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Fundamentals Mid-Term Exam Study Guide1) Define pharmacokinetics and pharmacodynamics. Outline phases of pharmacokinetics. Discuss
organs involved in pharmacokinetics.
Pharmacokinetics: is the study of how medications enter the body, reach their site of
action, metabolize and exit the body.
Pharmacodynamics: the process by which drugs alter cell physiology and affect the
body.
PHASES OF PHARMACOKINETICS
1. Absorption: this is the passage of medication molecules into the blood from the
site of administration.
Factors influencing absorption include:
o Route of administration: each route f medication has a different rate of
absorption. When applying medications of the skin absorption is slow
because of the physical make-up of the skin. Mucous membrane and
respiratory tract have a quick rate of absorption due to the tissues
containing blood vessels. Oral route is normally slow due to the passage
through the GI tract. However IV route has the fastest absorption rate.
o Ability of the Medication to dissolve: this depends largely on the
medication’s form and preparation. Solutions and suspensions already
in liquid state are absorbed more readily than tablets or capsules. Acidic
meds pass through gastric mucosa rapidly and medications that are
basic are not absorbed before reaching the small intestine
o Blood flow to the site of administration: medications are absorbed as
the blood comes in contacts with the site of administration. Therefore
the richer the blood supply to the site of admin, the faster the med is
absorbed.
o Body surface Area: larger surface area absorbs more; highly lipid-soluble
meds cross cell membranes easily and are absorbed quickly.
o Lipid Solubility: the cell membrane has a lipid layer, highly lipid-soluble
medications cross cell membranes and are absorbed quickly. Some oral
medications are better given between meals because at times food
changes the structure of a medication and therefore interrupts its
absorption. Also, some medications should not be given together. Some
interact with food so you may have to administer before or after meals,
with meals or on an empty stomach.
2. Distribution: distribution occurs within the body to tissues, organs and specific
sites of action. All this depends on:
o Circulation: how fast medication reaches the site depends on the
vascularity of the various tissues and organs. Conditions that limit blood
flow or blood perfusion inhibit the distribution of a medication. (Ex
patients with heart failure have impaired circulation.
o Membrane permeability: some membranes serve as barriers to passage
of medications; blood-brain area allows fat-soluble meds to pass into
, brain and CSF; fat-soluble and non-fat soluble agents can cross placenta
and cause fetal abnormalities such as respiratory depression; narcotics
can also create withdrawal symptoms
o Protein binding: is the degree to which medications bind to serum
proteins such as albumin affect their distribution. Meds bound to
albumin cannot exert pharmacological activity. However unbound or
free medication is its active form; older adults have decrease in albumin
because of change in liver function, patients with liver disease or
malnutrition also have issues, these pts are at risk for increased med
activity, toxicity or both.
3. Metabolism: Medications are metabolized into less potent or an inactive form;
o biotransformation occurs under the influence of enzymes that detoxify,
degrade and remove active chemicals
o most biotransformation occurs in the liver, liver degrades many harmful
chemicals before they are distributed to tissues. Decrease in liver
function causes a reduction in elimination and an increase in drug
accumulation, placing patents at risk for toxicity. This can also occur in
the lungs, kidneys, blood and intestines and other locations; if these
organs are not functioning properly, it affects the metabolism of the
medication and may result in toxic buildup of medication in the system.
4. Excretion: main organ for excretion are the kidneys; also excreted through the
liver, bowel, lungs, exocrine glands
o when the kidney cannot adequately excrete a medication, it may be
necessary to reduce the dose; maintenance of adequate fluid intake (8-
9 cups or 2L water/day) promotes proper elimination
o anesthetic gases and alcohol are excreted through the lungs
o And some meds cannot be taken during pregnancy because they can
pass through placental barrier or mammary glands
ALLL THE ORGANS INVOLVED IN PHARMACOKINETICS ARE BOLDED ABOVE.
2. What are the nursing diagnoses in regards to medication administration to patients?
o Anxiety
o Ineffective health maintenance
o Readiness for enhanced immunization status
o Deficient knowledge (medications)
o Noncompliance (medications)
o Disturbed visual sensory perception
o Impaired swallowing
o Effective therapeutic regimen management
3. What is a therapeutic effect of a drug? What is allergic and anaphylactic reactions to drugs?
What are side effects, toxic effects, idiosyncratic effects, and adverse effects of medications?
, Therapeutic effect: is the desired, expected or predictable response to medication
Allergic effect: unpredictable response to a medication.
o Some patients become immunologically sensitized to the initial dose of a medication,
with repeated administration the patient develops an allergic response to it, its chemical
preservatives or metabolite. The medication or chemical acts as an antigen, triggering
the release of antibodies in body .Symptoms vary depending on individual and
medication (ex: antibiotics cause high incidence of allergic reactions)
o Severe (anaphylactic) reactions, which are life threatening are characterized by sudden
constriction of bronchiolar muscles, edema of pharynx and larynx and severe wheezing
and shortness of breath, immediate medical attention required. Patient with a known
history of allergy to a medication should avoid exposure and wear an ID bracelet.
o Mild allergic reaction symptoms: urticarial is raised irregularly shaped skin eruptions
with reddened margins and pale centers.
- A rash is small raised vesicles that are red and distributed over entire body.
- Pruritus is itching of skin and accompanies most rashes;
- Rhinitis is inflammation of mucous membranes lining nose, causing swelling and
clear watery discharge.
Side effects: predictable, often unavoidable, unintended secondary effects produced at the
usual therapeutic dose. It can be harmless or can cause injury.
o If side effects are serious enough to negate beneficial effects, the medication is
discontinued.
o Patients often stop taking meds because of side effects.
Toxic effects: develop after prolonged intake of medication or when medication accumulates in
the blood stream because of impaired metabolism or excretion.
o Can have lethal effects depending on its action; some antidotes are available to treat
toxicities
Idiosyncratic effects: over reaction or under reaction to a medication.
o Not getting the expected outcome, (ex: is benadryl which can cause a child to get
agitated or excited instead of drowsy; not always predictable)
Adverse effects: unintended, undesirable, unpredictable severe responses to medications.
o Some are immediate, some take weeks or months to develop.
o When an adverse response occurs, medication is discontinued immediately and
reported to FDA medication-watch program.
o IE: antagonistic effect: antibiotics and birth control. Just cancel out
o Synergistic: they work together to make stronger
4) Discuss the process of drug administration: How does the nurse
proceed with administrating a medication to a patient? How does the
nurse evaluate the effectiveness of drug administration?
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