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PHARM 1st Exam
pharm first exam
192
Pharmacology
11th Grade
05/14/2012

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Cards

Term
what is the fourth leading COD?
Definition
drug toxicity
Term
pharmokinetics
Definition
absorption, distribution, metabolism, excretion
Term
pharmodynamics
Definition
drug receptor interaction, patient's functional state, plaecbo effects
Term
pharmokinetics and pharmodynamics are dependent on what?
Definition
individual: genetics, pathology, physiology, drug-drug interaction
Term
Cr CL
Definition
140- Age x Kg x .85 (if female) / 72 x Cr
Term
what is a physiologic variable?
Definition
age gender weight
Term
what is a pathological variable?
Definition
Diminished function of kidneys and liver
Term
how do genetic variable effect drug efficacy?
Definition
Can alter metabolism of drugs and predispose patient to unique interactions, i.e. allergies, hypersensitvity
Term
review "nursing roles"
Definition
Term
generic drug names are derived from..
Definition
they are derived from the chemical name
Term
why do drug companies make the drug names so hard?
Definition
so the trade name is used instead
Term
OTC drugs account for..
Definition
60% of all drugs administered
Term
which drug routes should take effect within 1-3 minutes?
Definition
4 i's- inhalers, IV, intraosseus, intrathecal
Term
which drug routes should take 15-30 min to take effect?
Definition
SL/PR, sublingual or bottom of mouth
Term
which drugs routes should take 45 min to an hour to take effect?
Definition
SPIT- subq, PO, IM, topical
Term
only unbound (free) drug molecules can..
(non protein binding)
Definition
leave the vascular system
Term
half life?
Definition
Defined as the time required for the
amount of drug in the body to
decrease by 50%
Term
anticoagulant thrombosis
Definition
arterial thrombosis, venous thrombosis
Term
most important ADR's
Definition
Anaphylaxis, psychosis, insomnia, increased bg,
cushinoid s/s. usually most deadly ADRs are rare.
Term
is unfractioned heparin iv and regular heparin (sub q) protein bound?
Definition
YES
Term
half life of heparin? pregnancy?
Definition
1.5 hrs, yes its safe
Term
bleeding rate for heparin patients
Definition
10%
Term
how many pts get heparin induced thrombocytopenia?
Definition
3%, life threatening
Term
action of heparin
Definition
suppress production of fibrin
Term
advantage of LOVENOX/enoxaparin
Definition
no labs needed because of fixed dose
Term
oral version of heparin
Definition
coumadin, warfarin
Term
warfarin coumadin prevents..
Definition
thromboembolism, by suppressing vitamin K dependent clotting factors
Term
is warfarin coumadin teratogenic?
Definition
YES, causes fetal hemorrhage, category X
Term
major problems with warfarin
Definition
99% protein bound, Vitamin K will change INR, delayed action (doesnt effect clotting factors already circulating), NSAIDS increase risk for bleeding
Term
dosing regimen for coumadin
Definition
1mg on even day, 3 mg on odd days, 5 mg every Sun
Term
warfarin antidotes
Definition
vitamin k, FFP,
Term
Heparin, use PT or PTT?
Definition
PTT (letters equal 10)
Term
Coumadin, use PT or PTT?
Definition
PT (letters equal 10)
Term
platelet life cycle?
Definition
8 days
Term
ASA lasts the lifetime of a..
Definition
platelet!
Term
NSAIDS and ASA
Definition
nsaids may block some effects of ASA
Term
low therapeutic dose of ASA
Definition
100 mcg
Term
anti-inflammatory dose of ASA
Definition
400 mcg
Term
ASA toxicity
Definition
>400 mcg
Term
adverse effects of ASA
Definition
Bleeding; GIB and hemorrhagic stroke
Term
is ASA ok with pregnancy, kids with febrile diseases, or hypersensitive/allergy
Definition
NO (category D), no and NO.
Term
clopidogrel uses?
Definition
prevents blockage of cornary artery stents, reduces thrombotic events in patients with acute coronary synrdromes, MI, ischemic stroke
Term
adverse effect of clopidorgel
Definition
purpura, petechiae
Term
action of clopidogrel
Definition
dilates the vascular bed, and prevents platelet aggregation (like riot police)
Term
MEC
Definition
minimum effective concentration of a drug
Term
4 major categories of diuretics
Definition
high ceiling (loop), thiazide, osmotic and potassium sparing
Term
two types of potassium sparing
Definition
aldosterone antagonists (spiralactone), non aldersterne antagonists (triamterene)
Term
normal ptt
Definition
40
Term
therapeutic ptt (pt on heparin)
Definition
60-80
Term
number one use of baby aspirin..
Definition
to prevent CV events, MI attacks
Term
goal for htn on antihypertensives
Definition
140/90
Term
goal for htn w/kidney disease
Definition
130/80
Term
there is no antidote for..
Definition
dabigatran, pradexa
Term
baroreceptors sense what
Definition
low BP and increase vasoconstriction to compensate
Term
diuretics make everything go down, except..
Definition
acid/base and glucose, H&H
Term
furosemide..
Definition
LASIX
Term
lasix risks..
Definition
hypokalemia, dehydration, lowers Cl, Na, lower BP, increase BG, it can be ototoxix.
Term
lasix DI
Definition
it augments other BP meds, dagoxin, NSAIDS, can lead to LITHIUM toxicity
Term
l
Definition
Term
beginning (and end) dose for lasix..
Definition
20 mg, upper end 80 mg
Term
hydrochlorathiazide (gentler than lasix)
Definition
hypokalemia, dehydration,
Term
thiazides wont work for people who have..
Definition
renal failure
Term
Hydrochlorathiazide
Definition
it can potentiate any other medicine that can decrease BP
Term
Spironolactone (Aldactone) uses
Definition
Therapeutic uses
Hypertension
Edematous states
Heart failure (decrease mortality in severe failure)
Primary hyperaldosteronism
Premenstrual syndrome
Polycystic ovary syndrome
Acne in young women
Term
aldactone is..
Definition
potassium sparing, so watch for extra potassium intake
Term
PNS/cholinergic system major neurotransmitter
Definition
acetylCHOLINE
Term
neurotransmitter for SNS
Definition
epinephrine
Term
alpha blockers
Definition
HTN, relaxes smooth muscle bladder (for hypertrophic prostate- makes it easier to pee)
Term
alpha blocker side effects
Definition
1% lose consciousness, know prazosin (Minipress)
Term
alpha agonist name and uses
Definition
clonidine (Catapres) used for HTN, and pain
Term
the big problem with clonidine is that it..
Definition
causes a rebound HIGH BP if taken off of it (education: you cannot run out of this medicine!!)
Term
selective BB
Definition
blocks B1 metoprolol
Term
nonselective Beta Blockers
Definition
blocks B1 and B2, propranlol - will cause more effecs on the entire body than selective
Term
BB uses
Definition
Angina, HTN, arrythmias, MI, CHF, hyperthroidism
Term
ADR to BBs beta 1
Definition
bradycardia, reduce cardiac output, don't withdraw quickly
Term
ADR of BBs beta 2
Definition
same as B1, plus bronchoconstriction, inhibition of glycogenolysis, CNS side effects
Term
BB propranolol info
Definition
60 mg bid, interferes with epinephrine antidote for anaphylactic reaction, effects glycogenolysis,
Term
ACE inhibitors..
Definition
inhbits RAAS system, WHICH constricts blood vessels, acts on kidneys to promote retention of NA and K and water and excretion of K. so it reverses all that.
Term
ACE I's ADRs
Definition
teratogenic, first dose hypotension, cough (5-10% pts), hyperkalemia, renal failure, angioedema
Term
calcium channel blockers..
Definition
prevent calcium ions from entering cells, slow down AV and SA node, treats HTN, angina, cardiac dysrhythmias
Term
CCb are divided into two classes..
Definition
dihydropyridines-nifedipine, amlopidine
nondihydropyridines-verapamil, diltiazem
Term
hydralazine can cause sle syndrome, which can cause..
Definition
kidney problems, along with other SLE symptoms
Term
digoxin is a positive inotrope which..
Definition
increases CO and increases UO
Term
therapeutic uses of digoxin..
Definition
bring down heart rate
Term
digoxin is no longer first line drug for..
Definition
CHF< lowers life expectancy in women
Term
digoxin is contraindicated with..
Definition
diuretics, except K sparing. abx, CCBs, amiodarone
Term
antidotes to dig toxicity..
Definition
digibind, charcoal
Term
make sure with digoxin that..
Definition
full minute of apical pulse, hold if less than 60 bpm, check for potassium levels, watch for dysrhythmias- normally brady
Term
"lol" drugs
Definition
beta blockers
Term
"pril" drugs
Definition
ace inhibitors and RAAS meds
Term
verapamil
Definition
CCB
Term
diltiazem
Definition
CCB
Term
nifedipine, amlodipine
Definition
CCB
Term
hydralazine
Definition
vasodilators
Term
digoxin
Definition
heart failure
Term
amiodarone
Definition
antidysrhythmics
Term
"statin" drugs
Definition
antilipidemics
Term
gemifibrozil
Definition
antilipids
Term
niacin, cholesrayamine
Definition
antilipids
Term
nitroglycerin, isorbide
Definition
antianginal
Term
clonidine
Definition
antihypertensive
Term
nurses are involved in which part of the therapeutic obejective of drug therapy?
Definition
assessing the pt for adverse effects of drug therapy (not prescribing or recommending or any crap like that)
Term
with antihypertensive meds, if pt's bp is 110/70, should you adminster med?
Definition
check to see if data is congruent with previous measurements, if its a sudden drop, dont give
Term
if pt has low respirations of 9 breaths/min what post op med should you avoid giving?
Definition
opiate analgesic
Term
nursing dx for patient on opiate analgesic
Definition
risk for injury
Term
when changing pt from trade to generic, what should you monitor?
Definition
blood levels to insure avoidance of toxic levels
Term
protein bounds drugs in circulation are not able to
Definition
exert its action
Term
first pass effect is
Definition
the reduction of the effectivness of a drug by the time it reaches systemic circulation (mostly caused by liver and gut wall) these drugs should go iv or im instead
Term
sublingual is a good way to admister orally without the effects of..
Definition
first pass effect, sublingual allows for direct absorption
Term
while administering an iv push morphine, pts breathing drops from `15 to 11, what do you do?
Definition
stop infusing
Term
excretion of a drug may be impaired if..
Definition
patients GFR is below 30 m/l
Term
in pacu, what can promote excretion of most anesthetics?
Definition
deep breathing
Term
for drugs with a narrow therapetic range you should..
Definition
carefully monitor pt for therapeutic and toxic effects, be diligent about timing of adminstering the drug, monitor blood levels to see if its in therapeutic range
Term
what inhibits the CYP3A4/drug metabolizing enyzyme?
Definition
grapefruit juice
Term
inhibiting CYP3A4 can cause what?
Definition
excessive levels of the drug in the blood bc its not metabolized as well
Term
an order of "peak and trough levels" indicates the need for what?
Definition
draw blood at peak hour:1.5 hours after infusion, trough level:30 minutes before next dose
Term
why cant heparin be given orally
Definition
because its large and negatively charge - limiting absorption
Term
bad platelet ranges
Definition
below 100k
Term
for tea-
Definition
protamine!
Term
PTT result indicating heparin therapy is in therapeutic range..
Definition
60-80 seconds.
Term
a Rx for lovenox is based upon..
Definition
pts weight, if ordered twice a day, should be every 12 hours
Term
pt prescribed aspirin should take it how if experiencing chest pain?
Definition
chew and swallow a tablet with a glass of water (any dose size)
Term
high doses of aspirin should be discontinued how long before a surgery?
Definition
1 week
Term
aspirin can cause what in children w a possible viral infection
Definition
reyes syndrome
Term
there may be no sxs for a person on longeterm aspirin who has a
Definition
stomach ulcer
Term
pts with high levels of ASA may exhibit
Definition
ringing in the ears
Term
baby w ASA toxicity, breaths: 14, what would lab results look like? ph
Definition
low breathing rate= low pH, increased CO2,
Term
a pt with aspirin rx should avoid..
Definition
ibuprofen
Term
enteric coated tablets..
Definition
irritate the stomach the least
Term
alpha receptor antagonists end in what?
Definition
-osin
Term
minipress should be taken in the..
Definition
morning
Term
viagra and alpha adrenergic antagonists can cause what
Definition
hypotension and vascular collapse
Term
beta receptor antagonists ends in what?
Definition
lol
Term
what would warrant withholding a beta blocker and contacting the prescriber?
Definition
apical pulse of 48 beats per minute
Term
metoprolol can cause excessive cardiosuppression if taken with..
Definition
verapamil
Term
the most common adverse affect with clonidine is..
Definition
rebound hypertension
Term
clonidine patients should take a larger dose at..
Definition
bedtime
Term
diabetic on lasix should be monitored for
Definition
increased thirst confusion and dry hot skin
Term
lab tests for high ceiling diueretics
Definition
electrolytes, glucose, LDL/HDL, uric acid
Term
signs of hypokalemia for pts on lasix
Definition
muscle weakness and constipation
Term
which OTC can counteract diuretics?
Definition
ibuprofen
Term
diuretic recommended for early HTN
Definition
thiazide
Term
spironalactone+ what? may increase risk for hyperkalemia
Definition
-pril, -sartan (A I's, angiotensin receptor blockers)
Term
ARB drugs end in what suffix? angiotensin receptor blockers.
Definition
sartan
Term
ACE i"s end in what suffix?
Definition
pril
Term
adverse effect of ACE i's
Definition
dry cough
Term
ACE i's lab tests..
Definition
fasting blood sugar, Na, K
Term
Ace-i, plus salt substitute can show up as what on an EKG
Definition
tall, peaked T waves
Term
do not take what with ACEi's
Definition
nsaids
Term
lab result that could increase the risk for lithium toxicity
Definition
low Na, less than 135
Term
a less selective drug means..
Definition
it affects more areas, therefore MORE side effects
Term
CCBs lower BP by
Definition
vasodilation
Term
dihydropyridine CCBs primarily effect
Definition
arterioles
Term
verapamil and diltiazem causes
Definition
reduce force of contraction, av node suppression
Term
dihydropyridine CCB drug suffix is
Definition
pine
Term
priority assessment before adminstering diltizem/cardizem
Definition
apical pulse
Term
verapamil and beta blocker- check for..
Definition
crackles in lungs, SOB, weight gain of 3 lbs in 24hr
Term
digitalis toxicity sxs
Definition
anorexia and nausea, low potassium
Term
hydralazine works by..
Definition
reducing the work of the heart by expanding the space in vessel into which the heart is ejecting blood
Term
orthostatic hypotension is more likely to occur in a patient who is receiving a venous vasodilator or arteriole vasodilator?
Definition
venous vasodilator
Term
an adverse reaction hydralazine that should be reported
Definition
120 bpms
Term
reflex tachycardia can be treated by which drug
Definition
lol- BABs
Term
which drug is prescribed for pts w heart failure who are prescribed hydralazine (which causes sodium retention)?
Definition
furosemid/lasix
Term
when a patient is NOT ambulatory, where would signs of edema first normally appear?
Definition
saccral area
Term
BP is best assessed when patient is in what position?
Definition
sitting with feet flat on floor
Term
reflex tachy would be most likely experienced by a pt on which med?
Definition
a direct acting vasodilator
Term
what is the most important part of pt education with hypertensive meds?
Definition
COMPLIANCE AND ADHERENCE
Term
which is the most alarming respiratory finding?
Definition
high pitched musical inspiration, AIRWAY!
Term
the recommended time goal for lowering BP when a pt is in acute congestive heart failure
Definition
60 minutes
Term
beta blockers may mask..
Definition
symptoms of hypoglycemia
Term
CHF drug that decreases aldosterone production that results in vasodilation and mild reduction in blood volume
Definition
ARBS- sartan sisters- angiotensin receptor blockers
Term
chf drug that is effective when kidney function is impaired
Definition
furosemide/lasix, high ceiling loop diuretics
Term
CHF drug that increases force of contraction, decreases heart rate reduces vasoconstriction and increases urine production
Definition
DIGOXIN
Term
CHF drug that increases level of kinins and decrease aldosterone- resulting in vasodilation
Definition
ACE i's- pril!, angiotensin converting enzyme inhibitors
Term
CHF drug that prolongs survival of HF pts by blocking aldosterone receptors and preventing heart remodeling, heart and vascular fibrosis, baroreceptor dysfunction, and dysrythmias - excretes water and sodium, conserves K
Definition
- aldosterone receptor antagonists- spironolactone
Term
Chf drug that reduces blood volume, can cause hypokaelmia and increase the risk of digitalis toxicity- not effective when kidney function is impaired
Definition
thiazide diuretics
Term
Chf drug that slightly reduces blood volume by causing loss of Na, and water with conservation of K
Definition
K sparing diuretics- triameterene
Term
chf drug that slows the heart rate and can reduce the force of contraction if dose not carefully titrated
Definition
beta adrenergic blockers, metoprolol- BAB lol
Term
BNP elevation- b-natriuretic peptide suggests Hf because..
Definition
bnp is released when the hearts chambers stretch
Term
if nurse cannot hear apical pulse of patient with HF, she should move the stethoscope to the..
Definition
left side
Term
nitrogylcerin and isosorbide reduce the workload of the myocardium by..
Definition
decreasing the amount of blood returning to the heart
Term
drug induced lupus like syndrome can cause..
Definition
kidney problems
Term
anorexia and nausea are signs of which electrolyte imbalance?
Definition
hypokalemia
Term
blocking this ion from entering slows depolarization..
Definition
sodium channels
Term
blocking this ion from exiting can reduce the force of contraction
Definition
calcium entry
Term
blocking this ion from exiting increases the amount of time when the cell cannot be stimulated to contract
Definition
potassium channels
Term
primary nursing dx for a pt w dysrhythmia
Definition
alteration in cardiac output
Term
LDL should be less than
Definition
a 100, but better below 70
Term
HDL should be..
Definition
more than 60, less than 40 is bad
Term
triglyceride levels..
Definition
below 150 is desirable, 600 is crazy.
Term
which complication of diabetes causes the most deaths?
Definition
cardiovascular effects
Term
what defines intensive insulin therapy?
Definition
requires four injections of a rapid acting insulin each day in addition to an injection of a basal insulin
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