NR 293 Week 1 Concepts; Introduction to Pharmacology

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Robin Williams

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Nursing

Course

NR 293 Pharmacology

Institute

Chamberlain

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48

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Week 1 Concepts: Introduction to Pharmacology Introduction to Pharmacology Prepare: Introduction to Pharmacology Which of the following substances can be defined as a drug? Select all that apply. Lemon water St. John’s Wort Marijuana Ibuprofen Garlic Lisinopril Which term describes the proprietary name for a medication? Chemical name Code name Trade name Generic name Which word describes how the drug is delivered through the body? Excretion Distribution Absorption Administration Self Check: How Drugs Move Through the Body Please place the following in the order they occur in the body: Absorption Distribution Effect Excretion Self Check: Drug Names Using the drop-down menus, choose the correct definition of each name type. Chemical name: Name describing the molecular structure of a drug Generic name: Name identifying the drug within a class Brand name: Proprietary name used for marketing Self Check: Drug Naming By Pharmaceutical Companies Which actions may a pharmaceutical company take to create a new drug? Select all that apply. Take a generic drug and rename it Change the way a generic medication is distributed Change the way a generic medication is absorbed Combine two medications together Create a new medication Self Check: Administration of Medication Using the labels below, drag and drop the route to the correct location on the image. Self Check: Medication Phenytoin, an anti-seizure drug can cause drowsiness. Which medication related term or phrase best describes this occurrence? Adverse drug effect Indication Drug interaction Side effect Reflect: Introduction to Pharmacology Medication Administration 164850207871Match the medication administration route to the correct location on the image. FDA Regulations The U.S. Food and Drug Administration (FDA) regulates the production of which products? Select all that apply. Prescribed medication Child restraint packaging for toys Cosmetics Grocery stores Food labels Dietary supplements Cigarettes Administering Medication What must the nurse consider when administering a medication? Select all that apply. Insurance status Cultural issues Age Legal issues Ethical issues Pregnancy Status Medication Labels Bill is looking at a blood pressure medication. The label says Basicide 10mg/25mg. Which of the following is accurate? The label should not be used to identify this medication If half the medication is taken, the patient gets 10mg total This medication comes in two dosages This is a combination product containing two medications Medication Names Which name, when used by health care professionals, increases the safe administration of medications? Chemical name Marketing name Commercial name Trade name Generic name Medication Errors A medication error just occurred. Prioritize the following actions in order from the first to last actions the nurse must complete. Assess the patient for an adverse reaction Notify the healthcare provider Review the facilities procedure for adverse event reporting Complete an incident report Reflect on the incident to determine future precautions needed to prevent error Medication Route Select the correct medication route based on location. Medication Information Label the information below correctly using the drop-down menus. Generic name: Acetaminophen Trade Name: Tylenol Strength: 160 mg Route: Oral Form: Suspension Pharmacokinetics Prepare: Pharmacokinetics Order of Pharmacokinetics Put the following pharmacokinetics in the order in which they occur within the body. Absorption Distribution Metabolism Excretion Pharmacokinetics What is pharmacokinetics? Genetic variations in drug response The mechanism of action a drug has on living tissue What happens to the drug from the time is enters the body until it leaves The expected outcome or goal of a drug that is given Biomechanical Alteration Which step describes the biochemical alteration of a drug into an active or inactive metabolite? Absorption Excretion Metabolism Distribution Self Check: Drug’s Journey Through the Body The elimination of a drug and any of its metabolites Excretion The movement of a drug from its site of administration to the bloodstream Absorption Distribution is the transport of a drug through the bloodstream to its site of action Distribution Biochemical alteration of a drug into an active or inactive metabolite Metabolism Match the steps of how a drug moves through the body to their descriptions. Self Check: Absorption & Distribution Using the drop-down menus, select the words that complete the sentences accurately. A drug entering the body through the oral route is first absorbed in the intestine and goes through the liver in something called first pass metabolism. It then goes through distribution by binding to plasma proteins for transport throughout the body. Unbound drug is considered a(n) free drug, and is active in the blood Self Check: Metabolism If two drugs both go through the cytochrome p450 3A4 enzyme system in the liver, which statement accurately describes what occurs? They both go through the system at the same time and are metabolized equally. One drug blocks the other one, thereby decreasing the amount of the second drug. Drugs are not metabolized through the cytochrome p450 system. One drug blocks the other one, thereby increasing the amount of the second drug. Self Check: Elderly Patients Which factor affects absorption in an elderly patient? Increased gastric emptying Decreased gastric pH Movement through the entire GI tract increased Blood flow to the GI tract increased 40-50% Self Check: Half-Life The half-life of morphine is 2 hours. How long would it take for morphine sulfate to get to steady state in someone provided the maintain the same strength and dose? 10 hours 12 hours 24 hours 8 hours Reflect: Pharmacokinetics Transport of Medication How are most medications transported through the body? Bound to proteins White blood cells Iron Red blood cells Movement Through the Liver Oral medication goes through the liver after being absorbed by the intestine. What is the movement through the liver known as? Half-life Absorption First pass metabolism Steady state Insulin Effects Insulin is used to reduce blood glucose levels in diabetic patients. Reviewing the graph below which of the following are accurate statements? Select all that apply. The longer the duration, the lower the peak Lispro should be taken right before eating beacuse it has a quick onset and peak The larger the peak, the longer the duration Glargine would be good to take before a meal as it will lower blood sugar for one or two meals NPH (intermediate) lasts 24 hours Half-Life & Steady State Calculate the following for each medication and select the correct response from the drop-down menu. What is the amount of medication left after one half life? How long will the medication take to reach steady state assuming 5 half-lives if the patient takes the medication as ordered? Amoxicillin 800mg every 6 hours Half-Life: 1 hour Steady State: 30 hours Metoprolol 100mg twice daily Half-Life: 4.5 hours Steady State: 60 hours Acetaminophen 500mg every 8 hours Half-Life: 3 hours Steady State: 40 hours Duration of Insulin Look at the following onset, peak, and duration graphic showing five different types of insulin. Select the correct duration for the following based on the table: Lispro: 9 hours Regular: 10 hours NPH: 16 hours Glargine: 20 hours Pharmacokinetics in the Elderly Absorption Distribution Metabolism Excretion Effects on the Elderly Slowed gastric emptying Blood flow to the GI tract decreased 40-50% Movement through the entire GI tract slowed Decreased percentage of total body water Increased fat content as lean body mass decreases Hepatic metabolism decreased because of less blood flow Decreased levels of microsomal enzymes Glomerular filtration rate (GFR) decreased 40-50% Fewer intact nephrons Decreased gastric pH Fewer protein binding sites, specifically albumin Click and drag each item to where it affects pharmacokinetics in the elderly. Terms in Pharmacokinetics Which terms are used when discussing pharmacokinetics? Select all that apply. Onset and duration Bioavailability Steady state Receptor interactions Polymorphism Therapeutic window Peaks and Troughs Julie is on vancomycin, a powerful antibiotic. Julie’s peaks and troughs are being monitored by intermittent serum levels of vancomycin. You know that a trough level is drawn to determine the lowest therapeutic dose you want the patient to be at. The peak level is drawn to monitor and adjust the highest level the patient should be at without the medication being toxic. The peak level should be drawn two hours after the medication is given, and the trough level should be drawn immediately before the next dose is given. Pharmacodynamics Prepare: Pharmacodynamics (SIMILAR WORDING - DOUBLE CHECK QUESTION) Diminished Response When a drug binds to a receptor and has a diminished response, how is the drug best described? Partial agonist Antagonist Competitive antagonist Agonist Preventing Responses When a drug binds to a receptor and prevents a response, how is the drug best described? Comptetitive antagonist Partial agonist Antagonist Agonist Binding to Receptors When a drug binds to a receptor and has a response, how is the drug best described? Competitive antagonist Antagonist Agonist Partial agonist Self Check: Pharmacodynamic Targets Pharmacodynamic Targets Which are the pharmacodynamic targets of all drugs? Select all that apply. Enzyme Plasma protein Cell membrane Receptor Albumin Self Check: Selective Interaction Blocking Receptors Which term describes the binding of a drug to a receptor without completely blocking the receptor, causing a diminished response or effect? Partial antagonist Partial agonist Agonist Antagonist Receptor and Enzyme Activation A drug that prevents a receptor or enzyme from activating is referred by which term? Partial agonist Antagonist Competitive antagonist Agnoist Naloxone Naloxone is a drug that blocks the effect of an opioid by binding to the opioid receptor. What is the receptor interaction that takes place when both morphine (an opioid) and naloxone are taken? Morphine acts as an antagonist blocking naloxone from the receptor Naloxone acts as a competitive antagonist to block the receptor Naloxone act as an antagonist, blocking the opioid receptor Naloxone acts as an agonist, activating the opioid receptor Self Check: Interaction of Antibiotics Interaction of Antibiotics Which of the following describes the interaction of antibiotics on the inhibition of cell wall synthesis? This action is a competitive antagonist of the bacteria. This is an antagonistic effect on cell receptors. This is an competitive agonist with bacteria to take over a cell. This is a nonselective interaction with a bacterial cell wall. Reflect: Pharmacodynamics Faulty Physiologic System When a drug has a positive change to a faulty physiologic system, it is known as which of the following? Improved therapeutic index Therapeutic effect Pharmacokinetics Non-therapeutic effect Important Definitions Keeps the receptor or enzyme from activating by blocking all agonist Antagonist Competes with another agonist by blocking activity Competitive Antagonist Activates the receptor or enzyme Agonist Bind to a receptor or enzyme to inactivate the receptor Non-competitive Antagonist Partially activates the receptor or enzyme Partial Agonist Drag and drop the terms and match them with the correct definition. Interaction of Drugs The interaction of a drug with a receptor site or enzyme is called its pharmacodynamic effect. A drug can modify the effect of tissues or cells by activating a receptor, or acting as an agonist. A drug can deactivate with a cell, or act as an antagonist. Finally, a drug can compete with an agonist to deactivate a cell, which makes the drug a competitive antagonist. Antibiotic Targets Select which target the antibiotic is using in the image to the right. Blocked pathways and inhibit metabolism: Folic acid Competitive antagonist Partial agonist Non-selective interaction Antagonist Action of a Drug: PAY ATTENTION TO EACH BOLDED ONE Drug, Receptor, Cell turns on The example below describes a drug acting as a(n) agonist. Drug, Receptor, Cell turns off The example below describes a drug acting as a(n) antagonist. Cell turns on but diminished The example below describes a drug acting as a(n) partial agonist. Chemical, Drug, Drug blocks chemical, Receptor, Cell turns off The example below describes a drug acting as a(n) competitive antagonist. Pharmacotherapeutics Prepare: Pharmacotherapeutics Type of Therapy Which type of therapy is used to treat someone based on the clinical probability that the drug will work based on patient’s symptoms only? Prophylactic therapy Supplemental therapy Maintenance therapy Empiric therapy Factors in Drug Evaluation Which factors are included in the pharmacotherapeutic evaluation of a drug? Select all that apply. Patient’s social history Patient’s medical history Peak, onset, and duration Type of therapy needed Outcome goal for therapy Low Therapeutic Index Which sentence describes a drug with a low therapeutic index? There is no need to draw a blood level of the drug with dosage change. It is generally safe to increase the dose to a point. A slight change in dosage can mean toxicity. A dosage change does not require a lot of monitoring. Self Check: Drug Therapies Drug Therapies Which type of therapy is a treatment used to prevent a high risk condition from occurring? Maintenance therapy Prophylactic therapy Supplemental therapy Empiric therapy Self Check: Drug Therapy Monitoring Drug Therapy Monitoring During an office visit, it is noted the patient’s blood pressure has improved after starting the new blood pressure medication. Physical assessment A patient’s spouse leaves a message saying that the patient seems a lot more drowsy after seeing the provider last week, he thinks it might be the new medication. Family observation The patient calls the office and says they get dizzy after taking their morning medications. Patient report The nurse reports a protime of 1.9 for a patient on warfarin (Coumadin). The provider decides to increase the dosage. Laboratory Drag and drop the type of monitoring that was used in each of the situations Self Check: Therapeutic Index Therapeutic Index A low therapeutic index means that there is a small difference between a drugs active dose and its toxic dosage. A drug with a low therapeutic index has a higher likelihood of causing an adverse reaction. Warfarin has a low therapeutic index because a slight change in dose could be toxic. Amoxicillin has a high therapeutic index because it is rarely toxic at a higher dose. Self Check: Drug Toxicity Drug Toxicity Which conditions can cause drug toxicity? Select all that apply. Liver failure Overdose Neurological impairment Heart failure Kidney failure Self Check: Drug Reactions Drug Reactions Using the drop-down menus, select the correct drug reaction. Question 1 / 3 Fred says that when he doesn’t take his morphine, he gets a sweaty, a runny nose, and nauseous with vomiting. Once he takes it, the symptoms go away. Physical dependence Question 2 / 3 Sara says that when she doesn’t take her tramadol, it is all she thinks about and craves. She will do anything to get her tramadol. Psychological dependence Question 3 / 3 Murray says that he takes his pregabalin for his neuropathy symptoms, but it doesn’t seem to work as well as it once did. He thinks he needs more. Tolerance Self Check: Drug Combinations Drug Combinations Which sentence describes how acetaminophen combines with codeine to work in Tylenol #3? The codeine has an antagonistic effect with the acetaminophen The codeine has a synergistic effect with the acetaminophen The codeine has an additive effect with the acetaminophen The codeine has an incompatible effect with the acetaminophen Reflect: Pharmacotherapeutics Toxic Levels Which situation can cause a toxic level of a drug in a person’s system? Select all that apply. Renal insufficiency Change from generic to trade name drug Increased water intake Higher drug dosage Increased temperature Therapeutic Index 216226207872Drag and drop the correct label to the appropriate location in the image below. Reaction Types Choose which type of reaction each of the following people is experiencing. Question 1 / 3 Priscilla was arrested for stealing Percocet from her mother. Tolerance Physical dependence Drug toxicity Psychological dependence Question 2 / 3 Elden was admitted to a detox center because he ran out of pain medication and started experiencing anxiety, tremors, and dizziness. Psychological dependence Tolerance Physical dependence Drug toxicity Question 3 / 3 Mandy says that one drink used to make her drunk, but now it takes 4 drinks to feel about the same. Physical dependence Tolerance Drug toxicity Psychological dependence Types of Therapy Wayne uses ear drops before he gets in the pool everyday so he doesn’t get swimmer’s ear. Prophylactic Lisa got a refill of her albuterol inhaler which is being used to treat her asthma. Maintenance Fran is taking Percocet to alleviate some of her pain from the breast cancer. Palliative Maria takes a multivitamin everyday to stay healthy. Supplemental Jacob was prescribed amoxicillin to treat the ear pain because the provider presumed he might have an ear infection. Empiric George took diphenhydramine to treat the rhinorrhea (runny nose) he had with this cold. Supportive Drag and drop each type of therapy to match which is being used in the example. Interactions I notice that when I eat a lot of salads, my warfarin doesn’t work as well because my protime levels are lower. Antagonistic effect When I take my atorvastatin with grapefruit juice, I get side effects from my medication including muscle soreness. Additive effect I was told not to eat certain foods with my antidepressant because it can cause really high blood pressure. Incompatible effect When I take ibuprofen and use warm compresses it relieves my pain more than each one of them alone does. Synergistic effect Drag and drop each interaction to match each situation presented below. Treatment Therapies Empiric Drag and drop the following treatment therapies to match the with their descriptions. Treatment when someone has symptoms that are suspicious of a condition that is treatable, but no testing or limited testing is done. Treatment to prevent something that there is a high risk may occur in the future. Prophylactic Used to treat ill or acute conditions. Used to treat disea

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