Pharm

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amanda430
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304403
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Pharm
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2015-06-25 17:24:41
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PHARM
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Pharm
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Exam 1
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  1. What is the nursing process?
    • Assessment
    • Diagnosis
    • Goals
    • Interventions
    • evaluation
  2. Nurse's Role with Medications
    • Assess pt
    • store meds
    • administer
    • reassess pt
    • document
  3. Define drugs
    affects body
  4. Definfe Medications
    improves health
  5. What are the categories of controlled drugs
    • 1- not approved for medical use
    • 2. narcotic analgesic-opiates/barbituates
    • 3. Sedatives, Anabolic Steroids
    • 4. Sedative-Hypnotic
    • 5. Paritally Controlled
  6. Off label use
    medication designed for a specific use but is used for another
  7. Name characteristics of therapeutic effects
    • palliative
    • curative
    • supportive
    • substitue
    • chemotherapeutic
    • restorative
  8. Define tolerance
    body becomes more effective at breaking down medication
  9. Cross-Tolerance
    b/c of tolerance to another drug, a drug that is broken down by the same enzymes will be tolerated better
  10. What are the Teratogenicity drug categories?
    • A-no risk-studies on people
    • B: No risk- animal studies
    • c: Potential Risk- Animal Studies
    • D: Evidence of Risk
    • X: DO NOT USE
  11. What do you look for in your assessment?
    • Allergies
    • REc. Rx
    • OTC Rx
    • Age
    • Body Size
    • Sex-Teratogenicity
    • Ethnicity
    • Genetics
    • Dose
  12. Prototype for Opioid Analgesics
    Morphine
  13. Physiology of Pain-What vasodilates?
    • Prostaglandins 
    • Bradykinin
  14. What is exogenous vs. endogenous pain relief
    • exogenous is something you take to relieve pain
    • endogenous is something your body produces to relieve pain
  15. Describe exogenous pain relief
    • morphine
    • binds to opiate MU receptors in CNS
  16. Describe endogenous pain relief
    • system of opioid peptides: endorphins, seratonin, GABA
    • activated by exercies , meditation etc
  17. Somatic pain
    localized in one area
  18. Visceral pain
    hurts in an area of the body, non distint
  19. Neropathic pain
    sharp shooting pain
  20. 3 categories for pain management
    • 1. Opiates/opoids 
    • 2. non opiates; acetaminophen, ASA, NSAIDs
    • 3. Adjuvant: Benzodiazepine, TCA, Corticosteroids
  21. What is the therapeutic effect of opiates (morphine)
    interferes with pain impulses, lowers pain
  22. What are the 4 ADE of opiates (morphine)
    • Depresses CNS
    • Depresses GI Tract
    • Alters psychological response to pain
    • produces euphoria
  23. What is the ROA (route of administration) for Opiates (Morphine)
    • PO
    • IV
    • Patch (slow release)
    • PCA (Patient Controlled Analgesia)
  24. What are the common clinical uses of Opiates (morphine)?
    • Severe-Moderate/Pain relief
    • Acute Pulmonary Edema
    • Severe non-productive cough (Codeine, Antitussive)
  25. You should use opiates (morphine) cautiously when...
    • resperatory depression is present
    • Chronic Lung Disease
    • Kidney/Renal disease
    • Increase Intracranial Pressure
  26. What are opiates (morphine) infrequently used for?
    • Invasive diagnostic tests
    • labor-delivery
    • pre-op sedation
  27. What is important to watch for when giving an opiate (morphine)
    more than 1 CNS depressant taken
  28. What is the prototype for Opiate Antagonist
    Naloxone (Narcan)
  29. What is the purpose of an opiate antagonist (Naloxone, Narcan)
    • Counter act opiates
    • Binds to opiate receptors so opiates cannot
  30. What is the prototype for Agonist/Antagonist Opiate?
    Pentazocine (talwin)
  31. When is it deemed that opiates are being abused?
    when used for mind-altering purposes
  32. What are the treatments for Opiate (morphine) abuse?
    • Bupienorphine (Suboxone)
    • Methadone
  33. What is Pharmacodynamics?
    effects of drug on the body
  34. Pharmacokinetics
    movement of drug through the body
  35. Pharmacotherapeutics
    clinical therapeutic use of a drug
  36. Therapeutic Index
    amount of drug needed for a therapeutic effect vs. amount of drug for a harmful event
  37. How do drugs cross membranes?
    • Channels-Pores
    • Transport Systems
    • Direct Penetration of membrane
  38. what is ADME
    The path of drug throughout the body
  39. What does ADME stand for?
    • Absorption
    • Distribution
    • Metabolism
    • Excretion
  40. Another word for metabolism is...
    biotransformation
  41. How are drugs excreted?
    urine or bile
  42. What happens via metabolism when a drug is administered via IV
    bypasses the liver
  43. What is enteral?
    absorbed via GI tract
  44. Paraenteral
    • Not absorbed via GI tract
    • ex. Stomach
  45. What are the 3 things that affect Pharmacokinetics( movement of drug throughout the body)
    • Lipid Solubility
    • Ionization
    • Protein Binding
  46. What occurs with a lipid soluble drug?
    • it's uncharged/non-polar
    • Crosses membrane easily
  47. What occurs with a Ionized drug?
    • it's charged, either acidic or basic
    • Like crosses membranes in like substances 
    • Affects where the drug is absorbed
  48. What occurs with Protein Binding Drugs?
    • Binds to plasma protein in blood (albumin)
    • when bound it is unavailable for distribution
    • effects rate of DME
  49. What is first pass effect?
    a lot of drugs get metabolized through the first time
  50. What artery feeds the liver?
    Hepatic Artery
  51. What is the level of toxicity?
    concentration in blood is harmful
  52. What is bioavailability?
    how much drug is available in the blood
  53. What is titration
    giving small doses until desired effect is achieved
  54. Describe a subcutaneous administration
    • Can be prompt or slow
    • depends on vascularity of area
  55. What is a contraindication with intramuscular administration?
    if a pt is on anticoagulants, it can enhance bleeding from the site
  56. What are the 2 types of factors that affect drug distribution?
    • Physiological
    • Physiochemical
  57. What physiological factors affect drug distribution?
    • CO, regional blood flow, capillary permeability
    • Anything that affects blood flow
  58. What are some physiochemical factors affecting drug distribution
    lipid solubility, pH, drug binding to plasma proteins
  59. Define Sequestration
    drugs gets taught in adipose tissue or bone and can redistribute later on
  60. What is the main Superfamily responsible for drug metabolism?
    Cytochrome P-450 Superfamily
  61. Define fundamental Tenet?
    relationship exists between effect of drug vs. blood concentration
  62. What are 4 important parameters of blood concentration?
    • Bioavailability: how much is needed to obtain a certain blood concentration
    • Volume of distribution: How much space does the drug take up?
    • Clearance: Body's effiiciancy at eliminating the drug
    • Elimination Half-Life: how long it takes to decrease blood concentration by half
  63. What is bioavailability
    How much drug is needed to obtain a certain level of blood concentration
  64. What is volume of distribution?
    How much space does the drug take up?
  65. What is clearance?
    Body's Efficiancy at eliminating the drug
  66. What is Elimination Half-Life?
    How long it takes to decrease the blood concentration of a drug by half
  67. What is a loading dose?
    A large initial dose
  68. What is therapeutic drug monitoring?
    making sure the blood concentration stays within the therapeutic index
  69. What is enzyme induction?
    liver will make more enzymes to metabolize medications
  70. What is enzyme inhibition?
    Stops metabolism of drugs
  71. What does a short half-life indicate?
    The drugs frequency will be higher
  72. What occurs after arachidonic Acid is produced?
    COX I and COX II are produced
  73. What is COX I
    physiological, protective
  74. What is COX II
    Pathological (ADE)
  75. What does COX I do?
    Maintains GI Tract, Renal functioning, smooth muscle, blood clotting
  76. What does COX II do?
    • inflammation
    • edema 
    • leukocytes
    • Release of cytocines
  77. What blocks both COX I and COX II
    ASA, Acetaminophen, NSAID
  78. What blocks just COX II?
    COX II Inhibitors
  79. What is the prototype for ASA?
    Aspirin
  80. What are the therapeutics effects of ASA (Aspirin)
    • Mild analgesic (1-3)
    • Anti-Inflammatory
    • Anti pyretic (affects hypothalamus)
    • Anti-Thrombotic (inhibits platelet aggregation-can also be and ADE)
  81. What does platelet aggregation mean?
    platelets stick together
  82. What are ADE of ASA (Aspirin)?
    • Tinnitus
    • Reye's Syndrome (children w/viral infection)
    • N/V
    • GI System
    • Bleeding
    • Pregnancy- prolongs gestation/labor/hemorrhage
    • ASA Sensitive Asthma
  83. What age should a child NOT take aspirin (ASA)
    12
  84. What are the signs/symptoms of Salislate poisoning?
    • mental Confusion
    • Diaphoresis (Vasodilation)
    • Thirst
    • Hyperventilation (causes metabolic acidosis, helps bring pH back to normal)
  85. What do you always ask
    • allergies
    • other meds
  86. What is the prototype of NSAID?
    Ibuprofen (advil
  87. What are the therapeutic effects of NSAID (Ibuprofen, advil)
    • Mild Analgesic
    • Anti-Inflammatory
    • Antipyretic
    • Anti-thrombotic (only binds for duration of drugs within the system)
  88. What are the ADEs of NSAIDs (Ibuprofen, Advil)
    • CNS depressant-drowsiness
    • Eyes- blurring
    • Category B
    • GI System- N/V, ulcer
    • Renal-Kidney Necrosis
    • Tinnitus
  89. What are drug interactions for NSAIDs (Ibuprofen, Advil)
    • Steroids
    • Lithium
    • Alcohol
    • Oral anticoagulants
    • Oral hypoglycemic
    • Heparin
  90. when should you stop taking NSAIDs or Aspririn pre-op?
    1 week before surgery
  91. What is the brand name of Acetaminophin?
    Tylenol
  92. What are the therapeutic uses of Acetaminophin (Tylenol)
    • Mild Analgesic
    • Antipyretic
    • NO ANTI-INFLAMMATORY
  93. What are some ADEs of Acetaminophen (Tylenol)
    • Hepatoxicity (lg doses, used with alcohol)
    • Renal Toxicity
    • Contraindicated liver or kidney disease
    • Rash
    • Uriticaria
    • N
  94. What occurs during Acetaminophen induce hepatotoxicity
    • 1-24 hours: N/V, diaphoresis, Malaise 
    • 24-48 hrs: decreased UA, pain in RUQ
    • 2-6 days: ecchymosis, jaundice, increased bilirubin, renal failure
  95. What is the antidote for acetaminophen hepatotoxicity?
    • Acetylcystein ( mucomyst)
    • must be given within 24 hours
  96. What is the prototype for COX II Inhibitors
    Celecoxib (celebrex)
  97. What are the therapeutic uses of COX II inhibitors (Celecoxib, celebrex)
    • Mild Analgesic
    • Anti-Inflammatory
  98. What are ADE of COX II Inhibitors?
    • BLACK BOX WARNING
    • increased risk of MI
    • CVA because it increases platlet activitiy
  99. what is the purpose of an anti-anxiety/sedatives
    relax
  100. What is the purpose of hypnotics?
    Sleep
  101. What occurs when you take a lg dose of anti-anxiety
    you get sleepy
  102. What occurs when you take a sm dose of hypnotics?
    anti-anxiety
  103. What is the prototype for Barbituates?
    Phenobarbital
  104. What is the purpose of barbiturates (phenobarbital)
    designed to be a short aciting, medium acting, and/or long acting anti-anxiety
  105. What is an ADE of Barbiturates?
    interferes with REM sleep
  106. What is the prototype for benzodiazepine
    diazepam (valium)
  107. What is the action of benzodiazepine
    • enhances GABA
    • Anti-anxiety
    • ETOH w/draw
    • Anti-seizure
  108. What are the actions of barbituates/Benzos/Misc
    • Depresses CNS
    • -Skeletal muscle relaxation
    • -sedative effect
    • -anti-convulsant
  109. What are the therapeutic actions of barbituates/benzo/misc?
    • Promote sleep/rest
    • anti-anxiety
    • cerebral palsy spasticity
    • pre-op
    • tx Status-epilepticus
    • Decrease Muscle Spasm
    • Diagnostic Procedures
    • Acute ETHOL w/draw
    • adjuvant drug w/ pain relief
  110. What are the contraindications of barbituates/benzo/mic?
    • decreased resp rate
    • severer liver and kidney 
    • hx of allergies
    • hx of drug abuse
    • potentially addictive
  111. What are the ADE of barbituates/benzo/misc
    • paradoxical reaction
    • drowsiness 
    • ataxia (unsteady gait)
    • confusion
  112. What is pt teaching for barbituates/benzo/misc
    • no alcohol
    • dont drive until you know how it will affect you
    • take only as prescribed
    • increase fluid intake and fiber
    • C and DB q2hr 
    • store in secure place
  113. What occurs during a barbituate/benzo/misc overdose?
    • resp support
    • fluids and diuretics
    • NG Lange
    • Flumazenil (romazicon)
  114. What are the two systems in the Autonomic nervous system
    • Sympathetic > Adrenergic > Neurepinephrine
    • Parasympathetic >Cholinergic > Acetylcholine
  115. Define Adrenergic Agonist
    Stimulates SNS
  116. Define Sympathomimetic
    Stimulates or mimics sympathetic
  117. What is the adrenergic prototype?
    Epinephrine (Adrenalin)
  118. Define Adrenergic Blocker
    blocks the SNS system
  119. Adrenergic Alpha blocker prototype
    minipress
  120. Adrenergic beta blockers prototype
    propranolol (inderal)
  121. What is the protottype for adrenergic?
    Epinephrine
  122. What is the prototype for Cholinergic
    Neostigmine (Prostigmine)
  123. What do cholinergic blockers do?
    Blocks PSNS
  124. What is the prototype of anti-cholinergic
    Atropine
  125. What is chronotropic?
    HR
  126. What is inotropic?
    force of contraction
  127. What is dromotropic?
    AV Node

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