Objective 3 Flashcards by Kaitlyn Dominie

any chemical that affects the physiological processes of a living organism

drug

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Grouped together based on their similar properties

drug classification

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The study or science of drugs

pharmacology

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what are the subspeciality areas of pharmacology

Pharmaceutics,
Pharmacotherapeutics,Pharmacokinetics,
Pharmacodynamics, Pharmacogenetics,
Pharmacoeconomics, Pharmacognosy, Toxicology

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what are the 3 basic phases of pharmacology?

pharmaceutics
pharmacokientics
pharmacodynamics

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Study of how various dosage forms influence the way in which
the drug affects the body

pharmaceutics

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must be broken down by gut enzymes and pH
before they are small enough to enter circulatory system to be
transported to site of action

oral dosage

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work directly on the surface of the
skin, some must pass through the skin to get into circulations

topical

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what are the various oral preparations?

Liquids (e.g., elixirs, syrups)
 Suspension solutions
 Powders
 Capsules
 Tablets
 Coated tablets
 Enteric-coated tablets

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Study of what the body does to the drug
 Involves absorption, distribution, metabolism and excretion of
drugs … this will be discussed later in more detail

pharmacokinetics

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Study of what the drug does to the body
 Involves drug receptor relationships, enzyme interactions and
nonselective interactions

pharmacodynamics

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what the body does to the drug, or
what happens to the drug, from the moment it is put into the
body until all components are expelled by the body

pharmacokinetics

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is the Movement of a drug from site of administration into
bloodstream for distribution to target tissues

absorption

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describes the extent of the drug absorption; how it has
to pass through systems to get to the systemic circulation for use by the
body (% of unchanged drug that makes it into circulation)

bioavailability

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the initial metabolism in the liver of a drug absorbed from
the GI tract before the drug reaches the systemic circulation through
bloodstream

first pass effect

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what does absorption rate depend on?

route
solubility
blood flow
bodily conditions

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enteral, parenteral, percutaneous

route of administration

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ability of a drug to dissolve

solubility of the drug

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edema, infection, congestion of BV, poor circulation, and poor pumping of heart can affect blood flow

blood flow

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influenced by presence/absence of food in stomach, condition of site of adm, & blood flow to area

bodily conditions

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Movement of particles from a region of high
concentration to region of low concentration; perfume
in a room; a passive process

diffusion

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Movement of water (fluid) through a
semipermeable membrane from an area of lesser
solute concentration to an area of greater solute
concentration in an attempt to equalize concentrations
on both sides of the membrane; a passive process

osmosis

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Movement of a substance through a filter or
through a material that prevents passage of certain
molecules; follows a pressure gradient, with substance
moving from an area of high pressure to low pressure

filtration

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Occurs after absorption
refers to the ways in which drugs are
transported by the bloodstream to the site of action.
 Transported first to areas with extensive blood supply
 Circulates via blood and lymphatic system; larger
organs with larger blood supply receive drug faster
(heart, liver, brain and kidneys)
 Areas with smaller blood supply will have a slower
distribution (muscle, fat, & skin)

distribution

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bound to proteins (albumin), pharmacologically inactive

bound portion

‘free’, pharmacologically active produces therapeutic effect

unbound portion

involves the biochemical alteration of a drug into any of the following: an inactive metabolite, a more soluble compound, a more potent metabolite or a less active metabolite

biotransformation

Drug is broken down by enzymes via chemical reactions to be used by the body; an irreversible transformation of parent to ‘child’ compounds  Usually happens in the liver by means of various complex chemical reactions (involving P450 enzymes) until they become chemically inactive aka biotransformation

metabolic

Many drugs can inhibit the breakdown of drugs by chemical enzymes. Decreases or delays in drug metabolism can result in accumulation of the drug &prolonged effects which can lead to drug toxicity

enzyme inhibitors

On the other hand, some drugs can stimulate drug metabolism. This can cause decreased pharmacological effects requiring that the medication be administered more frequently to achieve the therapeutic response for the patient.

enzyme inducers

Process by which inactive chemicals, chemical by products and waste(metabolites) are removed from the body.  The kidney is the primary organ responsible but can occur via the GI tract (with help from the liver; released in the bile out into intestines) as feces (biliary excretion), exhaled through the lungs and/or evaporated from the skin during sweating  Small amounts can even be expelled via the tears, saliva, or breastmilk  By the time they reach the kidneys they have undergone an extensive amount of biotransformation (metabolism)  Important to know how drugs are metabolize and excreted for monitoring purposes

excretion

is the time required for serum(blood) drug levels to be reduced by one-half (50%) during the elimination phase; a measure for the rate @ which a drug is eliminated from the body

half-life

refers to the point when the amount of drug removed via elimination (kidney clearance) is equal to the amount of drug absorbed with each dose. Once steady-state is reached, there are consistent levels of drug in the body that correlate with maximum therapeutic benefits

steady state

time it takes for a drug to elicit a therapeutic response

onset of action

The time it takes for a drug to reach its maximal therapeutic response: reflects increasing drug concentrations at the site of action (levels start to fall after this as a result of metabolism and excretion).

peak effect

The length of time the drugs concentration is sufficient to elicit a therapeutic response (without more doses)

duration of action

are also used to describe drug concentrations (measured by drug samples).Time plays a key role in the peak level (highest blood level concentration) and trough level (lowest blood level) of a drug. If peak level is too high than toxicity can occur (will discuss further)

peak and trough

What the drug does to the body (actions of the drug)  The relationship between drug concentrations and the pharmacological response Desired Action(actions of the drug

pharmacodynamics

expected response of the medication

desired action

what are the 3 different ways that drugs can exert their actions?

receptors... drugs act by forming a chemical bond with specific receptor sites, similar to a lock and key concept. 2. enzymes 3. nonselective interactions

drugs act by forming a chemical bond with specific receptor sites (lock and key) * Drugs help create a chemical reaction to change or mimic the way the body acts * The site of such reaction occurs at the receptor site; a reactive site on the surface or inside of the cell * Drug-receptor interaction is the joining of the drug molecule with a reactive site on the surface of a cell or tissue

receptors

drugs that attach but produce only a small chemical response

partial agonists

a drug that attaches and causes no chemical drug response; prevents an agonist from attaching

antagonist

A drug that attaches and activates the receptor fully causing a similar action as the body’s own chemicals

agonist

are substances that catalyze nearly every biochemical reaction in a cell

enzymes

occurs when the drug chemically binds to an enzyme molecule in such a way that it changes (inhibits or enhances) the way the enzyme interacts with the normal target molecules

drug-enzyme interaction

These drugs do not interact with receptors or enzymes. * Their main targets are cell membranes and various cellular processes, like metabolism * These drugs are capable of either physically interfering with or chemically altering cellular structures or processes. (Eg. Cancer treatment or even some antibiotics) * The resulting alteration.... will cause a defect in the final product or state, leading to cell death (lysis or starvation)

nonselective interactions

Clinical use of drugs to prevent and treat diseases  Before any drug therapy is started an end point or expected outcome of therapy should be established  The outcome of therapy should be patient specific and established collaborately (multidisciplinary approach), need to be clearly defined ,measurable and observable, realistic and prioritized

pharmacotherapeutics

intense, utilized with acutely ill patients; to sustain life/treat disease (eg: chemo for Ca, vasopressors to maintain BP and Cardiac output after open Heart Surgery)

acute therapy

helps prevent progression of an already existing disease/condition; treat chronic illnesses (eg: blood pressure medications; birth control)

maintence therapy

aka replacement; supplies substance in order to maintain normal function; can’t be made by the body or produced insufficiently (eg: insulin/iron)

supplemental therapy

comfort upmost importance; provide relief of symptoms exacerbated by disease/condition; quality of life in end of life care (eg: opioid use in final stages of Ca)

palliative therapy

maintains body functions during recovery (eg: electrolytes during dehydration, Use of Blood products after blood loss in surgery)

supportive therapy

provided to prevent illness or undesirable outcomes during planned events (eg: vaccines-prophylactic for travel)

prophylactic therapy

Based on clinical probabilities (antibiotics-prior to result of C&S)

empirical therapy

ratio of a drug’s toxic level to the level that provides therapeutic benefits. The safety of a drug is determined by this index

therapeutic index

decreasing response to repeated drug doses

tolerance

physiological or psychological need for a drug

dependence

the physiological need for a drug to avoid physical withdrawal symptoms (tachycardia, restlessness)

physical dependence

is the obsessive desire for the effects of a drug

psychological dependence

Any undesirable occurrence related to administering or failing to administer a prescribed medication

adverse drug events

what are the 2 most common ADEs?

medication errors adverse drug reactions

a compromise in the 10 Rights...so, to prevent or try to avoid, recall the 7 (10) rights of medication administration  MEs occur during prescribing, dispensing, administering or monitoring of drug therapy

medication errors (MEs)

are reactions to a drug that is unexpected and undesirable and occurs at therapeutic drug doses; may or may not be caused by MEs * range from mild – life threatening * may occur after 1st dose, few doses or many doses * may or may not be caused by a medication error

adverse drug reactions

what are the four general categories for ADRs?

pharmacological allergic idiosyncratic drug interaction

is an extension of a drugs normal effects in the body (ie: lowering BP, but does so to an extent, the patient becomes hypotensive)  pharmacological reactions that result in adverse effects are predictable and well-known, unlikely to result in a change in management of the patient’s condition  they have predictable frequency and intensity and are most often related to the dose

pharmacological reaction

A drug allergy occurs because the individual’s immune system views the drug as a foreign substance or “antigen”.  The presence of the foreign substance or antigen stimulates the antigen-antibody response that in turn prompts the body to produce antibodies.  If an individual takes the drug after the antigen-antibody response has occurred, an allergic reaction results.

response of the immune system

what are the S&S assoicated with an allergic reaction?

Hives (urticaria)  Rashes  Shortness of breath  Dyspnea  Cyanosis  Wheezing  Swelling  Loss of consciousness

Strange, unique or unpredictable response; unexpected  Genetically determined abnormal response to ordinary doses of a drug  Usually caused by a deficiency or excess of drug-metabolizing enzymes  Usually happens after the 1st administration  Most often specific to an individual  Paradoxical response is a type of idiosyncratic response in that you get reactions that are opposite of what you would expect

idiosyncratic

When the simultaneous presence of two (or more) drugs in body produces an unwanted response  This can be in the form of one drug accentuating, or reducing the effects of another  While some drug interactions might have a positive result, the greater majority will result in harmful effects

drug interactions

when two drugs with similar actions are given together; the action of one plus the action of the other results in the total effect of both drugs being given

additive effects

when the action of one drug enhances the effect of another. The combined effect of the two given together has a greater effect than the sum of the effects for each drug given alone

synergistic effects

effects of one drug counteract or interfere with the effects of another; the result is less than the sum of the effects for each drug if given alone

antagonistic effects

Used to describe parenteral drugs  When 2 drugs or solutions are mixed together and the result is chemical deterioration of one or both of the drugs.  Will often see precipitate, haziness or color change.

incompatibility

Cancer causing effects of drugs, other chemicals, radiation, and viruses.  Agents that produce theses effects are called Carcinogens

carcinogenic

A drug that has potential to induce birth defects  More dangerous during the first trimester (3rd wk-end of 3rd mnth)  Drugs that are capable of crossing the placenta can cause drug induced teratogenesis

teratogenic

A drug whose effects are permanent changes in the genetic composition of living organisms and can be  alterations in chromosome structure  Chromosome number changes  Changes in DNA (genetic code)

mutagenic

Usually related to dose of drug  Dosage exceeds amount that body can eliminate  Degree of impairment to body depends on organ/tissue involved

drug toxicity

when does drug toxicity occur?

Narrow therapeutic margin of safety  Drug is taken over long period of time  Overdose (intentional or nonintentional)  Drug-drug interactions

Science of poisons and unwanted responses to both drugs and chemicals

toxicology