Pharm 1 test review.docx

Pharm 1 Test review What are the characteristics of an “ideal drug”? Quick acting No interactions No side effects Cheap How do you know if a medication is a combination drug? Combined with more than one generic ingredient What body systems are mainly responsible for the excretion of drugs from the b...

Pharm 1 Test review What are the characteristics of an “ideal drug”? Quick acting No interactions No side effects Cheap How do you know if a medication is a combination drug? Combined with more than one generic ingredient What body systems are mainly responsible for the excretion of drugs from the body? Kidneys Liver (through the bile) Feces Sweat Breathing Breast milk Silvia What is the difference between potency and efficacy of a drug? Potency is the concentration of the drug Efficacy is the maximum effect of the drug What must the nurse be aware of when administering drugs to children or the elderly? Dosage Weight for infants Route Decrease liver and kidney function in elders Genetics is an individual factor that may elicit different responses to a medication. What are some others? Age Sex (gender) Body mass Lifestyle choices Why might two clients who have hypertension and are taking the same medication each receive a different dose? Age Weight Gender Define median effective dose. 50% of the population takes the dose What is the process for drug approval in Canada? Clinical trials (animals, healthy volunteers, infected volunteers, etc) *never test on pregnant women* *regulation is important* Chemical, generic, and trade names of a medication. Why might a generic drug be suggested for a client? More affordable treatment option Define pharmacokinetics. What are the 4 components? What is the half-life of a medication? The amount of time needed for the plasma concentration to be decreased by 50% What is the first-pass effect? The medication is metabolized at the specific location before it reaches its site of action What is a loading dose? Higher dose given Usually at the beginning to get it to the therapeutic range quicker Pharmacodynamics: How does the drug change the body? What the effects and actions the drug has on the body What is the effectiveness of the average dose? Will provide an effective result to the median effective population (50%) Agonists vs antagonists: Agonists: agonists activate receptors and induce a biological response Antagonists: block receptors and inhibit the action of agonists Pregnancy categories: A: been well-studied in pregnant women, and there is no evidence of risk to the fetus during the first trimester (and sometimes throughout pregnancy). B: studied in animals, and there is no evidence of risk to the fetus. However, there are limited or no controlled studies in pregnant women. C: shown adverse effects in animal studies, but there may be insufficient data from human studies to determine the risk to the fetus. D: have shown evidence of fetal risk in humans, but the potential benefits may outweigh the potential risks in certain situations. These medications are used during pregnancy only if there are no safer alternatives available X: shown significant evidence of fetal abnormalities or risks in humans, and the risks clearly outweigh any potential benefits. infant/young children - dosages/ injection sites: Dosage is calculated based on weight per dose Injection sites: vasterlis lateralis site, most fat, easiest to inject Elderly - polypharmcy, adverse drug events, impact on pharmcokinetics: Polypharmcy: concurrent use of multiple medications by an individual, typically defined as taking five or more medications regularly. Elderly individuals are particularly susceptible to polypharmacy due to the higher prevalence of chronic diseases and the use of multiple healthcare providers. Adverse drug events: ADEs are unintended and harmful reactions to medications, including side effects, allergic reactions, and medication errors. Elderly patients are at increased risk of ADEs due to age-related changes in drug metabolism, reduced renal function, and higher likelihood of polypharmacy. Pharmacokinetics: processes by which medications are absorbed, distributed, metabolized, and excreted by the body. Age-related changes in pharmacokinetics can affect the absorption, distribution, metabolism, and elimination of drugs in elderly patients. Heparin and lowmolecular heparin: What it does: prevent the formation of blood clots and are used for the prevention and treatment of various thromboembolic disorders. Nursing responsibilities: know the history of the patient, educate of the medication, administor with the proper instructions, monitor the patient Antagonist: Protamine Sulfate: a positively charged molecule that binds to heparin, neutralizing its anticoagulant effects. Heparin Therapeutic effects and uses Acute thromboembolic disorders including DVT, pulmonary embolism, unstable angina, evolving MI Prophylaxis for clotting Mechanism of action Activates antithrombin lll, which inhibits thrombin and factor Xa (Prothrombinase) Prevents clot formation, does not break down existing clots Adverse effects Mild allergic symptoms Osteoporosis Skin lesions Serious adverse effects Abnormal bleeding Heparin-induced thrombocytopenia Causes by abnormal antibodies that activate platelets, causing clots to form and depleting platelet counts in blood Is moitored by activated partial thromboplasti times (aPTTs) Is available in parenteral form Has a short half-life (1.5 hours) Has as it antidote protamine sulfate (codamine sulfate) Nursing implications Intravenous (IV) doses are usually double-checked with another nurse Ensure that subcutaneous doses are given subcutaneously, not intramuscularly Subcutaneous doses should be given in areas of deep subcutaneous fat, and sites should be rotated Do not give subcutaneous doses within 5cm of: The umbilicus, abdominal incisions, open woulds, scars, drainage tubes, stomas Do not aspirate subcutaneous injections or massage injection site May cause hematoma formation Low molecular weight heparins: Less side effects Less laboratory monitoring Given subcutaneously Warfarin (Coumadin) Therapeutic effects and uses Prophylaxis of thromboembolic events DVT Pulmonary embolism Prophylaxis arterial thromboembolism Prevention of CVA/MI Prevent clotting in long-term indwelling catheters Mechanism of action Inhibits the action of vitamin K Adverse effects Mircoembolism Osteoporosis, bone fractures Serious adverse effects Abnormal bleeding Antidote Vitamin K Why might a client might receive both heparin and warfarin for a period of several days: Heparin and warfarin may be used together as part of bridging therapy for patients who require anticoagulation but cannot be immediately started on warfarin or have a temporary interruption in oral anticoagulant therapy Pulmonary disorders: Salmeterol (Servent, diskhaler disk) Therapeutic uses and effects Long-acting beta2 agonist indicated for prevention of asthma epiosdes in patients with severe persistent asthma Chronic bronchitis Mechanism of action Stimulates beta2 receptors in smooth muscles of bronchioles promoting bronchodilation and improved airflow and ventilation Adverse effects Throat irritation Headache Restlessness, insomnia, nervousness Dry mouth Serious adverse effects Tachycardia, chest pain Paradoxical bronchospasm Allergic response Tremor Dextromethorphan Trade names Koffex DM, Robitussin DM Therapeutic effects Treating non-productive cough Mechanism of action Raises the cough threshold in the CNS Adverse effects At moderate dose, dizziness, sedation Serous adverse effects Abuse can cause CNS toxicity Depression Ataxia, slurred speech Stupor Seizure Coma, respiratory depression Salbutamol (Ventolin) Therapeutic Effects ​​relieve symptoms of asthma,(COPD), and other respiratory conditions characterized by bronchoconstriction. Mechanism of action as beta2-adrenergic agonists. It selectively stimulates beta2-adrenergic receptors in the bronchial smooth muscle, Adverse effects tremors Tachycardia (rapid heart rate) Palpitations Headache Nervousness or restlessness Hypokalemia (low potassium levels) Serious adverse effects Paradoxical bronchospasm (worsening of bronchoconstriction) Cardiac arrhythmias (including atrial fibrillation, supraventricular tachycardia, and ventricular arrhythmias) Hypokalemia (especially with excessive or prolonged use) Allergic reactions, including angioedema and anaphylaxis What could happen if there is an interruption in anticonvulsant therapy? Can have serious consequences for those who are on the medications to manage and control seizures. Potential outcomes for interrupting include increased risk of seizures, status epilepticus, worsening of epilepsy, increased injury risks, psychosocial impact, withdrawal symptoms. Drugs that Potentiate GABA Action -Barbiturates that include phenobarbital (PMS-Phe, benzodiazepines, and miscellaneous GABA agents -They suppress the firing ability of neurons Drugs used in treatment: Pharmacotherapy with proton pump inhibitors (PPIs): PPIs H+/K+ pump on parietal cells, reducing acid secretion in the therapy of PUD and GERD Should be taken about 30 minutes before meals No crushing, has to be taken whole Pharmacotherapy with antacids: Composed of carbonate, hydroxide and bicarbonate compounds that neutralize stomach acid Calcium carbonate, aluminum carbonate Aluminum hydroxide, magnesium hydroxide Sodium bicarbonate Can affect absorption of drugs, especially those that require an acidic environment Neutralize stomach acid Are inexpensive and effective Simethicone added to reduce gas Relieve symptoms but do not promote ulcer healing Pharmacotherapy with antacids Adverse effects of calcium antacids Constipation, aggravation of kidney stones Milk alkali syndrome – hypercalcemia Adverse effects of aluminum antacids Constipation, hypophosphatemia Adverse effects of sodium anatacids Fluid retention Adverse effects of magnesium antacids Hypermagnesemia (fatigue, dysrhythmias, hypotension) Pharmacotherapy with H2-receptor antagonists: Available OTC and by prescription Pharmacokinetic properties Rapid absorption in small intestine 30-minute onset of action Half-life from 1 to 4 hours Antacids diminish the absorption of H2-receptor antagonists Miscellaneous drugs used for PUD and GERD: Sucralfate Stimulates mucous, bicarbonate, and prostaglandin Misoprostol Prostaglandin agonist, promotes mucous secretion and inhibition of acid secretion Bismuth compounds Used for dyspepsia, heartburn, and diarrhea Barbiturates Low doses reduce anxiety Moderate doses promote sleep Rarely prescribed for anxiety or insomnia because of side effects Examples of Barbiturates Phenobarbital (PMS- Phenobarbital) Pentobarbital (Nembutal) Prototype drug Barbiturates Prototype drug: Phenobarbital (PMS- Phenobarbital) Mechanism of Action: Enhancing the action of GABA Primary use: Controlling seizures, insomnia Adverse effects: dependence, drowsiness, vitamin deficiencies, laryngospasm Drugs that Potentiate GABA action Include barbiturates, benzodiazepines, and miscellaneous GABA agents Suppress the firing ability of neurons Prototype Drug: Lorazepam (Ativan) Mechanism of action: Potentiates the effects of GABA Primary use: For anxiety disorders, pre-anesthetic, sedation and to manage status epilepticus Adverse effects: Drowsiness, sedation, amnesia, weakness, disorientation, ataxia, sleep disturbance, blood pressure changes, blurred/ double vision, nausea and vomiting Examples of Benzodiazepines Clonazepam (Rivotril) Clorazepate (Apo-Clorazepate) Diazepam (Valium) Lorazepam (Ativan) Prototype Drug: Benzodiazepines Shortens the length of time to fall asleep and reduces interruptions of sleep Different benzodiazepines are indicated for diverse uses Short term insomnia Generalized anxiety disorders Controlling seizures Alcohol withdrawal Muscle Relaxation Anesthesia Prototype Drug: Diazepam (Valium) Mechanism of Action: Binds to the GABA receptor- chloride channels and suppresses neuronal activity in the limbic system Primary use: Used for short-term seizure control, claiming and relaxation Adverse Effects: Drowsiness and dizziness. When given IV- hypotension, muscle weakness, tachycardia, and respiratory depression Classes of Medication used to treat Anxiety and Sleep Disorders CNS Depressants Benzodiazepines Barbiturates Definitions Sedative: Cause sedation or relaxation Anxiolytic: Relieves anxiety (Sedatives used for this) Hypnotic: Can induce sleep (higher dose of sedative) Types of Anxiety Disorders Generalized anxiety disorder (GAD) Phobias Panic disorders Obsessive-compulsive disorder (OCD) Post Traumatic stress disorder (PTSD) Hydantoins and Phenytoin-Like Drugs -Desensitize sodium channels -Sodium movement is factor that determines whether neuron will undergo an action potential Prototype Drug: Hydatoins Prototype drug: Phenytoin (Dilantin) Mechanism of action: to desensitize sodium channels Primary use: treating all types of epilepsy except absences seizures Adverse effects: dysrhythmias, headache, nystagmus, ataxia, confusion, slurred speech, CNS depression, gingival hyperplasia, skin rash, blood dyscrasias Drug Approval Process Regulation is important Drugs affecting the autonomic nervous system Adrenergics – sympathomimetics Fight-Flight ­BP ­HR ­respirations Bronchioles dilate Pupils dilate Peripheral blood vessel constrict Adrenergic drugs: · Epinephrine – cardiac arrest, asthma, anaphylaxis · Dopamine – treat shock · Phenylephrine – nasal decongestant (can cause rebound congestion with prolonged use) Side effects: tachycardia, palpitations, hypertension, nervousness, hyperglycemia Cholinergics – parasympathomimetics Rest & Digest ­ secretions ­ peristalsis and bladder contractions Cholinergic drugs: · Bethanechol (Duvoid) – direct – treat non-obstructive urinary retention due to atony · Donepezil (Aricept) – indirect – treat early Alzheimers Side effects: nausea, vomiting, diarrhea, sweating, bradycardia, bronchospasm, respiratory depression,hypotension Adrenergic antagonists Beta-blockers ¯BP ¯HR Beta-blocker drugs: Atenolol/metoprolol-beta1 Propranolol-beta1 and beta2 Side effects: hypotension, bradycardia, fatigue, depression, hypoglycemia (inhibits response to low blood sugar Anticholinergics Drying of secretions Decreased motility GI and GU Dilated pupils ­HR Bronchodilation Anticholinergic drugs: · Atropine – suppress secretions during surgery · Oxybutynin (Ditropan) – treat overactive bladder by relaxing smooth muscle in bladder Side effects: dry mouth, urinary retention, constipation, blurred vision, confusion, tachycardia Therapeutic Action: Antacids Neutralize stomach acid Are inexpensive and effective Simethicone added to reduce gas Relieve symptoms but do not promote ulcer healing Therapeutic Action: Antibiotics -The regimen often includes: Proton pump inhibitor and Bismuth compounds (inhibit bacterial growth, prevent H. pylori from adhering to gastric mucosa) Drug Classes Used for Treating Bowel Disorders -Laxatives -Antidiarrheals -Antiemetics Therapeutic Action: Laxatives Promote bowel movements Available OTC for self-treatment of simple constipation Bulk-forming agents absorb water, adding size to fecal mass Stool softeners or surfactants cause more water and fat to be absorbed into stools Stimulants irritate bowel to increase peristalsis Saline or osmotic laxatives are not absorbed intestine (pull water into fecal mass to create more watery stool) Herbal agents are natural products available OTC (most commonly used herbal laxative is senna) Miscellaneous agents include mineral oil (acts by lubricating stool and colon mucosa) Therapeutic Action: Antidiarrheals For mild diarrhea Effective at returning elimination patterns to normal For severe cases, the opioids are the most efficacious of the antidiarrheal agents Therapeutic Action: Antiemetics Drugs from at least eight different classes -Used to prevent nausea and vomiting Acts by inhibiting dopamine or serotonin receptors in brain Prototype Drug: Antiemetics Prototype drug: Prochlorperazine (PMS- Prochlorperazine, Stemetill) Mechanisms of action: Blocks dopamine receptors in brain- inhibits signals to vomiting center in medulla Primary use: For severe nausea and vomiting- Also used to treat psychosis Adverse Effects: Dose-re;ated anticholinergic side effects Dry mouth, sedation, constipation Orthostatic hypotension, tachycardia Extrapyramidal symptoms are serious concern with prolonged therapy https://quizgecko.com/quiz/pharmacology-week-1-medications-and-drugs-gostv8 (full lectures)