW Absorption and Distribution
describe the factors the decrease AND increase Metabolism: - Pharmacokinetics
Factors that DECREASE Metabolism: 1. Cardiovascular Dysfunction - heart failure 2. Renal Insufficiency - poor function of the kidneys that may be due to a reduction in blood-flow to the kidneys caused by renal artery disease 3. Starvation 4. Obstructive Jaundice - condition in which there is blockage of the flow of bile out of the liver 5. Slow Acetylator - low acetylation may lead to higher blood levels of the drug and thus, to an increase in toxic reactions 6. Ketoconazole Therapy - treat fungal infections in its oral form Factors that INCREASE Metabolism: 1. Fast Acetylator - an organism capable of metabolic acetylation - individuals that differ in their inherited ability to metabolize certain drugs 2. Barbiturate Therapy - increase the activity of a chemical in the brain that helps transmit signals 3. Rifampin Therapy - used to prevent and treat tuberculosis and other infections 4. Phenytoin Therapy - it can treat and prevent seizures
Chapter 1 Review Questions - the nurse is preparing a care plan for a patient who has been newly diagnosed with type 2 diabetes mellitus. state the correct order of steps of the nursing process for the care plan:
Nursing Process Steps for a Plan of Care: 1. Assessment 2. Human Needs Statement 3. Planning 4. Implementation 5. Evaluation
definition of a Metabolite: - Chapter 2 Vocabulary
a chemical form of a drug that is the product of one or more biochemical (metabolic) reactions involving the parent drug - active metabolites are those that have pharmacologic activity of their own, even if the parent drug is inactive - inactive metabolites lack pharmacologic activity and are simply drug waste products awaiting excretion from the body (via the urinary, gastrointestinal, or respiratory tract)
describe the Routes of Absorption: - Pharmacokinetics
a drug's route of administration affects the rate & extent of adsorption of that drug 1. External - GI Tract - the drug is absorbed into the systemic circulation through the oral or gastric mucosa, or the small intestine A) oral C) buccal B) sublingual D) rectal - can be topical 2. Parenteral - Intravenous (fastest delivery into the blood circulation) - Intramuscular (within a muscle) - Subcutaneous (within the subcutaneous tissue - below the dermis and epidermis) - Intradermal (within the dermis) - Intraarticular (within a joint) - Intraathecal (within a sheath - spinal cord) - Intraarterial (within an artery) 3. Topical - skin (including transdermal patches) - eyes - lungs (inhalation) - ears - rectum - nose - vagina
definition of Adverse Effects: - Chapter 2 Vocabulary
a general term for any undesirable effects that are a direct response to one or more drugs
definition of Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency: - Chapter 2 Vocabulary
a hereditary condition in which red blood cells break down when the body is exposed to certain drugs
definition of Bioavailability: - Chapter 2 Vocabulary
a measure of the extent of drug absorption for a given drug or more (from 0% to 100%) - term used to quantify the percentage of the dose of a drug that reaches systemic circulation
definition of Drug Classification: - Chapter 2 Vocabulary
a method of grouping drugs - may be based on structure or therapeutic use
definition of Dependence: - Chapter 2 Vocabulary
a state in which there is a compulsive or chronic need, as for a drug
definition of Bioequivalent:
a term in pharmacokinetics used to assess the expected in vivo biological equivalence of two proprietary preparations of a drug - if two products are said to be bioequivalent it means that they would be expected to be, for all intents and purposes, the same
definition of a P-Glycoprotein: - Chapter 2 Vocabulary
a transporter protein that moves drugs out of cells and into the gut, urine, or bile
definition of Drug Interaction: - Chapter 2 Vocabulary
alteration in the pharmacological or pharmacokinetic activity of a given drug caused by the presence of one or more additional drugs - it is usually related to effects on the enzymes required for metabolism of the involved drugs
definition of an Idiosyncratic Reaction: - Chapter 2 Vocabulary
an abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to a particular patient
definition of an Allergic Reaction: - Chapter 2 Vocabulary
an immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication - a type of Adverse Drug Event
definition of a Prodrug: - Chapter 2 Vocabulary
an inactive drug dose form that is converted to an active metabolite by various biochemical reactions once it is inside the body
Chapter 3 Review Questions - when the nurse is reviewing a list of medications taken by an 88 year old patient, the patient says "I get dizzy when I stand up." she also state that she has nearly fainted "a time or two" in the afternoons. her systolic blood pressure drops 15 its when she stands up. which type of medication may be responsible for these effects?: A) nonsteroidal anti-inflammatory drugs (NSAIDs) B) cardiac glycosides C) anticoagulants D) antihypertensives
antihypertensives - syncope, falls = nausea, hypertension, diarrhea, bradycardia, heart failure, and impotence
definition of a Drug: - Chapter 2 Vocabulary
any chemical that affects the physiological processes of a living organism
definition of Contraindication: - Chapter 2 Vocabulary
any condition, especially one related to a disease state or patient characteristic, including current or recent drug therapy, which renders a particular form of treatment improper or undesirable
definition of an Adverse Drug Event: - Chapter 2 Vocabulary
any undesirable occurrence related to administering or failing to administer a prescribed medication
definition of an Adverse Drug Reaction: - Chapter 2 Vocabulary
any unexpected, unintended, undesired, or excessive response to a medication given at therapeutic dosages (as opposed to overdose)
definition of Side Effects:
are unwanted or unexpected events or reactions to a drug - also known as Adverse Events
Chapter 3 Review Questions - an 82 year old patient is admitted to the hospital after an episode of confusion at home. the nurse is accessing the current medications he is taking at home. which method is the best way to assess his home medications?: A) ask the patient what medications he takes at home B) ask the patient's wife what meds he takes at home C) ask the patient's wife to bring his meds to the hospital in their original containers D) contact the patient's pharmacy for a list of the patient's current medications
ask the patient's wife to bring his medications to the hospital in their original containers
Chapter 2 Review Questions - the nurse is giving medications to a patient in heart failure. the intravenous route is chosen instead of the intramuscular route. what physical function does the nurse recognize as the most influential when deciding to use the intravenous route of drug administration?: A) altered biliary function B) increased glomerular filtration C) reduced liver metabolism D) diminished circulation
diminished circulation - provides rapid onset, allows more direct control of drug levels in the blood, gives the option of a larger fluid volume (diluting irritating drugs), and avoids first-pass metabolism
Chapter 2 Review Questions - the nurse is caring for a patient with cirrhosis or hepatitis, and recognizes that abnormalities in which the phase of pharmacokinetics may occur in this patient?: A) absorption B) distribution C) metabolism D) excretion
distribution - transport of a drug by the bloodstream to its site of action
definition of Antagonistic Effects: - Chapter 2 Vocabulary
drug interactions in which the effect of a combination of two or more drugs is less than the sum of the individual effects of the same drug given alone (1 + 1 = less than 2) - it is usually caused by an antagonizing (blocking or reducing) effect of one drug on another
definition of Additive Effects: - Chapter 2 Vocabulary
drug interactions in which the effect of a combination of two or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone - 1 + 1 = 2 (compare w/ synergistic effects)
Chapter 2 Review Questions - an elderly women took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. the nurse recognizes that this woman has experienced which type of reaction or effect?: A) allergic reaction B) idiosyncratic reaction C) mutagenic effect D) synergistic effect
idiosyncratic effect - NOT the result of a known pharmacologic property of a drug or of a patient allergy, but instead occurs unexpectedly in a particular patient
definition of Trough Level: - Therapeutic Drug Monitoring
lowest blood level! - levels are drawn just before the next dose is given - measures the rate at which the drug is excreted -- lowest plasma concentration - a HIGH Trough means there is a higher risk for toxic effects
Chapter 2 Review Questions - a patient who has hypertension is now taking a daily dose of beta blocker. which term best describes this type of therapy?: A) palliative therapy B) maintenance therapy C) supportive therapy D) supplemental therapy
maintenance therapy - prevents the progression of a disease or condition
describe the Protein Binding of Drugs: - Pharmacokinetics - Distribution
medications bind to enzymes, phospholipids, or proteins - Albumin is a Protein - serum protein normal level 3.5-5.5g/dL -- if protein low, then medication may not be distributed
Chapter 3 Review Questions - while teaching a 76 year old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. this intervention is important for the older adult patient because of which alternations in pharmacokinetics?: A) increased renal excretion of protein-bound drugs B) more alkaline gastric pH, resulting in more adverse effects C) decreased blood flow to the liver, resulting in altered metabolism D) less adipose tissue to store fat-soluble drugs
more alkaline gastric pH, resulting in more adverse effects - during the implementation phase
describe Pharmacokinetics - Absorption:
movement of a drug from its site of administration into the bloodstream for distribution to the tissues - Bioavailability - term used to quantify the percentage of the dose of a drug that reaches systemic circulation - First-Pass Effect - the process in which a drug passes to the liver first (hepatic first-pass)
definition of the Generic Name:
name given by the United States Adopted Names Council - nonproprietary name
definition of Biotransformation: - Chapter 2 Vocabulary
one or more biochemical reactions involving a parent drug - occurs mainly in the liver and produces a metabolite that is either active or inactive - also known as Metabolism
Chapter 1 Review Questions - a patient has a new prescription for blood pressure medication that may cause him to feel dizzy during the first few days of therapy. which is the best human needs statement for this situation?: A) physical activity B) physical safety C) freedom pain D) interchange of gases
patient safety - identification of human needs is the result of clinical judgement about a human response to health conditions and / or life processes, critical thinking, creativity, and accurate collection of data regarding the patient as well as the drug
describe Drug Therapy during Pregnancy:
pregnancy - concern for FIRST and LAST Trimester medications - First Trimester problems are usually Teratogenic or Mutagenic - Last Trimester is usually transfer of medications to the fetus due to greater blood flow to the fetus - drugs cross the placenta by Diffusion - factors affecting safety - A) drug properties B) fetal gestational age C) maternal factors
definition of Enzymes: - Chapter 2 Vocabulary
protein molecules that catalyze one or more of a variety of biochemical reactions, including those related to the body's physiological processes - as well as those related to drug metabolism
describe Drug Therapy in Elderly Patients:
reduced kidney function and reduced liver function, so doses are lower - older people often on diuretics - experience dehydration rapidly -- observe for leg cramps, fatigue, dehydration on these patients - additional risk to older adults - drugs affect balance, cause confusion, cognition (the high risk meds are sedatives) The Elderly - Pharmacokinetics: 1. Absorption - gastric pH less - gastric emptying slowed - movement through GI Tract slowed - blood flow to GI tract reduced - use of laxatives may accelerate GI motility 2. Distribution - lower total body water percentages - increased fat content - decreased production of proteins by the liver, resulting in decreased protein binding of drugs (& increased circulation of free drugs) 3. Metabolism - aging liver produces fewer microsomal enzymes, affecting drug metabolism - reduced blood flow to the liver 4. Excretion - decreased glomerular filtration rate - decreased number of intact nephrons
definition of Tolerance: - Chapter 2 Vocabulary
reduced response to a drug after prolonged use
Chapter 1 Review Questions - an 86 year old patient is being discharged to home on drug therapy for hyperthyroidism and has very little information regarding the medication. which statement best reflects a realistic outcome of patient teaching activities?: A) the patient and the patient's daughter will state the proper way to take the drug B) the nurse will provide teaching about the drug's adverse effects C) the patient will state all symptoms of toxicity of the drug D) the patient will call the prescriber if adverse effects occur
the patient and the patient's daughter will state the proper way to take the drug
Chapter 3 Review Questions - a pregnant patient who is at 32 weeks' gestation has a cold and calls the office to ask about taking an over the counter medication that us rated pregnancy category A. which answer by the nurse is correct?: A) "this drug causes problems in the human fetus, so you should not take this medication." B) "this drug may cause problems in the human fetus, but nothing has been proven in clinical trials. it is best not to take this medication." C) "this drug has not caused problems in animals, but no testing has been done in humans. it is probably safe to take." D) "studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it."
studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it
definition of the Blood-Brain Barrier: - Chapter 2 Vocabulary
the barrier system that restricts the passage of various chemicals and microscopic entities (e.g., bacteria, viruses) between the bloodstream and the CNS - it still allows for the passage of essential substances such as oxygen
describe Pharmacokinetics - Metabolism / Biotransformation:
the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite - mostly by the liver so if have liver disease then won't metabolize !!! 1. Liver (main organ) 4. Lungs 2. Skeletal Muscle 5. Plasma 3. Kidneys 6. Intestinal Mucosa
definition of Incompatibility: - Chapter 2 Vocabulary
the characteristic that causes two parenteral drugs or solutions to undergo a reaction when mixed or given together that results in the chemical deterioration of at least one of the drugs
definition of Therapeutic Effect: - Chapter 2 Vocabulary
the desired or intended effect of a particular drug
definition of Drug-Induced Teratogenesis: - Chapter 2 Vocabulary
the development of congenital anomalies or defects in the developing fetus - caused by the toxic effects of drugs
definition of the Trade Name:
the drug has a registered trademark - use of the name is restricted by the drug's patent owner (usually the manufacturer) - proprietary name
describe Pharmacokinetics - Excretion:
the elimination of drugs from the body 1. Kidneys (main organ) - 90% of excretion is via the kidneys - BUN (blood urea nitrogen) if high-early renal failure - normal is 7-20mg/dL 2. Liver 3. Bowel - Biliary Excretion - Enterohepatic Recirculation
definition of a Prototypical Drug: - Chapter 2 Vocabulary
the first form of a drug, or first in a class of drugs - denoted as "key drugs"
definition of Cytochrome P-450: - Chapter 2 Vocabulary
the general name for a large class of enzymes that plays a significant role in drug metabolism and drug interactions
definition of Duration of Action: - Chapter 2 Vocabulary
the length of time the concentration of a drug in the blood or tissues us sufficient to elicit a response
describe the Pediatric Concerns:
the liver is not fully developed & the kidneys are not fully developed (organ maturity) Pharmacokinetic Changes in Pediatric Patients: 1. Absorption - gastric pH is less acidic - gastric emptying is slowed - intramuscular absorption is faster and irregular 2. Distribution - greater total body water ; means lower fat content - decreased level of protein binding - immature blood-brain barrier (more drugs enter the brain) 3. Metabolism - the liver is immature (does not produce enough microsomal enzymes) - older children may have increased metabolism, requiring higher doses than infants 4. Excretion - kidney immaturity affects glomerular filtration rate and tubular secretion - decreased perfusion rate of the kidneys may reduce excretion of drugs
definition of a Chemical Name: - Chapter 2 Vocabulary
the name that describes the chemical composition and molecular structure of a drug
Chapter 1 Review Questions - a patient's medical record includes an order that reads as follows: "Atenolol 25 mg, once daily at 0900." which action by the nurse is correct?: A) the nurse does not give the drug B) the nurse gives the drug orally C) the nurse gives the drug intravenously D) the nurse contacts the prescriber to clarify the dosage route
the nurse contacts the prescribe to clarify the dosage route - dosage route was not stated in the instructions, so clarification is needed
definition of Drug Effects: - Chapter 2 Vocabulary
the psychological reactions of the body to a drug - can be Therapeutic or Toxic - describe how the body is affected as a whole by the drug 1. Onset - the time it takes for the drug to elicit a therapeutic response 2. Peak - the time it takes for a drug to reach its maximum therapeutic response 3. Duration - the time a drug concentration is sufficient to elicit a therapeutic response
definition of Therapeutic Index:
the ratio of a drug's toxic levels that maximize drug efficacy and minimize risk for toxicity (essentially it is a scale) - the ratio between the toxic and therapeutic concentrations of a drug!!
describe Pharmacokinetics:
the study of what the body does to the drug - refers to what happens to a drug from the time it is put into the body until the parent drug & all metabolites have left the body - a drug's time to Onset of Action, time to Peak Effect, and Duration of Action 1. Absorption 3. Metabolism 2. Distribution 4. Excretion
describe Pharmacokinetics - Distribution:
the transport of a drug by the bloodstream to its site of action - Protein-Binding - Water-Soluble vs. Fat-Soluble - Blood-Brain Barrier - Areas of RAPID Distribution - A) heart C) kidneys B) liver D) brain - Areas of SLOW Distribution - A) muscle C) fat B) skin
definition of Polypharmacy:
the use of many different drugs concurrently in treating a patient, who often has several health problems - as the number of medications a person takes increases, so does the risk for drug interactions and ADRs
