Pharm 1 Final Flashcards
What are the 3 properties of an ideal drug?
1) Effectiveness: Most important. Does is to what its supposed to.
2) Safety: Doesn’t produce harmful effects, even in high doses.
3) Selectivity: Only does what its supposed to do.
Pharmacokinetics
How the body acts on the drugs.
What is the 4 pharmacokinetic process?
1) Absorption
2) Distribution
3) metabolism
4) excretion
Pharmacodynamics
The impact of the drugs on the body.
What is the Nursing process in drug therapy?
ADPIE
A - Assessment. Collect data. Provides foundation
D - Diagnosis. (nurse diagnosis).
P - Plan.
I - Implement. Carry out and record outcomes.
E - Evaluation. Determines degree of tx success.
Controlled Substance Act…
-The lower the number the, the higher the abuse, the tighter the control.
-The higher the number, the lower the abuse, the looser the control.
I - Has no medical use in US. (heroin)
II - Used in US, potential for abuse.
How many names does each drug have, and what are they?
1) Chemical: chemistry nomenclature.
2) Generic: Each drug has ONE generic name.
3) Trade Name: (brand name). Created by drug company and easier to remember. Must be FDA approved.
What are the problems with the generic drug name?
Generic: Too many syllables. Difficult to pronounce, remember, not used much.
What are the problems with the Trade name?
One drug with multiple names.
What’s the problem with OTC drugs?
Active ingredients can change without changing the trade name.
What is absorption?
Movement of drug from the site of administration into the blood.
What is distribution?
Movement of drug from blood into the interstitial space of tissues and then into the cells.
What is Metabolism?
Enzymatically mediated alteration of the drug structure.
What is Excretion?
Movement of drugs and metabolites out of the body.
What are the 3 ways cells cross membranes?
1) Channels/Pores: These are small and very few things pass through. Most drugs have a molecular weight of 300-500 and these only allow about 200 MW.
2) Transport systems: Carriers that move drugs from one side of the cell membrane to the othwer. Some use energy, some don’t. These are selective. (ex. P-glycoprotein)
3) *Direct membrane penetration: Most Common! Resort to this because drugs are too large to pass through channels. To do this, drugs must be Lipophilic.
What factors effect absorption?
- Rate of dissolution.
- Surface area.
- Blood flow.
- Lipid solubility.
- pH partitioning. (if one side of membrane is more acidic, basic drugs will be drawn to it).
What are the barriers, patterns, advantages, and disadvantages to the IM route?
- Barriers: Capillary wall –> insignificant.
- Patterns: Depends on water solubility and blood flow.
- Advantages: Depot preparations = absorbed over long period so it lowers # of injections.
- Disadvantages: Discomfort. Inconvenient. Local tissue injury, nerve damage, bleeding risk.
What are the barriers, patterns, advantages, and disadvantages to the PO route?
- Barriers: Layer of epithelial cells, the capillary wall. P-glycoproteins transporting drugs back out of the cell.
- Patterns: Depends on pH of stomach, solubility, food in gut etc…
- Advantages: Easy, convenient, inexpensive, safer.
- Disadvantages: Variability, inactivation from stomach, patient has to remember to do it, local irritation.
What are the barriers, advantages, and disadvantages to the IV route?
- Barriers: None
- Advantages: Rapid onset. Know exactly how much in system. Permits use of fluid and irritant drugs.
- Disadvantages: Difficult. Need provider/equipment. Irreversible, fluid overload, embolism.
What are the barriers, patterns, advantages, and disadvantages to the SQ route?
Nearly identical to IM
What happens if a drug binds to Albumin which is always in the blood stream?
The drug will have no effect. Albumin is 69,000 MW and because its so big it cant leave the blood stream.
What is a drug half life?
The amount of time it takes a drug in the body to decrease by 50%. When the amount of drug being administered reaches the amount of drug being eliminated, plateau will have been reached.
How many half life’s does it take for a drug to reach its plateau?
4
Maximal Efficacy?
The point to where, even if you give more drug, it wont have an effect.
Potency?
The amount of drug that must be given to elicit an effect.
If a drug is more selective, it has less…?
Side effects.
If a drug only interacts with a few receptors…?
It has a limited drug response.
If a drug interacts with many receptors…?
A wide variety of responses may occur.
What are 3 receptor-less drugs?
1) Antacids: Interacts with stomach molecules.
2) Antiseptic Alcohol: Breaks down bacterial proteins.
3) Magnesium enemas: Causes osmotic reactions to hold fluid in the bowel.
What does the therapeutic index measure?
It measure a drugs safety. The higher the index, the safer the drug. Drugs with a low index will be as harmful as they are effective.
What are the two androgens?
Testosterone and 17-alpha-alkylated.
What are the uses of the Androgens?
- male hypogonadism: don’t produce enough testosterone.
- Delayed puberty
- Replacement therapy
- Wasting in patients with AIDS.
- Anemias
What are the effects of the Androgens?
- Male: Increases genitals, body hair appears, bone/skeletal muscle increase. Sperm production/maturation.
- Female: Maintenance of libido and promotion of clitoral growth.
What anabolic effect do androgens have?
Promotes growth of skeletal muscle
What erythropoietic effect does Androgen have?
Increases RBC production.
What are the adverse effects of Androgen?
-Virilization in women/girl/boys (acne, deepened voice, hair, libido, clitoral enlargement, menstrual irregularities.
-Hepatotoxicity
-Premature epiphyseal closure.
-Increased LDL’s, decreased HDL’s.
-TERATOGENIC
-Promotes growth of prostate cancer (not cause)
-Edema
Gynocomastia
What is the Androgen Prototype?
Testosterone
What oral agents are used to treat ED?
PDE5 Inhibitors
What are PDE5 Inhibitors
Viagra, Levitra, and Cialis.
Patients who use Viagra, should avoid which class of drugs? What is Viagra also used to treat?
- Alpha Blockers.
- Pulmonary artery Hypertension
What are the Adverse effects of the PDE5 Inhibitors?
Hypotension, Priapism, optic neuropathy, sudden hearing loss, MI, Sexual activity due to increased libido can cause heart events (not the drug itself).
What are the PDE5 Inhibitor drug interactions?
- Nitrates (hypotension)
- Alpha blockers (hypotension)
- CYP 3A4 Inhibitors.
What are the contraindications of the PDE5 Inhibitors?
- Men with cardiac problems in the last 6 months.
- Men with hypotension
- Men with hypertension
- Heart failure
What are the non-oral meds for ED?
- Papaverine + Phentolamine
- Alprostadil
What are the adverse effects of Papaverine + Phentolamine?
- Priapism
- O. Hypotension
- Painless nodules
What meds are used to treat PBH?
- **5 alpha reductase inhibitors (finasteride and dutasteride)
- Alpha 1 adrenergic antagonists
What are the adverse effects of the 5 alpha reductase inhibitors?
- Gynomastia
- Decreased ejaculation fluid
- TERATOGENIC
What are the adverse effects of the alpha 1 adrenergic antagonists?
-Vasodilation
-Hypotension
-Somnolence (drowsy)
-Nasal congestion
complications for men undergoing cataract surgery.
What are the Non selective alpha 1 drugs and what are their adverse effects?
- Alfuzosin, Terazosin and Doxazosin.
- vasodilation
- drowsy
- Nasal congestion
What are the selective alpha 1 drugs and what are their adverse effects?
- Silodosin and Tamsulosin
- Abnormal Ejaculation
- cataract surgery complications
What are cycloplegics?
Drugs that paralyze the muscle.
What are mydriatics?
Drugs that dilate the pupil
What effect do anticholinergic drugs have on the eye?
Cycloplegia and mydriasis.
What anticholinergics are used for the eye?
Atropine, cyclopentaolate, homatropine, scopolamine, tropicamide.
What are the adverse effects of the anticholinergic drugs on the eye?
Blurry vision, photophobia (intolerance to light), angle closure, systemic effects.
What is phenylephrines effect on the eyes? What are its Adverse effects on the eye?
- Its an alpha agonist. It causes Mydriasis.
- A/E: Angle closure and floaters.
What drugs are used to treat Allergic conjunctivitis?
- Mast Cell Stabilizers: Cromolyn and lodoxamide.
- Histamine 1 receptor agonists: Azelastine and olopadine.
- NSAIDs
- Glucocorticoids
- Ocular decongestants
What are the adverse effects of using glucocorticoids for allergic conjunctivitis?
Cataracts, Eye infection, increased Intra-ocular pressure.
What are the adverse effects of using Ocular decongestants for allergic conjunctivitis?
Vasoconstriction, rebound congestion.
What is used to treat age related dry macular degeneration?
High dose of antioxidants and zinc.
What class of drugs are used to treat age related wet macular degeneration?
Angiogenesis Inhibitors.
What are the Adverse effects of angiogenesis inhibitors?
Endophthalmitis, increased intraocular pressure, ocular discomfort, blurred vision, floaters, punctate keratitis.
What are the classes of drugs used to treat glaucoma? ABCCMP
- Beta blockers
- prostaglandin analogs
- alpha 2 agonists
- muscarinic agonists
- cholinesterase inhibitors
- carbonic anhydrase inhibitors.
What are the side effects of Beta blockers used for Glaucoma?
Decreased HR, Decreased pulse, bronchospasm, AV block.
What are the side effects of prostaglandins used for Glaucoma?
Increased brown pigment, more effective in African americans
What are the side effects of muscarinic agonists used for Glaucoma?
Retinal detachment and local irritation.
What are the side effects of cholinesterase inhibitors used for Glaucoma?
cataracts
What are the side effects of carbonic anhydrase inhibitors used for Glaucoma?
Allergies and bitter taste.
What is the preferred approach to treating Acute Otitis Media?
A high dose of amoxicillin/clavulanate.
What is What are the 4 stratagies of treating Recurrent Otitis Media?
1) Short term antibacterial therapy
2) Prophylactic antibacterial therapy
3) prevention and tx of the influenza
4) tympanostomy tubes
What are the preferred drugs for treating Acute Otitis Externa?
fluoroquinolones. These are not ototoxic and don’t cause local reactions.
What are the oral medications for AOE?
cephalexin and ciprofloxacin. Only for adults.
What drugs treat Fungal Otitis Externa?
Clotrimazole, itraconazole and fluconazole.
How is Fungal Necrotizing Otitis externa treated?
Anti-psuedomonal therapy. Primaxin or merrem IV.
What ways can Acne be treated?
1) Nondrug tx
2) Topical antibiotic
3) Oral drugs.
What are some of the meds used for acne?
- Topical: Benzoyl Peroxide, clindamycin and erythromycin, dapsone (can turn skin yellow or orange), retinoids.
- Oral: Isotretinoin (Accutane), sprironolactone.
What are the Topical Drugs used for Psoriasis?
- Glucocorticoids (thinning of the skin)
- Vitamin D3 analogs (itchy) (calcipotriene, calcitriol)
- Tazarotene (dry skin, itchy, burning)
- anthralin
- tars (stink, itchy, burning)
What are the Systemic drugs used for Psoriasis?
- Methotrexate: (GI problems, bone marrow suppression, liver, TERATOGENIC)
- Acetretin: (hair loss, skin peeling and all kinds of face issues, TERATOGENIC)
- Cyclosporin: (Kidney damage)
Which drugs are used to treat Actinic Keratosis?
- Flurouracil (topical)
- Imiquimod
Whats used to treat Eczema?
Immunosuppresents: Pimecroliumus and tacrolumus.
What drugs are used to treat warts?
Cryotherapy (freeze), podophyllin, bichloracetic and trichloracetic acid, imiquimod and podofilox.
What drugs are used for the prevention of warts?
Gardisil and Cervarix.
What drugs are used to treat Seborrheic dermatitis and dandruff?
Ketoconazole and Nizoral (head and shoulder)
What drugs are used for Hair loss?
Topical minoxidil (HTN), Finesteride (used for BPH and baldness)
What is a drug used for Pulmonary Arterial Hypertension?
Sildenafil
What is neonatal respiratory distress syndrome a deficiency in?
Lung surfactant
What are some drugs used to treat Neonatal respiratory distress syndrome?
-“actant”
Poractant alfa
calfactant
beractant
-Prenatal of postnatal glucocorticoids (“methasone”)
-The risks don’t outweigh the benefits postnatal.
What 7 things are used to treat Cystic Fibrosis?
-Pancreatic enzymes
-fat soluble vitamins
-Chronic inhaled antibiotics (tobramycin, aztreonam)
-Oral and IV antibiotics
-Inhaled Dornase Alfa
-Oral ibuprofen
-Inhaled B2 agonists
-
What drugs are used to treat Sickle Cell anemia?
- Analgesics
- glucocorticoids
- Hydroxyurea (severe myelosuppression)
What drugs are used to treat Hyperuricemia (gout) due to cancer chemotherapy?
Rasburicase
Allopurinol
Drugs used for dialysis patients…
- Calcium binders: Calcium carbonate and calium acetate.
- Non calcium binders: Sevelamer hydrochloride, sevelamer carbonate, lanthanum carbonate
Drug classes used for Fibromyalgia:
- Amitriptyline
- SSRIs
- SNRIs
- Anticonvulsants
- Analgesics
- sleep aids
Drugs used for Lupus…
- NSAIDs
- Glucocorticoids
- Hydroxychloroquine
- Immunosuppressants
- Belimumab
