8-1 Flashcards
Drug idiosyncrasy
unusual or abnormal reaction that do not occur in the vast majority of patients taking the same drug.
Drug tolerance
decreased response to a drug, requiring an increase in dosage to achieve the desired effect
Cumulative drug effect
not fully metabolized a dose of a drug before the next dose is given.
Toxic
harmful drug effect if it is delivered in high dose or when blood concentration levels exceed therapeutic level
- May be reversible or irreversible depending on organ/tissue damage. Liver=regenerate. hearing loss=irreversible
- have to know the signs and symptoms of toxicity for drugs you are giving.
Pharmacogenetics Reactions
Inherited traits that cause abnormal metabolism of the drug. Ex: G6PD patient taking aspirin or sulfonamides will have hemolysis of their RBCs.
Pharmaceutic phase
The dissolution of a drug. Usually applying to the breakdown of tablets.
**example was when you take aspirin and it starts to breakdown in the stomach to be absorbed
Additive drug reaction
combined effect of two drugs is equal to the sum of each drug given alone
Antagonist Drug Reaction
drug interferes with the action of another, causing neutralization or a decrease in the effect of one drug.
Drug - Food Interactions
food may impair or enhance its absorption
Age
Immature or aging organ function affects metabolism of a drug.
Weight
Average weight is approximately 150 lb for both men and women
Gender
Women require smaller dose due to differences in body fat and water ratio compared to men.
Disease
Liver disease may affect ability to metabolize or detoxify a drug.
Route of Administration
IV drug produce the most rapid response
Prescription drugs
written prescription by an accredited authorized prescriber provider. Faxed prescriptions are no longer authorized as per Chapter 21 of the MANMED.
Non-Prescription drugs
(OTC)
Where can you put med requests
Where can you put controlled substances requests
CHCS
DOD prescription (DD 1289),
poly- prescription (NAVMED 6710/6).
Controlled substances shall be written only on the DD 1289, never on a poly-prescription.
qualities of writing prescriptions
metric system, and quantity to be dispensed. Prescriptions should be written generically.
Can Narcotics be placed on refills?
NEVER PLACE A NARCOTIC ON REFILL!!!
How do you document that you’ve written a DD 1289
Proper SOAP note documentation must be completed, including drug administered, quantity, and directions
Factors that alter Bioavailability are
i. (1) The drug from (e,g tablet, capsule, sustained release, liquid, trans-dermal patch, inhalation).
ii. (2) Route of administration
iii. (3) Changes in Liver metabolism caused by dysfunction.
iv. (4) G I mucosa and motility.
v. (5) Food and drugs
vi. (6) Solubility: Drugs that are fat soluble are absorbed faster than water-soluble drugs.
toxic
Too high
decreased effect
Too low
Metabolism
occurs in the Liver, Kidneys, lungs, plasma, and intestinal mucosa.
Bioavailability
subcategory of absorption. It is the percentage of the administered drug dose that reaches the systemic circulation. For drugs taken orally, bioavailability occurs only after the medication has been absorbed and metabolized by the liver. Oral drugs that have a first pass hepatic metabolism may only have a bioavailability of 20-40% as opposed to I.V medications that have a 100% bioavailability.
Psychological dependence
compulsion to use a substance to obtain a pleasurable experience.
Therapeutic Effect:
toxic
Too high
Therapeutic Effect:
decreased effect
Too low
Antagonist
binds to receptor stronger than the agonist thus producing no pharmacologic
What do the kidneys discrete
Kidney excretes the inactive compounds from the body in the urine
Allergic reaction
the individual’s immune system views the drug as a foreign substance.
Pharmacogenetic disorder
abnormal response to normal doses of a drug.
Half - Life
Time required for the body to eliminate 50% of the drug
1.Kidney, Liver disease and old age can increase the half-life increasing risk of toxicity.
Pharmacodynamic
Drug’s actions and effects within the body.
i. (1) Primary or desired effect.
ii. (2) Secondary effects (side effects) – desired or undesired
Basic units are as follows
Weight
Micrograms (mcg) or Milligrams (mg) Grams (g) Kilgrams (kg)
Basic units are as follows
Volume
Milliliter (ml) or Liter (l) Note: 1 Milliliter (ml) = 1 Cubic Centimeter (cc)
Basic units are as follows
Length
Meter or (m)
Frequently used unit conversion
i. (1) 1 kilogram = 1000 grams
ii. (2) 1 gram = 1000 milligrams
iii. (3) 1 milligram = 1000 micrograms
Conversions
If you are converting to a larger unit of measure, you must move the decimal to
the left
Conversions
If you are converting to a smaller unit of measure, you must move the decimal to
the right
ratio
the relationship of one number to another.
All percentages are ratios expressed as parts per hundred
the most frequent route of drug administration and rarely causes physical discomfort when taken properly.
oral route
Oral medications may be administered via the following methods
i. (1) Nasogastric tube
ii. (2) Buccal route: Drug is placed between the cheek and either the upper or lower jaw and allowed to dissolve.
iii. (3) Sublingual route: The drug is placed or sprayed under the tongue
Parenteral drug administration means giving the drug by one of following routes
i. (1) Subcutaneous
ii. (2) Intramuscular
iii. (3) Intravenous
iv. (4) Intradermal
Subcutaneous
places the drug into the tissues between the skin and the muscle. This method is absorbed more slowly than IM injections
Intramuscular
places the medication directly into the muscle. The rich supply of blood vessels in the muscle tissue allows the medication to be rapidly absorbed.
Intravenous
directly into the blood via a needle or catheter inserted into a vein. The drug action occurs almost immediately since there is a direct path to the drug receptors.
Intradermal
typically used to administer sensitivity tests, such as the tuberculin test. The needle is inserted at a 15-degree angle, and the medication/agent is placed between the first and second layers of the skin, allowing for a slow absorption
. Drugs may also be applied to the skin and mucus membranes using several routes:
i. (1) Topical
ii. (2) Transdermal
iii. (3) Inhalation
Topical
applied directly to the skin.
variety of forms including creams, ointments, sprays, liquids, suppositories, as well as ophthalmic and otic forms
Transdermal
transdermal route are rapidly absorbed from the skin and have systemic effects
implanted on a small patch
This method maintains a relatively constant blood concentration and reduces the possibility of toxicity
Inhalation
Drug droplets, vapors, and gas are administered through the mucus membranes of the respiratory tract. The patient breathes the drug through a face mask, nebulizer or an endotracheal tube. The drugs administered via inhalation primarily have a local effect on the lungs
Sedatives and Hypnotics
that cause a dose-dependent depression of the Central Nervous System function, inducing sedation, sleep, and unconsciousness with increasing dose
What kind of agents are in sedative and hypnotics
barbiturates, benzodiazepine and melatonin agonists.
Antianxiety Drugs
- 1) Benzodiazepines (for short term use only)
- 2) Non- Benzodiazepines.
- (a) Most benzodiazepines causes generalized CNS depression (Sedative- Hypnotics). Benzodiazepines may produce tolerance with long-term use and have potential for psychological or physical dependence. These agents have NO analgesic properties
Benzo
Non-Benzo
benzo: Bind to specific benzodiazepine receptors in the GABA receptor complex, which enhances the binding of this inhibitory neurotransmitter
non-benzo: Act on brain’s dopamine and serotonin receptors
Antidepressants
Class of antidepressants
- (a) Tricyclic antidepressants (TCAs)
- (b) Monoamine Oxidase Inhibitors (MAOI)
- (c) Selective Serotonin Reuptake Inhibitors (SSRI)
- (d) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- (e) Serotonin Reuptake inhibitor/Antagonist
- (f) Dopamine/Norepinephrine-Reuptake Inhibitor
Antianxiety Drugs
1) Benzodiazepines (for short term use only)
2) Non- Benzodiazepines.
(a) Most benzodiazepines causes generalized CNS depression (Sedative- Hypnotics). Benzodiazepines may produce tolerance with long-term use and have potential for psychological or physical dependence. These agents have NO analgesic properties
Antidepressants
Class of antidepressants
(a) Tricyclic antidepressants (TCAs)
(b) Monoamine Oxidase Inhibitors (MAOI)
(c) Selective Serotonin Reuptake Inhibitors (SSRI)
(d) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
(e) Serotonin Reuptake inhibitor/Antagonist
(f) Dopamine/Norepinephrine-Reuptake Inhibitor
Antidepressant
Action
(a) TCAs
(b) Increase levels of norepinephrine and serotonin by inhibiting their reuptake, and block the action of acetylcholine
(c) MAOI: Inhibits the activity of Monoamine oxidase resulting in increased endogenous neuro-hormones.
(d) SSRI: Increase serotonin by inhibiting neuronal uptake to CNS.
antianxiety
Adverse Effects
Long term use of benzodiazepines: Withdrawal syndrome after as little as 4-6 weeks of therapy. Never discontinue abruptly decrease over 4-6 weeks
antianxiety
situations when benzodiazepines are used
Benzodiazepines are used primarily in acute situations.
Antipsychotic
Action
- Block dopamine receptors in the brain; also alter dopamine release and turnover. Peripheral effects include anticholinergic properties and alpha-adrenergic blockade
- Antipsychotics are classified as “typical” (1st Generation) and “atypical” (2nd Generation). Phenothiazine are known as “typical” anti-psychotics. Newer (2nd Generation) are also known “atypical” agents and have fewer adverse reationa
- Antipsychotics are classified as “typical” (1st Generation) and “atypical” (2nd Generation). Phenothiazine are known as “typical” anti-psychotics. Newer (2nd Generation) are also known “atypical” agents and have fewer adverse reationa
antipsychotic
use
Treatment of acute and chronic psychoses, particularly when accompanied by increased psychomotor activity. Use of Clozapine is limited to schizophrenia unresponsive to conventional therapy. Selected agents are also used as antihistamine or antiemetic. Chlorpromazine is also used in the treatment of intractable hiccups.
Antipsychotic
Examples
- (a) Haloperidol: Haldol (1st Generation)
- (b) Prochlorperazine: Compazine (1st Generation)
- (c) Quetiapine: Seroquel (2nd Generation)
- (d) Olanzapine: Zyprexa (2nd Generation)
Antipsychotic
Patient Management
Assess deviation from normal: Poor eye contact, failure to answer questions, and monotone speech
CNS Stimulants Amphetamines and Anorexiants
Action
Produce CNS stimulation by increasing levels of neurotransmitters in the CNS. Produce CNS and respiratory stimulation, dilated pupils, increased motor activity and mental alertness, and a diminished sense of fatigue.
CNS Stimulants Amphetamines and Anorexiants
Use
The treatment of narcolepsy and as adjunctive treatment in the management of attention deficit hyperactivity disorder (ADHD).
CNS Stimulants Amphetamines and Anorexiants
Patient Management
- (a) Take the drug in the morning 30-45 minutes before breakfast and before lunch.
- (b) Insomnia and anorexia usually disappear during continued therapy.
- (c) May be given on only school days.
- (d) Do NOT increase the dose or take the drug more frequently.
- (e) Decrease coffee or caffeine
CNS Stimulants Amphetamines and Anorexiants
Examples:
- (a) Amphetamines
a. 1) Methylphenidate HCL: Concerta
b. 2) Dextroamphetamine: Adderall - (b) Anorexiants
a. 1) Phentermine: Ionamin
Anticonvulsants
Action
- (a) Reduction of excitability of the neurons of the brain.
- (b) Types of seizures
Anticonvulsants
Use
Decrease the incidence and severity of seizures of various etiologies. Some anticonvulsants are used parenterally in the immediate treatment of seizures. It is not uncommon for patients to require more than one anticonvulsant to control seizures on a long-term basis. Many regimens are evaluated with serum level monitoring. Several anticonvulsants also are used to treat neuropathic pain & headache syndromes.
Anticonvulsants
Treatments
Benzo
Non Benzo
Benzo
Diazepam: (IV) Valium
Nonbenzo
Phenytoin: (IV/TAB) Dilatin
Antiemetics/Antinauseants
action
Depresses the CNS
Phenothiazines act on the chemoreceptor trigger zone to inhibit nausea and vomiting. Primarily by inhibiting the chemoreceptor trigger zone or by depressing the sensitivity of the vestibular apparatus of the inner ear.
Antiemetics/Antinauseants
Use
i. (a) Antiemetic: Prophylaxis or treatment of nausea or vomiting.
ii. (b) Antivertigo: Treatment of vertigo
Antiemetics/Antinauseants
examples
Non Diphenhydramine : benadryl (Antivertigo) Meclizine : antivert (antivertigo) Ondansetron : Zofran (antiemetics) Metoclopramide : Reglan (antiemetics) Phenothiazines Promethazine: Phenergan (Antiemetics)
Anesthetics
Action
Local anesthetics: Produce a local anesthesia by inhibiting transport of ions across neuronal membranes, thereby preventing initiation and conduction of normal nerve impulses
Ketamine
Anesthetics
Use
utilized to produce a loss of sensation prior to minor painful procedures including: Insertion of cannula or needles Arterial/venous/lumbar puncture, Intramuscular injections, Subcutaneous injections, Dermal procedures, Laser treatments, Circumcision. May be applied to genital mucous membranes in preparation for superficial minor surgery.
2. (b) Induction of General or Regional Anesthetic
Anesthetics
Example
Lidocaine
Ketamine
Analgesics
Classes
- (a) Salicylate
- (b) Non-salicylate
- (c) Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
- (d) Urinary Analgesics
Analgesics
Salicylates
(1) Action
Inhibition of prostaglandins, dilates peripheral blood vessels (cools body), prolong bleeding by inhibiting aggregation of platelets
(2) Use:
(a) Relief of mild to moderate pain
(b) Reduction of body temperature
(c) Inflammatory conditions
(d) Decrease risk of myocardial infarction
(e) Prevention and treatment of blood clots.
(3) Adverse Effects:
(a) Gastric upset, heartburn, nausea, vomiting, anorexia, and gastrointestinal bleeding.
(b) May cause Reye Syndrome in children with chickenpox or influenza.
(4) Contraindication/Warning/Caution:
(a) Not recommended for use during pregnancy (Pregnancy (Cat D)).
(b) Not recommended for use in patients with bleeding disorders.
(5) Examples:
(a) Aspirin: Bayer, Ecotrin, Enteric coated Aspirin
Analgesics
Non-salicylate
(1) Action:
(a) Analgesic and antipyretic
(2) Use:
(a) Relieve mild to moderate pain
(b) Reduce body temperature (antipyretic)
(c) Arthritis
(3) Adverse Effects:
(a) Urticaria
(b) Hemolytic anemia
(c) Hepatotoxicity
(d) Hypersensitivity to acetaminophen or any component of the formulation.
(e) Severe hepatic impairment or severe active liver disease.
(f) OTC labeling: When used for self-medication, do not use with other drug products containing acetaminophen or if allergic.
(4) Contraindication/Warning/Caution:
(a) Hepatotoxicity: Acetaminophen is associated with acute liver failure, at time resulting in liver transplant and death. Hepatotoxicity is usually associated with excessive acetaminophen intake and often involves more than one product that contains acetaminophen. Do not exceeds the maximum recommended daily dose (>4g daily in adults). In addition, chronic daily may also result in liver damage in some patients.
(5) Patient Management:
(a) Tylenol may be administered orally without regard to food; may administer with food to decrease possible GI upset.
(b) Mostly safe in pregnancy. (Pregnancy (CAT: B))
(c) Assess for alcohol use before prescribing Tylenol.
(6) Examples:
(a) Acetaminophen: Tylenol
(b) Benzocaine-Menthol: Cepacol
Analgesics
Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
(1) Action: Inhibit the action of the enzyme cyclooxygenase (COX-1 & COX-2 (Nonselective) or Cox 2 -Selective) which is responsible for prostaglandin synthesis.
(a) Anti-inflammatory
(b) Analgesic
(c) Antipyretic
(2) Use:
(a) Arthritis
(b) Mild to moderate pain relief.
(c) Dysmenorrhea (painful menstruation)
(d) Fever reduction
(3) Adverse Effects:
(a) Gastrointestinal: Nausea, and vomiting
(b) FDA warning: Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase your risk of heart attack or stroke.
(c) Celecoxib: Dyspepsia, and renal function
1) (Relative reduction in GI toxicity compared with nonselective NSAIDs)
(d) Ibuprofen: Due to effects on platelets and their role in clotting. Increased risk with higher dose. FDA Warning: https://www.fda.gov/ForConsumers/Cons
(4) Contraindication/Warning/Caution:
(a) Celecoxib (COX-2 Selective) –> allergy to sulfonamides
(b) Ibuprofen (Non-Selective) –> peptic ulcer, GI bleed, and hypertension
(5) Patient Management:
(a) Stop if prolonged bleeding or dark stools.
(b) Long term use may lead to GI bleed. COX-2 Selective NSAIDS are preferred for long term use to reduced the risk of GI bleed.
(c) Take with food or milk
(6) Examples:
(a) NSAIDS:
1) Ibuprofen: Motrin, Advil
2) Indomethacin: Indocin
3) Ketorolac: Toradol
4) Naproxen: Aleve, Naprosyn
5) Celecoxib (selective COX 2 inhibitor): Celebrex
6) Meloxicam (selective COX 2 inhibitor): Mobic
7) Note: Indomethacin is first line treatment for Gout.
8) Mobic is used for once a day dosing. Toradol is used for acute pain in the clinic usually given IM at 30-60 mg.
Analgesics
Class Urinary Anesthetic/Analgesic
(1) Action: Pyridium is a topical bladder and urethral anesthetic and analgesic through an unknown mechanism.
(2) Use: Is a bladder analgesic used to treat pain associated with a urinary tract infection.
(3) Dose: Is 100 mg TID for 5 days as needed for dysuria.
(4) Adverse Effects:
(a) Pyridium is known to turn the patient’s urine a reddish-orange color that can stain undergarments. Warn patients about these two changes.
(b) Headaches, dizziness
(c) Stomach cramps
(5) Contraindication/Warning/Caution:
(a) Allergy to Pyridium or renal insufficiency.
(b) Patient Management: Pregnancy B
(6) Examples:
a) Phenazopyridine: Pyridium
Narcotic Analgesics
Action
- (a) Opioids bind to opiate receptors in the CNS, where they act as agonists of endogenously occurring opioid peptides (endorphins). The result is alteration to the perception of and response to pain.1.
Narcotic Analgesics
Use
- (a) Narcotic analgesics-short term management of moderate to severe pain.
Narcotic Analgesics
Examples
- (a) Agonist:
- (b) Codeine: Codeine
- (c) Fentanyl: Sublimaze
- (d) Hydromorphone: Dilaudid
- (e) Methadone: Dolophine
- (f) Morphine sulfate: MS Contin
- (g) Oxycodone: OxyContin
- (h) Hydrocodone: Norco, Lortab, and Vicodin
Narcotic Antagonist
Action
An opioid antagonist is a receptor antagonist that acts on opioid receptors. Naloxone is a commonly used opioid antagonist drug which is competitive antagonists that bind to the opioid receptors with higher affinity than agonists but do not activate the receptors. This effectively blocks the receptor, preventing the body from responding to opiates and endorphins.
Narcotic Antagonist
Use
Overdose of a Narcotic
Narcotic Antagonist
Examples
Naloxone: Narcan
Narcotic Antagonist
Patient Management:
(a) Vital Signs
(b) Monitor for respiratory depression
(c) Dependency side effect risk
Antihistamines
Actions
antihistamines work by binding to histamine H¹ receptors in mast cells smooth muscle, and endothelium in the body as well as in the in the brain. They suppress the histamine-induced wheal response (swelling) and flare response (vasodilation)
antihistamines (histamines)
uses
a. (a) H¹- antihistamines are used to treat allergic reactions (e.g., itching, runny nose, and sneezing). In addition, they may be used to treat insomnia, motion sickness, or vertigo caused by problems with the inner ear (Dimenhydrinate and Meclizine), urticaria, and as adjunctive therapy in anaphylactic reactions and angioedema. Topical and ophthalmic antihistamines may minimize systemic side effects,
b. (b) H² - antihistamines bind to histamine H² receptors in the upper gastrointestinal tract, primarily in the stomach. Antihistamines that target the histamine H² -receptor are used to treat gastric acid conditions (e.g., peptic ulcers and acid reflux). May also help with the relief of Parkinson-like reactions (Diphenhydramine)
Antihistamines (histamines)
Adverse Reaction
Anticholinergic effects: Drying effect may increase thickening of bronchial secretions, dizziness, fatigue, hypotension, and headache.`
Antihistamines (histamines
examples
a. (a) 1st Generation Antihistamines
i. 1) Diphenhydramine: Benadryl, Diphenhydramine may be used for the treatment of allergic conditions in pregnant women when a first-generation antihistamine is indicated (Pregnancy Cat: B).
ii. 2) Hydroxyzine: Atarax
iii. 3) Promethazine: Phenergan
b. (b) 2nd Generation Antihistamines
i. 1) Cetirizine HCL: Zyrtec
ii. 2) Fexofenadine: Allegra
iii. 3) Loratadine: Claritin
Antihistamines (decongestant)
Action
The vast majority of decongestants act by enhancing norepinephrine (noradrenaline) and epinephrine (adrenaline) or adrenergic activity by stimulating the alpha-adrenergic receptors.
Antihistamines (decongestant)
Use
Common cold, hay fever or upper respiratory allergies, sinuses congestion, and pressure.
Antihistamines (decongestant)
Examples
Oxymetazoline HCL
Pseudoephedrine:
Bronchodilators
Action
- Release stimulants and reuptake inhibitors that increase the levels of endogenous catecholamines. Beta² receptors are in bronchial smooth muscle and when stimulated cause relaxation (dilation) of bronchioles.
Bronchodilators
Use
Reversible Airway Obstruction caused by bronchospasm due to bronchial asthma, exercise-induced bronchospasm, bronchitis, emphysema, and other Obstructive pulmonary disease.
