Pharm 1-5

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Pharm 1-5
2015-09-07 18:45:21

Pharm 1-5
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  1. therapeutics
    the branch of medicine concerned with the prevention of disease and treatment of suffering
  2. pharmacotherapy
    the application of drugs to prevent disease and ease suffering
  3. drugs
    • a chemical agent capable of producing biologic responses within the body
    • may be desirable (therapeutic) or undesirable (adverse)
  4. medication
    a drug after it is administered
  5. biologics
    • agents naturally produced in animal cells, by microorganisms, or by the body itself
    • Ex: hormones, monoclonal antibodies, natural blood products and components, interferons, and vaccines
    • used to treat wide variety of illnesses and conditions
  6. CAM
    • complementary and alternative medicine
    • involve natural plant extracts, herbs, vitamins, minerals, dietary supplements, and many techniques considered by some to be unconventional
    • include manipulative and body based practises (acupuncture, hypnosis, massage)
  7. advantages of requiring a prescription
    • Health care provider has opportunity to examine pt & determine specific diagnosis
    • Practitioner can maximize therapy by ordering proper drug for pt condition and conveying amt and frequency of drug
    • has opportunity to teach proper use and side effects
  8. formulary
    • a list of drugs and drug recipes
    • the first standard commonly used by pharmacists
  9. pharmacopoeia
    • a medical reference summarizing standards of drug purity, strength, and directions for synthesis
    • 1975 the USP-NF (U.S. Parmacopoeia and National Formulary)... merged together to publish a annual publication which consists of verifying purity and exact amounts of ingredients found w/in many medications
  10. Natural vs. synthetic drugs
    • Natural is traditional, plants and animals and minerals.
    • Synthetic is free from impurities and its more available than natural
  11. Biologics Control Act
    • 1902
    • helped to standardize the quality of serums and other blood-related products
  12. Pure food and Drug Act
    • 1906
    • gave gov power to control the labeling of meds
  13. Sherley Amendment
    • 1912
    • prohibited the sale of drugs labeled w false therapeutic claims that were intended to defraud the consumer
  14. Food, Drug, and Cosmetic Act
    • 1938
    • the first law preventing the sale of drugs that had not been thoroughly tested before marketing
    • Later amendments required drug companies to prove safety and efficacy before it could be sold in US
  15. Dietary Supplement Health and Education Act
    • 1994
    • The act passed in reaction to the rising popularity of dietary supplements
    • it attempts to control misleading industry claims
  16. boxed warnings
    • 1997, created by FDA
    • to warn consumers of possible risks
  17. black box warnings
    • named after black box appearing around drug safety info located within packaged inserts
    • one of primary alerts for id'ing extreme advers drug reactions
  18. 4 stages of approval for therapeutic and biologic drugs
    • Preclinical investigation
    • clinical investigation
    • review of the new drug application
    • postmarketing surveillance
  19. preclinical investigation
    • first stage of approval
    • involves extensive lab research, test on human and microbial cells, and animals
  20. clinical investigation
    • 2nd phase of drug testing
    • takes place in 3 different stages termed clinical phase trials
    • are longest part of approval process
    • first perform on volunteers, then investigators address results and concerns
  21. 3 stages of clinical investigation
    • 1 ~ clinical pharmacologists perform tests on volunteers to determine proper dosage and to assess for adverse effects
    • 2 ~ large groups with the disease are given the meds
    • 3~ this is when investigators from different medical specialties address concerns and results
  22. NDA review
    • third phase of approval process
    • brand name is finalized
    • FDA permitted 6 months to initialy review
    • review time for new drugs is approx 17 to 24 months
  23. postmarket surveillance
    • final phase of drug approval process
    • begins after clinical trials and NDA review are completed
    • purpose is to survey harmful drug effects in larger population
  24. chapter 2
  25. therapeutic classification
    a method of organizing drugs based on their therapeutic usefulness in treating particular diseases
  26. pharmacologic classification
    refers to the way a drug works at the molecular, tissue, and body system levels
  27. mechanism of action
    • how a drug produces it's physiological effect in the body
    • addressed by the pharmacologic classification of a drug
  28. prototype drug
    • is the well-understood drug model with which other drugs in it's representative class are compared
    • by leaning characteristics of prototype drug, students may predict the actions and adverse effects of other drugs in same class
  29. 3 basic types of drug names
    chemical, generic, and trade
  30. chemical name
    • assigned using standard nomenclature established by IUPAC (International Union of Pure and Applied Chemistry)
    • drug has only one chemical name
    • often complicated and difficult to remember or pronounce
  31. generic name
    • assigned by the U.S. Adopted Name Counsel
    • W few exceptions, generic names are less complicated and easier to remember than chemical names
    • Only one generic name for each drug, students usually memorize it
  32. trade name
    • assigned by company marketing the drug
    • usually selected to be short and easy to remember
    • In US, a drug developer is given exclusive rights to name and market a drug 17 yrs after the New Drug Application is submitted. because it takes so long for a drug to get approved, the amount of time spent on the approval is subtracted from the 17 years
  33. combination drug
    • contains more than one active generic ingredient
    • poses a problem in trying to match one generic name with one product
    • Rule of thumb: the active ingredients are described by their generic name, which is usually lowercased, whereas trade name is capitalized
  34. bioavailability
    the physiological ability of the drug to reach its target cells and produce it's effect
  35. dependence
    a physiological or psychological need for a substance
  36. physical dependence
    • refers to altered physical condition caused by the adaptation of the nervous system to repeated drug use
    • when drug is no longer available, physical signs of discomfort are displayed known as withdrawal
  37. scheduled drugs
    • classified according to their potential for abuse
    • Schedule I drugs have highest potential for abuse, schedule 5 has least
  38. Schedule I drugs
    • Highest potential for abuse & physical and psychological dependency 
    • Restricted for us in situations of medical necessity, if at all allowed
    • have little or no therapeutic value
    • are intended for research purposes only

    Ex: heroin, LSD, Marijuana, peyote, ecstacy
  39. Schedule II drugs
    • Have a high potential risk for abuse, and high potential for physical and psychological dependency
    • A special order form must be used, orders must be written and signed by the health care provider. Phone orders are not permitted, nor are refills, pt's must visit doc first

    Ex: oxycodone, amphetamine, cocaine,
  40. Schedule III drugs
    • Have a moderate potential for abuse and physical dependency
    • Has high potential for psychological dependency
    • Used therapeutically w prescription, some drugs no longer used

    • Ex: combination products containing less than 15 mg of hydrocodone, no more than 90 mg of codeine per dosage unit
    • anabolic steriods included
  41. Schedule IV drugs
    • Have lower potential for abuse, and physical or psychological dependency
    • Used therapeutically w prescription

    Ex: Alprzolam, diazepam, lorazepam, triazolam
  42. controlled substance
    a drug whose use is restricted by the Controlled Substances Act of 1970
  43. What role does the DEA play
    • Drug enforcement Administration
    • US gov agency hospitals and pharmacies must register with and then use their assigned reg #'s to purchase scheduled drugs
    • They also must maintain complete records of all quantities purchased and sold
    • Those with prescriptive authority must also register and receive an assigned number before prescribing controlled drugs
  44. teratogen
    a substance that has the potential to cause a defect in an unborn child during pregnancy
  45. teratogenic risk
    • classifications that place drugs into categories A, B, C, D, and X
    • A is safest group while X poses the most danger to fetus
  46. Chapter 3
  47. allergic reaction
    an acquired hyperresponse of body defenses to a foreign substance
  48. anaphylaxis
    a severe type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators in inflammation that can lead to life threatening shock
  49. treatment of anaphylaxis
    • stop drug
    • give epi
    • treat shock w IV
    • antihistimine
    • albuterol
    • high flow O2
    • steroids
  50. AEs
    • Adverse events
    • effect that shouldn't or isn't expected to happen 
    • side effects are expected
  51. drug effect
    implies a known effect with an intended therapeutic outcome
  52. 3 checks of drug administration
    the nurse uses in conjunction with the 5 steps to help ensure pt safety and drug effectiveness

    • 1 - checking the drug w MAR (medication administration record) or medication info system when removing it from the med drawer, fridge or controlled sub locker
    • 2 - checking drug when preparing it, pouring it, taking it out of the unit-dose container, connecting the iv tubing to bag
    • 3 - checking drug before administering to the pt
  53. Five rights of drug administration
    • Right patient
    • Right medication
    • Right dose
    • Right route of administration
    • Right time of delivery
  54. compliance
    taking a medication in the manner prescribed by health care provider
  55. enteral vs. parenteral route of drug administration
    • enteral ~ drugs delivered via GI tract(oral, rectal, gastro and nasal tubes)
    • parenteral ~ drugs delivered other than GI tract (IV, sub Q, IM)
  56. STAT
    • refers to any med that is needed immediately and is to be given only once
    • often associated with emergency meds
    • time btwn writing and administering the drug should be less than 5 mins
  57. Metric system of measurement
    • The volume of a drug is expressed in terms of liters (L) or milliliters (mL)
    • The metric weight of a drug is stated in kilograms (kg), grams (g), milligrams (mg) or micrograms (mcg)
  58. CHAPTER 4
  59. Pharmacokinetics
    the study of drug movement throughout the body
  60. 4 categories of processes involved with pharmacokinetics
    • Absorption 
    • distribution
    • metabolism
    • excretion
  61. What two processes do drugs primarily use to cross body membranes
    • Active transport - moving a chemical against a concentration gradient
    • Diffusion or passive transport - moving a chemical from an area of higher concentration to an area of lower concentration
  62. absorption
    • a process involving the movement of a substance from it's site of administration, across body membranes, to circulating fluids
    • Drugs can be absorbed through skin & associated mucus membranes, GI or respiratory tract
  63. rapid absorption
    Sub-lingual, IV, inhalation
  64. slow absorption
    oral, sub-Q, IM
  65. affinity
    • parts of the body that have an attraction for certain medications
    • Bone marrow, teeth, eyes, and adipose tissue have specially high affinity
  66. drug protein complexes
    • happens when a drug binds reversibly to plasma proteins, particularly albumin
    • these complexes are too large to cross capillary membranes; thus the drug is not available for distribution to body tissues
    • Drugs bound to proteins circulate in the plasma until they are released or displaced from the complex
    • Only unbound (free) drugs can reach their target cells or be excreted by kidneys
    • See pic on pg 40
  67. importance of blood-brain barrier
    some meds such as sedatives and antianxiety agents and anticonvulsants readily cross blood-brain barrier to produce actions in CNS. In contrast, most antitumor meds don't easily cross blood-brain barrier, making brain cancer difficult to treat
  68. distribution
    • involves the transport of drugs throughout the body
    • simplest factor determining distribution is the about of blood flow to body tissues. 
    • Heart, liver, kidneys and brain receive the most blood supply
    • Skin, bone, and adipose tissue receive lower blood supply
    • therefore, it is more difficult to deliver high concentrations of drugs to those areas
  69. metabolism
    • also called biotransformation
    • the process of chemically converting a drug to a form that is usually more easily removed from the body
    • liver is primary site of drug metabolism, although the kidneys and cells of intestinal tract also have high metabolic rates
  70. conjugates
    the addition of side chains to drugs during metabolism, that makes them more water soluble and more easily excreted by kidneys
  71. P-450
    • hepatic microsomal enzyme system ~ system by which most metabolism in liver is accomplished
    • primary actions are to inactivate drugs and accelerate their excretion
    • Sometimes this process can produce a chemical alteration that makes the resulting molecule more active than the original
    • Ex: narcotic analgesic codeine undergoes biotransformation to morphine
    • some agents are prodrugs
  72. prodrugs
    drugs that have no pharmacologic activity unless they are first metabolized to their active form by the body
  73. enzyme induction
    • the process by which a few drugs have the ability to increase the metabolic activity in the lever
    • Ex: phenobarbital causes liver to synthesize more microsomal enzymes. By doing so it increases the rte of it's own metabolism as well as that of other drugs metabolized in the liver. These pt's may need higher doses of meds to achieve optimum therapeutic effect
  74. first-pass effect
    • happens when drugs are absorbed orally, they cross directly into the hepatic portal circulation, which carries blood to the liver before it gets distributed to other body tissues.
    • Thus, as blood passes through liver circulation, some drugs can be completely metabolized to an inactive form before they ever reach general circulation
  75. Excretion
    • Process by which drugs are removed from the body
    • the rate at which meds are excreted determines the concentration of drugs in bloodstream and tissues
    • primary site for drug excretion is kidneys
    • Lungs help excrete drugs that can be easily changed into a gaseous form
    • Glandular activity can help water-soluble drugs secrete into saliva, sweat or breast milk
  76. Renal failure and toxicity
    • Impairment of kidney function can dramatically affect pharmacokinetics
    • pts have diminished ability to excrete meds and retain drugs for extended time
    • Doses of these pts must be reduced to avoid drug toxicity
    • Because small to moderate changes in renal status can cause rapid increases in serum drug levels, nurse must monitor kidney function in pts receiving drugs that may be nephrotoxic
  77. minimum effective concentration
    the amount of drug required to produce a therapeutic effect
  78. toxic concentration
    the level of drug that will result in serious adverse effects
  79. therapeutic range
    the plasma drug concentration btwn the minimum effective concentration and the toxic concentration
  80. onset of drug action
    represents the amount of time it takes to product a therapeutic effect after drug administration
  81. peak plasma level
    occurs when the med has reached it's highest concentration in the bloodstream
  82. duration of drug action
    • the amount of time it takes for a drug to maintain it's desired effect until termination of action 
    • Many variable can effect it: amount of drug given, how often drug is scheduled, route drug is admin, interations
  83. plasma half-life
    • t1/2
    • most common description of a drugs duration of action
    • defined as the length of time required for the plasma concentration of a medication to decrease by one-half after administration. 
    • The longer it takes a drug to be excreted, the greater it's half-life
  84. Dangers associated with drug administration and pts with renal or hepatic disease
    • the plasma half-life of a drug will increase (less effective excretion)
    • drug concentration may reach toxic levels
    • In these pts, meds must be given less frequently or dosages must be reduced
  85. loading dose
    • a higher amount of drug, often given only once or twice to "prime" the bloodstream with a sufficient level of drug
    • way to reach plateau faster followed by regular maintenance doses
  86. maintenance doses
    Given intermittently, before plasma levels can drop back toward zero, to keep the plasma drug concentration in the therapeutic range
  87. efficacy vs potency
    • efficacy ~ how effective a drug is
    • Potency ~ how much of drug is needed to have effect

    Efficacy over potency (almost always!)
  88. antagonistic purpose
    • drug that prevents a response from occurring
    • may be used to prevent effects from previously administered drugs
  89. Lethal dose
    • the amount of a drug that causes death in 50% of ANIMALS 
    • used to assess safety
  90. Maximum dose
    point at which an increase of dose yields little to no increase in response
  91. median effective dose
    dose that 50% of population needs to get desired result
  92. nursing dx
    clinical judgments of a pt's actual or potential health problem within nurses scope of practice to address

    provide basis for establishing goals and outcomes, planning interventions, and evaluation the effectiveness of care plan

    • unlike medical dx, nursing dx focus on pt response to actual or potential health and life processes
    • *focuses on pt needs, not nurses
  93. outcome/goal identification
    • based on nursing diagnosis
    • goal/outcome must match prioritized goals
  94. SMART goals
    • Specific
    • Measurable
    • Attainable
    • Realistic
    • Timable
  95. preventing medication errors
    • 5 rights
    • take time - no distractions
    • follow policies/procedures
    • verify/clarify orders
    • no verbal
    • pt participation
    • check with pharmacist
  96. common med errors
    • wrong dose (most often)
    • wrong med
    • wrong route
  97. reporting med errors
    • must tell physician
    • document in factual manner
    • put in med record, DO NOT indicate mistake
    • follow protocol to protect pt
    • do not document in pt med record
    • tell pt
  98. fatal med errors
    50% in older than 60
  99. preimplantation period
    • weeks 1-2 of first trimester
    • developing embryo has not yet established physical connection
    • sometimes called the "all or none" period because exposure to a teratogen either causes death of embryo or has no effect
  100. embryonic period
    • from 3-8 weeks post conception
    • period of rapid development and maximum sensitivities to teratogens
    • teratogenic agents taken during this phase can lead to structural malformation and spontaneous abortion
  101. fetal period
    • from 9 - 40 weeks
    • continued growth
    • exposure to teratogens more likely to produce slowed growth or impaired organ function, rather than gross structural malformations
  102. drug risk category A
    Adequate studies show no increase risk of fetal abnormalities to fetus in any trimester
  103. drug risk category B
    • animal studies revealed no evidence of harm to fetus, however no adequate studies for pregnant women
    • OR
    • animal studies have shown AE, but adequate studies in prego women failed to demonstrate risk to fetus in any trimester
  104. drug risk category C
    • Animal studies have shown adverse effect, no adequate studies in prego women
    • OR
    • No animal studies conducted, no adequate studies in prego women
  105. drug risk category D
    • adequate studies in prego women have demonstrated risk
    • *however, benefits of therapy may outweigh potential risk Ex: drug may be acceptable in life-threatening situation or serious disease where safer drugs can't be used
  106. drug risk category X
    • adequate studies in animals or prego women have demonstrated positive evidence of fetal abnormalities or risks
    • Use of product is contraindicated in women who are or may become prego
    • No indication for use in pregnancy
  107. principle complications in drug therapy in older adults
    • degeneration of organ systems
    • multiple and severe illness
    • polypharmacy
    • unreliable compliance
  108. ethnicity vs culture
    • ethnicity implies people have biologic and genetic similarities
    • culture is set of beliefs, values and norms within a community
  109. etoh addiction
  110. DT
    • delirium tremors ~ occurs in those who have constantly consumed alcohol 
    • Sx include hallucinations, confusion, disorientation and agitation.  
    • Pts experience anxiety, pain, paranoia, sensations of something on skin
    • Antiseizure meds may be used
    • Valium (sedatives) can be used for withdrawal
  111. most commonly abused drug
  112. alcohol
    • Ethyl alcohol
    • CNS depressant
    • easily crosses blood-brain barrier
    • Presence of food in stomach slows the absorption
    • Metabolism occurs at a slow rate, 15 mL per hour, not affected by presence of food
  113. drugs that cause physical dependence
    opioids, alcohol, sedatives, nicotine, CNS stimulants
  114. drugs that cause psychological dependence
    marijuana, crack cocaine
  115. What drugs can cause life threatening withdrawal
    • Alcohol and sedatives 
    • (Nebutal, barbiturates)
  116. Describe Nembutal withdrawal
    • Is a barbiturate
    • Historic use for barbiturates: treating sleep disorders and epilepsy
    • Withdrawal symptoms resemble those of alcohol
    • overdoses are extremely dangerous, suppress respiratory centers in brain, user may stop breathing or lapse into coma
  117. cross tolerance
    occurs when tolerance is developed for one substance, and the tolerance extends to closely related drugs
  118. Most dangerous infectious disease
  119. Nerve agent antidote
    • nerve agent antidote and Mark I injector kits that contain atropine (anticholinergic drug) or related medication 
    • Atropine blocks the attachment of Ach to receptor sites and prevents the overstimulation caused by the nerve agent
    • *recall nerve agents work by overstimulation of Ach at both central and peripheral sites. They bloc AchE, which normally degrade Ach. Therefore it increases the action of acetylcholine (Ach) at the synaptic cleft
  120. radiation sickness symptoms
    • can occur within hours or days after extreme doses or radiation
    • Immediate symptoms are nausea, vomiting and diarrhea
    • Later symptoms include weight loss, anorexia, fatigue, and bone marrow suppression
    • Pt's who survive acute exposure are at high risk for developing various cancers, particularly leukemia
  121. Explain CDC's role associated with bioterrorism attacks
    • The CDC manages SNS (Strategic National Stockpile) which is a program designed to ensure immediate deployment of essential medical materials to a community
    • Stockpile includes: antibiotics, vaccines, medical/surgical and pt support supplies such as bandages, airway and IV equipment
  122. Components of SNS
    • has two components:
    • Push Package is first, consists of preassembled set of supplies and pharmaceuticals designed to provide response to unknown biologic/chemical threat. Located where they can reach a community in US within 12 hrs of attack
    • VMI is second (vendor managed inventory), shipped after chemical/biologic threat has been ID'd. Consists of supplies and meds more specific to threat, designed to arrive within 24 to 36 hours
  123. sympathetic  neurotransmitter
  124. parasympathetic neurotransmitter
  125. norepinephrine
    • stimulates sympathetic system--
    • increased HR and BP
    • decrease saliva
    • gastric secretions
    • dilates pupils and bronchi
  126. acetylcholine
    • stimulates parasympathetic system--
    • decrease HR and BP
    • increased saliva, secretions
    • decrease respiratory rate
  127. adergenic
    • "add-ru-nur-jic"
    • the receptors at the ends of postganglionic sympathetic neurons 

    •  two basic types of adrenergic receptors:
    • Alpha receptors (α receptors) - further divide into subtypes alpha1 and alpha2

    Beta receptors (β receptors) - further subdivide into beta1, beta2, and beta3
  128. cholinergic
    • "kohl-in-er-jic"
    • refers to nerves that release Ach
    • parasympathetic
    • two types:
    • Nicotinic receptors
    • muscarinic receptors
  129. alpha blockers
    • relaxes vascular smooth muscle
    • used as vasodilator
    • decreased BP
    • used to increase urine flow
  130. beta blockers
    • all used on cardiovasular system
    • decrease rate and force of heart contraction
    • treats hypertension