□ State the three (3) most important characteristics of any drug. - ANSWER-think of the drugs' "succESS":
E_ffectiveness
S_afety
S_electivity.
□
... [Show More] Is it possible to have a selective drug? - ANSWER-No. All medications have side effects.
□ Define the four phases of pharmacokinetics. - ANSWER-Absorption, distribution, metabolism, and excretion.
Think: "ADME"
A_bsorption
D_istribution
M_etabolism
E_xcretion
□ Define pharmacodynamics. - ANSWER-The nature and intensity of the response that the drug has on the body.
"pharmaco-do-to-my-body-namics"
□ Which member of the health care team is most likely to observe and evaluate drug responses and intervene if required? - ANSWER-The nurse
□ Name the three most important goals of pre-administration assessment. - ANSWER-a) Evaluate effects
b) identify high-risk patients
c) assess for self care
□ What factors can predispose an individual to adverse reactions from drugs? - ANSWER-a) Allergies
b) pregnancy
c) age
d) genetics
e) pathological disease (kidney or liver)
□ What measures help reduce adverse reactions of medication administration? - ANSWER-Think: H&H
History - get a thorough patient history
High-risk & education - identify those with risk factors
□ What type of research is required to assess drug therapies? - ANSWER-The randomized controlled trial is required for all new medications.
□ What is a "blinded" study? - ANSWER-Participants don't know if they belong to the control or experimental group.
□ Which Amendment strengthened drug regulation after the Thalidomide tragedy in Europe? - ANSWER-The Harris-Kefauver Amendment to the FDA and the Cosmetic Act of 1962.
□ What is the purpose of having a trade name (proprietary or brand name) for a drug? - ANSWER-Trade names are easy to recall and pronounce and good for marketing purposes.
□ What is one of the problems with trade names? - ANSWER-Using 2 brand named drugs that have the same ingredient can lead to overdose.
□ What are some limitations in the testing process used to bring drugs to market? - ANSWER-Information on women and children is limited.
□ What is another limitation in the testing process used to bring drugs to market? - ANSWER-New drugs are likely to have adverse effects not detected in clinical trials
□ What is the cost to develop a new drug in the U.S.? - ANSWER-It can exceed $800 million dollars.
□ When writing the names of drugs generic names are not capitalized and brand name are____________? - ANSWER-Capitalized
□ Which scheduled drugs can NPs prescribe in the state of Florida? - ANSWER-Since 2017 NPs have prescriptive authority for controlled substances
□ Give an example of Schedule II drugs. - ANSWER-Codeine, fentanyl, hydromorphone, morphine, dextroamphetamine.
□ Give examples of Schedule III drugs. - ANSWER-Narcotics:
Vicodin
Codeine
Suboxone (buprenorphine)
Others:
Didrex (benzemphetamine)
Ketamine
A-Phedrin (psuedoepherine)
Abilify (aripiprazole)
Accupril (quinapril)
Accutane (isotretinoin)
Tylenol PM (acetamynophen with diphenhydramine)
anabolic steroids.
Pepcid (famotidine)
□ Give an example of a Schedule IV drugs. - ANSWER-Benodiazepines: CNS effect, open GABA-a channels
examples:
Tramadol (Ultram)
Xanax (alprazolam)
Valium (diazepam)
Klonopin (clonazepam)
Ativan (Lorazepam)
□ Benzodiazepines are Schedule_________ drugs? - ANSWER-Schedule IV drugs.
□ Which scheduled drugs can not be called into the pharmacy and require a hard copy? - ANSWER-Schedule II drugs.
□ Equal active ingredients dosage form, identical disintegration, rate of absorption, efficacy, and safety are features of what type of drugs? - ANSWER-Generic bioequivalent drugs.
□ A warning that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects is known as____________? - ANSWER-A Black Box Warning
□ Name a few drugs that have a Black Box Warning. - ANSWER-SSRI's, metformin, & salmeterol have black box warnings.
□ Which class of antihypertensive drugs are recommended in African Americans (AAs)? - ANSWER-Diuretics and CCBs are first line antihypertensive drugs due to low renin in AAs.
□ Activity of CYP 2D6 is lower in Asians and may require (lower or higher) doses of drugs utilizing this metabolizing enzyme? - ANSWER-- CYP 2D6 activity is lower. Lower doses are needed in Asians.
- Think LOWER activity = LOWER doses
□ What are the four (4) basic pharmacokinetic processes? - ANSWER-Absorption, distribution, metabolism, and excretion.
□ Are highly lipid-soluble drugs absorbed more (rapidly or slowly) than drugs whose lipid solubility is low? - ANSWER-Highly lipid-soluble are absorbed more rapidly than low lipid-soluble drugs.
□ Why are highly lipid-soluble drugs absorbed more rapidly than low lipid soluble drugs? - ANSWER-High lipid-soluble drugs cross membranes that separate them from the blood.
□ Define the term parenteral? - ANSWER-Outside the GI tract. (i.e. given by injection as in IVSub-Q, or IM).
□ At what rate should IV meds be administered? - ANSWER-Over one full minute.
□ How long does it take an IV drug injected in the anti-cubital space to reach the brain? - ANSWER-A drug injected in the anti-cubital space takes 15 seconds to reach the brain.
□ What are depot preparations? - ANSWER-Preparations from which the drug is absorbed slowly over an extended time.
□ What kinds of compounds do not pass freely from the maternal bloodstream into the blood of the fetus? - ANSWER-Ionized highly polar, protein bound drugs remain in the bloodstream.
□ Benzathine penicillin G can be released at a therapeutic amount over one month from a single IM injection what type of preparation would this be called? - ANSWER-A depot preparation
□ What types of compounds pass freely from the maternal blood stream into the blood of the fetus? - ANSWER-- Lipid soluble compounds
- non-ionized compounds
□ What can occur when two highly protein bound drugs are given together? - ANSWER-Highly protein bound drugs when given together compete for sites on the protein
□ What happens when two highly protein bound drugs are given together and compete for sites on the protein? - ANSWER-Drug with the weakest attraction becomes "free" and can reach toxic levels
□ Give an example of a drug that is highly bound to protein. - ANSWER-Warfarin is 99% bound to protein, ASA and fluoxetine (Prozac) are others.
□ Drugs that are highly bound to protein may exhibit (increased or decreased) levels in the blood when the patient is found to be in a malnourished state. - ANSWER-Increased
□ Define biotransformation (drug metabolism). - ANSWER-Enzymatic alteration of drug structure
□ Where does most drug metabolism (biotransformation) take place? - ANSWER-In the liver
□ If two drugs are given that both utilize the same p450 hepatic microsomal system the drug level in the blood of the drug that is not metabolized (increases or decreases)? - ANSWER-Increases
□ At what age does hepatic maturation occur? - ANSWER-At about 1 year after birth
□ Drug metabolizing capacity in infants is (decreased or increased)? - ANSWER-Decreased
□ Some drugs are inactive and when metabolized undergo conversion to an active form. Other drugs are converted into more active forms.
For example codeine is metabolized into morphine. Some children have the ability to rapidly metabolize codeine (ultra-rapid metabolism of codeine to morphine). The out-come of this will lead to toxicity due to (increased or decreased) opioid effect? - ANSWER-- Increased effect leading to respiratory arrest
- Do not prescribe codeine to children.
- See the Boxed Warnings in ePocrates
□ How is the first pass effect is circumvented? - ANSWER-When a drug is given parenterally (IV, IM, SL, or SQ).
□ How is the first pass effect circumvented? - ANSWER-The drug bypasses the liver allowing it to go directly into blood stream when given parenterally.
□ What is an example of a drug that if given orally would be destroyed in the "first pass" through the GI tract? - ANSWER-Nitroglycerin given sublingual
□ What aspect of pharmacokinetics (absorption, distribution, excretion, & metabolism) is affected in patients with kidney disease? - ANSWER-Excretion
□ The range of plasma drug level that falls between minimum effective concentration (MEC) and the toxic concentration is called what? - ANSWER-The therapeutic range
□ A drug with a narrow therapeutic range is (more or less) dangerous? - ANSWER-More dangerous
□ The time required for the amount of drug in the body to decrease by 50% is called what? - ANSWER-The drug half-life
□ How many half-lives does it take for a drug to reach plateau? - ANSWER-It takes approximately four half-lives to reach plateau
□ Drugs that have a long half-life need to be administered (more or less) frequently than drugs that have a short half-life. - ANSWER-Less frequently
□ What is a loading dose? - ANSWER-A large initial dose to hasten time to plateau
□ Can drugs give cells new function? - ANSWER-No
□ Agonist are molecules that (prevent or activate) receptors. - ANSWER-Activate
□ Antagonists (activate or prevent) receptor activation? - ANSWER-Prevent
□ Drugs that mimic the body's own regulatory molecules are called (agonists or antagonists)? - ANSWER-Agonists
□ What is a partial agonist? - ANSWER-An agonist that has less effect than a full agonist
□ Give an example of a partial agonist. - ANSWER-- Pentazocine (Talwin)
- Buprenorphine (Subutex)
- Suboxone (buprenorphine/ naloxone)
□ Desensitizing occurs when the receptors of a cell are continually exposed to an agonist (molecules that activate receptors or drugs that mimic the body's response) the cell becomes less responsive. What is this known as? - ANSWER-Down-regulation
□ The dose that is required to produce a defined therapeutic response in 50% of the population is known as what? - ANSWER-ED50
□ It is defined as the ratio of a drug's LD50 (which is average lethal dose in 50% on animals tested) to its ED50 (therapeutic dose in 50% of a population), what is this known as? - ANSWER-The therapeutic index (the measure of drug safety).
□ A drug with a high therapeutic index is considered (safe or unsafe)? - ANSWER-Safe
□ Laxatives (reduce or increase) absorption? - ANSWER-Laxatives speed passage of drugs through REDUCING absorption
□ Drugs that depress peristalsis (reduce or increase) absorption? - ANSWER-Drugs that prolong drug time in the intestine increase absorption
□ What are two drugs known to decrease peristalsis and cause increased drug time (and increased absorption) in the intestines? - ANSWER-Morphine and atropine
□ When an inducing drug such as phenobarbital is taken concurrently with another medication the metabolism of the other medications is (increased or decreased)? - ANSWER-The metabolism is INCREASED and the drug is excreted more rapidly
□ Accelerated metabolism would lead to (increased or decreased) blood levels of other drugs? - ANSWER-Decreased blood levels
□ (More or less) of the other medication would be needed? - ANSWER-More would be needed
□ Give examples of drugs known as inducers. - ANSWER-Phenytoin, phenobarbital, St. John's wort.
□ Grapefruit juice can (inhibit or induce) the metabolism of certain drugs thereby (raising or lowering) their blood levels? - ANSWER-Inhibit the metabolism of certain drugs raising their blood levels.
□ What are the potential consequences when calcium channel blockers are taken with grapefruit juice? - ANSWER-Grapefruit juice inhibits the metabolism of the CCBs leading to hypotension and possibly toxicity
□ How long would the impact of grapefruit juice be expected to last? - ANSWER-Up to 3 days
□ How would you administer a drug "on an empty stomach"? - ANSWER-Give the drug either 1 hour before meals or 2 hours after meals
□ Patients over what age account for over 50% of all adverse drug reactions (ADR's). - ANSWER-Elders over the age of 65
□ When do side effects usually occur? - ANSWER-Soon after the onset of drug or in some cases weeks or months afterwards
□ Can an allergic reaction occur without prior sensitization to the immune system? - ANSWER-For an allergic reaction to occur there must be prior sensitization
□ Define idiosyncratic effect from a drug. - ANSWER-An uncommon drug response resulting from a genetic predisposition
□ Succinylcholine a drug used to promote flaccid paralysis of skeletal muscle, can cause paralysis. In most patients, the paralysis is brief. However, in some patients the genes that code for succinylcholine-metabolizing enzymes are abnormal, producing enzymes that inactivate the drug slowly leading to prolonged paralysis.
What type of effect is this? - ANSWER-An idiosyncratic effect
□ What is a life threatening response characterized by bronchospasm laryngeal edema, and drop in BP? - ANSWER-Anaphylaxis
□ Why is abrupt discontinuation of a medication discouraged? - ANSWER-Abrupt discontinuation of medications can lead to withdrawal reactions
□ What is the potential consequence of a medication that prolongs the QT interval? - ANSWER-Fatal dysrhythmia such as torsade's de pointes
□ Why are women at more at risk for QT interval prolongation? - ANSWER-Women have longer QT intervals than men
□ What is the most common cause of acute liver failure and hepatotoxicity? - ANSWER-Drugs are the leading cause of acute liver failure (hepatotoxicity) in the U.S
□ Define teratogenic. - ANSWER-A drug induced birth defect.
□ Define iatrogenic. - ANSWER-Caused by medical intervention
□ What are the three most common causes of fatal medication errors? - ANSWER-1. human factors
2. communication mistakes
3. name confusion
□ What is REMS? - ANSWER-R_isk E_valuation and M_itigation S_trategy
- is imposed by the FDA on some drugs to decrease the risk of serious reaction
□ What are the four drugs/classes that cause the greatest number of adverse reactions? - ANSWER-1) Blood thinners
2) insulin
3) digoxin
4) Sulfonylureas
□ What setting do most of the drug errors occur? - ANSWER-Outpatient or ambulatory settings
□ Which is correct?
a. 2.0 mg
b. 0.2 mg
c. .2 mg
d. 0.2 mg - ANSWER-b & d
□ MS (morphine sulfate), MSO4 and MSGO4, > (greater than), < (less than), abbreviations for drug names, apothecary units, @, Cc, ug....all have one thing in common. What is it? - ANSWER-Abbreviations that are on the "Do Not Use List"
□ Why are the elderly are more sensitive to drugs? - ANSWER-- organ dysfunction
- polypharmacy
- comorbidities
- cognitive decline
□ A patient with kidney or liver disease would require (higher or lower) dosages of medicine? - ANSWER-Lower doses
□ A patient with kidney or liver disease would require (higher or lower) dosages of medicine? - ANSWER-Lower doses
□ The ability of a drug to reach the systemic circulation from its site of administration is known as what? - ANSWER-Bioavailability
□ The component of a drug response that is caused by psychologic factors and not by the biochemical or physiologic properties of the drug is known as what? - ANSWER-Placebo effect
□ A form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time is known as what? - ANSWER-Tachyphylaxis
□ Give an example of a drug that exhibits tachyphylaxis. - ANSWER-Nitroglycerine
□ Define tolerance. - ANSWER-Decreased responsiveness to a drug as a result of repeated drug administration
□ A patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency that takes aspirin or a sulfonamide is at risk for what disorder? - ANSWER-Hemolysis (red blood cell destruction)
□ During pregnancy, increased renal blood flow leads to accelerated excretion of drugs. This process may require (increased or decreased) drug amount? - ANSWER-Increase in drug dosages
□ Equal active dosage form, identical disintegration, rate of absorption, efficacy, and safety are features of what type of drugs? - ANSWER-Generic bioequivalent drugs
□ A warning that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects is known as what? - ANSWER-A Black Box Warning
□ Name a few drugs that have a Black Box Warning. - ANSWER-- SSRI's (Lexapro, Pexeva, Celexa, Prozac, Paxil) ---> suicide
- salmeterol (Serevent Diskus) --->death r/t asthma
- rosiglitazone (Avandia) --->CHF
- antipsychotics (risperidone---> CV events or infection, Seroquel---> cv & infect + suicide )
- liraglutide (Victoza) ---> (thyroid CA)
□ Which class of antihypertensive drugs are recommended in African Americans? - ANSWER-Diuretics are first line antihypertensive drugs, CCB's second line
□ Activity of CYP 2D6 is (lower or higher) in Asians and may require (lower or higher) doses of drugs utilizing this metabolizing enzyme? - ANSWER-CYP 2D6 is lower, requires lower dosing among Asians
□ Which herbal remedy is an INDUCER and can decrease the levels of warfarin, cyclosporine, oral contraceptives and antiretroviral medications? - ANSWER-St. John's wort
□ Name a drug that is an INDUCER. - ANSWER-- phenobarbital
- phenytoin
- St. John's wort
□ A disease or condition produced by a doctor or other health care provider or drugs is known as what? - ANSWER-An iatrogenic effect
□ Pharmacokinetics can change throughout the lifespan, T/F? - ANSWER-True
□ Do pharmacodynamics change throughout the lifespan? - ANSWER-No
□ Give examples of drugs that have genetic testing recommended - ANSWER-- warfarin
- carbamazepine (Tegretol)
- trastuzumab (Kadcyla) for breast CA
- abacavir (ziagen) for HIV
Write in the Definition: Agonist - ANSWER-- molecules that activate receptors
- when drugs simply bind to receptors and mimic the actions of the bodys own regulatory molecules
- a drug that has an affinity and high intrinsic activity [Show Less]