Module 1 Flashcards
Fundamentals
Chemical Name
scientific name, describes atomic, molecular structure
Generic Name
non-proprietary(brand) name. ex:ibuprofen
Trade Name
(brand, proprietary) selected by drug company, copyright protected. ex: Advil
Why/When use of generic name
1962, Federal government mandated used of ONE official name per drug. Listed in United States Pharmacopeia( book list of medicinal drugs w/their effects) and National Formulary
Drug Classes:
Pharmacologic class:
Therapeutic class:
- groups drugs with similar characteristics. Can be used for multiple uses.
Beta-adrenergic blockers(B/P meds)
Benzodiazepines.
-groups drugs by therapeutic use
Anti-hypertensives
Anti-fungals
Drug sources are traditionally from natural sources:
Plants:
Animals:
Minerals:
- alkaloids(contains nitrogen, ex: caffeine, nicotine), glycosides(restore circulation, ex digoxin), gums(seaweed extractions), resins, oils
- hormones (insuline), oils (cod liver oil, enzymes(produced by living organism that acts as a catalyst (speeds up) biochemical reaction)(pepsin), vaccines(microorganisms)
- metallic(lithium), non-metallic(iron, iodine, epsom salts)
Today drugs are created..
synthetically in a laboratory by isolating and intensifying the active component and manipulate molecular structures.
How drug is administered effected by what?
quantity given
absorption rate
distribution in body
Administration Routs:
Oral
Sublingual
Translingual
Buccal
Rectal, vaginal
Inhalation
Topical
Transdermal
- PO patient conscious, can swallow, drugs withstands stomach acids.
- into capillary bed under tongue
- on the tongue(trans is prefix for across, over, beyond)
- placed in pouch between cheek and gums
- PR suppositories, ointments, creams, gels
- gases rapidly absorbed, metered-dose inhaler
- local delivery through skin, mucous membrane (dermatologic, ophthalmic, nasal preparations)
- “patch” applied to skin, drug enters blood through capillaries
Drugs admin routes not destroyed by stomach acids? bypass stomach?
sublingual, buccal, translingual
Administration routes:
Gastric
Intradermal
Intravenous
Intramuscular
Subcutaneous
- goes directly into the GI system, patient can’t ingest orally
- injected into skin (dermis)
- IV rapid onset, injected directly into blood
- IM injected into muscle, drug enters blood through capillaries
- SubQ, SC injected into subcutaneous(deepest skin) tissue, drug enters blood through capillaries
Parenteral
around gastrointestinal tract, involves skin puncture (IV, IM, SubQ)
Who monitors drug development?
FDA Food and Drug Administration
Phases of Drug Development:
First?
Second?
Third? phase 1 phase 2 phase 3 phase 4
Fourth?
- animal studies on safety, effectiveness
- IND( Investigational New Drug) new drug application after animal studies prove safety, effectiveness. yr 4
- human clinical trials
phase 1-tested on healthy volunteers
phase 2-tested on people with specific disease
phase 3- more people, look for adverse effects
phase 4 post-market surveillance, reports from doctors on therapeutic or adverse effects. - NDA (new drug application years later) yr8-9
Invitro studies➡Animal testing➡Clinical testing➡Marketing➡generic available
IND
Treatment Investigational New Drug- expedited approval due to public health threat (AIDS drugs)
Pharmacokinetics deffinition
Study of what happens from time a drug enters the body until it, and all its metabolites, leave the body. The branch of pharmacology concerned with the movement of drugs within the body.
Pharmacokinetics order of operations
Absobtion➡Distribution➡Metabolism➡Excretion➡Onset of action➡Peak concentration level➡Duration of action
Pharmacokinetics- Absorption
- slow
- Fast
- Slowest
Influenced by:
-rate drug leaves site of administration
Slow: oral, IM, SC
Fast: seconds to minutes (sublingual, IV, inhalation)
Slowest: hours to days (rectally, sustained-release)
blood flow, stress, diet, drug formulation, drug to drug interactions
First-Pass Effect
Stomach-intestines-liver via portal circulation-metabolized by liver(first-pass effect)-remains put into systemic circulation. (is a phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation)
Systemic circulation
IV 100% bio-available. The part of the cardiovascular system which carries oxygenated blood away from the heart to the body, and returns deoxygenated blood back to the heart.
Distribution
drug delivery to site of action (body tissues, fluids)
Distribution places and rates depend on?
Blood Flow: faster to heart, liver, kidneys, slower to internal organs, skin, fat, muscle
Solubility: lipid-soluble crosses cell membranes and blood to brain barrier; water-soluble can’t cross cell membranes
Protein binding: bound part therapeutically inactive; free (unbound) portion active (the more free the drug remains from proteins in the blood the more effective it becomes)
Metabolism
When the body changes drugs from dosage form to excretable water-soluble form:
- into inactive metabolites
- into active metabolites with own pharmacologic action
Pro-drugs
when drugs are given in inactive form and become active after they metabolize.
Excretion: Kidneys Lungs Exocrine (excrete)glands Skin Intestinal tract
Drug elimination from body urine exhalation sweat, saliva, milk sweat feces
Half-Life
Steady state:
the length of time it takes for 1/2 of the drugs original dose to be removed from plasma by biological processes. This can help determine dosage frequency
Drug administration by the time drug excretion has begun. drug administration equals drug excretion.
Onset of Action
time interval from drug administration to therapeutic effect
Peak Concentration
absorption rate is equal to elimination rate
Duration of action
length of therapeutic effect
Pharmacodynamics
Drug successfully binds receptor on cell surface ➡message sent to cell nucleus to perform action.
study of mechanism(processes) of drug action of biological system
-Drug forms chemical bond with specific receptor sites on surface of cell
Pharmacodynamics:
Agonist drugs:
Antagonist drugs:
-initiate cell response after binding to a cell receptor. After complete binding, cell responds to message sent to nucleus. ACTIVATION
incomplete binding, BLOCKING to prevent cell responses. no message sent to nucleus from body
Antagonist
Competitive:
Non-competitive
- competes with agonist for receptor site, REVERSABLE binding. prevents the activity of other drugs already in the system. (Naloxone or Narcan is used to reverse opioid overdose caused by Heroin for example)
- binds receptor, blocking agonist binding, IRREVERSABLE binding
Receptors
present on cell surface. different organs, tissues have different types of receptors
Non-Selective drugs
work at multiple receptors➡ widespread effects
Selective drugs
work at specific receptors ➡ specific effect..localized
Potency
Dose-response curve
amount of drug required to produce desired response
ex: if smaller dose of morphine than codeine required to achieve same effect, then morphine is more potent than codeine.
- Graphic representation of dosage and response
Therapeutic index
Small(low)therapeutic index
Large (high) therapeutic index
ratio b/t therapeutic and toxic dose, measure of a drug’s safety
- narrow range b/t safe and lethal dosage (warfarin). dosage is critically important
- wide margin of safety, low risk of toxic effect (penicillin)
Therapeutic window
dosage range b/t minimum effective and minimum toxic dose
Pharmacotherapeutics
Tolerance
Dependence
- physical
- psychological
use of drugs to treat disease. reasoning.
-decreased response to repetitive drug doses
- physical or psychological need for drug, withdrawal symptoms when drug stopped
* physiologic need for drug (opioid in patient with cancer-related pain)
* desire for euphoric effect, typically in recreational drug use.
Controlled Substances Act of 1970
Drugs are categorized:
also known as Comprehensive Drug Abuse Prevention and Control Act: Regulates manufacture, distribution, dispensing of drugs with abuse potential.
in 5 schedules, based on abuse potential, physical/psychological dependence.
Controlled Substances
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Schedule 5
C-1 High abuse potential, no accepted medical use in the US (heroin, LSD, marijuana???, peyote)
C-II Potential for high abuse with severe physical or psychological dependence (meperidine, methadone, morphine, oxycodone, amphetamines, barbiturates)
C-III Potential for moderate physical or psychological dependence (non-barbiturate sedatives, non-amphetamine stimulants)
C-IV Limited dependence potential (some sedatives and anxiety agents, non-narcotic analgesics)
C-V Limited abuse potential (small amounts of narcotics (codeine) used as anti-tussives or anti-diarrheals)
Dispensing Regulations
C-I
C-II
C-III
C-IV
C-V
1 only with approved protocol
2 written prescription (if telephoned in, written prescription within 24 hours), no prescription refills, container warning label
- written or oral prescription that expires in 6 months, maximum 5 refills in 6-month period, container warning label
- written or oral prescription that expires in 6 months, maximum; 5 refills in 6 month period, contaner warning label
- written prescription or OTC (varies with state law)
Pregnancy Concerns
Teratogen:
prescription, non-prescription medications carry risk of causing birth defects in developing fetus
-any substance that causes abnormal development in fetus
There are 5 Drug categories effecting pregnancy
Category A
Category B
Category C
Category D
Category X
A. Studies indicate no risk to fetus
B. Studies indicate no risk to animal fetus, information on humans not available
C. Adverse effects reported in animal fetus, information in humans not available
D. Possible fetal risk in humans reported, select cases may warrant use when consider potential benefit versus risk
X. Fetal abnormalities reported, positive evidence of fetal risk in humans available from animal and/or human studies, these drugs should not be used in pregnant women.
Drug Interactions:
Additive effect:
Synergistic effect:
Antagonistic effect:
- effect of 2 similar drugs together = higher sum of either drug alone ; allows for smaller doses of each drug, avoiding toxic effect of either
- combined effect of 2 drugs is greater than the sum of either alone.
- combined effect of 2 drugs less than either alone. Cancel each other out.
Interactions
Food:
Drug:
- alters rate/ amount of drug absorbed in GI tract
- impairs vitamin/mineral absorption
Adverse Effects can be?
- Dose-related=
- Secondary Effect
- Hypersensitivity
- Overdose
Iatrogenic effect
*Sensitivity-related
undesirable drug response, either a side-effect or a harmful effect
majority of reactions come from this
- constipation, sedation
- patient’s immune system sees drug as dangerous foreign substance
- toxic reaction with excessive dose
- unintentional effect, physician or treatment-induced, mimics pathological disorder
- rare; drug allergy, genetically determined.
Prescription Drugs
designated by federal government as potentially harmful
Must be prescribed by a licensed health care provider
Prescription must contain:
name of drug
dosage
method and times of administration
signature of prescriber
other info('Dispense as Written' to ensure brand name dispensing)a.c
before meals
ad lib
as desired
b.i.d.
2 times a day
C with a line above it
with
cap
capsule
d.c.
discontinue
dil.
dilute
elix.
elixir
ext
extract
fld.
fluid
gt(t)
drop(s)
h
hour
h.s.
at bedtime
IM
intramuscular
IV
intravenous
NS (N/S)
normal saline
OD
right eye
os
mouth
OS
left eye
OU
both eyes
p with a line over it
after
p.c.
after meals
per
by
p.o.; per os
by mouth
p.r.n.
when necessary/required
q.
every
q.a.m.
every morning
q.d.
every day
q.h.
every hour
q.2.h.
every two hours
q.h.s.
every night at bedtime
q.i.d.
4 times a day
q.o.d.
every other day
q.s.
as much as required
s with a line over it
without
soln.
solution
stat.
immediately
s.q.; s.c.
subcutaneous
supp,
suppository
susp.
suspension
syp.
syrup
tab.
tablet
t.i.d.
3 times a day
tr. or tinct.
tincture
ung.
ointment
