Pharm 105 -2 Study Guide Final Exam Review PDF

Pharm 105 -2 Study guide 1. Key terms from each of the chapters covered over the term (weeks 1- 12) 2. Various Pharmacological terms- pharmacokinetic etc. Pharmacodynamics- the study of biochemical interactions of drugs and their sites of activity Pharmacoeconomics-the...

Pharm 105 -2 Study guide 1. Key terms from each of the chapters covered over the term (weeks 1- 12) 2. Various Pharmacological terms- pharmacokinetic etc. Pharmacodynamics- the study of biochemical interactions of drugs and their sites of activity Pharmacoeconomics-the study of the economic factors impacting the cost of drug therapy Pharmacogenomics-the study of the influence of genetic factors impacting the cost of drug therapy Pharmacognosy-the study of drugs that are obtained from plants and other natural sources Pharmacokinetics-the study of drug absorption, distribution and excretion of drugs pharmacology-the broadest term for the study of the science of drugs Pharmacotherapeutics-the treatment of the pathological conditions using drugs- also known as therapeutics 3. Nursing Care plan – ADPIE and relevance to pharmacology Assessment, diagnosis, planning, implementation and evaluation. 4. Know what is: Pharmacology, generic name, trade name. Generic name is the name that is derived from the chemical name. Trade name is the brand name given by the company selling the drug. 5. Pharmacotherapeutics Drug therapy 6. Adverse drug reaction Undesirable effect from a drug or health product 7. Synergistic effect When two drug interact, giving a greater effect than if the drugs were given individually 8. Therapeutic effect The response after a treatment of any kind, in pharmacology that would be the effect achieved from the medications 9. Additive effect When combining two drugs equals the sum of the drugs given independently 10. Distribution When and how the drug transfers through the body 11. Metabolism  Pharm 105 -2 Study guide The metabolic breakdown of the drugs by a living organism, usually through specialized enzymatic systems. 12. Excretion How the body excretes and gets rid of the drug waste from the body, pee, poo, sweat ect. 13. Half- life, peak, onset and duration Half-life- the time it takes to be absorbed to 50% of its potential Peak- the time it takes to get to the highest of the effect Onset-the time it takes for the drug to start working Duration-The time it takes for the drug to go through the system 14. Pharmacodynamics The study of biochemical and physiological effects of drugs 15. Pharmacokinetics The study of the movement of drugs through the body 16. Pharmacognosy The study of medication derived from plants and natural sources 17. Pharmacoeconomics The study of the cost of effect of medications 18. What is a therapeutic response? How the body reacts to the treatment of the drug, expected response to a treatment. Ex: acetaminophen taken for headache; therapeutic effect is pain relief from headache 19. Know the parenteral drug route, what body system does this encompass Parenteral- any route of drug given other than enteral, IM, IV, SUB, Catheter Administration that by passes the digestive system 20. Action of drugs bound to plasma protein Protein binding drugs bind to the protein and may need an extra dose because the protein will absorb the binding drug until there is no room left then the body will take the extra drug floating around. Sometimes another drug will be giving at the same time to bind, allowing the original drug to be able to be used 21. Types of reactions such as idiosyncratic, allergic (name others) Adverse drug reaction-harmful, unintended reaction to a drug Idiosyncratic-abnormal, unwanted reaction to a drug Allergic-immune response to a medication  Pharm 105 -2 Study guide 22. Medication errors, medication reconciliation – know the process of medication reconciliation Medication error-a preventable error that causes harm or has the potential to cause harm Medication reconciliation-combining patient medications to new meds prescribed, as well as what family DR./er DR. orders to see if there are any duplicate or unneeded medications in use. 23. Adverse drug reaction, Adverse drug event ADE-harm caused by the administration of medication, weather it was intentional or unintentional medication administration ADR-harmful reaction to a medication that is administered in the correct way 24. Considerations across a lifespan regarding excretion, metabolism and distribution Neonates are age 0–1-month-old, infants are 1 month to 12 months, and child 1-12 years and adolescent 13-19 years. Neonates and infants will need smaller doses due to size and underdevelopment of some organs. It can cause increased or decreased efficiency and safety. Same consideration for the elderly, organs do not work as well, metabolism has slowed down and can likely cause adverse effects. 25. Ethnocultural considerations Some ethnic groups can have varied responses to some medications. Some may have therapeutic effects to different doses, and some may have adverse effects. Other considerations include communication at patient teachings, the use of proper language, no slang 26. what is polypharmacy where the patient received multiple medication for various diagnosis form various doctors. 27. What is a nomogram A tool to help HCP design dosing regimens tailored to individual patients 28. Define and know examples of affective and cognitive domain Cognitive domain: concerns the intellect (remembering and understanding patient teachings) Affective domain: all about emotions and attitudes (receiving and responding to patient teachings) 29. OTC medications Medications that can be purchased without a prescription 30. FDA Food and Drug administration 31. Double blind study Where the patient and the test giver do not know who gets the placebo  Pharm 105 -2 Study guide 32. Controlled drug and substances act Federal law in Canada that regulates the possession, distribution and sales of drugs and pharmaceuticals that are controlled or illegal. 33. Agonist, antagonist, partial agonist Agonist- binds to the receptor and activates it mimicking the natural effects Partial agonist- binds to receptor but only partially activates it with lower efficiency Antagonist- binds to receptor but does not activate it 34. H2 receptor antagonists H2 blockers- class of medications that block the action of histamine, this decreases the production of stomach acid, used to treat Pepcid ulcers, Gerd and dyspepsia Famotidine (Pepcid) ranitidine (Zantac) 35. Conditions that cause Hypocalcemia and treatments Hypocalcemia is when the calcium in the blood (not the bones) is too low Common side effect of having the thyroid removed Caused by hypothyroidism, vitamin d deficiency, kidney failure Others may be pancreatitis, pseudothyroidism, hypomagnesemia, and certain genetic disorders. 36. Simethicone Antiflatulant medication that helps relieve gas symptoms. Silicone compound that is not absorbed in the GI tract and is excreted in stools. It causes the gas bubbles to be more flexible allowing them to gather in the intestines allowing for easier passage Uses: bloating and gas and abdominal pain Brand name: Alka-Seltzer, Gas-x, 37. Know the various types of antacids and the mechanism of action of each- know about what they do to stomach PH Calcium-carbonate- most common (Tums) causes constipation Magnesium hydroxide- milk of magnesia- causes diarrhea (used as laxative in clinical setting) Aluminum hydroxide- (Amphojel, Acid-Gone) (best for those with renal issues as they are easier to excrete) causes constipation Sodium bicarbonate- (baking soda) Alka-Seltzer cases fluid retention and higher sodium levels. Do not use with patients with hypertension or fluid overload. antacids neutralize the stomach acid, they bring the ph down to 4, if it is there at that level for too long it can create more acid in the stomach and it is called acid rebound (overuse) increases gastric mobility and discomfort. Treats GERD, treats GI ulcers,  Pharm 105 -2 Study guide 38. Antacids - which cause diarrhea and which cause constipation Contraindicated in elderly and children and those with renal complications Diarrhea causing are magnesium hydroxide Constipation causing are calcium carbonate, aluminum hydroxide, 39. Pepto Bismol Bismuth subsalicylate- used to treat diarrhea, nausea, heartburn, indigestion, gas and upset stomach. Tablet or liquid form can cause constipation and dark colour stools. 40. Know how to apply dermatological drugs Patches: date the new patch, apply with clean gloves, apply to site that is clean, dry and removed of hair. Creams/ointments: use gloves, apply even strokes in direction of the hair, do not rub vigorously, apply thin layer 41. Know the various types of inhalers used for asthma attacks- which one would you take first and why? Albuterol aka salbutamol (Ventolin) take first as it is a bronchodilator and will open, the airways to allow the other medications into the lungs. Short acting rescue inhaler. Beta-antagonist. Ipratropium (Atrovent)- anticholinergic, lessen the mucus in addition to opening the airways, they take longer to work than the short acting ones. 42. What is an inhaled corticosteroid (ICS)- List one trade name and generic name Inhaled corticosteroids also known as glucocorticoids, can cause thrush, oral candidiasis, infection in the mouth that occurs due to overgrowth of Candida (a fungus). When using a corticosteroid inhaler- have the patient rinse mouth after each use. These inhalers are used to treat asthma, COPD, and chronic breathing disorders. They reduce the inflammation in the airway. Fluticasone- Flovent Beclomethasone- Qvar Redihaler 43. Know Salbutamol, fluticasone, ipratropium – MOA, indications and patient teachings for all Salbutamol-(Ventolin), Inhaled bronchodilator, used to open the airways, this is used as a rescue inhaler. Use this first to open airways followed by other inhalers. Fluticasone-(Flovent), inhaled corticosteroid used to treat asthma, MOA: reduces airway inflammation, side effects: sore throat, oral candidiasis (thrush), bone demineralization with long term use. Ipratropium-(Atrovent), treats COPD, rhinitis, asthma, MOA-blocks the Ach receptors in the lungs causing bronchodilation. Side effects: dry mouth, bitter taste, throat/nasal irritation. 44. Oral thrush can be due to which inhaler and why?  Pharm 105 -2 Study guide Fluticasone- Flovent can happen due to a lack of immune response in people with chronic health conditions. 45. Know the anatomy of the upper and lower respiratory tract? URT includes structures that are located outside the chest cavity: mouth, nose, nasopharynx, laryngopharynx, and larynx. LRT includes structures located inside the chest cavity: trachea, bronchioles, bronchi, alveoli and the lungs. 46. List medical conditions that are diagnosed in the upper respiratory system vs. lower Conditions of URT: colds, rhinitis, and hay fever Conditions of LRT: asthma, emphysema, bronchitis and COPD 47. Calcium salts – adverse effects for both IV & PO routes Used in the treatment of osteoporosis when dietary intake is insufficient. PO route Can cause constipation, severe diarrhea, and abdominal pain. IV route can cause syncope(fainting) bradycardia and paresthesia (tingling feeling) 48. List all the various skins conditions listed in the textbook- know which are fungal and which are bacterial Dermatosis is any skin condition Bacterial infections related to skin: folliculitis, impetigo, furuncles, carbuncles, papules, pustules, vesicles, and cellulitis drugs to treat are bacitracin, neomycin, and polymyxin Acne is common and can be caused by bacteria and commonly treated with benzoyl peroxide, clindamycin, and tetracycline Fungal infections: dermatophytes and Malassezia furfur, grow in moist areas, toes, groin etc.. Treated with antifungals like clotrimazole (Canesten) 49. Anatomy of the Ear (all the structures and their functions) Outer ear-contains tragus, lobe, helix and auricle- funnels in sound middle ear-contains tympanic membrane, external auditory canal- vibrates the sound and causes vibrations inner ear-Inca, malleus, stapes, cochlea, vestibular apparatus- amplifies the sound and sends it to the brain for processing 50. Types of infections related to ears (internal ear, middle ear and external ear canal) External ear conditions: contact dermatitis, seborrhea, and psoriasis. Evidenced by itching, redness, inflammation weeping and drainage. They respond well to topical medications. Outer and middle ear: most common are bacterial infections, fungal infections, inflammation and earwax buildup. If left untreated can lead to hearing loss, infection of the ear canal is called otitis externa, and infection of the middle ear is called otitis media (common in children) 51. What is cerumen and how can it be removed  Pharm 105 -2 Study guide Ear wax and can be removed by getting the ears flushed, can soften it with mineral oil. Emulsifying otic drugs such as carbamide peroxide can soften the wax before being flushed 52. Anatomy of the Eye (all the structures and their functions) The protective and external layer (cornea and sclera), the vascular middle layer (choroid, iris, ciliary body) and internal layer known as the retina. Lacrimal glands produce tears and bathe the eye and cleanse the exposed anterior portion of the eye. Lens lets in the light, aqueous humor and vitreous humor contribute to the intraocular pressure of the eye. 53. Various disorders effecting the eye and treatments Glaucoma- inhibition of flow of the aqueous humor causing intraocular pressure in the eye. Two types of glaucoma, open angle glaucoma and angle closure glaucoma. Treatment involves reducing the pressure in the eye. Medications include: latanoprost (Xalatan), bimoprotost (Lumigan), brimonidine (Alphagan), brinzolamide (Azarga), and timolol (Timoptic). Inflammatory diseases of the eye are usually caused by viruses, Antimicrobials are used to tret these infections like conjunctivitis, keratitis, uveitis and endophthalmitis. Ciprofloxacin hydrochloride (Ciloxan) is a synthetic quinolone antibiotic to treat these infections. 54. Medications used for intraocular pressure Adrenergic Blockers reduce IOP, B1 blockers are: betaxolol, and B1/B2 blockers are levobunolol hydrochloride and timolol (Timoptic, Azarga). 55. Anemia medications Erythropoiesis-stimulating agents-(Epoetin alfa (Eprex)) are used to treat pernicious anemia (anemia due to deficiency in vit B12 and therefore not making enough RBC’s), malabsorption syndrome and hemolytic anemia. Iron-(ferreous salts)- deficiency in iron can cause anemia, taking an iron supplement or iron infusion will treat anemia. Folic acid- anemia deficient in folic acid are treated with folic acid, also helps prevent neural tube defects. 56. Hemoglobin and oxygen carrying component of it Hemoglobin (heme + globin) is a molecule that is responsible for carrying almost all the oxygen in the blood. 57. Different type of anemias (megoblastic, hypochromic, microcytic, pernicious) Anemia due to vitamin B12 deficiency- Anemia due to folate (folic acid) deficiency Anemia due to iron deficiency Anemia of chronic disease- caused from chronic long-term diseases like kidney disease, cancer, ulcerative colitis or rheumatoid arthritis.  Pharm 105 -2 Study guide Hemolytic anemia- autoimmune disorder where the body breaks down RBC’s Idiopathic aplastic anemia-the production of new blood cells stops Megaloblastic anemia-results form the inhibition of DNA synthesis during red blood cell production. Pernicious anemia-where not enough red blood cells are produced due to the deficiency in Vit B12 Microcytic anemia- characterised by smaller than normal RBC’s Sickle cell anemia- abnormality of the oxygen carrying protein hemoglobin found in red blood cells. Thalassemia-inherited blood disorders that result in abnormal hemoglobin, it can effect the production of RBC’s 58. Types of blood cells, and names for abnormally shaped red blood cells Erythrocytes- red blood cells Leukocytes-white blood cells Thrombocytes- platelets Poikilocytosis- abnormal shaped blood cells 59. What part of the cell carries the oxygen and what part carries the iron Iron is a major part of hemoglobin that is a type of protein in RBC’s, they carry oxygen from the lungs to the entire body- without iron there are not enough RBCs to transport the oxygen 60. Know Parenteral Nutrition and Total parenteral nutrition Perenteral nutrition is the IV administration of nutrition outside of the GI tract. Total parenteral nutrition (TPN) is the only source of nutrition that the patient is receiving 61. Know side effects of peripheral versus central TPN Peripheral TPN nutrition is nutrition that bypasses the digestive system, is the only nutrition that the patient receives, they have no other source of nutrition. Both can cause infection, blood clots, Glucose imbalances, parenteral nutrition associated liver disease (PNALD), gall bladder problems, osteoporosis. 62. Know what the role of essential fatty acids are They are acids that the body cannot produce on their own, they help with cell development and ell death. 63. Anabolism The process of chemical reactions that build larger molecules from smaller molecule or atoms. Also known as anabolic pathways or anabolic process. 64. Dumping syndrome When food, especially high sugar foods, moves from the stomach to the small intestine to quickly after you eat- can cause diarrhea, nausea and vomiting  Pharm 105 -2 Study guide 65. Know the most common type of enteral nutrition Most common is enteral nutritional formulas -standard/polymeric, Ensure (protein formulas) 66. Enteral nutrition versus parenteral nutrition Enteral nutrition will enter the GI tract where parenteral bypasses the GI tract 67. Know how to administer meds through various routes – Ophthalmic, buccal, NG tube, otic, topical, IV, IM Opthmolic- tilt head slightly back, clean gloves, pull down lower lid and drop room temp eye drops into the lachrymal space. Buccal- medication should be placed between tongue and cheek NG tube- tube that goes through the nose down into the stomach Otic- pull down pinna and have patient tilt head to the side. Drop in medication that is room temperature. Have the patient wait for ten minutes before going to the next side if needed. Topical- apply this coat of topical cream or ointment to the area, transdermal patches need to be placed on clean skin and the other patch must be removed before a new patch is placed. IM- injection should be done at 90degree angle to clean skin. Best practice is z-track method. IV- tilt the beveled tip of the needle upwards, insert the needle just through the skin into the vein, thread the needle up the vein. 68. Understand how Nausea and vomiting work Emetic afferent and efferent impulses stimulate nausea and vomiting peripherally via the GI tract and centrally via the CNS. These control the degree of the nausea and vomiting that the patient has. 69. What is the main goal of antiemetic therapy For the prevention of nausea and vomiting 70. Know the various antiemetic drugs- MOA- Gravol, ondansetron Dimenhydrinate (gravol/ Dramamine)- MOA: reduces equilibrium through antimuscarinic effects of histamine H1 antagonism. Scopolamine (Transderm)- MOA: anticholinergic that inhibits the muscarinic receptors in the parasympathetic nervous system and acts on the smooth muscles. Ondansetron (Zofran) MOA: blocks serotonin receptors in the chemoreceptor trigger zone 71. Antigout medication – Allopurinol – therapeutic effects Allopurinol used to treat gout, inflammation in one or more joints, often the big toe, due to collection of uric acid deposits.  Pharm 105 -2 Study guide MOA: inhibits xanthine oxidase which is the enzyme that converts hypoxanthine to xanthine, and xanthine to uric acid. Therapeutic effects: prevents and lowers high uric acid levels in the blood which leads to gout. Side effect: nausea, diarrhea and drowsiness. 72. Uses of ASA- MOA, side effects, patient teachings Acetylsalicylic acid belongs to a group of medications called analgesics (pain relievers), antipyretics (fever reducers), anti-inflammatories (inflammation reducers), and platelet aggregation inhibitors (anti-clotting agents). Relieves mild to moderate fever, relief of swelling, stiffness and joint pain from arthritis. It is also used to prevent blood clots in heart and stroke patients. Never give aspirin to children. MOA: decreases the production of prostaglandins Patient teachings: Take as directed, swallow the extended-release capsules, take with full glass of water, do not break or crush. 73. Know the various types of laxatives- for example - stimulant, bulk forming etc. Bisacodyl (Dulcolax)- stimulant laxative, treats constipation Docusate (Colace)- stool softener, treats constipation Lactulose (Lactulose)- laxative, osmotic, treats constipation Mineral oil- (Fleet enema)- laxative emollient, treats constipation Polyethylene glycol PEG (Lax a Day/ Restoralax)- laxative osmotic Sennosides (Senokot)- laxative stimulant Psyllium mucilloid (Metamucil) laxative- bulk forming 74. Patient teaching for taking laxatives – which one causes dependence and why Loperamide (Imodium)- dependence with long-term use Patient teachings: Taking stimulant laxatives can cause you to lose muscle tone in the Colon/take on empty stomach Drink lots of water during use especially bulk forming Proper diet and exercise 75. Imodium indications for use and side effect Loperamide (Imodium) medication of the opioid receptor agonist that’s used to reduce the frequency of diarrhea. Used for IBS, IBD, Crohn’s and colitis. Side effects: allergic reactions, heart arrhythmia, redness, blistering, peeling of the skin, severe stomach pain, trouble passing urine, bloating, blurry vision, constipation, dizziness, drowsiness, nausea, gas. 76. Antidiarrheal medications – various types and their MOA (how do adsorbents, anticholinergics, intestinal flora modifiers work)  Pharm 105 -2 Study guide Absorbent: bismuth subsalicylate (Pepto-Bismol), taken orally, protective properties because it coats the intestinal wall as well as antimicrobial since it can kill causative bacteria. Reduces stomach acid. Antimotility- slows peristalsis, two types: anticholinergic (hyoscyamine/ Anaspaz) and opioid like medication (loperamide/Imodium) Probiotics: helps restore the natural flora found in the intestine. Lactobacillus. Should be taken when using antibiotics. 77. Nursing consideration when administering antidiarrheals and patient teachings Use as prescribed Report to HCP if symptoms worsen Dry mouth, can use hard candy to produce saliva Pepto-Bismol can turn stools tarry black Increase fluid intake Exercise If taking senna, avoid other meds for 1 hour 78. HIV and treatments Human immunodeficiency virus (HIV)- if untreated can lead to acquired immunodeficiency syndrome (AIDS) -HIV is a retro virus that attacks the immune system Treatment: antiretroviral therapy (ART), work by stopping the virus replicating in the body, this can help the immune system repair itself and prevent further damage. There is no cure. 79. What is an Antigen A substance capable of stimulating a immune response 80. Antiviral drugs Medications that help your body fight of viruses that cause disease. They can protect you from getting viral infections an spreading to others. Example: influenza (Amantadine)- prevents patient from contracting the influenza virus. 81. List all the various skins conditions listed in the textbook- know which are fungal and which are bacterial Bacterial- antibacterials are used to treat Folliculitis- inflammation of a follicle, usually a hair follicle Impetigo- a pus-generating, contagious, superficial skin infection, caused by staph or strep bacteria, usually on the face. Furuncles-painful skin nodules from staph organisms that enters the hair follicles Carbuncles- necrotizing infections of the skin and subcutaneous tissues Pustules- visible collections of pus on the skin Cellulitis-infection of the skin and subcutaneous tissue and sometimes the muscle, usually an infection from a wound that has got staphylococcus bacteria  Pharm 105 -2 Study guide Vesicles- small sacs containing liquid, also called cysts Antifungal infections- Antifungal meds are used to treat Tinea- fungal skin disease caused by dermatophyte, causes itching, scaling, and sometimes painful lesions. Also called ring worm. Dermatophytes- any of the common types of fungi that infect hair, skin, nails, Acne vulgus- inflammatory disease of the gland of the skin causing pimples Actinic keratosis- slowly developing thickening of the skin Atopic dermatitis- chronic skin inflammation Basel cell carcinoma- type of skin cancer, most common Dermatitis- any inflammation of the skin Eczema- a pruritic, papulovesicular dermatitis accruing as a reaction to many agents, causing itchy, dry, scaly skin and sometimes oozing. Pediculosis- infestation of lice Pruritus- an unpleasant sensation that provokes the desire to rub or scratch the skin. Psoriasis- common and chronic squamous cell dermatitis with polygenic (multi gene) inheritance Scabies- contagious disease from an itch mite, intense itching, 82. Methotrexate dermatological treatment- client education on application Treats sever psoriasis, psoriatic arthritis and nail psoriasis, Teachings: Avoid when pregnant/breastfeeding Avoid alcohol as it may increase side effects Stick to a weekly schedule and stick to the same day Can cause nausea, vomiting 83. Know the various dermatological conditions in chapter 56 (key terms) See above 84. Natural health products and safety, are they safe? Generally safe with fewer side effects than medications, they still must be taken following directions and can be contraindications with other medications. always notify your DR. of all natural products that you are taking. 85. What are iatrogenic effects Negative outcomes for patients which have been caused by an intervention Examples: hair loss, diabetes, vomiting, nausea, brain damage 86. Know the various Vitamin B’s and their uses Water soluble, and act as co-enzymes, stored in the body, they help to power enzymes.  Pharm 105 -2 Study guide B1- Thiamine- turns food into ATP which is energy for the cells B2- Riboflavin -helps energy production, cellular function, and metabolism - B3- Niacin-helps transfer energy from food into ATP, helps repair DNA B5- Pantothenic acid-helps build and breakdown fatty acids B6- Pyridoxine-helps maintain levels of amino acids B7- Biotin-assist with enzymes to help break down fats, helps with healthy hair, skin, nails B9- folate/folic acid-helps with decrease in neural tube defects, B12- Cobalamin- helps form RBC’s and DNA 87. Vitamin D- patient teachings – and indication for use, side effects Vitamin D – lipid soluble vitamin, helps absorb calcium and phosphorus from the intestine and supresses the release of parathyroid hormone that causes bone breakdown. Teaching: It is stored in the body, so you do not need to take it everyday, take appropriate doses Indications: Digoxin, thiazide diuretics, high blood pressure meds, kidney stones, people with high calcium levels and certain types of cancer. Aluminum, atorvastatin, steroids, stimulant laxatives. Side effects: nausea, vomiting, constipation, weakness, confusion, heart rhythm problems, kidney stones. 88. Iron supplements and patient teachings Ferrous fumarate- prevention and treatment of iron deficiency and anemia Side effects- hypotension, hypertension, tachycardia, dark stools, constipation, epigastric pain Teachings: explain the purpose of the treatment comply with medication regime advise of stool change (green/black) 89. Iron supplements and common side effects Side effects- hypotension, hypertension, tachycardia, dark stools, constipation, epigastric pain 90. Parts of the hemoglobin, which part contains iron Hemoglobin develops in cells in the bone marrow that become red blood cells. When red cells die, hemoglobin is broken up: iron is salvaged, transported to the bone marrow by proteins called transferrin, and used again in the production of new red blood cells; the remainder of the hemoglobin forms the basis of bilirubin, a chemical that is excreted into the bile and gives the feces their characteristic yellow-brown colour. 91. Water soluble vitamins- name them Vitamin C- and all the b vitamins Thiamine (B1) Riboflavin (B2) Niacin (B3)  Pharm 105 -2 Study guide Pantothenic acid (B4) Pyridoxine (B6) Biotin (B7) folic acid/folate (B9) cobalamin (B12) 92. Fat soluble vitamins – name them Vitamin A-strengthens immune system, helps with vision, especially night vision, helps with reproductive functions Vitamin D-works with calcium to strengthen bones and supports the immune system Vitamin E- supports immune health Vitamin K – helps with blood clotting and bone health 93. What is a Coenzyme A coenzyme is an organic non-protein compound that binds with an enzyme to catalyze a reaction. Coenzymes are often broadly called cofactors, but they are chemically different. A coenzyme cannot function alone but can be reused several times when paired with an enzyme. 94. Vitamin K – is used for what? Helps with blood clotting and bone health and prevents osteoporosis 95. Antibiotic therapy and drug interactions in the case of antibiotics, where the interplay between co-administered drugs can change the pharmacological activity of the antibiotic and may affect the treatment of the infection. Interactions: alcohol, tinidazole and Metronidazole (antibiotics) doxycycline (antibiotic) Birth control pills 96. Antibiotic therapy and nursing considerations When administering antibiotics, nurses should1: Check culture and sensitivity reports to ensure that this is the drug of choice for this patient. Ensure that patient receives full course of aminoglycosides as prescribed, divided around the clock to increase effectiveness and decrease the risk for development of resistant strains of bacteria. 97. Penicillin antibiotics penicillin is a type of antibiotic derived from Penicillium fungi. An antibiotic is a type of medicine that inhibits the growth of, or kills, bacteria.  Pharm 105 -2 Study guide aminopenicillins antipseudomonal penicillins beta-lactamase inhibitors natural penicillin penicillinase resistant penicillin 98. How do combination antiretrovirals work in the body. When are they effective and why? Antiviral combinations have more than one antiviral agent in the one pill or dose. Using a combination of antiviral agents reduces the risk of resistant virus strains from emerging. Antiviral agents are used to inhibit production of viruses that cause disease. 99. Vancomycin Vancomycin is an antibiotic. Oral (taken by mouth) vancomycin fights bacteria in the intestines. Vancomycin is used to treat an infection of the intestines caused by Clostridium difficile, which can cause watery or bloody diarrhea. This medicine is also used to treat staph infections that can cause inflammation of the colon and small intestines. 100. When do symptoms of HIV appear First symptoms can appear within the first few weeks of contracting the virus. 101. What is Tetracycline? Know the following: Drug classification, Indication for use, Patient teachings – re why can you not take with milk and cheese? Drug class: Oral antibiotic Uses: used to treat infections, including acne, cholera, plague, syphilis, malaria. Patient teachings: take wit a full glass of water to prevent irritation to the esophagus, take on empty stomach (either 1 hr before or 2 hrs after a meal). Avoid sunlight including tanning beds, Avoid dairy as it can impair absorption. 102. What is Penicillin? Know the following: Drug classification, Indication for use, Contraindications, Patient teachings, What medications may result in drug interaction penicillin is an antibiotic medication. That treat bacterial infections like strep throat, ear infections and UTI’s. Drug class: Natural penicillin Indications for use: treat bacterial infections like strep throat, ear infections and UTI’s. Contraindications: asthma, kidney disease, bleeding disorders, allergy, patients on birth control Patient teachings: take medications for the entire duration even if symptoms are gone, don’t give this medication to another person, medication can cause diarrhea, if there is blood in stools call the HCP, Medication interactions: methotrexate (Rheumetrax), probenecid (benemid) 103. What is a superinfection? How is caused?  Pharm 105 -2 Study guide A second infection superimposed on an earlier one, usually by a different bacterial agent, that is resistant to the treatment of the first infection. They are caused by the growth of resistant organisms (bacteria, fungi) that are normally held in check by the normal forms of bacteria in the oral and GI tract. 106. What is Acyclovir? Know the following, Drug classification, Indication for use, Contraindications & adverse side effects, Patient teachings An antiviral drug that slows the growth and spread of the herpes virus in the body. Drug class: Purine nucleosides Used to treat infections caused by herpes virus such as genital warts, cold sores, shingles, and chicken pox, Contraindications: hypersensitivity, kidney problems, immunosuppression, dehydration, sexual contact during herpes outbreak, allergic reactions. Adverse effects: easy bruising and bleeding, changes in behaviour, confusion and hallucinations, signs of kidney problems- little to no urination, difficult urination and swelling in the feet. Patient teachings: 107. What is prophylactic therapy? Know and understand this, indications to do this type of therapy The guarding or prevention of the spread or occurrence of disease or infection. Example: an antiemetic may be given to prevent the nausea associated with the side effects of anaesthesia. 108. Empiric therapy Where it treats the symptoms but not the condition, not knowing what the condition is, an “educated guess” 109. Cephalosporins A class of antibiotics MOA: like penicillin, they bind to proteins that interfere with cell enzymes, first generation: cefazolin, cephalothin, cephapirin, cephradine, cefadroxil and cephalexin adverse reactions: nausea, vomiting, lack of appetite and abdominal pain. 110. Nephrotoxicity Toxicity in the kidneys, poisonous effect of substances (toxic substances and medications) 111. Ototoxicity Toxicity of the ear, specifically the cochlea or auditory canal, usually a side effect from medications. Reversable and temporary or can cause permanent damage. Ototoxic drugs include, antibiotics, loop diuretics (such as furosemide), and some NSAID’s 112. Aminoglycoside therapy – uses and side effects Organic molecule that contains amino sugar substructures.  Pharm 105 -2 Study guide Treats ineffective endocarditis, sepsis, complicated intraabdominal infections Adverse effects: renal toxicity, vestibular and auditory toxicity and prolongation of effects of neuromuscular blockers. 113. Know the various anesthetic drugs General anesthetic drugs: Isoflurane (Forane)- rapid onset, little to no toxicity Sevoflurane- widely used, rapid onset, used in outpatient surgical settings Ketamine hydrochloride (Ketalar)- given by IV, used in both general a procedural setting, binds to receptors in bot the CNS and PNS including opioid receptors Nitrous oxide- (laughing gas)- only inhaled gas currently used. Weaker of general anesthetics, primarily used for dental procedures. Propofol ( Diprivan)- parenteral general anastatic, used for the induction and maintenance of general anastatic, used for sedation for mechanical ventilation, deep rapid sedation, has no analgesic properties. Dexmedetomidine (Precedex)- alpha-adrenergic receptor agonist, produces dose dependent sedation, decreased anxiety, and analgesia without respiratory depression. Procedural and surgery with short duration, adverse effects are hypertension, hypotension, bradycardia, nausea. Local anesthetics: Second major class of anesthetics, they reduce pain sensations at the level of peripheral nerves, also called regional anesthetics because they render a specific portion of the body without pain, Belong to two major groups: esters or amides, classified as either parenteral (injectable) or topical anesthetics, Topical: Lidocaine (Bactin), benzocaine (Solarcaine) IV- Lidocaïne hydrochloride (Xylocain), tetracaine hydrochloride (Protocaine) 114. Naloxone – what is it used for An opioid antagonist- used to Reverse the effects of opioids, used in overdoses. 115. Opioid agonist- antagonist, what are they used for : Opioid antagonist- bind to the receptor cell and generate no response (Naltrexone, Naloxone) Opioid agonist-antagonist- used to treat opioid dependence and pain by reducing withdrawal symptoms and affecting pain receptors. They have both agonist and antagonist factors. (buprenorphine, butorphanol) used to treat opioid addictions as they attach to a receptor site before an opioid can, lower addiction potential, and lower analgesic efficiency. 116. What is an opioid agonist  Pharm 105 -2 Study guide Opioid agonist- medication that produces similar effect to morphine, (heroin, codeine, oxycodone, methadone are examples) produce pain relief and respiratory depression, used in local anesthesia, cough suppression, pulmonary edema in Myocardial ischemia 117. General anesthetic versus local anesthetics know the difference in both and meds associated with General anesthesia- a drug induced state where the CNS nerve impulses are altered to reduce pain through the entire body. Local anesthesia- A drug induced state where the peripheral or spinal nerve impulses are altered to reduce pain or sensation to some parts of the body. 118. Side effects of anesthesia (local and general) General: pulmonary aspiration, myocardial depression, hepatotoxicity, malignant hypothermia (Rare), 119. What is the difference between procedural sedation and local anesthetic Local anastatic numbs an area to reduce or eliminate pain to that are, the patient is awake, usually used for dental work. They work by blocking the nerves that produce pain, (Benzocaine, lidocaine) Sedation can control the pain but can also alleviate anxiety and reduce patient movement, the patient is awake but calm and relaxed. (Trazadone, Lorazepam, dexmedetomidine) 120. Malignant hyperthermia- when can this occur Severe reaction to some anesthesia medications, include symptoms of high body temp, rigid muscles, rapid heart rate, without prompt treatment it can be fatal. It is caused by a gene mutation and when ex posed to certain anesthetics it can trigger a reaction. Usually inherited but sometimes can be just a random gene change. 121. What is Spinal anesthesia Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long 122. What are Adjunct anesthetics Drugs used in combination with the anastatic drugs to control the adverse effects of anesthetics or to help minimize the anastatic state in the patient. 123. What is a balanced anesthesia The practice of using combinations of different drugs rather than a single drug to produce an anastatic.  Pharm 105 -2 Study guide 124. Overton Meyer theory – what is this The theory that describes the relationship between the lipid solubility of anesthetic drugs and their potency. 125. Procedural sedation – and situation where you might see this being done A milder form of general anaesthesia of that causes partial or complete loss of consciousness but does not generally reduce normal respiratory drive (formerly called conscious sedation) 126. Indications for use of a local anesthetic versus and general General is for more serios procedures where the patient would need to be unconscious or surgery is long, local is used when just an area needs to be free of pain and the patient is usually awake, example spinal anesthesia when a woman id delivery a baby. 127. Nursing implications for someone who is recovering post-operative after having general anesthetic- ** AIRWAY- Oxygenation Observation of all body systems ABC’s airway, breathing, circulation, vital signs Document all observations Assessing the temperature is important due to risk of malignant hyperthermia Oxygen is supplied due to the respiratory depression, monitor spo2 levels Asses neurological reflexes. 128. What is an analgesic A pain reliever or painkiller. 129. Acute pain versus chronic pain Acute pain- sudden onset and will go away Chronic- gradual pain that lasts longer than three months 130. Antagonist A chemical substance that binds to and blocks the activation of certain receptor cells preventing a biological response. 131. Addiction versus tolerance, what is the difference Tolerance is when a person gets used to the medication, and addiction is when a person cannot control the usage of the medication. 132. Opiate analgesics A class of drugs that that derive, or mimic natural substances found in the opium poppy plant. Opioids work in the brain to produce a variety of effects including pain relief, they act on opioid receptors to produce morphine-like effects. Tramadol, oxycodone, fentanyl, methadone, meperidine, codeine and buprenorphine.  Pharm 105 -2 Study guide 133. Opioid naïve A patient that has never had treatment for opioid drugs before 134. Phantom pain The feeling of tingling, or pain in a limb that has been amputated and no longer there 135. Pain threshold The amount of pain that a person can handle, each person’s threshold can be different 136. Adjuvant analgesic drugs Medication designed to control pain but can be used for other treatments like as antidepressants (mental health) and anticonvulsants (seizure disorders), local anesthetics, topical agents, and steroids. 137. Acetaminophen – drug toxicity, adverse effects and patient teachings Acetaminophen (Tylenol) common OTC medication, high doses can lead to complications, do not exceed 4000mg per day. Toxic dose is 7,000-10,000 mg per day. Can cause liver damage and liver necrosis. Side effects from toxicity- nausea, vomiting, abdominal pain, headache, liver damage, rectal bleeding (stomach ulcers), jaundice. Always use the medication as directed, do not take multiple medications that contain acetaminophen, educate on the signs of overdose. 138. NSAIDS- patient teachings, contraindications, list a few trade names of NSAIDS Do not use NSIAD’s for fever longer than 10 unless ok’d by DR. Swallow whole, do not crush or chew Take with water or food to help with stomach 139. What are common indications for use of NSAIDs? Used for pain relief, inflammation reduction and fever. Common uses are for: headache, menstrual cramps, sprains, strains, colds and flu, arthritis and chronic arthritis pain. 140. What are therapeutic effects of using NSAIDs? NSAID’s block the cox inhibitor that makes prostaglandins. By blocking the production of prostaglandins, NSAID’s help relieve the discomfort of fever and reduce inflammation associated with pain. 141. What are the contraindications of NSAID use? Contradicted in patients with NSAID hypersensitivity or salicylate hypersensitivity, as well as patients with an allergic reaction. Patients with liver or kidney problem, third trimester of pregnancy, and those that have had coronary artery bypass surgery.  Pharm 105 -2 Study guide 142. Uses of ASA’s? Acetylsalicylic acid belongs to a group of medications called analgesics (pain relievers), antipyretics (fever reducers), anti-inflammatories (inflammation reducers), and platelet aggregation inhibitors (anti-clotting agents). Relieves mild to moderate fever, relief of swelling, stiffness and joint pain from arthritis. It is also used to prevent blood clots in heart and stroke patients. Never give aspirin to children. 143. Adverse effects Adverse effect is the undesired harmful effect resulting from medication or other intervention like surgery. 144. What is chronic salicylate intoxication? A salicylate is a drug that is found in many OTC medications like aspirin, bismuth subsalicylate (Pepto-Bismol), magnesium salicylate. Chronic overdose of salicylates, which causes intoxication. Symptoms include confusion, bizarre behavior and hyperventilation. 145. What are the uses for glucosamine? Side effects? Generally used for osteoarthritis, can be used for joint pain, rheumatoid arthritis and MS Side effects: bloating, diarrhea, nausea, constipation 146. Why is aspirin not given to children? Aspirin in children can lead to Reye’ syndrome- which is sudden brain damage and liver function issues. 147. Patient teachings and considerations for all the various drug classes in the study tools