Chapter 11 Basic Principles of Pharmacology Flashcards
Who is recognized as the Father of pharmacology?
Claudius Galen
What did Claudius Galen believe was the reason for illness?
It was the result of a imbalance of blood, phlegm, black bile, and yellow bile.
Father of medicine?
Hippocrates
A book that contains a list of medical substances with their formulas, uses, and methods of preparation?
Formulary
A book describing drugs, chemicals, and medicinal preparations in a country or specific geographical area?
Pharmacopeia
Any substance (other then food or device) intended for use in the diagnosis, cure, relief, treatment, or prevention of disease, or to affect the structure , or function of the human body or animals?
Drug
The study of drugs and their effects and actions on the host?
Pharmacology
What early drug was used to treat vomiting and nausea? (base for Antropine)
Belladonna
Spanish emperor Frederick II declared pharmacy a separate entity from medicine in what year?
It was not widely accepted as such until what century?
1240
16Th century
Medicines developed for the diagnosis and/or treatment of rare diseases or conditions?
Orphan drugs
Name some Diseases that may need orphan drugs
Sickle cell anemia. Lou Gehrig's disease Cystic fibrosis. Non-Hodgkin Lymphoma Hemophilia. Muscular dystrophy. Tourette's syndrome.
Name that is the precise description of a chemical composition and molecular structure?
Chemical name
The name listed in the Pharmacopoeia
Official name
Name proposed by the first manufacturer when it was submitted for approval from the FDA. (The U.S. Adopted Names Council actually assigns it)
Generic name AKA non-proprietary name
Brand name or proprietary name given the chemical compound by the company that makes it.
Trade name.
The companies drug patent is good for how long
20 years
Can the drug original drug name ever be used by another drug company after the patent has expired.
No
Large group plant based substances that contagion nitrogen and are found in nature.
Alkaloids
Common suffix for alkaloids
-ine
A compound that yields a sugar and one or more other products when it’s parts are separated.
Glycoside
Common early glycoside that comes from the Purple Foxglove plant.
Digitalis
Plant residue used for medicinal and recreational purposes.
(Common example)
Gum
Opium gum
Extracts from flowers, leaves, stems, roots, seeds, and bark.
(Common example)
Oil
Wintergreen oil
Drugs chemically derived in a lab and have no impurities?
Common example
Synthetic drugs
Insulin
Before 1980 what very common drug came from pigs and cows.
Insulin
What main system is used for drug classification?
What year was it first published?
The Anatomical Therapeutic Chemical Classification System
1976
What are the three main areas of drug classifications?
- Body system area
- Mechanism of action area
- Class of agent area
The body system area is also called
The drug physiological classification
The mechanism of action area is also called
The therapeutic classification
The class of agent area is also called the
Chemical classification
A reference that has over 4000 pages of drug info indexed by generic name official name chemical name etc and is updated every year.
Physicians desk reference.
This reference provides health care professionals with information about uses for drugs included in the labeling approved by the FDA and those that are not (OFF LABEL USES).
American Hospital Formulary Service
Before what year was their no legal control of pharmaceutical substances.
1906
The first Act the standardized the name, strength, quality, quantity, and purity of the drugs in the beginning if the twentieth century. It was eventually replaced by what Law
The Pure Food and Drug Act
The Federal Food, Drug Act of 1938
What act established the word “narcotic”
The Harrison Narcotics Act of 1914
The Harrison Act of 1914 was eventually replaced by what law in 1970
The Controlled Substance Act of 1970
What Act required everyone to have a prescription for certain drugs?
The Durham-Humphrey Amendments of 1928
What Act was the FIRST legislation that dealt with drug safety specifically due to a major tragedy that killed 107 people (mainly children)
The Federal Food, Drug, and Cosmetic Act of 1938.
The Comprehensive Drug Abuse Prevention and Control Act of 1970 does what
It is the legal basis by which the manufacture, importation, possession, and distribution of certain drugs are regulated by the US and sets up five schedules (classifications) of abuse potential and potential for addiction.
The FDA is part of what larger government agency
US Department of Health and Human Services
What agency enforces controlled substances laws and monitors the need for changing schedules of abused drugs.
DEA
The test of a substance to find out its components (amount and purity)?
Assay
What is the name if the test that takes into account the effect it has on a organism and compares it to the result with some agreed standard.
Bioassay
What reference is the official public standards-setting authority for prescription and over the counter medicines.
Pharmacopeia
Schedule I of Controlled Substances Accepted use in US. Y/N Abuse potential? Potential for addiction? Examples:
No
High
May lead to severe dependence
Heroin peyote marijuana LSD
Schedule II of Controlled Substances Accepted use in US. Y/N Abuse potential? Potential for addiction? Examples:
Yes High May lead to severe physical and psych dependence Morphine codeine oxycodone methadone pentobarbital cocaine opium
Schedule III of Controlled Substances Accepted use in US. Y/N Abuse potential? Potential for addiction? Examples:
Yes
Less abuse potential then I and II
Moderate to low physical or high psych dependence
Anabolic steroids hydro condone Vicodin Tylenol 3
Schedule IV of Controlled Substances Accepted use in US. Y/N Abuse potential? Potential for addiction? Examples:
Yes Lower abuse potential compared with III Limited physical and psych dependence Benzodiazepines lorazepam anti depressants Anti psychosis phenobarbital
Schedule V of Controlled Substances Accepted use in US. Y/N Abuse potential? Potential for addiction? Examples:
Yes
Limited physical and psych dependence
Cough suppressants with small amounts of codeine or opioids Lomotil Phrenergan
Studies on tissue models are called
In vivo
Studies on animals are called
In vitro
The FDA approval process for an Investigational drug has how many phases.
4 official phases with a preclinical that is not counted in the beginning.
Which investigational phase is closely monitored by the FDA. First time on a human. 20 to 80 people.
Phase 1
Which investigational phase is closely monitored by the FDA and is usually one a couple hundred people. Preliminary data is analyzed for effectiveness on a specific disease and side effects.
Phase II
Which investigational phase has expanded controlled and uncontrolled trials. Involves hundreds to several thousand people. Info on thy drugs effectiveness and safety is analyzed. Data on its predictability is gathered. If everything is good the manufacturer officially files a New Drug Application with the FDA.
Phase III
Which investigational phase has post marketing surveillance. Drug is released for general use. Not closely regulated by the FDA.
Phase IV
The Peripheral Nervous system consists of 2 subdivisions.
The somatic and autonomic subdivisions.
The Somatic Nervous system does what
Controls movement of voluntary muscles
The Autonomic Nervous System does what
Regulates many involuntary functions.
The Autonomic Nervous System has how many divisions and name
Two
- The sympathetic (adrenergic) system
- The parasympathetic ( cholinergic) system.
Motor pathways of the somatic nervous system use how many neurons to conduct information from the CNS to the muscle innervated by the nerve.
1
Motor pathways of the ANS use how many neurons send information from the CNS to the Effector.
2
A muscle, gland, or organ on which the ANS exerts an effect.
Effector.
Anatomically. Where does the sympathetic division of the ANS originate and extend to on the spinal column.
T1 to L2.
The parasympathetic division is composed of what cranial nerves and spinal nerves that exit the sacrum.
Cranial nerves III, VII, IX, and X.
S2 to S4
Examples if a sympathetic response.
^HR BP contraction conduction cardiac output
Bronchodilation. Shunts blood to skeletal muscles
^glucose. Pupils dilation. ^Sweat
Example of a parasympathetic response
Lower HR contractility conduction and cardiac output. Decreased RR. Bronchial constriction. Pupils constrict. Increased GI secretions
Empty bladder and bowel.
Each nerve impulse generates an action potential and chemical charge of either a neurotransmitter or ________________.
Neuropeptide
Simply, a ganglion is nothing but a
Junction between the pre ganglionic and post ganglionic nerves
The autonomic ganglion is where which two major areas meet.
The CNS and peripheral nervous system
What is the official name of the junction (ganglia) between the two neurons.
Synaptic junction
A chemical molecule that travels to the other side of the synaptic junction is called a
Neurotransmitter.
A neurotransmitter reaches the other side of the synaptic junction and interacts with a ________ in order to cause another nerve impulse or physiological action on the target organ.
Receptor
Parasympathetic stimulation often involves a response from how many organs.
1
Sympathetic preganglionic neurons are usually _______ in length and postganglionic are usually _________ in length and this explains why 1 sympathetic stimuli are so widespread as compared to Parasympathetic stimuli.
Sympathetic
Pre short.
Post long.
Two main categories of neurotransmitters.
Cholinergic and adrenergic.
In general, the adrenergic (sympathetic) neurotransmitter is
Norepinephrine
In general, the cholinergic (parasympathetic) neurotransmitter is
Acetylcholine.
The sympathetic and parasympathetic PRE ganglion neurotransmitter is always
Acetylcholine
What are the two exceptions in the sympathetic division that has acetylcholine as the main neuro transmitter.
The post ganglionic neurons that act on sweat glands and the post ganglionic neurons that act on the blood vessels of the skeletal system.
Post ganglionic fibers in the sympathetic system that release norepinephrine are called _________ fibers. And the fibers in the parasympathetic system that release acetylcholine are called _________ fibers
Adrenergic
Cholinergic
Termination if the synaptic transmission ends when the synaptic cleft is ________ of all neurotransmitters.
Cleared
What are the two main cholinergic receptors found the parasympathetic division of the CNS
- Nicotinic
2. Muscarinic
Three areas that the nicotine receptors are located
Skeletal muscle
The cells of the Adrenal medulla
The cell bodies of all post ganglionic neurons of the para sympathetic and sympathetic divisions of the ANS.
Where are muscarinic receptors located.
Located on the smooth muscle.
Acetylcholine binds to the nicotinic receptors in _________ response.
Excitatory response
Acetylcholine binds with the muscarinic receptor in what type of response.
Excitatory or inhibition, depending on the target tissues in which the receptors are found.
In the parasympathetic division the DRUGS that stimulate these receptors are called
Parasympathomimetics
In the parasympathetic division the DRUGS that block or inhibit these receptors are called
Parasympatholytics
Drugs that stimulate the sympathetic receptors are called
Sympathomimetics
Drugs that block or inhibit the sympathetic receptors are called
Sympatholytics
Sympathetic receptors are categorized in 5 main types name
Alpha 1 Alpha 2 Beta 1 Beta 2 Dopamine
Where are the Alpha 1 receptors found where on the human anatomy
Eyes, blood vessels, bladder, and male reproductive system.
Stimulation of Alpha 1 receptors causes what major response
Constriction
Alpha 2 receptors are found in what parts of the human anatomy
Digestive system and on the presynaptic nerve terminals in the peripheral nervous system
Stimulation of the Alpha 2 receptors result in what.
Decreased secretions, decrease peristalsis, and suppression of further norepinephrine release.
Where are Beta 1 receptors found
Heart and kidneys
Stimulation of the Beta 1 receptors results in what
Increased HR, contractility, irritability of the heart.
Release of Renin into the blood which results in angiotensin being released which increases vasoconstriction and BP.
Where are Beta 2 receptors located
Arterioles of the heart, lungs, and skeletal muscle.
Stimulation of the Beta 2 receptors result in what major reaction.
Dilation. Glycogenolysis (breakdown of glycogen to glucose).
Stimulation of the Beta 3 receptor which is a little known receptor plays a major role in heart failure. What does it produce when stimulated.
Decreased myocardial contractility.
Where are dopamine receptors located.
Renal, mesenteric (GI support structure), and visceral blood vessels.
Stimulation of the Dopamine receptors result in what.
Dilation
Norepinephrine stimulates what receptors.
Alpha 1, Alpha 2, and Beta 1 receptors.
What major receptors does norepinephrine not stimulate.
Beta 2 or dopamine.
Lack of serotonin in the body is said to be the cause of what psych problem.
Depression
Stimulation of serotonin results in het physiological affect.
Diastalsis
What major receptors does epinephrine effect.
All Alpha and Beta receptors.
Endorphins are neurotransmitters that function in the transmission of signals
Within the nervous system.
The two most common factors that lead to the release of endorphins.
Stress and pain.
Most drugs exert their effects by binding with _________ located on the cell membrane.
Protein molecules (receptors)
Hormones circulated in the body react with receptors on the ________ __________.
Target organ
Receptor and molecular interaction is determined by
Mop antibiotic and fit
Adrenergic and cholinergic belong to a family of receptors called.
G protein-coupled receptors (GPCRs)
G protein-coupled receptors (GPCRs) are composed of proteins that wind back and forth through the cell membrane how many times.
7
GPCR systems have three parts
The receptor site itself
G protein
An Effector
A second messenger (AKA biochemical messenger) does what.
Example:
Relays signals from the receptor on the surface of the cell to the target molecules in the cells nucleus and internal fluid where the physiological action is to take place. They greatly AMPLIFY the strength of the signal received. Ca++
When a receptor has a prolonged exposure to a substance (hormone, neurotransmitter, or drug molecule) the cell may decrease the number of receptors to exposed to the substance to reduce its sensitivity. This is called
Downregulation
When a receptor is blocked by a substance long term, the cell will increase the number of receptors to improve its sensitivity. This is called
Up regulation.
Drug tolerance and physical dependence are influenced by 2 things
Down and up regulation
Drug action results from a physiochemical interaction between a drug and a
Functionally important molecule in the body
Most drugs combine with
Receptor sites on a target cell or within the cell itself
Medication ground into a powder mad mixed with a solvent usually water is called
Liquid drug form
A drug swallowed and put in this form for its ease of administration is called
Solid drug form.
Name some liquid drugs.
Elixir drug water and alcohol Emulsion water and oil Extract which is boiled off Spirit has aromatic substances Syrup disguise taste with sugar Tincture extract in alcohol
Fastest to slowest. 4 Enteral drug routes
Sublingual, rectal, nasogastric, oral.
Fastest to slowest. 5 Parenteral drug routes
IV, Interosseous, Inter cardiac Tracheal, Inhalation, Intralingual, Intranasal IM Sub Q Intradermal
This effect refers to the breakdown of a drug in the liver and walls of the intestines before it reaches the systemic circulation.
First pass effect.
What type of effect only effects a certain part of the body
Local effect
Effects the entire body
Systemic effect
An enteral drug passes through ANY portion of the
Digestive tract
For sublingual drug administration, the drug is absorbed in the ________ membranes and into the blood vessels and by passes the _____ _____ circulation.
Mucous membranes
Hepatic portal circulation.
For sublingual Nitroglycerin to work effectively. The PT must be For the drug to be absorbed effectively.
Properly hydrated
This drug administration route bypasses the voluntary swallowing reflex and allows drugs to be directly placed in the stomach. Used for activated charcoal administration
Gastric
This drug administration class bypasses the GI tract and avoids the first pass effect.
Parenteral
Do not try a IV access line on a child in ________ distress.
Respiratory
This drug administration route has a large surface area consisting of large vasculature it is still disordered extremely UNPREDICTABLE.
Endotracheal
Endotracheal route medications. Remember the acronym.
NAVEL Naloxone Atropine Vasopressin Epinephrine Lidocaine
If IV access is not possible where can glucagon be given
IM
Estrogen patches are found where
Buttocks or thighs
Nitro patches are found where
Upper chest
This route for medication goes straight into the spinal cord
Intrathecal
For Sub Q drug administration the drug must be _______ soluble.
Water
This route of drug administration goes between the dermal layers of the skin and is used for local anesthetic and allergy testing.
Intradermal
The science of preparing and dispensing drugs is called.
Pharmaceutics
The process by which a drug is absorbed, distributed, metabolized, and eliminated is called
Pharmacokinetics
Four main processes of pharmacokinetics are
Absorption, Distribution,
Metabolism, Elimination and Excretion
Most drug movement occurs by this mechanism and does not use energy.
Passive transport
Does facilitated transport use energy/ATP.
No.
When a substance has to go against the concentrating radiant in the cell this type of transport utilizes energy and is called
Active transport
A great example of a active transport system is
The sodium/potassium pump at the cell membrane
Alkaline medications are more readily absorbed in the
Small intestine
A drug is absorbed if it is in what form
Liquid form
The speed with which and how much of a drug reaches its intended site of action is called
Bioavailability
For enteric absorption most drugs are absorbed in the ______ portion of the small intestine.
Duodenum
Many drugs attach to protein molecules in the ______ for distribution.
Plasma.
What plasma protein is the most abundant and binds to the widest range of drugs.
Albumin
What proteins serve as drug reservoirs by default due to their large size.
Plasma proteins
By binding to plasma proteins a drug dose can
Be stored in the body and released as needed
Water solvable drugs tend to stay where in the body due to the fact that they do not pass easily through the fatty bilayers of the cells.
The blood and interstitial space. (the fluid that surrounds the cell)
What barrier protects the brain and it’s internal fluids from contamination.
The blood brain barrier
To pass the blood brain barrier you must be ___ soluble.
Fat
What conditions can damage the blood brain barrier.
Hypertension MS trauma
Water and fat soluble drugs can pass easily through this barrier when a women is pregnant.
The placenta barrier
Metabolism is the chemical modification of the original drug by the body and also called
Biotransformation
Which organ is the chief organ of metabolism.
Liver
A drug that is transformed into a more active drug during metabolism it is called
Prodrug
Most FDA approved drugs are transformed into harmless form called a
metabolite
Which organ is the site often used for excretion (elimination).
Kidneys
Most drug metabolites not bound to plasma proteins are excreted in the
Urine
The liver excretes drug metabolites into _____ and then is released into the small intestine
Bile
THe process where drug metabolites are excreted in bile, reabsorbed, returned to the liver, metabolized once more and excreted though the urine is called
Enterohepatic cycling.
The intensity or strength of the attraction between a drug and it’s receptor is called
Affinity
The ability for a drug to produce a physiologic response is after attaching to a receptor is a called
Efficacy
A drug that causes a physiological response to the receptor to which it binds is called
Agonist
A drug that only gets a small physiological effect when binding to a receptor is called a
Partial agonist
A partial agonist is said to have affinity and some
Efficacy
A drug that binds to a receptor and blocks or causes an opposite response in the receptor is called an
Agonist
A mechanism by which a drug is processed by enzymes is called
Acetylation
Drugs that do not need receptors or enzymes for a desired effect are called. Examples are antacids and skin ointments
Non specific drug interaction
The dose required to produce beneficial effect in 50% of the drug tested population is called
Therapeutic dose. (Effective dose) ED
The dose that kills 50# of the tested population is called
The median lethal dose. LD50
The dose that 50# of the population show signs of toxicity is called
The toxic dose. Or TD50
The description of a drug activity based on its dosage is called
Plasma level profile
The therapeutic effect of a drug dose closely is seen when a _______ _________ is reached
Steady state
When the amount of drug ingested matches up with the amount of drug being excreted it is called
Steady state
The time necessary for the concentration of the drug in the blood to be reduced by 50%is called the
Half life
The drug concentration level required to elicit a physiological therapeutic response in most patients is called
Therapeutic threshold (minimum effective concentration)
This index pertains to the drugs margin of safety
Therapeutic index. TI =LD50/ED50
Thy drugs therapeutic range is determined by what equation. .
TR=TD50-MEC (minimum effective concentration)
A wider therapeutic range means what
It is safer
The closer the therapeutic index gets to 1 means what
It is more dangerous it is
IV drugs given to a person who is suffering from hypothermia are usually administered how
Given at longer intervals due to the slow metabolic rate the person may have due to the cold
Atropine decreases the bodies ability to
Sweat
What are some major environmental hazards a person taking tricyclics antidepressants can suffer
Severe sunburn and extreme sensitivity to ultraviolet rays for the sun
The study of inherited differences (variation) in drug metabolism and response is called
Pharmacogenetics
If a person lacks aldehyde dehydrogenase what can’t they ingest.
Ethanol
Some antibiotics must be given three times a day in order to maintain their __________ ________ and maintain optimal results
Therapeutic concentration
Drug-food interactions can usually be avoided if the person takes the drug ___hour before or ___ hours after eating.
1 hour before or 2 hours after they eat
An unintentional, undesirable, and often unpredictable effect of a drug used at therapeutic doses to prevent, diagnose, or treat disease is called
Adverse reaction
The ability of one drug to limit the physiological function of another is called
Interference
A drug or agent that is harmful to the development of an embryo is called a
Teratogen
Although the pregnancy risk category is useful caution should be used with drugs that fall under those categories for which only animal data are available which ones
Categories B and C
An infants liver does not really mature to its full capacity to metabolize drugs until ___ years old.
1
The kidneys of a newborn do not become functionally mature until the child is approximately how old.
30 month
When a geriatric is taking multiple drugs it is referred to as
Polypharmacy
Lasix is also called
Furosemide
The drug with the higher affinity for any receptor has a ________ absorption rate.
Higher
________ is where major alterations can occur in the therapeutic effects of medications.
Metabolism
Most drug-drug interactions involve which kind of drugs.
Over the counter
This drug is one of the more common drugs that patients often have that is outdated or expired.
Nitroglycerin
What pregnancy risk level. No evidence or risk exists for the pregnancy.
Level A
What pregnancy risk level. The risk of human fetal harm is possible but remote
Level B
What pregnancy risk level. Human fetal risk cannot be ruled out.
Level C
What pregnancy risk level. Positive evidence of human fetal risk exists.
Level D
What pregnancy risk level. Contraindicated during pregnancy.
Level X
