Module 1C: Basic Pharmacology Flashcards
Medication Classifications
Primarily, a medication’s therapeutic action dictates the classification, but sometimes it is done by chemical formulations, body systems they act on, or symptoms the medication relieves.
*Some medications fall into more than one category.
EX: Gabapentin and pregabalin. Both medications are anticonvulsants; they treat seizures. However, they are also analgesics because they help relieve neuropathic (nerve) pain.
Analgesics
Indication: Relieve pain
Ex: Acetaminophen, hydrocodone, codeine
Antacids/anti-ulcer
Indication: Gastroesophageal Reflux Disease (GERD)
Ex: Esomeprazole, calcium carbonate, famotidine
Antibiotics
Indication: Bacterial infections
Ex: Amoxicillin, ciprofloxacin, sulfamethoxazole
Anticholinergics
Indication: Smooth muscle spasms
Ex: Ipratropium, dicyclomine, hyoscyamine
Anticoagulants
Indication: Delay blood clotting
Ex: Warfarin, apixaban, heparin
Anticonvulsants
Indication: Prevent or control seizures
Ex: Clonazepam, phenytoin, gabapentin
Antidepressants
Indication: Relieve depression
Ex: Doxepin, fluoxetine, duloxetine, selegiline
Antidiarrheals
Indication: Reduce diarrhea
Ex: Bismuth subsalicylate, loperamide, dipehnoxylate/atropine
Antiemetics
Indication: Reduce nausea, vomiting
Ex: Metoclopramide, ondansetron
Antifungals
Indication: Fungal infections
Ex: Fluconazole, nystatin, miconazole
Antihistamines
Indication: Relieve allergies
Ex: Diphenhydramine, cetirizine, loratadine
Antihypertensives
Indication: Lower blood pressure
Ex: Metoprolol, lisinopril, valsartan, clonidine
Anti-inflammatories
Indication: Reduce inflammation
Ex: Ibuprofen, celecoxib, naproxen
Antilipemics
Indication: Lower cholesterol
Ex: Atorvastatin, fenofibrate, cholestyramine
Antimigraine agents
Indication: Relieve migraine headaches
Ex: Topiramate, sumatriptan, rizatriptan, zolmitriptan
Anti-osteoporosis agents
Indication: Improve bone density
Ex: Alendronate, raloxifene, calcitonin
Antipsychotics
Indication: Psychosis
Ex: Quetiapine, haloperidol, risperidone
Antipyretics
Indication: Reduce fever
Ex: Acetaminophen, ibuprofen, aspirin
Skeletal/muscle relaxants
Indication: Reduce or prevent muscle spasms
Ex: Cyclobenzaprine, methocarbamol, carisoprodol
Antitussives/expectorants
Indication: Control cough, promote the elimination of mucus
Ex: Dextromethorphan, codeine, guaifenesin
Antivirals
Indication: Viral infections
Ex: Acyclovir, interferon, oseltamivir
Anxiolytics (anti-anxiety)
Indication: Reduce anxiety
Ex: Clonazepam, diazepam, lorazepam
Bronchodilators
Indication: Relax airway muscles
Ex: Albuterol, isoproterenol, theophylline
Central nervous system stimulants
Indication: Reduce hyperactivity
Ex: Methylphenidate, dextroamphetamine, lisdexamfetamine
Contraceptives
Indication: Prevent pregnancy
Ex: Medroxyprogesterone acetate, ethinyl estradiol, drospirenone
Decongestants
Indication: Relieve nasal congestion
Ex: Pseudoephedrine, phenylephrine, oxymetazoline
Diuretics
Indication: Eliminate excess fluid
Ex: Furosemide, hydrochlorothiazide, bumetanide
Hormone replacements
Indication: Stabilize hormone deficiencies
Ex: Levothyroxine, insulin, desmopressin, estrogen
Laxatives, stool softeners
Indication: Promote bowel movements
Ex: Magnesium hydroxide, bisacodyl, docusate sodium
Oral hypoglycemics
Indication: Reduce blood glucose
Ex: Metformin, glyburide, pioglitazone
Sedative-hypnotics
Indication: Induce sleep/relaxation
Ex: Zolpidem, temazepam, eszopiclone
Controlled Substances Act (CSA)
Statute that identifies all regulated substances into one of five schedules depending on potential for abuse.
ex: amphetamine mixed salts (Adderall, a schedule II drug)
Side Effects
A secondary reaction to the one intended.
Cause undesirable unintended actions on the body, such as nausea or dry mouth, and can limit the usefulness of the medication.
Schedule I Substances
Includes substances with a high potential for abuse and currently no approved medical use in the U.S. They are illegal, and providers may not prescribe them.
EX: heroin, mescaline, and lysergic acid diethylamide (LSD).
*Schedule I still includes cannabis (marijuana) even though it is legal for medical use with a prescription in many states.
Schedule II Substances
Includes substances that have a high potential for abuse, are considered dangerous, and can lead to psychological and physical dependence.
EX: morphine, methadone, oxycodone, hydromorphone, hydrocodone, fentanyl, and amphetamine
Schedule II prescriptions must be signed by hand, except as rules allow regarding distribution of electronic or printed prescriptions. Schedule II substances must be stored in a safe or steel cabinet of substantial construction.
Schedule III Substances
Includes substances with moderate to low potential for physical and psychological dependence.
EX: ketamine, anabolic steroids, acetaminophen with codeine, and buprenorphine.
Schedule IV Substances
Includes substances that have a low potential for abuse and dependence.
EX: tramadol and benzodiazepines including diazepam, alprazolam, chlordiazepoxide, and clonazepam.
Schedule V Substances
Includes substances that contain limited quantities of some narcotics, usually for antidiarrheal, antitussive, and analgesic purposes.
EX: diphenoxylate with atropine, guaifenesin with codeine, and pregabalin.
Controlled Substance Refills
Schedule III, IV, and V controlled substances may not be filled or refilled more than 6 months after the date on which the prescription was issued and may not be refilled more than five times in 6 months.
Therapeutic Effects
The helpful effect that the provider is hoping will help the patient to feel better
Adverse Effects
Unintended, harmful actions of the medication, such as an allergic reaction, and prevent further use of the medication
Indications
The problems for which the provider prescribes a particular medication
Contraindications
Symptoms or conditions that make a specific treatment or medication inadvisable or even dangerous
Precautions
Problems that pose a lesser risk but require close observation and monitoring during medication therapy
Side Effects vs Adverse Effects
Side Effects: PREDICTABLE and are nearly unavoidable but not necessarily harmful.
*EX: side effect of diphenhydramine is drowsiness
Adverse Effects: UNPREDICTABLE effects like allergic reactions
Indications vs Contraindications
Indication for a medication is the symptoms or reason a medication is prescribed
Contraindications are symptoms or conditions that make a particular treatment or medication inadvisable or even dangerous
*EX: previous allergic reactions or acetaminophen is toxic to the liver- patients with liver disease should not take
Contraindications vs Interactions
Both reasons to avoid a particular treatment or medication
Contraindications: symptoms or conditions that make a particular treatment or medication inadvisable or even dangerous
*EX: previous allergic reactions
Interactions: occurs when a medication reacts with another drug, food, drink, or condition.
*EX: antibiotics reduce the effectiveness of oral contraceptives
Metric System
The metric system quantifies weight in kilograms (kg), grams (g), milligrams (mg), and micrograms (mcg). It measures volume in deciliters (dL), liters (L), and milliliters (mL). Length is in kilometers (km), meters (m), centimeters (cm), and millimeters (mm). There are other metric values, but these are most used in practice.
Metric System Unit Conversions
Relationship to base unit:
micro- ÷ 1,000,000
milli- ÷ 1,000
centi- ÷ 100
base unit
kilo- × 1,000
Standard System
Standard, or household, measurements of medications are still common, especially for liquid oral medications taken at home. Many liquid medications come with measuring cups with marked household and metric equivalents.
Standard to Metric Liquid Conversion
Standard value = Metric equivalent:
15 drops (gtt) = 1 mL
1 teaspoon (tsp) = 5 mL
1 tablespoon (tbsp) = 15 mL
1 fluid ounce (oz), 2 tbsp = 30 mL
1 cup = 240 mL
1 pint = 480 mL (about 500 mL)
1 quart = 960 mL (about 1 L)
1 gallon = 3,830 mL
2.2 pounds (lb) = 1 kilogram (kg)
Why is it important for medical assistants to understand how to convert metric measurements to standard measurements?
Many at-home medications are prescribed or directed in metric doses. These medications typically come with measurement cups that indicate metric measurements, but patients may misplace these cups and call the clinic for advice on measuring the accurate dosage using standard measurements.
Aerosols
Route: Inhalation
Caplets
Route: oral
Capsules
Route: oral
Creams
Route: Topical, vaginal, rectal
Drops
Route: Otic, ophthalmic, nasal
Dry powder for inhalation
Route: Inhalation
Elixirs
Route: oral
Emulsions
Route: oral
Foams
Route: vaginal
Gels
Route: Oral, topical, rectal
Injectable liquids
Route: IV, IM, subcutaneous, ID
Liniments
Route: Topical
Lotions
Route: Topical
Lozenges
Route: oral
Mist
Route: Inhalation, nasal
Ointments
Route: Topical, ophthalmic, otic, vaginal, rectal
Patches
Route: Topical
Powders
Route: Topical
Powders for reconstitution
Route: IV, IM, subcutaneous, ID
Solid extracts, fluid extracts
Route: oral
Solutions
Route: Oral, topical, vaginal, urethral, rectal
Sprays
Route: Topical, nasal, inhalation, sublingual
Steam
Route: Inhalation
Suppositories
Route: vaginal, rectal
Suspensions
Route: oral
Syrups
Route: oral
Tablets
Route: oral, buccal, sublingual, vaginal
Tinctures
Route: oral, topical
Strategies to Avoid Errors in Handling Look-Alike and Sound-Alike Medications
- Do not use abbreviations for medication names.
- Use “tall man” (mixed case) letters to emphasize parts of medication names that could cause confusion (cefoTEtan and cefOXitin).
- Change the appearance of look-alike medication names to alert staff to their differences.
- Create labels with indications or purposes for use, such as adding a “diuretic” label to hydrochlorothiazide packaging.
- Store look-alike or sound-alike medications in separate areas in medication cabinets or rooms.
- Alter computer selection screens to avoid having look-alike medication names appear consecutively.
3 checks before administering any medication
- Check the medication against the prescription when the medication is selected.
- Check the medication and prescription when preparing the dose.
- Recheck the medication before restocking the bottle.
Medication Routes
The most common routes fall into two general categories:
1. enteral (through the gastrointestinal tract)
- parenteral (outside the gastrointestinal tract). Most commonly, parenteral refers to injections—intramuscular, intradermal, subcutaneous, and intravenous—but also includes routes like topical, vaginal, and inhalation.
Nonparenteral Routes
Route: oral
Locations: Mouth, stomach, intestines
Medication Formulation: Mouth, stomach, intestines
Parenteral Routes for Medications—Injectable
- Route: Intradermal
Locations: Skin of the upper chest, forearms, upper back
Medication Formulation: Injectable liquid - Route: Intramuscular (IM)
Locations: Deltoid, vastus lateralis, ventrogluteal muscles
Medication Formulation: Injectable liquid - Route: Subcutaneous (SQ or Sub-Q)
Locations: Upper arms, abdomen, buttocks, upper outer thighs
Medication Formulation: Injectable liquid
Parenteral Routes—Noninjectable
- Route: Topical
Locations: On the skin
Medication Formulation: Gels, tinctures, solutions, ointments, lotions, creams, liniments, powders, patches, sprays - Route: Vaginal/rectal
Locations: Vagina/vulva, rectum/anus
Medication Formulation: Suppositories, solutions, creams, ointments, gels, foams
Pharmacokinetics
The study of how medications move through the body. Helps with understanding a medication’s onset of activity, the peak time of its effects, and how long its effects will last.
4 actions pharmacokinetics:
1. absorption
2. distribution
3. metabolism
4. excretion
Absorption
Through the process of absorption, the body converts the medication into a form the body can use and moves it into the bloodstream.
The process of absorption also varies with the route.
- IV administration, the medication goes directly to the bloodstream, so the onset of action is much quicker than other routes
- Oral tablets or capsules move through the stomach or intestines to be absorbed
- Oral liquids are absorbed the same way but have faster absorption because the fluids in the stomach do not have to break them down into an absorbable form
Factors that affect the speed of absorption: how easily the medication dissolves in fat and surface area
Distribution
The transportation of the medication throughout the body. The bloodstream carries the medication to the body’s tissues and organs.
Barriers to medication distribution:
- The blood-brain barrier protects the brain from dangerous chemicals but can also make it difficult to get some therapeutic substances into brain tissues.
- On the other hand, some medications cross the placental barrier very easily, which is why many medications are risky for pregnant patients.
Metabolism
Changes active forms of the medication into harmless metabolites ready for excretion through urine or feces. The liver is the primary organ of metabolism, but the kidneys also metabolize some medications.
Factors that affect metabolism:
- age (Infants and older adults have the least efficient metabolism, so medication dosages must be modified to compensate for this variation)
- how many medications they take
- the health of various organs and tissues
- genetic makeup
Excretion
The removal of a medication’s metabolites from the body.
The kidneys accomplish most of this through urine, but feces, saliva, bile, sweat glands, breast milk, and even exhaled air eliminate some medications.
A medication’s half-life is how long it takes for the processes of metabolism and excretion to eliminate half a dose of a medication. Knowledge of half-lives helps determine dosing intervals. If a patient does not receive the next dose before the half-life time, the therapeutic level of the medication will be too low (below the therapeutic range) to be effective.
5 Rights of Medication Administration
Collection of safety checks that everyone who administers medications to patients must perform to avoid medication errors.
- Right patient
- Right medication
- Right dose
- Right time
- Right route
(NEW: plus the right technique and the right documentation)
Where should a medical assistant look for reliable information on medications when needed?
Medical assistants can find reliable, medically approved medication information through validated books and internet sources, approved phone apps, and package inserts.
EX: Physicians’ Desk Reference
