mod 1 Flashcards
pharmacology
study bio effect drugs on body
pharmacokinetics (4 components)
what happens to drugs in body
pharmadynamics
MOA, effects of body
med names
chemical - longest and used in research typically
generic - official name, always lower cased
ex. acetomedafine
trade- brand name, easier to say, always capitalized
definitions
therapeutic effects - desired effect
side effects- unintended effects, unavoidable, expected
toxicities- harmful effects
adverse effects - unexpected and dangerous reaction
allergic- unexpected, may be dangerous, immune response
what we need to know about meds
name (generic) classication (drug class) MOA common/serious side effects contraindications nursing indications
drug approval
FDA
preclinical - animal testing phase 1- healthy volunteer humans phase 2- volunteers with disease phase 3- vast clinical market, must say side effects phase 4- continued eval by FDA
controlled subs
schedule 1-5
schedule 1 - not approved
schedule 2- narcotics, high potential abuse
sched 3- less pot abuse (non barb sedatives, nonamphetamines, stims
sched 4- some pot abuse (sedatives, anti-anx)
sched 5- low pot abuse - cough surrup
OTC meds
consumers must be able to diagnose own condition and monitor effectiveness easily
dietary supps
can only claim affect on body stucture and function, not med condition
adverse interactions
- can incr toxicity pres med or cause decrease therapeutic effect
teratogens
congental malformatiopns dev fetus
Cat A- safe B- lack studies C- no studies, animal studies risk D- poss risk fetus, dis with OB X- known risk, not outweigh benefits (Isotretinoin, Acutane)
pharmacogenomics
how genes affect response to drug
cellular adaption
changes body cell go through to permit survival and mx cell function
- size/form
atrophy- decrease shrink size
- physiologic- developmental issue (birth)
-pathologic- decrease workload change env conditions - blood supply, hormones
++decreased protein synthesis and/or incre protein catabolism
hypertrophy- incr size and function, mechanical stimuli
- heart and kidneys most prone negative adaptation, hypertension w/ inc BP
hyperplasia- incr # cells from incr rate cell division prolong injury
++ turns into dysplasia
- only cells have ability divide (skin, intestinal, glandular)
- physiologic- pregnancy and wound healing
-pathologic- cancers
dysplasia- abnormal changes of mature cells - atypical hyperplasia
- often with neoplastic growths, but NOT MEAN CANCEROUS - inflammation and chronic irritation
metaplasia- reversible replacement 1 type mature cell to another, can predispose to cancer
neoplasia- abnormal cell growth, gene mutation
anaplasia- cells diff to immature form or embryonic form (cancerous)
neoplasms- tumor
benign- differentiated immarture cells, unable to metastasize, grow slow, encapsulated, not cause severe probs
malignant/cancer - undifferentiated, more anaplastic, rapid growth, metastasize, no capsule
necrosis
irreversible, sweliing, burst cell, inflamation
ischemic necrosis- infarction
can lead to gangrene and breading ground bacteria
liquefactive necrosis- tissue w lots of lipids or number inflammatory cells
gangrene - disruption blood supply with bacteria
dry- blackened, dry, line demarcation
wet- liquefacation, foul, rapid spread, extensive damage, systemic, no line demarcation
gas- destroys connective tissues, gaseous bubbles, found in soil
infection
host take over
localized- spec place
systemic- spread sev regions
causes
common- virus and bacteria
virus- only DNA/RNA must have host cells, covid, aids, flu
bacteria - much larger virus, single-celled, 1 strand DNA, reproduce inside/outside cell - strep, tb, uti
rare fungal - yeast inf protozoa- wet, malaria helminths - hook worm prion- only composed on protein- mad cow
modes transportation
must have reservoir to live and grow - humans, insects, envir direct- kiss, sex, contact, droplet indirect- airborne - vehicle- food, water, blood - Hep A - vector- misquito- malaria
port entry organisms
oro and nasopharynx- airways, lungs, stomach and GI
genitourinary- sex, catheter
skin- biggest barrier and biggest vulnerability if cut or not intact
translocation- move bacteria across intestinal lining
++PEROTINEAL CAVITY, blood stream
blood- transfusion, needle sticks
maternal-fetal trans- cross placenta - zeka virus
stages infection
incubation- first get symptoms prodromal- onset nonspecific symptoms acute- get specific S/S convalescent- S/s get better resolution- pathogen elimination
infectious process
injury- short per vasoconstriction - stop bleeding and invasion orgs, then prolonged VASODILATION- allow blood flow, bring immune cells, ++inflammation- warmth, redness, swelling
incr permeability- fluid pulled out vascular space (blood vessel) and into place injury
immigration leukocytes- neutrophils attack area, also eosinophils, NK cells, monocytes
phagocytosis- leukocytes arrive and eat invaders - neutrophils and monocytes primary
exudate- leaky stuff from phagocytosis - 4 types
systematic symptoms- if not localized - FEVER- good- helps stim def mx to rid body orgs, slow bacteria virulent and divide, improved our immune syste- better neutrophil and macrophage func, improve antibody and T-cell activation
colonization- spec body site- not cause s/s, not sick
infection- cause s/s, have infection
- incr temp, HR, RR
- -labs- culture and urinalysis
cultures-
- gram stain- blood, urine, body fluids, gram - more dangerous++
culture and sensitivity- 24 hrs basic result, 72 id and pattern- says which antibiotic bacteria sensitive to
+++ sputum, urine, blood,
- skin contamination
urine- dipstick- pH 5-98 normal nitrates (normal negative) - bacteria change nitrate into nitrites luekocytes- normal neg blood- (normal <5)
healthcare infections- nosocomial
MRSA- resistant spec drug
CRE- resistant entire class meds
MDRO- multi drug resistant org
superinfection- new infection occurs when treating diff infection- kill helpful flora+++ GI tract
– C Diff- extreme diarrhea, id with PCR, do not put on anti diarrhea meds
tx with Po/iv metronidazole or vancomycin
- candidiasis- skin yeast infection, oral/vaginal, thrust when in mouth
tx with antifungal
inflammation
ends with itis
begins healing process
- detroys invaders, limits spread, prepares damage tissue for repair
S/S
Localized- redness, swelling, heat, pain, loss function
- causes- exogenous (trauma); endogenous (ischemia) ** acute only last 2 weeks
events inflammation
- tissue injury
- vasodilation and vascular permeability
- leukocyte recruitment (chemotaxis with neutrophils)
- phagocytosis antigens
exudates from phagocytosis (leaky fluid) x 4
- serous- watery, low protein mild inflam
- serosanguineous- pink-tinged, small amount RBC
- purulent- severe inflammed w bacteria - abscesses req drainage
- hemmorrhagic- most severe, lots RBC
- -
systemic manifestations infection
driven by cytokines
- fever, incr neutrophils, lethargy, muscle catabolism
specific adaptive immunity
major histocompatibility complex (MHC)
- cluster genes chromosome 6 - human leukocyte antigen complex (name tag)
proteins made by these genese are on cell surface, id as self and are MHC class 1 and II
recognize/destroy foreign invaders
retain memory (adaptive) - WBC
- B cells (humoral) - body fluids
- T-cells (cell mediated)- antigens on cells
MHC- proteins used to see self and non-self
humoral immunity = antibody immunity
B-cells- antibody mediated immunity
- memory cells- remember antigen, puts name tag
- plasma cells- secrete antibodies, bind to antigen
antibodies (immunoglobulins)
5 classes IgG- most common, bacteria and virus IgM- cytotoxic functions, new infections IgA- secretory functions, bodily fluids IgD- stims B cells, B-cell helpers IgE- allergic rx, sig mast cell degranulation
immunity
passive- pass person to person , mother to fetus, injection antibodies
- IgA- breastmilk, IgG- placenta
active- body’s own response through B-cells, active infection, vaccines
titer test confirms immunity
vaccines
traditional- inactive, killed
attenuated- live, weakened form **not give to pregnant, weakened immune, chronic disease ** nasal flu vaccine
toxoids- inactive toxins stimulate production antitoxin *tetanus
conjugate- protein/toxin from one attache to disease-causing org to stim response *H influenza
mRNA- snip of genetic code ** covid vaccines
3 phases drug action
- pharmaceutic (dissolution)
- pharmacokinetic (what body does to drug)
- pharmacodynamic (what drug does to body)
- pharmaceutical- PO drugs only
- disintegration and dissolution - pharmacokinetic 4 processes
- absorption- GI, small intestine
- distribution- blood
- metabolism/biotransformation- liver
- excretion- kidneys
first pass effect
PO drugs only
metabolism of drug before systemic circulation by liver
- bioavailability is amount left after first pass
3 routes absorption
Enteral- PO
- by way of GI
- -enteric coated breaks down small intestine not stomach
- PO breaks down stomach, absorbed small intestine
- SL, buccal, rectal - no first pass, highly vascular tissue
- parenteral- SQ, IM, IV, intrathecal, epidural,
- no first pass and IV fastest - topical (transdermal) - no first pass, slow - eyes skin, ears, nose , lungs
pharmacokinetics - distribution
movement drug through body and to target site ** need adequate blood circulation
- disruptions - decreased blood flow - peripheral vascular disease, abscesses, tumors
blood brain barrier- brain very tight junctions, lipid-soluble only, alcohol, glucose can cross, not fully devel in infants
protein binding effect- temp storage drug allows longer availability
goal- maintain steady free drug/unbound AKA Steady State
**only UNBOUND drug is active and exert effects
- reversible process
**Albumin primary plasma protein and drug binds
hypoalbuminemia- malnutrition, liver disease - incr free drug, overdose and toxicity to drug
pharmacokinetics - 3. metabolism
aka biotransformation
- drug becomes inactivated - metabolite in LIVER
- converts to water-soluble metabolite for kidney excretion
CYP450 - enzyme metabolize drug, used by 1/2 drugs
- substrate- drug uses 450 for metabolism
- inducer- makes drug inactive, reduces amount drug body and therapeutic effect
- inhibitor - slow drug metabolism, incr amount drug body, incr risk toxicity, decrease drug breakdown
- *grapefruit juice known CYP450 inhibitor meaning incr drug amount and lead to loxicity
pharmacokinetics - 4. excretion kidneys
elimination, gen only hydrophilic drug, must be water soluble
- *kidneys through glomerular filtration, tubular secretion, tubular reabsorption
- if drug heavily excreted and not reabsorbed, need frequent drug admin to keep steady state
kidney disfunction - decr kidney = incr drug and toxicity
renal labs - blood urea nitrogen (BUN), creatine
**glomerular filtration rate (GFR)- best measure kidney function - GFR of drugs is related to free drug concentration in plasma
half-life - time required drug decrease by 50%
- takes 5 half lives for 97% elim and varies drug to drug
- take 4-5 half-lives for steady state - control effective state - when intake drug =amount metabolised/excreted
around the clock dosing
goal maintain 50%
used for chronic pain and PRN for breakthrough pain
onset - time takes drug elicit therapeutic effects
peak- time reach max therapeutic effect
duration- time drug conc is sufficient to elicit therapeutic response
phase 3 drug action: pharmacodynamic- what drug does to body
drugs may incr/decr, replace, inhibit, destroy, protect, or irritate to cause response
- exert multiple rather than single response - some desired, some not (side effects)
receptors- proteins on cell surface
- hormones and neurotransmitters interact w drugs to produce effects = drug-receptor complex
agonist- stimulate, initiate desired effect, binds to receptor
antagonist- inhibits/blocks, prevents/blocks nat substances (ligands) from binding to site to cause a response
- receptor-less activation- chem/physical interaction ex- antacid
drugs worrisome
narrow therapeutic index- ratio - controls toxicity
black box warning- keeps drugs on market- package insert, product label, on magazine/advertising
adverse drug reaction
MED ERRORS, 3rd leading cause death prevent errors 1. restrict 2. practice drug differentiation "tall man" 3. use computerized systems 4. make pt info accessible 5. standardize and simplify 6. apply reminders 7. include pt therapy 8. don't use trailing zeros 9. use leading zeros
high alert meds
heparin insulin opiods injectable KCL neuromuscular blocking agents chemotherapy drugs
drug interactions that increase therapeutic effect
- additive - 2 drugs same MOA
- synergism/potentiation- 2 drug diff MOA but result combined effect greater than alone
- displacement- moves 1 drug from protein-binding site to second drug - incr effect of displaced drug
drugs interactions decrease therapeutic effects
- antidote- given to antagonize toxic effect - narcan
- decrease intestinal absorption- PO meds
- activation CYP450 - incr metab rate drug
older adults and pharmacokinetics
hepatic- decrease drug metabolism
GI- decrease absorption PO
cardiac- decrease circulation= decrease distribution
renal- drug excretion less completely
pathophysiology
patho- abnormal
study disease and injury and how affect body
pathology- lab study of cells and tissues
disease
disrupt homeostasis
- homeo- same
- stasis- balance
- physical, mental, social (autism)
maintain equilibrium
feedback control group
causes disease - need susceptible host, conducive environment, and pathogen
intrinsic - genes, immunity, age, gender
extrinsic- bacteria, virus, injury, bx, stressors, fungi
process disease
- ID - S/S
- occurrence- how often and when
- diagnosis- ID
- etiology- cause, what call
- prognosis- likelihood recovery
stages disease
- exposure- where?
- onset
- sudden
- insidious- slow, gradual (chronic)
- latent- dormant
- prodromal- indicates onset
- manifestation- S/S - Remission - not active
- convalescence- recovery
causes/type disease
idiopathic- unknown
latrogenic- caused by tx - MDRO
exacerbation- worsening disease - asthma
terminology
hypo- under hyper- over, above penia- lack of, deficiency cytosis- cells, increase osis- process, condition, production/increase, invasion/infection itis- inflammation path- disease/suffering
cough
acute/chronic allergies smoking meds sputum
systems: heart and lungs
others:
pain (headache), swelling/edema, fever, fatigue, weight loss
