Pharmacology Exam 1 Review
5 patient rights:
Patient
Drug
Dose
Time
Route
Can lipid soluble drugs penetrate membranes?
Yes, fairly easily. Water soluble drugs need a carrier across membranes.
Is pregnancy category X safe? True or false?
False
*for exam, know the difference between pregnancy warning categories
How do enteric coated drugs affect absorption?
Enteric coats pass stomach so it’s only released in small intestine.
Should we crush an enteric coated drug?
No, and likewise with sustained-release drugs.
When patient has low protein in blood, what is their potential for increased drug activity or
toxicity?
Decreased albumin level expected
Bound drug vs. free drug in relation to protein-binding.
Free drug can interact with receptors
Bound drugs circulate through the body bound to a plasma protein
Altered kidney function, what to do with medication doses?
Reduce medication dose.
Morphine for pain can lead to constipation, what will that do to drug absorption?
Absorption is increased, this drug interaction is considered pharmacokinetics.
Patient receives a laxative, what does it do to GI tract?
Increase motility, decreases medication absorption.
Lasik’s (95% protein bound) and Ibuprofen (98% protein bound) are given together, what
happens?
Will compete for protein binding, will see more free drug and potentially toxicity.
If drug affects cardiac output, it may also decrease blood getting to the kidneys. What happens
to drug elimination?
Drug elimination will decrease, potential toxicity.
OTC drugs are completely safe?
False, can have interactions, mask symptoms, delay diagnoses/treatment.
Bioavailability
Amount of the administered dose that gets into circulation
What has more bioavailability, IV or oral medication?
IV (no first pass effect)
What is biotransformation?
Synonymous with metabolism
Morphine is given oral and IV, which has a higher dose?
Oral
Oral drug goes from portal vein to liver, can be metabolized or inactivated. What happened?
First pass effect
Routes of admin with first pass effect?
Oral
Caring for a patient with cirrhosis, would they have higher or lower doses of meds?
Generally lower if metabolized by the liver
Half-life of a drug?
Amount of time it takes for concentration in plasma reduce by ½
200mg with half-life of 24 hours = 100mg day 2 = 50mg day 3
What prolongs half-life of a drug?
Liver, kidney, cardiac problems (excretion organs)
Every drug has side effects?
True
Patient taking Amoxicillin, they have hives/itching. What is the reaction occurring?
Allergic
What is the purpose of administering Narcan?
Antagonist for opioid receptor
Patient taking Benadryl complains of drowsiness. What is the reaction occurring?
Side effect because we can predict reaction from histamine
Pediatric and older adult client considerations
Pediatrics
● Weight and body size consideration
● Organ maturity consideration
● Metabolism and excretion consideration
● “kids aren’t just small adults”
Older adults
● on average have some loss of organ function
● consider potential for more drug toxicity, side-effects, and excretion issues
Additive vs Synergistic drug interactions - both involve 2 drugs leading to increased effect
Synergy = effects are greater than the sum of parts
Additive = physiologically these drugs now work better together than alone
Ex: not supposed to combine nitroglycerin and Viagra because the synergist effect is dramatic
(BP drops)