-
if the patient has a head ache, the nurse doesn’t want to give some really strong pain medication, like morphine. We would probably want something with a lower _______ such as aspirin.
efficacy
-
if a drug LACKS _______, that can be important. What can happen is that very large doses may be used to get the effect needed, and this might not be very convenient.
potency
-
_______ is the largest effect that a drug can produce as
indicated by height of ____-_____ ______.
- max efficacy
- Dose-Response curve
-
Match the ______ of the response with the patient’s need
intensity
-
"point of saturation" is another term for ____ _____.
max efficacy
-
___________ is the remainder of an orally administered drug that reaches systemic circulation.
bioavailability
-
Chemically equivalent drugs can differ in bioavailability because of different ______ __ ______ and ________ __ ______.
onset of action; intensity of effects
-
The rate drugs are ______ is the primary determinant of the concentration of drug in the blood stream.
excreted
-
Renal ______ accounts for most drug excretion, however drugs are also subjected to _______ in the renal tubule.
filtration; reabsorption
-
3 processes of excretion
- glomerular filtration
- passive reabsorption
- active tubular secretion
-
water-soluble drugs would be excreted by ______ ______ unless the drug was bound by a _______.
glomerular filtration; protein
-
lipid-soluble drugs could avoid excretion because of ______ ______, which will move drug from tubule into blood stream.
passive absorption
-
lipid-soluble drugs could only be excreted in the kidneys by means of _____ ______ _____, which requires active transport.
active tubular secretion
-
______ ______ drives reabsorption of drug from lumen of tubule back into bloodstream.
Concentration gradient
-
pharmacokinetic processes determine drug concentrations at ____ __ _____. However, you can only MEASURE the drug levels in the _____ _____.
sites of action; blood plasma
-
therapeutic window vs. therapeutic ratio is parallel to therapeutic ______ vs. therapeutic _____
range; index
-
At some point, the amount eliminated in the dosing interval will equal the dose. This is know as _______.
plateau/steady state
-
______, as the highest plasma level, must be kept below ____ concentration.
Peaks; toxic
-
______, as the lowest plasma level, must be kept above _____.
Troughs; MEC
-
Drug A administered 10mg/day. Peaks exceed toxic concentration and troughs fall below MEC. However, mean concentration is in therapeutic range. What are 2 nursing implication?
- 1) Drug A administered 5mg, twice a day, so that mean concentration the same but peaks lower and troughs higher
- 2) TEST & MONITOR BLOOD LEVELS
-
How would pharmacological therapy affect half-life in a patient with liver disease who is receiving a drug that undergoes hepatic metabolism?
- half-life: prolonged
- 1) At normal dosing, the drug could accumulate to toxic levels.
- 2) The provider would need to decrease the dose and/or extend the timing interval of the doses.
-
How would pharmacological therapy affect half-life in a patient who is taking Drug A and Drug B, where Drug A is an inducer of metabolizing enzymes for Drug B? List 2 nursing implications.
- half-life: shortened
- 1) The active form of the drug may not reach therapeutic levels in the body.
- 2) The provider would need to increase the dose and/or shorten the timing interval of doses
-
an immune response that requires prior sensitization of immune system
Allergic reaction
-
Direct chemical example of drug-drug interactions.
IV precipitate
-
antacids increase gastric pH and impacts ionization of drugs; laxatives decrease transit time for absorption; narcotics decrease peristalsis and prolong transit time.
these are examples of what. check all that apply.
- Absorption
- drug-drug interactions
- adverse drug reactions
-
competition for protein binding; alteration in extracellular pH.
these are examples of what. check all that apply.
- Distribution
- drug-drug interactions
- adverse drug reactions
-
induction/inhibition of enzymes (cytochrome P450 enzyme families); common inducers are phenobarbital & carbamazepine (anti-seizure drugs), rifampin (tuberculosis drug), tobacco, & some “herbal supplements,” such as St. John’s wort.
these are examples of what. check all that apply.
- Metabolism
- drug-drug interactions
- adverse drug reactions
-
decreased CO decreases perfusion of glomerulus; alteration in urinary pH affects ionization; competition for transporter binding
these are examples of what. check all that apply.
- Excretion
- drug-drug interactions
- adverse drug reactions
-
P-glycoprotein subject to induction/inhibition by drugs;
interaction at same or different receptor sites (agonist-antagonist)
these are examples of what. check all that apply.
- Metabolism
- drug-drug interactions
- adverse drug reactions
-
Acetaminophen, a drug metabolized by the liver, is administered to a patient with liver failure. Which of the following is true?
A.The half-life may be shortened in this patient.
B.Drug levels will be decreased in this patient.
C.The patient will metabolize the drug more quickly.
D.The patient is more likely to experience a toxic effect of acetaminophen.
D) The patient is more likely to experience a toxic effect of acetaminophen.
-
To reach the therapeutic range more quickly, we can give a ________, which is a large dose given at the start of therapy
loading dose
-
A more potent drug produces desired effect at lower dosage, as indicated by position of curve along X-axis.
relative potency
-
amount of drug that must be given to produce a desired effect
relative potency
-
Selectivity
Specific fit/interaction (shape, charge, etc.)
-
________ is reflected in drug’s potency in direct proportion.
affinity
-
________ is in direct proportion to maximal efficacy.
intrinsic activity
-
Intensity of response to drug related to # receptors occupied, but also related to activation of receptors after binding
Modified Occupancy Theory
-
Accounts for differences in potency and maximal efficacy
Modified Occupancy Theory
-
nursing implications for protein binding.
- nephrotoxicity
- ex: albumin
-
nursing implication for 1st pass
parenteral instead of PO
-
-
passive acquired immunity
- series of injections of antibody
- ex: Hep B immunoglobulin
-
stages of inflammation
vascular & cellular
-
vascular phases of inflammation
- 1st: vasoconstriction
- 2nd: vasodilation
-
vascular phase
s/s
fxn
- s/s: injury, swelling, warmth, pain, erythema
- fxn: blood losss
- increace WBC
- increase permeability
- increase leakage of fluids
-
cellular phases of inflammation
- 1st: Migration & Adhesion
- 2nd: Transmigration
- 3rd: Chemtaxis
- 4th: Phagocytosis
-
migration & adhesion
- 1st phase of cellular inflammation
- migration: WBC @ injury site
- adhesion: WBC @endothelium
-
transmigration
- 2nd phase of cellular inflammation
- WBC permeate
-
chemotaxis
- 3rd phase of cellular inflammation
- chemical gradient
-
phagocytosis
- 4th phase of cellular inflammation
- WBC consume antigen/debris
-
phagocytic leukocytes
- NK
- neutrophil
- dendritic
- macrophage
-
an immune cell that phagocytizes an antigen
present antigen cell (APC)
-
cells of inflammation
- endothelial cells
- platelets
- leukocytes
-
eosinophil
- anti-parasitic
- release cytokines during asthma attack @ respiratory tract
-
basophils
release histamine @ blood
-
mast cells
release histamine @ tissue
-
*Complement proteins: vasodilation; é capillary permeability; promote leukocyte activation, chemotaxis, and augment phagocytosis
-
Complement system –cascade of plasma proteins
-
2 types of inflammatory mediators
- 1) cell-derived
- 2) plasma-derived
-
2 types of cell-derived inflammatory mediators
- 1) histamine
- 2) arachidonic acid metabolites
-
2 types of plasma-derived inflammatory mediators
- 1) kinin
- 2) complement protein
-
vasodilation; capillary permeability; promote leukocyte activation, chemotaxis, and augment phagocytosis
Complement proteins
-
an effector of innate and humoral/adaptive immunity
complement system
-
peptides, polysaccharides, lipids, nucleic acids; has unique molecular shape recognized by specific receptor on lymphocyte
Antigens
-
Recognition of antigen and stimulation by cytokines
B and T cells
-
clones that differentiate into effector and memory cell
B and T cells
-
B lymphocyte immunity is to _____, as T lymphocyte immunity is to ________.
humoral; cell -mediated
-
MHC
major histocompatability complex
-
Membrane-bound proteins that display peptides to T cells; recognizes self vs nonself; expressed on APCs
MHC
-
In adaptive immunity, activation requires 2 signals. what are they?
- 1st: Antigen
- 2nd: Antigen-presenting cells (APCs) found in innate immunity
- ex: dendritic cells or macrophages
-
-
IgA
- secretion @ mucous membrane
- prevents entry
-
IgM
- body fluids
- pulls into clumps
-
IgD
- surface of B cells
- receptor
-
IgE
- mast cells
- 1st responder
- allergy
-
master switch; TH cell receptor binds to MHC-II and antigen complex on APC; secretes cytokines; helps activate B cells bound with same antigen
CD4+
-
effector; TC cell receptor binds MHC-I and antigen complex; injects preformed cytotoxic proteins into target cell
CD8+
-
Discrimination of self and non-self
Self tolerance
-
Can initiate, maintain, and down-regulate without help of the nervous system or other systems
Self-regulation
-
Targets very select antigens
Specificity
-
Can invoke specific immune response to an indefinite number of different antigens
Diversity
-
only Immune system and CNS have these types of cells memory
Memory
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