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Pharmacology: Understanding Drugs, Their Actions, and Patient Safety, Exams of Nursing

Frontier Nursing University (FNU)Nursing

This comprehensive overview of pharmacology covers key concepts like pharmacokinetics, pharmacodynamics, drug interactions, and patient safety. It explores the study of drugs, their effects on living organisms, and factors impacting drug efficacy and adverse reactions. Topics include the FDA's drug approval process, pharmacokinetic aspects, protein binding, drug half-life, first-pass effect, and drug hypersensitivity. It also discusses medication reconciliation, generic vs. brand-name drugs, ethnopharmacology, and considerations for special patient populations. The document further covers OTC medications, antioxidants, and off-label drug use, serving as a valuable resource for understanding the principles of pharmacology and factors healthcare professionals must consider in drug therapy management.

Typology: Exams

2023/2024

Available from 08/16/2024

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PC707 Module 1 Study Guide | 100% Correct
Answers | Verified | Latest 2024 Version
What is prescriptive authority? - ✔✔Legal right to prescribe drugs
Is the Physicians Desk Reference a reliable source to use when prescribing drugs? - ✔✔No--it is not
evidence-based and it is not updated
What is the sunshine act? - ✔✔
-part of the affordable care act
-limits providers on accepting gifts from pharmaceutical companies
-reduces bias
What is pharmacology? - ✔✔
-study of the drugs and their actions and effects on living things
-legal drugs, illegal drugs, prescription drugs, OTC drugs
How does the FDA define drugs that they approve? - ✔✔-chemicals that have been proved for safety and
efficacy
What must providers consider when prescribing? - ✔✔-the dose
-the route of administration
-indications
-side effects of consequence
-adverse effects
-contraindications
-significant drug-drug interactions
-appropriate monitoring
-treatment of side effects if necessary
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Download Pharmacology: Understanding Drugs, Their Actions, and Patient Safety and more Exams Nursing in PDF only on Docsity!

PC707 Module 1 Study Guide | 100% Correct

Answers | Verified | Latest 2024 Version

What is prescriptive authority? - ✔✔Legal right to prescribe drugs Is the Physicians Desk Reference a reliable source to use when prescribing drugs? - ✔✔No--it is not evidence-based and it is not updated What is the sunshine act? - ✔✔

  • part of the affordable care act
  • limits providers on accepting gifts from pharmaceutical companies
  • reduces bias What is pharmacology? - ✔✔
  • study of the drugs and their actions and effects on living things
  • legal drugs, illegal drugs, prescription drugs, OTC drugs How does the FDA define drugs that they approve? - ✔✔-chemicals that have been proved for safety and efficacy What must providers consider when prescribing? - ✔✔-the dose
  • the route of administration
  • indications
  • side effects of consequence
  • adverse effects
  • contraindications
  • significant drug-drug interactions
  • appropriate monitoring
  • treatment of side effects if necessary

What is pharmacokinetics? - ✔✔-how drugs move in the body and what the body does with it How does pharmacokinetics influence prescribing? - ✔✔-the route

  • the dosage needed
  • dosing intervals What are the 4 aspects of pharmacokinetics? - ✔✔-absorption
  • distribution
  • metabolism
  • excretion What affects bioavailability the most? - ✔✔PO administration What is a pro-drug? - ✔✔-a drug that needs to be metabolized to become "activated" What is the major organ of metabolism? - ✔✔-Liver
  • Uses enzymes called "CYPs"
  • these enzymes can induce or inhibit metabolism What is protein-binding? - ✔✔-drugs that have a high affinity for proteins will bind with them and therefore become unable to bind to receptor sites
  • in order to activate receptors they must be free circulating molecules What is the half-life of a drug? - ✔✔-how long it takes for a drug at its original amount to be reduced by 50% Why is it important to know the half-life of a drug? - ✔✔-to help determine dosing intervals to maintain therapeutic levels What is the first-pass effect? - ✔✔-alteration of the drug dose by metabolism before it reaches systemic circulation

What are contraindications? - ✔✔-do not give

  • the risks outweigh the benefits What are relative contraindications? - ✔✔-the consideration that there are rare exceptions to the rule
  • the risk of NOT taking the medication potentially is greater than the risk of taking it What are precautions? - ✔✔-"warnings"
  • clinically significant
  • providers must weight the risks vs benefits What is a black box warning? - ✔✔-a potential adverse effect is serious enough that the risk must be thoughtfully considered OR
  • a potential adverse effect that can be reduced or eliminated by appropriate use OR
  • FDA has approved with restrictions to assure safe use If a drug has a high protein affinity--the protein binding sites must saturated in order for what to happen? - ✔✔-free drug to be able to circulate and activate receptors When taking two different drugs that are both highly protein bound, how does stopping or starting a drug affect the levels of the other drug? - ✔✔-if one drug is suddenly stopped it opens up protein binding sites for the other drug to bind to--reducing plasma drug levels
  • if a new drug is started--it will replace some of the protein binding sites--which then increases the plasma drug levels of the drug that was already present What sources should providers use when prescribing? - ✔✔-whenever possible you must utilize the highest levels of evidence
  • OR trusted experts in the field (ACOG, CDC, American Cancer Society, etc.)

What is an enzyme inhibitor? - ✔✔-inhibits the enzyme action causing decreased metabolism

  • this can increase the drug levels
  • it can affect all drugs that utilize the same metabolic pathway What is an enzyme inducer? - ✔✔-increases the enzymes that induces metabolism
  • this decreases drug levels
  • it can affect all drugs that utilize the same metabolic pathway What is an agonist? - ✔✔-a drug that binds to AND activates a receptor What is a partial agonist? - ✔✔A drug that binds to and activates a receptor but produces a smaller effect at full dosage than a full agonist What is an antagonist? - ✔✔-A molecule that binds to a receptor but does NOT activate it--it blocks the activating drug from binding to the receptor When is a drug-drug interaction risk the greatest? - ✔✔-when a patient is taking multiple medications (poly-pharmacy) What is the most common cause of ER visits from an adverse drug reaction? - ✔✔-bleeding from anticoagulants Why must a person limit or discontinue use of grapefruit juice when taking certain drugs? - ✔✔-it inhibits metabolism
  • this can increase drug levels--potentially to dangerous levels
  • one cup of juice can inhibit metabolism for up to 72 hours! Rule of safe prescribing? - ✔✔AVOID M pneumonic--Ask and Consider A-Allergies V-Vitamins & Herbs

What is type 4 hypersensitivity? - ✔✔-Cell mediated (cytotoxic t cells)

  • delayed response
  • diffuse, bilateral, symmetrical
  • Ex: drug rash, contact dermatitis, steven-johnson syndrome What is a pseudo allergy? - ✔✔-mast cell degranulation by a non-IgE mediated mechanism
  • Ex: opiate analgesic causes direct mast cell activation--causing itching What does the QT interval represent? - ✔✔ventricular depolarization and repolarization A longer QT interval increases the risk of what? - ✔✔-ventricular dysrhythmias (particularly Torsades de pointe)
  • sudden cardiac death Who is at an increased risk of a long QT interval? - ✔✔-females
  • electrolyte imbalances (hypokalemia, hypomagnesemia, hypocalcemia)
  • renal or hepatic problems
  • taking multiple drugs that can prolong QT interval
  • grapefruit juice that might inhibit metabolism of drugs that prolong QT interval
  • diuretic use (reduces electrolytes)
  • bradycardia
  • underlying cardiac disease
  • digitalis therapy
  • family history of long QT syndrome
  • congenital long QT syndrome What factors can impact pharmacokinetics, pharmacodynamics, drug efficacy and likelihood of drug reactions? - ✔✔-age, sex, weight, genetics, diet, co-existing diseases, etc. Why are pharmaceutical companies less likely to research children? - ✔✔-ethical risks
  • health risks
  • cost Why are infants at a higher risk of adverse effects from drugs? - ✔✔-organ immaturity
  • under-developed blood brain barrier
  • variable peristalsis
  • variable blood flow to muscles
  • increased total % body water (affects distribution)
  • reduced metabolism What is polypharmacy? - ✔✔use of multiple medications Number of drug reactions is closely related to number of drugs a person is taking. True or false? - ✔✔True What are some prescribing issues with the elderly? - ✔✔-polypharmacy
  • disease-drug reactions (Ex: cirrhosis and tylenol)
  • physiologic changes (Ex: renal & hepatic dysfunction)
  • multiple prescriptions from different specialities
  • poor adherence What is the Beers criteria? - ✔✔-lists potentially inappropriate drugs that lead to adverse effects in the elderly
  • particularly in those greater than 65 years old
  • not applicable to those in hospice or palliative care
  • a tool not a guideline--must use your own clinical judgment What is a START and STOP criteria? - ✔✔START--criteria to help determine the right tx for the elderly STOP--criteria to help determine medications to stop
  • these are tools not guidelines--must use your own clinical judgment

How is prophylactic treatment different from acute treatment? - ✔✔-action is taken to PREVENT disease Number of refills are based on what? - ✔✔-when you want them to come back for follow-up Reconciling of medications must occur with every patient at every encounter. True or false? - ✔✔True Can you send an electronic prescription for a schedule II drug? - ✔✔No--a written prescription is required. In a prescription, what is the "Sig"? - ✔✔-means "to write"

  • your directions on how to take the medication Does a generic substitution contain the same amount of active drug as the brand name drug? - ✔✔-Yes
  • They are "essentially similar"
  • They have bioequivalence
  • The generic drug has to be within 80-125% of the same pharmacokinetics as the brand drug Do generic drugs and brand name drugs have the same bioavailability? - ✔✔No, just because they are bioequivalent (they have the same amount of the active drug) does not mean they have the same bioavailability (the rate and extent that the active drug is absorbed and becomes available at the target site) When would a brand name be medically necessary? - ✔✔-certain chronic diseases
  • drugs with a narrow therapeutic index and consistency in the medication is important What is pharmacogenomics? - ✔✔-the study of how genes affect a person's response to drugs
  • "personalization" of drug therapy What is a very important aspect of genetic variations to consider when prescribing? - ✔✔-variations of genes that code for metabolism
  • is the person a poor, intermediate, extensive, or ultra-rapid metabolizer?

What happens if a person who is a ultra-rapid metabolizer takes a "pro-drug"? - ✔✔Since the pro-drug needs to be metabolized to become active, the ultra-rapid metabolizer will quickly activate the medication and the person will experience a quicker than normal drug response What happens if a person who is a poor metabolizer takes a "pro-drug"? - ✔✔Since the pro-drug needs to be metabolized to become active, the poor metabolizer will most likely not be able to activate the medication and the person will not experience a drug response What is ethnopharmacology? - ✔✔-understanding the specific impact of cultural factors on patient drug response

  • does not 100% predict a specific outcome based on racial or cultural factors--but can predict a potential risk for a particular response Patient teaching for women of child-bearing age is important to: - ✔✔-keep good communication so the patient tells you as soon as they are pregnant or plan to become pregnant Things to remember when prescribing to pregnant and lactating women: - ✔✔-start low and increase dose only if necessary
  • avoid medications whenever possible
  • use drugs with the safest profile and have been studied the longest
  • use one drug rather than many
  • make sure dating of the pregnancy is accurate
  • try to avoid medications during the first trimester
  • try to pick topical over systemic
  • shared decision making is very important! What is the "all or none" period? - ✔✔-in the preimplantation period--a teratogen will either cause a miscarriage or will survive How does a teratogen affect the embryogenesis or "organogenesis" period? - ✔✔-most critical period of high sensitivity and susceptibility of potential complications from exposure
  • the first trimester
  • patients can self-diagnose in order to take it
  • condition can be self-managed All OTC's are safe. True or false? - ✔✔False
  • there is still the potential for adverse effects, drug interactions, and potential for abuse Commonly used OTC: - ✔✔-NSAIDS
  • Aspirin (ASA)
  • Acetaminophen (APAP)
  • Antacids
  • Decongestants
  • Topical nasal decongestants
  • Antihistamines All complementary and alternative medicines are considered safe and effective. True or false? - ✔✔False
  • they are not all safe
  • they do not require FDA approval for "safety and efficacy"
  • potential for drug interactions exist What are RDAs? - ✔✔-Recommended Dietary Allowance
  • nutrient intake goals for individuals that meets the needs of nearly all healthy people What is the general recommendations for RDAs? - ✔✔-do not take more than 150% of the RDA What are water-soluble vitamins? - ✔✔-Vitamin B and C
  • water soluble--easily excreted by the kidneys
  • not stored in large amounts so need to ingest frequently

What are fat-soluble vitamins? - ✔✔-A, D, E, K

  • stored in the liver and fatty tissue Vitamin A in high doses is: - ✔✔-highly teratogenic What is chelation? - ✔✔-bonding of drug molecules to metal ions
  • chelation can reduce drug absorption
  • if a patient is taking "metals" like iron, magnesium, calcium, aluminum--make sure they space their medications at least 2 hours apart in order to decrease chance of chelation
  • this is why patients taking tetracyclines should not take milk products with it because of the potential chelating effect of "calcium" What is absorption? - ✔✔-movement of a drug from site of administration into the blood Distribution? - ✔✔-movement from blood to interstitial space of tissues and into the cells Metabolism? - ✔✔-enzymes changing the drug structure
  • usually into an "inactive form" to be excreted, but sometimes metabolism is needed to produce active metabolites (pro-drugs) The rate of absorption determines: - ✔✔-how soon effects will begin
  • the amount absorbed determines how intense the effects are Why are malnourished individuals at risk for drug toxicity? - ✔✔-they have reduced nutrients and co- factors available for proper metabolism
  • this decreases metabolism and allows for drug levels to build up in the body What types of drugs are excreted more often in the breastmilk? - ✔✔-Lipid soluble drugs Although plasma drug levels are not able to tell us the actual drug levels available at the target sites, they are highly predictive of: - ✔✔-therapeutic and toxic responses

What is the PLLR system? - ✔✔-the new labeling system for drugs in pregnancy and lactation

  • contains a pregnancy exposure registry
  • categories for pregnancy, lactation, females and males of reproductive potential
  • provides risk summaries, clinical considerations, data
  • easier to navigate
  • helps the provider to weigh risks versus benefits Antioxidants help to: - ✔✔-neutralize free radicals (normal by-products of metabolism that can cause tissue injury or "oxidative stress") What is an off-label use? - ✔✔-using a medication for a purpose other than what it was FDA approved for
  • just because labeling is lacking for a specific age group or condition does not mean it is unsafe or improper to use--it just means there is insufficient evidence for approval at this time
  • many drugs are utilized as "off-label" for children--because ethically, there are limited evidence for children When a drug is used "off-label" what should the provider make sure to do? - ✔✔-Shared decision making
  • Informed consent
  • Document these in the medical chart What is an anticholinergic reaction? - ✔✔-when a drug produces effects caused by opposing of acetylcholine
  • dry mouth, blurry vision, constipation, drowsiness, trouble urinating etc.
  • elderly patients are most at risk because of the changes from aging Ace inhibitors in pregnancy: - ✔✔-contraindicated
  • known teratogens
  • especially in the first trimester
  • must use a hypertension medication with a safer profile

Accutane in pregnancy: - ✔✔-contraindicated

  • teratogen
  • category X Can you prescribe to family members or friends? - ✔✔-every person deserves the same level of care in a professional setting
  • must have a bona-fide patient provider relationship
  • some states deem it illegal
  • it can be unethical to do so
  • avoid whenever possible Can you write a prescription for a patient and change the directions in order for the patient to save money? - ✔✔-no, you must write the prescription exactly as you want the patient to take it
  • you can potentially write a prescription for a higher mg and have the patient take half of it in order to save money--but you must indicate exactly the amount the patient will be taking and for exactly how many days the dosage will provide What are the main components on a prescription? - ✔✔-patient name, address, birth date
  • date of issuance
  • name, strength, dosage, and quantity of the medication
  • Sig (directions for use)
  • refills authorized
  • prescribers signature
  • DEA number when applicable
  • for controlled substances always write numbers out
  • if a brand name is indicated--make sure to write why WHO's six step model of rational prescribing: - ✔✔-define the patient problem
  • specify the therapeutic objective
  • choose the treatment
  • start the treatment

Kava and Comfrey are alternative therapies that should be used with extreme caution or should be avoided because they can cause: - ✔✔-severe liver damage Cranberry juice may cause what: - ✔✔-increased bleeding in those taking warfarin St johns wort should be used with caution because it can: - ✔✔-can induce metabolism and increase other drugs to dangerous levels

  • cause serotonin syndrome when taking with other serotonin increasing drugs Glucocorticoids can cause what in children? - ✔✔-growth suppression Drug accumulation secondary to reduced renal excretion is the most important cause of what in older adults? - ✔✔-adverse drug reactions and side effects Extreme caution must be taken with iron and children because it may cause: - ✔✔-iron poisoning and death How much vitamin D is recommended? - ✔✔- 1000 - 2000 IU/day
  • good reference for therapeutic level is 30-50 ng/mL