Term
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Definition
| It is what we deal with in nursing, it is defined as the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy |
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Definition
| constitutes a description of a drug using the nomenclature of chemistry (e.g. acetyl salicylic acid) |
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Definition
| (nonproprietary) is assigned by the united states adopted names council. Generic names are less complex then chemical names but typically more complex than trade names. |
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Term
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Definition
| (proprietary) or brand names are the names under which a drug is marketed. These names are created by drug companies with the intention that they be easy for nurses, physicians, pharmacists to recall and pronounce. |
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Term
| What meaning does the legislation related to drugs have for the nurse's role? |
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Definition
| For patient advocacy, to educate and protect because the job of the drug companies is sales and not education of drug information. |
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Term
| What is the difference between prescription and OTC? |
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Definition
| Prescriptions have to have a written prescription from a physician or nurse practioner and purchaced at a pharmacy. OTC can be purchased without a prescription and purchased pretty much any where |
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Term
| How does a drug become an OTC? |
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Definition
| The FDA has to permit the drug for it to become an OTC |
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Term
| How do drugs differ from herbal supplements? |
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Definition
| Herbal supplements are considered dietary supplements, this allows them to slide through FDA regulation. They are inconsistant in quality. They have variable potency. The can have significant reactions with other drugs. |
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Definition
| Drugs that have a high potential for abuse |
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Term
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Definition
| Are the categories in which drugs are placed |
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Definition
| Have a high potential for abuse, no accepted medical use (LSD, Heroin) |
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Definition
| high potential for abuse, but acceptable for medical use (morphine, mereridine) |
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Definition
| May cause dependency (Codiene, Tylenol and ASA w/codeine) |
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Term
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Definition
| mild physical/psychological dependence (diazepam, phenobarbitol) |
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Definition
| limited potential for dependence (OTC codeine cough syrup, lomotil) |
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Term
| Describe the phases of testing of new drugs. What are the implications of this process for the public? For the nurse? |
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Definition
| Clinical trial occor in four phases and may take 2 to 10 years to complete. The first three phases are done before a new drug is marketed. Some drugs are released before adverse effects show up so, this is where the nurse needs to document any adverse affects of the new drug so the public can be aware of these effects. |
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Term
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Definition
| are usually conducted in normal volunteers. However, if a drug is likely to have several side effects, as many anticancer drugs do, the trial is done in volunteer patients who have the disease under consideration |
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Term
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Definition
| tested on patients. The objective is to determine therapeutic effects, dosage range and safety. A small population of patients (500-5000) receive the drug, of these only a few hundred take it for more then 3 to 6 months. Upon completing phase III, the drug manufactures applies to the FDA for conditional approval of a new drug application. If conditional approval is granted phase IV begins. |
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Term
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Definition
| the new drug is release for general use, permitting observation of its effects in a large population. Frequently, new adverse effects are revealed. The succes of phase IV depends largely on the voluntary reporting by prescribing physicians. (note until recently info on drugs use in women and children was limited. New drugs are likely to have adverse effects that weren't detected during clinical trials. |
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Term
| Primary Prevention (illness prevention model) |
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Definition
| Precedes disease-health education, physical exercise, nutrition and immunizations |
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Term
| Secondary prevention (illness prevention model) |
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Definition
| Focuses on current disease-reduce serverity, return to optimum health, early care is provided in an acute care hospital |
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Term
| tertiary prevention (illness prevention model) |
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Definition
| long term care permanant and not reversible-occurs when a disease or disability is permanent and not reversible, prevent complications, activities are primarily rehabilitative. |
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Term
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Definition
| the study of the disorder or breakdown of the human body's function. |
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Term
| How is homeostasis regulated |
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Definition
| Most homeostatic control mechanisms in the body function on principles of negative feedback and some positive feedback. Which causes the controller to respond in a manner that oppose or negative deviation from normal set point level. |
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Definition
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Term
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Definition
| resulting from the activity of a physician. |
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Definition
| objectively identifiable aberrtion of the disease (fever, reddening of the skin, palable mass) |
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Definition
| subjective feeling of discomfort that an affected individual can report to an observer. (nausea, malaise, pain) |
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Definition
| the period preceding the onset of a disorder |
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Definition
| a period of time when there is no apparent change in status. The time required for elastic structures to tighten to prepare for the development of tension |
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Definition
| patient functions normally although the disease processes are well established. |
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Definition
| a relatively sudden increase in severity of a disease or any of its signs or symptoms. |
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Term
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Definition
| a condition or conditions caused by and following a disease. |
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Term
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Definition
| a new seperate process that may arise secondarily because of some change produced by the original entity |
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Term
| How does the structure of the cell membrane lead to selective permeability to lipid soluble and water soluble molecules. |
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Definition
| The cell membrane of the cell also called the phospholipid bilayer, which is impearmeable to most water soluble molecules, including ions, glucose, amino acids, but permeable to lipid soluble substances such as oxygen and steroid hormones. |
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Term
| How are large and small molecules transported across cell membranes. |
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Definition
| Large lipid insoluble molecules are transported across the plasma membrane by endocytosis and exocytosis. Small lipid insoluble molecules are transported across the plasma membrane by two kinds of membrane proteins...carriers and channels. |
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Term
| How do carrier-mediated and channel-mediated transports differ? |
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Definition
Carrier protiens may have active or passive transport functions (active transport includes sodium/potassium pumps, calcium pumps. Passive carriers include those that allow glucose entry into insulin sensitive cells)
Channels are always passive and allow ions to move down their concentration gradients only. Channels open and close in response to specific signals, such as voltage gated, ligand binding, and mechanical pressure. |
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Term
| How is cellular ATP produced in a cell? |
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Definition
| ATP is produce by ATP synthase, a protein in the mitochondrial membrane. ATP synthase produces ATP by capturing energy of the proton gradient and using it to form a bond between ADP and P(inorganic phosphate) in total about 30 ATP molecules are produced per glucose molecule. |
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Term
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Definition
| a reduction in oxygen at the tissue level that may lead to failure of aerobic production of ATP. (excessive lactic acid from pyruvate) |
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Term
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Definition
| the process of converting large molecules of carbohydrate, protein, and fat to smaller molecules to be utilized for energy. |
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Definition
| which directly connects the cytoplasm of adjoining cells |
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Definition
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Term
| Secretion of chemical mediators (ligands) |
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Definition
| most ligands are water soluble molecules that interact with receptors on the cell surface. These receptors are of three general type: ion channels, enzyme, and g protein linked. |
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Term
| How are extracellular signals transmitted intracellulary via receptor mechanisms. |
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Definition
| Ligands bind to a receptor...this opens a channel and changes and external message into an internal one. A lipid soluble molecule can diffuse through the cell membrane and attach to a receptor inside that cell and initiate a message that way. |
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Term
| How is an action potential generated? |
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Definition
| Cells with voltage gated ion channels are excitable and can produce and conduct action potentials. An action potential from the opening of fast sodium channels, which allows sodium to rush into the cell. This cause the cell to reach threshold and an action potential is generated. |
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Term
| How doe changes in extracellular potassium affect the resting membrane potential? |
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Definition
A high level of serum potassium results in a hypoplarization of the membrane. (hyperkalemia, the rmp is closer to threshold-makes it easier to achieve an action potential)
A low serum potassium level results in membrane hyperpolarization (hypokalemia-moves the rmp farther away from threshold making more difficult to achieve an action potential) |
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Term
| What is the relationship between stress and disease? |
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Definition
| A number of disorders ar thought to be related to excessive stress or inappopriate stress responses. These include asthma, palpitations, headaches, menstrual irregularity, rashes, and digestive disturbances. |
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Term
| How do genetic, age, gender, culture, ethnicity, influence an individuals's stress response? |
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Definition
| Coping is biopsychosocial process of thinking and functioning appropriatedly, as culturally defined, in a stressfull situation. In some americans cultures, coping is usually viewed as the ability to carry on normal activities without excessive emotional reactions. Aging itself is stressfull. Furthermore, stress and stress related mechanisms augment age related changes in the body. |
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Term
| What is the physiological response to stress? How are the newroendocrine and immune systems and the stress response related. |
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Definition
| The stress response involves three major body systems: nervous, endocrine, and immune. These systems work together in a coordinated manner to summon the body's defenses in response to a variety of stressors including psychological, physiological, and immunological. the primary role of the NS is appraisal of a stimulus as stressful and activation of the sympathetic NS. Norepinephrine is released from sympathetic nerve endings increases heart rate and contractility, blood vessel constriction, enhanced blood flow to skeletal muscles, reduced GI motility and secretion, and dilates pupils. Important stress related endocrine hormones include epinephrine from the adrenal medulla, corisol from the adrenal cortex, and ADH from the posterior putitary. The role of the immune system in the stress response is less well characterized. Chatecholamines and stress hormones affect the activity of the immune system. |
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Term
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Definition
| the study of drug movement throughout the body |
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Term
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Definition
| the movement of a drug from its site of administration into the blood |
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Term
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Definition
| drug movement of a drug from its site of administration into the blood. |
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Term
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Definition
| biotransformation-enzymatically mediated alteration of drug structure |
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Term
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Definition
| the movement of drugs and their metabolites out of the body. |
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Term
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Definition
rate of dissolution-the faster a drug can be dissoloved the faster it will be absorbed
Surface area-the larger the surface area the faster the absorption
Lipid solubility-highly lipid soluble molecules are absorbed more quickly because they are able to pass through the cell membrane by simple diffusion.
Ph partiotioning-acidic drugs in basic plasma and vise versa. |
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Term
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Definition
Tissue perfusion-the rate at which drugs are delivered to particular tissue is determined by blood flow to the tissues.
plasma protein binding-usually albumin-drugs that bind to receptors on albumin molecules
Physiological barriers-BBB and placenta
drug storage sites-adipose, bone, teeth, muscle |
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Term
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Definition
Unbound-free-active drug able to exit into the blood stream and exert and effect.
bound-inactive drug
Affinity-have to change the concentration of free drug..when it goes down the alubumin molecules lets go of more drug.
Competition-two drugs competing for space...more free drug exerting an effect on the tissues..more drug effect
hypoalbuminemia-increased free drug-increase risk for toxicity-malnurished dont have much albumin- |
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Term
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Definition
| in the brain cerebral spinal fluid and glial cells make a functional barrier...water, hydrogen ions, oxygen ions, co2 ions pass through...lipid soluble will pass..and drugs that have a transport system that are designed for them...if they don't they can't get through...antibiotics are hard to pass |
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Term
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Definition
| capillary bed that controls what passes from the mother to the fetus...more drugs can pass through so its hardly a barrier at all |
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Term
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Definition
Number of functional liver cells-decrease in size-litter livers (children)not going to metabolize as well..this affects the elderly too.
Disease-not going to metabolize as well |
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Term
| Impact of drugs on metabolism |
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Definition
Competition for enzyme systems-only three that works on drugs-if two drugs are competing for one system this will increase the duration
Stimulation of enzyme synthesis-drugs that cause the body to make more enzymes, problem because enzymes available might have to give more drug
nutritional state-synthesis and function of enzyme systems-normal synthesis...patient that is malnurished is at risk for toxicity. |
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Term
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Definition
renal excretion-Glomerular filtration-moving between blood and urine..non discriminatory, protein bound drugs need to be freed to get out of there, this can increase duration
passive tubular reabsortpion-lipid soluble will pop back into the blood stream
Active tubular secretion-moves this against their gradients requires pumps and energy
Biliary excretion- liver-bile-feces, enterhepatic recirculation...basically gets released and gets recyled back to the liver (prolong duration)
lesser sites of excretion-lungs, sweat, tears, breast milk(especially concern about active metabolites) |
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Term
| Discuss the physiologic changes that contribute to vations in pharmacokinetics generally, and specifically for the very young and the elderly. |
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Definition
| Infants and small children have a leaky BBB this allows drugs that wouldn't normally be absorbed by an adult to be absorbed in their little brains. Children and elderly's liver don't metabolize drugs as easy because of fewer liver cells. |
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Term
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Definition
| the study of biochemical and physiologic effects on drugs and the molecular mechanisms by which those effects are produced. |
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Term
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Definition
refers to the amount of drug we must give to elicit and effect.
(10 MSO4=1mg of hydromorphone (more potent does it do a better job...no) |
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Term
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Definition
refers to a drugs maximal effect
-ASA controls mild to moderate pain
_MSO4 controls mild to severe pain, thus MSO4 is more efficacious (effective) in relieving severe pain than ASA |
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Term
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Definition
| refers to the strength of the attraction between drug and its receptor. Drugs with high affinity are strongly attracted to their receptors. |
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Term
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Definition
| molecules that activate receptors |
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Term
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Definition
| produce their effects by preventing receptors activation by endogenous regulatory molecules and drugs. |
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Term
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Definition
| is an agonist that has only moderate intrinsic activity...the maximal effect that a partial agonist can produce is lower than that of a full agonist |
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Term
| minimum effective concentration |
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Definition
| the plasma drug level below the therapeutic effects will not occur. To be a benefit, a drug must be present in concentrations at or above MEC |
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Term
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Definition
| is the range of plasma drug levels falling between the MEC and the toxic concentrations |
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Term
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Definition
| when plateau must be achieve more quickly, a large initial dose that is administered |
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Term
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Definition
| after high drug levels have be established with a loading dose, plateau can be maintained by give smaller (maintenance) doese |
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Term
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Definition
| the time required for the amount of the drug in the body to be decreased by 50% |
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Term
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Definition
| the end of latent period when MEC is reached (reflection of absorption) |
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Term
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Definition
| time of maximum plasma concentration (when most drug is present) |
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Term
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Definition
| the length of time that plasma drug levels remain about MEC (reflection of metabolism and excretion) |
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Term
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Definition
| the highest drug level is the peak and the lowest is the trough |
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Term
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Definition
| occurs when plasma drug levels climb too high |
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Term
| What is the plateau principle? What does this information mean to a nurse? |
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Definition
| Plateau is when the administering repeated doses of a drug cause that drug to build up in the body until a steady level has been achieved. What this information means in nursing is that if a drug takes too long to reach plateau a loading dose may have to be administered then a maintanence dose |
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Term
| Define first pass effect. How is it compensated for in drug administration? |
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Definition
| First pass effect refers to the rapid hepatic inactivation of certain oral drugs. When drugs are administered orally, they are absorbed from the GI and carried directly to the liver via the hepatic portal system. If the capacity of the liver to metabolize a drug is extremely high, that drug can be completely inactivated on the first pass to the liver. This means that some drugs such as nitro must be given in a specific way (sublingual) this way the drug can exert its effect before being deactivated by hepatic enzymes. |
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Term
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Definition
Most common route is PO (oral admin) 80% of drugs in clinical practice.
Most convenient and safe route-can put enteric coating and time release capsules
Usually least expensive
Variable absorption problems-soluble drugs move right through
ionization and ph of environment
gastric and digestive enzymes
alteration in moltility
food and drug interactions
local irritation |
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Term
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Definition
IV-large volumes very rapid-fastest onset cause there is no absorption
most expensive and inconvenient
absorption affected by perfusion-muscles get more perfusion, faster onset
heat increases blood flow-increases absorption
cold decreases absorption |
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Term
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Definition
Any application to the skin has a slower absorption
most topical usually for local effects only, no distribution issues
caution with abraded skin (breaks in the skin and rashes)
transdermal-systemic effects with controlled release into circulation-patch that good for a longer period of time |
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Term
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Definition
| can be immediate or delayed...antibody/antigen reaction |
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Term
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Definition
| Metabolic changes...but its not an allergy |
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Term
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Definition
| toxity(excessive doese...problem metabolizing the drug) |
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Term
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Definition
| physical or psychological (basically they have a reliance on the effects of the drug)intense craving..physical dependence means you have to keep taking the drug to prevent withdrawl. |
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Term
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Definition
| when dependency occurs with one drug...it will be dependent to all like drugs |
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Term
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Definition
| capable of causing changes to tissues that are malignant...radiation therapy..cancer drugs can cause other cancers |
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Term
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Definition
| this is a drug capable of causing a birth defect. |
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Term
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Definition
| means that a drug response that the body adjusts to the amount of drug you are giving...the body is saying you need to take more to do what it wants to happen. |
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Term
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Definition
| is a measure of drug saftey..it is the ratio of a drugs lethal dose (LD) to its effective does (ED) |
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Term
| What other factors affect the body's response to drug therapy |
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Definition
| BSA (body surface area), gender, age, genetics, polypharmacy, nutrition, pathophysiolody, psychosocial |
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Term
| What are the 5 right plus one of administration |
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Definition
Right Drug
Right route
Right dose
Right Time
Right patient
Right documentation
(triple check) |
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Term
| Describe the nurse's responsibility in administering medications |
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Definition
Assess the patient
-collect baseline data
-identify high risk patients
Dosage and Administration
-determine the rationale for use
-five rights plus one
-minimize side effects and ADR's
-Utilize non-pharmacologic interventions
-take appropriate actions in the event of drug error-report it to your superiours...own up to it...if you don't consiquences could happen. |
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Term
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Definition
| mediate responsed to acetylcholine |
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Term
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Definition
| mediate all responsed with epinephrine and norepinephrine |
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Term
| Activation of nictotinic (n) |
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Definition
| receptors promote ganglionic transmission at all ganglia of the sympathetic and parasympathetic. promotes the release of epinephrine from the adrenal medulla |
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Term
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Definition
| cause contraction of skeletal muscles |
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Term
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Definition
| located on the organs of the parasympathetic..causes increase of glandular secretion (from pulmonary, gastric, intestinal, and sweat glands), contraction of smooth muscle in the bronchi, bladder, and GI tract, contraction of sphincter muscles of iris (miosis), contraction of ciliary muscle of the eye causing the lens to focus for near vision |
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Term
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Definition
| pupil dilation, vasoconstriction, ejacuation, contraction of bladder neck and prostatic capsule |
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Term
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Definition
| inhibition of transmitter release at presynaptic nerve terminals |
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Term
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Definition
Heat-increase rate, increase force of contraction, increase AV conduction velocity
Kidney-renin release |
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Term
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Definition
| bronchial dilation, uterus relaxation of smooth muscle, skeletal muscle vasodilation, glycogenolysis, skeletal muscle contraction |
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Term
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Definition
| Dilation of kidney vasculature |
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Term
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Definition
| bind to muscarinic receptors and activates receptors..closely resembles those produced by stimulation of parasympathetic nerves. |
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Term
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Definition
| block the actions of AcH at muscarinic receptors |
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Term
| Indirect-acting/cholinesterase inhibitors |
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Definition
| prevents the break down of AcH which enhances the actions of ACh release from cholinergic neurons. |
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Term
| sympatholytic/alph and beta blockers |
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Definition
| block the activation of alpha and beta receptors |
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Term
| sympathomimetic/adrenergic agonists |
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Definition
| activate adrenergic receptors to stimulate the sympethetic ns. |
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