322 Old Important
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| absoprtion | taken into the body, moved to the bloodstream
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| disintegration | breakdown to smaller particles
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| dissolution | combining small particles with liquid to be absorbed from GI into blood stream
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| distribution | drug is delivered to tissues; based on blood flow, capillary permeability, protein binding and solubility
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| high distribution | small, lipid soluble, unbound
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| low distribution | large, water soluble, bound
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| metabolism | liver converts drug into a form that can be excreted; patients with hepatitis or cirrhosis can develop toxicity
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| excretion | kidney removes drugs from the body; if kidney injury leads to drug accumulation
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| shorter half life | dies out quickly, need more doses
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| first pass effect | drugs are inactivated on their first pass through the liver, need a higher or loading dose
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| bioavailability | percent of drug ready for use; IV is always 100, oral depends on GI secretion and motor function
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| PO drug fastest | liquid since it's already broken down
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| protein binding | reversible; bound molecules cannot reach their site of action
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| patient with lower albumin | drug toxicity
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| safety in administration | right patient, drug, dose, time, route, assessment
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| phase 1 | evaluate safe dosage and side effects; small group, no comorbidities
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| phase 2 | tested in patients with the disease, determine therapeutic effects, safety and effectiveness
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| phase 3 | clinical market, prescribers observe closely
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| phase 4 | unexpected effect identified here, post marketing surveillance
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| anticholinergic bronchodilators | allow air passages to remain open; chosen if patient expericnes side effects from regular bronchodilator
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| short acting inhaler | albuterol, relieves and stops asthma attack in its track
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| long acting inhlaer | salmeterol, prophylactically used for prevention, taken around the clock
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| steroid and bronchodilator | long term to prevent attack; decrease inflammation and keep airways open
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| side effects of bronchodilators | nervousness, restlessness, BP and HR increase
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| rebound congestion | happens if nasal decongestant is used longer than 3 days
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| 1st generation antihistamine | diphenhydramine causes sleepiness and hangover, dry mouth common
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| 2nd generation antihistamine | less able to pass BBB and cause sedation, loratidine
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| opioid antitussive | guaf, must be taken with water
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| expectorant | loosens bronchial secretions and reduces surface tension; less sticky
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| osmotic laxative | hyper osmolar salts pull water into colon and increase water in feces to increase bulk; used in bowel preps; lactulose
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| stimulant laxative | increases peristalsis by irritating nerve endings; dulcolax; most abused; senna
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| bulk forming laxatives | natural fibrous substance, increases bulk and peristalsis, need to increase water and fiber intake
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| emollient laxative | stool softener, docusate, used for cardiac patients, give with water
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| antiemetic | serotonin antagonist; ondansetron for chemo, nausea; no drowsiness side effect; headache, dizziness
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| PUD | use endoscopy tissue sample for H pylori, breath test; double antibiotic therapy and PPI
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| H2 blockers | reduce acid secretion, work quicker than a PPI
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| PPI | suppress secretion of hydrochloric acid and does not allow the body to produce HCl
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| metronidazole | gut antibiotic, metallic taste
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| digoxin toxicity | anorexia, malaise, vomiting, halos around objects, confusion and delirium, bradycardia, low potassium increases risk
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| antidote digoxin | digoxin immune fab, digibind; excretes through the urine
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| nitroglycerin | promotes rapid vasodilation, dilates veins leads to less blood flow to heart, dilates arteries less resistance; used for angina, MI
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| side effect nitroglycerin | hypotension, syncope
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| administration nitroglycerin | sublingual, onset 1 to 3 minutes, feel zing; 1 dose under tongue every 5 minutes, 3 doses max; has high first pass
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| beta blocker - olol | diminish SNS response which lowers BP and HR
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| calcium channel blocker - diltiazem | relax coronary artery spasm, relax arterioles; peripheral edema, flushing, headache, slows and controls heart rate
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| ace inhibitors - pril | vasodilates, causes dry nonproductive cough, hyperkalemia
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| thiazide | do not use in renal patients, if potassium is too low, do not administer
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| loop | potent, choose for renal patients
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| osmotic | increased intracranial pressure, glaucoma
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| potassium sparing | monitor potassium levels
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| warfarin | inhibits synthesis of vitamin K, monitor PT and INR
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| warfarin antidote | vitamin K
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| heparin | accelerates anticoagulation cascade and prolong clotting time; monitor PTT
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| heparin antidote | protamine sulfate
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| anticoagulant teaching | examine for signs of bleeding, inform dentist when on anticoagulants, use soft toothbrush, electric razor and avoid leafy greens
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| adverse reaction of statins | rhabdomyolysis - breakdown of skeletal muscle that releases damaging protein, causes renal failure
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| statin monitor | avoid grapefruit juice, monitor BUN, Cr, liver functions test, have annual eye exams
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| priority seizure assessment | neuro and safety - side rails padded, lowest position, know timing of seizure, recovery position - side lying
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| hydantoins | 10 - 20, causes gingival hyperplasia, nystagmus, purple glove syndrome
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| iminostilbene | 4 - 12, hematologic toxicity, GI distress, interaction with grapefruit juice
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| succinimides | 40 - 100; blood dycrasias, SJS, lupus, suicidal ideation
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| valproic acid | 50 - 100; liver toxicity is deadly, GI upset, insomnia, thrombocytonpenia
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| parkinson's | lack of dopamine affects the extrapyramidal tract - controls posture, balance, locomotion
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| parkinson care | improve ability to perform ADL's, safety
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| dopaminergic | increases mobility, carvidopa added to levodopa so it can reach the brain; can cause EPS and orthostatic hypotension
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| myasthenia gravis | decreased ACh prevents normal muscle contraction; concerned about respiratory muscles and airway
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| myasthenia crisis | underdosing acetylcholinesterase inhibitors causes generalized muscle weakness and intercostal muscle failure
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| myasthenia crisis treatment | neostigmine - fast acting AChE inhibitor
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| cholinergic crisis | overdosing acetylcholinesterase inhibitors, causes respiratory paralysis and arrest within 30 minutes
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| cholinergic crisis antidote | atropine
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