Exam 1 Material Flashcards
Define pharmacology
The study of medicine
Define pharmacotherapeutics
Using medicine to treat disease and alleviate suffering
Define pharmaceutics
The science of preparing and dispensing/sale of drugs
Define drugs/medications
Chemically produced products that elicit an effect
Define biologics
Produced naturally in animal cells, microorganisms, or the body (ex. flu vaccine) Fastest growing group of drugs
Define biosimilar
A biologic that is almost identical to an existing, FDA approved biologic medication (reference product)
Define complementary and alternative medicine (CAM)
Natural plant extracts, herbs, vitamins, minerals, dietary supplements, therapies (massage, acupuncture, PT)
Define therapeutic drug classification
What is the clinical indicator
Define pharmacologic drug classification
How the drug works within the body; its mechanism of action
What are the 3 different types of drug names?
Chemical Generic Trade
What is a chemical drug name?
- Only one chemical name per drug; assigned
- Usually too long and difficult to be practical
What is a generic drug name?
- Only one generic name per drug; assigned
- Commonly used in practice
- Starts with a lowercase letter
What is a trade drug name?
- Brand, proprietary name
- May be several trade names for one drug
- Assigned by manufacturer
- Patient’s may know this better
- First letter will be capitalized
What is bioavailability?
- Physiologic ability of drug to reach target cells and produce an effect
- Factor that can be taken into consideration when comparing generic vs brand drugs
- Small changes can cause changes in bioavailavility
- Some drugs you can’t substitute them without permission (immunosuppressants)
Prescription vs over the counter medications
- Prescriptions
- Patient education
- Stronger dosage
- Drug interactions are noted
- Takes time and money
- More expensive
- OTC
- Cheaper
- Convienent
- Patient education through pharmacologist available
- Treat yourself
- May not be the right drug to treat
- Drug interactions may not be noted
FDA stages of approval for a new medication
- Preclinical investigation (Safety)
- Basic science research, lab tests on cells, animal testing
- Clinical investigation (Efficacy)
- Clinical phase trial
- New drug application (NDA) reviewed (Confirm)
- Phase III trails and animal testing may continue
- Postmarketing studies (Review)
- Continue to observe humans for adverse effects (long term)
What is a schedule I drug?
A drug with the highest abuse potential; little or no therapeutic effects
Examples: heroin, LSD, ecstacy, marijuana
What is a scheudle II drug?
A highly controlled drug
Examples: Dilaudid, fentanyl, methamphetamine, cocaine, Ritalin
What is a scheule III drug?
Medium potential for abuse
Examples: codeine, ketamine, anabolic steroids, testosterone
What is a schedule IV drug?
A drug with little abuse potential
Examples: Xanax, Valium, Versed, Tramadol
What is a schedule V drug?
Has the lowest abuse potential; some available without prescription
Examples: Lomotil, Lyrica, cough syrup with codeine
What is a teratogenic substance?
Something that has the ability to harm a developing fetus or embryo
Why did the FDA implement the Pregnancy and Lactation Labeling Rule (PLLR)?
To better inform providers, pregnant, and lactating women about the risks and benefits of taking medication. The new labeling should help assist health professionals inform patients as well as allow patients to make their own informed and educated decisions for themselves.
How did the pregnancy categories change?
Went from:
- Pregnancy
- Labor and Delivery
- Nursing Mothers
To:
- Pregnancy (includes L&D)
- Lactating women (includes nursing)
- Females and Males of Reproductive Potential
Are OTC medications included in the pregnancy label change?
No
How can medication be administered enterally?
- Tablets/capsules
- Sublingual/buccal
- Nasogastric/gastrostomy tube
How can medication be administered topically?
- Lotion/gel/powder
- Inhalation
- Instillation/irrigation
- Transdermal
- Ophthalmic
- Otic
- Nasal
- Vaginal
- Rectal
How can medication be administered parenterally?
- Intradermal
- Subcutaneous (SC/SQ)
- Intamuscular (IM)
- Intravenous (IV)
- Intraosseous (IO)
- Epidural
- Spinal
What is the enteral route?
- Deposits into stomach or intestines
- Most common route for medications
- Convenient and less costly
How does are medications absorbed through the enteral route?
Through the surfaces of the oral mucosa, somach, and intestine
- PO - orally - goes to stomach
- NGT - nasogastric tube (Dobhoff/Corpak) - goes to stomach through nose
- PEG tube (percutaneous endoscopic gastrostomy tube) - goes directly to stomach
Why can some tablets/capsule not be crushed?
If they are extended release, this would cause all of the medication to be available at once rather than allow the medication to be absorbed over an extended period of time.
Could cause toxic overdose
What are some similarities and differences of sublingual and buccal medication administration?
- Sublingual (under tongue)
- Rich blood supply leads to rapid onset
- Not destroyed by digestive enzymes in stomach
- No first-pass effect
- Buccal (between gum and cheek)
- Absorbed more slowly than sublingual
- Not destroyed by digestive enzymes in stomach
- No first-pass effect
Describe topical medications.
Applied to skin or membranes of eye, ear, nose, respiratory tract, urinary tract, vagina, or rectum.
Can produce a local or system effect - local has less adverse effects.
Describe parenteral medications.
- Invasive (invades the body)
- Carries risk of infection
- Medication is delieverd with a needle into skin, subcutaneous tissue, muscle vein, artery, body cavity, or organ
Define pharmacokinetics.
What the body does to the drug
- Absorption - where will it get in?
- Distribution - where will it go?
- Metabolism - how is it broken down?
- Excretion - how does it leave?
Define pharmacodynamics
What the drug does to the body
What affects absorption of a drug?
- A dugs is absorbed from the site of administration across one or more membranes into the bloodstream
- Factors that affect absorption include;
- Drug formation: pill vs liquid
- Blood flow to absorption site
- Surface area available for absorption
- Contact time at absorption surface
- Drug-drug or drug-food interactions
- Route of administration: pill vs IV
- Absorption is 100% complete if a drug is administered IV (100% bioavailability)
Define bioavailabililty
The amount of active drug reaching systemic circulation (the bloodstream) after administration
Define distribution of drugs and factors that influence it
Transport of drugs throughout the body
Factors that affect distribution include:
- Blood flow to body tissues
- Lipid solubility - based on cell membranes
- Binding to plasma proteins (albumin)
- Anatomic barriers (brain, placenta)
Define metabolism of drugs and its characteristics.
The liver is the primary site of drug metabolism, chemically converting drugs to less active forms for removal from the body
- The cytochrome P450 (CYP450) enzyme system is responsible for most metabolism in the liver
- Some people have differences in this enzyme system
- An important factor that affects metabolism is first-pass effect
- Metabolism usually deactivates a drug
- Metabolism ACTIVATES prodrugs
- Additional factors affecting metabolism include:
- Age
- Genetics
- Liver disease
- Kidney disease
What is the first-pass effect?
- Applies to medications administered orally or directly into the stomach (via a tube)
- First-pass effect impacts the bioavailability of medications administered via the enteral route
- If a drug has a high first-pass effect, the IV dose will be much smaller compared to the oral dose
- Oral dose will have a less effect unless given larger quantities
Define excretion of a drug and some of its properties.
- Drugs are primarily removed from the body by the kidneys (urine), but may also be excreted by the respiratory tract (exhalation), bile (defecation), and glands (sweating)
- Kidneys - when there is dysfunction, the drug action can be prolonged and cause increased adverse effects
- Respiratory - affected by diffusion and blood flow to lungs
- Bile - more bile is recirculated back to the liver, which can lead to prolonged drug action; some bile exits through feces
- Tends to recirculate - not excreted as quickly
- Glands - many drugs can be excreted via breast glands
- Some IV drugs people can taste (secreted through salivary glands)
Define therapeutic range.
Plasma concentration of drug between minimum and effective concentration and toxic concentration
*Some drugs have a much narrower therapeutic range* - CAUTION
Define onset
Time it takes after drug administration to produce a therapeutic effect
Define peak for a medication
When the medication has reached its highest concentration in the bloodstream
- Some medications require a loading dose in order to achieve therapeutic effect in a reasonable amount of time
- Most drugs take 4 half-lives until it reaches an effective concentration
Define duration of action
Length of time drug maintains therapeutic effect
Define half-life of a drug
Length of time for drug concentration in plasma to be decreased by half; can be affected by liver and/or kidney function
- Medications that are taken once a day typically have a long half life
- Medictions that have a short half-life are taken more frequently
Define potency of a drug
Drug strength at a certain dose
Define efficacy of a drug
Drug’s ability to produce a more intense response
Would you rather have a drug with a higher efficacy or higher potency? Why?
Efficacy because you want to have a drug that will give a better effect
What is a drug agonist?
A drug that binds to a receptor site and produces the same response as the natural messenger
What is a drug antagonist?
A drug that bins to a receptor site and prevents the agonist or natural messenger from binding (produces no effect by itself); “blocker”
Define mechanism of action (MOA)
How the drug produces the desired effect(s)
What is pharmacogenomics?
The study of how genetic variation affects a person’s response to drug therapy
- Arose as a result of the Human Genome Project
- Realized that drugs don’t work the same way for everyone (largely due to genetic differences in enzymes)
- “The study of the genome-wide role of human variation in drug response. Pharmacogenomics also includes the application og genomic technologies in drug discovery, disposition, and function.”
What is precision medicine?
Using the right drug for the right individual for the specific disease afflicting the individual
- Hope to predict whether a medication will be effective and prevent adverse drug reactions
- Goal is for more specific and successful individualized treatment
Define genome
The genome of an organism encompasses all the genetic material in the cell.
In humans, this would include the 3 billion base pairs ontained in the chromosomes in the nucleus and the approximately 16,000 base pairs in the mitochondria.
Define pharmacogenetics
The study of the role of genetic variation in determining individual drug response. Generally, pharmacogenetics has been limited to the effects of one or a few genes.
In what ways do genes interact with drugs?
- Drug metabolism: genetic variationin coding of enzymesthat metabolize drugs
- Enzyme may inactivate an active drug, or activate a prodrug into an active agent
- Drug transporters: genetic variation in coding of membrane transporters that move drugs in or out of cells
- Affects pharmacokinetics
- Can have differing effects depending on where the transporter is expressed (kidney, brain, etc)
- Drug target: genetic variation in coding for direct target of drugs
- Affects pharmacodynamics
- Usually results in decreased efficacy of the drug
What is the most common disease that benefits from pharmacogenomics?
Cancer
Drugs are less likely to be a “one-size-fits all”
Why do grapefruit/juice don’t mix with some medications?
It can:
- Block enzymes that metabolize the drug (cause too much of the drug) - most common
- Blocks the action of CYP3A4 in the small intestine that breaks down the drugs
- Block transporters of the drug (too little of the drug)
What is medication half-life? What implications does it have?
The amount of time it takes the body to reduce the medication by half.
If you take more of a medication before the initial dose is out of the body, the body can accumulate the drug and can cause toxicity.
Important with acetaminophen because many drugs contain this compound and accidental overdose is common.
6 Rights of Medication Administration
- Right Patient
- Right Medication
- Right Dose
- Right Time
- Right Route
- Right Documentation
What technology helps decrease medication errors?
- Computerized order entry
- Clinical decision support systems - computer recommends
- Barcode medication administration (BCMA)
- Smart infusion pumps
- Medication dispensing cabinets
What is anaphylaxis?
Sever allergic reaction that can cause: tingling-senation, severe shortness of breath, swelling, decreased blood pressure, increased heart rate, uneasy feeling
What is angioedema?
Swelling of tissue unders kin (often includes tissues of the face and airway causing an airway to be put in)
Severe allergic reaction
What causes an allergic reaction?
The immune system overreacts to a foriegn substance (allergen)
It is an unexpected chemical response
What is Toxic Epidermal Necrolysis (TEN)?
A severe reaction to a medication that causes widespread erythema, necrosis, bullous detachment of epidermis and mucrous membranes.
Involves > 30% of body surface
Will begin to develop over days and continue to develop even after medication is stopped.
What is Steven-Johnson Syndrome (SJS)?
Minor form of Toxic Epidermal Necrolysis (TEN).
Involves <10% of body surface
What is medication compliance and what are factors that influence it?
Taking the medication in which it was prescribed or the directions indicate.
Factors:
- Finances
- Didn’t work previously
- Transportation
- Side effects
- Mistrust
- Availability
- Forgetfulness
- Intolerance
What is the Beers criteria?
List of potentially inappropriate medications for older adults.
Medications associated with poor outcomes (falls, confusion, mortality).
Avoided, but used when necessary - may decrease dose
What is a prototype drug?
A model drug that is used to represent a broad drug class.
Allows you to predict actions and adverse effects of other medications in the same drug class.
Not always the most widely used drug in the class.
What is pain?
- Whatever a person says it is, existing whenever a person says it does
- Subjective experience
- Warns the body to avoid a potentially ganerous situation
- Prompts individuals to seek medical attention
- Affected by psychological and emotional processes
What is acute pain?
Starts suddently. Warning of disease or threat to the body.
Does not last longer than 6 months.
Disappears when underlying cause has been treated or is healed.
Can develop into chronic pain. Needs to be treated so this does not happen.
Examples: broken bones, labor, surgery, burns, cuts
What is chronic pain?
Pain that persists beyond healing and lasts longer than 6 months.
Can lead to depression, fear, anxiety, and anger.
Examples: back pain, cancer, arthritis, neurogenic
How do you assess pain?
There are different scales that can be used.
What is nociceptive pain and how do you treat it?
Nerve endings receive and submit pain signals to the CNS.
Responds well to traditional pain relief methods.
Two types: somatic and visceral.
What is somatic pain?
Localized; damage or injury to skin, tissues, bones, or muscles.
What is visceral pain?
Deep, dull, throbbing, generalized; damage or injury to internal organs (viscera)
What is neuropathic pain? What causes it? How is it treated?
Direct injury to the nerves.
Character of pain: shooting, burning, stabbing, pins and needles
More difficult to treat. Treatments include: antiepileptics, antidepressants, NSAIDs, Topical creams.
Caused by: shingles, diabetes, carpal tunnel, sciatic nerve pain, phantom limb pain, disc bulging.
What are some nonpharmacological pain relief methods?
- Physical therapy
- Art/music therapy
- Imagery
- Massage
- Therapeutic touch
- Acupuncture
- Reiki
- Prayer/meditation
What are analgesics?
- Medications to relieve pain
- Opioids (narcotics): moderate to severe pain; act within the CNS by targeting kappa and mu receptors
- Nonopioids: act at the nociceptor level; do not work at the CNS level
What responses are triggered by activating the mu receptor?
- Analgesia (ability to reduce pain)
- Decreased GI motility
- Euphoria
- Physical dependence
- Respiratory depression
- Sedation
What reponses are triggered by activating the kappa receptor?
- Analgesia (ability to reduce pain)
- Decreased GI motility
- Miosis (constricted pupils)
- Sedation
What are opioid agaonists?
- Potential to cause physical and psychological dependence
- Powerful CNS depressants
- Common adverse effects: respiratory depression, sedation, nausea, vomiting, constipation
- Morphine
Therapeutic class of morphine
Opiod analgesic
Pharmacological class of morphine
Opioid analgesic
Indication of morphne use
Severe pain, pulmonary edema, chest pain with MI
Mechanism of action of morphine
Binds to mu and kappa receptors, altering perception and response to pain while producing generalized CNS depression
Adverse effects of morphine
Confusion (especially in older patients), sedation, hypotension, respiratory depression, constipation, dizziness, itching, nausea, vomiting
Can develop a tolerance over time to analgesic, sedative, and euphoric effects, and nausea
Interactions of morphine
Use of monamine oxidase inhibitors (MAOIs; antidepressants) within the past 14 days
Other sedatives, hypnotics, and alcohol
Would you ever give someone extended-release morphine and immediate-release morphine at the same time?
Yes - to someone who has chronic pain.
Want to get rid of “break-through” pain (acute pain).
Extended release may not kick in for an hour or so.
Would you ever give someone an opioid analgesic (such as morphine) and a nonopioid analgesic (such as acetaminophen)?
Yes - percoset is acetaminophen and oxycodone
What is a patient controlled analgesia (PCA) pump? What is its purpose?
Can be used IV, epidural, or SC (dosing will differ).
Typically morphine, fentanyl, or hydromorphone.
Only the patient pushes the button.
Hopefully they end up with less doses.
What is an opioid antagonist?
An opiod blocker. Prevents the effects of opioid agonists by blocking the receptor site.
Therapeutic class of naloxone (Narcan, Evzio)
Treatment of acute opioid overdose
Pharmacologic class of naloxone (Narcan, Evzio)
Opioid receptor blocker
Mechanism of action of naloxone (Narcan, Evzio)
Blocks mu and kappa receptors to reverse the effects of opioids (including CNS and respiratory depression)
Administration of naloxone (Narcan, Evzio)
IV, IM, SC, or intranasal
Therapeutic class of buprenorphine (Buprenex)
Opioid analgesic
Pharmacologic class of buprenorphine (Buprenex)
Opioid agonist/anatagonist
Indications of buprenorphine (Buprenex)
Moderate to severe pain, treatment of opioid dependence, supression of withdrawal symptoms in detoxification
Mechanism of action for buprenorphine (Buprenex)
Binds to opiate receptors, altering perception and response to pain. Partial antagonist properties.