Pharm Exam 1 study guide PDF

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chapters on test- intro to drugs, drugs and the body, toxic effects of drugs , the nursing process in drug therapy and patient safety ...

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Chapter 1: Introduction to Drugs https://quizlet.com/260831403/flashcards Pharmacology: study of the biological effects of chemicals Drugs: chemicals that are introduced into the body to cause some sort of change Healthcare providers

Nurses

Focus on how chemicals act on living organisms

Deal with Pharmacotherapeutics

Pharmacotherapeutics: clinical pharmacology; uses drugs to treat, prevent and diagnose disease - Drugs effects on the body and bodys response to the drug Adverse effects: undesired negative effects Side effects: known to happen Genetic engineering: the process of altering DNA The Food and Drug Administration (FDA): an agency of the U.S. Department of Health and Human Services that regulates the development and sale of drugs Nursing responsibilities for drug therapy: - Administering drugs - Assessing drug effects - Intervening to make the drug regimen more tolerable - Providing patient teaching about drugs and drug regimes - Monitoring the overall pt care plan to prevent medication errors Sources of drugs: - Natural - Plants - Marijuana, foxglove (digitalis purpurea), poppy animals - Animals - Insulin for treating diabetes from cows and pigs - Inorganic compounds - Salts; aluminum, fluoride, iron and even gold Synthetic: -

Chemically modified from a natural source

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Ex: Insulin from cows and pigs, aspirin

Preclinical Trials: test on animals - Discarded for: - lack therapeutic activity - Are too toxic; teratogenic - Have small safety margin Phase 1: Test on human VOLUNTEERS - Discarded for: - Are too toxic - Produce unacceptable side effects - In cases in which volunteers with the disease participate, lack of efficacy Phase 2: test on people with disease (know they are getting drug) - Discarded for: - Are less effective than expected - Are too toxic - Produce unacceptable side effects - Have a low benefit to risk ratio - Are not as effective available drugs Phase 3: Drug use in vast clinical market - Discarded for: - Produce unacceptable side effects - Produce unexpected responses FDA APPROVAL Phase 4: continual evaluation of drug

Brand name: trade name; pharmaceutical company that developed it Ex: advil/tylenol Generic name: original designation that the drug was given when the drug company applies for the approval process Ex: Acetaminophen Chemical names: names that reflect the chemical structure of a drug

Pregnancy and Drug Safety:

Category A: adequate studies in women have not demonstrated risk to the fetus in the first trimester of pregnancy, and there is no evidence in later trimesters; NOTHING IS A USUALLY Category B: no controlled studies in humans; animal studies show no risk to the fetus EX: motrin, tylenol Category C: animal studies show adverse effects but there are no adequate human studies EX: antidepressants Category D: evidence of human fetal risk; benefits may outweigh risks in certain situations EX: sedatives Category X: controlled studies in animals or humans demonstrate fetal abnormalities; risk in pregnant women outweighs any possible benefit EX: testosterone

Controlled substances= drugs with abuse potential - Closely monitored by the DEA (Drug Enforcement Agency) - Enforce the codes -

Drugs are given a limited time patent; length of time depends on chemical involved - When patent runs out on a brand name drug, the drug can be produced by other manufacturers Generic Drugs: chemicals that are produced by companies involved solely in the manufacturing of drugs - Bioavailability= the rate and extent to which the parent compound reaches the general circulation

Orphan Drugs: drugs that have been discovered but are not financially viable and therefore have not been adopted by a drug company - Can either be useful drugs that could treat a rare disease (but are not financially viable) or have dangerous adverse effects Over the counter drugs (OTC): products that are available without a prescription for selftreatment for a variety of complaints Sources of Drug info: - Labels and Inserts - Drug label: - have specific info that identifies a specific drug - It is essential to understand how to read a drug label - Package Inserts - Prepared by the manufacturer - Contains the chemical and study info that led to the drug’s approval - Difficult to understand and read - Reference Book - Journals - Internet Info

Chapter 2: Drugs and the Body Pharmacodynamics: how the drug affects the body; study of the interactions between the chemical components of living systems and the living systems and the foreign chemicals, including drugs, that enter living organisms - Drugs usually work is 4 ways: 1. To replace or act as substitutes for missing chemicals 2. Increase or stimulate certain cellular activities 3. Depress or slow cellular activity 4. Interfere with the functioning of foreign cells a. Chemotherapeutic agents: drugs that interfere with the functioning of foreign cell populations, causing cell death Receptor sites: where drug binds to the cell; reacts with chemicals to cause an effect within the cell Agonist: drugs that interact directly with a receptor site to cause the same activity as natural chemicals Antagonist: react with receptor sites to block normal stimulation Competitive antagonist: binds to the same receptor site as agonist, blocks the effects of agonist Noncompetitive antagonist: binds to a site on the receptor other than the agonist-binding site to

prevent activation Drug-enzyme interactions: causes an effect by interfering with the enzyme systems that act as catalysts for various chemical reactions Selective toxicity: property of chemotherapeutic agent that affects only systems found in foreign cells without affecting healthy human

Pharmacokinetics: how the body acts on the drug ** kidneys and liver are organs most affected by drugs - Onset of drug action - Drug half life - Timing of the peak life - Duration of the drugs effect - Metabolism or biotransformation of the drug - Site of excretion Critical concentration: amount of the drug that is needed to cause a therapeutic effect Loading dose: a higher dose than that usually used for treatment to reach the critical concentration Dynamic equilibrium: the actual concentration that a drug reaches in the body ● Absorption from the site of entry ● Distribution to the active site ● Biotransformation (metabolism) ● Excretion from body ABSORPTION: refers to the process of introducing a drug into the body Routes of administration: - Oral, IV, IM, rectal, topical, nasal, inhalation, subq - Oral- safest way of administering drugs; absorbed more slowly Absorption processes: ➢ Passive diffusion: high→ low concentration ➢ Active transport: low→ high concentration; ENERGY!! ➢ Filtration: movement through pores in cell DISTRIBUTION: movement of a drug to the body’s tissues ➔ Protein Binding- refers to the degree to which drugs attach to proteins - The more bound to the med, the more difficult it is for the med to be released and cross membranes to reach tissue cells ➔ Blood-Brain Barrier- protective system of cellular activity that keeps things (ex: foreign invaders) away from the CNS - Drugs that are not lipid soluble have a difficult time passing; most antibiotics are NOT lipid soluble ➔ Placenta and Breast Milk- many drugs pass through the placenta and breast milk

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Only administer drug if benefits outweigh the risks Check the ability of drug to pass through breast milk when giving a drug to breastfeeding mother

BIOTRANSFORMATION (METABOLISM): process when a drug changes to another chemical through a chemical rxn in the body ➔ First-Pass Effect- drugs that are taken orally→ only receiving a portion of the drug because the liver filters the drug ➔ Hepatic Enzyme System EXCRETION: removal of a drug from the body; **kidneys play the main role in this process HALF-LIFE: the time it takes for the amount of drug in the body to decrease to one half of the peak level it previously achieved - Affected by absorption, distribution, metabolism, and excretion - Ex:

Factors Influencing Drug Effects: -

Weight, age, gender, psychological factors, physiological factors, pathological factors, genetic factors, environmental factors, drug tolerance, accumulation factors, interactions, **most vulnerable: - the very young- organs are not fully developed - very old- meds stay in body longer; don’t excrete drug as quickly

Optimal therapeutic effect:

Chapter 3: Toxic Effects of Drugs Adverse effects: undesired effects that may be unpleasant or dangerous Reasons for an adverse effect to occur: ➔ The drug may have other effects on the body besides the therapeutic effect ➔ The patient may be sensitive to the dru ➔ The drug actions on the body may cause other responses that are undesired or unpleasant ➔ The patient may be taking too much or too little of the drug Types of adverse effects: ■ Primary action: overdose; extension of desired effect (a simple overdose) ■ Secondary action: undesired effect produced in addition to the pharmaceutical effect; adverse effects are inevitable ■ Hypersensitivity: excessive response to primary or secondary effect of drug ■ Drug allergy: body forms antibodies to a drug after exposure, causing an immune

response when exposed ➢ 4 types of allergic reactions: i. Anaphylactic: *immediate reaction; mucous membranes swell; bronchi constrict; respiratory distress; hives, rash; panic feeling; increased HR ii. Cytotoxic: cell death; decrease in RBC, WBC and platelets; decreased liver function iii. Serum sickness: antibodies deposit in blood vessels; fever swollen joints and lymph nodes, edema of face and joints iv. Delayed reaction: occurs several hours to days after exposure; rash hives swollen joints

Drug-Induced Tissue and Organ Damage Dermatological Reactions: adverse reactions involving the skin ❖ Rashes, hives: ➢ Assessment: - Abnormalities to the skin, red areas, blisters ➢ Intervention: - Provide skin care - Discontinue drug in severe cases ❖ Stomatitis: inflammation of the mucous membranes ➢ Assessment: - swollen gums, swollen and red tongue, difficulty swallowing, raised areas of tongue ➢ Intervention: - Mouth care Superinfections: destruction of the body’s normal flora (healthy bacteria in the GI tract) ➢ Assessment: - Fever, diarrhea, *vaginal discharge, black or hair tongue - Women can get yeast infections ➢ Intervention: - Mouth and skin care, administer antifungal meds as needed - Stop drug responsible for the superinfection Blood Dyscrasia: blood marrow suppression; drugs cause cell death ➢ Assessment: - Fever, chills, weakness, decreased RBCs, WBCs, and platelets ➢ Intervention: - Monitor blood counts, protective measures

Toxicity: Liver Injury: **First-pass effect: oral drugs carried to liver after absorption ➢ Assessment: - Fever, nausea, jaundice, change in color of urine or stool, elevated liver enzymes ➢ Intervention: - discontinue the drug Renal Injury: ➢ Assessment: - Elevated blood urea nitrogen, elevated creatinine concentration, change in urine pattern ➢ Intervention: - Discontinued drugs as needed Poisoning: when an overdose of a drug damages multiple body systems ➢ Assessment: depends on drug ➢ Intervention: depends on drug

Alterations in Glucose Metabolism: Hypoglycemia: low glucose levels ➢ Assessment: - Fatigue, drowsiness, hunger, anxiety, headaches, cold, clammy skin, shaking and lack of coordination, confusion ➢ Intervention: - Restore glucose Hyperglycemia: high glucose levels ➢ Assessment: - Fatigue, polyuria, polyphagia, polydipsia, hot or flushed skin, fruity breath ➢ Intervention: - Administer insulin therapy to decrease glucose level

Electrolyte Imbalances: Hypokalemia: low potassium levels ➢ Assessment: - Weakness, numbness, muscle cramps, nausea, vomiting, diarrhea, decreased bowel sounds, irregular pulse, disorientation

➢ Intervention: - Replace serum potassium and monitor levels - EKG Hyperkalemia: high potassium levels ➢ Assessment: - Weakness, muscle cramps, slow heart rate, decreased urine output, difficulty breathing ➢ Intervention: - Decrease the serum potassium levels - Monitor cardiac rhythm

Sensory effect: Ocular Damage: ➢ Assessment: - Blurry vision, color vision changes, corneal damage, blindness ➢ Intervention: monitor for vision changes when giving a med that is known to cause ocular damage; discontinue med as appropriate Auditory Damage: ➢ Assessment: - Dizziness, ringing in ears (tinnitus), loss of balance, hearing loss ➢ Intervention: - Monitor for hearing loss; discontinue med as appropriate if decrease in hearing loss is noted

Neurological Effects: General Central Nervous System Effects: ➢ Assessment: - Confusion, delirium, insomnia, drowsiness, hyper/hyporeflexia, bizarre dreams, hallucinations, numbness, tingling ➢ Intervention: - Prevent injury Atropine-like (Anticholinergic) Effects: drugs block effect of the parasympathetic nervous system; blocking cholinergic receptors ➢ Assessment: - Dry mouth, urinary retention, blurred vision ➢ Intervention: - Mouth care; sugarless lozenges to help keep mouth moist Parkinson-like Syndrome: drugs that affect dopamine levels in brain

➢ Assessment: - Lack of activity, muscular tremors drooling, change in gait, jitters, spasms ➢ Intervention: - Discontinue drug Neuroleptic Malignant Syndrome: drugs directly affect the CNS that can cause NMS ➢ Assessment: - Neurological symptoms; slowed reflexes, rigidity, involuntary movements ➢ Intervention: - Discontinue drug if needed

Teratogenicity -

Any drug that causes harm to the developing fetus or embryo Advise the pregnant woman that any med may have possible effects on the baby Weigh the actual benefits against the potential risks Discuss with pregnant women that they should not take meds without checking with their health care provider first Fetal problems related to drug exposure in utero: Fetal death Nervous system disruption Skeletal limb disruption Cardiac defects low -set ears Deafness

Chapter 4: The Nursing Process in Drug Therapy and Patient Safety ***Nurses deal with the whole person; physical, emotional, intellectual, social, cultural, and spiritual aspects; teach the patient how best to cope with the therapy to ensure the most favorable outcome Assessment ★ History ○ Chronic conditions ○ Drug use ○ Allergies ○ Level of education ○ Social support ○ Financial supports $$$$ ○ Pattern of healthcare ★ Physical examination

○ Weight ■ Weight based drugs- pediatrics (mg/kg) *never in pounds ○ Age ■ Drug can damage immature organs (liver and kidneys) of children ○ Physical parameters related to disease or drug effect Nursing Diagnosis ★ Statement of the pt’s status from nursing perspective ★ Shows actual or potential alteration in pt function based on assessment of clinical situation ★ Leads to a particular goal and set of interventions Planning ★ Prioritizing info gathered to plan the pt care ★ Goal setting ★ Ensuring effective response to drug therapy, minimizing adverse effects,understanding drug regiment Implementation ★ Proper Drug Administration ★ Comfort Measures ○ Placebo effect ○ Managing adverse effects ○ Lifestyle adjustment ★ Patient/Family Education Evaluation ★ Continuing process of patient care ★ Leads to changes in assessment, diagnosis, and intervention MEDICATION ERRORS - Physician prescribes drug - Pharmacist dispenses drug - Nurse administers drug NURSE’S ROLE - Right patient - Right drug - Right storage - Right route - Right dose - Right time - Right preparation - Right recording PATIENT’S ROLE - Keep list of meds: Rx, OTC, herbal

- Know which each drug is being used to treat - Read labels, follow directions - Store drugs in dry place, away from children and pets - Speak up Children’s drug regimens - Keep a list of all child’s meds: Rx, OTC, herbal - Never use adult meds to treat child - Read all labels before giving child a drug - Measure liquid meds using appropriate measuring devices - Call healthcare provider immediately if child gets worse or has trouble with a drug - Can also call POISON CONTROL!!! - Don’t hesitate to ask questions!! REPORTING OF MEDICATION ERROR - Must be reported on a national level and international level - Help prevent future recurrences...