EXAMS 1 Flashcards
what is pharmacology
study of uses, effects and modes of actions of drugs.
includes the pharmacokinetics and pharmacodynamics in addition to physical and chemical properties of drug
science of pharm draws multiple disciples including
anatomy physiology psych chemistry microbiology
what is a drug
any chemical that can affect living processes. can be man made or naturally occuring
what is clinical pharmacology
the study of drugs in humans. this can be applied to both patients and healthy volunteers in medical studies
pharmacotherapy
the use of drugs to diagnose, prevent or treat disease or to prevent pregnancy
historically sources of drugs
animals
plants
minerals
modern day sources of drugs
- synthetic compounds manufactured in labs
- natural molecules that are altered
- biotechnology
prototype of opioid analgesics
morphine
what are prototype drugs
individual drugs that represent a group of drugs. also the standard to which new drugs are compared
Every drug has 3 names. what are they
- chemical
- Generic (non-proprietary)
- Brand (proprietary, trade)
How many generic names per drug
only 1 generic name per drug
who assigns generic names of drugs
assigned by United States Adopted Names Council
who creates brand names of drugs
created by drug companies
What names should you use for drugs. chemical, generic or brand
Always use GENERIC
a single drug can have multiple brand names. true or false
true. example ibuprofen can come in the from of advil, motrin, tylenol
products with the same brand name may have different ingredients internationally. true or false
True.
Allegra in the US is an allergy medication but in germany, its a migrane medication
generic names of drugs indicates what
indicates drug class
what is the pharmacologic class of drugs that ends in (-cillin)
penicillin antibiotic
what is the therapeutic use of drugs that ends in (-cillin)
bacterial infection
what is the pharmacologic class of drugs that ends in (-statin)
HMG-CoA reductase inhibitor
what is the therapeutic use of drugs that ends in (-statin)
high cholesterol
what is the pharmacologic class of drugs that ends in (-olol)
beta-blocker
what is the therapeutic use of drugs that ends in (-olol)
hypertension, astrial fibrillation
what is the pharmacologic class of drugs that ends in (-pril)
angiotensin-converting enzyme inhibitor
what is the therapeutic use of drugs that ends in (-pril)
hypertension
how many categories of controlled substances
schedule (I-V) 1-5
out of the 5 schedules of controlled substances. Which schedule is not accepted for medical use
Schedule 1.
examples are heroin, ecstasy(MDMA)
what schedule of control substances is the lowest abused potentially
schedule V
what does new drug development uses
uses a randomized controlled trial (RCT) design, randomization and binding
What is the randomized Controlled trial (RCT) design
comparing two patients with the same disease state. One is given experimental drug (treatment), one gets placebo or standard of care (control)
Why is randomization important in RCT new drug development
randomization prevents allocation bias
randomized Controlled Trial (RCT) allows researches to determine what?
allows researchers to determine if a new drug is better, worse or equal to standard care
Limitations During Drug Development
- exclusion of some populations (minorities, women, pregnant women, children
- failure to detect all adverse events
what does proton-pump inhibitors do
used to treat stomach related problems
drugs are considered hazardous if they are?
carcinogenic teratogenic toxic to reproduction genotoxic toxic to organs
six rights of medication administration
patient drug dose route time documentation
what is pharmacokinetics
study of drug movement throughout the body
4 core processes of pharmacokinetics
ADME absorption distribution(blood) metabolism (enzymatic chnage) elimination
3 primary methods of movement of drugs to the body
- channels and pores
- transport systems
- direct penetration of the membrane
movement of drugs throughout the body during “ADME” involves?
crossing membranes
what drugs uses the channels and pores method of drugs gettin into the body
Sodium and potassium
What are the sizes of the channels drugs passes throug
channels are small
What is transport system?
movement of drugs from one side of the membrane to another
what is passive transport
movement via a concentration gradient
What is active transport
requires energy expendicture
All transport systems are selective or not
they are all selective
what role does drug structure play in its transportation
drug structure determines if the drug will be transported
what are P-glycoprotein (OGP) transporters
trasnmembrane protein that transport drugs out of the cells. liver-bile kidneys - renal tubule (urine) placenta - maternal blood intestine - intestinal lumen
What is the most common method of drug movement
Direct penetration of the membrane
What drugs passes through the membranes in the easiest way possible
lipophilic drugs pass through membranes the easiest
what molecules cannot readily cross membranes?
polar molecules and ions
What is absorption
the movement of drug from site of administration to the blood stream
what does the rate of absorption determine?
It determines how soon effects of the drug will begin
what is another name for rate of absorption
onset of action
what does amount of absorption determines
it determines how intense the effects will be
factors that affect rate of absorption
- rate of dissolution
-surface area
-blood flow
lipid solubility
route of administration
Two main routes of administration
Enternal
Parenteral (IV, IM and SQ)
what does the route of administration has a large impact on
it has a large impact on rate and extent of absorption
what are the barriers to IV route medications?
No barries (absorption bypassed)
absorption pattern of IV medications
instant
Advantages of IV route medications
- Rapid onset
- precise control over drug levels
- 100% bioavailability (cus everything goes straight to the blood stream)
What does bioavailability mean
the amount of drug that reaches bloodstream and can cause effect
Disadvantages of IV route of medication
- Expensive
- irrevisble
- inconvenients
- difficult to administer
- Drug must go into solution
What are the barriers to IM and Subcutaneous (SQ) route medications?
capillary wall (easy to pass)
Absorption pattern of IM and SQ Route Medication
- rapid with water soluble drugs and areas of high blood flow.
- slower with poorly soluble drugs and low blood flow
Advantages of IM and SQ Route Medication
- permits use of poorly soluble drugs
- permits use of depot formulation
disadvantages of IM and SQ Route Medication
- possible discomfort
- inconvenient
- potential for injury
prototype of penicillin
antibiotic
what is blinding in new drug development
participants and or researchers are unaware of what group the participant is in. prevents bias too
what are the barries to absorption of oral (po) drugs
GI tract, capillary wall, PGP proteins
what is absorption pattern of oral (po) drugs
- slow and variable
- impacted by rate of dissolution, lipohilicity, blood flow and pH partitioning
advatanges of oral route drugs
-easy
-convenient
-inexpensive
ideal for self medication
potentially reversible
-possibly safer than parenteral routes
disadavantages of oral route drugs
- patient must be conscious and cooperative
- variable bioavailability
- variability in absorption and response
- inactivation of some drugs by gastric acid
Parenteral administration is better when
- there is a medical emergency
- plasma levels need tight control
- drug is destroyed by gastric acid (insulin)
- drug could injure tissues
- drugs cannot cross membranes
- depot preparation needed
- patient cannot take drugs by mouth
What is distribution
drug movement from the blood to other parts of the body
distributions of drugs are determined by
- blood flow to tissues
- ability to exit the bloodstream
- ability to enter cells
what is the important of well perfused tissues in drug distribution
drugs will reach that area
tissues that are not well perfused will ??
has less drug exposure example abscess or tumor
most drugs must exit the blood to have an effect. true or false
true
where do drugs exit the blood at?
- drugs exit the blood at capillary beds
- large spaces between cells for drugs to pass through
- movement to intertidal spaces is easy
what does the blood brain barrier in the central nervous sites do?
- prevents easy passage cus theres tight junctions between cells
for drugs to cross the blood brain barrier, the drug must be what?
drugs must be lipophilic or have specific transporters
drug molecules bound to proteins can leave the blood. true or false
false. they cannot leave the blood
proteins are larger than drugs and will remain in the blood stream
true
drug molecules unbound or free can?
they can leave the blood unlike drug molecules bonded to proteins
what can protein binding do?
- can restrict distribution and source of drug interactions
what is metabolism in drugs
the method by which drugs are inactivated or biotransformed in the body
most drug metabolisms occurs in _____ by the _____
occurs in the liver by cytochrome P450 enzyme system
CYP450 can be further broken down into subcategories of?
CYP34A and CYP2C9
besides the liver, metabolism can also happen in?
serum, lungs and kidneys
what happens when drugs are metabolized?
- drug inactivation
- increased therapeutic action
- activation of pro drugs
increased or decreased drug toxicity
accelerated renal clearance of drugs
the first-pass effect impacts what type of drugs
impacts drugs taken orally
the liver has the potential to inactivate all drug before it reaches site of action. true or false
true
all drugs undergo rapid hepatic inactivation. true or false
false. only some drugs
after absorption of drug in the GI tract, where does the drug goes to?
drug goes to the liver via portal circulation
what are some special considerations for metabolism
- age
- induction and inhibition of drug metabolizing (CYP450) enzymes
- nutritional status
- completions between drugs
what is the most common and important route of drug excretion?
via the kidneys
facts that affect renal excretion?
- age
- competition for active tubular transport
what are some non-renal routes of drug excretion
- feces
- bile
- lungs
the onset of action and intensity of drug effects can be predicated with the use of?
ADME
what are plasma(serum) drug levels?
it’s the lab measurement of the amount of drug in the blood at a point in time
plasma levels and drugs levels have what kind of correlation?
they have a direct correlation at the site of action
why is it important to monitor plasma (serum) drug levels
it can help determine weather if too much drug is present which is toxic
or
too little drug is present which is subtherapeutic
define the term minimum effective concentration (MEC):
smallest concentration of drug that will cause an effect
define toxic contractions of plasma levels
plasma levels about this will have toxic effects
define therapeutic range of plasma levels
it’s the range between the minimum effective concentration (MEC) and the toxic concentration
what is the goal of the therapeutic range
to keep the drug levels in the safe range between the toxic concentration and the minimum effect concentration
medication may have a _____ or _____ therapeutic range
wide or narrow
after single dose of medication, drug levels rise during which of the ADME
drug level rises during the absorption/distribution
where do drug levels fall after taking a single dose of medication?
drug levels fall during elimination (metabolism/excretion)
what is the latent period of a drug?
it’s the period until drug takes effect
drugs will exert therapeutic effect until it falls below??
minimum effective concentration (MEC)
define the serum half life
the time required for the amount of drug in the body to decrease by 50%
serum half-life are determined by?
metabolism and excretion
drugs with short half half-life???
leaves the body quickly
drugs with long-half life??
leaves the body slowly
about 100% of drugs leave the body in how many half-lives
leaves the body in 5 half-lives
what is the dosing interval of short half-life drugs?
dosing more frequently cus they leave the body quickly
what is the dosing interval of long half life drugs?
dosing less frequent cus they take long to leave the body
multiple doses can cause what to drug levels?
multiple doses can cause drug levels to build up in the body and eventually reach plateau
what is another name of plateau stage?
steady-state
describe what happens at the plateau stage?
when the amount of drugs administered is equal to the amount eliminated
how many half-lives is needed to reach the plateau/steady state?
about 4 half lives
what is loading dose?
large dose of drug given to reach close to plateau levels
what is maintenance dose?
smaller doses given to maintain plateau levels
what is pharmacodynamics (PD)
- drugs actions on target cells and their corresponding response
- what drug does to the body and how it does it
why is it important to understand basic pharmacodynamics
- educating patients
- making decisions to administer as need (prn)drugs
- evaluating patients for harmful or therapeutic effects of drugs
most drugs interrupts with____ to have a therapeutic effect
receptors
what are receptors
functional proteins in a cell that the drug binds to to produce an effect
when drug is bound to a receptor? response or no response
response
when a drug is not bound to receptor response or no response
no response
drug binding to receptors is usually____
reversible
the general equation for drug interaction with receptors
D+R = D-R COMPLEX - RESPONSE
receptors interact with what kind of compounds
endogenous
drugs can only mimic or block the actions of _____compounds
endogenous
can drugs give cells new functions?
no they cannot. they can only enhance or prevent actions typically caused by endogenous compounds
what are agonist
- moclecules that activates receptors or mimic the effects of an endogenous molecule
agonists always make processes got faster
false. they can make processes go slower if that is the physiologic action of the receptor it binds to
what are partial agonist
agonist with only moderate activity. the maximal effect a partial agonist can produce is less than a full agonist
what is an antagonist
a molecule that prevents receptor activation
does antagonist have their own effects effects on receptors?
they have no effects of their own on receptors
how does antagonist produce their effects on receptors?
antagonist produces their effects by preventing activation of the receptors by endogenous substance
physiologic variables that determine the intensity of a drug response
- age, gender, weight
pathologic variables that determine the intensity of a drug response
changes in organ function
genetic variables that determine the intensity of a drug response
differences in enzymes that metabolize drugs
what is the Drug-Drug interactions (DDI)
action of one drug may be increased or decreased by the presence of another drug.
can occurs anytime a patient takes more than 1 drug
interactions of DDI can?
- intended and desired
- unintended and undesired
DDI are very important for what drugs?
important for drugs with a narrow therapeutic index
risk of serious DDIs is directly proportional to_____
the number of drugs a patient takes
what is the grape juice effect
grapefruit juice can inhibit some hepatic drug metabolizing enzymes.
increases concentration of drugs broken down by those enzymes
what are the drug food interactions
- can cause increase or decrease drip absorption
- increased toxicity
- decreased drug efficacy (direct impact of drug actions green. example leafy vegetables [vitamin K]and warfarin
what are adverse drug reactions (ADR)
any anxious, unintended and undesired effect that occurs at a normal drug doses
adverse drug reactions (ADR) can have an intensity ranges from_______ to ______
mild to life threatening
what is an allergic reaction of a drug?
an immune reacting to a drug. requires prior exposure to the body to the sensitized.
intensity of response of allergic reaction is_______ of drug dose administered
independent
what is an idiosyncratic effect
uncommon drug response resulting from a genetic predisposition
what is a paradoxical effect
opposite of the intended drug response
what is latrogenic disease
disease that occurs as a result of medical care or treatment
what is a the carcinogenic effect
ability of a drug or environmental chemicals to cause cancer
what is teratogenic effect
drug induced child defect.
defects to new child born due to some drug that may have been administered to the parents
what are hepatotoxic drugs
leading causes of a cute liver failure
effect of QTc prolong drugs
QTcs are medications that increase the length of the QTcs interval (ventricular repolarization)
patients are at risk of developing arrhythmias
what percentage of ADRs are identified before a drug comes to the market?
only about 50%
what is wrong with the 5 rights of medication
the approach lacks application of pharmacology to patient centered care
10 rights of medication
patient drug dose time route reason documentation patient education evaluation to refuse mediacation
what are the nursing processes
assessment diagnosis - dosage and administration planning - minimize adverse effect implementation - drug administration, patient educa evaluation
what are some most common fatal medication errors
overdose
wrong drug
wrong route
how are medication errors classified
- direct - cause harm directly example overdose
- indirect - cause harm indirectly cus there wasn’t enough to treat the condition. example antibiotic dose too low and ineffective
90% of medication errors are attributed to what?
human factors
- performance deficit
- knowledge deficits
- miscalculation of dose
- communication mistakes (poor handwriting/ miscommunication of drug name/dose/route)
- name confusion
what are some ways to reduce medication errors
- create environment of just culture
- encourage patients and family members be active participants in care
- provide healthcare workers with necessary tools to dispense and administer medications safely
- replace handwriting with typed orders
pediatric patients are more sensitive to drugs
true
there’s greater interpatient variability in drug effects among pediatrics. true or false
true
pharmacodynamics in differences in pediatrics are due to?
- differences in target cell sites
- changes in number of protein receptors
- chnages in body composition over time
what group of people are at risk for more intense and prolonged drug responses
neonates and infants
how are protein bindings in infants
protein bindings are lower in infants
children tend to require higher doses of medications than adults. true or false
true
metabolism remains high in children over 1 year but starts to decrease at what age?
starts to decrease at age 2
adults from 65 and above are more sensitive to drugs than younger adults. true or false
true
older adults experience higher rates of adverse drug reactions ADRs and drug-drug interactions DDI. true or false
true
factors that contribute to ADRs
- changes in Pharmacokinetics
- multiple disease states and severity of disease
- multi- drug therapy
- poor adherence
alteration in receptors occur in what group of people
adults
beta blocking drugs are _____ effective in older adults
less
warfarins are _____ effecting in older adult
more
changes in receptors can cause
increase sensitivity to drugs
decrease efficacy of drugs
pharmacokinetics (PK) in older adults (metabolism)
decreased hepatic blood flow
decreased hepatic mass
decreased hepatic enzyme activity
results in decreased drug exposure
pharmacokinetics (PK) in older adults (excretion)
decreased renal blood flow
decreased GFR
decreased number of nephrons
results in increased drug exposure
advertise drug reactions in older adults are ____ more common and of eyes avoidable
seven times
adverse drug reactions in older adults contribute to ____% of all hospital admissions
-16%
adverse drug reactions in older adults causes ___% of medication related deaths
50%
