Exam 1 Flashcards
Pharmacodynamics
The study of the effects of drugs on the body
Beneficence
the duty to protect research subjects from harm. It involves assessing potential risks and possible benefits and ensuring the benefits are greater than the risk.
Risk-Benefit Ratio
absorption
the movement of the drug into the bloodstream after administration
excipients
Fillers and inert substances—such as simple syrup, vegetable gums, aromatic powder, honey, and various elixirs
used in drug preparation to allow the drug to take on a particular size and shape and to enhance drug dissolution
Pharmacokinetics
The process of drug movement throughout the body that is necessary to achieve drug action
Pharmacogenetics
The study of genetic factors that influence an individual’s response to a specific drug
6 Rights of Medication Safety
- Right patient
- Right drug
- Right dose
- Right route
- Right time
- Right documentation
Chemical Name
Describes the chemical structure of the drug
› N-aceTYL-p-aminopheno
Generic Name
Official, nonproprietary name
Brand (Trade) Name
Proprietary name
Generic Drugs
› Must be approved by the FDA
› Same active ingredients as brand-name drug
› Usually less expensive
› May contain products that aid in providing the shape of the tablets, control the timing of release in the body
› Health care provider must state on prescription whether a generic drug can be substituted for the brand name drug
Over-the -Counter (OTC) Drugs
Drugs that have been found safe and appropriate for use without the direct supervision of a health care provider
› Important for the nurse to be aware of their clients use of OTC drugs
Enteric-coated (EC) drugs
resist disintegration in the gastric acid of the stomach
should not be crushed because crushing alters the place and time of absorption of the drug
ext/sustained-release (beaded) capsules
should not be crushed
Bioavailability
the percentage of administered drug available for activity orally administered drugs, bioavailability is affected by absorption and first-pass metabolism;
IV = 100%, PO = <100%
Factors that alter bioavailability
(1) drug form, such as tablet, capsule, sustained-release beads, liquid, transdermal patch, suppository, or inhalation
(2) route of administration (e.g., enteral, topical, or parenteral)
(3) gastric mucosa and motility;
(4) administration with food and other drugs; and
(5) changes in liver metabolism caused by liver dysfunction or inadequate hepatic blood flow
Distribution
the movement of the drug from the circulation to body tissues
protein binding
The portion of the drug bound to protein is inactive because it is not available to interact with tissue receptors and therefore is unable to exert a pharmacologic effect
Free drugs
are able to exit blood vessels and reach their site of action, causing a pharmacologic response;
primarily relevant when considering protein-bound drugs, but they can be a factor for any drug that binds to plasma proteins
Metabolism (biotransformation)
process by which the body chemically changes drugs into a form that can be excreted
primary site of metabolism
liver
half-life
time it takes for the amount of drug in the body to be reduced by half
Loading Dose
a large initial dose, known as a loading dose, that is significantly higher than maintenance dosing, therapeutic effects can be obtained while a steady state is reached
excretion
elimination of drugs from the body, is through the kidneys
creatinine and blood urea nitrogen (BUN).
Creatinine = a metabolic by-product of muscle that is excreted by the kidneys;
BUN = is the metabolic breakdown product of protein metabolism.
will be high if kidneys are failing + creatinine clearance (assumed to be low)
decreased kidney function = longer drug halflife and increased drug exposure/toxicity
CR = (creatinine clearance) used to estimate the GFR, which measures how well the kidneys are filtering waste products
informed consent
clients have the right to be informed and participation is voluntary
autonomy
right to self determination
Justice
equability or equal selection of research participants
dose-response relationship
the body’s physiologic response to changes in drug concentration at the site of action.
Potency
a measure of a drug’s strength / amount required to produce a specific effect. Potency does not directly refer to the drug concentration but instead compares the concentration of one drug to another
A drug with high potency requires a lower dose or concentration to produce the same effect compared to a drug with lower potency.
maximal efficacy
the maximum effect or response that a drug can produce, representing the upper limit of its pharmacological effect; regardless of the dose or concentration. It is a characteristic of the drug itself.
(different from peak concentration)
therapeutic index (TI)
describes the relationship between the therapeutic dose of a drug (ED) and the toxic dose of a drug (TD)
Onset
time it takes for a drug to reach the minimum effective concentration
peak
occurs when it reaches its highest concentration in the blood.
nonspecific / nonselective drug
Drugs that affect multiple receptor sites
Mechanisms of drug action
(1) stimulation, (2) depression, (3) irritation, (4) replacement, (5) cytotoxic action, (6) antimicrobial action, and (7) modification of immune status.
tachyphylaxis
an acute, rapid decrease in response to a drug, not indicative of time; it may occur after the first dose or after several doses
Additive Drug Effects
When two drugs are administered in combination, and the response is increased beyond what either could produce alone (1+1=2)
can be desirable or undesirable
Synergistic Drug Effects
the clinical effect of the two drugs given together is substantially greater than that of either drug alone.
(1+1>2)
Antagonistic Drug Effects
one drug reduces or blocks the effect of the other
photosensitivity
skin reaction caused by exposure to sunlight. It is caused most often by the interaction of a drug and exposure to ultraviolet A (UVA) light, which can cause cellular damage; however, ultraviolet B (UVB) light may also contribute to drug-induced photosensitivity reactions.
Ethnomedicine
sometimes referred to as folk medicine or traditional medicine, is a focus within medical anthropology that examines the ways in which people in different cultures conceptualize health and illness.
substitutes for hormonal replacement therapy
flaxseed, licorice, black cohosh, and soybeans
European descent (Biologic Variations)
Poor metabolizers of antidepressants, antipsychotics, cardiovascular agents, and isoniazid, which can lead to toxicity
African Descent (Biologic Variations)
Diminished therapeutic effects from beta blockers, ACE inhibitors, and warfarin
Latin American descent (Biologic Variations)
There is great biologic diversity among Latin Americans, who can have European, Native American, and Asian biomarkers.
Native American descent (Biologic Variations)
Increased vasomotor response to alcohol
Asian descent (Biologic Variation)
Diminished therapeutic effects of codeine; rapid metabolizers of isoniazid
Middle-Eastern descent (biologic Variation)
Many genetic diseases such as thalassemia
Botanicals
additive substances that come from plants
herb
any plant that is used for culinary or medicinal purposes
Dietary Supplement Health and Education Act (DSHEA)
Ensure products are safe and label information is truthful and not misleading.
Current Good Manufacturing Practices (CGMPs)
Standards require package labels that declare quality and strength of contents and that product is without contaminants and impurities.
Potential Hazards of Herbs
Some herbal products can affect lab results,
Many products may interfere with absorption, breakdown, and excretion of anesthetics, anticoagulants, and other drugs used in surgery
Chamomile
treat sleeplessness, anxiety, and stomach or intestinal ailments
Cinnamon
believed treatment for bronchitis, gastrointestinal (GI) problems, anorexia, and diabetes
little evidence is available to support any of these claims.
Echinacea
used for colds, flu, and infections, skin problems (acne), thought to stimulate the immune system to fight infection
Garlic
reported to lower cholesterol, decrease blood pressure, and reduce heart disease
used to prevent cancer of the stomach and colon
cautioned not to take garlic if they have a bleeding disorder
Ginger
used to treat postoperative, pregnancy-related, and chemotherapy-related nausea as well as motion sickness and diarrhea, may provide relief from pain, swelling, and stiffness of both osteoarthritis and rheumatoid arthritis.
Ginkgo
treat ailments such as asthma, bronchitis, fatigue, and tinnitus, used to improve memory, prevent Alzheimer disease and other dementias, decrease intermittent claudication, and as a treatment for sexual dysfunction and multiple sclerosis
Ginseng
said to boost the immune system, increase a person’s sense of well-being, and increase stamina
used to treat erectile dysfunction, hepatitis C, and menopausal symptoms and to lower glucose and blood pressure
Hawthorn
used in the treatment of heart disease (e.g., heart failure and angina). It has also been used to treat digestive issues and kidney disease
Licorice Root
used to treat stomach ulcers, bronchitis, sore throat, and viral hepatitis
Milk Thistle
used widely to treat cirrhosis, chronic hepatitis, and gallbladder disorders. It has also seen use in the treatment of elevated cholesterol and insulin resistance in type 2 diabetes
Peppermint
used to treat a wide variety of ailments, from nausea, indigestion, and irritable bowel syndrome (IBS) to cold symptoms, headaches, and muscle and nerve pain
St. John’s Wort
treat mental disorders and nerve pain,
also been used as a treatment for malaria, sleep disorders, and wounds
Turmeric
used for heartburn, stomach ulcers, gallstones, inflammation, and cancer.
Valerian
treatment of insomnia; it has also been used to treat anxiety, headaches, depression, irregular heartbeat, and tremors.
Just Culture
encourages organizations to avoid using punitive approaches in reporting drug errors because they focus on punishing individuals for reporting such errors
Forms and routes of administration
› Sublingual, buccal
- Oral
› Tablets, capsules; liquids, suspensions, elixirs
- Transdermal, topical
- Instillation
› Drops, sprays
- Inhalation
- Nasogastric and gastrostomy tubes
- Suppositories
- Parenteral
sublingual and buccal routes
remain in place until fully absorbed
- No food or fluid should be taken while the medication is in place
Liquids
› Elixirs: Sweetened, hydroalcoholic liquids used in the preparation of oral liquid medications.
› Emulsions: A mixture of two liquids that are not mutually soluble.
› Suspensions: Liquids in which particles are mixed but not dissolved
Meter-dosed inhalers (MDIs)
Handheld devices used to deliver asthma and bronchitis drugs to the
lower respiratory tract
Spacers
Devices used to enhance the delivery of medication from the MDI
Suppositories
Useful route for babies, in uncooperative patients, and in cases of vomiting or certain digestive disorders
Factors affecting absorption
- Blood circulation
- Pain, stress
- Food texture, fat content, temperature
- pH
- Route of administration
Drug movement from GI tract to liver
- Via portal vein
- First pass effect
- Bioavailability
Liver Enzymes
Aspartate transaminase (AST) 0 - 35 U/L
Alanine aminotransferase (ALT) 4 - 36 U/L
Alkaline phosphatase (ALP) 30 - 120 U/L
Primary effect
Desirable effect: Diphnehydramine- Antihistamine
Secondary effect
Desirable or undesirable: Diphenhydramine- makes you drowsy
Agonists
Drugs that activate receptors and produce a desired response are called agonists
antagonists
Drugs that prevent receptor activation and block a response
Health care providers will use genomic information to:
› Tailor treatments to the individual patient
› Personalize the care for the patient
Genomics
study of all of the genes in the human genome together, including their interaction with one another, their interactions with the environment, and the influence of other cultural and psychosocial factors
What is the goal of Pharmacogenetics
To create an individualized drug treatment program that involves the best choice and dose of drugs for a particular patient
1914: The Harrison Narcotic Act
This act required prescriptions for drugs that exceeded set narcotic limits. It also mandated increased record keeping by physicians and pharmacists.
1938: The Federal Food, Drug, and Cosmetic Act
ensure a drug was safe prior to marketing. It is the FDA’s responsibility to ensure that all drugs are tested for harmful effects; it also required that drugs be labeled with accurate information and have detailed literature in the drug packaging that explains adverse effects.
1970: The Comprehensive Drug Abuse Prevention and Control Act
designed to remedy the escalating problem of drug abuse, included several provisions: (1) promotion of drug education and research into the prevention and treatment of drug dependence; (2) strengthening of enforcement authority; (3) establishment of treatment and rehabilitation facilities; and (4) designation of schedules, or categories, for controlled substances according to abuse liability.
1994: Dietary Supplement Health and Education Act
This act established labeling requirements for dietary supplements and authorized the FDA to promote safe manufacturing practices. It classified dietary supplements as food.
2003: Pediatric Research Equity Act
Research Equity Act
This act authorizes the FDA to require that drug manufacturers test certain drugs and biologic products for their safety and effectiveness in children, noting that “children are not small adults.” Additionally, studies that involve children must be conducted with the same drug and in the same disease process as adults.
Tuskegee Experiment
U.S. 1940’s White doctors refused black community cure for syphilis (penicillin), wanted to see what would happen, many men died
Nuremberg Trials
Nazi experiments on twins and other captives, often torturous. Mosquitos with malaria released into camps
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