Exam 1 module 1 chapter 1 Flashcards
General, non-med information
Pharmacokinetics
How mediations travel through the body
Absorbtion
Transmission of medications from location of administration to the bloodstream
Types of absorbtion
Oral, GI tract sublingual/Buffalo, mucous membranes- other, rectal, vagi al inhalation, I trader also/topical, subcutaneous/intramuscular Intravenous
Most commonly route of administration
Enteral- through GI and parenteral- by injection
Barriers to absorption and absorption pattern for oral
Barriers: meds must pass through later of epithelial cells that line GI tract
Pattern: vary greatly D/t Stability and solubility of meds GI PH and emptying time Presence of food in stomach/intestines Concurrent meds Forms of meds (enteric coated, liquids) fluids
Barriers and pattern or sublingual / Buffalo absorption
Barriers: swallowing before dissolution allows gastric Ph to inactivate meds
Pattern: quick absorbtion systemically through highly vascular mucous membranes
Barriers and pattern of absorption of other mucous membranes (rectal/vaginal)
Barriers: stools or Infectious material limiting tissue contact
Pattern: easy absorption with both local and systemic effects
Inhalation mouth or nose. Barriers and pattern
Barriers: inspiration effort
Pattern: rapid absorption through a dollar capillary networks
Intradermal/ topical barriers and pattern
Barriers: close proximity epidermal cells
Pattern: slow gradual absorption; effects primarily local but systemic as well especially with lipid soluble medication passing through subq fatty tissue
Subcutaneous/ intramuscular barriers and pattern
Barrier: capillary walls have large spaces between cells therefore no significant barriers
Pattern : solubility of meds in water: high soluble
Meds have rapid absorption 10-30min
Poor soluble meds have slow absorption
Blood perfusion/ high=fast low= slow
Intravenous barriers/patterns
No barriers
Pattern:immediate enters directly to blood
Complete reaches blood in its entirety
Distribution def
The transportation of medications to sites of action by bodily fluids
Factors influencing distribution
Circulation
Permeability of cell membrane plasma protein binding
Permeability influence on distribution
Medication must be able to pass through tissues and membranes to reach target area
Lipid soluble meds or those with transport system can cross blood brain barrier and placenta
Plasma protein binding distribution factors
Meds compete for protein binding sites w in bloodstream primarily albumin. Ability of med to bond to protein affects how much of med will leave and travel to target tissue
Two meds can compete for same binding site= toxicity
Metabolism
Aka bio transformation
Changes meds into less active or inactive form by action of enzymes
Occurs in: liver primarily
Also: Kinsey’s lungs intestines and blood
Factors Influencing rate of metabolism of medication
Age
Increase in some medication metabolizing enzymes
First pass effect
Similar metabolic pathways nutrition status
outcomes of metabolism
increased renal excretion of medication, inactivation of medications, increased therapeutic effect, activation of premedication’s into active forms, dec. toxicity when active forms of meds become inactive; increased toxicity when inactive forms of med. become active forms
excretion
elimination of meds from body
where does drug elimination take place
primarily kidney’s
also: liver, lungs, intestines, exocrine glands (breast milk)
minimum effective concentration (MEC)
min amount of medication required to create therapeutic effect
medication dosing attempts to regulate medication response to maintain plasma levels between
min. effective concentration and the toxic concentration
therapeutic index
depends on if drug has high or low therapeutic index; route of administration
nursing process
assessment, diagnosis, planning, implementation, evaluation
non- adherence
due to lack of resource or inability to take due to uncontrolled circumstances
noncompliance
patient does not want to take meds/ wont take
enteral
drug is absorbed into systemic circulation through mucosa of stomach and or small/large intestines
goes through first pass
oral, rectal, sublingual
do sublingual medication go through first pass
no, even though they are enteral
what is the fastest enteral drug route
sublingual
parenteral
shots/invasive
injectable form/solutions
parenteral injection types
subcutaneous, intradermal, intramuscular, IV (fastest)
topicals
aerosols, ointments, creams, pastes
types of topicals
transdermal, inhalation, intraocular, vaginal, inhaler
first pass
when drugs are inactivated or diverted by liver before reaching general circulation and site of action
how does malnourishment effect drug distribution?
have decreased albumin which decreases plasma protein binding sites for medications= more free drug which leads to toxicity
how does circulation affect drug distribution?
poor circulation decreases distribution and good= increased circulation
poor distribution to bone and brain bc Connective tissue poorly vascularize
what enzyme in liver helps metabolize
lipid soluble medications?
cytochrome P 450
what decreased metabolism of drugs?
CV disease, renal insufficiency, starvation, obstructive jaundice, slow acetylators
fast acetylators
metabolize medication more quickly
slow/fast acetylators
the enzyme in the liver either responds slower or faster in the liver, it is a gene trait in the liver enzyme
what increases metabolism of medications?
fast acetylators, barbiturates, rifampin, phenytoin
medication half life
the time it takes for half of the original amount of a drug to be removed
onset
time it takes for drug to elicit a therapeutic response
peak
time it takes for a drug to reach its max therapeutic response
duration
the amount of time /duration that the drug concentration is enough to elicit a therapeutic response
mechanism of action
how the drug works
drugs produce actions/therapeutic effects by:
modifying rate at which target cells or tissue fx
modifying the fx of the target cells or tissue
agonst
bind to the receptor and response occurs
partial agonist
binds to receptor and acts as agonist/antagosit
antagonist
bind to receptor preventing binding of agonists and endogenous compounds
pharmacodynamics
describes interactions between medications and target cells, body systems, and organs to produce effects
negligence
general term denotes conduct lacking in due care, carelessness, deviation from standard care that a reasonable person would use in a particular set of circumstances
DOES NOT involve intent, just made a mistake
malpractice
failure of professional to act in accordance w/ professional standards, knew you should have done it but didn’t- INTENT is involved
therapeutic range/index
range between min. effective concentration and toxic level
pharmacokinetics
refers to how medications travel through the body
what is the most common route of administration?
oral or enteral
sublingual enteral route
under tongue
swallowing before absorption = inactivation d/t gastric PH
topical routes/kinds
transdermal, eye, ear, nose, rectal suppositories, vaginal
transdermal
medication in skin patch, absorbed through skin
systemic effects
inhalation routes/kinds
MDI- metered dose inhaler
DPI- dry-powder inhalers
intradermal (parenteral)
for TB test or allergy tests- between dermis skin layers
subcutaneous
insulin/heparin, injected into fat pad areas (abdomen, thigh)
intramuscular
used for irritating medications;
advantages to parenteral admin
use for poorly soluble medications
use for admin. meds that have slow absorption for an extended period of time
parenteral
intradermal, subq/IM/IV, epidural
non-first pass routes
routes that bypass the liver and are not inactivated or diverted before reaching the site of action/circulation
distribution
transport drug of drug via bodily fluids to its site of action through circulation, cell membrane permeability
what can alter metabolism of medications
health of liver, presence of various diseases and other medications
