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pharm final review p
tara's pharm final review part one
| Question | Answer |
|---|---|
| ENDOCRINE AXIS | HYPOTHALMOS TRIGGERS RELEASE OF TROPIC HORMONE (STIMULATING HORMONE) WHICH TRIGGERS TARGET ORGAN, TARGET ORGAN MAKES OWN HORMONE WHICH THEN TRIGGERS HYPOTHALMOS AND IT CONTINUES IN CIRCLE |
| INCREASE IN OWN HORMONE CAUSES | DECREASE IN STIMULATING HORMONE (NEGATIVE FEEDBACK) |
| (PD) ESTROGEN AND PROGESTERONE | NEGATIVE FEEDBACK ON FSH/LH RELEASE |
| INCREASE IN ESTROGEN AND PROGESTERONE EQUALS | DECREASE IN FSH/LH |
| FULL EFFICACY OF ORAL CONTRACEPTIVES | TAKES ONE MONTH |
| IF UTERUS HAS HEAVY SPOTTING | CAN USE OC WITH DECREASE PROGESTERONE COMPONENT |
| STILL NEED TO USE ALTERNATIVE PLAN FOR ONE MONTH WHEN | YOU CHANGE LEVELS OF HORMONE IN OC |
| OC IS ABOUT 85% EFFECTIVE WHEN | AROUND 2 WEEKS |
| (PK) ABSORPTION OF ANTIBIOTICS IS | DEPENDANT UPON GUT BACTERIA |
| ANTIBIOTICS | ALTERNATIVE CONTRACEPTION FOR ONE MONTH |
| METABOLISM OF ORAL CONTRACEPTIVES | SUBJECT TO ENZYME INDUCTION |
| SE/ADR'S OF OC CAN HAVE INCREASE OR DECREASE | ACNE AND WEIGHT |
| YAZ | CAN CAUSE K+ RETENTION |
| OC SE/ADR'S = ACHES | (A)BDOMINAL PAIN (GALL BLADDER DISEASE/ INTESTINAL INFARCTS), (C)HEST/CALF PAIN (DVT,PE,MI), (H)EADACHE (STROKE), (E)YE SIGHT (IF SUDDENLY CALL MD), (S)ELF EXAMS |
| CAN CHANGE SHAPE OF EYEBALL | ESTROGEN |
| EX QUESTIONS: ORAL CONTRACEPTIVES | NEGATIVE FEEDBACK, SUPPRESS FSH/LH |
| IF MISS MORE THEN 2 DAYS OF OC | USE BACK UP METHOD |
| OTHER DRUGS | CAN EFFECT EFFICACY OF OC |
| ACHES CAN BE SIGNS OF | THROMBOEMBULIS |
| CONTACT SIZES CAN BE AFFEECTED BY | ORAL CONTRACEPTIVES |
| REASON FOR CONDOM FAILURE | EXPRIATION DATES, IMPROPER STORAGE, IMPROPER SIZE, NO ROOM FOR EJACULATE, PUT WRONG SIDE OUT |
| TELLS YOU WHEN SOMETHING IS WRONG, BUT IT CAN PERSIST BEYOND BEING USEFUL | PAIN |
| 2 TYPES OF PAIN | VISCERAL AND BONE/DENTAL |
| OPIATES FOR | VISCERAL |
| NSAIDS FOR | BONE/DENTAL |
| ACETAMINOPHEN FOR | VISCERAL AND BONE/DENTAL |
| BY THE #'S GOAL OF PAIN RELEIF IS | FULL PAIN RELIEF |
| AS LITTLE AS % REDUCTION MAY BE ALL THAT IS POSSIBLE WITH MEDS | 30% |
| TEACH CLIENTS ABOUT | BEING REALISTIC WITH PAIN GOAL |
| PAIN DURING THE HEALING PROCESS, SNS INVOLVEMENT (INCREASE HR, BP), LITTLE PSYCHOLOGICAL COMPONENT | ACUTE PAIN |
| PAIN BEYOND THE HEALING PHASE, BLUNTED TO NON EXISTENT SNS RESPONSE, USUALLY SIGNFICANT PSYCHOLOGICAL COMPONENT | CHRONIC PAIN |
| GATE THEORY | REFLEXES NOT AWARE AT FIRST, HIGHER CORTICES (QUAL, QUANT), THALMUS IS FIRST AWARE OF PAIN(GENERIC) |
| NATURAL PAIN KILLERS IN CNS THAT WORK ON PERCEPTION OF PAIN,ARE PROTEINS AND CAN'T CROSS THE BLOOD BRAIN BARRIER | ENDORPHINS |
| MIMIC ENDORPHINS-MOST ARE STABLE IN STOMACH ACID AND CROSS THE BLOOD BRAIN BARRIER | OPIATES |
| OPIATE CLASS: NATURAL DERIVATIVES | MORPHINE(GOLD STANDARD), CODIENE (POOR PAIN KILLER) |
| OPIATES HAVE SYNERGY WITH | ACETAMINOPHEN (ANALGESIA) |
| SEMI-SYNTHETICS | WEAKEST TO STRONGEST HYDROCODONE (LORTAB), OXYCODONE (PERCOCOET), HYDROMORPHONE (DILAUDID) |
| DON'T COMBINE WITH ACETAMINOPHEN | HYDROMORPHONE (DILAUDID) |
| STRONGEST SEMI-SYNTHETICS | OXYMORPHONE |
| EX QUESTION 4 CLIENTS-SAME DOSE, ROUTE WHO IS IN WORSE PAIN | ONE ON OXYMORPHONE |
| MOST SEVERE SE/ADR'S FOR OXYMORPHONE | RESP DEPRESSION |
| FULL SYNTHETICS | MEPERIDINE/DEMEROL FANTANYL/DURAGESIC |
| FENTANYL/DURAGESIC LAST | 72 HOURS |
| GENERAL PHARMACEUTICS IF BRAND ENDS IN "CET" | OPIATE AND ACETAMINOPHEN |
| IF IT ENDS IN "COTIN" | SUSTAINED RELEASE (DON'T CRUSH) |
| PATCH DISPOSAL | FOLD AND FLUSH |
| PATCH | CLIP HAIR, AVAOID ALCOHOL/HEAT |
| (PK) ABSORPTION OF OPIATES | PO |
| (PK) METABOLISM OF OPIATES | SUBJECT TO ENZYME INDUCTION AND INHIBITION |
| OPIATES PO ROUTE ARE ALL SUBJECT TO | 1ST PASS EFFECT |
| EXCRETION OF OPIATES | METABOLITES; RENALLY EXCRETED (CAN SEE IN PEE TEST) |
| EX QUESTION4 CLIENTS WHY IS ROUTE IMPORTANT PO VS IV FOR OPIATES | FIRST PASS EFFECT |
| science and engineering of dosage forms | pharmaceutics |
| what the body does to the drug (in vs out) | pharmacokinetics |
| what the drug does to the body | pharmacodynamics |
| too much drug | toxicology |
| function of the dose not the substance | toxicity |
| pharmaceutics Po routes | immediate release- short onset, short duration (acute) OR sustained release- short or long onset, long duration (maintence) |
| ex of sustained | XL,SR,CR end in "contin" =NEVER CRUSH |
| NEVER DO THIS TO PATCHES | CUT IN HALF |
| 4 PHASES OF PHARMACOKINETICS | ABSORPTION, DISTRIBUTION, METABOLISM, EXCRETION |
| ABSORPTION AND DISTRIBUTION | RESPONSIBLE FOR DRUG GOING INTO THE BODY |
| METABOLISM AND EXCRETION | RESPONSIBLE FOR DRUG GOING OUT OF BODY |
| PRIMARY ORGAN FOR METABOLISM | LIVER |
| PRIMARY ORGAN FOR EXCRETION | KIDNEYS |
| (PK) ABSORPTION | PROCESS OF DRUG ENTERING THE BLOOD STREAM IV ROUTE BYPASSES THIS (QUICK AND PRECISE) |
| IN GENERAL; INCREASED BLOOD FLOW AT THE SITE OF ABSORPTION WILL | INCREASE ABSORPTION |
| DISTRIBUTION | DRUGS DO NOT DISTRIBUTE TO ALL TISSUES EQUALLY, ALL DRUGS ARE SOMEWHAT AMPHOTERIC(HYDRO/LIPID) |
| METABOLISM | ENZYMATIC, DEACTIVATES DRUGS AND OR ALTERS THEM AND MAKES THEM MORE HYDROPHILIC(WATER SOLUBLE=EASIER TO EXCRETE IN URINE) |
| DRUG "B" PREVENTS THE METABOLISM(DRUG OUT) OF DRUG 'A' WHICH LEADS TO DRUG ACCUMULATION AND POSSIBLE TOXICITY | ENZYME INHIBITION EX;TAGAMENT |
| DUE TO ENZYME INHIBITION | ASK 3 QUESTIONS-PRESCRIBED MEDS, OTC, AND HERBAL MEDS? |
| DRUG "B" INCREASES THE NUMBER OF ENZYMES THAT METABOLIZE DRUG 'A' WHICH COULD LEAD TO DECREASED THERAPEUTIC EFFECT | ENZYME INDUCTION-ASK SAME 3 QUESTIONS |
| INCREASE IN ENZYMES EQUALS | INCREASE IN RATE OUT |
| DECREASE IN ENZYMES EQUALS | DECREASE IN RATE OUT |
| (PK) EXCRETION | PRIMARY ORGAN-KIDNEY, SOME DRUGS BYPASS METABOLISM AND GO STRAIGHT TO EXCRETION |
| INCREASE IN BUN/CREAT | DECREASE IN RENAL FUNCTION |
| PHARMOCOKINETICS | THERAPEUTIC RANGE/WINDOW SUBJECT TO INHIBITORS=TOXICIITY AND INDUCERS=NO BENEFIT |
| PHARMACOKINETICS | FIRST PASS EFFECT-EXPLAINS WHY PO DOSES ARE HIGHER THEN IV, IM, DERMAL PATCH DOSES |
| PHARMOCODYNAMICS | AGONISTS, ANTAGONISTS |
| AGONISTS | PORMOTES BIOCHEMICAL PROCESSES |
| ANTAGONISTS | INHIBIT/PREVENT BIOCHEMICAL PROCESSES |
| SIDE EFFECT | AGONIST OR ANTAGONIST BINDING TO RECEPTORS CAUSING ADDITIONAL SIGNS AND SYMPTOMS, USUALLY UNDESIRABLE AND SOMETIMES DESIRABLE |
| SE VS ALLERGY | ALLERGY INVOLVES ACTIVATION OF IMMUNE SYSTEM EX;RAHSES, HIVES, ANAPHYLAXIS |
| PHARMACODYNAMICS | THERAPEUTIC INDEX |
| THERAPEUTIC INDEX | DIFFERENCE BETWEEN THERAPEUTIC AND TOXIC DOSES |
| ED50 | EFFECTIVE DOSE FOR 50% OF POPULATION |
| TD50 | TOXIC DOSE FOR 50% OF POPULATION |
| DIFFERENCE BETWEEN ED50 AND TD50 | THERAPEUTIC INDEX |
| EX OF WIDE THERAPEUTIC INDEX | PENICILLIN |
| EX OF NARROW THERAPEUTIC INDEX | DIGOXIN, INSULIN, DILANTIN |
| NARROW THERAPEUTIC INDEX | EASY TO OVERDOSE ON- SPEND MORE TIME ASSESSING FOR TOXICITY |
| PHARMACOKINETICS WITH PHARMACODYNAMICS HALF LIFE | AMOUNT OF TIME IT TAKES FOR A DRUG CP(CONCENTRATION OF PLASMA) TO DECREASE BY 50% |
| EACH DRUG HAS ITS OWN | HALF LIFE |
| RENAL/HEPATIC DYSFUNCTION | LENGTHENS HALF LIFE |
| HALF LIFE 2 HOURS | MULTIPLY BY 5=10 HOURS IS THE AMOUNT OF TIME BEFORE IT WILL BE OUT OF BODY |
| ADENOSINE | HIGH DOSE STOPS HEART AND HALF LIFE=10-15 SECONDS |
| AMIODERONE | CAN HAVE A HALF LIFE OF 35 DAYS(CRAZY) |
| GERD | COMPROMISED LES IN THE PRESENCE OF ACID, TX BY DECREASE ACIDITY OF STOMACH, DON'T OVER EAT, AVOID ALCOHOL, PEPPERMINT, SPICEY FOODS,HIGH FAT MEALS, CAN OCCUR AROUND THE CLOCK SO NEEDS TO BE MANAGED AROUND THE CLOCK |
| ACETYLCHOLINE ANTAGONIST-PROMOTES ACID RELEASE | ANTICHOLINERGICS |
| ALL CAUSE DRY MOUTH, DRY EYES, URINARY RETENTION, CONSTIPATION, AND IF THEY CROSS INTO THE CNS THERE IS A RISK FOR DELIRIUM | ANTICHOLINERGICS (SHORT HALF LIFE) |
| H2-ANTAGONIST (TIDINE) EX CIMETIDINE (TAGAMENT) | BLOCKS HISTAMINE AT THE H2 RECEPTOR, ONLY DOSED 2-3 TIMES PER DAY SO BETTER THEN ANTICHOLINERGIC AND CHEAP |
| STRONG ENZYME INHIBITOR | TAGAMENT-SO IMPORTANT TO ASK WHAT THEY ARE TAKING B/C IT CAN AFFECT OTHER DRUGS METABOLISM |
| ONLY DOSED 1-2 TIMES PER DAY, A IITTLE EXPENSIVE, BUT THE HAVE NO BROAD PHARMACOKINETIC INTERAACTIONS (METABOLISM) | PROTON PUMP INHIBITORS (PRAZOLE) EX OMEPRAZOLE (PRILOSEC)- ONLY AVAIL GENERICALLY |
| ANTACIDS (ACUTE) | FORM OF METAL ION BOUND TO A BASE, A BASE IS WHAT NEUTRALIZES THE ACID, THE METAL IS WHAT CAUSES THE SE/ADR'S |
| SODIUM BICARB | DUE TO THE NA, IT IS GOING TO CAUSE INCREASED WATER LOAD, SO BAD FOR CARDIOVASCULAR ISSUES |
| CALCIUM CARBONATE- TUMS | CAN HAVE ACID REBOUND WITH OVERUSE |
| ANTACIDS | AVOID NA BICARB WITH CARDIO VASCULAR ISSUES |
| MOM | PULLS WATER INTO BOWEL, WHICH CAUSES DIARRHEA |
| ALUMINUM | CAUSES CONSTIPATION |
| MOM AND ALUMINUM TOGETHER | MAALOX=STOOL SOFTNER |
| CLIENT C/O HEART BURN FOLLOWED BY CONSTIPATION | USE MAALOX |
| BULK LAXATIVES (FIBER)-SAFEST ONE | METAMUCIL-CITRACEL |
| DON'T TAKE WITH MEDS AND MAKE SURE PT IS HYDRATED | BULK LAXATIVES |
| STIMULANT LAXATIVE | SYSTEMICALLY ABSORBED AND END UP IN BREAST MILK |
| OSMOTIC LAXATIVES | MAG CITRATE- IT CLEANS YOU OUT, MOST LIKELY ABUSED BY DIETERS |
| LUBRICANT LAXATIVES | MINERAL OIL=FOOD FOR BACTERIA IN LUNGS, IF YOU ASPIRATE, CAN LEAD TO BRONCHITIS THEN COPD THEN DEATH |
| FLAMMABLE, DISCONTINUE PROIR TO SURGERY (24HOURS)-CAN CATCH ON FIRE | LACTULOSE |
| FOR TX OF IRON DEFIENCY ANEMIA, REPLACEMENT THERAPY(AGONIST), PHARMACOKINETICALLY-REQUIRES A ACIDIC ENVIRONMENT TO BE ABSORBED, SO POSSIBLE ISSUES WITH MEDS THAT TX ACID | IRON SALTS |
| IRON SALTS | GIVE +/- 1 HOUR FROM ANTACIDS, BECAUSE H2 ANTAGONIST AND PROTON PUMP INHIBITORS ARE AROUND THE CLOCK-GIVE WITH VIT C (ACIDIC) |
| SE/ADR'S OF IRON SALTS | N/V-THEY CAN TAKE WITH FOOD IF ISSUE, CONSTIPATION-CAN USE BULK LAXATIVE BUT DON'T GIVE AT THE SAME TIME, IRON GIVES YOU BLACK STOOLS NOT TARRY(GI BLEED) |
| CHILDHOOD DEATH FROM OVERDOSE, SO KEEP OUT OF REACH OF CHILDREN | IRON |
| non producers of insulin so must get it from an outside source(tend to be younger) | type 1 diabetic |
| normal insulin is released by pancreas and has 2 phases | 1st one:basal- 1 unit of insulin per hour from pancreas 2nd one; post prandial(meal)- 5 units of insulin in an hour after a meal from pancreas |
| post prandial mimick | regular insulin |
| basal mimick | lantus (long acting insulin) |
| (PK) ABSORPTION OF INSULIN | FOR REGULAR INSULIN EASILY PASS THROUGH MEMBRANE AND THAT GIVES IT SHORT ONSET AND SHORT DURATION (BOLUS) |
| HAS AN ACID PH, BUT AT THAT ACID PH IT FORMS LONG CHAINS, SO IT DOESN'T EASILY FIT THROUGH THE MEMBRANE, BUT W/ BUFFERS, THERE IS A REGULAR/STEADY BREAKUP, SO ONCE IT IS BROKEN, IT CAN EASILY PASS THROUGH, BUT B/C IT PEAKS SLOWLY-LONGER PEAK AND DURATION | LANTUS (LONG ACTING) |
| CAN'T MIX WITH ANY OTHER INSULINS | LANTUS(CLOUDY) |
| DON'T FOR SQ INSULIN INJECTIONS | DON'T HAVE EXCESS HEAT, RUB SITE, FLEX MUSCLES |
| EXERCISE WILL CHANGE | INSULIN NEEDS-CONSULT MD FIRST-CARRY GLUCOSE SOURCE WITH THEM |
| ALCOHOL CONSUMPTION SHOULD BE AVOIDED WITH DIABETICS B/C | IT MESSES UP THEIR GLUCOSE CONTROL (FLUSH OF BLOOD THROUGH SKIN) |
| CARE OF SQ INSULIN | ROTATE SITE(SAME TYPE) EX ARM TO ARM |
| MORE LIFE DANGEROUS | HYPOGLYCEMIA S/S- FIGHT OR FLIGHT(^HR, ALTERED BREATHING, DIAPHORETIC) |
| FAMILY INVOLVED WITH INSULIN TX B/C | MAY CONFUSE S/S OF HYPOGLYCEMIA WITH INTOXICATION |
| HYPERGLYCEMIA- SICK DAYS | IF THEY FEEL FLU LIKE S/S AND EXCESS THIRST-CALL MD HAVE SOME WIGGLE ROOM W/ HYPERGLYCEMIA |
| STORAGE AND HANDLING-INSULIN | NO EXCESS HEAT, NO CARS,NO FREEZE/FROST, BEST PLACE IN FRIDGE DOOR, KEEP SUPPLIES TOGETHER, |
| INSULIN FRESH FROM FRIDGE WILL | STING, ROLL TO WARM-IF YOU SHAKE IT WILL ALTER DOSE |
| NEED TO KNOW FOR INSULIN | MEDIC ALERT BRACLET, PARENTS SHOULD ALSO READ PT INFO |
| INFECTIOUS DISEASE- GRAM POSITIVE | STAPH AND STREP (MRSA) |
| GRAM NEGATIVE | E.COLI, PSEUDOMONOS, AUROGENOSA |
| C&S TELLS YOU | WHAT THE BUG IS AND WHAT KILLS IT, BUT WE DON'T WAIT-START EMPIRIC THERAPY(BEST GUESS) |
| EMPIRICALLY GRAM NEGATIVE W/O C&S FOR | UTI |
| GRAM POSITIVE -MOST OF THE TIME IS | SKIN INFECTION EX;CELLULITIS |
| ONCE C&S IN-OFTEN CHG ABT-CALLED | STREAMLINE THERAPY-4 REASONS-LESS $, LESS TOXIC, LIMIT RESISTANCE, LIMIT SUPER INFECTION(ON TOP OF) |
| COMMON IN WOMEN POST ABT | YEAST |
| ABT NEED TO BE RESERVED FOR WHEN REALLY NEEDED DUE TO | RESISTANCE |
| TIMING FOR ABT | NEED CONSISTENT,SAME TIME EACH DAY-FIRST DOSE KILLS WIMPY ONES, SKIPPED DOSE LEAVES THE STRONGER ONES |
| NEED TO FINISH ABT B/C | IF YOU STOP-MORE RESILENT STRAINS CAN REGROW |
| IF MISS ABT(WITHIN 2 HOURS) TAKE IT | IF LONGER THEN 2 HOURS-WAIT TILL NEXT DOSE |
| BETA-LACTAMS-PENICILLINS OLDER | 1ST PCN-NATURAL PCN-COVER GRAM+ > - ,ALTERED PCN INTO NEW CLASS-ANTISTAPHYLOCOCCAL PCN'S (COVER + > -) EX OXICILLIN |
| BETA-LACTAMS-PENICILLINS NEWER | AMINOPENICILLINS-COVER +/- EQUAL(EX; AMOXICILLIN, AMPICILLIN) AND ANTIPSEUDOMONAS-COVER GRAM - > + ( EX; PIPERCILLIN) |
| ENZYME THAT BREAKS UP PCN, SO IT DOESN'T WORK WELL | BETA-LACTAMASE |
| COMMONLY ADDED TO BROAD SPECTRUM ABT'S TO BLOCK ENZYME, THEREFORE WILL PREVENT PCN FROM GETTING BROKEN UP | BETA-LACTAMASE INHIBITORS EX; AMOXICILLIN W/ CLAVULANIC ACID=AUGMENTAN(BREATHES NEW LIFE INTO OLD ABTS |
| CLAVULANIC ACID OVERCOMES | ENZYME |
| ALL PCN'S WILL | SOFTEN STOOL(DIARRHEA)-DON'T DOUBLE UP |
| CEPHALOSPORINS (PD) | B-LACTAMS-CELL WALL LYSIS -NO INHIBITORS |
| CEPHALOSPORINS DIVIDED INTO GENERATIONS | 1ST GENERATION-GRAM + > - 2ND GEN-GRAM + = - 3RD GEN-GRAM - > + (MIRRORS PROGRESSION OF PCN'S) |
| CLIENT WITH UTI | 3RD GENERATION BEST |
| SLIENT SKIN INFECTION | 1ST GENERATION BEST |
| CLIENT HAVING ABDOMINAL SX | PROPHAYLAXIS-SO WE USE 2ND GENERATION |
| (PK) CEPH/-CILLINS EXCRETION | ^BUN/CREAT= DECREASE RENAL FUNCTION, SO SINCE ABT ARE RENALLY EXCRETED IT WILL GIVE YOU A LONGER HALF LIFE AND IF THEY BUILD UP IN BODY-CAN BE TOXIC, SO IF RENAL IMPAIRED-MAINTAIN SAME DOSE BUT LONGER DOSE INTERVAL |
| HOLY CRAP THAT'S ENOUGH FOR NOW SEE PART TWO FOR THE OTHER HALF:) |
Created by:
lmtherrera
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