Module 1 Flashcards
Drug
Any chemical that affects the physiologic process of a living organism
Pharmacology
Study of drugs
Science of preparing & dispensing drugs, including dosage form design(dosage form determines rate of which dissolution occurs; capsule-GI track, solution-GI track).
Pharmaceutics
Pharmacokinetics
The study of what happens to a drug from the time it is put into the body until the parent drug & all metabolites have left the body (Absorption, distribution-transport of drug by blood stream to site of action, metabolism aka biotransformation, excretion)
Pharmacodynamics
The study of the biochemical & physiologic interactions of drugs in their sites of activity. It examines the physicochemical properties of drugs & their pharmoacologic interactions with the body receptors.
pharmacogenomics
Study of the influence of genetic factors on drug response, including the nature of genetic aberrations that result in the absence, overabundunce, or insufficiency of drug-metabolizing enzymes.
pharmacoeconomics
Study of economic factors impact the cost of drug therapy.
pharmacotherapeutics
The treatment of pathologic conditions through the use of drugs.
pharmacognosy
The study of drugs that are obtained from natural plant & animal sources.
toxicology
the study of poisons, including toxic drug effects, & applicable treatments.
additive effects
Drug interactions in which the effect of a combination of two or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone( 1+1=2)
Any undesirable occurrence related to administering or failing to administer a prescribed medication.
Adverse drug event
A general term for any undesirable effects that are a direct response to one or more drugs
Adverse effect
Any unexpected, unintended, undesired , or excessive response to a medication given at the therapeutic dosages.
Adverse drug reaction
Agonist
a drug that binds to & stimulates the activity of one or more receptors in the body.
An immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication; a type of adverse drug event.
Allergic reactions
A drug that binds to & inhibits the activity of one or more receptors in the body. Also called inhibitors.
Antagonist
Drug interactions in which the effect of a combination of two or more drugs is less than the sum of the individual effects of the same drugs given alone(1+1= less than 2) It is usually caused by an antagonizing (blocking or reducing) effect of one drug on another.
Antagonistic effect
Bioavailability
A measure of the extent of drug aborption for a given drug & route(from 0-100%).
One or more biochemical reactions involving a parent drug. Occurs mainly in the liver & produces a metabolite that is either active or inactive(aka metabolism).
Biotransformation
Any condition, especially one related to a a disease state or patient characteristic, including current or recent drug therapy that renders a particular form of treatment improper or undesirable
Contraindication
A general name for a large class of enzymes that play a significant role in drug metabolism &drug interactions
Cytochrome P-430
A state in which there is a compulsive or chronic need, as for a drug.
Dependence
The processes involved in the interaction between a drug & body cells.
Drug action
The development of congenital anomalies or defects in the developing fetus caused by the toxic effects of drugs.
Drug-induced teratogenesis
The length of time the concentration of a drug in the blood or tissues is sufficient to elicit a response.
Duration of Action
The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.
First-pass effect
A hereditary condition in which red blood cells breakdown when the body is exposed to certain drugs.
Glucose-6-phosphate dehydrogenase(G6PD) deficiency
The time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduce by 50%.
Half-life
The characteristic that causes two parenteral drugs or solutions to undergo a reaction when mixed or given together that results in the chemical deterioration of at least one of the drugs.
Incompatibility
Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause patient harm.
Medication error
A chemical form of a drug that is the product of one or more biochemical(metabolic) reactions involving the parent drug. Active metabolites are those that have pharmacologic activity of their own, even if the parent drug is inactive. Inactive metabolites lack pharmoacologic activity & are simply drug waste products awaiting excretion from the body(urination,BM,respiration)
Metabolite
The time required for a drug to elicit a therapeutic response after dosing.
Onset of action
Chemical form of drug before it is metabolized.
Parent drug
The time required for drug to reach its maximum therapeutic response in the body.
Peak effect
Ten maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring.
Peak level
An inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body.
Prodrug
The physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose.
Steady State
Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater that the sum of the individual effects of the same drugs given alone.(1+1 greater than 2)
Synergistic effects
The desired or intended effect of a particular medication.
Therapeutic effect
The ratio between the toxic &therapeutic concentrations of a drug
Therapeutic index
Reduced response to a drug after prolonged use.
Tolerance
The lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug monitoring.
Trough level
Category A Studies indicate no risk to human fetus
Category B Studies indicate no risk to animal fetus; info on human fetus not available
Category C Adverse effects reported in animal fetus ; info on humans not available
Category D Possible fetal risk has been reported, however in select cases consideration of the potential benefit vs risk, may warrant use of these drugs in pregnant woman.
Category X Fetal abnormalities have been reported & positive evidence of fetal risk in humans is available from animal & human studies. These Drugs are not to be used in pregnant woman
Pregnancy Safety Categories
Absorption:
Gastric PH is less acidic /acid producing cells in stomach are immature until appox 1-2yrs
Gastric Emptying slow or irregular peristalsis
First-pass elimination by the liver is reduced because of the immaturity of the liver & reduced levels of microsomal enzymes
Intramuscular absorption is faster & irregular
Pharmacokinetic changes in neonate & pediatric patient
Distribution:
Total body water is 70-80% in full term infants, 85% premature newborns & 64% in children 1-12yrs
Fat content is lower in young patients/ greater total body water
Protein binding is decreased because of decreased production of protein by immature liver
More drugs enter the brain because of immature blood brain barrier
Pharmacokinetic changes in neonate & pediatric patient
Metabolism:
Levels of microsomal enzymes are decrease because of the immature liver does not produce enough yet
Older children may have increased metabolism & require higher dosages once hepatic enzymes are produced
Many variables affect metabolism in premature infants, infant and children, including the status of liver enzyme production, genetic differences & substances to which the mother was exposed during pregnancy
Pharmacokinetic changes in neonate & pediatric patient
Excretion:
Glomerular filtration rate & tubular secretion & resorption are all decreased in young patients/immature kidneys
Perfusion of the kidneys may be decreased, which results in reduced renal function, concentrating ability, & excretion of drug
Pharmacokinetic changes in neonate & pediatric patient
Cardiovascular- decrease output=decreased absorption & distribution; decreased blood flow =decreased absorption & distribution
Gastrointestinal- increase in PH( alkaline gastric secretions)= altered absorption;
decreased peristalsis=delayed gastric emptying
Hepatic- decreased enzyme production=decreased metabolism; decreased blood flow =decreased metabolism
Renal- decreased blood flow =decreased excretion; decreased glomerular filtration rate= decreased excretion
Physiologic Changes in the Elderly Patient
1) potentially inappropriate medications & classes to avoid in the older adult
2) potentially inappropriate medications & classes to avoid in older adults with certain diseases & syndromes
3) medications to be used with caution in older adults
Beers Criteria for Prevention of Adverse Drug events in older adults
What are the Six rights of medication administration?
Right patient Right drug Right time Right dose Right route Right documentation
A type of warning that appears in the drug’s prescribing information & (required by FDA) to alert prescriber’s of serious adverse events that have occurred with the drug
Black box warning
The customary beliefs, social forms & material traits of a racial, religious or social group
Culture
variation in response to a drug because of a patients age, gender,size and/or body composition.
Drug polymorphism
The rules of conduct recognized in respect toa particular class of human actions or a particular group
Ethics
Relating to or chacteristics of a human group having racial, religious, language & other traits in common
Ethnicity
An act that protects health insurance coverage for workers & their families when they change jobs.It also protects patient info (confidentiality).
Health Insurance Portability and Accountability Act (HIPAA)
Any drug listed on one of t the schedules of the Controlled Subtance Act
Controlled substance
Another name for prescription drugs
Legend drugs
A special type of negligence or the failure of a professional and/or individual with specialized education & training to act in a reasonable and prudent way
Malpractice
Legal term established under the Harrison Narcotic Act of 1914. Any class or substance that blunt the senses,as opium,morphine, belladonna and alcohol, that in large quantities produce euphoria,stupor or coma that can cause habituation or addiction and used in medicine to relieve pain, cause sedation and induce sleep.
Narcotic
The failure to act in a reasonable & prudent manner or failure of the nurse to give the care that a reasonably prudent (cautious) nurse would render or use under similar circumstances
Negligence
Descendants of a common ancestor; tribe, family or people believed to belong to the same lineage
Race
Nonmaleficence
Do no harm
veracity
the duty to tell the truth
justice
fair and equal in one’s action
Autonomy
self determination & the ability to act on one’s own
Beneficence
ethical principle of doing or actively promoting good
Premature=
Age Classification
The use of many different drugs concurrently in treating a patient, who often has several health problems
Polypharmacy
A graphic tool for estimating drug dosages using various bod measurements
Nonogram
A patients particular response to normal dosage of drug.(it is genetic)
Idiosyncratic reaction
Period of greatest danger of drug induced developmental defects( period of fetus cell proliferation: organ development)
First Trimester
The period of greatest percentage of maternally absorbed drug gets to the fetus( increase blood flow to fetus)>
Third Trimester
In 1999 the high percentage of medical errors was brought to the fore front by
Institute of Medicine (IOM)
Allergic reaction(often predictable) Idiosynciratic reaction (usually unpredictable)
Two components of Adverse Drug Reaction
CNS, Anticoagulants & Chemotherapeutic drugs
Drugs commonly involved in severe medication errors
Drugs identified as those that, because of potentially toxic nature, require special care when prescribing, dispensing and /or administering.(Potential for harm is increased because of potency)
High-Alert medication
Three steps:
1) Verification-pt. meds & over counter
2) Clarification-review of info to ensure meds & dosage are appropriate
3) Reconciliation- Further investigation of discrepancies & documentation in med orders
Steps in Medication Reconciliation
At admission
Status change
Patient transfer
Discharge
When is Medication Reconciliation performed?
Unintentional adverse effects that are caused by the actions of a prescriber, other health care professional or by a specific treatment
Iatrogenic effects
