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Pharmacokinetics

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refers to how medications travel through the body.

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Absorption

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Transmission of medication from location of administration to the blood stream.

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Distribution

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Transportation of medications to site of action by body fluids.

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Metabolism

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Changes medications into less active forms or inactive forms by enzymes. Primarily happens in the liver.

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Excretion

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Elimination of medications from the body. Usually the kidneys but can be liver, lungs, bowel and exocrine glands.

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protein, target tissues

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The ability of a medication to bind to a ___ can effect how the medication will leave and travel to ___

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Low Therapeutic Index

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Medications have this and they must be monitored by serum medication level monitoring

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Trough Levels

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Drawn immediately before the next medication dose, regardless of the route of administration.

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Half Life

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Refers to period f time needed for the medication in the body to be reduced by 50%

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Long Half Life

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Medications leave the body more slowly; more than 24 hours. Greater risk for medication accumulation and toxicity.

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Agonist

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Medication that can mimic the receptor activity regulated by endogenous compounds. i.e. morphine because it activates the receptors that produce analgesia, sedation, constipation, and other effects. drug that produces a response

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Antagonist

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Medication that can block normal receptor activity regulated by endogenous compounds or receptor activity caused by other medications. i.e. losartin works by blocking angiotensin II receptor blockers on blood vessel, which prevents vasoconstriction. Drug that blocks a response

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Partial Agonists

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May act as agonist/antagonist. Limited affinity to receptor site. i.e. nalbuphine acts as an antagonist at mu receptors and an agonist at kappa receptors, causing analgesia at low doses, with minimal respiratory depression.

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Non-parenteral routes of Administration

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Oral, sublingual, transdermal, topical, opthalamic, otic, rectal, vaginal, nasal.

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Therapeutic Effect

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This is the preferred and expected effect for which the medication is administered to a specific client.

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Side Effects

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Usually expected and inevitable when a medication is administered at a therapeutic dose.

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Adverse Effects

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There are undesired, inadvertent, and unexpected dangerous effects of the medication.

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Toxic Effects

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Medications can have specific risks and manifestations of toxicity.

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Components of a prescription

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Clients full name, date and time of prescription, name of medication, dosage of medication, route of administration, time and frequency, signature of provider.

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Six Rights of Safe Medication Administration

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Right Client, Right Drug, Right Dose, Right Time, Right Route, Right Documentation.

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Diabetes mellitus

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Chronic illness that results from an absolue or relative deficiency of insulin, often combined with cellular resistance to insulin's actions.

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Rapid-acting

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Humalog. Onset less than 15 minutes; peak 30min-1hr; Duration 3-4 hours

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Short-acting

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Regular (Humulin R). Onset 30min-1hr; Peak 2-3 hr; Duration 5-7hr

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Intermediate-acting

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NPH (Humulin N). Onset 1hr; Peak 4-12 hr; duration 18-24 hr.

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Long-acting

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insulin glargine (Lantus,Levemir). Onset 1hr; has no peak; duration 24hr

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The purpose of insulin

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promote cellular uptake of glucose, converts glucose into glycogen, and moves potassium into cells (along with glucose).

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Diabetic Ketoacidosis

answer

One of the most serious complications of hyperglycemia. Caused by drawing fluid out of the cell into circulation, excreted by kidneys. Results in Polyuria, dehydration & electrolyte imbalance. This increases fat metabolism and ketones, resulting in metabolic acidosis.

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Hyperglycemic nonketotic syndrome

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blood glucose level about 600mg/dl resulting in diabetic coma

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Hypoglycemia acute onset

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low blood glucose level. symptoms in include; tachycardia, palpitations, diaphoreses, shakiness

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Hypoglycemia gradual onset

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low blood glucose level. symptoms include; headache, tremors, weakness,

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Metformin (Glucophage)

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Reduces production of glucose from the liver by suppression of gluconeogenesis. In a nut shell it prevents glucose from being made and forces body to use what is in storage. used as first medication in diabetes 2 because drug does not induce weight gain or hypoglycemia and has few adverse effects.

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Thiazolidinedionesn (Glitazones)

answer

Increase cellular response to insulin by decreasing insulin resistance.

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Alpha glucosidase inhibitors (Precose, Glyset)

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Slows carbohydrate absorption and digestion

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Hepatotoxicity

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Liver toxicity due to drug accumulation. most drugs are metabolized in the liver and it is vulnerable to drug-induced injury.

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Extrapyramidal symptoms (EPS)

answer

Abnormal body movements such as tremors, rigidity, uncontrolled restlessness, spastic movement of head, neck, eyes, and it can take months to develop. Common with mental disorder meds

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Anticholinergic Effects

answer

(drying effect). Dry mouth, photophobia, urinary retention.

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Toxicity

answer

is severe or a life threatening condition. It can be caused by excessive dose but can occur at therapeutic levels.

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Allergic Reaction

answer

is an immune response to a medication. You have to have been previously exposed and develop antibodies. Can be minor or serious; rash and hives to anaphylaxis.

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Immunosuppression

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Is a decreased or absent immune response.

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Central Nervous System Effects

answer

may result from stimulation or depression of the CNS.

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Cardiovascular Effects

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may involve blood vessels and the heart. Antihypersensitives can cause orthostatic hypotension.

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Gastrointestinal Effects

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may result from local irritation of the GI tract. Stimulation of the vomiting center also results in adverse effects.

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Hematologic Effects

answer

relatively common and potentially life-threatening with some groups of medications. Bone marrow depression, anticancer drugs, anticoagulants, thrombolytics.

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Nephrotoxicity

answer

may occur with a number of medications, but is primarily the result of antimicrobial agents and NSAIDs. Impaired kidney function may interfere with excretion, leading to accumulation and adverse effects.

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Anaphylactic Reaction

answer

Life threatening immediate allergic reaction that causes respiratory distress, severe broncho-spasm, and cardiovascular collapse.

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Consuming foods with tyramine

answer

while taking MAOIs can lead to hypersensitve crisis.

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Vitamin K

answer

can decrease the therapeutic effects of warfarin (Coumadin) and place clients at risk for developing blood clots.

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Tetracycline

answer

can interact with a chelating agent such as milk, and form an insoluble, unabsorbable compound.

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Grapefruit Juice

answer

seems to act by inhibiting presystemic medication metabolism in the small bowel, thus increasing absorption of certain oral medications such as nifedipine (Procardia) a calcium channel blocker. may cause drug toxicity.

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Morphine (Duramorph)

answer

depresses respiratory function, so it should be used cautiously with asthma or impaired respiratory function.

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Pregnancy Category A

answer

There is no evidence of risk to the fetus during pregnancy based on adequate and well-controlled studies

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Pregnancy Category B

answer

There is no evidence of risk to animal fetus based on studies but there are no adequate and well controlled studies in pregnant women or there is risk in animal fetus but studies in pregnant women show no risk to the fetus

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Pregnancy Category C

answer

Adverse effects have been demonstrated on animal fetuses, but there are no adequate and well controlled studies in pregnant. The use of these medications during pregnancy may be warranted based on potential benefits/

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Pregnancy Category D

answer

Adverse effects have been demonstrated on human fetuses. use may be warranted on potential benefits.

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Pregnancy Category X

answer

Adverse effects have been demonstrated on animal and human fetuses. The use of these medications are contraindicated during pregnancy because risks outweigh benefits.

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Liver and Kidney Function

answer

are immature in young children and often decreased in older adults.

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Tolerance

answer

Responsiveness to a medication is reduced and may require higher doses.

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Inadequate gastric acid

answer

inhibits the absorption of medications that require acid to dissolve

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Diarrhea

answer

causes oral medications to pass through the GI tract too quickly to be absorbed

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Vascular insufficiency

answer

prevents distribution of medications to affected tissue

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Liver disease/failure

answer

impairs medication metabolism, which may cause toxicity

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Kidney disease/failure

answer

prevents or delays medication excretion, which may cause toxicity.

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Medication error

answer

an event that results in a patient receiving inappropriate medication or failing to receive it as prescribed

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Parenteral Routes of Administration

answer

intramuscular, subcutaneous, intradermal, intravenous, intratracheal, and epidural.

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Accumulation

answer

Process which occurs when the rate of drug administration exceeds drug excretion resulting in gradual increase in the blood level of the drug

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Bioavailability

answer

The percentage of an administered dose which is absorbed. The rate and extent to which an active drug or metabolite enter the general circulation, permitting access to the site of action.

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Cross-tolerance

answer

a situation in which the development of tolerance to one drug creates a tolerance to other drugs with similar pharmacological effects

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Efficacy

answer

The ability of a drug to produce a specific result, regardless of dosage.

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Hepatic First Pass effects

answer

a phenomenon which occurs whereby a drug which has been absorbed by the GI system is extensively metabolized by the liver prior to reaching the systemic circulation

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Idiosyncratic reactions

answer

An unusual response to a drug. It can manifest as an accelerated, toxic, or inappropriate response to the usual therapeutic dose of a drug

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peak drug level

answer

the highest plasma concentration of a drug at a specific time

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Pharmacodynamics

answer

Study of drug concentration and its effect on a living organism

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Pharmacogenetics

answer

Area of pharmacology that examines the role of genetics in drug response.

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Placebo

answer

a physiological benefit from a compound that may not have the chemical structure of a drug effect

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insulin lipodystrophy

answer

the loss of local fat deposits in patients with diabetes as a complication of repeated insulin injections into the same subcutaneous tissue

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sustained release and enteric coated capsules

answer

must be swallowed whole to be effective.

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Deltoid

answer

the site that is easily accessible but not suitable for repeated injections or injections of more than 2 ml

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Following rectal insertion of suppository

answer

client should remain in a side-lying position for 5-10 minutes

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intradermal

answer

3/8-5/8 inches in length needle

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Intramuscular

answer

1/2-1 1/2 inch needle

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Subcutaneous

answer

1/2-5/8 inch in length needle

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Pharmacokinetic factors specific to children

answer

Decreased gastric acid, slower gastric emptying, decreased first pass metabolism, increased absorption of topical medication, lower blood pressure, higher body water content. Decreased serum protein binding sites until 1 year.

question

Pharmacokinetic factors specific to older adults

answer

increased gastric pH (alkaline), decreased GI motility and gastric emptying, decreased blood flow through cardiovascular system, liver, and kidneys, decreased hepatic enzyme function, decreased kidney function and glomerular filtration rate, decreased protein binding sites, decrease body water, increased body fat, and decreased lean body mass.

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vancomycin

answer

is excreted unchanged in the kidneys and should be used cautiously in a client who has renal impairment

question

digoxin

answer

clients taking __ should be monitored closely for dysrhythmias. Hyperkalemia places client at higher risk for toxicity

question

Safety of insulin therapy in older adults

answer

may be affected by reduced vision, mobility and coordination problems, and decreased memory.

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Insulin

answer

is a small protein that is destroyed by stomach acids and intestinal enzymes. that is why it should be injected

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48 hours

answer

metformin should be withheld for __ before and after using contrast material and surgical procedures requiring anesthesia.

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Kidney disease

answer

Metformin should not be given to anyone with ___ and elevated creatnine levels. most common side effects are abdominal discomfort and diarrhea.

question

conditions that decrease drug clearance

answer

Metformin is contraindicated in___ ___ __ __ ___ , such as liver disease, alcoholism, or severe congestive heart failure

question

lactic acidosis

answer

Meformin can cause __ __ in patients with renal insufficiencies with presenting symptoms; fatigue, unusual muscle pain, difficulty breathing, unusual or unexpected stomach discomfort, dizziness lightheadedness, or irregular heartbeats.

question

fluid retention

answer

Major side effects in TZD treatment are an increase in adipose tissue and __ ___

question

abdominal discomfort

answer

The most common side effects of Alpha-Glucoidase Inhibitors (Acarbose) include; flatulence, diarrhea, and ___ ___ .

question

Black Box Warning

answer

is a government designation indicating that a drug has at least one serious side effect and must be used with caution.

question

0.5- 1

answer

A usual starting dose of insulin is between__ unit/kg of body weight per day.

question

blood glucose

answer

The patients patterns__ __ determines insulin dosage

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more normal

answer

Mixture of short and intermediate acting insulins produce a__ __ blood glucose response in some patients than does a single dose.

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mixed insulin

answer

Patients response to__ __ may differ from the response to the same insulins given seperately.

question

shorter acting

answer

When rapid acting or short acting insulin is mixed with a longer acting insulin, draw the ___ ___ dose first.

question

15 minutes

answer

When rapid acting insulin is mixed with an intermediate acting or long acting, the mixture should be given with ___ __ before a meal.

question

lipoatrophy

answer

is a loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in insulin

question

Lipohypertrophy

answer

is an increased swelling of fat that occurs at the site of repeated insulin injections

question

Dawn Phenomenon

answer

fasting hyperglycemia that results from nighttime release of growth hormone. it is managed by providing more insulin for the overnight period.

question

When should patients be instructed to take antacids for optimal effect

answer

At least one hour apart from other medications. They may interfere with absorption of other medications if taken together

question

How long can unopened insulin be stored and where?

answer

in the fridge until expiration date.

question

How long can premixed insulin be stored?

answer

3 months

question

How do you store premixed insulin in syringes?

answer

1-2 weeks, vertical with needle up and should be rotated to mix before administering.

question

How should an opened vial of insulin be stored?

answer

At room temperature; no sunlight or heat and discard after 1 month.

question

Why are alpha receptor blockers and angiotensin converting enzyme inhibitors less effective in African Americans?

answer

They have abnormally low levels of the enzyme that metabolizes these drugs. Diuretics are more commonly used to treat their hypertension.

question

How do diuretics lower blood pressure?

answer

They help rid you body of sodium and water. They decrease the amount of fluid by pulling it from the vessels and excreting it through the kidneys. The lesser amount of fluid flowing through the blood vessels decreases the pressure of the blood on arterial walls.

question

Why are inhaled steroids not recommended for acute asthmatic episodes?

answer

They do not produce immediate effects. They are better used for prophylactic measures.

question

diabetes insipidous

answer

disorder of the posterior lobe of the pituatary gland that causes excessive thirst and excretion of large volumes of dilute urine

question

non-sulfonylurea secretagogue

answer

type of oral anitidiabetic agent that stimulates insulin release; also called glinide

question

polydipsia

answer

excessive thirst and fluid intake

question

polyphagia

answer

excessive hunger

question

polyuria

answer

excess urination

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