Final Flashcards
What is a drug?
Anything that alters the normal function of the body
What is pharmacology?
The study of drugs
What is therapeutics?
Any drug used to cure a disease or disorder
Naming a drug is based on what 5 things?
- chemical
- code
- generic
- official
- trade
What is the chemical name?
Based on the chemical structure
What is the code name?
Experimental, drug shows potential and is usually alpha numeric
What is the generic name?
Non proprietary name, related to the chemical and may not be the same in US and Canada
What is the official name?
Fully approved and adopted by the USP and NF
What is the trade name?
Legally registered brand name
3’4 dehydrase-isopylamino-benzyl alcohol hydrochloride is an example of what?
Chemical name
Isoproterenol HCL is an example of what?
Generic and official names
Isuprel and Norisodrine are examples of what?
Trade names
This sets standards, identity and purity. It is uniform strength and very objective
USP-NF
This is published by APA and established formulations not in the USP. It is revised continuously
AHFS
This is the reprint of the manual literature which includes a list of generic names, classes, pictures. It lacks objectivity and is a good general reference
PDR
This is published by ASHP and discusses drug classes and new drugs that are not in the USP-NF. It is very objective and very informative
Hospital Formulary
What are the six sources of drugs?
- plant
- animal
- micro org
- mineral
- synthetic
- bioengineered
What are some examples of plants and the drugs that come from them?
Purple fox glove (digitalis), deadly nightshade (atropine) and opium poppy (morphine)
What are some examples of animals and the drugs that come from them?
Bovine thyroid gland (throxine) and porcine pancreas (natural insulin)
What are some examples of micro organisms and the drugs that come from them?
Molds (penicillin) and bacteria (streptomycin)
What are some examples of minerals?
Iron
What are some examples of synthetic?
Albuterol
What are some examples of bioengineered and the drugs that come from them?
Cell cultured (urokinase) and recumbiant DNA (R-Hirudin)
What are the six parts of a prescription?
- pt’s name, address and date
- superscription
- inscription
- subscription
- sig
- name of prescriber
What is the superscription of a prescription?
Rx pharmacist recipe
What is the inscription of a prescription?
Lists name and quantity
What is the subscription of a prescription?
Directions of preparing
What is the sig of a prescription?
Instructions from the pharmacist to the patient
What are some considerations of administering drugs?
- have a written order
- know desired effect
- always know the drug to be given
- document if pt refuses
- know symptoms of overdose and treatment
What are the six rights of drugs?
- right client
- right drug
- right dose
- right rime
- right route
- right documentation
What are the seven aerosolized agents?
- adrenergic
- anticholinergic
- antiasmathic
- antiinfective
- corticosteroid
- exogenous surfactant
- mucoactive
What is the pharmaceutical phase of drug administration?
The making of a drug available to the body for absorption
What is the dosage form of a drug?
The physical state of the drug in association with non-drug components
What is administration?
The portal of entry for the drug into the body
What are the five dosage forms?
- oral (enteral)
- injectable
- aerosol/MDI
- suppository
- sublingual
What are the five routes of administration?
- enteral
- parenteral
- transdermal
- inhalation
- topical
What route is the safest and what route is the fastest?
Oral is the safest and parenteral is the fastest
What is the pharmokinetic phase?
The time course and deposition of a drug in the body
What four things is the pharmokinetic phase based on?
- absorption
- distribution
- metabolism
- elimination
What is the pharmacodynamic phase?
The interaction of drug molecules with target receptor sites (how a drug works)
What are the three ways drugs produce effects?
- key fits lock and causes a reaction
- key fits lock but does not cause a reaction
- key alters membrane permeability
What does it mean when a key fits a lock but does not cause a reaction?
The drug blocks the receptor site to keep reactions from occurring
What are the three things that must happen for lock and key?
- drug must reach receptor site
- drug must be specific to receptor site
- drug specificity depends on chemical structure
What are the terms for lock and key?
- affinity
- efficacy
- agonist
- antagonist
What does affinity mean?
Likeness or attraction
What does efficacy mean?
Effect
What does agonist mean?
Both affinity and efficacy
What does antagonist mean?
Affinity but not efficacy
What are the four types of drug interactions?
- additive
- synergism
- potentiation
- antagonism
What is additive?
1+1=2. Two drugs that both do what they’re supposed to do
What is synergism?
1+1=3. Two drugs that work better together than separate
What is potentiation?
1+0=2. One drug doesn’t do anything but the second drug does better because the first one is there
What is antagonism?
1+1=0. Cancel each other out
What is addiction?
Physical need
What is dependence?
Psychological need
What is an allergy?
A damaging immune response to a substance
What is anaphylaxis?
A severe hypersensitivity reaction
What is a carcinogen?
A drug that causes cancer
What is cumulation?
The drug is excreted slower than it’s given so it builds up
What is desensitization?
Less affected by a drug
What is half-life?
How much time it takes to decrease the drug in your body by half
What is the paradoxical effect?
Get the opposite effect that you expect
What is potency?
Strength of a drug
What is resistance?
Lack or responsiveness no matter how much of the drug you take
What is a side effect?
Any effect that occurs that wasn’t the desired effect
What is tachyphylaxis?
Rapidly developing drug tolerance
What is a teratogen?
A drug that causes birth defects
What is tolerance?
When you need more and more of a drug to produce the desired effect
What is maximal effect?
The greatest response that can be produced by a drug (no further response can be elicited)
What does ED 50 mean?
Half of the test subjects improve
What does LD 50 mean?
Half of the test subjects die
For the therapeutic index, the ____ the number the more dangerous
Smaller
What parts of the body does the central nervous contain?
Brain and spinal cord
What are the parts of the autonomic nervous system?
Sympathetic, parasympathetic and nonadrenergic noncholinergic (NANC)
What is the sympathetic system?
It is the general alarm system. It is not essential for life and is considered the “fight or flight” system
What is the parasympathetic system?
It regulates daily functions
what are the four main things that the parasympathetic system regulates?
- salivation
- lacrimation
- urination
- defication
The peripheral nervous system contains what?
The sensory, somatic and autonomic nervous systems
What is the sensory system?
Afferent. Input to the brain such as light, heat and pressure
What is the somatic system?
Efferent. Away from the brain and largely voluntary skeletal muscle
What are the parts of the sympathetic branch?
- short preganglionic fiber
- ganglionic synapse
- long postganglionic fiber
- neuroeffector synapse
Sympathetic fibers innervate the ____ and cause the release of ____ into general circulation
Adrenal medulla; epinephrine
Circulating epinephrine stimulates all receptors to responding ___ even if no sympathetic nerves are present
Norepinephrine
Sympathetic nerve stimulation is both ___ and ___
Electrical and chemical
What neurotransmitter is at the ganglionic synapse in the sympathetic system?
Acetylcholine
What neurotransmitter is at the neuroeffector synapse in the sympathetic system?
Norepinephrine
Sympathetic sweat glands release ___ instead of norepinephrine
Acetylcholine
Preganglionic sympathetic nerve fibers directly innervate the ____, where the neurotransmitter is ___
Adrenal medulla; acetylcholine
What does A1 stimulation cause?
Constriction in the lungs and blood vessels
What does B1 stimulation cause?
Increase HR, contractile force and automaticity
What does chronotropic mean?
Increases HR
What does ionotropic mean?
Increases contractile force
What does automaticity mean?
Increases jumpiness
What does B2 stimulation cause?
Dilation in the lungs and blood vessels
What are the steps of the beta receptor theory?
- A Gprotein linked receptor is stimulated by either a natural sympathetic reaction or a specific beta agent that has been given
- this activates G proteins called Gs
- this causes the release of adenylyl cyclase
- Adenyl cyclas converts ATP to cyclic 3’5’ amp
- cyclic 3’5’ amp causes direct bronchodilation and inhibits mast cell degranulation
- cyclic 3’5’ amp is broken down by phosphodiesterase and becomes 5’ amp
- 5’ amp has no action on bronchial smooth muscle
What are the steps of the parasympathetic receptor theory?
- A muscarinic receptor is stimulated by either a natural sympathetic reaction or a specific beta agent that has been given
- this activates G proteins called Gs
- this causes the release of gyanylate cyclase
- Gyanylate cyclas converts GTP to cyclic 3’5’ gmp
- cyclic 3’5’ gmp causes direct bronchoconstriction and enhances release of inflammatory chemicals
- cyclic 3’5’ gmp is broken down by phosphodiesterase and becomes 5’ gmp
- 5’ gmp has no action on bronchial muscle
What are the three ways to inactivate norepinephrine?
Reuptake 1, deactivation by COMT and deactivation by MAO
What is reuptake 1?
Reabsorbed into post-synaptic membrane at the site (lock and key reaction)
What is deactivation by COMT?
Catechololmethyl transface. Catechol nuclei are broken down by the COMT enzyme
What is deactivation by MAO?
Monoamine oxidase
What is the most common way to inactivate norepinephrine?
Deactivation by COMT
What are the parts of the parasympathetic branch?
- very long pre ganglionic fiber
- ganglionic synapse
- short post ganglionic fiber
- neuroeffector synapse
What parasympathetic neurotransmitter is at the ganglionic synapse?
Acetylcholine
What parasympathetic neurotransmitter is at the neuroeffector synapse?
Acetylcholine
Increased ___ causes the release of acetylcholine and increases constriction
Calcium
What are the four parasympathetic agents?
- metacoline (bronchoconstriction)
- carachol (relieves urinary retention)
- bethanechol (relieves urinary retention)
- pilocarpine (myosis in eptamology)
What are three parasympatholytic agents?
- atropine
- atrovent
- spiriva
How are parasympathetic agents inactivated?
- hydrolysis by cholinesterase enzymes
- split acetylcholine molecule into choline and acetate
Muscarinic receptors are located at ____ (bronchial mucus glands, cardiac muscle, smooth muscle)
Exocrine glands
Nicotinic receptors are found at ____ and ____
Ganglionic synapses and skeletal muscle sites
___ receptors are parasympathetic receptors found in airway smooth muscle and submucosal glands
M3
Parasympathomimetic/Cholinergic
Drugs that mimic the parasympathetic system and cause bronchoconstriction
Parasympatholytic/Anti-cholingeric
Drugs that block bronchoconstriction (indirect bronchodilators), i.e. atrovent
Sympathomimetic/catecholamine
Mimic the sympathetic system and cause bronchodilation
Adrenergic/adrenomimetic
Look like the sympathetic system, i.e. albuterol
Sympatholytic/antiadrenergic
Compete with the sympathetic system and cause bronchoconstriction
What is adrenergic?
A drug that stimulates a receptor for norepinephrine or epinephrine
What is antiadrenergic?
A drug that blocks a receptor for norepinephrine or epinephrine
____ is the lumen of the airway reduced. It can be due to bronchospasm, mucosal edema or secretions
Bronchoconstriction
___ is another name for muscle constriction
Bronchospasm
____ means swelling
Mucosal edema
What are the three agents used for bronchospasm relief?
- sympathomimetic
- parasympatholytic
- methylxanthines
What are two agents used for mucosal edema relief?
- alpha adrenergic
- corticosteroid
___ always results in ___ but not all ___ is caused by ___
Bronchospasm; bronchoconstriction; bronchoconstriction; bronchospasm
A general indication of ___ bronchodilators is when relaxation of airway smooth muscle in the presence of ___ airflow obstruction in diseases such as ____, _____, ____ and _____
Adrenergic; reversible; asthma, emphysema, bronchiectasis, and bronchiectasis
Relaxation of bronchial smooth muscle to produce bronchodilation in ___, ___, ___ and ___ is an indication of bronchodilators
Asthma, COPD, bronchiectasis and other obstructive diseases
How long do ultra short acting agents last and when are they used?
Less than 3 hours and emergencies
What are the three ultra short acting agents most commonly used?
a. epinephrine
b. racemic epinephrine
c. isoetharine
How long do short acting agents last and what are the indications?
4-6 hours and acute reversible obstruction
What are some examples of short acting agents?
a. albuterol
b. levalbuterol
c. metaproterenol
d. pirbuterol
e. bitolterol
What is the difference between saligenins and resorcinals?
Saligenins have HOCH2 and resorcinals only have OH
How long do long acting agents last and when are they used?
8-12 hours and maintenance and control of bronchospasm
What are some examples of long acting agents?
a. salmeterol
b. formoterol
c. arformoterol
Catecholamines are inactivated by heat, light and air. This is a phenomenon known as _____
Beta blockade
The ____ enzyme is found in the liver and kidneys and degrades catechols (making catechols unsuitable for oral administration because they are inactivated by the gut and liver)
COMT
What are some of the side effects associated with catecholamines?
a. nausea
b. headache
c. dizziness
d. skeletal muscle tremor
e. tachycardia
What are the naturally occurring catecholamines?
a. epineprhine
b. norepineprhine
c. dopamine
What are the man made catecholamines?
a. isoetharine
b. isoproterenol
___ are mirror images of each other
Isomers
____ is the stereoisomer of epinephrine
Racemic epineprhine
____ is used for status asthmaticus or cardiac issues
Epinephrine
What is used as a vasoconstrictor for its alpha effects to reduce swelling?
Racemic epineprhine
For a COPD patient, what are the drugs you would prescribe (in order by time)?
- albuterol PRN
- albuterol + atrovent PRN
- albuterol + atrovent q4h
- albuterol + atrovent + salmeterol q4h
- albuterol + atrovent + salmeterol q4h + corticosteroid
- albuterol + atrovent + salmeterol q4h + corticosteroid + xanthine
___ is the single (R) isomer form of racemic albuterol and contains no (S) isomer
Levalbuterol
What is the longest acting SVN?
brovanna
Levalbuterol is available in both a ___and___ form. The dosages are 0.31mg/3mL, 0.63mg/3mL, 1.25mg/3mL, and 1.25mg/0.5mL
MDI; SVN
The other name for levalbuterol is ____
xopenex
Extended released albuterol comes as a 4 or 8mg ____
tablet
Salmeterol is available as a ___ and is used for its ____ effect
DPI; bronchodilator
Formeterol comes as a DPI and SVN and is used for what three diseases?
a. asthma (5 years +)
b. exercise induced asthma
c. COPD
After administering a bronchodilator, what should you assess?
a. 20% increase in flow rates
b. ABG
c. blood glucose and potassium
d. reaction to freons and sulfites
___ lasts longer than epinephrine because it is not acted on by COMT
Albuterol
The B-agonist controversy, also known as the _____, is the increasing evidence of asthma mortality and morbidity despite advances in treatment
asthma paradox
What do anticholinergic (parasympatholytic) drugs do?
Block cholinergic induced bronchoconstriction
A ____ blocking agent is only effective if bronchoconstriction exists due to cholinergic activity
cholinergic
Anticholinergic agents are approved for ____ only
COPD
Anticholinergic agents may be used for ____ in addition to beta agonists, but only if the patient does not respond well to beta agonist therapy
asthma
What are the 4 specific anticholinergic agents?
a. atropine
b. atrovent
c. advair
d. spiriva
The physiology of anticholinergics is that they are ____ bronchodilators
indirect
These anticholinergic agents are ____ with albuterol
synergistic
Are tertiary or quaternary compounds better and why?
Quaternary because they do not cross the blood brain barrier
___ is a tertiary compound and ____ and ____ are quaternary compounds
Atropine; atrovent and spiriva
The mode of action of anticholinergics depends upon the degree of ____ to be blocked
tone
Bronchoconstriction in ____ may be due in part by vagally mediated reflex innervation of airway smooth muscle
COPD
When C-fibers are activated, they produced an ____ nerve impulse to the CNS which results in an ____ impulse to cause constriction of muscle, mucus secretion and cough (protection)
afferent; efferent
Anticholinergic agents work on __ receptors which causes bronchoconstriction and secretions
M3
____ comes as both an MDI (18Mg/2puffs) and SVN (0.5mg, 0.02%)
Atrovent
____ comes as a DPI (18Mg/inhalation)
Spiriva
___ and ____ both block M1, M2 and M3, but ____ works longer because it stays in the receptor site longer
Atrovent and spiriva; spiriva
What patients should you be cautious of using anticholinergic agents with?
a. prostatic hypertrophy patients
b. urinary retention patients
c. glaucoma patients
____ has a SLOWER onset, SLOWER peak, LONGER duration, and is located in the large central airways?
Anticholinergic
____ has FASTER onset, FASTER peak, SHORTER duration, has tremors, a fall in O2, tolerance and is located in the central, peripheral airways
Beta agonist
____ are used in the management of COPD and asthma as well as prematurity and apnea
Methylxanthines
What are some naturally occurring xanthine agents?
a. Coffee and cola
b. Tea leaves
c. Cocoa
What are some synthetic xanthine agents?
a. Oxiphylline
b. Aminophylline
c. Dyphylline
What forms is theophylline available in?
rectal, IV, and sustained release tablet
What are the three main general pharmacologic properties associated with xanthines?
a. CNS stimulation
b. Cardiac stimulation
c. Peripheral and coronary vasodilation
What is the mode of action of xanthines?
Inhibition of phosphodiesterase
How do you determine the dosage of xanthines?
Depends on the patient because everyone metabolizes it differently
Xanthines are metabolized in the liver and eliminated by the kidneys, which affects their ____
Activity
What is the general dosage range for xanthines and what is the therapeutic range?
10-20 Mg/mL for both
Xanthines ___ the diaphragm and ___ the drive to breathe
strengthen; increase
____ is the pure version while ____ is the IV version that allows it to stay in suspension in the IV bag
Theophylline; aminophylline
Below ___ the dosage of theophylline does not even work
5
Xanthines are really ___ bronchodilators
weak
What are some of the diseases that increase mucus?
a. cystic fibrosis
b. bronchiectasis
c. chronic/acute bronchitis
d. pneumonia
e. asthma
The purpose of administering a ____ is to decrease infection/inflammation and also the removal of irritants
mucolytic
Where is mucus produced?
submucosa
What factors affect mucociliary transport?
a. COPD
b. airway trauma
c. narcotics
d. cigarette smoke
____ is specialized epithelial cells which rest on the basement membrane
Mucosa
What is the top layer and traps debris?
Gel
Mucus is made up of ___ water and ___ protein
95%; 3%
When you ____ viscosity, you ___ elasticity
reduce; reduce
What is the mode of action of mucomyst?
Disulfide bond breaker
Bland aerosols ____ the mucus molecule directly
do not affect
____ are the most common delivery method to the respiratory tract
Aerosols
____ is when fluid is instilled directly into the respiratory tract
Direct instillation
What are the examples of bland aerosols?
a. normal saline or sterile water
b. hypertonic saline
c. hypotonic saline
Which bland aerosol therapy is used to produce a cough and sputum?
hypertonic
_____ is used for thick, viscous (uninfected) mucus and ____ is used for thick, purulent (infected) mucus
Mucomyst; pulmozyme
What is the dosage of mucomyst?
10-20% of 3-5 mL QID
What mucolytic would you use with cystic fibrosis?
Pulmozyme
____ is a proteolytic enzyme that breaks down the DNA material and therefore decreases the viscosity of the mucus
Pulmozyme
Pulmozyme is available in _____, is administered once per day and should be refrigerated and kept away from light
single dose ampules
What is used to treat alveolar pulmonary edema?
Ethyl alcohol
When a person cannot cough, you could try administering an ____ to directly stimulate a cough and mucus production
expectorant
What are the three indications for surfactant?
a. prophylactic treatment for low birth weight infants
b. prophylactic treatment for premature infants
c. rescue treatment for infants who have developed RDS
How are surfactants administered?
Instilled down the ET tube and the baby is swirled around
Surfactants are given as both ____ and ___ treatments
Prophylactic; rescue
What are the three types of exogenous surfactant preparations?
a. natural
b. synthetic
c. synthetic/natural
____ and ____ are both bovine surfactants while ____ is a porcine surfactant
Berfactant and calfactant; porfactant alfa
What is the mode of action of surfactant?
Replace and replenish a deficient endogenous surfactant pool in neonatal RDS
What are the hazards and complications of surfactant?
Airway occlusion, desaturation or bradycardia
What are the indications for administering corticosteroids?
a. step 2 asthma
b. COPD
c. management of seasonal, perennial allergic and non perennial rhinitis
The two types of asthma are ___ and ___
allergic; non allergic
The ____ phase of the inflammatory response creates local vasodilation and increased vascular permeability
early
The ____ phase of the inflammatory response develops ___ hours after administration and is much more difficult to resolve. As a result ____ and ___ are released and ___ occurs
late; 6-8; leukotrines, prostaglandins; mucus plugging
When are your cortisol levels highest?
Morning around 8am
The triple response of the inflammatory response consists of the _____, _____ and ____ phases
redness, flare and wheal
What is the most common side effect of inhaled steroid therapy?
Oral thrush
What are the three types of nonsteroidal antiasthma agents?
a. cromolyn sodium
b. anti-leukotrines
c. monoclonal antibodies
What is the general clinical indication of nonsteroidal antiasthma agents?
Prophylactic management of mild persistent (step 2) asthma
____ are short acting inhaled B2, systemic steroids (IV) and inhaled anticholinergic
relievers
What are the two most important facts when it comes to cromolyn?
a. prophylactic only
b. not a bronchodilator – may cause bronchoconstriction
Cromolyn ____ mast cell degranulation
inhibits
Antiinfective agents are given by ____ and _____
inhalation ;aerosolization
____, ____ and ____ are all commonly inhaled antiinfective agents
Pentamidine, ribavirin, and tobramycin
Aerosolized pentamidine is SVN fitted with a series of one-way valves and an ____ filter
expiratory
The mode of action for pentamidine is to ____ RNA and DNA synthesis, ____ oxidative phosphorylation and ____ with folate transformation
block; inhibit; interfere
Pentamidine is given in a 300 mg SVN once every ____
4 weeks
Ribavirin is active against____, ____ and ____
RSV, influenza and herpes simplex virus
____ comes in a 20mg/mL solution and is given 12-18 hours a day for a minimum of ___ days and a maximum of ___ days
Ribavirin; 3; 7
What is the clinical used of inhaled tobramycin?
Pulmonary infections such as CF
Tobramycin is given ___ consecutively with 28 days off following in a 300mg 5 mL ampoule
28 days
Tobramycin binds irreversibly to the 30S subunit of bacterial _____
ribosomes
