Pharm

Question 1

3 ways drugs can affect therapy

Answer 1

• hindering therapy
• facilitating therapy
• contributing to pt safety

Question 2

what is pharmacokinetics (PK)

Answer 2

what the BODY does to the drug

Question 3

4 components of pharmacokinetics

Answer 3

Absorption
Distribution
Metabolism
Excretion

Question 4

what is pharmacodynamics (PD)

Answer 4

what the DRUG does to the body

Question 5

4 components of pharmacodynamics

Answer 5

• MOA
• dose response
• effects
• SE aka ADR

Question 6

what is bioavailability

Answer 6

rate the drug is absorbed and reaches the bloodstream

Question 7

2 things bioavailability depends on

Answer 7

• route of administration
• drug’s ability to cross membrane barriers

Question 8

4 ways a drug crosses the membrane barriers

Answer 8

• active
• passive
• facilitated
• special processes

Question 9

what age related change causes a slight decrease in absorption

Answer 9

decreased gastric acidity

Question 10

2 results of slower rate of absorption in aging adult

Answer 10

• lower peak concentration
• delayed time to peak concentration

Question 11

equation for volume of distribution

Answer 11

Vd = amount of drug administered / concentration of drug in plasma

Question 12

the concentration of drug in what part of the blood is available for the body

Answer 12

plasma

Question 13

how does increased % body fat affect drug distribution (lipid soluble [dissolve] drugs, 4)

Answer 13

• increased Vd
• increased time to reach steady state
• increased time of elimination
• requires lower or less frequent maintenance doses

Question 14

how does decrease in % body muscle affect drug distribution (water soluble [dissolve] drugs, 4)

Answer 14

• decreased Vd
• decreased time to reach steady state
• increased serum concentration
• lower loading and maintenance doses

Question 15

define half life

Answer 15

the time to reduce the plasma concentration to one half its initial value

Question 16

two types of elimination

Answer 16

metabolism and excretion

Question 17

which pharmacokinetic variables are rate limiting factors

Answer 17

metabolism and excretion

Question 18

how does decreased hepatic blood flow affect metabolism

Answer 18

increased half life of low dependent drugs

Question 19

one common flow dependent drug

Answer 19

warfarin

Question 20

how does decreased liver mass affect metabolism

Answer 20

increased half life

Question 21

what is the first pass effect

Answer 21

part of dose is lost to metabolism in the gut and liver before it enters the systemic circulation

Question 22

what 4 age related changes effect elimination

Answer 22

• decreased renal BF
• decreased tubular secretion
• decreased kidney mass and number of glomeruli
• decreased GFR (glomerular filtration rate)

OR simplified

decreased kidney size, renal BF, number of fxnal nephrons, tubular secretion

Question 23

3 ways to decrease the risk of drug intolerance and toxicity

Answer 23

• lower doses
• longer intervals
• slower titrations

Question 24

when do most errors occur for adverse drug events

Answer 24

ordering and monitoring stages

Question 25

what is the prescribing cascade

Answer 25

drug 1 causes an ADE that is interpreted as a new med condition, then a new drug is rx and repeat

Question 26

risk factors for ADEvents (ADE, 6)

Answer 26

- multiple comorbidities - prior ADE - high risk drugs - low BW or BMI - age >85 years - hepatic/renal insufficiency

Question 27

a few characteristics of polypharm (4)

Answer 27

- use of 5 or more drugs - duplicate drugs - contraindicated drugs - inappropriate dose

Question 28

2 most common drug-drug interactions

Answer 28

CV and psychotropic drugs

Question 29

4 common drug interaction effects for DDI

Answer 29

confusion cog impair hypoTN acute renal failure

Question 30

Drug-disease interactions: NSAIDs and HTN

Answer 30

fluid retention; decreased effectiveness of diuretics

Question 31

Drug-disease interactions: NSAIDs and gastropathy

Answer 31

increased ulcer and bleeding risk

Question 32

Drug-disease interactions: metformin and CHF

Answer 32

hypoxia: increased risk of lactic acidosis

Question 33

Drug-disease interactions: Ca channel blocker, narcotics, anticholinergics and constipation

Answer 33

exacerbation of constipation

Question 34

Drug-disease interactions: BPH (benign prostatic hyperplasia) and anticholinergics

Answer 34

urinary retention

Question 35

Drug-disease interactions: NSAIDs or thiazolidinediones and CHF

Answer 35

fluid retention: CHF exacerbation

Question 36

4 ways to prevent adverse drug reactions

Answer 36

- low and slow rx - periodic re-eval of long term meds - early recognition ADRs - edu and communication

Question 37

5 reasons older adults don't adhere to meds

Answer 37

can't "ROARS" Read Open Afford Remember Swallow

Question 38

what is used to ID inappropriate drugs for older adults

Answer 38

american geriatric's society BEER's criteria

Question 39

what risk do NSAIDs cause (3)

Answer 39

- ulcer and GI bleed - increased BP

Question 40

2 risk anticoagulants

Answer 40

- risk of bleeds - subdural hematoma

Question 41

2 risks of antidepressants

Answer 41

increase risk of falls and hyponatremia

Question 42

risk of antihyperglycemics

Answer 42

hypoglycemia

Question 43

risk of antihypertensives

Answer 43

orthostasis

Question 44

risk of antiparkinsonian

Answer 44

confusion

Question 45

4 risks of diuretics

Answer 45

- orthostasis - dehydration - hypokalemia - hyperglycemia

Question 46

4 risks of hypnotics

Answer 46

- sedation - confusion - fall risk - delirium

Question 47

8 risks of digoxin**

Answer 47

- confusion - loss appetite - n/v - diarrhea - vision probs (yellow halos) - arrhythmias - tachy

Question 48

what is med reconciliation

Answer 48

- complete drug regimen - contact PCP if med issues

Question 49

4 ways PT help with med reconciliation

Answer 49

- edu - communicate - doc - recognize safety concerns