Pharm Notes Flashcards
How many schedules of controlled substances?
5
Drugs that have no accepted medical use, lack accepted safety, and have high abuse potentials: heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxy methamphetamine (MDMA or ecstasy), mescaline, and peyote.
Schedule I
Drugs that are used medically and have high abuse potentials: opioid analgesics (e.g., codeine, hydromorphone, methadone, meperidine, morphine, oxycodone), central nervous system (CNS) stimulants (e.g., cocaine, methamphetamine), and barbiturate sedative–hypnotics (e.g., pentobarbital).
Schedule II
Drugs with less potential for abuse than those in Schedules I and II, but abuse of which may lead to psychological or physical dependence: androgens and anabolic steroids, some depressants (e.g., ketamine, pentobarbital), some CNS stimulants (e.g., methylphenidate), and mixtures containing small amounts of controlled substances (e.g., codeine, barbiturates not listed in other schedules). These drugs and substances have an accepted medical use in the United States.
Schedule III
Drugs with an accepted medical use in the United States but with some potential for abuse: benzodiazepines (e.g., diazepam, lorazepam), other sedative–hypnotics (e.g., phenobarbital, chloral hydrate), and some prescription appetite suppressants (e.g., phentermine).
Schedule IV
Products containing moderate amounts of controlled substances. The pharmacist may dispense them without a physician’s prescription but with some restrictions regarding the amount, record keeping, and other safeguards. Included are cough suppressants containing small amounts of codeine and antidiarrheal drugs, such as diphenoxylate and atropine (Lomotil).
Schedule V
Negligence
Misfeasance
Omission
Nonfeasance
Giving the correct drug via the wrong route
Malfeasance
What are the specific processes involved in pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
+Onset of drug action is determined by the rate of absorption.
+Factors that affect the rate and extent of drug absorption;
-Dosage form, route of administration
-Administration site blood flow, GI function
-The presence of food or other drugs
Absorption process
+Drugs are carried by blood and tissue fluids to; Action sites, Metabolism sites, Excretion sites
+Depends on adequacy of blood circulation
Distribution process
The distribution process affected by
+Protein binding
+Blood–brain barrier
+Pregnancy
+Lactation
+The method by which drugs are inactivated or biotransformed by the body
+Drugs changed to; Inactive metabolites, Active metabolites, Prodrugs
Metabolic process
Drug-metabolizing enzymes are located within
+Kidneys
+Liver
+Red blood cells, plasma
+Lungs
+Gastrointestinal mucosa
Factors that affect drug metabolism
+Enzyme induction
+Enzyme inhibition
+elimination of a medication from the body
+Requires adequate function of; Circulatory system. Kidneys, bowel, Lungs, Skin
Excretion
Serum drug level?
+a laboratory measurement of the amount of a drug in the blood at a particular time
+Minimum effective concentration (MEC) must be present for efficacy.
+Toxic concentration: excessive level of medication in the bloodstream; caused by
-Single large dose
-Repeated small doses
-Slow metabolism of medication
Serum drug level reflects?
+Dosage, absorption
+Bioavailability, half-life
+Rates of metabolism, excretion
Receptor Theory of Drug Action
+Drugs exert their effects by chemically binding with receptor cells through
-Activation, inactivation, or alteration of intracellular enzymes
-Changes in the permeability of cell membranes to one or more ions
-Modification of the synthesis, release, or inactivation of neurohormones
-Agonists and antagonist drugs
What are Nonreceptor Drug Actions?
+Relatively few drugs do not act on receptor sites. These few drugs include
-Antacids
-Osmotic diuretics
-Several anticancer drugs
-Metal chelating agents
Drug-Related Variables
+Dosage
-Frequency, size, number of doses
+Route of administration
-Influences absorption and distribution
+Drug–diet interactions
+Drug–drug interactions
+Interactions that can increase therapeutic or adverse effects include
-Additive effects
-Synergism
-Interference
-Displacement
+Interactions in which drug effects are decreased include
-Antidote medication
-Decreased intestinal absorption of drugs
-Increased metabolism rate of drugs
+Main goals of treatment
-Starting treatment soon
after ingestion
-Supporting and stabilizing
vital function
-Preventing further damage
by
-Reducing absorption
-Increasing elimination
-Administering antidotes
whenever possible
Toxicology
6 Rights of Medication Administration
Right Patient
Right Drug
Right Dose
Right Route
Right Time
Right Documentation
what is a Black Box Warning
warning that the FDA can give prescription drug groups and individual drugs that may cause serious or life-threatening adverse effects
What information must be on a Medication Order
+The patient’s full name
+Name of the medication (brand, generic)
+Dose
+Route
+Frequency of administration
+Date
+Time
+Signature of the prescriber
Medication Delivery Systems “PO”
+By mouth (PO)
-Tablets
-Capsules
-Sublingual
Medication Delivery Systems “Controlled Release”
+Controlled release
-Enteric coated (to prevent
stomach upset)
-Maintains more consistent
serum drug levels
-Allows less frequent
administration
-More convenient for
patients
+Tablets, capsules
-Contain high amount of drug
-Intended to be absorbed
slowly over prolonged period
of time
-Should never be broken,
open, crushed, chewed
Medication Delivery Systems “Transdermal”
Systemic absorption through skin
Medication Delivery Systems “Pump delivery systems”
+External or implanted
+Refillable or long-acting
without refills
-Insulin, opioid analgesics,
anticancer medications
Medication Delivery Systems “Topical”
+Solutions
+Creams
+Suppositories
+Frequently used for local
treatment
Injection Sites: Sub-Q common sites
Upper arms, abdomen, back, thighs
Injection Sites: IM common sites
Ventrogluteal, deltoid, vastus lateralis muscles
Injection Sites: IV common sites
Back of hands, forearms
Drug Sources
(1) Plants
(2) Animals
(3) Minerals
(4) Synthetic compounds
Synthetic compounds - Synthetic drugs
are more standardized in their chemical characteristics, more consistent in their effects, and less likely to produce allergic reactions.
Semisynthetic drugs
(e.g., many antibiotics) are naturally occurring substances that have been chemically modified.
Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs.
Patient-Centered Care
Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Teamwork and Collaboration
Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Evidence-Based Practice (known as EBP)
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to improve the quality and safety of healthcare systems continuously.
Quality Improvement
Minimizes risk of harm to patients and providers through both system effectiveness and individual performance
Safety
Use information and technology to communicate, manage knowledge, mitigate error, and support decision-making.
Informatics
Beers Criteria for Potentially Inappropriate Medications Used in Older Adults
The American Geriatrics Society Beers Criteria, a list of medications that are generally considered best avoided in older adults and specifically in those with certain diseases, confirms that toxic medication effects and drug-related problems affect the safety of older adults.
Drugs that do not act on receptor sites
(1) Antacids, which act chemically to neutralize the hydrochloric acid produced by gastric parietal cells and thereby raise the pH of gastric fluid
(2) Osmotic diuretics (e.g., mannitol), which increase the osmolarity of plasma and pull water out of tissues into the bloodstream
(3) Drugs structurally similar to nutrients body cells require (e.g., purines, pyrimidines) can be incorporated into cellular constituents, such as nucleic acids, which interfere with normal cell functioning. Several anticancer drugs act by this mechanism.
(4) Metal chelating agents, which combine with toxic metals to form a complex that can be more readily excreted
Decreased intestinal absorption of drugs
which occurs when drugs combine to produce nonabsorbable compounds. For example, drugs containing aluminum, calcium, or magnesium bind with oral tetracycline (if taken at the same time) to decrease its absorption and therefore its antibiotic effect.
Increased metabolism rate of drugs
Activation of drug-metabolizing enzymes in the liver, therefore decreasing the drug’s effects.
Newly developed drugs have been extensively tested using a five-phase process before being marketed for general use.
In phase 0, drug testing occurs in animals and small groups of humans.
In Phase 1, a few doses are given to a certain number of healthy volunteers.
In Phase 2, a few doses are given to a certain number of subjects with the disease or symptom for which the drug is being studied. In
In phase 3, the drug is given to different populations and different dosages by using the drug in combination with other drugs. in a double-blind, placebo-controlled design, half of the subjects receive the new drug and half receive a placebo.
In Phase 4, the FDA allows the drug to be marketed and requires manufacturers to continue post-marketing monitoring and electronic report submission of the drug’s safety and effectiveness.
are more standardized in their chemical characteristics, more consistent in their effects, and less likely to produce allergic reactions.
Synthetic compounds
