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Pharmacokinetics involves - ANSWER-absorption, distribution, metabolism and elimination). Absorption: - ANSWER-absorption from the administration site either directly or indirectly into the blood/plasma. Distribution: - ANSWER-reversibly or irreversibly move from the bloodstream into the interstitial and intracellular Metabolism: - ANSWER-biotransformed via hepatic metabolism or by other tissues. Elimination: - ANSWER-tissues. lastly, the drug and its metabolites are eliminated from the body. route of administration with the highest bioavailability - ANSWER- intravenous; putting entire dose into a patient's vein and bypassing absorption. avoids first-pass metabolism - ANSWER-Intravenous route administration has variable and erratic absorption. n - ANSWER-Rectal administration
- Steady state (SS) - ANSWER-absorption. n is usually reached within 4- half-lives of drug. Half-life of a drug is - ANSWER-how long it takes for half the drug to be excreted from the body. Determines how frequently the drug must be administered. Predicts how long toxic effects can last.is constant with first- order pharmacokinetics of a drug. Zero-order (nonlinear) pharmacokinetics - ANSWER-means a drug is metabolized at a constant rate per unit time. CYP3A4 substrate drugs - ANSWER-may have enhanced activity if any CYP3A4 inducer drugs are used along with it. Drug development process involves these steps according to the FDA: - ANSWER-Discovery: laboratory research to develop the new drug. Preclinical research with animal testing for safety (Phase I). Clinical research on human subjects for medication safety (Phase II). Clinical research in humans comparing the new drug to accepted medications placebo depending on the study (Phase III). FDA review of the results to determine approval. Post marketing study to identify adverse effects not found in earlier clinical studies (Phase IV)
- Medication safety organizations - ANSWER-The Institute for Safe Medication Practices (ISMP) The Institute of Medicine (IOM) The Joint Commission The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Food and Drug Administration (FDA) Safe Use Initiative Two basic type of ADRS: - ANSWER-pharmacological and idiosyncratic. 85% to 90% of ADRS - ANSWER-are pharmacological. Adverse drug reactions are usually preventable, - ANSWER-frequently occur in a hospital or nursing home setting, and include medication errors, adverse drug effects, and allergic idiosyncratic type reactions. ADRS are not commonly reported; - ANSWER-the FDA does not mandate that ADRS be reported. Polypharmacy - ANSWER-involves using multiple health care providers for care, using multiple medications, and using several pharmacies prescription filling. Angiotensin converting enzyme inhibitors (ACEIS): - ANSWER-lisinopril, captopril, enalapril, ramipril, benazepril, fosinopril. ACEIS reduce blood pressure enzyme. - ANSWER-by suppressing the release of angiotensin-converting enzyme. Important side effects of ACE inhibitors - ANSWER-Important include cough and angioedema; discontinue the ACEI if angioedema occurs. Angiotensin II receptor blocking agents (ARBS): - ANSWER-Icandesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan). ARBS reduce blood pressure - ANSWER-by blocking angiotensin II receptors. Essential (primary) hypertension - ANSWER-Essential (primary) accounts for 90% of cases; secondary hypertension may caused by chronic renal failure. Nitroglycerin - ANSWER-Nitroglycerin is a nitrate drug that can be administered IV, SL, a topical ointment and as a transdermal patch. Nitrates are contraindicated - ANSWER-with PDE-5 inhibitors (e.g., sildenafil and vardenafil) Amiodarone is the antiarrhythmic - ANSWER-Of choice when there is coexisting heart failure; can cause thyroid and pulmonary toxicity.
Raynaud's is treated - ANSWER-with dihydropyridine-type calcium channel blockers (e.g., nifedipine) because they cause peripheral vasodilation. Asthma - ANSWER-is an obstructive airway disease associated with airflow obstruction, mucus production, hyperreactivity of the bronchial tissue, and inflammation. Mild persistent asthma - ANSWER-is best treated with a short-acting beta- agonist (SABA) plus an inhaled corticosteroid.
. Moderate persistent asthma - ANSWER-is best treated with an inhaled low- dose corticosteroid and a long-acting bronchodilator. Severe persistent asthma - ANSWER-is best treated with a long-acting beta- agonist (LABA), plus a high-potency inhaled corticosteroid, plus an oral corticosteroid drug. Inhaled short-acting beta-2 agonists (SABA) - ANSWER-are indicated only for PRN use. Long-acting beta-2 agonists (LABA, e.g., salmeterol) - ANSWER-should never be used in an acute asthma exacerbation; use a short-acting beta-2 agonist (SABA, e.g., albuterol). short-acting Short-acting beta-2 agonists (SABA) - ANSWER-are used in acute asthmatic attacks, but can increase heart rate, tremors, nervousness, and reduce serum potassium levels. , Instruct a patient on any inhaled corticosteroid - ANSWER-rinse the mouth after each use Advair (fluticasone and salmeterol) - ANSWER-Advair example of a long- acting beta agonist and a corticosteroid. Anoro ellipta (umeclidium/vilanterol) - ANSWER-is an example of a long- acting beta agonist and an anticholinergic agent. Combivent (albuterol/ipratropium) - ANSWER-example of a short-acting beta agonist and an anticholinergic agent. Tiotropium - ANSWER-Tiotropium is long-acting anticholinergic agent, not for acute asthmatic attacks, and is used once a day in asthma and COPD. Cystic fibrosis (CF) - ANSWER-is a pulmonary disorder typically seen in childhood, with an increased production of a protein-producing thick mucus that blocks the airways, pancreatic ducts, sweat gland ducts, and vas deferens. CF of the pancreas - ANSWER-also known as fibrocystic disease of the
pancreas.
Ankylosing spondylitis - ANSWER-is a chronic inflammatory joint disease characterized by fusion and stiffening of the spine and sacroiliac joints. acetaminophen overdose. - ANSWER-Acute liver disorders (e.g., acute hepatitis, hepatotoxicity) may be caused by Osteoblast cells on bone - ANSWER-cause bone formation; osteoclasts are cells on bone - ANSWER-that cause bone breakdown. Osteomalacia - ANSWER-is a condition of insufficient bone mineralization (softening of bone). Osteoporosis - ANSWER-is a metabolic disorder with reduced bone mass/density. Osteosarcoma - ANSWER-is cancer of the bone. Paget's disease - ANSWER-is a disorder in which abnormal new bone growth occurs at a faster rate than normal, involving increased resorption of spongy bone tissue. ing pathologic fracture - ANSWER-dorbeod fracture occurring at the site of a pre-existing bone abnormality, and occurs with a force that is considerably less than that which would cause a bone fracture at a different site. Antidiuretic hormone (ADH) - ANSWER-is synthesized in the hypothalamus and causes the reabsorption of water in the distal tubule and collecting duct of the kidney. essential treatment for hyponatremia - ANSWER-normal saline IV (0.9%NaCl). Orthostasis can be a significant side effect - ANSWER-with use of a diuretic drug. Orthostatic hypotension - ANSWER-defined as a decrease of>20mmHg systolic blood pressure or decrease of >10mmHgdiastolic blood pressure within 3 minutes of assuming a standing position. Causes of hyperkalemia: - ANSWER-low potassium intake, renal insufficiency, systemic lupus erythematosus, Addison's disease, use of potassium-sparing diuretics. Treatment of hyperkalemia - ANSWER-include calcium gluconate, loop diuretics, patiromer (Veltassa), thiazide diuretics, sodium polystyrene sulfonate (Kayexalate), regular insulin IV, and inhaled albuterol. Insulin and beta-2 agonist inhalers are used to treat - ANSWER-hyperkalemia because they move potassium from the bloodstream into the cells; insulin also increases the transport of glucose from the bloodstream into the cells.
Calcium and phosphate homeostasis is affected by - ANSWER-parathyroid hormone, vitamin D, and calcitonin. Hypercalcemia causes: - ANSWER-bone hyperplasia, neoplasms, and thiazide diuretics. Hypercalcemia treatments: - ANSWER-calcitonin, pamidronate, zoledronic acid. Insufficient dietary intake of vitamin D can result in - ANSWER-cardiovascular disease, osteoporosis, and rickets. Insufficient dietary intake of vitamin B12 can result in - ANSWER-pernicious anemia. patient with metabolic alkalosis and partial respiratory compensation will have symptoms - ANSWER-fatigue, cool pale hands and feet, a new-onset systolic heart murmur, and vomiting coffee-ground looking material. Hypokalemia will increase - ANSWER-digoxin toxicity. Hyperparathyroidism can cause - ANSWER-secondary renal failure. Primary hyperparathyroidism is typically caused by - ANSWER-a tumor in the parathyroid gland. Hyperglycemia can occur with - ANSWER-increased release of cortisol, epinephrine, glucagon, and growth hormone into the bloodstream. Hypoglycemia can be caused by - ANSWER-starvation and intense exercise. patient with type I diabetes who exercises heavily may have symptoms of - ANSWER-hunger, headache, lightheadedness, confusion, tachycardia, and pallor due to hypoglycemia. Obesity is a risk factor for developing - ANSWER-type 2 diabetes because of increased insulin resistance. Glucagon stimulates - ANSWER-glycogenolysis by the liver. Dawn phenomenon (dawn effect) - ANSWER-occurs in the early morning hours (i.e., between 2 a.m. and 8 a.m.); blood glucose levels increase in patients with diabetes. There is not nighttime hypoglycemia. Somogyi effect - ANSWER-occurs after an episode of untreated nighttime hypoglycemia, causing increased blood glucose levels in the morning; treated by increasing food intake near bedtime or reducing the evening insulin dose.
Adverse effects of opioid analgesic agents include - ANSWER-constipation, addiction, overdose, sedation, and impaired daily functioning. preferred laxative for managing opioid-induced constipation (OIC). - ANSWER-Docusate, Gluten-sensitive enteropathy (celiac sprue) - ANSWER-is an autoimmune disorder of the small intestine in which the affected patient cannot absorb certain cereal proteins. Dumping syndrome (rapid gastric emptying) - ANSWER-can occur after a partial gastrectomy and has symptoms of rapid pulse, hypotension, pallor, weakness, sweating, and faintness. Dumping syndrome can cause - ANSWER-a high osmotic gradient in the small intestine, resulting in a rapid movement of fluid from blood vessels into the intestinal lumen. organ that can regrow back to its original size - ANSWER-The liver depending on the area of tissue removed; this is a type of compensatory hyperplasia. Vitamin B12 deficiency can occur - ANSWER-after a partial gastrectomy; this may cause the patient to develop a pernicious anemia. UFH: - ANSWER-unfractionated heparin. LMWH: - ANSWER-(low molecular weight heparin) enoxaparin (Lovenox); inhibits factor Xa. Heparin produces rapid anticoagulation by binding with - ANSWER- antithrombin III, and inhibits factors IXa, Xa, XIIa, and XIII. aPTT - ANSWER-Monitor heparin (low dose SC heparin [5000 units BID] does not require aPTT monitoring). Warfarin inhibits vitamin K-dependent blood factors - ANSWER-II, VII, IX and X; takes several days for its anticoagulant effect. (INR) - ANSWER-Monitor the International Normalized Ratio when warfarin is used. Blood Factor Ila inhibitor - ANSWER-(direct thrombin inhibitor): dabigatran (Pradaxa). antidote to dabigatran-induced hemorrhage - ANSWER-idarucizumab. Blood factor Xa inhibitors: - ANSWER-apixaban (Eliquis), edoxaban (Savaysa), rivaroxaban (Xarelto), fondaparinux (Arixtra).
Eptifibatide - ANSWER-binds to GPII6/IIla receptor sites on platelets. symptom of hemolytic anemia - ANSWER-jaundice, caused by the destruction of heme that is greater than the hepatic conjugation and excretion of bilirubin. Jaundice can be caused by - ANSWER-hemolytic anemia, sickle cell anemia, pancreatitis,o cholecystitis, and multidrug therapy used to treat pulmonary tuberculosis. Erythropoietin - ANSWER-is a substance manufactured in the kidney; the anemia of chronic renal failure reduces erythropoietin production, and should be used to correct the anemia of chronic renal failure. Sumatriptan is the only triptan - ANSWER-available as an injection as well as tablets and a nasal spray. Sumatriptan and zolmitriptan are the only triptans - ANSWER-available as nasal sprays. Intravenous anesthetics: - ANSWER-ketamine, thiopental, fentanyl, propofol, dexmedetomidine. Propofol - ANSWER-has a rapid onset, does not usually cause nausea, and poor analgesia. ICU delirium commonly occurs in elderly patients, treated with - ANSWER- haloperidol, although dexmedetomidine (Precedex) is the preferred drug for sedation in the elderly. If respiratory depression is a concern, - ANSWER-dexmedetomidine (Precedex) is the preferred anesthetic; however, it should not be used longer than 24 hours, per the FDA-approved product information. Selective serotonin reuptake inhibitors (SSRIS); - ANSWER-citalopram (Celexa), escitalopram c (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), vortioxetine (Trintellix).
. Side effects of SSRIS - ANSWER-weight gain, decreased sexual libido, and insomnia. Olanzapine, - ANSWER-a second-generation antipsychotic, has the advantage of being available as a long-acting injection for acute psychotic reactions. Drugs most effective in alcohol withdrawal - ANSWER-lorazepam (Ativan) and phenobarbital; if liver dysfunction is present, lorazepam is the preferred agent because of its different metabolic pathway than other benzodiazepines. All benzodiazepine drugs - ANSWER-(e.g., diazepam, lorazepam,
Drugs acting on the sympathetic nervous system include - ANSWER- epinephrine, norepinephrine, dopamine and dobutamine. Drugs acting on the parasympathetic nervous system include - ANSWER- atropine, oxybutynin, and ipratropium. Arachnoid villi - ANSWER-absorb excess cerebrospinal fluid (CSF) that accumulates in the cerebral venous sinuses that surround the brain; the villi maintain normal CSF volume and pressure. The circle of Willis - ANSWER-supplies collateral blood flow to the brain. The adrenal medulla - ANSWER-will increase secretion of the catecholamines epinephrine and norepinephrine due to sympathetic stimulation caused by increased stress. Antidiuretic hormone (ADH) - ANSWER-is synthesized in the hypothalamus, and acts on the renal tubular cells. cause diabetes insipidus (DI). - ANSWER-Low levels of antidiuretic hormone (ADH) patients have a laboratory finding of low urine specific gravity. - ANSWER- Diabetes insipidus (DI) patients Multiple sclerosis - ANSWER-a disorder involving the demyelination of CNS nerve fibers (central component of the pathological model). Alzheimer's disease (AD) - ANSWER-is the development of neurofibrillary tangles in the CNS. may experience at least one seizure during their lifetime. - ANSWER- Roughly 10% of the U.S. population third most common neurologic disorder (after cerebrovascular disease and Alzheimer's disease). - ANSWER-Epilepsy Several mechanisms involved in seizure activity, - ANSWER-but all have swift, excessive, and synchronous discharge of cerebral neurons. Generalized seizure types include - ANSWER-tonic-clonic (grand mal), absence (petit mal), clonic, myoclonic, tonic, and atonic; there is loss of consciousness and no memory of the event. Antiepileptic drugs reduce seizure activity by - ANSWER-reducing sodium and/or calcium influx into brain cells, increasing the inhibitory gamma- amino butyric acid
(GABA) activity, enhancing the influx of chloride, and interfering with excitatory glutamate transmission. Antiepileptic drugs suppress seizure activity; - ANSWER-they do not cure epilepsy. Phenytoin is highly plasma protein bound, - ANSWER-serum levels should be interpreted according to the patient's serum albumin level. Antiepileptic agents have many drug interactions, - ANSWER-are therapeutically monitored by measuring blood levels, and are not totally safe to use in a pregnant patient. antibiotics inhibit bacterial cell wall synthesis and integrity. - ANSWER- Penicillins, cephalosporins, carbapenems, and other beta-lactam antibiotics antibiotics inhibit specific bacterial proteins. - ANSWER-Tetracycline, macrolide, azalide and aminoglycoside antibiotics Empiric antimicrobial therapy - ANSWER-based on the patient's history and the site of infection when susceptibility data are not available. primary cause of antimicrobial resistance - ANSWER-primary is the indiscriminate use of antibiotic agents. Cross-resistance seen with penicillin and cephalosporin drugs can occur because - ANSWER-both antibiotic classes have a beta-lactam ring that the enzyme beta-lactamase from an organism can attack and destroy, rendering the antibiotic ineffective vs. the organism. Antibiograms - ANSWER-are charts of local antimicrobial resistance patterns developed by local laboratories. Clostridium difficile (C. difficile) - ANSWER-organism producing a toxin that causes antibiotic-associated pseudomembranous colitis (AAPMC). This type of diarrhea occurs often with clindamycin use. Individuals with glucose-6 phosphate dehydrogenase (G6PD) deficiency - ANSWER-have increased side effects when given sulfonamide drugs; avoid their use in these individuals. Isoniazid (INH) is used to treat tuberculosis, is administered with - ANSWER- vitamin B6 (pyridoxine) to reduce the side effect of peripheral neuropathy. Tetracycline hydrochloride can cause - ANSWER-stunted growth in children and should not be used; however, doxycycline and minocycline are safe for adolescent patients to use.
good first-line antibiotic agent for UTI treatment in reasonably healthy individuals not previously taking antibiotics. - ANSWER-Cotrimoxazole (trimethoprim-sulfamethoxazole) may have disseminated abdominal discomfort and be quite confused. - ANSWER-Elderly patient with a UTI most common bacterial organism causing uncomplicated urinary tract infections - ANSWER-is Escherichia coli, a gram-negative aerobic rod. requires close monitoring of renal function (can cause nephrotoxicity) and hearing (can cause ototoxicity). - ANSWER-Amphotericin B used to treat C. difficile infection. - ANSWER-Metronidazole and oral vancomycin should not drink alcohol during therapy and abstain for at least two days after the therapy course is completed. - ANSWER-Patients taking metronidazole highly active vs. Candida species (also many drug interactions-hepatic enzyme inhibition). - ANSWER-Fluconazole requires careful monitoring of hepatic enzymes (ALT, AST, alkaline phosphatase), and bilirubin. - ANSWER-Ketoconazole onychomycosis. - ANSWER-fungal nail infection Tinea capitis - ANSWER-head lice; tinea corporis - ANSWER-body lice. all have characteristic elevated, firm, and rough lesions that have a flat top surface > 1 cm in diameter. - ANSWER-Psoriasis or seborrheic and actinic keratoses Retinoids - ANSWER-vitamin A derivatives used to treat acne, psoriasis, photoaging. retinoids can cause - ANSWER-dry skin, skin irritation and peeling, a reddened skin area, and photosensitivity. contraindicated in pregnancy because of a very high risk of birth defects. - ANSWER-Oral isotretinoin Topical tazarotene - ANSWER-used for both acne and psoriasis. Azelaic acid - ANSWER-used to treat mild to moderate inflammatory acne, with minor skin irritation.
Koplik spots - ANSWER-white spots that are surrounded by red ring/circle, are found on the buccal mucosa and are associated with rubeola. generalized urticaria. - ANSWER-common sign of an allergic reaction Eczema - ANSWER-an inflammatory skin disorder also known as dermatitis and characterized by itching (pruritus) and lesions with indistinct borders. skin condition with elevated and firm circumscribed lesions <1 cm in diameter. - ANSWER-wart (lichen planus or verruca) Adverse topical corticosteroid effects include - ANSWER-thinning of the skin, dermatitis, striae, purpura, local skin infections, and hypopigmentation. should not be used over a large surface area in children - ANSWER- Potent topical corticosteroids because of hypothalamic-pituitary-adrenal axis suppression, growth retardation, and systemic toxicity. Wet gangrene - ANSWER-associated with liquefactive necrosis of the skin. often have a red butterfly-shaped rash across their face. - ANSWER- Individuals with systemic lupus erythematosus (SLE) caused by the deposition of circulating immune complexes containing an antibody that attacks the host DNA, resulting in tissue damage. - ANSWER- SLE recurrent UTI - ANSWER-is an infection that is caused by different organisms; recurrent UTIS are seen more frequently than a relapsing UTI. relapsing UTI - ANSWER-infection caused by the same organism; past occurrence of cryptorchidism has an increased risk of - ANSWER- developing testicular cancer. Testicular cancer - ANSWER-typically occurs in young men between age 5 and 35 years of age. Elderly men with underlying medical conditions, such as benign prostatic hypertrophy (BPH), - ANSWER-should avoid drugs that have high anticholinergic activity (e.g., diphenhydramine). Testicular torsion - ANSWER-the rotation of a testis, resulting in twisting of spermatic cord blood vessels. varicocele, - ANSWER-A cause of male infertility which results in low sperm count.
