FOCUS ?'s Flashcards
What served an important purpose in early pharmacy?
Our instinct to survive
What was the early evidence of drug use?
Cool water alleviated pain
Leaves from plants treat infected skin areas
Mud to close and heal wounds
What was the trial and error approach that shaped early pharmacy?
Drug therapy
Why did people become sick in early history?
Evil spirits
What treated sickness in early history?*
- compassion of a god
- observance of ceremonies
- absence of evil spirits
- healing intent of the dispenser (bribe if you want to be healed properly)
What were the failures and successes of the tribal apothecaries?
Failures: inactive agents, underdosing, overdosing, poisoning
Successes: coincidence, inconsequential effect of drug, placebo effect
Who discovered biological acids?*
Karl Wilhelm Scheele
Who isolated morphine from opium?*
Friedrich Serturner
What did Joseph Caventou and Joseph Pelletier do?*
Combined their talents to isolate drugs from tree bark
Why were the USP and NF created? What are they?*
Need for uniform standards to ensure quality
They are organized sets of monographs or books of standards (written in high degree of clarity and specificity)
*What are the two major goals of pharmaceutical care for pharmacists?
prevent related morbidity (drug induced disease)
prevent drug related mortality (drug induced death)
What are some factors necessary for being successful at pharmaceutical care?*
- current knowledge on drugs and drug therapy
- good information skills
- good communication skills
- caring
- socio- economics (business contacts and health)
- * health related quality of life most important
What was the goal of the food and drug act of 1906?
Drugs must comply with standards for strength, purity, and quality
What did the Sherley amendment say?*
No more false claims
Declared products misbranded
(1912 manufacturers claims of therapeutic benefit)
What caused the federal food, drug and cosmetic act of 1938 to come about? What did the act provide?*
Sulfanilamide tragedy
Required drugs be tested for SAFETY, required tests to be submitted to the gov’t via NDA, mandated drugs be labeled with adequate directions, authorized FDA to conduct unannounced inspections
*Who played a key role in the thalidomide tragedy in the U.S.??
Dr. Frances Kelsey - recognized drug was acting differently in people than animals
*What act did the thalidomide tragedy result in?
What did the act do?
Kefauver Harris Amendments of 1962 which required drug needed to be safe AND efficacious before approval
Drugs from 1906- 1938 grandfathered in
What did the Durham Humphrey act do?
No refills w/o valid prescription
OTC vs prescription
Refilling necessary only if authorized in prescription
The comprehensive drug abuse prevention and control act of 1970 further supported the Durham Humphrey act by doing what?
Establishing 5 schedules for drug classification for those that were more likely to be abused
Differentiate between schedules I - IV
I - high potential (marijauna)
II - high potential (codeine, oxycodone, fentanyl)
III - moderate potential (vicodin, suboxone)
IV - low potential (diazepam, clonazepam)
V - low potential (phenergan with codeine)
*What are the pregnancy categories? Worst to best?
Category A: studies failed to demonstrate risk to fetus
Category B
Category C
Category D
Category X: animal studies of humans demonstrated fetal abnormalities - serious risk
*What are black box warnings?
FDAs strongest labeling requirements used for high risk meds.
- stresses importance of close patient monitoring, no reminder ads allowed
*What did the drug listing act of 1972 create? What are the components?
The NDC - permanent registration code to identify manufacturer or distributor. (10-11 digits)
The first 4 digits are the labeler code (identify manufacturer or distributor)
The next 3-4 digits are the product code (identify drug formulation)
The last 3-2 are the package code (size and type)
what did the drug price competition and patent terms restoration act say?
any originally approved new drug can be filed through ANDA, bypassing animal and human study testing
Speed up time to market generics
- What did the 1987 prescription drug marketing act do?
Dingell bill
- prohibit reimportation of drugs, prohibit sales, trading and purchasing of drugs
- Protect supply of prescription agents and prevent repackaged and mislabeled drugs from entering market
*Dietary supplement health and education of 1994 said what?
The dietary supplement labels needed to say “This product is not intended to diagnose, treat, cure or prevent any disease”
body function influences were ok
What did FDAMA do? (FDA modernization act)
- expand patient’s access to investigational treatment for serious life - threatening diseases
- accelerate approval of new drugs
- pediatric use of investigational drugs now made possible
*What are the classes of drug product recall?
Class I: exposure will cause serious adverse health consequences, or even death
Class II: exposure will cause temporary or medically reversible adverse health consequences
Class III: exposure not likely to result in adverse health effects
Why was the synthesis of antipyrene important?
It was done in a test tube which changed the way drugs were made from this point forward.
*What did Alexander Flemming do?
Discover penicillin
*What did James- Watson Crick do?
Solve DNA structure
Where did the following come from? What is the issue with plant poisons? Morphine Quinine Digitalis Belladonna
Batch to batch consistency is a problem with plants. Morphine - opium poppy Quinine - cinchona bark Digitalis - foxglove Belladonna - deadly night shade
What does vinca rosea treat?
Melanoma
What tree is involved with creating 3/4 of treatment for a cancer patient?
Pacific yew (taxus brevifolia)
*Who performs services involved with drug discovery?
Chemists
Pharmacologists
Toxicologists
Formulation developers (pharmaceuticals)
What is the purpose of drug development? Who usually does it and where?
Drug development is used to provide superior dosage forms and a way of delivering effective drugs throughout the body.
Mostly done by scientists with a phD at a pharmaceutical company or school of pharmacy
What are the properties investigated in early formulation studies?
Drug solubility, partition coefficient, dissolution rate, physical form, stability
*Drug solubility
less than 10mg/ml is considered poorly soluble
- Partition coefficient
preference for lipid vs. aqueous phase
*Dissolution rate
speed at which a drug substance dissolves in a medium (at physiological temperatures)
*Physical form
crystal vs amorphous vs powder will alter rate and extent of absorption
*Stability
retention of drug substances within dosage forms
What are characteristics of the “goal drug”?
Can produce a desired effect
Can be administered @ the most desirable route (orally)
Can be administered @ minimal dosage and frequency
After exerting necessary effect should be eliminated from the body efficiently and w/o negative side effects
What is a “lead compound”?
Compound that is the closes agent to the goal drug possessing the fundamental desired biologic of pharmacologic activity.
*Pharmacology (drug researcher)
Determines biologic activity and mechanism of drug action in vivo and in vitro
*Drug metabolism (drug researcher)
determines the absorption, distribution, metabolism and elimination (ADME)
*Toxicology (drug researcher)
deals with adverse and undesirable effects of the drug
- what is the maximum tolerated dose? lethal dose?
What is the main reason for drug related side effects?
Non specific delivery to intended targets
What is CDER, what does it do?
Center for drug and evaluation research
- assess benefit to risk relationship (is a particular drug safe and effective enough?)
- make drugs available to the public sooner
- provide clear standards for drug evaluation
- high priority drugs (significant advantage over current therapies)
Investigational New Drug Application is used for what?
Once a drug has been developed, before it can be tested in humans it must be filed with the FDA via an IND application
- protects rights and safety of subjects and makes certain the research objectives can be achieved with the investigational plan
*Main purpose was to provide the FDA with sufficient info to make a meaningful eval of a new drug
*What happens in the Phase I clinical trials?
drug should show promise as a useful drug
- What is the safe does in 20-100 patients?
- Usually less than one year
- to determine toxicology, metabolism and pharmacologic actions
- patients tested don’t need to have the disease
What is the application in phase I clinical trials?
The plan for the study, chemical structure, animal testing results, manufacturing info
CTM for phase one studies?
- biopharmaceutical properties
- practical considerations (supply of bulk, time it takes to prepare bulk stock)
Advantages and disadvantages of extemporaneous formulations
What are advantages and disadvantages of extemporaneous formulations?
+ : short development time, minimal drug substance requirements (few hundred grams), minimal formulation development, minimal analytical work
- : unpleasant taste, patient compliance issue, dosing inconvenience for multiple dose studies
*Phase II clinical trials
To determine compound’s effectiveness
- drug tested in ~100-300 people
- patients have the disease
- extensive pharmacologic, toxicologoical and pharmacological testing
- many clinical agents don’t make it to this point
CTM for phase II
- capsules or tablets typically necessary
- generally same form used as in phase I EXCEPT when required dosage strength is not supported, when medium large scale is not feasible
- can introduce a new formulation closer to desired commercial dosage form
- covers a large range dose so # of strengths may be large. - dose range determined by pharmaceutical scientists, pharmacokineticists, and clinical study and clinical supply coordinators
In CTM II what are limitations of high and low dose strengths?
High: dissolution and processability
Low: content uniformity and stability issues
*Phase III Clinical Trials
To demonstrate long-term safety and efficacy of drug product; to discover drug’s efficacy standards
- 1000- 3000 patients in many centers
- carried out over several years
- how good is the drug in treating the disease or condition?
- short term side effects and risks in patients with impaired health?
- used in several randomized, controlled studies in clinical research facilities, veterans administration, university teaching hospitals
CTM for phase III
- stability data needed on at least 3 primary batches of drug products
- stability testing must cover minimum period of 12 months typically @ 25C
- changes in dosage strengths and manufacturability of CTM may be necessary to achieve specific goals
- same formulation, processing and packaging procedures as with commercial product is recommended
How long can the development of a drug take?
up to 15 years, most of the time spent in clinical trials
*Usual adult dose
starting dose for a patient
- Usual dosage range
safety dose range for administering drug product