Nurs 319-test 1

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Nurs 319-test 1
2011-01-24 18:02:59

pathopharmacology test 1
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  1. any chemical that can affect living processes
  2. the study of drugs and their interactions with living systems
  3. the study of drugs in humans (patient's and healthy volunteers)
    clinical pharmacology
  4. the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy
    therapeutics or pharmacotherapeutics
  5. What are the 3 major properties of an ideal drug?
    • effectiveness (most important)
    • safety
    • selectivity
  6. What are some additional properties of an ideal drug?
    • reversible action
    • predictability
    • ease of administration
    • low cost
    • freedom from drug interaction
    • chemical stability
    • possession of a simple generic name
  7. What factors determine the intensity of a drug response?
    • administration (route, amount of dosage, timing)
    • pharmacokinetics
    • pharmacodynamics
    • individual variation (physiology-age, gender, weight, genetics, pathphysiology)
  8. What are sources of drugs?
    • plants
    • animals/humans
    • minerals
    • chemicals
  9. What are the types of drug therapy?
    • prescription drugs-healthcare provider must write
    • nonprescription drugs-OTC drugs
    • controlled drugs-regulated by the federal, state and local government
    • recreational drugs-people obtain by illegal means
  10. What are the different names fo drugs?
    • chemical name
    • generic name
    • brand/trade name
  11. What are some sources of drug information?
    • U.S. Pharmacopeia (USP)
    • National Formulary-Supplement to the USP
    • PDR
    • Nursing Drug Handbooks
    • Internet
    • Pharmaceutical companies
  12. What does the USP provide regarding drug information?
    • drug must be of high standard to be listed
    • drugs are reviewed every 5 years
    • info.: strength, quality, purity, packaging, safety, labeling, dosage form
  13. What does the PDR provide regarding drug information?
    • list pharmaceutical companies
    • color pictures of medications
    • drug action
    • recommended dosage
    • indications for use
    • side effects
  14. What does the Nursing Drug Handbook rpovide with regards to drug information?
    • generic and trade names
    • indication for use and recommended doses
    • action & pharmacokinetics
    • side effects & nursing implications
    • teaching tips
  15. first federal law protecting the public from mislabed and dangerous products, developed by the USP
    Pure Food and Drug Act of 1906
  16. legislative act that required pharmaceutical companies to test products for safety before selling them
    Food, Drug, and Cosmetic Act of 1938
  17. legislative act that defined prescription v. nonprescription drugs
    1952: Durham-Humphrey Amendment of the 1938 Act
  18. legislative act resulting from the thalidomide tragedy, required safety and efficacy testing of drugs
    1962: Kefauver-Harris Amendment of the 1938 Act
  19. legislative act to fast track drugs anf allow off-label uses of drugs
    Food and Drug Administration Modernization Act (1997)
  20. law that allowed the testing of drugs already on the marker
    Best Pharmaceuticals for Children (2002)
  21. law that required the testing of all drugs to be used on children
    Pediatric Research Equity Act of 2003
  22. What are the regulatory agencies for drugs?
    FDA, CDC, DEA, ANA, state board of nursing
  23. What is involved in the pre-clinical testing of new drugs?
    • extensive animal studies
    • submit Investigation New Drug (IND) application
    • application reviewed by FDA & is approved then clinical testing may begin
  24. What is involved in the clinical testing of a new drug?
    • human studies
    • phase 1-studies the effects of the drug on a small group of healthy volunteers
    • phase 2-studies the effects of the drug on a small number of individuals with the disease, looks at effectiveness and side effects
    • phase 3-studies the effects of the drug on a large number of individuals with the disease
    • submit a new drug application (ND) to FDA, hsa to be apporved in order to marker the drug
    • phase 4-post market studies, volunteer basis
  25. rights of human subjects to be protected in medical research
    nuremburg code
  26. What is the purpose of informed consent in research?
    • describes the study in detail
    • hazards, risks, and benefits of study
    • payment
    • study termination
    • confidentiality
  27. What are the basic tasks for giving informed consent?
    • decision making capacity
    • information/education
    • understanding
    • free-choice
    • obtain informed consent
    • documentation
  28. What are the nursing responsibilities that are specific to drug therapy?
    • goals of drug therapy
    • mechanism of drug action
    • expected effects
    • proper administraiton techniques
    • contraindications
    • assess responses
    • client education
  29. What is the purpose of assessment in the nursing process with regards to drug therapy?
    • gather data: subjective & objective
    • assess learning needs
    • verify & cluster
  30. What is the purpose of nursing diagnosis in the nursing process with regards to drug therapy?
    • formulate nursing diagnosis (NANDA list)-identify health care needs of clients within the realm of nursing practice
    • nursing diagnosis related to drug therapy-knowledge deficit, noncompliance, or a diagnosis related to side effects
  31. What is the purpose of planning in the nursing process with regards to drug therapy?
    establish goals-patient oriented, use action verbs, MEASURABLE, time limited
  32. What is the purpose of interventions in the nursing process with regards to drug therapy?
    • education-why are you taking it? intended therapeutic response? how often? side effects and which to report?
    • medications orders
    • administration of medications
    • documentation: date, time, med, dose, route
    • w/holding medication: pt refuses, side effects. notify physician
  33. What is the window for administering a medication?
    30 minutes
  34. What are the 5 rights of medication administration?
    • right patient
    • right drug
    • right dose
    • right route
    • right time
  35. What are the components of a drug order?
    • date & time
    • patient name & hospital #
    • drug, dosage, route, frequency, lot #
    • MD name
    • nurses name & title
  36. What are the types of drug orders?
    • written orders v. fax orders
    • phone orders v. verbal orders
    • standing order
  37. What is the purpose of evaluation in the nursing process with regards to drug therapy?
    • effectiveness of meds for therapeutic & non-therapeutic responses (30 minutes to 1 hour)
    • determine the extent to which goals of care have been achieved
    • compare client response to outcome and document responses
    • analyze reasons for results and conclusions
    • modify care plan
  38. What are the 3 phases of drug action?
    • pharmakinetic phase-MUST occur first
    • pharmacodynamic phase
    • pharmacotherapeutic phase
  39. the mechanisms by which drugs interact, on a molecular level, with constituents of cells or cellular environments to produce biochemical and/or physiological changes in cells, tissues, organs, and ultimately patients
  40. In order for a drug to have pharmacologic effects, it must be capable of?
    influencing some functioning of some cells
  41. The ultimate objective is to select drugs that have a _____ and ______ .
    • very narrow
    • well-defined target or very specific action in the body
  42. The narrower the action of a drug, the ____ widespread damage/adverse effects
  43. What are the 3 theories of drug action?
    • nonspecific theory
    • drug enzyme theory
    • drug receptor binding
  44. produce dynamic effects by influencing the environment of cells, does not require interaction b/t tje drug & cell
    nonspecific theory
  45. What are the 5 mechanisms of the nonspecific drug theory?
    • alteration of body chemistry
    • aborption of toxins, electrolytes, bile salts, and other drugs in the intestinal tract
    • imposition of a physical barrier
    • lubrication
    • alteration of surface tension
  46. What is the mechanism of the nonspecific theory of drug action that alters body chemistry and an example?
    • alters gastric or extracellular pH
    • extracellular osmotic pressure
    • composition of extracellular electrolytes
    • example: antacids are used to alter gastric pH
  47. What is the mechanism of the nonspecific theory of drug action that involves the absoprtion of toxins, electrolytes, bile salts, and other drugs in the intestinal tract and an example?
    • drugs have an irreversible bond in the intestinal tract which prevents absorption
    • example: activated charcoal binds to (absorbs) other orally ingested drugs & toxins, preventing their absorption
  48. What is the mechanism of the nonspecific theory of drug action that involves the imposition of a physical barrier and an example?
    • block injury to cells from their exterior
    • example: sunscreens coat the skin cells blocking UV radiation injury from the sun
  49. What is the mechanism of the nonspecific theory of drug action that involves lubrication and an example?
    • by decreasing mechanical injury to the cells, they perform a protective function
    • example: mineral oil decreases friction b/t colonic wall and stool, allowing easier defecation
  50. What is the mechanism of the nonspecific theory of drug action that alters surface tension and an example?
    • allows solids and liquids to mix, liquid becomes solid
    • example: stool softeners alter the surface of hard stool allowing water from the colonic lumen to enter the stool, making it softer
  51. What are the 2 forms of drug-enzyme interaction with regards to the drug enzyme theory of drug action? What are examples of each?
    • drug may bind to the same physical location on the enzyme, preventing the enzyme from functioning normally (digoxin)
    • drug may interact with an enzyme target changing the physical structure of the enzyme and disrupting its integrity (ACE inhibitors)
  52. mimic actions of the body, can cause a response when they bond to the receptor
  53. What are the 2 types of agonists and example of each?
    • agonist I-bind to the same receptor site as endogenous biomediator (epinephrine, opiates)
    • agonist II-bind to a different site on the receptor, but enhances the natural effect of the endogenous biomediator on its own receptor (thyroid hormone, benzodiazepines)
  54. blocks the actions of the body, has no intrinsic activity of their own
  55. What are the 3 types of antagonist and example of each?
    • antagonist I-bind to the same site and inhibit or block the action of the natural compound (atropine, H2 receptor blockers)
    • antagonist II-bind to a different molecular extracellular site from the endogenous biomediator and partially inhibit the action of the natural compound (calcium channel blockers)
    • antagonist III-translocate and inhibit receptor's signal on the inside of the cell, either at the internal part of the receptor or some other secondary messenger mechanims inside the cell (Viagra)
  56. s-shaped curce that demonstrates the dosage rance that produces the desired response for each drug
    log-dose drug response curve
  57. the average dose that produces half of the desired response on most patients (recommended dose)
    effective dose-ED 50
  58. How is the ED 50 defined?
    • objective measurements-single patient measurement
    • subjective symptoms-100's of subjects required
  59. produces death in one half of test animals
    lethal dose-LD 50
  60. measurement of a drug's safety/toxicity
    • therapeutic index
    • TI = LD50/ED50
  61. The wider the curves (further away the LD50 & ED 50 curves) on a graph, the ______

    The narrower the curves, ______
    safer the drug

    more toxic the drug
  62. the measurement of the amount of active ingredient of the drug
    relative potency
  63. the drug with the least amount of active ingrediant producing its ED50 is the most _____
  64. the ability of a drug to produce an effect
    maximal efficacy
  65. What are the different types of drug therapies and examples of each?
    • acute-new or immediate problem (appendicitis)
    • maintenance-maintains current functions, does not prevent progression (insulin, BP meds)
    • supplemental-maintains normal functions (vitamins)
    • supportive-maintains body function integrity (IV fluids)
    • prophylatic-preventive care (antibiotics prior to surgery)
    • palliative-end of life care, comfort measures (pain meds)
  66. What is a Type A adverse drug reaction?
    • intrinsic adverse drug reaction
    • direct extension of the known pharmacodynamic actions
    • most common type of ADR-60-70% of all known ADR's
    • predictable
    • dose-dependent
  67. What is a Type B adverse drug reaction?
    • idiosyncratic adverse drug reaction
    • uncommon, unpredictable DR that is not explained by pharmacodynamics
    • 20-30% of ADR's
    • independent of the size of the dose of drug administered
    • may be genetically linked
  68. What are the different types of type A intrinsic ADR's?
    toxic reaciton, tachyphylaxis, tolerance, dependence (physical and psychological), additive/synergist effects, antagonist effects
  69. What are the different typess of type B idiosyncratic ADR's?
    • allergic reaction/anaphylaxis
    • idiosyncratic or paradoxial response
    • carcinogenic effect
    • teratogenic effect
    • extrapyramidal effect
    • serum sickness
    • fetal alcohol syndrome
    • iatrogenic reaction
  70. drug poisoing or an overdose
    toxic reaction
  71. tolerance occurs very rapidly to a drug with just a few doses
  72. decrease responsivenesss to a drug as a result of repeated drug administration
  73. physical symptoms from withdrawing from a drug
    physical dependence
  74. intense cravings for a drug
    psychological dependence
  75. combining 2 drugs which increases their effects
    additive/synergistic effects
  76. blocking the effects of a drug
    antagonistic effects
  77. results from an immune response, must have previously been exposed
    allergic reaction/anaphylaxis
  78. an effect that is opposite of what is expected
    idiosyncratic or paradoxial response
  79. the ability of certain medications and environment chemicals to cause cancers
    carcinogenic effect
  80. a drug-induced birth defect
    teratogenic effect
  81. mimick's Parkinson's disease
    extrapyramidal effect
  82. a delayed reaction that occurs about a week after the administration of a drug
    serum sickness
  83. caused by a mother drinking alcohol during pregnancy which leads to congenital defects in the fetal body
    fetal alcohol syndrome
  84. a healthcare induced ADR
    iatrogenic reaction
  85. sensitivity or an abnormal reaction to light
  86. mixing 2 substances which turns the substances a chalky consistency
  87. taking 8+ drugs, including OTC drugs
  88. therapeutic effects with inactive substances