Ch. 2: Pharmacologic Principles Flashcards by Bethany Au

Define:
Drug
Pharmacology

Drug: any chemical that affects the physiologic processes of a living organism

Pharmacology: study/science of drugs

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Explain the patent life

The time after discovery of a drug for the founder to have full control/jurisdiction over it and the price

Price of drug is usually much higher during the patent life

After the patent life expires, the drug can be created in generic forms by other manufacturers, and the price usually drops

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What drug name is always used by nurses?

Generic name (nonproprietary)

Not the trademark name

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Define:
Pharmaceutics
Pharmacokinetics
Pharmacodynamics
Pharmacogenomics

Pharmaceutics: Different dosage forms have different properties/dissolution rates/effects on the body

Pharmacokinetics: What the body does to the drug- Absorption, Distribution, Metabolism, Excretion

Pharmacodynamics: What the drug does to the body

Pharmacogenomics: genetic factors/drug responses

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Define:
Pharmacotherapeutics
Pharmacognosy
Pharmacoeconomics
Toxicology

Pharmacotherapeutics: Expected outcomes of drug therapy

Pharmacognosy: natural drug sources (plants/animals)

Pharmacoeconomics: factors influencing the cost of drug therapy

Toxicology: poisons/unwanted responses to drugs

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List the different med forms in order of fastest dissolution to slowest

Oral disintegration, buccal tablets, oral soluble wafers

Liquids, elixers, syrups

Suspension solutions

Powders

Capsules

Tablets

Coated tablets

Enteric-coated tablets

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Why do enteric-coated tablets take so long to be absorbed?

They are designed to break down in the alkaline environment of the small intestine

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Explain:
Bioavailability
First-Pass Effect

Which form of med has 100% bioavailability?

Which form of med has a high first-pass effect?

Bioavailability: the extent of drug absorption (IV= 100%)

First-Pass Effect: Drugs taken through the enteral route must pass through the liver before reaching the bloodstream- much smaller amount reaches bloodstream due to liver metabolism into inactive metabolites

PO meds have a high first-pass effect

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List the 4 First-Pass Routes

Hepatic Arterial
Oral
Portal Venous
Rectal (can be non-first-pass too)

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Which 4 organs are drugs distributed to first?

Heart, Liver, Kidneys, Brain

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What is required before a drug can be distributed outside of the blood vessel?

It must detach from a plasma protein

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What happens when drugs compete for albumin binding sites?

More unbound drugs may be present in the bloodstream, leading to more interactions

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What 4 forms can metabolism (biotransformation) change a drug into?

Inactive metabolite
More soluble compound
More potent active metabolite
Less active metabolite

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Which cytochrome enzyme targets lipid-soluble drugs that are more difficult to eliminate and are responsible for the metabolism of most medications?

Cytochrome P-450 Enzymes

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Explain lipophilic vs hydrophilic drugs

Which form is required for drug excretion?

Lipophilic: dissolves in fat/oil, crosses cell membrane easily and quickly

Hydrophilic: dissolves in water, needs help/time to cross cell membrane

Hydrophilic form is required for the drug to be excreted

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Where are most drugs made more water-soluble?

Liver

What is biliary excretion?

Excretion through intestines

What is enterohepatic recirculation?

Fat-soluble drugs can be released into bile and can be taken up again into the bloodstream

What is the Half-Life?

After how many half-lives can a drug be considered effectively removed from the body?

The time required for half of a given drug to be removed from the body

5 half-lives

Explain Steady State

Physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose

Important for antibiotics

If the half life can range from 10-60 hours, how long will it take to effectively remove the drug from the body?

10x5=50 hours
60x5= 300 hours

can take 50-300 hours to remove

Explain:
Peak Level
Trough Level

Peak level: highest concentration in blood
Trough level: lowest concentration in blood (taken 30 mins before next dose)

Explain:
Onset of action
Peak Effect
Duration of Action

Onset of Action: time required for the drug to elicit a response- when it starts working

Peak Effect: time required for a drug to reach max therapeutic response- when it’s the strongest

Duration of Action: Length of time the drug concentration is sufficient to elicit a therapeutic response- how long it lasts

Explain therapeutic drug monitoring

What do you do is the trough is too high for the next dose?

Monitoring the peaks the troughs of meds to determine correct dosing

Trough too high= hold drug, notify provider

Define: Therapeutic effect Mechanisms of Action -Drug-receptor relationship -Enzymes -Nonselective Interactions

Therapeutic Effect: Desired/intended effect Mechanisms: how the drug does it Drug-receptor relationship: Drug binds to cell receptor and produces a response Enzymes: drug inhibits or enhances an enzyme's action Nonselective Interactions: Drug targets the cell membrane or a cellular process

Explain the following drug-receptor interactions: Agonist Partial Agonist Antagonist Competitive Antagonist Noncompetitive Antagonist

Agonist: Drug binds to receptor- there is a response Partial Agonist: Drug binds to receptor- diminished response Antagonist: Drug binds to receptor: NO response, prevents binding of agonist Competitive Antagonist: Drug competes with agonist for receptor binding, if it binds, there is no response Noncompetitive Antagonist: Drug combines with different parts of the receptor and inactivates it, agonist then has no effect

Explain off-label prescriptions

Meds prescribed for a non-FDA approved indication (allowed)

Explain the following aspects of pharmacotherapeutics: -Contraindications -Acute Therapy -Maintenance Therapy -Supplemental Therapy

Contraindications: pt condition that makes a med use dangerous Acute: Sustains life/treats disease- vasopressors, epi-pens Maintenance: prevents progression of a disease or condition- antihypertentives, birth control pills Supplemental: supplies body w/ a substance needed for normal functions: insulin

Explain the following aspects of pharmacotherapeutics: -Palliative Therapy -Supportive Therapy -Prophylactic Therapy -Empiric Therapy

Palliative: relief of symptoms to improve quality of life (opioids) Supportive: maintains integrity of body functions while pt recovers from illness/trauma (IV fluids) Prophylactic: Prevents illness/undesired outcomes (vaccines) Empiric: Based on clinical probabilities (antibiotics)

Explain the following: Monitoring Therapeutic Response Adverse Effects Toxic Effects

Monitoring: evaluating the effectiveness of the therapy Therapeutic Response: beneficial effects Adverse effects: unintended effects Toxic effects: poisonous/harmful effects

Explain the following: Therapeutic index Low vs. High Therapeutic index

Ratio of a drug's toxic level to the level providing therapeutic benefits Low/Narrow: Greater likelihood of adverse reaction High: Smaller likelihood of adverse reaction

Explain the following: Tolerance Dependence Physical Dependence Psychological Dependence

Tolerance: decreasing response to repeating drug doses Dependence: physiologic or psychological need for a drug Physical Dependence: physiologic need for a drug to avoid physical withdrawal symptoms Psychological Dependence: Addiction- obsessive desire for the effects of a drug

Explain the following Effects: Additive Synergistic Antagonistic Incompatibility

Additive: Drugs w/ similar actions (1+1=2) Synergistic: Drugs interact in a way that amplified the effect greater than the sum of the effects for each given alone (1+1= >2) Antagonistic: Combination of the 2 drugs diminishes the effects (1+1=<2) Incompatibility: 2 parenteral drugs/meds are mixed together- causes chemical deterioration of one or both (precipitation, color change, haziness)

What drug interactions would result from the following combinations: Aspirin + Acetaminophen Caffeine + Alcohol Acetaminophen + Alcohol

Additive Antagonistic Synergistic- both are liver-toxic

Explain the following: Pharmacologic Reaction Hypersensitivity (allergic) Reaction Idiosyncratic Reaction Drug interaction Teratogenic Effect Mutagenic Effect Carcinogenic Effect

Pharmacologic: normal effects Hypersensitivity: immune system response to neutralize substance Idiosyncratic: unexpectedly in particular pt Drug interaction: unwanted effects of 2 drugs given together Teratogenic Effect: damaging to fetus Mutagenic Effect: permanent genetic composition changes in living organisms Carcinogenic Effect: Cancer-causing

Explain pharmacognosy Give 2 examples of animal sources of drugs

Study of natural drug sources like plants/animals/minerals Porcine: Pig: Heparin/Insulin Equine: Horse: conjugated estrogens

What is the treatment system based on for toxicology?

Prioritics: ABCs Prevention of absorption or speed its elimination from body

How would renal disease affect half-life?

Would delay it due to excretion difficulties