Shared Flashcard Set
|amount of time it takes for drug to be reduced by 50% in the blood|
|percentage of the drug that reaches the systemic circulation|
|oral drugs that enter the system and undergo rapid inactivation of the drug-leads to less drug in the system|
|Hepatic first pass: Elderly|
|diminished due to decreased liver function; increased risk of higher than therapeutic dose|
|Hepatic first pass: Women|
|Oral estragen undergoes extensive first pass; patches, vag rings and tablets are more affective|
|drugs used for other reasons than FDA approved or not in the population it was studied for|
|increases the amount of enzymes to metabolize drugs; decreases the concentration and pharmacodynamic effects of the drug|
|CYP 450 inhibitors: competitive inhibitors|
|when two drugs are administered concurrently and are metabolized by the same isoenzyme|
|CYP 450 inhibitors: non-competitive inhibitors|
|when two drugs compete for the same biding site but only one is metabolized by the isoenzyme|
|both competitive and non-competitive, the drug with the greatest affinity for the isoenzyme receptor is the inhibiting drug; causes the other drug to not be metabolized|
|level of drug in the blood stream to obtain therapuetic response|
|drugs that bind to receptors and produce a therapeutic effect|
|drugs that bind to receptors and block actions; prevent cells from doing something specific|
|"ties up" a drug; makes it unavailable to tx the body; most common is albumin|
|protein binding: increase in circulation|
|causes an increase in binding which causes a decreased pharmacological effect|
|protein binding: decrease in circulation|
|causes more free circulating drug which causes an increased pharmacological effect|
|Protein binding: clinical pearl|
|if pt with liver disease has elevated LFTs, the liver may not metabolize properly which increase the risk of toxic drug levels:give reduced dose of drug or hold|
|bc cells have high lipid concentrations; drugs that are fat soluble pass through the cells easier|
|Idiosyncratic Drug reaction|
|unusual or unexpected reaction|
|severe allergic drug reaction|
|Assessment necessary to choose the correct drug: 8 questions|
|Goal of therapy, related drug classes, mechanism of action, distinguishing features, how does the drug enter the body, how does the drug leave the body, safety profile of chosen drug|
|Medication reconcilliation, contraindications, any medical conditions, presence of kidney or liver disease|
|common practice; use with precaution|
|Issues to consider when prescribing generic versus proprietary drugs|
|bioequivalence and therapeutic efficacy may not be the same; difference in bioavailabilty could make the generic drug less effective|
|What are some unbiased sources for prescribing information|
|Mosby's GenRX, American Hospital Formulary, Tarascan, Sanford Guide,and ePocrates|
|To prevent prescribing errors|
|always include DOB, list quantity needed for the full course of tx, and know Joint Commission's "do not use" list|
|high risk for adverse reactions due to organ immaturity; underdeveloped blood brain barrier which cause drugs to pass more readily into the CNS|
|higher rate of metabolism than adults; drugs less protein bound;distributed affected by a higher concentration of water in client|
|decreased organ fx leads to decreased liver metabolism and decreased excretion by the kidneys|
|animal or human studies show no risk or animal studies show risk but not in human studies|
|animal studies have shown adverse effects; no human studies completed; or no human or animal studies available|
|Positive evidence of human fetal risk|
|Fetal abnormalities seen in humans and in animal studies. Contraindicated in pregnancy|
|Elements necessary for accurate RX|
|Name, address, DOB, license number, DEA number, name of collaborating MD, Date of issuance, name;strength;dosage; and quantity of drug, directions for usage, refills authorized, and prescriber's signature|
|Azole Antifungals: precipitant drug|
|Effects of simvastatin/lovastation with antifungals|
|risk of myopathy and rhabdomyolysis; caused by inhibition of sim/lov metabolism by CYP3A4|
|Antifungal Agents: Terbinafine(lamisil)|
|Antifungal Agents: Ciclopirox nail lacquer (Penlac)|
|Statins: Atorvastatin (Lipitor)|
|less metabolism of CYP3A4 but cases of myopathy with CYP3A4 reportedd|
|Which statins are not metabolized by CYP3A4?|
|Use of simvastatin and Amiodarone(cordarone) increases the risk of|
|myopathy and rhabdomyolysis|
|List the predisposing risk factors for for rhabdomyolysis|
|over 65ys of age,, uncontrolled hypothyroidism, and renal impairment|
|Simvastatin dose should not exceed____ in combination with__________|
|When used with certain Statins, this drug may cause an increase in bleeding|
|The mechanism that causes increased bleeding with usage of coumadin and certain statins is|
|the inhibition of warfarin metabolism by CYP2C9|
|List the statins that should not be given with Warfarin|
|List the two statins not known to interact with warfarin|
|A teratogen is a subtance that causes|
|malformations in fetal growth, structure, or development|
|Characteristic set of malformations, acts during a specfic window of vulnerability, and incidence of malformation increase with increasing dosage during exposure all all criteria of a|
Pharmacology Exam 1 Study Guide
What med route has the best absorption rates?
___ is the transmission of meds from the locaation of administration (GI, muscle, skin, subQ) to bloodstream.
thru the GI tract
There is no significant barrier to absorption of subQ and IM meds. Why?
Capillary wall has large spaces between cells
Rate of absorption for subQ and IM meds is determined by what 2 things?
- solubility of the med in water
- blood perfusion at site of injection
List the 3 major factors for distribution of drugs in the body.
- blood flow to tissues
- ability to exit vascular system
- ability to enter cells
___ refers to the ability of a drug to reach the systemic circulation from its site of administration.
Differences in bioavailability occur primarily with ___ preparations, not with ___ preparations.
Differences in bioavailability are of greatest concern for which drugs?
those w/ narrow therapeutic range
___ refers to the rapid hepatic inactivation of certain oral drugs.
1st pass effect
Explain the 1st pass effect.
When oral drugs are absorbed from the GI tract, they are carried directly to the liver via the hepatic portal vein. If the capacity of the liver to metabolize a drug is extremely high, that drug can be completely inactivated on its first pass through the liver. As a result, no therapeutic effects can occur.
How can you circumvent the 1st pass effect with drugs that undergo rapid hepatic metabolism?
Administer parenterally, which permits the drug to temporarily bypass the liver and reach therpeutic levels in the systemic blood
When plateau must be achieved more quickly, a large initial dose - or ___ - can be administered.
The highest drug level is referred to as the ___, and the lowest drug level is referred to as the ___.
peak concentration; trough concentration
___ concentration levels are drawn just before administering the next dose; ___ concentration levels are drawn after administering the medication (depending on route, etc.)
What is the time required for the amount of a drug to be reduced by 50%?
T/F Half-life is a factor in determining dosing interval.
A ___ is a nearly unavoidable secondary drug effect produced at therapeutic doses.
List 2 main characteristics of side effects.
T/F An adverse drug rxn is a side effect.
F; side effects are considered adverse rxns
List 6 adverse rxns besides side effects and allergic rxns.
- idiosyncratic effect
- iatrogenic disease
- physical dependence
- carcinogenic effect
- teratogenic effect
___ is an adverse drug rxn caused by excessive dosing.
T/F Toxicity includes only those severe rxns that occur when dosage is excessive.
F; Although the formal definition of toxicity includes only those severe rxns that occur when dosage is excessive, in everday parlance the term toxicity has com eto mean any severe ADR, regardless of the dose that caused it
An allergic rxn is an ___ response.
T/F For an allergic drug rxn to occur, there must be prior sensitization of the immune system
T/F The intensity of an allergic drug rxn is determined primarily by drug dosage.
F; determined primarily by degree of sensitization of the immune system, not by drug dosage
Most serious allergic drug rxns are caused by which drug family?
An ___ is an uncommmon drug response resulting from a genetic predisposition.
An ___ is a disease produced by a physician or drugs.
Iatrogenic diseases are nearly identical to ___ (naturally occurring) diseases.
___ develops during long-term use of certain drugs, such as opioids, alcohol, barbiturates, and amphetamines.
___ is a state in which the body has adapted to drug exposure in such a way that an abstinence syndrome will result if drug use is d/c.
___ refers to the ability of certain medications and environmental chemicals to cause cancers.
A ___ can be defined as a drug-induced birth defect.
What populations are at greatest risk for med reactions, toxicity, and ADRs?
- severe illness
- heart disease
___ is that component of a drug response that is caused by psychologic factors and not by the biochemical or physiologic properties of the drug.
A ___ is a preparation that is devoid of intrinsic pharmacologic activity.
T/F The placebo effect is believed to be a large fraction of the total response of any given drug.
F; a small fraction
T/F The placebo effect is always positive.
F; can be positive and negative
T/F Enough research has been done to indicate that significant gender-related differences exist in drug responses.
T (even though for many drugs, we don't know much about gender related differences b/c until recently, essentially all drug research was done on men)
When used to treat heart failure, digoxin may (increase/decrease) mortality in women while having no effect on mortality in men.
Alcohol is metabolized more (slowly/quickly) by women than by men. As a result, a woman who drinks the same amount as a man (on a wt. adjusted basis) will become (more/less) intoxicated.
Certain opioid analgesics are much more effective in (men/women) than in (men/women). As a result, pain relief can be achieved at lower doses in (men/women).
Quinidine causes greater QT interval prolongation in (men/women) than in (men/women). As a result, (men/women) given the drug are more likely to develop torsades de pointes, a potentially fatal cardiac dysrhythmia.
In what year did the FDA pressure drug companies to include women in clinical drug trials?
What are the major organs effected by alcohol?
- cardiovascular system
- respiratory system
What 2 acute effects does alcohol have on the brain?
- general depression of CNS function
- activation of reward circuit
What are 2 neuropsychiatric syndromes common in alcoholics?
- Wernicke's encephalopathy
- Korsakoff's psychosis
Both Wernicke's and Korsakoff's are caused by ___ deficiency, which results from poor diet and alcohol-induced suppression of ___ absorption.
A neuropsychiatric syndrome common in acoholics characterized by confusion, nystagmus, and abnormal ocular movements; readily reversible with thiamin
A neuropsychiatric syndrom common in alcoholics characterized bypolyneuropathy, inability to convert short-term memory into long-term, and confabulation; not reversible.
T/F Low to moderate drinking helps preserve cognitive function in older people and may protect against development of dementia.
T/F Alcohol is a great sleep aid.
F; it actually disrupts sleep
What is the most prominent cardiovascular effect when alcohol is consumed in moderation?
Dilation of cutaneous blood vessles, which increases blood flow to the skin imparting a sensaiton of warmth, while promoting heat loss
What are two cardivascular effects of chronic and excessive alcohol consumption?
- direct damage to myocardium (increasing risk of HF)
- dose-dependent elevation of BP
T/F There is clear evidence that people who drink moderately experience less ischemic stroke, CAD, MI, and HF. With heavy drinking the risk of heart disease and stroke is increased.
Moderate alcohol consumption includes ___ drinks/day or less for men and ___ drink/day or less for women.
Heavy alcohol consumption includes ___ or more drinks/day.
Like all other CNS depressants, alcohol depresses ___.
Alcohol-induced liver damage can progress from ___ to ___ to ___, depending on amount consumed.
fatty liver; hepatitis; cirrhosis
T/F Alcohol abuse is unquestionably the major cause of fatal cirrhosis.
___ is a condition characterized by proliferation of fibrous tissue and destruction of liver parenchymal cells.
Immoderate use of alcohol can cause ___ by (1) stimulating secretion of gastric acid, and (2) in high concentrations, injuring gastric mucosa directly.
Alcohol is a ___. It promotes urine formation by inhibiting the release of ADH from the pituitary.
How does ADH work?
Acts on kidneys to promote water reabsorption, thereby decreasing urine formation.
About 35% of cases of acute pancreatitis can be attributed to alcohol, making alcohol the ___ most common cause of the disorder. Only ___% of alcoholics develop pancreatitis.
What are the common social factors of drug abuse?
- desire for social status and approval
- peer pressure
List factors that contribute to drug abuse.
- reinforcing properties of drugs
- physical dependence
- psychologic dependence
- social factors
- drug availability
- individual vulnerability
___ is an intense subjective need for a drug.
What are the drug schedules for addictive substances?
- Schedule 1: high tendency for abuse, no accepted medical use; marijuana, ecstasy, LSD, GHB; not sold by pharmacies, not available w/ physician prescription
- Schedule 2: high tendency for abuse, may have accepted medical use, can produce dependency/addiction; cocaine, opium, morphine, fentanyl, amphetamines, methamphetamines; may be available w/ physician prescription
- Schedule 3: less abuse/addiction potential, accepted medical use; anabolic steroids, codeine, ketamine, hydrocodone w/ aspirin, hydrocodone w/ acetaminophen; may be available w/ prescription
- Schedule 4: low abuse potential, accepted medical use, limited addictive properties; valium, xanax, phenobarbital, rohypnol; may be available w/ prescription
- Schedule 5: lowest chance of abuse, accepted medical use in US, lowest chance of dependence; cough suppressants w/ codeine; regulated but don't generally require prescription
What medications interact with alcohol?
- CNS depressants: intensifies psychologic and physiologic manifestations of CNS depression, and greatly increases risk of death from respiratory depression
- NSAIDs: significant gastric bleeding
- Acetaminophen: poses risk of potentially fatal liver injury
- Disulfiram: variety of potentially dangerous adverse effects
- Antihypertensives: alcohol counteracts (since it raises BP when consumption is high); in moderation, may aid antihypertensives
What are the underlying causes of malnutrition in the chronic alcoholic?
- poor diet
- malabsorption of nutrients and vitamins
Malabsorption in the chronic alcoholic results from...
alcohol induced damage to the GI mucosa
Why does poor diet occur in the chronic acoholic?
Meet up to 50% of caloric needs w/ alcohol, and therefore consume subnormal amounts of foods w/ high nutritional value
B/c of their poor diet, alcoholics are in need of ___, ___ and ___.
fat; protein; vitamins
The ___ vitamins are especially needed in alcoholics.
T/F Alcoholics frequently require fluid replacement therapy and antibiotics.
What drugs are used in the rehab of alcoholism?
In theory, any drug that has cross-dependence with alcohol (any CNS depressant) should be effective in facilitating withdrawal, however in actual practice, ___ are the drugs of choice.
T/F Benzodiazepines are most effective at facilitating alcohol withdrawal, but are not always safe.
F; are safe
How do benzodiazepines facilitate alcohol withdrawal?
Decrease withdrawal symptoms, stabilize vitals, prevent seizures and delirium tremens
What benzodiazepines are used most often to facilitate alcohol withdrawal?
- chlordiazepoxide (Librium)
- diazepam (Valium)
- oxazepam (Serax)
- lorazepam (Ativan)
T/F To facilitate alcohol withdrawa, benzodiazepines are only administered around around the clock on a fixed schedule.
F; PRN administration is just as effective and permits speedier withdrawal
What are some other drugs that may be combined with a benzodiazepine to improve alcohol withdrawal outcome?
- carbamazepine (antiepileptic)
- clonidine (alpha adrenergic agonist)
- atenolol, propranolol (beta adrenergic blockers)
In the US, what 3 drugs are approved for maintaining alcohol abstinence?
- disulfiram (Antabuse)
- naltrexone (ReVia, Vivitrol)
- acamprosate (Campral)
___ works by causeing an unpleasant rxn if alcohol is consumed; disrupts alcohol metabolism.
___ blocks the pleasurable effects of alcohol and decreases craving.
___ reduces some of the unpleasant feelings (tension, dysphoria, anxiety) brought on by alcohol abstinence.
Of the 3 alcohol abstinence drugs, which appears to be the most effective?
This alcohol abstinence drug has no applications outside the treatment of alcoholism.
The constellation of effects caused by alcohol plus disulfiram is referred to as ___ syndrome, a potentially dangerous event. In its mild form manifestations include: n/v, flushing, palpitations, headache, sweating, thirst, chest pain, weakness, blurred vision, hypotension; the rxn can be brought on by as little as ___ mL of alcohol. Severe manifestations are life threatening and include: respiratory depression, cardiovascular collapse/dysrhythmias, MI, acute CHF, convulsions, death.
T/F Alcoholics who lack the determination to stop drinking should not receive disulfiram.
What are some key points in disulfiram patient education?
- Avoid ALL forms of alcohol
- Effects will persist about 2 weeks after last dose
- Carry identification indicating status
Naltrexone falls under what drug class?
Pure opioid antagonist
What happens if naltrexone is given to an opioid dependent individual?
Since it's an opioid antagonist, it precipitates withdrawal
T/F Unlike disulfiram, patients are not required to stop drinking before starting naltrexone.
F; like disulfiram, patients must stop
Which alcohol abstinence drug should be used only as part of a comprehensive management program that includes psychosocial support?
T/F Combining acamprosate with naltrexone is more effective than acamprosate alone, but no better than naltrexone alone.
Which 2 alcohol abstinence drugs are oral, and which is oral and IM?
- disulfiram, acamprosate
What are 2 drugs that are less commonly used for alcohol abstinence, and what are they currently approved for?
- topiramate (Topamax); epilepsy and migraine
- ondansetron (Zofran); n/v in cancer patients
___ is the principle methylxanthine employed in asthma.
What are the 2 most prominent actions of the methylxanthines?
- CNS excitation
This drug has a narrow therapeutic range, is usually administered by mouth, and is not administered by inhalation b/c it is not active by this route.
In the past, this drug was a first line med for asthma and nearly all patients with chronic asthma took it. However, use of this drug has declined sharply. Why?
theophylline; we now have safer, more effective meds (inhaled glucocorticoids, inhaled beta2 agonists)
Benefits of theophylline derive primarily from ___.
Oral theophylline is used for maintenance therapy of...
chronic stable asthma
Although (more/less) effective than beta2 agonists, theophylline has a (longer/shorter) duration of action.
Becasue its effects are prolonged, theophylline may be most appropriate for patients who experience what?
T/F Theophylline is metabolized in the liver, and rates of metabolism are fairly consistent.
F; rates of metabolism vary widely
What is the therapeutic drug level range for theophylline?
___ is a methylxanthine with pharmacologic properties like those of theophylline, and should thus be avoided.
What drugs reduce theophylline levels?
What drugs increase theophylline levels?
- fluoroquinolone antibiotics (ciprofloxacin)
___ (formerly available as Truphylline) is a theophylline salt that is considerably more soluble than theophylline itself.
T/F Pharm properties of aminophylline and theophylline are identical.
Which route is most often used for aminophylline?
Because of its relatively high solubility, ___ is the preferred from of theophylline for IV use.
The usual loading dose for aminophylline is ___; the maintenance therapeutice range is ___.
This asthma inhalation device is small, hand-held, pressurized and delivers a measured dose of drug with each actuation. Hand-lung coordinaiton is required. Only 10% of the dose reaches the lungs; about 80% impacts the oropharynx and is swallowed, and the remaining 10% is left in the device or exhaled.
MDI (metered dose inhaler)
This asthma inhalation device delivers drugs in the form of a dry, micronized powder directly to the lungs. No propellant is employed and they are breath activated (don't require lung-hand coordination). About 20% of dose reaches the lungs.
DPI (dry powder inhaler)
This asthma inhalation device is a small machine used to convert a drug solution into amist. Takes several minutes to deliver, but may be most effective.
What are the 2 major classifications of asthma drugs?
What are 4 anti-inflammatory drug classifications for asthma?
- leukotriene modifiers
- cromolyn, nedocromil
What are 3 brochodilator drug classifications for asthma?
- beta2 adrenergic agonists
beclomethasone dipropionate (QVAR)
fluticasone propionate (Flovent)
mometasone furoate (Asmanex)
triamcinolone acetonide (Axmacort)
What are these?
anti-inflammatories, inhaled glucocorticoids
What are these?
anti-inflammatories, oral glucocorticoids
What are these?
anti-inflammatories, leukotriene modifiers
What are these?
What is this?
anti-inflammatory, IgE antagonist
albuterol (AccuNeb, ProAir, Proventil, Ventolin)
What are these?
bronchodilators, inhaled short acting beta2 adrenergic agonists (SABAs)
formoterol (Foradil, Perforomist)
What are these?
bronchodilators, inhaled long acting beta2 adrenergic agonists (LABAs)
What are these?
bronchodilators, oral beta2 adrenergic agonists
theophylline (Theo24, Theochron, Uniphyl, Elixophyllin)
What is this?
What are these?
This med class is the foundation of asthma therapy, is taken daily for long-term control, and addresses the underlying disease process (inflammation).
What are the principle prophylactic anti-inflammatories used for asthma?
These are 1st line drugs used for asthma, are considered very safe, are not administered PRN, and have adverse effects of oropharyngeal candidiasis and dysphonia.
When are oral glucocorticoids indicated for asthma?
When severe; only when symptoms can't be controlled w/ safer meds (inhaled glucocorticoids, beta2s)
Toxicity of oral glucocorticoids (increases/decreases/stays the same) with duration of use.
Although alone these are less effective than glucocorticoids, they are very effective when combined with glucocorticoids.
Although used for prophylaxis of chronic asthma, this class of anti-inflammatories should not be used as 1st line therapy.
This class of anti-inflammatories for asthma is only administered orally.
This is the safest of all antiasthma meds; used for prophylaxis of chronic asthma, EIB, allergic rhinitis; must be administered on a fixed schedule.
This anti-inflammatory asthma med is no longer available in the US.
Cromolyn is AKA a ___
mast cell stabilizer
This anti-inflammatory med is a 2nd line agent indicated only for patients whose asthma is caused by specific allergen, and when preferred options have failed. It's very expensive, viscous, and is only administered subQ. It's long-term safety is unknown.
This major class of asthma meds provides symptomatic relief but does not alter the underlying disease process (inflammation).
T/F Unless attacks are mild/infrequent, patients taking a bronchodilator should also be taking inhaled glucocorticoids for long-term suppression of inflammation.
There is evidence that this class of bronchodilators can increase risk of asthma related death when used alone.
Beta2 adrenergic agonists
Beta2 adrenergic agonists are most effective for...
relieving acute bronchospasm and preventing EIB
What are the 3 subclasses of beta2 adrenergic agonists?
These beta2 adrenergic agonists are used to abort an ongoing attack, are adnministered PRN or before exercise.
These beta2 adrenergic agonists are used to abort an ongoing attack and for prolonged prophylaxis (though not 1st choice), are administered on a fixed schedule, and should never be used alone.
These beta2 adrenergic agonists are used for long-term control of asthma (though not 1st choice) and should never be used alone.
This class of bronchodilators is only approved for COPD, but is used for asthma. They block muscarinic receptors in bronchi, and are only administered by inhalation. Contraindicated in those with peanut allergy.
Combination asthma meds combine what two classes of drugs? What are 2 examples?
- glucocorticoids (anti-inflammatories) + LABAs (bronchodilators)
- Advair, Symbicort
These are reserved for asthma not adequately controlled with an inhaled glucocorticoid alone.
Allergic rhinits can be either ___ or ___.
What causes seasonal allergic rhinitis?
Outdoor allergens (hay fever; occurs Spring, Fall)
What causes perennial allergic rhinitis?
Indoor allergens (dust mites, pet dander)
What are side effects of antihistamines?
- dry mouth
- dry eyes
- bitter taste
In what ways are antibiotics misused?
- untreatable infection
- fever of unknown origin
- absence of adequate bacteriologic info
- omission of surgical drainage
- when surgery should be employed
What is the only situation in which fever, by itself, constitutes a legitimate indication for antibiotic use?
In severely immunocompromised host
T/F Except in life-threatening situations, antibiotic therapy should not be undertaken in the absence of bacteriologic info.
What are the major side effects of antibiotics?
- Aminoglycosides: hearing loss, dizziness, kidney damage
- Cephalosporins: n/d, allergic rxns
- Fluoroquinolones: nervousness, tremors, seizures, inflammation/rupture of tendons, arrhythmias, diarrhea and colitis, sometimes fatal liver damage
- Macrolides: n/v/d, arrhythmias, jaundice
- Monobactam: allergic rxns
- Penicillins: n/v/d, allergy w/ serious anaphylaxis
- Polypeptides: kidney and nerve damage
- Sulfonamides: n/v/d, allergy, decrease in white blood cell and platelet counts, sensitivity to sunlight, possibly increased tendency to bleed if used with warfarin
- Tetracyclines: GI upset, sensitivity to sunlight, staining of teeth in the fetus if used late in pregnancy or in children under 8 years of age
Without this - consisting of immune system and phagocytic cells - successful antimicrobial therapy would be rare.
T/F In most cases, the drugs we use do not cure infection alone. Rather, they work in concert with host defense systems to subdue infection.
When treating immunocompromised, the only hope of treating infection lies w/ drugs that are rapidly ___, and even those may prove inadequate.
What class does gentamycin belong to?
Gentamicin treats serious infections caused by what kind of bacteria?
Gran-negative bacilli (Pseudomonas aeruginosa, E. coli)
In hospitals where resistance isn't a problem, ___ is often the preferred aminoglycoside for use agains E. coli. Why?
Gentamicin is cross-resistant to ___.
For infections that are resistant to gentamicin and tobramycin, ___ is usually effective.
What med can be combined with vancomycin, a cephalosporin, or a peniccilin to treat serious infections caused by certain gram-positive cocci (Enterococcus, streptococci, Staph)?
Like all other aminoglycosides, gentamicin is toxic to what 2 things?
Gentamicin is inactivated by ___ and should not be mixed with these drugs in the same IV.
Drug or chemical damage to the inner ear.
T/F Only some aminoglycosides can accumulate w/in the inner ear, causing cellular injury that can impair both hearing and balance.
How do aminoglycosides cause impairment of hearing?
By damaging sensory hair cells in the cochlea
How do aminoglycosides cause disruption of balance?
By damaging sensory hair cells of the vestibular apparatus
The risk of ototoxicity is r/t primarily excessive ___ levels of drug.
Is cellular injury from ototoxicity d/t prolonged exposure or brief exposure at high levels?
In addition to high trough levels, the risk of ototoxicity is increased by wht 3 things?
- renal impairment
- concurrent use of ethacrynic acid
- aminoglycosides in excessive doses or form more than 10 days
What is the first sign of impending cochlear damage?
What's the first sign of impending vestibular damage?
What are later signs of damage from ototoxicity?
Ototoxicity is largely (reversible/irreversible).
What's the most serious adverse effect of vancomycin?
Renin Angiotensin Aldosterone System
What 4 drug classes are associated w/ RAAS?
- ACE (angiotensin converting enzyme) inhibitors
- ARBs (angiotensin II receptor blockers)
- DRIs (direct renin inhibitors)
- aldosterone antagonists
For many of the RAAS related meds, aldosterone release is inhibited, which may result in ___, especially when combined with potassium supplements, salt substitutes, potassium-sparing diuretics, or other RAAS meds. Why?
- With inhibition of aldosterone, instead of reabsorbing sodium/water and excreting potassium, the body reabsorbs potassium and excretes sodium/water.
What is the major vasoconstricort of the RAAS, and how does volume increase to increase BP?
- angiotensin II
- With stimulated production of aldosterone, kidneys then retain sodium/water and excrete potassium, increasing fluid volume.
What meds cause vasodilation and a decrease in afterload? How do they work?
- *Calcium channel blockers (diltiazem, verapamil, nifedipine), alpha adrenergic blockers (phentolamine, prazosin, terazosin), ACE inhibitors (captopril, enalapril), ARBs (losartan), DRIs (aliskiren), others (*hydralazine, *minoxidil, nitroprusside, *diazoxide)
- All of these drugs dilate resistance vessels (arterioles), causing a decrease in cardiac afterload (the force the heart works against to pump blood). By decreasing afterload, arteriolar dilators reduce cardiac work while causeing cardiac output and tissue perfusion to increase.
These block beta adrenergic receptors.
Beta adrenergic antagonists (beta blockers)
What makes the difference between a beta blocker being therapeutic vs nontherapeutic?
Selectivity...therapeutic effects result from blockade of beta1 receptors of the heart only; nontherapeutic effects result from blockade of both beta1 and beta2 receptors
What are the 3 major consequences of blocking beta1 receptors in the heart?
- reduced HR
- reduced force of contraction
- reduced velocity of impulse conduction through the AV node
What are beta blockers used for?
- angina pectoris
- cardiac dysrhythmias
- stage fright
What are the 2 "c's" associated with beta blockers?
What's the most important factor of success of thrombolytic drugs?
Time b/w onset of symptoms and delivery of the med
How long do you have to administer a thrombolytic med for it to be effective following a stroke?
What's the chief use for low-molecular wt heparins?
prevention and treatment of DVT
The most significant adverse effects of alpha adrenergic antagonists result from blockade of (alpha1/alpha2) receptors.
What are the main side effects of pts on alpha blockers?
- orthostatic hypotension
- reflex tachycardia
- nasal congestion
- inhibition of ejaculation
- sodium retention, increased fluid volume
What are the main side effects of pts on beta blockers?
- Beta1: bradycardi, reduced CO, precipitation of HF, AV heart block, rebound cardiac excitation
- Beta2: bronchoconstriction, inhibition of glycogenolysis
What med would you give if the pt's fluid volume increased after giving an alpha blocker?
Why is heparin not administered orally? What is used instead?
- It's too large and too polar to permit intestinal absorption
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Patho/pharm Exam 1
biomedical study of the interaction of chemical substances with living organisms
naturally produced in the human or animal body
(vaccines, blood, blood components)
deals with the use of drugs in prevention, diagnosis, and treatment of diseases
study of how the drug moves through the body and the effects it has on the body
actions of a drug on a specific organ
(mechanism of action, receptor interactions, dose-response relationship and therapeutic/toxic reactions)
convergence of pharmacology and genetics
study of dosages of medicines and drugs
scientific study of poisons, pollutants, and the undesireable effects of drugs
refers to the chemical makeup of a drug and defines the unique chemical structure
universal names that are not registered to anyone
a pharmaceutical equivalent or alternative that does not show differences in the rate and extent of absorption
how a drug gets to the site of action
movement of a drug from the site of administration across one or more body membranes
biphospholipid cell membranes
non-polar = fat soluble
polar = water soluble
- smooth muscle excitation
- nasal decongestant and treatment of hypotension
- inhibits release of NE
- lowers BP of the organ it's attached to
- primarily found on heart muscle and blood vessels
- increases heart rate and strength through renin secretion
- found on all organs except heart
- causes smooth muscle relaxation/vasodilation
- relaxes bronchioles
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Module 1: Principles of Pharmacology(Reading assignment: chap. 1,2,4,5)IntroductionA. Basic terms Nurses use pharmaco-therapeutics dailyo Understand pharmacologyo Substance use- causes cellular changes and then cause ao Reaction-(hope) be a positive reaction Pharmacokinetics: what the body does to the drug Pharmacodynamics: what drug does to the body Understand side effects/adverse reactions And drug chemistries such as: half-lives/therapeutic indexB. Drug properties Efficacy: maximal response drug can produce Potency: index of how much to give for desired response Drug (Characteristics): (3)o Effectiveness- Drug does what it is intended to do Most important properties U.S. Laws require to be proven effective before released for useo Safety Does no harm, even if given at high doses for a long time (there is no drug safe at that level) Proper dosing and selection should reduce the adverse effectso Selectivity only produces the outcomes intended. There are no side effects Know how to administer and signs to watch for There is not thing as a safe and selective drug There is laws and rules to protect the patientC. Therapeutic objective GOAL FOR DRUG USE: Provide maximum benefit with minimum harm Other factors for drug selection:o Administration easeo Stabilityo CostD. Drug intensity (factors): Administration dosage size, route and timing are critical (medication errors, patient ad ...
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Exam guide pharmacology 1 study
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Welcome to your ultimate set of nursing pharmacology questions for the NCLEX! In this nursing test bank, test your competence in nursing pharmacology with these 500+ practice NCLEX questions. This quiz aims to help nursing students review concepts of nursing pharmacology and provide an alternative to Quizlet or ATI.
Nursing Pharmacology Questions and Test Banks
In this section are the practice problems and questions for nursing pharmacology. There are 530+ nursing pharmacology practice questions in this nursing test bank partitioned into 11 parts. Nursing topics include medication administration, dosage calculations, general concepts about nursing pharmacology, cardiovascular drugs, antibiotics and anti-infectives, neurological medications, psychiatric medications, drugs for the respiratory system, gastrointestinal system, and endocrine system.
All questions on this set are updated to give you the most challenging questions, along with insightful rationales to reinforce learning.
Quizzes included in this guide are:
- Comprehensive Nursing Pharmacology Practice Quiz #1 | 50 Questions
- Comprehensive Nursing Pharmacology Practice Quiz #2 | 50 Questions
- Comprehensive Nursing Pharmacology Practice Quiz #3 | 50 Questions
- Comprehensive Nursing Pharmacology Practice Quiz #4 | 50 Questions
- Comprehensive Nursing Pharmacology Practice Quiz #5 | 50 Questions
- Comprehensive Nursing Pharmacology Practice Quiz #6 | 50 Questions
- Cardiovascular Drugs and Medications | 80 Questions
- Psychiatric Drugs and Medications 50 Questions
- Respiratory Drugs and Medications | 30 Questions
- Gastrointestinal Drugs and Medications | 30 Questions
- Endocrine Drugs and Medications | 40 Questions
- Read and understand each question before choosing the best answer.
- Since this is a review, answers and rationales are shown after you click on the "Check" button.
- There is no time limit, answer the questions at your own pace.
- Once all questions are answered, you'll be prompted to click the "Quiz Summary" button where you'll be shown the questions you've answered or placed under "Review". Click on the "Finish Quiz" button to show your rating.
- After the quiz, please make sure to read the questions and rationales again by click on the "View Questions" button.
- Comment us your thoughts, scores, ratings, and questions about the quiz in the comments section below!
1.Comprehensive Nursing Pharmacology NCLEX Practice Quiz #1 | 50 Questions
Comprehensive Nursing Pharmacology NCLEX Practice Quiz #1 | 50 Questions
Welcome to your first set of nursing pharmacology practice questions. This 50-question NCLEX practice quiz covers different nursing pharmacology topics but mostly anti-infectives, antibiotics, and topical agents.
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Looking for the rationales? Please click on the “View Questions” button below to review your answers and read through the rationales for each question.
Question 1 of 50
A 2-year-old child is receiving temporary total parenteral nutrition (TPN) through a central venous line. This is the first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of this child, which one would be a priority at this time?
Question 2 of 50
Nurse Jamie is administering the initial total parenteral nutrition solution to a client. Which of the following assessments requires the nurse’s immediate attention?
Question 3 of 50
Nurse Susan administered intravenous gamma globulin to an 18 month-old child with AIDS. The parent asks why this medication is being given. What is the nurse’s best response?
Question 4 of 50
When caring for a client with total parenteral nutrition (TPN), what is the most important action on the part of the nurse?
Question 5 of 50
The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which assessment would require the nurse’s immediate action?
Question 6 of 50
Nurse Celine is caring for a client with clinical depression who is receiving an MAO inhibitor. When providing instructions about precautions with this medication, the nurse should instruct the client to:
Question 7 of 50
While providing home care to a client with congestive heart failure, the nurse is asked how long diuretics must be taken. The best response to this client should be:
Question 8 of 50
George, age 8, is admitted with rheumatic fever. Which clinical finding indicates to the nurse that George needs to continue taking the salicylates he had received at home?
Question 9 of 50
An order is written to start an IV on a 74-year-old client who is getting ready to go to the operating room for a total hip replacement. What gauge of catheter would best meet the needs of this client?
Question 10 of 50
A client with an acute exacerbation of rheumatoid arthritis is admitted to the hospital for treatment. Which drug, used to treat clients with rheumatoid arthritis, has both an anti-inflammatory and immunosuppressive effect?
Question 11 of 50
Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge?
Question 12 of 50
A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply?
Question 13 of 50
The nurse is caring for an elderly client who has been diagnosed as having sundown syndrome. He is alert and oriented during the day but becomes disoriented and disruptive around dinnertime. He is hospitalized for evaluation. The nurse asks the client and his family to list all of the medications, prescription and nonprescription, he is currently taking. What is the primary reason for this action?
Question 14 of 50
A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits, during which diabetic teaching has been implemented. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy?
Question 15 of 50
Mrs. Johanson’s physician has prescribed tetracycline 500 mg PO q6h. While assessing Mrs. Johanson’s nursing history for allergies, the nurse notes that Mrs. Johanson is also taking oral contraceptives. What is the most appropriate initial nursing intervention?
Question 16 of 50
An adult client’s insulin dosage is 10 units of regular insulin and 15 units of NPH insulin in the morning. The client should be taught to expect the first insulin peak:
Question 17 of 50
An adult is hospitalized for treatment of deep electrical burns. Burn wound sepsis develops and mafenide acetate 10% (Sulfamylon) is ordered BID. While applying the Sulfamylon to the wound, it is important for the nurse to prepare the client for expected responses to the topical application, which include:
Question 18 of 50
Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s solution for the client. The nurse understands that the primary reason for giving Lugol’s solution preoperatively is to:
Question 19 of 50
A two-year-old child with congestive heart failure has been receiving digoxin for one week. The nurse needs to recognize that an early sign of digitalis toxicity is:
Question 20 of 50
Mr. Bates is admitted to the surgical ICU following left adrenalectomy. He is sleepy but easily aroused. An IV containing hydrocortisone is running. The nurse planning care for Mr. Bates knows it is essential to include which of the following nursing interventions at this time?
Question 21 of 50
Corinne is experiencing diarrhea after consuming her prescribed antibiotics for the whole week. This is because:
Question 22 of 50
When a client with chronic obstructive pulmonary disease is taking theophylline also receives ciprofloxacin (Cipro), which of the following interactions would occur?
Question 23 of 50
The client at highest risk for nephrotoxicity with aminoglycoside use is a:
Question 24 of 50
When assessing clients for evidence of a penicillin allergy, which of the following symptoms may not be considered to be a true hypersensitivity reaction?
Question 25 of 50
All of the following symptoms are evidence of a superinfection except:
Question 26 of 50
Which of the following statements is true when educating clients about penicillin therapy?
Question 27 of 50
Antonietta is taking antitubercular, the most common adverse effect she may be experiencing is:
Question 28 of 50
In the treatment of tuberculosis, the therapeutic rationale for combination drug therapy is to:
Question 29 of 50
Changes in visual acuity and color perception are associated with treatment by which of the following agents?
Question 30 of 50
Which of the following groups of antitubercular agents includes first-line agents?
Question 31 of 50
Antitubercular therapy may be determined ineffective when:
Question 32 of 50
Fluconazole (Diflucan) can be administered to a client with:
Question 33 of 50
When administering amphotericin B, which of the following must be used?
Question 34 of 50
Which of the following nursing diagnoses might occur when administering large parenteral doses of amphotericin B with vancomycin (Vancocin)?
Question 35 of 50
Arvic, a 16-year-old student, has acquired systemic fungal infection, he should be treated with:
Question 36 of 50
Which of the following must always be present before beginning antifungal therapy?
Question 37 of 50
Which choice describes the action of nucleoside analogs?
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