NUR 119 Mod 1

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NUR 119 Mod 1
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  1. Which statement is the best description of a drug's serum half-life?

    A. the time required for half of a drug dose to be absorbed
    B. the time required for a drug to be totally effective
    C. the time required for half of the drug dose to be completely distributed
    D. the time required after absorption for half of the drug to be eliminated
    D. the time required after absorption for half of the drug to be eliminated
    (this multiple choice question has been scrambled)
  2. Which (actors most commonly affect a drug's action?

    A. poor circulation, pain, stress, hunger, fasting
    B. stress, hunger, weather, pH of the drug
    C. poor circulation, hunger, stress, BM1
    D. BMI, pH of drug, stress, poor circulation
    A. poor circulation, pain, stress, hunger, fasting
    (this multiple choice question has been scrambled)
  3. Older Pt rules-of-thumb
    Tired organs

    Accumulate drugs dur to age

    Use smallest effective dose

    Use shortest effective time

    e.g. Start low, go slow

    Try non-drug measures first

    Keep in mind their vision and tactile abilities
  4. Pts on herbal therapies vis-a-vis surgery
    Stop all herbal therapies 2-3 weeks before surgery.
  5. Saint John's Wart
    Less depression

    Similar to Prozac (increases serotonin in the brain)

    Inhibits metabolism of many drugs
  6. ginseng
    Extra energy and increased mental alertness

    May depress or stimulate the CNS.

    May cause hypertension, palpitations.

    May increase the risk of bleeding.

    Decreases blood glucose and cholesterol (again is this too much?).
  7. garlic
    Decreases BP, BS & lipids

    May increase the risk of bleeding.

    May decrease glucose and cholesterol (too much?)
  8. Echinacia
    Good for the common cold.

    Stimulates the immune system, may aggravate autoimmune disorders.

    Hepatoxic.
  9. Chamomile
    It has a calming effect...

    May increase the risk of bleeding.
  10. Name 3 drug forms that cannot be crushed and why?
    • Enteric: designed to be absorbed in SI not stomach
    • Anything ER, SR, XR or XL: Results in a faster release of drug for distrubution that designed
    • Capsules: Same reason as above.
  11. Meds in ears...
    Nose - (head back, maintain 2 -3 minutes)
  12. Admin of meds to eye...
    • 0: Wash hands, don gloves
    • 1: Into conjunctival sac
    • 2: Press lacrimal duct for 1-2 min to prevent systemic absorption.
    • 3: Pt eyes closed for 1-2 min to promote absorption
  13. Antidote for Coumadin
    Vitamin K
  14. Antidote for Opioids
    Narcan
  15. Antidote for Heparin
    Protamine sulfate (1 mg per 100 units of heparin that had been given over the past four hours) has been given to counteract the anticoagulant effect of heparin.
  16. Antidote for Digoxin
    Digibind - the specific antidote is antidigoxin (antibody fragments against digoxin, trade names of Digibind and Digifab).
  17. Antidote for Tylenol
    Mucomyst also known as N-acetylcysteine or N-acetyl-L-cysteine (abbreviated NAC).

    The antidote to acetaminophen overdose, N-acetylcysteine (NAC), is most effective when taken within eight-hours of an overdose.
  18. Antidote for Tricyclic Antidipressants
    Sodium Bicarbonate
  19. Tachyphylaxis?
    Tolerance after only a few doses
  20. Tolerance as an adverse effect
    Larger doses needed.
  21. Administation of Steroids
    Must be taken with foods
  22. Adverse effects: Carcinogenicity
    Many anticancer drugs, e.g. Cyclopamine, are paradoxically carcinogenic in healthy individuals
  23. Adverse effects: Teratogenicity
    Harmful to the developing fetus
  24. Adverse effects: Dependence
    Any of the C-II through C-IV drugs,
  25. Adverse effects: Idiosyncrasy
    Unbexpected with 1st time dose.
  26. Adverse effects: Hypersensitivity
  27. Adverse effects: Nephrotoxicity
    Motrin
  28. Adverse effects: Hepatoxicity
    • Tylenol (acetominophen)
    • Thorazine
    • MAO inhibitors
    • Dilantin
    • aspirin
  29. Adverse effects: Hematologic
    Phenytoin sodium is a commonly used antiepileptic.

    Has been suggested that phenytoin causes a reduction in folic acid levels, predisposing patients to megaloblastic anemia.
  30. Adverse effects: Gastrointestinal
    • Nausea
    • vomiting
    • diarrhea
    • bleeding
  31. Adverse effects: CNS
    Stimulation or depression
  32. AAAA are more severe than side effects and are always BBBB. They may be mild or severe.
    • A: Adverse reactions
    • B: Undesirable.
  33. Ethnopharmacology?
    The study of drug responses that may be unique to an individual due to social, cultural and biologic phenomena.
  34. Categories & characteristics of Photosensitivity
    Photoallergy & Phototoxicity

    Photoallergy is immune-based and is only related to previous exposure.

    Phototoxicity may be dose-based and resaults in damage (serious sun burn) to skin where exposed.

    • 1: SPF 15 or greater and
    • 2: Avoid sunlight and
    • 3: Wear protective clothing
  35. Drug-drug interaction: Antagonism
    Each drug's actions nullify the other drugs actions with a net 0 result.

    Narcan nullifys the actions of drugs.
  36. Drug-drug interaction: Displacement
    If the binding sites of one drug are "used up" by a 2 drug, this increases the effects of the displaced drug as the displaced drug is circulating in unbound orfree form

    e.g. aspirin * Coumadin = increased anticoagulant effect
  37. Drug-drug interaction: Interference
    Intensified effects of 2nd drug due to lst drug interfering with its metabolism and excretion

    e.g. Tagament interferes with many drugs
  38. Drug-drug interaction: Synergism
    Because they have different sites of action: Tylenol + Codeine = increased pain relief

    Per the book, their "clinical effect is substantially better than the combined effect of the two."
  39. Drug-drug interaction: Additive
    Can be desirable or not.

    Sedative + alcohol = increased sedation.

    Beta blocker + diuretic = better treatment of hypertension.
  40. Digitalis contraindications?
    • With digoxin and
    • Decreased serum potassium and
    • Decreased serum magnesium or
    • Increased serum calcium level,
    • Digitalis toxicity may result.

    Drugs from the thiazide diuretic group can cause abnormal electrolyte concentrations.

    • An example is hydrochlorothiazide (HydroDIURIL), which can
    • Decrease serum potassium, magnesium, and sodium levels and
    • Increase the serum calcium level.

    Hydrochloro-thiazide promotes potassium loss, and low serum potassium results in an increase in the uptake of digoxin by myocardial tissue.

    This sensitization of the myocardium to digoxin increases the risk of digitalis-induced arrhythmias.

    When digoxin and hydrochlorothiazide are taken together, the nurse should observe the client for digitalis toxicity.

    Symptoms are nausea, vomiting, bradycardia, and stated visual problems, e.g. "yellow vision".

    Clients on long-term therapy should have regular digoxin levels drawn to detect earlytoxicity.
  41. Pro & Con Food considerations?
    • Pro - with food: beta blocker metoprolol (Lopressor)
    • Con - without food: Levothyroxine
  42. Tetracycline contraindication?
    Dairy products can interfere with the antibiotic effects of tetracycline.
  43. Coumadin contraindication?
    Vitamin K found in green leafy vegetables will inactivate the blood thinning effects of Coumadin.
  44. MAOI contraindication?
    • If monoamine metabolism is compromised by the use of monoamine oxidase inhibitors (MAOIs) and
    • Foods high in tyramine are ingested, then
    • A hypertensive crisis can result,
    • As tyramine can cause the release of stored monoamines, such as dopamine, norepinephrine and epinephrine.
  45. Foods that are high in tyramine?
    • Beer
    • Wine
    • Cheese
    • Yeast products
    • Chicken livers
    • Pickled herring
  46. Discuss the following nonreceptor drug actions: Antacids
    Neutralize hydrochloric acid
  47. Discuss the following nonreceptor drug action: Osmotic diuretics
    Increase osmolarity of the plasma and pull water out of the tissues into the blood, e.g. Manitol for head injuries
  48. Discuss the following nonreceptor drug action: Nucleic acids
    Similar to nutrients / incorporated into body
  49. Discuss the following nonreceptor drug action: Metal chelating agents
    Combine with toxic metals for excretion
  50. List 5 characteristics of receptors.
    • Different types - mainly proteins
    • Number of sites available affects extent of drug action
    • Drugs chemical structure affects ability of the drug to reach tissues
    • Drug reaction with receptors causes agonism or antagonism
    • Receptors may increase or decrease in their sensitivity
  51. What happens when drug molecules bind with receptors?
    • Stimulation or inhibition of cell function
    • Changes in cell permeability
    • Involvement of neurohormones (i.e. acetylcholine, norepinephrine, serotonin)
  52. What is the "ligand-binding domain"?
    It is the site on the receptor at which drugs bind.
  53. Where are receptors located?
    • Kinase-linked receptors: The ligand-binding domain for drug binding is on the cell surface.
    • Ligand-gated ion channels: The channel spans the cell membrane and, with this type of receptor, the channel opens, allowing for the flow of ions into and out of the cells.
    • G protein-coupled receptor systems: There are three components to this receptor response: (1) the receptor, (2) the G protein that binds with guanosine triphosphate (GTP),and (3) the effector that is either an enzyme or an ion channel.
    • Nuclear receptors: Found in the cell nucleus (not on the surface) of the cell membrane.
  54. Types of drug receptors?
    • 1: Kinase-linked receptors
    • 2: Ligand-gated ion channels
    • 3: G protein-coupled receptor systems
    • 4: Nuclear receptors.
  55. MTC
    Minimum Toxic Concentration
  56. Rules-of-thumb for drug half-lives:
    • 4 to 5 half-lives of administration to...
    • Reach steady state or to...
    • Drop below MEC

    At "steady state" the intake = metabolized & excreted.
  57. Toxcity?
    • The first adverse symptoms that occur at a particular dose.
    • Affects on metabolism and toxicity are interrelated.
    • Toxicity is more prevalent in persons with liver or renal impairment or in the very young or old Pt.
  58. MEC
    Minimum Effective Concentration, i.e. just at the therapeutic level.
  59. Serum Drug level?
    Amount of drug in the blood at a particular time.
  60. What can happen if drug excretion is impaired?
    • Renal dysfunction either in older adults or as a result of kidney disorders, drug dosage usually needs to be decreased.
    • When creatinine clearance is decreased, drug dosage likewise may need to be decreased.
    • Continuous drug dosing according to a prescribed dosing regimen without evaluating creatinine clearance could result in drug toxicity.
    • Normal creatinine clearance is 85 to 135 mL/min.
    • Older adult clients may have a creatinine clearance of 60 mL/min.
  61. What is enterohepatic recirculation?
    • 1: Excreted in the bile
    • 2: Reabsorbed by the SI
    • 3: Returned to the liver
    • 4: Excreted by the kidney
  62. When are drugs not eliminated by the kidneys?
    When they are bound to proteins
  63. How are drugs excreted?
    • Drug elimination is most often via the kidney, although elimination may also take place via the [7 factors?]
    • 1: liver
    • 2: bile
    • 3: feces
    • 4: lungs
    • 5: saliva
    • 6: sweat
    • 7: breast milk
  64. What conditions cause an increase in metabolism?
    • Steroids
    • High protein diets
    • Enzyme inducers
    • Anticonvulsant drugs
    • Cigarette smoke
    • Tagamet (antiulcer) is an enzyme inhibitor, so it would NOT "INC Metabolism"!
  65. Enzyme inhibition - defined
    Increases drug action by reducing availability of enzymes for metabolism. (more often the case)

    In this case, smaller doses of the drug are needed because of slower drug metabolism.
  66. Enzyme induction - defined
    Most often decreases drug action, that is increased activated (induced) enzymes will more rapidly metabolize drugs into non-active forms for secretion.

    However, enzyme may be responsible for metabolizing a pro-drug into a drug, which can increase drug action
  67. What is metabolism of a drug?
    • Most often metabolism refers liver enzymes changing a lipid soluable drug into a water-sol for excretion by kidneys.
    • Some times though the liver can change a drug into something more potent than the drug itself.
    • The old (decreased liver func) and the young (imature liver func) are more suseptible to drugs.
  68. What kind of drugs are able to act on body cells?
    Only those that are free, that is not bound to any proteins
  69. Discuss where drugs are distributed quickly or slowly.
    It all depends on vasculature. So, fat - slow; muscle - fast, at least for injections.
  70. The term distribution refers to the drug becoming available to body fluids and body tissues. Distribution is influenced by [4 factors?].
    • blood flow
    • affinity to the tissue
    • drug dosage
    • drug concentration in the body
  71. Drug absorption can be altered by [8 factors?].
    • blood flow
    • pain
    • stress
    • hunger
    • fasting
    • food
    • pH
    • method of administration
  72. Fastest drug absorption?
    mucous membranes - faster than IV per Maddie
  73. How are lungs involved in drug interactions?
    Lungs can quickly take in drugs to the blood supply because of its great area 70 m2 (25' x 35') and lungs are also an
  74. How are drugs "absorbed"?
    • Drugs must get to systemic circulation to be utilized.
    • Oral meds may be affected by vomiting or diarrhea.
    • IM will be faster than SQ because of greater vasculature.
  75. Factors that alter bioavailability?
    • 1: the drug form (e.g., tablet, capsule, sustained-release, liquid, transdermalpatch, rectal suppository, inhalation)
    • 2: route of administration (e.g., oral, rectal, topical, parenteral)
    • 3: Gl mucosa and motility
    • 4: food and other drugs
    • 5: changes in liver metabolism caused by liver dysfunction or inadequate hepatic blood flow
  76. Bioavailability?
    Percentage of drug that reaches systemic circulation.

    For oral drugs that have a high rate of liver metabolism (20-40%), 3 to 5 times the dose ca be required po to match to bioavailability of an IV dose which usually has bioavailability of 100%.
  77. What is the difference between lipid and water soluble drugs? Which of the 2 crosses the cell membrane easily?
    The GI membrane of the SI is mostly lipid and protein, so lipid soluable drugs can pass across the membrane via passive diffusion.

    Water soluable drugs require a carrier - protein or enzyme - to cross and energy.

    Lipid soluable (and non-ionized) drugs are absorbed faster than water-soluable and/or ionized drugs.
  78. What is the pharmaceutic phase of drug action?
    It applies only to oral meds and it is the dissolution of the pill, i.e. oral "liquids" are already in solution.

    Fillers are called excipients
  79. FDA's Drug Pregnancy Categories
    • A: No risk to fetus
    • B: No risk in animal studies; well-controlled studies in pregnant women are not available
    • C: Animal studies indicate a risk to the fetus. Risk-v-benefit?
    • D: A risk to the human fetus has been proved; Risk-v-benefit? life-threatening conditions
    • Z: A risk to the human fetus has been proved. Risk outweighs the benefit
  80. 1914 Drug Act
    • Harrison Narcotics Tax Act
    • Regulated importation, taxation and distribution of opium
    • It also stated that docs could write Rx for narcotics for treatment, but not for treatment of addiction
  81. Harrison Narcotics Tax Act
    • 1914
    • Regulated importation, taxation and distribution of opium
    • It also stated that docs could write Rx for narcotics for treatment, but not for treatment of addiction
  82. Timeframe for drug to be given on an "empty" stomach?
    1 hour before or 2 hours after a meal.
  83. Define pharmacology
    The study of effects of chemical subtsances on living tissues
  84. What is a generic name?
    The official or nonproprietary name of a drug. It is not owned by any drug company.
  85. Food, Drug, and Cosmetic Act
    • 1938
    • Empowered FDA
    • Regulate manufacture & marketing of drugs
    • Tested for harmful effects
    • Labels with accurate information
    • Only safe by FDA approved marketing
  86. 1938 Drug Act
    • Food, Drug, and Cosmetic Act
    • Empowered FDA
    • Regulate manufacture & marketing of drugs
    • Tested for harmful effects
    • Labels with accurate information
    • Only safe by FDA approved marketing
  87. Durham - Humphrey Amendment
    • 1952
    • With or w/o Rx
    • Refilled only w/ new Rx
  88. 1952 Drug Act
    • Durham - Humphrey Amendment
    • With or w/o Rx
    • Refilled only w/ new Rx
  89. Kefauver -Harris Amendment
    • 1962
    • Thalidomide tragedy of the 1950s
    • European infants limb deformities
    • Adverse reactions & contraindications labeled
  90. 1962 Drug Act
    • Kefauver -Harris Amendment
    • Thalidomide tragedy of the 1950s
    • European infants limb deformities
    • Adverse reactions & contraindications labeled
  91. Controlled Substances Act
    • 1970
    • Prevention & treatment drug dependence
    • Categories: I thru V
  92. 1970 Drug Act
    • Controlled Substances Act
    • Prevention & treatment drug dependence
    • Categories: I thru V
  93. FDA Modernization Act
    • 1997
    • Review & use accelerated
    • Tested in children bef marketing
    • Clinical data necessary for serious
    • Discontinue drugs 6 months notification
  94. 1997 Drug Act
    • FDA Modernization Act
    • Review & use accelerated
    • Tested in children bef marketing
    • Clinical data necessary for serious
    • Discontinue drugs 6 months notification
  95. HIPPA
    • 2003
    • Privacy of individually identifiable health information
  96. 2003 Drug Act
    • HIPPA
    • Privacy of individually identifiable health information
  97. Medicare Prescription Drug Improvement and Modernization Act
    • 2003
    • Financial assistance to seniors
  98. 2003 Drug Act
    • Medicare Prescription Drug Improvement and Modernization Act
    • Financial assistance to seniors
  99. Schedule I Definiton and examples?
    • High potential for drug abuse.
    • No accepted medical use.
    • Labeled C-I.

    • heroin
    • LSD
    • mescaline

    marijuana [except when prescribed with cancer treatment], peyote, psilocybin)
  100. Schedule II Definiton and examples?
    • High potential for drug abuse.
    • Accepted medical use.
    • Can lead to strong physical and psychological dependency.
    • Labeled C-II

    • meperidine (Demerol) this drug is not used because it causes seizures
    • morphine
    • methadone
    • hydrocodone
    • hydromorphone
    • oxycodone
    • codeine
    • amphetamines
    • secobarbital
    • pentobarbital
  101. Schedule III Definiton and examples?
    • Medically accepted drugs.
    • Less potential for abuse is less than that for schedules I and II.
    • May cause dependence.
    • Labeled C-lll.

    • codeine preparations
    • androgens, i.e. anabolic steroids
    • paregoric
    • nonnarcotic drugs (pentazocine, propoxyphene)
  102. Schedule IV Definiton and examples?
    • Medically accepted drugs.
    • Some potential for abuse.
    • May cause dependence.
    • Labeled C-IV.

    • phenobarbital
    • benzodiazepines (diazepam, xanax, oxazepam, lorazepam, chlordiazepoxide)
    • chloral hydrate
  103. What are prototype drugs and example?
    Key examples of drugs in a category

    • e.g. Morphine as a narcotic analgesic
    • Used to relieve pain
    • CNS depression (drowsiness to depression)
    • Major adverse effect: respiratory depression
    • High potential for abuse
    • Caution for those with respiratory depression or decreased respirations.
  104. Schedule V Definiton and examples?
    • Medically accepted drugs.
    • Very limited potential for dependence.
    • Labeled C-V.

    opioid-controlled substances for diarrhea and cough
  105. How do nurse practice acts influence drug administration?
    In some states a nurse who gives a drug w/o a doc's order violates the nurse practise act and can lose license.
  106. What would "qualify" a Pt for the appropriate admin of lopressor?
    Since lopressor is a drup to treat hypertension, the Pt should not have low BP when given.
  107. Malfeasance
    Giving the correct drug but by the wrong route that results in the client's death
  108. Nonfeasance
    Omission; omitting a drug dose that resultsin the client's death
  109. Misfeasance
    Negligence; giving the wrong drug or drug dose that results in the client's death
  110. What Rx item can modify the "time" right?
    The MAR "parameter", e.g. Hold for HR less than ...
  111. Phase 4 clinical testing?
    FDA evaluates and allows marketing for further study.
  112. Phase 3 clinical testing?
    Much larger sample using controls, i.e. double-blind with placebos
  113. Phase 2 clinical testing?
    Give to a small group of those with symptons or disease for which drug is intended
  114. Phase 1 clinical testing?
    Doses to healthy volunteers
  115. How does HIPPA affect drug admin?
    If Pt has visitors, you need to ask Pt if it is OK to talk about their drugs.
  116. ANA Code of Ethics
    • 1: Unrestricted by social or economic status, personal attributes, or the nature of health problems
    • 2: Primary commitment to patient, whether individual, family, group, or community
    • 3: Advocates rights of patient
    • 4: Appropriate delegation of tasks
    • 5: Same duties to self; Continue professional growth
    • 6: Health Care environment
    • 7: Advancement of the profession
    • 8: Collaborates with other health professionals
    • 9: Articulating nursing values
  117. Metabolism or biotransformation may occur in either the AAAA or the BBBB. Most often it takes place in the BBBB.
    • A: GI tract
    • B: liver
  118. The term distribution refers to the drug becoming available to body fluids and body tissues. Distribution is influenced by [4 factors?].
    • blood flow
    • affinity to the tissue
    • drug dosage
    • drug concentration in the body
  119. Drug absorption can be altered by [8 factors?].
    • blood flow
    • pain
    • stress
    • hunger
    • fasting
    • food
    • pH
    • method of administration
  120. AAAA is accomplished by cells BBBB a drug particle to carry the drug across the membrane.
    • A: Pinocytosis
    • B: engulfing
  121. Active absorption requires energy to move a drug AAAA.
    against a concentration gradient
  122. Passive absorption takes place without energy, by AAAA.
    diffusion
  123. AAAA is the movement of the drug to the body fluids. It takes place by BBBB absorption, CCCC absorption, and DDDD.
    • A: Absorption
    • B: passive - most common
    • C: active - or active transport, which requires a carrier and energy
    • D: pinocytosis

    Also "facilitated diffusion" which requires a carrier, but no energy.

    Active transport moves against the concentration grad - low to high
  124. The four parts of the AAAA phase achieve drug action. These phases are BBBB, CCCC, metabolism or DDDD, and excretion or EEEE.
    • A: pharmacokinetics
    • B: absorption
    • C: distribution
    • D: biotransformation
    • E: elimination
  125. In the AAAA phase, drugs become a solution. This phase takes place in the gastrointestinal, or GI, tract; thus it is absent with BBBB administration.
    • A: Pharmaceutic
    • B: parenteral
  126. The term AAAA refers to the effects of drug concentration on the body systems.
    pharmacodynamics
  127. To understand the AAAA of a drug, the nurse must understand the BBBB
    • A: pharmacodynamics
    • B: different aspects of drug action.
  128. Subcutaneous Needle
    • 3/8 - 5/8
    • 1 inch if obese

    • 24 - 26
    • 26 - 30 for insulin

    0.5 - 1.0 mL
  129. Deltoid IM
    1 inch

    23 - 25

    0.5 - 1.0 mL
  130. Dorsal Gluteal, Ventral Gluteal or Vastus Lateralis
    • 1 1/2
    • 2 inch if obese

    20 - 22

    Up to 3.0 mL
  131. Intradermal
    1/4 - 5/8

    25 - 27

    up to 0.1 mL
  132. Deltoid landmarks
    • 1. Acromion Process
    • 2. Top of axilla
  133. Dorsal Gluteal landmarks
    • 1. Posterior superior iliac spine (note: towards the spine)
    • 2. Greater trochanter (note: lateral side of leg)
  134. Ventrogluteal landmarks
    • 1. Greater trochanter
    • 2. Anterior superior iliac spine (note: towards umbilicus)
    • 3. Iliac crest (note: lateral leg above greater trochanter)
  135. Vastus lateralis landmarks
    • 1. Greater trochanter
    • 2. Lateral femoral condyle
  136. Subcutaneous upper arm landmarks
    • 1. Acromion process (hand breath below)
    • 2. Elbow (hands breath above)
  137. Which statement places the four processes of pharmacokinetics in the correct sequence?

    A. absorption, distribution, metabolism, excretion
    B. distribution, metabolism, absorption, excretion
    C. absorption, metabolism, distribution, excretion
    D. distribution, absorption, metabolism, excretion
    A. absorption, distribution, metabolism, excretion
    (this multiple choice question has been scrambled)
  138. Subcutaneous abdomen landmarks
    • 1. 2 inches away from umbilicus
    • 2. Above level of iliac crest

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