ADME Detective
During this phase, drugs move through the bloodstream to tissues and target sites.
What is distribution?
This term describes the amount of an administered drug that reaches systemic circulation and can act on cells.
What is bioavailability?
A college student receives a meningitis vaccine before moving into a dormitory. This is this type of therapy.
What is prophylactic therapy?
A patient's pain decreases from 8/10 to 3/10 after IV morphine.
What is a therapeutic effect?
The time when a medication first begins producing an effect is called this.
What is onset?
Two drugs with similar pharmacologic actions increase the overall effect when taken together.
What is an additive interaction?
This phase describes movement of a drug from its site of entry into the bloodstream.
What is absorption?
Oral medications are typically absorbed into the bloodstream at these structures in the small intestine.
What are the villi?
A febrile neutropenic patient receives broad-spectrum antibiotics before the specific organism is known.
What is empiric therapy?
A patient develops mild nausea after receiving an IV pain medication.
What is a side effect?
This represents the greatest drug concentration and greatest therapeutic effect.
What is peak?
Two drugs with different mechanisms of action produce greater effects when given together.
What is a synergistic interaction?
The kidneys perform a major role in this phase by removing drugs or their metabolites through urine.
What is excretion?
Drugs administered by this route are technically not absorbed because they are delivered directly into the bloodstream.
What is the intravenous (IV) route?
IV naloxone is administered in the emergency department for an opioid overdose.
What is acute therapy?
A patient's respiratory rate decreases to 6 breaths/min after receiving an opioid.
What is an adverse effect?
This is the length of time a medication produces its desired therapeutic effect.
What is duration?
Naloxone reverses the effects of morphine. This demonstrates this type of interaction.
What is an antagonistic interaction?
Also called biotransformation, this phase changes a drug from its original form to an inactive or new form.
What is metabolism?
An oral drug travels from the GI tract to the liver, where a portion is metabolized before reaching systemic circulation. Name this phenomenon.
What is the first-pass effect?
A patient takes metformin every day to control type 2 diabetes and prevent progression of the condition.
What is maintenance therapy?
A patient develops hives and difficulty breathing shortly after receiving an antibiotic. The immune system has interpreted the medication as a foreign substance.
What is an allergic effect/reaction?
A drug has a half-life of 6 hours. After 6 hours, this percentage of its blood concentration has been eliminated.
What is 50%?
Calcium decreases the absorption of tetracycline antibiotics, potentially reducing their effectiveness.
What is interference?
A patient with kidney disease receives repeated doses of a medication. The drug begins accumulating because the body cannot remove it efficiently. Identify the pharmacokinetic phase primarily affected and the major safety concern.
What are impaired excretion and increased risk of drug accumulation/toxicity?
Because of first-pass metabolism, an oral medication may have less of the administered drug reach systemic circulation. This pharmacokinetic property is therefore reduced.
What is bioavailability?
A patient arrives with findings strongly suggesting bacterial meningitis. IV antibiotics are started before the organism is confirmed. Explain why this is classified as empiric rather than prophylactic therapy.
What is because treatment is initiated based on clinical probability/current symptoms rather than to prevent a future illness or event?
A patient experiences an unusual response to a medication that is opposite of what would normally be expected. The response may be related to a unique genetic difference in drug breakdown.
What is an idiosyncratic effect?
A patient receives a medication with a narrow margin between therapeutic and toxic levels. The provider orders a trough level. When should the nurse anticipate drawing the level?
What is approximately 30-60 minutes before the next dose?
Aspirin displaces warfarin from plasma protein-binding sites. Predict what happens to the amount of free warfarin and the patient's risk for bleeding.
What are increased free warfarin and increased risk of bleeding/toxicity?
Daily Double 1
A patient with significant liver dysfunction is receiving a medication primarily metabolized by the liver. The nurse notices that the effects of the medication are lasting longer than expected.
Which ADME phase is impaired?
What is Metabolism?
Daily Double 2
A patient with significant liver dysfunction is receiving a medication primarily metabolized by the liver. The nurse notices that the effects of the medication are lasting longer than expected.
1. What may happen to the drug level?
2. What complication should the nurse be concerned about?
What is it that the medication may accumulate and increase the risk for adverse effects/toxicity?
Daily Double 3: Tolerance or Cumulation?
Patient A: After taking the medication for an extended period, increasingly larger doses are required to achieve the same effect.
Patient B: Has impaired kidney function and develops increasingly high drug levels with repeated doses.
What is Patient A = tolerance?
What is Patient B = cumulation?