Pharm 1 Exam (2) Flashcards
Pharmacology
study of drugs that alter functions of living organisms
Drug Therapy
use of drugs to prevent, diagnose, and treat signs/symptoms/disease processes
Medications
drugs given for therapeutic purpose
Systemic Drug
entered into the body and blood stream takes it (IV antibiotic/PO meds) works through blood stream (typically more rapid when going through IV)
Local
at site of application (sunscreen/hydrocortisone)
atropa belladonna
plant associated with Atropine
papauarum Somniferum
plant associated with Morphine
Rauvolfia Serpentina
Plant associated with reserpine
Synthetic compounds
Manufactured in laboratories. More standardized in chemical compounds, more consistent in affect, less likely to produce allergies
semi-synthetic
naturally occurring in nature, but chemical modified (ex. Antibiotics)
Drugs are classified according to effects on
- Specific body systems (morphine=CNS)
- Therapeutic Uses: (Morphine=potent analgesic)
- Chemical Characteristics (Morphine=narcotic)
Drug Prototype
Individual drugs that represent a group of drugs (typically the first/pioneer of a group) (Ex. Morphine=Opioid Analgesics)
Comprehensive Drug Abuse Prevention and Control Act
Regulated the manufacturing and distribution of controlled substances
Food, drug, cosmetic Act of 1938:
requires that official drugs meet standards of purity and strength determined by chemical analysis or bioassay
Durham-Humphery Amendment
Designates which medications must be prescribed by a healthcare professional
Controlled Substances Act:
Categorizes controlled substances according to therapeutic strength and potential for abuse
Drug Enforcement Administration (DEA):
Enforces the Controlled Substances Act
Controlled Substance Act 1970:
Regulates manufacturing and distribution of narcotics, depressants, stimulants, hallucinogens, and anabolic steroids
Schedule 1 Drugs:
Ecstasy + Heroin
Schedule 2 Drugs:
Hydromorphone, methadone
Schedule 3 Drugs:
Hydrocodone + Acetaminophen
Schedule 4 Drugs:
Alprazolam
Schedule 5 drugs:
Robitussin
Federal Food, Drug, & Cosmetic Act of 1938:
Standards for testing drug toxicity and monitoring labeling
FDA pregnancy Categories (A, B, C, D, X)
A: controlled studies of pregnant women show 0 risk in 1st trimester
B: Animal studies show no risk or animals show risk unconfirmed in humans
C: Animal studies show risk–caution advised–benefits greater than risk
D: Evidence of risk to human fetuses. Use only when benefits outweigh risk
X: Risk outweighs benefits: do not use if pregnant
Teratogenic
fetal for a fetus
Pharmacokinetics
Absorption/Distribution/Metabolism/Excretion
Lipophilic
love lipid membrane and dissolve into the cell membrane
lipophobic
cannot pass through the lipid membrane
Pharmacodynamics:
The effects that the drugs has on the body
4 Ways Drugs work:
Replace or act as substitutions for missing chemicals
Increase or stimulate certain cell activities
Depress or slow cellular activities
Interfere with the functioning of forgein cells (chemotherapeutic drugs)
Non-receptor drug actions
Antiacids, osmotic diuretics, anticancer drugs, metal chelating agents
Metal chelating agents
liquid that binds to toxic metal in body and excretes it
Non-Specific Drug Effects
Work on certain receptors that may be present in several different organs or tissues
epinephrine affects receptors in
A1, B1, and B2
Absorption
Process that occurs from the time the drug enters the body to the time it enters the bloodstream to be circulated to the tissues.
Active Transport:
molecules move across membrane from lower to higher concentration (takes energy)
Passive Transport:
molecules move across the cell membrane from high concentration to lower concentration
Onset of drug action
beginning of drug starting to work. This is determined by rate and extent of drugs absorbed through the following factors:
Dosage, form, rate of administration
Administration site blood flow, GI function
Presence of food or other drugs in the body
Levothyroxine
must be taken on an empty stomach or it is absorbed there and excrited without effect
Absorption of internal medications Altercations
Altered by GI motility (bowel obstruction)
Altered by presence of food in the stomach
Altered by pH of stomach
Altered by amount of bowel surface area
Pain/stress might divert blood flow from stomach and affect absorption
parenteral medicine
absorbed outside the GI tract (quicker)
Types of Parenteral medicine
IV (fastest), IM (fast), subcutaneous (slowest)
Distribution
Transport of drug molecules in the body
Protein binding
drugs attach to protein molecules and travel to the site of action.
albumin
the protein that drugs typically attach to
Inactive Drug
When a drug is bound to protein it is inactive. Unbound drugs are free and active. MUST HAVE ADEQUATE ALBUMIN
unbound drugs
Only unbound drugs can move through capillaries and have an effect. As a result, drugs can be stored and released as needed through protein binding.
Hypoalbuminemia
must be monitored for excessive free drug in the body. Can cause increased risk for toxicity
Drug ionization
Ionized drugs are positively charged and are not as easily absorbed as non-ionized drugs
Metabolism
The method by which drugs are inactivated or biotransformed by the body: occurs primarily in the liver
Impact the efficacy of the drug
Diseases in liver, RBC, PLasma, Kidneys, Lungs, and GI mucosa impact the efficacy of the drug
Cytochrome P450:
enzyme in liver primarily responsible for metabolizing drugs
First Pass Effect
typically seen in oral medication. The concentration of the drug is greatly reduced before it reaches the systemic circulation. Fraction of the drug lost in process of absorption.
Enzymatic induction
chronic usage of a drug to liver and the liver produces more enzymes and the drug dosage must be increased because the metabolism is also increased.
Enzyme Inhibition
2 drugs requiring the same enzyme to break them down are taken at the same time and the metabolism is decreased so dosage should be decreased or monitored for high “drug to remain”
Excretion
Elimination of medication from the body. Requires adequate function of organs of excretion.
most important organ of excretion.
Liver
Other organs that excrete
skin, saliva, lungs, bile, feces
Factors affecting excretion:
Glomerular filtration rate (GFR): should be more than 60 (kidney lab)
Blood uria nitrogen (BUN): 10-20mL/dL (kidney test)
Creatinine (CR+): 0.1-1.4 (kidney test)
Urine acidity: urine pH 4.5-8. Determines ionization acidic urine affects excretion of weak acids and bases (decreases reabsorption)
Onset
Time it takes for a drug to produce a response
Peak
time to reach highest concentration reached before next dose
Trough
lowest level of concentration reached before next dose
Duration
length of time that the concentration is great enough to produce a response
Plateau
Maintained level of concentration with fixed dosages
Half-Life
Time for excretion to lower the concentration by half
Cross-tolerance:
tolerant to one drug and also to a drug with a similar effect
(Barbiturate and alcohol)
Tolerance
the same dosage of the drug no longer elicits the same response
Serum Drug Level:
a lab measurement of the amount of a given drug in the body at a particular time
Therapeutic Index
margin between effectiveness and toxicity of medication
Digoxin
heart medicine is an example of narrow TI with a TI of 0.5-2ng/mL
Minimum Effective Concentration (MEC)
Must be present for efficacy or for a drug response
Loading dose
larger than normal volume of drug given initially to attain a more rapid therapeutic drug level of the drug to produce a response
Toxic Concentration
Excessive level of medication in the bloodstream; caused by:
Single large dose, repeated small doses, slow metabolism of medicine
Additive effects
two drugs doing the same thing taken together
Synergism
combining drugs leads to larger than expected effect (drugs used have a different mechanism or act on a different site) increase response
Interference
two drugs taken together where one drug affects metabolism of the second drug
Displacement
two drugs are attracted to the same protein and the stronger one kicks off the weaker one.
Antidote medication
counteract a medication given in too much volume, incorrectly, or on accident
Adverse effects
any undesired response to medication administration
NSED
non-steroidal anti-inflammatory
Nephrotoxicity
drugs that damage kidneys
Hypersensitivity
allergic reactions to medications
Serum Glucose Levels
medications that raise blood sugar. Not good for diabetics (steroids do this) 70-110=WNL
Drug Fever
Drug triggers the temperature feature in brain and patient develops fever
Idiosyncrasy
unexplainable event upon first dosage–typically genetic
Drug dependence
people become dependent on their medications
Carcinogenicity
medications can cause cancer
EMARS
electronic medication administration record system
Medications most associated with errors
Insulin (subcutaneous)
Heparin blood thinner (IV or Sub Cue) (DVT-bloodclots-5000units/mL on first dose)
Warfarin: blood thinner (oral) pts with higher risk of blood clots
Index for medication errors: A-I
A: No error.
B-D: error no harm.
E-H: error harm
I: error, death
Z track injection
pulling skin towards you while administering med so the skin does not become irritated
Phase 1
Determines if treatment is safe. Are there side effects? Does the treatment work better than current treatment? Involves 15-100 participants. Goal is to test safe dosages
Phase 2
Determine how well the new treatment works? How it affects larger groups, how much is given to be effective, what types of diseases it treats. Typically about 50-300 people. Goal is to see if it is as effective as current treatments
Phase 3
Compares new treatment with best available treatment. 300-3000 people. Only 10% of phase II become phase III
Pediatric population
birth–18y/o
IM muscles used for vaccines
deltoid or vastus lateralis
Infants Age
4w–1year
Toddler + Preschool:
1–5y/o
School Aged
5–18y/o
Child
1–12 y/o
Adolescent
12-18 y/o
Polypharmacy
many medications
Prednisone
myalgia medication
