(FINALS) UNIT 4: MEDICATION MANAGEMENT Flashcards
page 1-3: hanggang cardio
refers to the site, area of administration and application of medication to the body
2 types
routes of administration
enteral and parenteral
- refers to anything involving the alimentary tract, from the mouth to the rectum
- medication is absorbed into the bloodstream and metabolized by the liver
- may include routes such as ‘oral, buccal, sublingual, Anaso-gastric and rectal
enteral
- literally means to avoid the gastrointestinal tract and refers to any route of administration outside of or beside the alimentary tract
- Injectable drugs that enter the body directly and are not required to be absorbed in the gastrointestinal tract before they show their effect
- Injectable drugs are usually in the form of ______ or ______, which are mixed with a sterile diluent to render an injectable solution.
Advantage:
1. More rapid onset of action (show their effects more quickly) than other routes of administration
Disadvantages:
1. Not a convenient route
2. Once administered the injected drug cannot be retrieved
- solutions or powders
PARENTERAL ROA
- intraarterial
- intrathecal
- intraspinal
- epidural
- intradermal (ID)
- intravenous (IV)
- subcutaneous (SC or subq)
- intramuscular (IM)
- intra-articular
- intrasynovial
- intraocular
- intracardiac
other ROA
- Topical
- local effect
- systemic effect - Inhalation
- vaporization
- gas inhalation
- nebulization - Vaginal drug
- Intraurethral
Frequently used parenteral route
intraarterial
Injected into the space surrounding the spinal cord
intrathecal
Directing to a fluid in the spinal column
intraspinal
Injected into the dura matter (epidural space) of the spinal cord
epidural
- Injected into the top layer of the skin at a slight angle
- This is exclusive for diagnostic agents.
intradermal (ID)
- Injected into the vein which allows for rapid adsorption
- Includes IV push, IV piggyback and IV infusion
intravenous (IV)
- Injected into the fatty layer under the skin
- Absorption is rapid
subcutaneous (SC or subq)
- If the drug is in aqueous (water) solution, absorption is rapid.
- However, if the drug is in an oily liquid or in the form of a suspension, it can prolong the release of the drug.
intramuscular (IM)
Injected into the joint
intra-articular
Injected in between the joint (synovial fluid)
intrasynovial
intraocular
for eyes
intracardiac
for heart
are applied to a surface area of the body
_________: drug will relieve itching, burning, or other skin conditions without being absorbed into the bloodstream
_________: drug is absorbed through the skin into the bloodstream
TOPICAL (dermal, ophthalmic, otic)
- local effect
- systemic effect
- a means of introducing medications through the respiratory system in the form of a gas, vapor, or powder
________: process by which a drug is changed from a liquid or solid to a gas or vapor by the use of heat
________: almost entirely restricted to anesthesia
________: process by which a drug is converted into a fine spray by the use of compressed gas
inhalation
a. vaporization
b. gas inhalation
c. nebulization
inserted to produce a local effect
vaginal drugs
- most common to males
- administered right after urination (to lubricate)
- semi-pellet; suppositories
SE: priaprism, (prolonged painful effect), hypotension, dizziness
intraurethral
drug categories and classifications
A. LEGAL CLASSIFICATIONS
B. PREGNANCY RISK CATEGORIES
C. LACTATION SAFETY CATEGORIES
D. SCHEDULES OF CONTROLLED SUBSTANCES
- samples are based on Section 2 Annex A - Philippine Schedules of Dangerous Drugs by PDEA
E. THERAPEUTIC CATEGORY
- pharmacological vs pharmaceutical
- acute vs chronic
A drug may be classified by the chemical type/structure of the active ingredient, by the _____________ (the specific way in which the body responds to ta drug) or by the _____________ (the specific biochemical reaction that occurs when you take the drug).
Each drug can be classified into one or more drug classes.
- physiologic effect
- mechanism of action
LEGAL CLASSIFICATIONS
- OTC medications
- Prescription drugs (ethical drugs)
- pharmacist-only medication
- a new legal classification of drug introduced in RA 10918
- medications which may be considered as OTC but may only be dispensed by a registered pharmacist
pharmacist-only medications
- paracetamol (hepatotoxicity - liver disease)
- antihistamines
- antitussive
- Adequate and well controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy.
- Studies indicate NO risk to the human fetus.
CATEGORY A
- vitamins
- saline nasal spray (salinase)
- Studies indicate no risk to animal fetus
- information in humans is not available
- Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well controlled studies in pregnant women.
safe din for PW (amibiasis)
CATEGORY B
- acetaminophen, amoxicillin
- clindamycin, ibuprofen, metronidazole, penicillin, lamotrigine, leviteracitam
[paracetamol can be taken]
- Adverse effects reported in animal fetus
- information in humans is not available
- Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
benefit outweighs risks
CATEGORY C
- fluoroquinolones, gentamicin, saccharin, aspirin
- aspirin, ethosuximide, gabapentin, gentamycin, felbamate, fluorokinose
- Possible fetal risk in humans reported, however, considering potential benefit vs risk may, in selected cases, warrant the use of these drugs in pregnant women.
- There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of drugs in pregnant women despite potential risks.
CATEGORY D
- phenytoin, valproic acid
- ace inhibitors, antineoplastics, carbamezepine, fosphenitoin, phenobarbitals, tetracyclines
- Fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and/or human studies
- should NOT be used by pregnant women
- Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of drugs in pregnant women clearly outweigh potential benefits.
- contraindicated to pregnant women
CATEGORY X
- thalidomide, -statins, contraceptives
- ergotamine, isotetrinoin, OCPs (oral contraceptives),
hypercholesterolemia
phocomelia
severe acne
hair thinning
- Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant.
- Controlled studies in breastfeeding women fail to demonstrate a risk to the Infant and the possibility of harm to the breastfeeding infant is remote: or the product is not orally bioavailable in an infant.
L1 - SAFEST
- paracetamol
- vitamins
- Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant.
- Evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
L2 - SAFER
- carbamazepine
- haloperidol
- olanzapine
- tricyclics
- valproic acid
- There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible;
- or, controlled studies show only minimal non-threatening adverse effects.
- Drugs should be given only if the potential benefit justifies the potential risk to the infant.
L3 - MODERATELY SAFE
- alprazolam
- chlordiazepoxide
- clonazepam
- clorazepate
- positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant
- e.g. if the drug is needed in a life- threatening situation of for a serious disease for which safer drugs cannot be used or are ineffective)
L4 - POSSIBLE HAZARDOUS
- lithium
- loxapine
- quetiapine
- thioridazine
- Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant.
- Risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding.
- Drug is contraindicated in women who are breastfeeding an infant.
L5 - CONTRAINDICATED
[high risk to lactating babies]
- doxepin
- drug has a high potential for abuse.
- has NO currently accepted medical use in treatment in the United States
- lack of accepted safety for Use of the drug under medical supervision.
- all research related are the under US law
SCHEDULE 1
NARCOTICS
- Heroin and many non-marketed synthetic narcotics
HALLUCINOGENS
- LSD, MDA, STP, DMT, DET, mescaline, peyote
- Marijuana
- Methaqualone
- Flunitrazepam (Rohypnol)
- drug has a high potential for abuse
- drug HAS a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions
- Abuse of the drug may lead to severe psychological or physical dependence.
SCHEDULE 2
OPIODS
- Opium and opium alkaloids
- Derived phenanthrene alkaloids such as codeine, morphine
- Designated synthetic drugs: meperidine, methadone, levorphanol, fentanyl, alfentanil
STIMULANTS:
- Coca leaves and cocaine
- Amphetamine, Dextroamphetamine, Methamphetamine
- Methylphenidate
CANNABINOIDS: Nabilone
DEPRESSANTS: Amobarbital, Pentobarbital, Secobarbital
- drug has a potential for abuse less than the drugs in schedules I and II
- has a currently accepted medical use in treatment in the United States
Abuse of the drug may lead to moderate or low physical dependence or high psychological dependence
SCHEDULE 3
OPIODS:
- Buprenorphine
- Mixture of Buprenorphine and Naloxone (Suboxone)
STIMULANTS: Benzphetamine, Phendimetrazine
DEPRESSANTS: Schedule Il barbiturates in mixtures with noncontrolled drugs or in suppository dosage form such as Butabarbital, Ketamine
CANNABINOIDS: Dronabinol
ANABOLIC STEROIDS: Fluoxymesterone, Methyltestosterone, Oxymetholone
- drug has a low potential for abuse relative to the drugs in schedule Ill.
- has a currently accepted medical use in treatment in the United States
Abuse of the drug may lead to limited physical dependence or psychological dependence relative to the drugs in schedule III
- Prescription must be rewritten after 6 months or five refills; differs from Schedule Ill in penalties for Illegal possession
SCHEDULE 4
OPIODS: Butorphanol
STIMULANTS: Ammodafinil and Phentermine
DEPRESSANTS: (Benzodiazepines):
- Alprazolam (Xanax), Midazolam
- Clonazepam, Diazepam (Valium), Flurazepam, Lorazepam
- Chloral hydrate
- Meprobamate
- drug has a low potential for abuse relative to the drugs in schedule IV
- drug has a currently accepted medical use in treatment in the United States
- Abuse of the drug may lead to limited physical dependence or psychological dependence relative to the drugs in schedule IV.
SCHEDULE 5
CODEINE: 200 mg/100 mL
DIFENOXIN PREPARATIONS: 0.5 mg + 25 mcg atropine
DIHYDROCODEINE PREPARATIONS: 10 mg/100 mL
E. THERAPEUTIC CATEGORY
__________: how drug exert action in body (mechanism)
__________: use of substance in formulation
__________: severe/sudden; treatable (caused by virus, injury)
__________: long, developing syndrome
- pharmacological
- pharmaceutical
- acute
- chronic
chemical substances produced by living organisms that destroy or slow down growth of microorganisms
ANTIMICROBIALS OR ANTI-INFECTIVES
- antiseptic vs disinfectant
- antibacterials
- anti-mycobacterials
- antifungal
- antiviral
- antiparasitics
+ antiprotozoal
+ anthelmintics
_______: living; skin
_______: non-living: surgical equipments
- antiseptic
- disinfectants
Used to kill or inhibit growth of bacteria in infections such as syphilis, gonorrhea, sepsis and typhoid fever
ANTIBACTERIALS
Specific drugs in the management of tuberculosis
ANTI-MYCOBACTERIALS
“RIPES”
- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol
- Steptomycin
Used to kill or inhibit fungal growth in infections such as athlete’s foot and yeast infection
ANTIFUNGAL
- Amphotericin
- Ketoconazole
- Flucytosine
- Grieofulvin
- Nystatin
- Terbenafine
Used to kill or inhibit viral growth in infections such as influenza, MMR, chicken pox, dengue, hepatitis, rabies, polio
- influenza vaccine
- Measles, Mumps, & Rubella (MMR)
ANTIVIRAL
- Acyclovir
- Ribavirin
- Oseltamivir
- Zidovidine
- Foscarnet
- Amantadine
Used to kill or inhibit protozoal growth in infections such as amoebiasis, giardiasis, leishmaniasis, malaria
ANTIPROTOZOAL
ANTIMALARIALS
- Quinine
- Mefloruine
- Primaquine
- Atovaquone
AMOEBICIDES
- Metronidazole
- Emetine
- Diloxanide
ANTILEISHMANIALS
- Sodium stibogluconate
MISCELLANEOUS DRUGS:
- Pyrimethamine
Used to kill or inhibit worm infestation and growth in infections such as ascariasis, filariasis, schistosomiasis
ANTHELMINTICS
- Mebendazole
- Praziquantel
- Ivermectin
MUSCULOSKELETAL AGENTS
- anti-inflammatory
- anti-rheumatic
- anti-gout
- antispasmodic
Used to manage pain and alleviate signs of inflammation
ANTI-INFLAMMATORY
- ibuprofen
- naproxen
- aspirin
___________: form of arthritis that causes pain, swelling, stiffness and loss of function in your joints.
- can affect any joint but is common in the wrist and fingers
- an autoimmune disease, which means the arthritis results from your immune system attacking your body’s own tissues
- Rheumatoid arthritis (RA)
ANTI-RHEUMATIC
- Azathioprine
- cyclosporine
- hydroxychloroquine
- methotrexate
- cyclophosphamide
- ## infliximab
_______: kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation
- The use of ______ such as ibuprofen, naproxen, or indomethacin may be used as soon as your symptoms begin.
- ________ helps reduce pain, swelling, and inflammation.
- Corticosteroids can also be very effective.
- Gout
- NSAIDs
- Colchicine
ANTI-GOUT
- Colchicine (acute)
- allopurinol, febuxostat, probenecid, sulfinpyrazone (chronic)
- NSAIDS except Salicylates and Tolmetin
- Glucocorticoids (for symptomatic gout)
- Hypourecemics: Allopurinol
- treat symptoms such as pain and spasm in irritable bowel syndrome (IBS)
- may include spasm (colic), bloating and tummy (abdominal) pain
- used to reduce the movement (motility) of the gut (intestines).
ANTISPASMODIC
- Belladonna
- Chlordiazepoxide
- Dicyclomine
- Hysoscyamine (HNBB: Hyoscine-N-Butylbromide)
CARDIOVASCULAR AGENTS
- anti-hypertensive
- anti-arrhythmia
- antianginal
- dyslipidemic
- anticoagulant
- antiplatelet
- thrombolytic
- Hemostatics
__________ or ___________ is a condition where the arteries have persistently elevated blood pressure
__________: seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.
- Hypertension (HTN) or high blood pressure
- Antihypertensive therapy
ANTI-HYPERTENSION
- ace inhibitors
- diuretics
- Ca channel blockers
- fiazides
- angiotensine-2-receptor blocker
- vasodilator
- betablockers
- alphablockers
- Used to help treat abnormal heart rhythms and restore to normal rhythm and conduction
ANTI-ARRYTHMIA
- Class I: Procainamide (1A), Mexilitine (1B), Propafenone (1C)
- Class II: Beta blockers (-olol): Propranolol
- Class III: Amiodarone, Bretylium, Dofetilide
- Class IV: Calcium channel blockers: Diltiazem, Verapamil
___________: chest pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries.
- act by increasing coronary blood flow and oxygen supply, or by preventing vasospasm and clot formation
- Angina Pectoris
ANTIANGINAL
- clonidine
Drugs that lower the lipid content in blood
DYSLIPIDEMIC
- clopidogrel
- statins
- fibrates
- atorvastatin
- colestipol
- cholestyramine
- nicotinic acid
Agents that reduce the ability of the blood to clot
ANTICOAGULANTS
- apixaban
- warfarin
Decrease platelet aggregation and inhibit thrombus formation
ANTIPLATELET
- aspirin
- clopidogrel
Drugs that are used to dissolve clots in thrombolysis
THROMBOLYTIC
- retavase
- streptase
- eminase
Agents that arrest bleeding or hemorrhage
HEMOSTATICS
- vasoconstrictors
