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Pharm > Exam 1: Intro to Pharm > Flashcards

Exam 1: Intro to Pharm Flashcards

1
Q

Pharmacotherapeutics

A

Therapeutic (medical) use of a drug
Diagnose, prevent, or treat disease

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2
Q

Six rights

A

Right drug
Right dose
Right patient
Right route
Right time
Right documentation

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3
Q

FDA Stages for Approval

A
  1. Preclinical investigation/testing (all in lab)
  2. Clinical investigation/testing (longest part)
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4
Q

Clinical investigation

A

Phase I: Normal (Healthy ) volunteers
Evaluation effects on humans & of drug metabolism

Phase II & III: tested on patients, determine therapeutic effects, dosage ranges, safety

Phase IV: Post marketing surveillance, used for gen. pop., new side effects reporting -> ADRs not found in stage 3

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5
Q

Properties of an Ideal Drug

A

“Maximum benefit with minimal harm!!”

Effectiveness - Elicits the response it is intended for
Safety - Causes no (or little) harm
Selectivity - Response limited for which it is given

also important:
Reversible action
Predictability
Easy to administer
Few drug interactions
Low cost
Chemically stable
Simple generic name

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6
Q

generic name vs trade/brand name

A

generic - official name given by manufacturer used in practice, sometimes ending of name can indicate drug classification (-cillin: antibiotic)

trade/brand - most common name, pt might know

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7
Q

generic drug

A

Tend to be lower cost
Lower cost than “Brand name” drugs …. bc generic is produced after the patent ends for original producer

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8
Q

brand drug vs. generic drug

A

Both: must have same Active Ingredient
contain same dose of same drug

Concern with generics:
Different binders and fillers
May change absorption-rate and extent
May not work the same

Generic drugs must have FDA approval

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9
Q

Sources of drugs

A

Plants

Animals or humans: such as Hormones

Minerals or mineral products

Synthetic
Made in the laboratory with same molecular function as natural molecule

Recombinant DNA: fragment of DNA is inserted into DNA of another organisms

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10
Q

Legend

A

Any drug that requires a prescription

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11
Q

Over-the-counter (nonprescription)

A

Many Legend drugs are now being approved for OTC sale

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12
Q

Scheduled/ Controlled drugs

A

Any drug with the potential of being abused
Class I –V
Class I extremely high abuse potential, no accepted medical use (Heroin and LSD)
Class II-V progressively less, have acceptable use but also potential for abuse

1970 Controlled Substance Act

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13
Q

Drug classification

A

drugs w/ similar characteristics

Treatment: symptoms/illness/disease
(Antiemetic, Analgesic, Antihypertensives)

Similar effect on a body system
(Diuretics, Antacid)

Similar pathophysiology effect
(ACE Inhibitor, Beta Blocker)

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14
Q

Pharmacoceutic Phase

A

only PO meds

Disintegration (for tablets, capsules are already in solution)
Dissolution - dissolve into the GI fluid before absorption (rate of dissolution dictates rate of absorption)

enteric coatings**

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15
Q

Pharmacokinetic phase

A

ADME

  1. absorption
  2. distribution
  3. metabolism
  4. excretion
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16
Q

Three primary ways to cross a cell membranes

A
  1. Pass through channels or pores (Only very small ions such as potassium)
    2.Pass with the aid of a transport system (Different transport mechanisms- P-Glycoprotein ex.)
  2. Direct penetration of the membrane (Most common)
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17
Q

P-Glycoprotein:

A

multidrug transporter protein

transports wide variety out of cell so it can be eliminated

present in liver, kidneys, placenta, intestine, and capillaries of the brain

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18
Q

“like dissolves like”

A

Lipid soluble drugs (lipophilic) can directly penetrate (mostly lipid) cell membranes

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19
Q

Ion transport

A

Ions (net electric charge) cannot cross membrane

depend on the pH of the environment as to whether the drug is non-ionized and able to cross cell membrane or not

“I(on) can’t get in!” example

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20
Q

Absorption

A

drug enters the body, gets into blood

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21
Q

Distribution

A

drug moves from blood to site of action

determined by factors of blood flow to tissues/organs abscesses/tumors ex. of low blood flow

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22
Q

Metabolism

A

biotransformation

enzymatic alteration of drug structure

most occurs in liver

Normal route is drug absorbed -> goes to liver via portal vein -> just passes through -> then into systemic circ -> after targeted effect -> returns to liver to be metabolized

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23
Q

Excretion

A

exits and is removed from body

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24
Q

Enteral vs parenteral

A

enteral - GI - PO & feeding tubes

parenteral - “by injection” IV, SQ, IM

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25
Q

Oral route

A

multiple preparations - have fillers & binders that allow for better dissolution and absorption

convenient & safe

absorption is variable on GI motility/enzymes & blood flow to GI tract

slower onset & peak times

**must pass through the liver via the portal vein “First pass effect”

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26
Q

enteric-coated drugs

A

Resist disintegration until in the small intestine

coated to resist pharmacoceutic phase

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27
Q

sustained release drugs

A

Formulation (actual structure of pill w/ different spheres or matrices) which allows drug to slowly release over time

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28
Q

IV route

A

parenteral route

less convenient, but immediate absorption (faster absorption and peak times)

Risks: no turning back, fluid overload, infection, etc.

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29
Q

IM/SQ route

A

large spaces b/t cells - drugs absorb by moving b/t cells, through channels and pores

blood flow impacts absorption - Deltoid = high blood flow

less convenient, complications

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30
Q

Bioavailability

A

The percentage of the administered drug dose that reaches the systemic circulation (bloodstream) unchanged

Oral never 100%, IV is 100%
oral doses require higher dose

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31
Q

Sublingual/buccal route

A

quick, self-administrable, economic

bitter taste, irritation of mucosa, not large quantities

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32
Q

Protein binding

A

drugs bind to proteins in body

albumin (plasma protein) - most drugs bind in some way in bloodstream and dependent on level of attraction

can restrict distribution

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33
Q

“free drug”

A

the drug that doesn’t bind and can create the action desired

34
Q

Blood brain barrier

A

only lipid soluble drugs or drugs w/ a carrier can pass through

capillaries have tight junctions

35
Q

Fetal-Placental barrier

A

Not an absolute barrier, lipid soluble & non-ionized agents pass through

36
Q

Cytochrome P450 Enzymes

A

most drug metabolism in the liver performed by them

different drugs metabolized by different enzymes

37
Q

Drug inactivation & accelerated excretion

A

drugs are inactivated by liver enzymes to become water soluble and be excreted

leads to accelerated renal excretion of drugs bc kidneys can’t excrete lipid solubles

38
Q

Increased therapeutic action/activation

A

some transformed into active metabolites w/ increased response (pro drugs)

codeine transforms into morphine after metabolism

39
Q

pro drugs

A

no pharmacologic activity UNTIL they are metabolized in the liver

40
Q

Increased or decreased toxicity

A

metabolism can change safe drugs (acetaminophen) may become toxic

most drugs are converted to inactive forms to excrete

41
Q

why is dosing different for infants and malnourished pts?

A

infants - decreased ability to metabolize drugs

malnourished - deficient hepatic enzymes

42
Q

First-Pass Effect

A

Certain drugs are partially or completely inactivated on the first pass through the liver (NOT NORMAL)

Result: drug may have minimal or no therapeutic effect

These are not given PO - think sublingual (nitro ex.)

43
Q

Cirrhosis or hepatitis

A

risks for drug toxicity due to inability to metabolize

prolonged half-life

44
Q

AST & ALT

A

liver enzymes that we check if drug can be hard on liver

45
Q

Renal drug excretion

A

Glomerular filtration (protein bound drugs will not filter)

Passive reabsorption (lipid soluble drugs can’t be excreted)

Active transport- P-glycoprotein pumps certain agents into urine

46
Q

Urine pH

A

affects drug excretion

acidic urine -> weak base drugs and vice versa

b/c they ionize the drug and make it no longer lipid soluble and won’t reabsorb back into the body

**important to help treat overdoses and improve excretion rate

47
Q

Renal disease

A

drug elimination slowed or impaired

can lead to drug accumulation

half-life prolonged

48
Q

Plasma half-life

A

1st: Time it takes for a medication to decrease concentration in the plasma by 50% after administration

2nd: time it takes for the second half of the drug concentration to be reduced by half again

takes about 4 half lives for any drug to be “almost” out of the blood stream

49
Q

Pharmacodynamic phase

A

drug’s effects on the body

Primary - therapeutic

Secondary - adverse

50
Q

Cellular receptors

A

Most drugs work because they bind to a particular “receptor” to create a response or to block a response

“Lock and Key” theory

selectivity (beta-blockers) and affinity (naloxone) are important

51
Q

Occupancy Theory

A

The intensity of the response to the drug is proportional to the number of receptors occupied.

52
Q

Agonist

A

Mimics the action of the endogenous molecule

Activates or “turns on” the receptor

53
Q

Antagonist

A

Blocks action of endogenous molecules

Prevent or shut down activation of the receptor

54
Q

Partial agonist

A

Mimics action like an agonist but with less intensity

Low affinity

55
Q

Maximal Efficacy

A

Largest effect that a drug can produce

56
Q

Relative Potency

A

Amount of drug we must give to elicit a response

Highly potent drugs require smaller doses

Plasma drug levels

57
Q

ED

A

Average effective dose in 50% of the population

May be referred to as the Minimum effective concentration (MEC)

58
Q

LD

A

Average lethal dose

Lethal to 50% of animals during testing

May be referred to as the Toxic concentration (MTC)

59
Q

Onset of Action

A

Period of time it takes after the drug is given to create a response

60
Q

Peak Action

A

Time it takes for a drug to reach it’s highest concentration

61
Q

Duration of action

A

Length of time during which the drug is present in a concentration great enough to produce a response

62
Q

Therapeutic Index

A

“therapeutic range” or “therapeutic window”

Estimates the margin of safety of a drug

63
Q

“low” or “narrow” therapeutic index

A

have a “narrow margin” of safety

serum drug levels monitored

ex - Digoxin, anticonvulsants, Gentamycin

64
Q

“high” therapeutic index

A

have a wide margin of safety

Less danger

65
Q

Peak serum level

A

Highest plasma concentration

Peak time will vary depending on drug and route

Drug guide will tell you the proposed peak time

Blood sample is drawn at the proposed peak time

66
Q

Trough serum level

A

Lowest plasma concentration

Blood is drawn before the next dose is due

67
Q

Side Effect

A

Predictable “secondary effect”

Sometimes harmless and beneficial
Sometimes causes injury

68
Q

Toxic Effect:

A

When a drug accumulates in the blood above a therapeutic level

69
Q

Idiosyncratic Reaction

A

Unpredictable.
Client overreacts or underreacts to a drug

70
Q

Allergic Reaction

A

Unpredictable immune response
May be mild or severe

71
Q

Carcinogenic

A

Ability of medications, environment and chemicals to cause cancer

72
Q

Teratogenic

A

Drug induced birth defect from a teratogen

highly dependent on when given in pregnancy

73
Q

Physical Dependence

A

Patient’s body has adapted to drug due to prolonged exposure – will experience withdrawal symptoms if drug is discontinued

74
Q

Drug interactions

A

An altered effect of a drug as a result of an interaction with another drug, nutrient or plasma/electrolyte levels

75
Q

Pharmacokinetic Drug Interactions

A

Changes that occur in the absorption, distribution, metabolism or elimination

76
Q

Pharmacodynamic Drug Interactions

A

Changes that occur in the drug’s effect on the body
Include Additive, Synergistic, or Antagonistic effects

77
Q

Enzyme Inducers

A

will increase the metabolic rate of other drugs
Increase in metabolism will likely cause rapid drug excretion and a decrease in drug concentration in the blood

78
Q

“Enzyme Inhibitors”

A

Drugs that inhibit the CYP Enzymes are “inhibitors”
Example : Cimetidine

Enzyme Inhibitors will decrease the metabolic rate of other drugs

If metabolism is decreased, the plasma concentrations of the other drugs will be increased

Toxicity is likely

79
Q

Additive Effect

A

When two drugs with similar action are administered
Can be desirable or undesirable
Example: Codeine and Acetaminophen

80
Q

Synergistic Effect

A

One drug potentiates the other
Clinical effect is substantially greater than the combined effect of the two
The effect can be desirable or undesirable
Example: Alcohol and a Narcotic

81
Q

Drug- nutrient interactions

A

Foods/nutrients can bind with drugs, causing less or slower drug absorption

ex. tetracycline w/ dairy

theophylline w/ caffeine

82
Q

Drug/lab considerations

A

Abnormal plasma or serum electrolyte concentrations can affect certain drug therapies

Example:
Patient with a decreased serum potassium level or an increase in serum calcium level will be more prone to Digoxin Toxicity

Pharm (11 decks)

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