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NUR 641E Midterm Study Guide
1. Prodrug: An inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body.
-Cytochrome P -Ex. Aspirin, psilocybin, heroin
2. Bioavailability: the rate at and the extent to which a nutrient is absorbed and used
-Attected by route of administration and drug dosage -Drug clearance (rate drug leaves circulation) -Steady state concentration -Attected by chemical stability, solubility, and first pass
3. Steady state (of a drug): stable level of drug in the body, occurs in 5 half lives of the drug
-rate of drug being added to system is equal to amount being eliminated from system
4. Pharmacokinetics: The process by which drugs are absorbed, distributed within the body, metabolized, and excreted.
-what the body does to the drug
5. First pass: the fact that a medication in the GI tract passes through the liver before entering other organs
6. does not: bioequivalence does/does not attect bioavailability
7. Bioequivalence: relative therapeutic ettectiveness of chemically equivalent drugs.
8. Bioavailability (is affected by): -chemical instability
- solubility -first pass metabolism
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9. Cytochrome P450: -enzymes that function to metabolize potentially toxic compounds, including drugs and products of endogenous metabolism such as
bilirubin, principally in the liver. -genetics influence presence of enzymes -attects metabolism of warfarin, antidepressants, antiepileptics, and statins. -the levels of these drugs are higher when taken with certain drugs that are inhibitors (ex. warfarin with omeprazole) because there is competition for enzyme metabolism. -inducers lead to decreased plasma concentration of drug.
10. cytochrome p450 inducer: An inducer increases the metabolism of a substrate resulting in a decreased level or ettect of the
substrate
11. cytochrome p450 inhibitor: An inhibitor decreases the metabolism of a substrate resulting in an increased level or ettect of the
substrate.
12. Clopidogrel: prodrug that must be activated by hepatic CYP2C19 metabolism; individuals who are poor metabolizers may not form the active
metabolite and have reduced antiplatelet response
13. half-life (determines): how often a drug is administered
14. 4-5: steady state is reached in - times the half-life
15. Warfarin (MOA): -Vitamin K antagonist
-Factors II, VII, IX, X -takes several days to take ettect -monitor INR
16. Vitamin K: warfarin antidote
17. Heparin (MOA): -rapid anticoagulation by binding with antithrombin III and inhibits factors IXa, Xa, XIIa, and XIII
-aPTT monitoring (low dose SQ does not require monitoring)
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26. enteric-coated: -protects the drug from stomach acid
-delivers to less acidic intestine -useful for drugs that are acid labile or irritating to stomach (ex. omeprazole, aspirin)
27. extended-release: -control drug release
-maintain therapeutic range over longer period -good for drugs with short half-life (i.e. morphine with half-life of 2-4 hours)
28. aPTT: activated partial thromboplastin time
29. 30-40 seconds: Normal activated partial thromboplastin time (APTT)
30. 1.5-2.5: therapeutic aPTT is x more than normal aPTT
31. low dose heparin: -5000 units BID
-does not require aPTT monitoring
32. INR: international normalized ratio
33. 2-3 (INR): therapeutic INR for warfarin
34. <1.1: normal INR
35. Dabigatran (Pradaxa): -direct thrombin inhibitor
- anticoagulant -blood factor IIa inhibitor
36. idarucizumab: antidote for dabigatran
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37. factor xa inhibitors: apixaban, edoxaban, rivarozaban, fondaparinux
38. apixiban (MOA): -Factor Xa inhibitor
39. Edoxaban (MOA): -Factor Xa inhibitor
40. Rivaroxaban (MOA): -factor Xa inhibitor
41. Fondaparinux (MOA): -factor Xa inhibitor
42. Pulmonary Embolism: -usually a clot from the leg that blocks the pulmonary vasculature
-attects right ventricle d/t backing up of blood
7 / 14 -congregate settings such as homeless shelters are high risk, including for employees -increased in the mid 90s d/t AIDS but have decreased since 2000s
51. isoniazid (INH): - antiTB
- take daily for 6-12 months and most likely with other meds too -worked if 3 neg. sputum cultures, no temp.
- Liver toxicity (hepato) check liver fxn --> JAUNDICE
- Don't take with alcohol (liver fxn remember?)
- Take on empty stomach
52. polypharmacy (side effects): - hallucinations
-appetite alterations -tiredness, decreased alertness, AMS -weakness, falls
- dizziness -skin rashes -anxiety, excitability
53. vertical transmission: when a parasite is transmitted from a parent to its ottspring
54. horizontal transmission: disease is spread through a population from one infected individual to another
55. empiric antimicrobial therapy: 1) site of infection and organism most likely to be colonizing the site
2) prior knowledge of bacteria known to colonize the person
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3) local bacteria resistance patterns of organisms that are available at the hospital
56. (antibiotics that) inhibit cell wall integrity: - penicillins
- ampicillin
- cephalosporins
- carbapenems
57. (antibiotics that) inhibit bacterial protein synthesis: - aminoglycoside
- tetracyclines
- fluoroquinolones
58. Fluoroquinolones: use is reserved for pneumonias or exasperations of chronic bronchitis to decrease the potential for development of further
development
59. endotoxic bacteria: -gram negative bacteria that stain red or pink
-stuck to outside of cell and released when the bacteria die
60. exotoxic bacteria: -gram positive bacteria that stain purple
-released from bacteria
61. invasion period: -when immune and inflammatory responses are initiated
62. pneumonia: -infection of lower respiratory tract
-sixth leading cause of death in U.S. -CAP, HCAP, HAP, VAP -HAP has 20-50% mortality
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68. (types of) T cells: Helper T cells (CD4+): stimulates cytotoxic t cells, B cells, and macrophages to develop immune response
Cytotoxic T cells (CD8+): simulates cell apopotosis Memory T cells: antigen specific t cells that retain a memory of prior infections
69. ABO (compatibility): O is universal donor; AB universal receiver
70. respiratory acidosis (causes): • Depression of the respiratory center.
(1) Head injuries.
(2) Oversedation with sedatives and/or narcotics.
- Conditions attecting pulmonary function.
(1) COPD
(2) Pneumonia.
(3) Atelectasis.
- Conditions that interfere with chest wall excursion.
(1) Thoracic trauma: flail chest.
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(2) Diseases attecting innervation of thoracic muscle (Guillain-Barré syndrome, myasthenia gravis, polio).
(3) Mechanical hypoventilation.
71. cytokines (cause fever): These proinflammatory cytokines reach the CNS where, through induction of central mediators such as prostaglandins
(PGs), they are able to increase the temperature set point and cause fever -hypothalamus regulates temperature
72. Asthma: -chronic inflammatory disorder of the bronchial mucosa that causes bronchial hyper-responsive- ness, constriction of the airways, and
variable airflow obstruction that is reversible -chest constriction, expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, an tachypnea, pulsus paradoxus, respiratory alkalosis, hypoxemia
73. pulsus paradoxus: beats have weaker amplitude with respiratory inspiration, stronger with expiration
74. increased (RR): - Fever
- Asthma
- Dehydration
- COPD
- Hyperventilation
- Lung conditions
- Infections
- Newborns
- Acidosis
- Overdoses
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83. loop diuretics (MOA): Act on ascending loop of Henle, inhibit sodium-potassium-chloride transporter; decrease renal vascular resistance
84. thiazide diuretics (MOA): Decrease sodium reabsorption at distal convoluted tubule; net loss of sodium and potassium
85. potassium sparing diuretics (MOA): Aldosterone antagonist in the distal convoluted tubule
86. atrial netriuretic peptide: acts acutely to reduce plasma volume by at least 3 mechanisms: increased renal excretion of salt and water,
vasodilation, and increased vascular permeability.
87. edema (oncotoic pressure): Edema occurs when there is a decrease in plasma oncotic pressure, an increase in hydrostatic pressure, an increase in
capillary permeability, or a combination of these factors. Edema also can be present when lymphatic flow is obstructed.
88. angiotensin: a peptide hormone that constricts blood vessels, causes the retention of sodium and water, and produces thirst and a salt appetite
89. amiodarone (pharmacokinetics): Onset: 2-3 days (oral) Within minutes (IV)
Peak Ettect: 3-7 days (oral) Duration: varies Half-life: 40-55 days
90. heart failure (patients): have more than just heart failure. look for underlying angina, HTN...
91. digoxin (and electrolytes): hypomagnesemia, hypercalcemia, and hypokalemia
92. hyperkalemia (renal failure): renal failure results in elevated potassium levels because the body cannot clear the excess potassium from
the blood stream through the kidneys like it normally does.
93. hyperkalemia (addison's disease): deficiency of aldosterone will result in decreased excretion of potassium
94. hypercalcemia (treatment): -calcitonin, pamidronate (nitrogen containing biphosphonate
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95. compensatory hyperplasia: an adaptive mechanism that enables certain organs to regenerate; occurs significantly in epidermal and intestinal
epithelia, hepatocytes, bone marrow cells, fibroblasts, and some bone, cartilage, and smooth muscle.
96. naproxen: NSAID said for use in CAD patient
97. NSAIDs (MOA): Reversibly inhibit COX-1 & COX-2 Block
prostaglandin synthesis
98. COX 2 inhibitor (MOA): Inhibits COX-2, but does not inhibit COX- 1
99. NSAID alternative: COX 2 inhibitors; given with risk of GI bleed (indicated by darkening stool and epigastric pain)
100. diphenhydramine (side effects): Cardiovascular: tachycardia, hypotension, palpitations Neurological: drowsiness, seizures
Respiratory: mucus plugs, wheezing
101. lortadine: lack of sedation and impairment of performance, longer duration of action, and absence of anticholinergic side ettects.
102. dimenhydrinate (onset of action): within 15 minutes; lasts 3-6 hours
103. (patients with history of kidney stones should) avoid: calcium
104. tendon rupture:
Fluoroquinolones have a black box warning for or tendonitis. There is an increased risk in elderly patients.
105. Pseudomembranous colitis: Clindamycin, ampicillin, cephalosporins (C. ditt)
106. chronic pain: episode of pain that lasts for 6 months or longer; may be intermittent or continuous. NOT cancer pain
