Pharmacology Basics Quiz

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Questions and Answers

Which term describes the study of drugs and their interactions with living systems?

  • Pharmacotherapeutics
  • Clinical Pharmacology
  • Therapeutic Objective
  • Pharmacology (correct)

What is the primary goal of pharmacotherapeutics?

  • To determine the ideal properties of a drug
  • To use drugs to diagnose, prevent or treat disease (correct)
  • To explore drug metabolism processes
  • To study the movement of drugs across cell membranes

Which property is considered one of the most important for an ideal drug?

  • Predictability
  • Low cost
  • Chemical stability
  • Effectiveness (correct)

What does it mean for a drug to be 'selective'?

<p>The drug only elicits the response for which it is given (B)</p> Signup and view all the answers

Why is it important for a drug to have a reversible action?

<p>To control the drug's effects after administration (D)</p> Signup and view all the answers

What is the primary objective of drug therapy?

<p>To provide maximum benefit with minimal harm (A)</p> Signup and view all the answers

Why is lipid solubility important for drug absorption?

<p>Because the cell membrane is a double layer of phospholipids (A)</p> Signup and view all the answers

Which of the following processes is NOT a part of pharmacokinetics?

<p>Drug effectiveness (C)</p> Signup and view all the answers

Which of the following is a disadvantage of administering intravenous (IV) medications?

<p>Once administered, the medication's effects are irreversible. (D)</p> Signup and view all the answers

What is a primary advantage of using the intravenous (IV) route for drug administration?

<p>It can accommodate large volumes of fluid. (A)</p> Signup and view all the answers

Why are enteric-coated tablets designed to dissolve in the intestines rather than in the stomach?

<p>To protect the medication from being degraded by stomach acid. (B)</p> Signup and view all the answers

What is a significant limitation of oral medication administration?

<p>It requires a conscious and cooperative patient. (C)</p> Signup and view all the answers

Which route of drug administration typically achieves a quick absorption, though not as fast as IV?

<p>Intramuscular/Subcutaneous (A)</p> Signup and view all the answers

What is a potential risk associated with administering certain intravenous medications?

<p>Severe local injury if extravasation occurs (A)</p> Signup and view all the answers

How does the concept of 'depot absorption' relate to certain intramuscular (IM) medications?

<p>It allows for prolonged, sustained release of the medication. (B)</p> Signup and view all the answers

What factor can cause variations in the bioavailability of tablets from different manufacturers?

<p>The rate of dissolution. (A)</p> Signup and view all the answers

What is the primary factor that determines if a drug molecule can leave the vascular space?

<p>Whether the drug is bound to a protein such as albumin (B)</p> Signup and view all the answers

If a drug is 99% bound to albumin, what percentage of the drug is available to interact with tissues?

<p>1% (A)</p> Signup and view all the answers

How do drugs typically produce their effects within the body?

<p>By interacting with specific receptor sites (A)</p> Signup and view all the answers

What is a key characteristic of the blood-brain barrier that impacts drug distribution?

<p>It has tight junctions that limit passage. (B)</p> Signup and view all the answers

Why are newborns more sensitive to medications that act on the brain?

<p>Their blood-brain barrier is not fully developed. (D)</p> Signup and view all the answers

Which of the following can limit drug distribution to tissues?

<p>The presence of abscesses or tumors (C)</p> Signup and view all the answers

Before administering a new medication to a patient, what is the most important piece of information to gather during the nursing assessment phase?

<p>The name, dosage, purpose, and timing of the drug. (B)</p> Signup and view all the answers

What effect can antacids have on the absorption of some drugs?

<p>Decrease the rate of absorption (A)</p> Signup and view all the answers

Which mechanism of drug transport across cell membranes relies primarily on the drug's lipid solubility?

<p>Direct penetration of the cell membrane (B)</p> Signup and view all the answers

A drug is administered orally but fails to reach systemic circulation. Which factor is MOST likely the issue?

<p>The drug has poor bioavailability. (C)</p> Signup and view all the answers

What role does the P-glycoprotein transporter system play in drug disposition?

<p>It pumps drugs out of cells for elimination or reduced exposure. (C)</p> Signup and view all the answers

Why is absorption faster in the intestines compared to the stomach?

<p>The intestines have a larger surface area due to microvilli. (D)</p> Signup and view all the answers

What is the definition of 'absorption' in drug pharmacokinetics?

<p>The movement of a drug from its administration site into the bloodstream. (A)</p> Signup and view all the answers

A patient is experiencing diarrhea. How might this impact the absorption of an orally-administered drug?

<p>It may decrease drug absorption due to reduced time in the digestive tract. (B)</p> Signup and view all the answers

If a drug's dosage varies depending on the route of administration, what is the primary reason for such adjustments?

<p>Variations in bioavailability due to the route. (A)</p> Signup and view all the answers

Which of the following affects the bioavailability of an oral drug?

<p>Gastric pH. (C)</p> Signup and view all the answers

What is the primary way drug-drug interactions can manifest?

<p>By altering the therapeutic or adverse effects of one or more drugs. (A)</p> Signup and view all the answers

Which of the following best describes a drug with a low therapeutic index?

<p>It has a very narrow margin of safety and needs to be used with greater caution. (C)</p> Signup and view all the answers

What is a 'side effect' of a drug, relative to an adverse effect?

<p>A side effect is a nearly unavoidable, secondary effect at a therapeutic dose. (D)</p> Signup and view all the answers

What effect is most closely associated with grapefruit juice when taken in conjunction with certain medications?

<p>It inhibits the enzymes that break down some drugs, increasing their levels. (C)</p> Signup and view all the answers

What is the 'LD50' value used to calculate a drug's therapeutic index?

<p>The dose that is lethal to 50% of animals treated. (D)</p> Signup and view all the answers

How do inducing agents primarily affect drug metabolism?

<p>They stimulate the synthesis of CYP isoenzymes, potentially decreasing drug levels. (A)</p> Signup and view all the answers

Which of the following best demonstrates a pharmacodynamic drug interaction?

<p>One drug changes how another drug binds to its cellular receptor. (C)</p> Signup and view all the answers

What is a typical consequence of combining a potassium-sparing diuretic with potassium salt substitutes?

<p>Greater chance of hyperkalemia, due to excess potassium. (A)</p> Signup and view all the answers

A patient is receiving a medication known to be highly bound to albumin. What would be the most likely consequence if the patient develops hypoalbuminemia?

<p>Decreased drug efficacy due to lower free drug concentration (D)</p> Signup and view all the answers

A patient requires regular administration of morphine sulfate for pain management. Which of the following aspects of the medication administration process should the nurse prioritize?

<p>Ensuring the patient understands the purpose of the medication and potential side effects. (B)</p> Signup and view all the answers

A patient is prescribed losartan 50 mg daily for hypertension. Which of the following actions should the nurse prioritize when providing medication education to this patient?

<p>Emphasize the importance of taking the medication as prescribed and adhering to the schedule. (E)</p> Signup and view all the answers

A patient is receiving ampicillin 2 grams every 8 hours orally, but they are experiencing difficulty swallowing the tablets. Which nursing action requires a physician's order?

<p>Suggesting an alternate route of administration, such as intravenous (IV) infusion. (B)</p> Signup and view all the answers

A patient is prescribed primidone 25 mg three times a week for hand tremors. What is the nurse's responsibility regarding the patient's knowledge of this medication?

<p>Ensuring the patient knows the name of the medication, dosage, and frequency of administration. (D)</p> Signup and view all the answers

A patient is receiving morphine sulfate 2-4 mg IV push every 1-2 hours as needed for chest pain. What specific information should the nurse prioritize in their patient education about this medication?

<p>The potential side effects of the medication, including respiratory depression. (B)</p> Signup and view all the answers

A nurse is preparing to administer medication to a patient who has difficulty understanding medical information. What is the most appropriate approach to ensure effective medication education?

<p>Using simple language and visuals to explain the medication's purpose, dosage, and side effects. (B)</p> Signup and view all the answers

A nurse is preparing to administer a medication intravenously (IV). What is the most important action to ensure patient safety?

<p>Checking the patient's armband and medication administration record (MAR) before administering the medication. (C)</p> Signup and view all the answers

A patient is experiencing a severe allergic reaction after receiving a medication. Which action should the nurse prioritize?

<p>Administering epinephrine according to the institution's protocol. (C)</p> Signup and view all the answers

What primarily causes the intensity of an allergic reaction?

<p>The individual's immune system response (A)</p> Signup and view all the answers

What is the main purpose of medication reconciliation?

<p>To create a list of all medications during healthcare transitions (B)</p> Signup and view all the answers

Which statement is true regarding medication errors?

<p>Over 90% can be traced back to human factors (A)</p> Signup and view all the answers

Idiosyncratic effects of medications typically stem from what?

<p>Genetic predisposition or unknown factors (A)</p> Signup and view all the answers

What is a recommended way to reduce medication errors in a healthcare setting?

<p>Enhance institutional culture focusing on safety (C)</p> Signup and view all the answers

What is Epi primarily used for in the context of allergic reactions?

<p>To treat anaphylaxis (C)</p> Signup and view all the answers

Which factor does NOT contribute to medication errors according to the content?

<p>Institutional safety protocols (C)</p> Signup and view all the answers

What role does the MER program play in medication safety?

<p>It encourages all healthcare providers to report medication errors (D)</p> Signup and view all the answers

What is the primary factor influencing the absorption rate of a drug administered orally?

<p>Surface area of absorption (B)</p> Signup and view all the answers

Which mechanism enables drugs to be excreted from the body through the kidneys?

<p>Active transport (D)</p> Signup and view all the answers

How do direct penetration of cell membranes primarily affect drug absorption?

<p>Drugs must be lipid soluble to penetrate. (D)</p> Signup and view all the answers

What happens to drug bioavailability when food is present in the stomach?

<p>It decreases because of drug interactions. (D)</p> Signup and view all the answers

Which factor does NOT influence the bioavailability of oral drug preparations?

<p>Patient age (D)</p> Signup and view all the answers

What is a major disadvantage of intravenous (IV) drug administration?

<p>High cost and requirement for special training (A)</p> Signup and view all the answers

Which of the following routes is associated with depot absorption?

<p>Intramuscular (D)</p> Signup and view all the answers

What is the main reason why some drugs require energy for transport across cell membranes?

<p>They are moving against their concentration gradient. (B)</p> Signup and view all the answers

Which type of drug transport is characterized by a selective receptor mechanism?

<p>Active transport (B)</p> Signup and view all the answers

What is a key characteristic of enteric-coated tablets?

<p>They protect the drug from stomach acid. (A)</p> Signup and view all the answers

In the case of a drug with high lipid solubility, what is likely to occur?

<p>It will be quickly absorbed through cell membranes. (B)</p> Signup and view all the answers

What factor can significantly affect the absorption of oral medications?

<p>Patient's consciousness and ability to cooperate (C)</p> Signup and view all the answers

Which of the following statements about intravenous (IV) drug errors is true?

<p>They are more common than errors in other routes. (C)</p> Signup and view all the answers

What is the onset time for intramuscular (IM) drug absorption compared to intravenous (IV)?

<p>Approximately 30 minutes, slower than IV (C)</p> Signup and view all the answers

What potential risk is associated with certain intravenous medications?

<p>Severe local injury if extravasation occurs (D)</p> Signup and view all the answers

What characteristic of oral medications contributes to variability in absorption?

<p>Differences in dissolution rates due to manufacturing variations (A)</p> Signup and view all the answers

What is the primary significance of understanding drug-drug interactions in patients taking multiple medications?

<p>They can significantly alter the outcome of therapy. (D)</p> Signup and view all the answers

Which factor increases the risk of adverse drug reactions in a patient?

<p>Having a low therapeutic index. (A)</p> Signup and view all the answers

Which type of drug interaction is characterized by intensified therapeutic effects or adverse effects?

<p>Pharmacodynamics interaction. (A)</p> Signup and view all the answers

What defines a drug with a low therapeutic index?

<p>It has a similar LD50 and ED50 value. (B)</p> Signup and view all the answers

Which of the following is a potential consequence of combining grapefruit with certain medications?

<p>Enhanced drug toxicity. (D)</p> Signup and view all the answers

What type of interaction occurs when two drugs have a combined toxic effect?

<p>Combined toxicity interaction. (D)</p> Signup and view all the answers

Why are side effects often predictable and dose-dependent?

<p>They are influenced by therapeutic dosing levels. (B)</p> Signup and view all the answers

What is a common drug-food interaction involving warfarin?

<p>Greens such as spinach. (D)</p> Signup and view all the answers

Flashcards

What is a drug?

Any chemical that affects living processes.

What is Pharmacology?

The study of drugs and their interactions with living systems.

What is Clinical Pharmacology?

The study of drugs in humans, including their effects, metabolism, and how they interact with the body.

What is Pharmacotherapeutics?

The use of drugs to diagnose, prevent, or treat diseases, or to prevent pregnancy.

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What is Effectiveness in drug properties?

The drug produces the desired effect in the body.

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What is Safety in drug properties?

The drug does not cause harmful effects.

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What is Selectivity in drug properties?

The drug only causes the intended effect and not other unwanted effects.

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What is Reversibility in drug properties?

The drug's effects are reversible and disappear after use.

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Absorption

The movement of a drug from its administration site into the bloodstream.

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Bioavailability

The ability of a drug to reach systemic circulation from its site of administration. It's mostly relevant for oral medications.

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P-glycoprotein transporter

A system that pumps drugs out of cells, like a bouncer removing unwanted guests. Found in liver, kidney, placenta, intestines, and brain.

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Pharmacokinetics

The study of what the body does to a drug, including absorption, distribution, metabolism, and excretion.

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Passage of drugs across membranes

Passage of drugs across cell membranes occurs via three mechanisms: channels/pores, transport systems, and direct penetration.

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Transport systems

A drug's structure dictates which transport system it uses to cross membranes (if any). Some systems require energy; others don't.

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Channels / pores

A system where only small ions like potassium (K) and sodium (Na) can pass through.

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Dosage & Administration

Many drugs have multiple uses (indications). The dosage can vary depending on the specific indication and route of administration.

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Intravenous Administration (IV)

The administration of a drug directly into a vein, offering rapid onset and precise control but demanding careful monitoring for potential complications like fluid overload and infection.

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Intramuscular/Subcutaneous Administration (IM/SubQ)

This route allows for quick drug absorption but slower than IV, typically around 30 minutes. It's useful for sustained effects, like with depot penicillin G, but can be painful and has limited injection sites.

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Oral Administration (PO)

This route involves swallowing a drug, providing a relatively safe and convenient option, but may have variable absorption rates due to factors like stomach acidity. It requires a conscious and cooperative patient.

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Enteric-Coated Tablets

These medications are protected by a special coating, preventing their breakdown in the stomach and allowing for absorption in the intestines, often used for medications that irritate the stomach or are sensitive to stomach acid.

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Sustained-Release Tablets

These tablets are designed to release their medication gradually over a period of time, offering a sustained effect. This provides a sustained release of the medication for a longer period of time.

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Drug Binding to Receptors

The degree to which a drug binds to its target receptor, impacting its potency and effectiveness, which can vary based on factors like an individual's tolerance levels.

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Drug Receptor Interaction

The specific action of a drug at its target receptor site, which can be influenced by factors like drug tolerance, placebo effects, receptor impairment, and drug interactions.

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Drug Binding

Only unbound drugs can leave the blood vessels and reach tissues. Bound drugs are too large to pass through the tiny openings in the vessel walls.

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Protein Binding: Warfarin vs Gentamicin

Different drugs bind to proteins in the blood with varying strengths. This affects how much of the drug is available for use in the body.

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Drug Receptor Sites

Drugs interact with specific molecules in the body, called receptors, to trigger an effect. Think of a key fitting into a lock.

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Receptor Properties

Receptors are natural control points in the body's processes. They are normally regulated by the body's own molecules. Drugs can only mimic or block these natural signals.

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Drug Distribution: Barriers

Drugs travel through the bloodstream to reach tissues. However, some barriers, like abscesses and tumors, restrict drug distribution due to lack of blood vessels.

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Blood-Brain Barrier (BBB)

The blood-brain barrier is a protective layer that restricts most drugs from entering the brain. Drugs must be lipid-soluble or have special transport systems to cross it.

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Placental Barrier

The placenta, which protects the fetus, also acts as a barrier, but some drugs can still cross, potentially harming the developing baby.

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Drug Naming

Drugs can be named in three ways: chemical, generic, and brand. Each name refers to the same molecule but with different levels of specificity.

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Self-Care Assessment

The nurse assesses the patient's ability to understand and manage their medications. This includes factors like dementia, critical illness, or depression, which may hinder their ability to take medications safely.

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Nurse Practice Act

This refers to the legal responsibility of nurses for any medications they administer or fail to administer. Mistakes can have serious consequences.

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Medication Safety

The nurse is legally responsible for ensuring the correct medication, dose, and route are administered. This includes checking the patient's armband against the medication administration record (MAR).

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Nurse's Drug Knowledge

The nurse must be knowledgeable about the drug's mechanism of action, its purpose, potential adverse effects, and the correct route of administration.

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Patient Medication Education

The nurse needs to assess the patient's understanding of their medications, including the name, dosage, route, and purpose. This ensures they can safely manage their medications at home.

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Medication History

The nurse should gather a complete list of all medications the patient is taking, including prescription, over-the-counter, recreational, and herbal supplements.

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Identifying High-Risk Patients

Nurses should assess the patient's history for factors that could affect medication response, such as liver or kidney function, genetic factors, drug allergies, pregnancy, age, or any pre-existing conditions.

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Changing Medication Routes

The nurse can adjust the route of administration if the patient has difficulty swallowing medications, or if a different route is deemed necessary. For example, switching from oral pills to a liquid or intravenous form.

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Therapeutic index

A measure of a drug's safety, calculated as the ratio of the lethal dose (LD50) to the effective dose (ED50). A large therapeutic index indicates a relatively safe drug, while a low index suggests a higher risk of toxicity.

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Intensified Drug interaction

A drug interaction that intensifies the therapeutic effect or adverse effect (AE) of another drug.

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Reduced Drug interaction

A drug interaction that reduces the therapeutic or adverse effect (AE) of another drug.

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Unique Drug interaction

A drug interaction that creates a unique response, different from the effect of either drug alone.

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Direct interaction

A drug interaction that occurs because of direct chemical or physical interaction between two drugs.

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Pharmacokinetic interaction

A drug interaction that occurs due to changes in the absorption, distribution, metabolism, or excretion of one drug by another.

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Pharmacodynamic interaction

A drug interaction that occurs when two drugs act on the same target or pathway, leading to an altered effect.

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Combined toxicity

A drug interaction that occurs when two drugs combined cause a toxic effect greater than the sum of their individual toxicities.

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Distribution

Movement of a drug from the bloodstream to tissues.

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Metabolism

The breakdown/change of a drug within the body.

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Excretion

Elimination or removal of a drug from the body. Usually involves the kidneys and liver.

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Drug passage across membranes

Drugs can cross cell membranes via 3 main ways: channels/pores, transport systems, and direct penetration.

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Direct Drug Interaction

A drug interaction that occurs when two drugs directly interact chemically or physically.

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Drug Absorption

The process of a drug moving from its administration site (e.g., mouth, injection) into the bloodstream. This is the first step for a drug to reach its target.

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Drug Distribution

The process of a drug traveling through the bloodstream and reaching its target tissue. However, certain barriers can limit the drug's distribution.

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Nurse's Responsibility in Medication Administration

The nurse is legally responsible for any medication administered or not administered, regardless of orders.

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Medication Administration Safety: Verification

The nurse must verify patient identity by checking the armband and the medication administration record (MAR). Asking the patient's name alone is insufficient.

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Nurse's Drug Knowledge and Responsibilities

The nurse must understand the drug's action, proper dosage, intended outcome, potential side effects, and correct administration route. They're also responsible for patient education.

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Identifying High-Risk Patients for Medications

Nurses must prioritize identifying patients at risk for adverse medication reactions or poor outcomes. This includes those with liver/kidney issues, drug allergies pregnancy, age, and genetics.

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Monitoring and Documentation of Drug Responses

The nurse must document the patient's response to each drug, including any side effects or therapeutic outcomes observed.

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Changing Medication Routes for Swallowing Difficulty

When a patient experiences difficulty swallowing tablets, the nurse may recommend alternative routes like liquids or IV administration. However, only a physician can change the medication orders.

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Intravenous Drug Administration (IV): Advantages and Disadvantages

Intravenous administration delivers drugs directly into the bloodstream. Advantages: faster absorption, controllable dosage, and suitability for various drugs. Disadvantages: irreversible, risk of infection, contamination, and fluid overload.

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Oral Medication: Absorption and First-Pass Effect

Oral medication offers convenience but may have variable absorption due to factors like food, other medications, and stomach pH. This is known as the first-pass effect, where some of the drug gets metabolized before reaching the bloodstream.

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Allergic Reaction

An immune response triggered by prior exposure to a substance, leading to a range of reactions from mild to life-threatening. The severity depends on the immune system's response, not the drug's dosage.

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Idiosyncratic Effect

An uncommon, unpredictable drug response often attributed to genetic factors or unknown predispositions. For example, individuals with G6PD deficiency may experience hemolysis after taking aspirin or sulfonamides.

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Medication Reconciliation

A comprehensive review and comparison of a patient's medication list conducted during transitions in care, such as hospital admission, discharge, or changes in care level. This helps ensure accurate and safe medication management.

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Medication Error

Any unintended error in the medication process, including prescribing, dispensing, administering, or monitoring. These errors can have serious consequences for patient safety.

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Medication Error Reporting Program

A confidential program designed to encourage healthcare providers to report medication errors. This helps track errors, identify patterns, and improve patient safety through knowledge gained from reported incidents.

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Study Notes

Basic Terms

  • Drug - any chemical affecting living processes
  • Pharmacology - study of drugs and their interactions with living systems
  • Clinical Pharmacology - study of drugs in humans
  • Pharmacotherapeutics - use of drugs for diagnosis, prevention, or treatment of disease or preventing pregnancy

Properties of the Ideal Drug

  • Most Important Properties: Effectiveness, safety, selectivity
    • Drugs must be effective before release
    • Safe drugs have minimal harmful effects with proper dosage and selection
    • Selective drugs produce only the intended response
  • No Perfect Drug: All drugs have side effects (SE)

More Ideal Characteristics

  • Reversible action
  • Predictable patient response
  • Ease of administration
  • Freedom from drug interactions
  • Low cost
  • Chemical stability
  • Simple generic name

Therapeutic Objective

  • Provide maximum benefit with minimal harm
  • Individual responses to medication vary

Pharmacokinetics

  • All four phases (absorption, distribution, metabolism, excretion) involve drug movement across cell membranes
  • Drug must be lipid soluble to cross cell membranes
  • Processes determine amount reaching site of action
    • Drug absorption
    • Drug distribution
    • Drug metabolism
    • Drug excretion
  • Individual variations in kidney/liver function affect drug action

Three Mechanisms to Cross Membranes

  • Passage through channels/pores
  • Transport systems (selective, some require energy)
  • P-glycoprotein transporter system (moves drugs out of cells; e.g., liver, kidney, placenta)

Passage of Drugs Across Cell Membranes

  • Channels/pores - small ions
  • Transport systems - drug structure determines transporter system; some require energy expenditure

Bioavailability

  • Ability of drug to reach systemic circulation from its site of administration
  • Affected by various factors (e.g., tablet disintegration time, enteric coatings, formulations, gastric pH, diarrhea, constipation, food)

Absorption

  • Definition: movement of drug from its site of administration into the bloodstream
  • Rate of absorption determines when action begins
  • Factors affecting absorption include dissolving rate, surface area, blood flow, and lipid solubility

Dosage & Administration

  • Dosage may vary depending on indication and route
  • Multiple indications are common
  • Route selection affects dosage

Routes: Intravenous (IV)

  • Positive: rapid onset, precise control, large volumes
  • Negative: expensive, inconvenient, irreversible, potential for errors, fluid overload, infection, embolism

Routes: Intramuscular (IM) / Subcutaneous (SubQ)

  • Positive: quick absorption, depot effect
  • Negative: painful, limited sites, risk of bleeding, less convenient

Routes: Oral (PO)

  • Barriers affect absorption
  • Safety advantage over other routes
  • Variability in absorption rate
  • Considerations for absorption include coatings and gastric pH

Other Routes

  • Inhalation
  • Rectal
  • Vaginal
  • Topicals
  • Transdermal
  • Heart, nerves, joints

Pharmacokinetics

  • Binding to receptors determines drug effect; tolerance/naivety, interference from other drugs affect binding
  • Individual variations influence patient response

Protein Binding (Albumin)

  • Only unbound drugs can leave the vascular space
  • Binding is reversible; strength of attraction varies between drugs and albumin

Drug Receptor Sites

  • Drug binding to receptors controls physiological processes

Drug Distribution

  • Distribution to tissues affected by vascular spaces (e.g., abscesses, tumors)
  • Blood-brain barrier (BBB), placental barrier limit drug distribution (Drugs must be lipid-soluble to cross BBB)
  • Newborns have heightened sensitivity to meds acting on the brain

Naming Drugs

  • Chemical, generic, brand

Drug Pre-Administration

  • Nursing process: assessment phase
  • Baseline data; includes drug name, dosage, purpose, timing
  • Risk factors (kidney/liver impairment, genetics, allergies, pregnancy, age)
  • Patient history, physical exam, lab results
  • Patient education

Nurse Practice Act

  • Responsibility for administered/not administered drugs
  • Check identifiers before administration
  • State name protocol essential

Routes of Drug Administration

  • IV (no barriers, fast, reversible, infections/contamination, fluid overload)
  • IM (capillary barrier, rapid, at-risk of injury/pain)
  • Subcutaneous (similar to IM)
  • Oral (food/med interaction, first pass effect, variable absorption, safety)
  • Other (topical, inhalant, etc)

Nursing Role in Changing Routes

  • Medication errors
  • Patient education

Drug Metabolism

  • Biotransformation - enzymatic alteration of drug structure
  • Usually occurs in the liver via cytochrome P450 (CYP) enzymes; (interactions possible)
  • Metabolism often results in drug excretion in the kidneys

Considerations in Drug Metabolism

  • Age affects metabolism, possibly necessitating dosage adjustments
  • First-pass effect – rapid hepatic inactivation of certain oral drugs. Hepatic metabolism affects effectiveness

Clinical Significance of Drug Interactions

  • Drug interactions impact the therapeutic response (potentiate/diminish)
  • Significance is increased with multiple medications
  • Interactions are important for drugs with low therapeutic indexes

Therapeutic Index

  • Measure of drug safety (LD50/ED50); large index indicates safety, small index indicates risk

Drugs Stimulating/Inhibiting CYP Isoenzymes

  • Drugs that stimulate increase levels of other drugs
  • Drugs that inhibit decrease levels of other drugs

Drug-Food Interactions

  • Grapefruit juice alters effects of certain drugs, influencing metabolism
  • Other interactions possible, consider food/drink/herbal interactions with specific drugs

Adverse Drug Reactions & Medication Errors

  • Undesirable effects of normal doses
  • Range in intensity from mild annoyance to life-threatening
  • Can be caused by multiple factors and range in risk depending on patient

Side Effects

  • Unintentional effects of therapeutic doses
  • Generally predictable, intensity related to dose

Drug Toxicity

  • Excessive drug dosage
  • Physiological effects (e.g., coma, hypoglycemia)

Allergic Reactions

  • Immune response (mild to life-threatening)
  • Prior sensitization required

Idiosyncratic Effects

  • Uncommon responses (genetic predispositions, unknown/rare responses; e.g., G6PD affecting aspirin)

Medication Reconciliation

  • Essential during transitions in care (hospitals, different levels of care)
  • List of current meds, indications, route, dosages, intervals, vitals
  • Include herbs, prescription/non-prescription meds (legal/illegal)

Medication Errors

  • Increased risk in hospitals; nurse is often last line against errors
  • Human factors are significant contributors to errors. Increased patient safety through education and process improvement

Ways to Reduce Errors

  • Educate patients and families
  • Standardize processes
  • Provide tools for safety
  • Promote medication error reporting

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Principles of Pharmacology PDF

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