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PAS 532 Practical Therapeutics 1 > introduction > Flashcards

introduction Flashcards

1
Q

pharmacology

A

study of how drugs act on the body and how the body responds to the drugs-includes actions, mechanisms, uses and adverse effects of drugs

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2
Q

pharmokinetics

A

absorption, distribution, metabolism, and excretion

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3
Q

mechanism of action

A

the detailed interaction with a specific site in the body to describe how a drug produces an affect in the body

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4
Q

pharmacodynamics

A

the body’s physiologic response to a drugr

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5
Q

absorption

A

movement of a drug from its site of administration into the blood-enteral (oral/GI tract) and parenteral (injection) or other routes

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6
Q

distribution

A

drug movement from the blood to the interstitial space of tissues and from there into cells

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7
Q

distribution is impacted by

A

blood flow, ability of drug to exit vascular system, and ability of drug to be absorbed by cells

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8
Q

volume of distribution

A

proportion constant that estimates the total amount of drug in the body to the plasma concentration at any given time
VD=amount of drug in body/plasma concentration of drug

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9
Q

drugs with high VD have greater

A

extravascular concentrations

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10
Q

metabolism

A

break down by liver enzymes or other enzymatic processes; metabolites may be the active drug or can be harmful if built up in the body

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11
Q

excretion

A

primarily refers to renal excretion, but can be fecal, breast milk, sweat, or other means for the drug of active drug metabolites to exit the body

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12
Q

intravenous (IV) absorption pattern

A

instantaneous

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13
Q

intravenous (IV) advantages

A

rapid onset –> ideal for emergencies
precise control over drug levels
permits use of large fluid volumes
permits use of irritant drugs

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14
Q

intravenous (IV) disadvantages

A

irreversible
expensive
inconvenient
difficult to do–>not suitable for self-administration
risk of fluid overload, infection, embolism
drug must be water soluble

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15
Q

intramuscular (IM) barriers to absorption

A

capillary wall-easy to pass

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16
Q

intravenous (IV) barriers to absorption

A

none

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17
Q

intramuscular (IM) absorption pattern

A

rapid with water-soluble drugs

slow with poorly soluble drugs

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18
Q

intramuscular (IM) advantages

A

permits use of poorly soluble drugs

permits use of depot preparations

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19
Q

intramuscular (IM) disadvantages

A

possible discomfort
inconvenient
potential for injury

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20
Q

subcutaneous (subQ) barriers to absorption

A

capillary wall-easy to pass

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21
Q

subcutaneous (subQ) absorption pattern

A

rapid with water-soluble drugs

slow with poorly soluble drugs

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22
Q

subcutaneous (subQ) advantages

A

permits use of poorly soluble drugs

permits use of depot preparations

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23
Q

subcutaneous (subQ) disadvantages

A

possible discomfort
inconvenient
potential for injury

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24
Q

oral (PO) barriers to absorption

A

epithelial lining of GI tract

capillary wall

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25
Q

oral (PO) absorption pattern

A

slow and variable

26
Q

Oral (PO) advantages

A 
easy
convenient
inexpensive
ideal for self-medication
potentially reversible-->safer than parenteral routes
27
Q

oral (PO) disadvantages

A

variability
possible nausea/vomiting from local irritation
patient must be conscious and cooperative
inactivation of some drugs by gastric acid/digestive enzymes

28
Q

most metabolism takes place in the

A

liver

29
Q

most metabolism is performed by

A

a group of enzymes called cytochrome P450 system or CYP P450

30
Q

cytochrome P450 System (CYP P450)

A

a group of 12 closely related enzyme families

each family is further designated to identify key individual enzymes

31
Q

what are the 3 CYP families responsible for metabolizing drugs?

A

CYP1, CYP2, CYP3

32
Q

metabolism can result in

A

metabolism can result in

33
Q

first-pass effect

A

rapid hepatic inactivation of certain drugs upon oral absorption and “first pass” through the liver

34
Q

half-life

A

the amount of time it takes for 50% of the drug to be eliminated (renally, liver metabolism, or other forms of excretion-often a combination)

35
Q

the 3 big characteristics of the ideal drug

A

effective
safe-often can be a risk vs. benefit discussion
selectivity-limited side effects/ADRs/ADEs

36
Q

additional desirable properties of the ideal drug

A 
reversible action
predictability
ease of administration
limited drug interactions
low cost
reasonable chemical stability
37
Q

agonist

A

stimulates a particular receptor

38
Q

antagonist

A

blocks a particular receptor

39
Q

competitive inhibition

A

the antagonist must have a stronger affinity for the receptor than the agonist

40
Q

non-competitive inhibition

A

irreversibly binds

41
Q

partial agonist

A

only partially activates the receptor-prevents a ceiling effect

42
Q

enzyme inhibitor

A

blocks a particular enzyme crucial in a biologic pathway

43
Q

dose-response relationship determines

A

minimum amount of drug to elicit a response
maximum response that can be elicited
dosage to produce desired increase in response

44
Q

maximal efficacy

A

maximum response a drug can elicit

45
Q

potency

A

the amount of drug we must give to elicit a response

46
Q

drug interactions

A

occur when two or more drugs change the therapeutic effect (increase or decrease) OR lead to adverse events

can be a result of multiple drugs that treat the same condition or treating multiple conditions with different drug classes

at times is due to changes in hepatic enzyme activity

47
Q

CYP 3A4 inducers cause CYP 3A4 enzymes to

A

metabolize more than usual–>decreases therapeutic effect

48
Q

CYP 3A4 inhibitors cause CYP 3A4 enzymes to

A

metabolize less than usual–>increases risk of side effects and increases therapeutic effect, at times to toxicity

49
Q

minimizing drug interactions

A

limit the number of drugs a patient is on
obtain a thorough medication history
tailoring specific drug therapy to reduce adverse interactions

50
Q

tailoring specific drug therapy to reduce adverse interactions

A

adjust doses in the presence of inducers/inhibitors

adjust timing of administration to minimize interference with absorption

monitoring more closely in additive or known agents that have drug interactions

extra caution when a patient is on a drug with a known narrow therapeutic range

51
Q

grapefruit juice

A

CYP 3A4 inhibitor-increases blood level of drugs

52
Q

adverse drug reactions

A

any noxious, unintended, and undesired effect that occurs at normal drug doses

53
Q

allergic reaction/anaphylaxis

A

more common with some classes of agents-all drugs have a listed ‘contraindication for those allergic to agent or agents similar in structure’

54
Q

other common ADRs

A 
idiosyncratic
carcinogenic
teratogenic (birth defect inducing)
hepatotoxic
nephrotoxic
QT interval prolonging drugs
55
Q

idiosyncratic ADR

A

uncommon drug response resulting from genetic predisposition

56
Q

medication guides

A

FDA approved patient education documents with information on how to minimize harm from potentially dangerous drugs-required for certain drugs (including sample dispensing)

57
Q

US boxed warnings

A

strongest safety warning a drug can carry and still remain on the market-vitally important to adhere to and understand

58
Q

Risk Evaluation and Mitigation Strategies (REMS)

A

a plan or program to minimize drug induced harm

59
Q

practical therapeutics

A

the treatments used to treat or prevent a particular disease

combination of pharmacology, pharmacokinetics, pharmacodynamics, DDIs, ADRs, and individual variation in addition to the clinical literature and the expert clinical guidelines

60
Q

last-line agents are reserved for patients with specific criteria

A

significant ADRs, multiple treatment failures, or other extenuating circumstances

PAS 532 Practical Therapeutics 1 (4 decks)

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