NUR 331 Applied Pharmacology and Pathophysiology
Northern Arizona University
From class notes
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| 4592375274 | Drug | Any chemical that affects living processes. | 0 | |
| 4604231471 | Examples of a drug | ~ Alcohol. ~ Tobacco. ~ Coffee. ~ Oxygen. | 1 | |
| 4604192600 | Pharmacology | The study of drugs and their effects in living systems. | 2 | |
| 4604194134 | Clinical pharmacology | The study of drugs and their effects in humans. | 3 | |
| 4604196099 | Pharmacotherapeutics | The use of drugs to diagnose, prevent, and treat disease. | 4 | |
| 4604200285 | Drugs in nursing | Requires the understanding of pathophysiology and pharmacology. | 5 | |
| 4604238561 | 3 names of a drug | ~ Chemical name. ~ Generic name. ~ Trade name. | 6 | |
| 4604239799 | What is the preferred name of a given drug? | Generic name. | 7 | |
| 4604241729 | Common sources of drugs | ~ Plants. ~ Animals. ~ Minerals. ~ Synthetic. | 8 | |
| 4604246790 | Categories of drug | ~ Prescription ~ Supplement ~ Over the counter | 9 | |
| 4604247672 | Prescription drugs | ~ Prescribed by MD, DO, NP, PA, NMD ~ Prescription requires DEA #. | 10 | |
| 4604250581 | Supplement drugs | ~ Commonly for dietary purposes. ~ Not regulated by FDA. ~ Rigorous research and clinical trials are not performed to determine the effects. ~ No prescription required. | 11 | |
| 4604253391 | Over the counter drugs | ~ Almost half of the US population uses several times per week. ~ No prescription required. | 12 | |
| 4604315004 | 2 major groups of medication administration route | ~ Parental, bypassing the GI. ~ Enteral, absorbed via GI and then the liver, not including sublingual and buccal. | 13 | |
| 4604308418 | Routes of medication administration | ~ Intravenous. ~ Intramuscular. ~ Subcutaneous. ~ Sublingual. ~ Oral. ~ Buccal. ~ G-tube, NG-tube, NJ-tube. ~ Topical. ~ Inhalation. ~ Ophthalmic. ~ Rectal. ~ Vaginal. | 14 | |
| 4604335594 | Advantages of IV | ~ Rapid onset. ~ Precise control over drug levels. ~ Permits use of larger fluid volumes. ~ Permits use of irritant drugs. ~ Absorption is not required. | 15 | |
| 4604339690 | Disadvantages of IV | ~ Irreversible. ~ Expensive. ~ Inconvenient. ~ Poorly suited for self-administration. ~ Risk of fluid overload, infection, embolism. ~ Drug must be water soluble. | 16 | |
| 4604347506 | Advantages of IM/SubQ | ~ Permits use of poorly soluble drugs. ~ Permits use of depot preparations. | 17 | |
| 4604354145 | Disadvantages of IM/SubQ | ~ Possible discomfort. ~ Inconvenient. ~ Potential for injury. | 18 | |
| 4604356351 | Advantages of oral | ~ Easy. ~ Convenient. ~ Inexpensive. ~ Ideal for self-medication. ~ Potentially reversible, and safer than parenteral routes. | 19 | |
| 4604357610 | Disadvantages of oral | ~ Variability. ~ Inactivation of some drugs by gastric acid and digestive enzymes. ~ Possible nausea and vomiting from local irritation. ~ Patient must be conscious and cooperative. | 20 | |
| 4604373475 | Examples of intervals of medication administration | ~ STAT (immediately and within 15 minutes). ~ ASAP/NOW (within 60 minutes). ~ Q day. ~ Q AM. ~ BID. ~ Q 1 hr. ~ Q 12 hr. ~ PRN. | 21 | |
| 4604427699 | TJC/JCAHO Do Not Use List | ~ U or u. (Write "unit.") ~ IU. (Write "International Unit.") ~ Q.D., QD, q.d., qd. (Write "daily.") ~ Q.O.D., QOD, q.o.d., qod. (Write out "every other day.") ~ Trailing zero. ~ Lack of leading zero. ~ MS. (Write "morphine sulfate.") ~ MSO4 and MgSO4. (Spell it out.) | 22 | |
| 4604489767 | US Standard Measurements | ~ 1 gallon = 4 quarts = 8 pints = 16 cups 128 fluid ounces. ~ 1 pound = 16 ounces. ~ 1 mile = 1760 yards = 5280 feet = 63360 inches. | 23 | |
| 4604508204 | 1 kg in pounds | 2.2 pounds | 24 | |
| 4604508205 | 1 pound in kg | 0.453592 kg | 25 | |
| 4604512812 | 1 ml in fluid ounce | 0.033814 fluid oz | 26 | |
| 4604517565 | 1 fluid ounce in ml | 29.5735 ml | 27 | |
| 4592384951 | Assess (step of drug use process) | ~ Assess the need. ~ By self or by healthcare provider. | 28 | |
| 4592392759 | Prescribe (step of drug use process) | ~ Prescribe the medication, amount, route, frequency. ~ By self or by healthcare provider. | 29 | |
| 4592375275 | 5 steps of the drug use process | 1. Assess. 2. Prescribe. 3. Dispense. 4. Administer. 5. Monitor. | 30 | |
| 4592395926 | Dispense (step of drug use process) | ~ From a pharmacy, dispenser, drug cabinet. ~ By self or by healthcare provider. | 31 | |
| 4592398087 | Administer (step of drug use process) | ~ By self or by caregiver in an outpatient setting. ~ By the healthcare provider in a clinical setting. | 32 | |
| 4592403726 | Monitor (step of drug use process) | ~ For efficacy of effects, signs and symptoms of side effects. ~ By self or by healthcare provider. | 33 | |
| 4592416733 | Medication error in the assess step of drug use process | ~ Caused by incomplete or incorrect assessments ~ Ex: Failure to weigh the patient. Misdiagnosing and deciding to use the wrong medication | 34 | |
| 4592431641 | Medication error in the prescribe step of drug use process | ~ The wrong medication or amount is prescribed. ~ Ex: Trailing zero. Leading zero. Illegible drug orders. Similar names. | 35 | |
| 4592431642 | Medication error in the dispense step of drug use process | ~ The wrong medication or amount is dispensed. | 36 | |
| 4592431643 | Medication error in the administer step of drug use process | ~ The wrong medication or amount is administered. ~ The wrong route is used. | 37 | |
| 4592432320 | Medication error in the monitor step of drug use process | ~ Failure to recognize adverse drug events. | 38 | |
| 4592459028 | Medication error patient deaths | ~ 98,000 deaths each year. ~ 4th most common cause of patient death. | 39 | |
| 4592464131 | Reporting medication errors and near-misses | ~ Always report for root analysis and improved process. | 40 | |
| 4592466757 | Sentinel event | Any unanticipated event in a healthcare setting resulting in death or serious physical psychological injury to a patient or patients, not related to the natural course of the patient's illness. | 41 | |
| 4592473576 | Adverse drug events | ~ Side effects. ~ Drug interactions. ~ Adverse drug reactions (ADR). | 42 | |
| 4592476389 | Side effects | ~ Often expected. ~ All drugs have side effects. | 43 | |
| 4592483260 | Drug interactions | ~ Interactions between drugs taken concurrently. ~ Effects can be intensified, reduced, or entirely new. | 44 | |
| 4592487516 | Adverse drug reactions (ADR) | ~ Any unintended effect as a result of use or misuse of drugs, or the interaction of two or more drugs. ~ Ex: Allergic reaction. | 45 | |
| 4592494230 | The nursing diagnosis (ADPIE) process and medication errors | ~ Systematic approach significantly reduces errors. ~ The process is used before and after drug administration. | 46 | |
| 4592514683 | Assessment (from ADPIE) and medication | ~ Medication reconciliation. ~ Subjective and objective assessments. | 47 | |
| 4592520362 | Diagnosis (from ADPIE) and medication | ~ Drug caused? ~ What drug can improve the condition? | 48 | |
| 4592520363 | Plan (from ADPIE) and medication | ~ Administer what drug? | 49 | |
| 4592521333 | Intervention/implementation (from ADPIE) and medication | ~ 6Rs of medication ~ Team effort with other healthcare providers. ~ Provide patient education. | 50 | |
| 4592520364 | Evaluation (from ADPIE) and medication | ~ Monitor and reassess drug effects ~ Goals obtained? | 51 | |
| 4592504841 | Medication reconciliation | ~ The process of creating the most accurate list possible of all medications a patient is taking, — including drug name, dosage, frequency, and route — and comparing that list against the physician's admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital. ~ The goal is to reduce errors caused during care transition which is 60% of medication errors. | 52 | |
| 4605766827 | 5 steps of medication reconciliation | 1. Create a list of current medications including the name, indication, route, dosage, dosing interval of all drugs taken at home, including vitamins, herbal products, and prescription and nonprescription drugs. 2. Create a list of all medications to be prescribed in the new setting. 3. Compare the medications on both lists. 4. Adjust medications based on the comparison. 5. Hand off the reconciled list to the patient and the new provider at care transitions. | 53 | |
| 4605794510 | When to conduct a medication reconciliation | ~ Hospital admission. ~ Care transition. ~ Hospital discharge. | 54 | |
| 4592500235 | 6 rights of medication | ~ Patient. ~ Drug. ~ Dose. ~ Time. ~ Route. ~ Documentation. | 55 | |
| 4592535957 | 3 phases of drug action | 1. Pharmaceutic. 2. Pharmocokinetic. 3. Pharmacodynamic. | 56 | |
| 4592539842 | The goal of medications | To obtain maximal effects with minimal harm. | 57 | |
| 4592541847 | Pharmacokinetics | ~ What the body does to the drug. ~ Membrane drug movement by diffusion, channels, or active transport. | 58 | |
| 4592548212 | 4 pharmacokinetic processes | 1. Absorption. 2. Distribution. 3. Metabolism (biotransformation). 4. Excretion. | 59 | |
| 4592553125 | Absorption (in pharmacokinetic process) is affected by | ~ The route of administration. ~ Solubility. ~ Blood flow. ~ Surface area of site of absorption. ~ Time of exposure. ~ Food. ~ Age. ~ Illness. | 60 | |
| 4605819112 | The route of administration that absorption does not apply to | IV. | 61 | |
| 4592574522 | Bioavailability | ~ The amount of drug that reaches vasculature after first pass. ~ IV route is 100% bioavailable. | 62 | |
| 4592553126 | Distribution (in pharmacokinetic process) | ~ Drug movement throughout the body from vasculature, interstitial, to intracellular. ~ By P-glycoprotein. ~ Affected by the volume and solubility. ~ Many drugs are albumin bound, and low albumin levels can cause issues. | 63 | |
| 4592553127 | Metabolism (biotransformation) (in pharmacokinetic process) | ~ The act of oxidation, reduction, hydrolysis, conjugation. ~ Occurs in the liver by the CYP450 enzyme system. | 64 | |
| 4592553128 | CYP450 enzyme system | ~ Major enzyme system in the liver involved in drug metabolism. ~ Can deactivate active chemicals or bioactivate inactive chemicals. ~ This is why some drugs cannot be given PO. | 65 | |
| 4592553129 | Excretion methods (in pharmacokinetic process) | ~ By diffusion or active transport. ~ By renal system (for most drugs). ~ By bile (which can cause enterohepatic recirculation). ~ Breast milk. ~ Lungs. ~ Sweat. ~ Saliva. | 66 | |
| 4604674168 | Elimination of drugs determine? | The duration of the drug. | 67 | |
| 4592604329 | Serum drug levels | ~ Affected by the pharmacokinetics. ~ Highly predictable for therapeutic and toxic levels. | 68 | |
| 4592613933 | Toxic concentration of drug | ~ Serum drug levels that cause adverse effects. | 69 | |
| 4592615430 | Minimum effective concentration (MEC) | ~ The minimum serum drug level that produces desired effects. | 70 | |
| 4592620674 | Therapeutic range | ~ The serum drug level above minimum effective concentration and the toxic concentration of drug. | 71 | |
| 4592628664 | Half-life | ~ The time it takes to decrease the level to 50%. ~ Consider the rule of thumb and plateau (steady-state) level. | 72 | |
| 4592641420 | Plateau (steady-state) level of medication | ~ After multiple administrations of a drug, a point is reached where the elimination of the drug is equal to dose administered. ~ Use the rule of thumb. | 73 | |
| 4592645887 | The rule of thumb to achieve the plateau level of medication | ~ After four administration and half-lives independent of drug dosage, the plateau is achieved. ~ If the drug is discontinued, it will take four half-lives to eliminate. | 74 | |
| 4592798980 | Peak and trough of drug accumulation | ~ Keep serum drug levels below the toxic level and above minimum effective concentration. ~ The peak is taken right after the 4th dose is administered. ~ The trough is taken right before the 5th dose is administered. | 75 | |
| 4592802693 | Loading dose | A high first dose and then subsequent normal doses to reach plateau more quickly. | 76 | |
| 4592669274 | Pharmacodynamics | ~ What the drug does to the body. ~ Enhance or inhibit existing functions of cells. ~ Graded dose response. ~ Maximal efficacy. ~ Potency. ~ Drug receptors. ~ Target molecules. ~ Individual variation exist. ~ Tolerance can develop. ~ Tachyphylaxis. ~ Withdrawal. | 77 | |
| 4592670202 | 3 phases of graded dose response | 1. Too low of dose to elicit measurable response. 2. Higher dose leads to higher response. 3. Point where a higher dose will no longer contribute to an increase in desired response. | 78 | |
| 4592704606 | Maximal efficacy of drugs | ~ Largest possible response a drug can produce. ~ The dose transitioned from end of phase 2 to phase 3. | 79 | |
| 4592712626 | Potency of drugs | ~ The amount of drug needed to produce a desired response. ~ Not related to maximal efficacy. | 80 | |
| 4592730183 | Drug receptors | ~ Binding of drugs to receptors elicits response to stimulate or inhibit. ~ Four receptor families in the body. ~ Usually reversible. | 81 | |
| 4592732770 | Target molecules | ~ Drugs that bind to cellular molecules and elicit desired response ~ Ex: Enzymes. Ribosomes. Tubulin. | 82 | |
| 4605829771 | Agonist | ~ A substance that fully activates the receptor that it attaches to. ~ Activates. | 83 | |
| 4605829772 | Antagonist | ~ A substance that attaches to a receptor but does not activate it or if it displaces an agonist at that receptor it seemingly deactivates it thereby reversing the effect of the agonist. ~ Inhibits. | 84 | |
| 4592755759 | 4 receptor families | ~ Cell membrane-embedded enzymes. ~ Ligand-gated ion channels. ~ G protein coupled receptor systems. ~ Transcription factors. | 85 | |
| 4592813770 | Cell membrane-embedded enzymes | ~ Cellular membrane receptor that stimulates enzyme production ~ Ex: Insulin acts on this receptor. | 86 | |
| 4592816053 | Ligand-gated ion channels | ~ Cellular membrane channel that opens or closes channels for specific ions ~ Ex: Na. Ca. | 87 | |
| 4592818005 | G protein-coupled receptor systems | 1. Cellular membrane receptor activates. 2. G protein activates. 3. Effector activates. Ex: Norepinephrine acts on this system. | 88 | |
| 4592823724 | Transcription factors | ~ Act within cell on DNA on regulate protein synthesis. ~ Ex: Thyroid hormone. Steroid hormone. | 89 | |
| 4592825705 | Selective drugs | ~ The higher the selectivity, the less side effects. ~ Receptors can be responsible for multiple effects. | 90 | |
| 4592829999 | Affinity | Attraction to receptor. | 91 | |
| 4592830998 | Intrinsic activity | Receptor activation. | 92 | |
| 4605842254 | Individual variation of pharmacodynamics | Requires the use of small doses in the beginning, and then titrating to response. | 93 | |
| 4605836329 | Pharmacodynamic tolerance | ~ Long use of an agonist can lead to higher MEC secondary to desensitization or refractory responses due to receptor destruction or modification by the cell. ~ Long use of an antagonist can cause hyper-sensitivity. | 94 | |
| 4605835010 | Metabolic tolerance | Accelerated drug metabolism occurs due to the drug stimulating the liver to produce more enzymes. | 95 | |
| 4592844804 | Tachyphylaxis | Rapidly diminishing response to successive doses of a drug, rendering it less effective. | 96 | |
| 4592847068 | Withdrawal | ~ Prolonged use of a drug can cause the body to become physically dependent. ~ The body may no longer produce the agent which elicits the same effects as the drug, and sudden discontinuation of the drug produces the opposite effects. | 97 | |
| 4592855693 | Pharmacogenomics | ~ The study of how genes affect individual drug responses. ~ Alterations in genes that code for certain drug metabolizing enzymes and targets. ~ Future possibility of individualized drug therapy for certain genotypes. ~ Results in bias such as "drug seekers." | 98 | |
| 4592868767 | FDA pregnancy categories | A. No risk. B. No risk in animals. C. Fetal risk in animals. D. Fetal risk in human. X. Avoid. | 99 | |
| 4605849138 | Pregnancy and drugs | ~ Tetratogenic drugs exist. ~ Pregnancy alters drug metabolism and excretion. ~ Some drugs pass the placental barrier. ~ Breast feeding can transmit drugs to the infant. | 100 | |
| 4592872614 | Teratogenic drug | ~ Drugs that cause gross fetal malformations during organogenesis. | 101 | |
| 4605869238 | Pediatric pharmacology challenges | ~ Dosing is not the same as adults, and not always less. ~ Compliance issues. ~ Body systems are immature, leading to toxicity. ~~ Liver until one year of age. ~~ Blood brain barrier until three months of age. ~~ Renal in neonates. | 102 | |
| 4605878990 | Geriatric pharmacology challenges | ~ Must consider varying physiologic states, disease processes, multiple drug use, compliance, nutrition. ~ Higher sensitivity than younger adults. ~ Declining body systems (liver, renal), leading to toxicity. | 103 |
