Chapter 3 - Pharmacology

Question 1

Food and Drug Administration (FDA)

Answer 1

responsible for regulating the safety and effectiveness of over the counter and prescription drugs

• include the approval of new drugs as well as the manufacturing and labeling, advertising and marketing, and efficacy and safety of all drugs
• approval for new drug could take 17.5 years

Question 2

Food and Drug Administration (FDA):

Removing Unsafe Medications

Answer 2

also, responsible for removing unsafe medications from the market

1. a drug manufacturer may contact the FDA after discovering a problem with one of their drugs
2. the FDA may identify an unsafe drug while inspecting a manufacturers facility
3. the FDA may receive reports of health problems associated with a specific drug
4. the Centers for Disease Control and Prevention (CDC) may alert the FDA about a specific drug

Question 3

Drug Enforcement Agency (DEA)

Answer 3

responsible for enforcing the laws and regulations of controlled substances
- federal law requires that all facilities that store, dispense, or administer controlled substances have a DEA certificate

Question 4

Storage and Packaging

Answer 4

kept in locked cabinet or closet

• controlled substances must be kept separately from prescription medications, which should also be kept separate from over the counter medications
• when possible, medications should be purchased in individual dose packs

Question 5

FDA Drug Recall Classes

Answer 5

Most serious 
(Class I)
- potential for serious health problems
(Class II)
- potential for temporary or slight health problem
(Class III)
- not likely to cause a health problem
Least serious

Question 6

Dispensing

Answer 6

refers to the act of providing multiple doses of a medication to a patient
- athletic trainers are not legally able to dispense medications to their patients

Question 7

Administering

Answer 7

refers to the direct application of a single dose

- athletic trainers are able to administer OTC medications to their patients

Question 8

Documentation and Inventory Control

Answer 8

medication log includes:
- patient’s name, date of service, reason for medication, prescription number (if given), physician name, medication name, strength, dosage form, quantity, expiration date, lot number, initials of AT, and initials of physician
an inventory audit of all medications should be performed at least once a year

Question 9

Expired Medication

Answer 9

all expired OTC and prescription medications should be removed from the current inventory, recorded in the medication log, and disposed of properly

• dispose through biohazard waste bag and waste removal procedure
• written log should be attached to the bag or container including the drug name, strength, dosage form, quantity,lot number, expiration date, and initials of person who completed the log

Question 10

Nomenclature:

Chemical

Answer 10

chemical name rather long and refers to the chemical structure of the drug

Question 11

Nomenclature:

Generic Name

Answer 11

nonproprietary, usually shorter and is derived from the chemical name

• only one generic name for each drug
  ex: ibuprofen = generic name

Question 12

Nomenclature:

Trade

Answer 12

the recognized brand name that is assigned to a drug by the manufacturer

• proprietary, therefore cannot be used by other manufacturers
• may be multiple trade names if more than one company markets the drug
  ex: Motrin and Advil = trade name

Question 13

Nomenclature:

Generic Drugs

Answer 13

every drug has a generic name but not every drug is available in a generic form

• copies of brand name drugs whose patents have expired
• usually cheaper
• must be therapeutically equivalent, meaning they must have the same chemical makeup and active ingredients as the original drug and produce the same medical effect

Question 14

Classification of Drugs:

Over the Counter (OTC)

Answer 14

do not require a prescription and also referred to as no prescription drugs

• many were prescription drugs that were approved by the FDA as nonprescription drugs
• typically contain less drug per dose compared to prescription drug

Question 15

Classification of Drugs:

Prescription

Answer 15

requires a written prescription from a physician or nurse practitioner and must be filled by a pharmacist
- typically associated with a greater potential for adverse reactions and generally prescribed for a restricted time period

Question 16

Classification of Drugs:

Controlled Substances

Answer 16

have a greater potential for abuse than prescription drugs

• divided into 5 schedules (I = highest potential for abuse like heroin, IV = least potential for abuse like fought suppressants)
• schedule III = narcotic pain medications and anabolic steroids

Question 17

Pharmacokinetics

Answer 17

the physiological processes of how the body acts on a drug and can be divided into four distinct phases: absorption, distribution, metabolism, and elimination

Question 18

Absorption

Answer 18

for a drug to produce a therapeutic effect, it must be absorbed into the bloodstream and distributed throughout the circulation to reach its site of action
- drug molecule must move across one or more membranes through simple diffusion, active transport, or passive diffusion

Question 19

Bioavailability

Answer 19

the amount of drug that is actually available in the body’s tissues

• usually only a fraction of the original dosage amount (varies among drugs)
• ex: bioavailability of 50%, then the body will absorb only 250 mg of a 500mg dose

Question 20

The “first-pass effect”

Answer 20

occurs if the drug is absorbed from the intestine into the liver before entering the systemic circulation

• liver is the main site for drug metabolism and may cause further inactivation of a portion of a drug
• influences the bioavailability and only factor when drug is taken orally

Question 21

Absorption: Passive Diffusion

Answer 21

the most common mechanism for moving medications across membranes

• the lipid solubility of a drug will affect its ability to diffuse across membranes
• lipid-soluble drugs will diffuse more quickly and easily and are capable of passing through the blood-brain barrier to affect the CNS
• greatest concentration to lowest concentration until equal on both sides

Question 22

Absorption: Active Transport

Answer 22

requires a protein to move the drug across a membrane

• the protein binds to the drug molecule and transports it through the membrane
• allows selective diffusion of drug molecules in a specific direction, regardless of the concentrations on either side of membrane
• requires energy

Question 23

Absorption: Facilitated Diffusion

Answer 23

combines the process of passive diffusion and active transport
- allows for drug selectively through the binding of a protein, however, the drug molecule will move only from areas of high concentration to low concentration

Question 24

Distribution

Answer 24

once absorption is complete, the drug is transported to its site of action via the circulatory system

• also affected by lipid solubility
• drugs with higher lipid solubility will be able to pass through more membranes providing a wider distribution, with respect to blood-brain barrier and fat cells

Question 25

Onset of action

Answer 25

the time it takes for drug molecules to reach their site of action in sufficient quantities to produce a therapeutic effect

Question 26

Duration of action

Answer 26

period of time when concentration levels are sufficient enough to produce a therapeutic effect

Question 27

Metabolism

Answer 27

the process by which drugs are inactivated and broken down into more water-soluble metabolites in preparation for excretion
- initiated by enzymes that react with the drug

Question 28

Elimination (excretion)

Answer 28

the process by which the body rid itself of a drug

- kidney serves as the primary site of drug excretion

Question 29

Half-life

Answer 29

the time it takes the reduce and the peak blood concentration of the drug by 50%

• ex: 50mg drug blood concentration, after 2 hours will reduce to 25mg and go down as time passes
• lipid-soluble drugs have longer half-lives than water-soluble drugs and stay in the body longer

Question 30

Pharmacodynamics

Answer 30

the process of how a drug acts on the body
- to produce a therapeutic effect, it must bind with a receptor which can be a molecule on the cell membrane or within the cell, at the site of action

Question 31

Receptor Theory of Drug Action

Answer 31

Agonist = a drug that fits the receptor and initiates a mechanism similar to the endogenous compound

Antagonist = a drug that fits the receptor but fails to initiate or blocks this mechanism

Question 32

Potency

Answer 32

the strength of the drug

• greater it is, the smaller the dose needed to produce a therapeutic effect
• greatest when blood concentration levels consistently stay within a certain therapeutic range = more drug molecules occupying receptor sites

Question 33

Dose response relationship

Answer 33

steady state = maintain blood levels within therapeutic range and achieved once the blood levels from continued dosing matches the level of excretion of a drug
loading dose = a greater than the maintenance dose (dose needed to maintain steady state) to increase the rate at which the drug reaches its therapeutic range

Question 34

Drug Interactions:

Agonistic (Additive)

Answer 34

when 2 drugs of the same type are taken together (2 stimulants or 2 depressants), increasing the overall effect
ex: alcohol combined with antihistamine = excessive drowsiness and loss of muscle coordination

Question 35

Drug Interactions:

Antagonistic (Inhibitive)

Answer 35

occur between 2 unrelated drugs

ex: antibiotics inhibit or reduce the effectiveness of oral contraceptives

Question 36

Placebo Effect

Answer 36

a phenomenon that results in a patient experiencing a relief of symptoms or an adverse effect that cannot be attributed to the medications taken
- believed that a patient’s anticipation of an effect causes the release of hormones or neuropeptides to contribute to the relief in symptoms

Question 37

Non-steroidal Anti-Inflammatory Drugs (NSAID)

Answer 37

used to treat acute and chronic inflammatory conditions such as sprains, strains, tendonitis (tissue connecting muscle to bone becomes inflamed), and bursitis (inflammation of the bursae, fluid filled sacs in joints)

• inhibit the COX-2 enzyme and reduce the production of prostaglandins for the pain and swelling
• prevent production of “good” prostaglandins from COX-1 enzyme that protect the stomach = gastric upset and ulcers
• analgesic = pain reducer
• antipyretic = fever reducer
• lipid soluble, so easily absorbed out of the stomach and intestines

Question 38

Corticosteroids

Answer 38

used to treat asthma, inflammatory bowel disease, dermatological conditions, tendonitis, bursitis, and allergic reaction

• reduce the inflammation by inhibiting the synthesis of arachidonic acid and its metabolite along both the COX and lipoxygenase path
• administered oral, inhalation, injection, and topical

Question 39

Medications for Treating pain:

Analgesics

Answer 39

used to treat pain and available in OTC and prescription form
-dosage slightly less than that used for treating inflammation

Question 40

Medications for Treating pain:

Acetaminophen

Answer 40

effectively reduce mild to moderate pain and fever, does not relieve inflammation
- known to block the COX enzyme in the brain

Question 41

Reye Syndrome

Answer 41

fatal disease that is associated with a previous viral illness like cold, flu, or chicken pox
- associated with the use of aspirin for treating the symptoms of a viral illness

Question 42

Medications for Treating pain:

Opioids (Narcotics)

Answer 42

used to treat moderate to severe pain like musculoskeletal pain or associated with cancers

• controlled substances, available prescription only
• opioid drugs bind to opioid receptors in the CNS to decrease the excitability of neurons and reduce pain