What does TGA stand for?
Therapeutic goods association
Therapeutic goods administration
Therapeutic goods analgesics
The Good administration
What is the TGA responsible for?
Evaluating, assessing and monitoring therapeutic goods in Australia
Prescribing medications to patients
Educating patients about the safety of drugs
Checking the validity of drug orders
Schedule 2 drugs are:
Pharmacist only e.g. panadiene
Controlled drugs e.g. morphine
Pharmacy medicine e.g. paracetamol
Prescription only e.g. antibiotics
Schedule 4 drugs are:
Prescription only e.g. antibiotics & hypertensive drugs
Controlled drugs e.g. morphine & endone
Pharmacy medicine e.g. paracetamol & ibuprofen
What are some considerations involved with schedule 8 - controlled drugs? (2 answers)
Can be administered by 1 RN
Are kept in an unlocked cupboard
Administration needs 2 RNs
Need to be kept in a locked cupboard
Generally schedule 3,4 & 8 medication are not advertised in the popular media except inhaled corticosteroids, vaginal anti-infective agents and nicotine to treat smoking dependence.
What are the 6 rights of drug administration?
Right patient, right drug, right dose, right time, right route, right to refuse
Right patient, right drug, right time, right dose, right hand, right to restrain
Right colour, right flavour, right drug, right dose, right patient, right route
Right patient, right drug, right dose, right time, right route
Which of the following are necessary for a medication order to be valid? (Pick 5 answers)
It needs to be dated
Is the drug name there?
Does NOT need to be legible
Signed by a nurse
Dose and unit of measurement need to be present
Route needs to be documented
Signed by a doctor, nurse practitioner or dentist
Which answer is not correct regarding roles and responsibilities of the healthcare team when administering drugs?
Doctor can diagnose and prescribe
Nurse can Prescribe and dispense
Nurse can assess, administer and evaluate
Pharmacist can advise and dispense
The generic name is also called the trade name, when drug companies market a drug they select a name and copyright it.
The Brand name is the official drug name, approved name given by the manufacturer and local authority.
Enteric coated preparations are not:
designed so disintegration occurs in the intestines rather than the stomach
Abbreviated EC on the container
to be crushed
Capsules can be either Hard gelatine capsules containing a drug as a solid, or soft gelatine capsules which can be opened and are useful for liquids drugs, or those that do not dissolve easily in water
What type of drug form is released slowly in the GIT and consists of layers of a drug enclosed in successive layers of inert coating?
Controlled release
Capsules
enteric coated preparations
Sustained/slow release
what type of drug has a semi permeable membrane coating, and can end up in faeces as a "ghost tablet"
Oral liquids
Controlled release tablets
topical preparations
Enteric coated preparations
A nicotine patch would be considered a(n)
oral liquid
Topical preparation
Capsule
Ointment
Linctus - is a syrup specially formulated for coughs
Elixers - is an alcoholic solution that is used when the required drug is water insoluble
Intradermal, subcutaneous, IM, IV, intraarterial & intrathecal are all what forms of administration?
Enteral
Parenteral
Transdermal
Gastro-intestinal
Pharmacodynamics is:
What the body does to the drug
What the drug does to the body
How the drug is altered as it travels through the body
Pharmacokinetics is:
the integration at a molecular level - between the drug molecules and the target cell, receptor where it will stimulate or inhibit the natural chemicals of the body
The drugs interaction with structural proteins
what is not 1 of the 4 aspects of pharmacokinetics:
Absorption - movement of drug molecules into the body from the site of administration
Distribution - the drug enters the bloodstream, and travels to the site of action, will be improved if the drug binds to albumin + globulins in the blood.
Disruption to the cellular membrane
Metabolism - alters chemical properties of drugs making them less lipophilic (fat soluble) and more readily excreted
Excretion - Excreted from the system in various ways e.g. urine, saliva, sweat, tears, breathing
Factors affecting;
absorption - chemical nature of the drug, pH of the stomach, Surface area available for absorption & route/solubility of drug
Distribution - lipid solubility
Metabolism - Hepatic 1st pass effect (oral meds)
What is the term for the fraction of the drug available to the systemic circulation, and is measured on a scale of 0 - 1 (1=100%)
Half life
Absorption percentage
Bioavailability
Hepatic first pass effect
Oral meds have a bioavailability of 1 or 100% and IV drugs have a bioavailability of <1
The following are listed in order of ________ to ________ regarding Rate of absorption
liquids syrups parenteral suspensions powders capsules tablets coated tablets enteric coated tablets
Fasted - Slowest
Slowest - Fasted
Where is the major site of metabolism?
Brain
Anus
Spleen
Liver
What is not efficient as a barrier to drugs, and may result in congenital abnormalities?
Blood brain barrier
Semipermeable membrane
Placental Barrier
Swiss cheese model
Metabolism occurs in 2 phases
Phase 1 - enzymes modify chemical structure of the drug
Phase 2 - the phase 1 metabolite is joined (conjugated) with another molecule to render the product soluble for excretion
The hepatic first pass effect
Removes the drug entirely
Increased bioavailability
Does not remove entire drug but it does reduce the bioavailability
recruits the cremaster muscles to aid in the metabolism of drugs
The kidneys, GIT as well as saliva, sweat, tears, breath and breast milk are all sites of excretion (drug clearance)
If the blood concentration of a drug is 1000mg/L at a 12pm, and this level drops to 500mg/L by 4pm. What is the half life?
2 hours
4 hours
6 hours
8 hours
An antihypertensive medication reducing a patients blood pressure too much and causing hypotension would be an example of a drug having:
The correct response
Too little response
Too much response
a nightmare
The use of many drugs at once, the use of drugs with no apparent indication, & the duplication of medication taking would indicate _________, which presents a major health care risk to patients
Polydrugs
Polydynamesis
Polysynthesis
Polypharmacy
The systems approach to errors identifies that : (pick 3 answers)
Errors occur just because people are dumb
Humans are fallable (capable of making mistakes)
Errors are deemed as causes not consequences
errors are deemed as consequences not causes
Investigations are needed to seek new ways of completing tasks.
The Swiss cheese model identifies that there are holes in the layers of defence which include:
Active conditions & Latent failures
Active failures & Latent conditions
Active failures may lie dormant for some time before combining with a latent condition to create an opportunity for error and if identified they can be remedied before these errors occur (e.g. staffing issues, inexperience or inadequate equipment/training)
Latent conditions are unsafe acts committed by people in direct contact with the patient (e.g. slips, trips, lapses, fumbles, mistakes & procedural violations)
The ANS (autonomic nervous system) is divided in the Sympathetic nervous system (rest & digest) and the Parasympathetic nervous system (fight or flight).
The sympathetic nervous system has short pre-ganglionic neurons that release _______ and long post-ganglionic neurons that release _____________ or noradrenaline onto the effector organ. These nerves are adrenergic
Adrenaline - Renin
Acetylcholine - Adrenaline
Adrenaline - Acetylcholine
Renin - Angiotensin II
The parasympathetic nervous system has long pre-ganglionic neurons that release ___________ and short post-ganglionic neurons that release ___________ . These nerves are cholinergic
Acetylcholine - Acetylcholine
Adrenaline - Adrenaline
The sympathetic nervous system dilates pupils, inhibits flow of saliva, accelerates heartbeat, dilates bronchi, inhibits peristalsis + gastric secretions, coverts glycogen to glucose (glycolysis), releases adrenaline + noradrenaline, and inhibits bladder contractions.
The parasympathetic nervous system stimulates flow of saliva, slows HR, contracts bronchi, stimulates peristalsis + gastric secretions, stimulates release of bile, contracts pupils and contracts the bladder.
Sympatholytics are Agonist drugs that will stimulate and induce the effects of fight or flight
Sympathomimetics are Antagonist drugs that will inhibit sympathetic stimulation.
Select the adrenergic receptors:
Nicotinic (responds to stimulation by nicotine, located in smooth + cardiac muscle as well as neuromuscular junction of skeletal muscle)
Alpha 1 (abundant on major arteries, associated with vasoconstrictive responses and increased BP)
Muscarinic (acetylcholine receptors, acting as the main end-receptor stimulated by acetylcholine released from postganglionic fibers in the parasympathetic nervous system.)
Beta 2 (abundant on bronchiolar smooth muscle and blood vessels within skeletal muscle, heart, brain and kidneys. Associated with bronchodilation and increased tissue perfusion)
Beta 1 (located on myocardium, smooth muscles, GIT sphincters and renal arterioles. Associated with rate/force of heart contraction)
Alpha 2 (Abundant on presynaptic terminal, involved with autoregulation of synaptic activity)
The roles of ___________ receptors include vasoconstriction (increased BP) , pupil dilation + contraction, urinary retention, glucose release, generalised sweating & GIT constriction (decrease motility).
Alpha 2
Alpha 1
Beta 1
Beta 2
The role of __________ receptors are bronchodilation, vasodilation, insulin release and decreased GIT motility.
The role of _________ receptors are increased HR, increased contractility of the heart, increased atrioventricular conduction, increased renin release and vasoconstriction.
Alpha 1 ________ drugs would cause ____________ , increased BP, pupil dilation, glucose release, sweating and reduced GIT motility.
Antagonist - vasodilation
cholinergic - vasoconstriction
agonist - vasoconstriction
blocker - vasoconstriction
Alpha 1 __________ drugs would cause __________ , reduced BP, pupil constriction, impotence, increased urination and increased GIT motility.
Agonist - vasoconstriction
Antagonist - vasoconstriction
Agonist - vasodilation
Alpha 2 agonist drugs can be used to treat ____________
Hypertension
Hyperglycaemia
Hypothyroidism
Diabetes mellitus
_________ agonist drugs would increase HR and CO, reduce GIT motility and stimulate the release of renin (increase blood flow and BP)
Select the incorrect statement from the following regarding phases of clinical trials:
Phase 1 clinical trials involve 20-80 health volunteers
Phase 2 clinical trials involve 100-150 volunteers with the targeted illness
Phase 3 clinical trials involve 1000-3000 volunteers with the targeted illness
Phase 4 clinical trial involves comparisons with other treatments and ongoing safety monitoring whilst out on the market.
Phase 1 clinical trials - drugs are tested on individuals from a lower socioeconomic background
__________ antagonist drugs (beta blockers) __________ HR, SV, and CO, increase GIT motility and inhibit renin release. Side effects can be dizziness, lethargy, insomnia, diarrhoea, bradycardia and hypotension.
Beta 2 - decrease
Alpha 1 - increase
Beta 1 - reduce
Beta 1 - increase
_______ agonist drugs cause _________ , an increase in skeletal muscle excitability (tremors), vasodilation, relaxation of the uterus, reduced bile secretion and increase glycogenolysis.
Beta 1 - vasoconstriction
Beta 2 - bronchodilation
Beta 1 - bronchodilation
Alpha 2 - bronchodilation
Ach (acetylcholine) is removed from the synaptic gap by an enzyme called ________________.
Acetylcholinesterase
Acetylcholinogen
Acetylcholinogenolysis
Acetylcholine converting enzyme
some side effects of Beta 2 agonist drugs include fine muscle tremors, nervousness, tachycardia, increased BGL + insulin levels and hypokalaemia (low k+)
Nicotinic agonists increase the feeling of relaxation and well being, also increase skeletal muscle tone (tremors)
What drug inhibits the breakdown of AcH and therefore enhances the effects of AcH at nicotinic and muscarinic receptors?
Acetylcholinesterase inhibitors
Acetylcholinesterase agonists
Autocoids
Muscarinic agonists
I am classed as an autocoid, I am a locally acting substance, I am released and confined to the same tissue and I am found in high concentration in the lungs, skin, GIT and CNS. what am I?
Prostaglandin
White blood cell
a robot
Histamine
Histamines are released from ________ and ________ when an allergen, foreign body, or injury is encountered.
G cells - red blood cells
enteroendocrine cells - basophils
Mast cells - Basophils
Sail cells - neutrophils
Histamines play a vital role in allergic and inflammatory reactions, some effects can be anaphylaxis, stimulation of pain receptors (nociceptors), vasodilation, and increased capillary permeability (leads to swelling).
1st generation anti-histamine drugs:
can cross the Blood brain barrier, causing drowsiness and possibly sedation.
can only cross the blood brain barrier in small amounts and are therefore not sedating
2nd generation anti-histamine drugs:
can cross the blood brain barrier, causing drowsiness and sedation
___________ can reduce acid stimulation in the stomach so these are beneficial when treating __________ and GORD (gastro - oesophageal reflux disease)
H1 agonists - hypertension
H2 antagonists - Peptic ulcers
H3 antagonists - peptic ulcers
NSAIDs block the synthesis of _____________ by interfering with the ________ and _________ enzymes.
histamines - COX 3 - COX 4
Prostaglandins - DIX 1 - DIX 2
Prostaglandins - COX 1 - COX 2
Histamines - COX 1 - COX 2
Regarding Chemical mediator communication which answer is most correct:
Endocrine signalling - molecules travel from signalling cell through the bloodstream to the target cell
Paracrine signalling - Signalling cell and the target cell are close together
All of these
Autocrine signalling - Signalling and target cell are the same cell.
all of the following are non-specific COX inhibitors, except:
Aspirin
Ibuprofen
Diclofenac
Celecoxib
Indomethicin
Prostaglandins do not cause constriction of smooth muscle, vasodilation, aggregation of platelets, increased sensitivity of neurons to pain, the mediation of inflammation, fever (pyrogenic) or the inhibition of acid secretion in the stomach.
Which of the following is not a cardiac medication (antihypertensive)
ACE inhibitors (suffix "pril")
Beta blockers (suffix "olol")
Calcium channel inhibitors
Anti diuretics
Loop diuretics
The inhibition of COX in peripheral tissue will reduce pain + inflammation. The inhibition of COX in the stomach removes the protective effect of PG (prostaglandin) and results in damage to the GI mucosa.
When a patient is on multiple medications that affect the metabolism, synthesis or uptake of serotonin, what happens to serotonin levels.
Builds up
Breaks down
No issues
Patient gets cooked
Serotonin builds up in the neurons of the CNS and it can cause:
A change in mental status
Hyperpyrexia
Ataxia (lack of voluntary coordination of muscle movements)
Noradrenaline, adrenaline and dopamine are known as catecholamines
