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Pharm 1 Final > Pharm One Final - 1 > Flashcards

Pharm One Final - 1 Flashcards

1
Q

What is a medication?

A

A drug used to prevent, diagnose, treat, or cure a disease.

antihistamines, beta blockers, antibiotics, chemotherapy

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2
Q

3 core ethical principles in drug studies

A

Justice, respect, and beneficence

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3
Q

Justice

A

Fair selection of subjects.
Enough subjects in the study.
Testing on the right people.
Distribution of benefits and burdens equitable.
Treating people equally.
Allocation resources to all individuals equally.
Reflects all social classes racial and ethnic groups

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4
Q

Respect

A

Subjects are treated as a person capable of making their own decisions
Subjects have the right to self-determination
Autonomy of the subject
Informed consent

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5
Q

Beneficence

A

Protecs subjects from harm.
Risk/Benefit ratio
Beneficence= Benefit

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6
Q

What are the 2 types of Trials in pharmaceutical research?

A

Pre- Clinical Trials -invivo and invitro animal

Clinical Phases -humans - 4 phases

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7
Q

Name the 4 phases of Clinical Trials

A

Phase 1 -Healthy Patients - small groups
SAFETY/SIDE EFFECTS/DOSAGE

Phase 2 -Have disease or condition - larger group
SAFETY/EFFECTIVENESS

Phase 3 -Have disease or condition - larger group
SAFETY/EFFECTIVENESS/
*SIDE EFFECTS/
*COMPARE TO OTHER DRUGS/
*TREATMENT BENEFITS

Phase 4 -Have disease or condition
- Aftermarket- drug being sold
DIFFERENT POPULATIONS/
LONG TERM EFFECTS

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8
Q

WHAT PHASE OF CLINICAL TRIALS CAN A DRUG BE DISCONTINUED?

A

Any of the 4 phases

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9
Q

LIST the 5 scheduled categories

A

1 - NO ACCEPTED Medical Use - HIGH POTENTIAL FOR ABUSE
Heroin, MDMA, LSD, Peyote
2 - High POTENTIAL FOR ABUSE That may lead to dependence
Used post-surgical for pain.
3 - Potential for ABUSE Not as high as 1 and 2
4. Lower potential for abuse than 3
5. Lower potential for abuse than 4

Remember if a drug addict is in a car accident (or sickle cell crisis) and is in pain, cannot deny them pain medication, even if it is a scheduled drug.

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10
Q

Where are narcotics kept?

A

LOCKED AREA.

PPTX also says double locked cabinet.

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11
Q

When and by who are NARCOTICS counted?

A

Count end of each shift (7 am and 7 pm)

Oncoming nurse counting and outgoing nurse verifying.

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12
Q

What needs to be documented with NARCOTICS?

A
  • The PURPOSE

- The RESPONSE (description and degree of pain/using same pain scale)

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13
Q

What are the THREE types names for a DRUG?

A

Chemical Name = ie C8H9NO2

Generic Name = non-proprietary assigned by FDA - acetaminophen
Generics mus onain the bioequivalent amount as their brand name.

Brand Name = proprietary, trademarked - Tylenol

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14
Q

Name Guidelines for Dietary Supplements

What can they declare with supporting data?

A

-Health claims
-Structure and Function Claims
-Nutrient content claims
-They DO NOT TREAT OR CURE
cannot claim it cures or treats

Regulated by FTC - truth in advertising

Manufacturing Guidelines
Good Manufacturing Practices require:
- quality
-strength
-free of impurities
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15
Q

Do HERBAL REMEDIES need to be reported to the provider?

Why?

A

YES
Side effects and drug interactions
AVOID CAMS if PG, nursing, trying to get PG, infants and iyoung children
Ingredients may not reflect all the ingredients in the remedy

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16
Q

What is Pharmacotherapeutics?

PHARMACO - THERAPEUTICS

A

Use of of drugs to prevent, treat, and diagnose disease as well as to alter normal function (birth control)

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17
Q

Pharmaco-KINETICS

WHAT does ADME stand for?

A

Absorption
Distribution
Metabolism/Biotransformation
Excretion/Elimination

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18
Q

What is Pharmacokinetics?

PHARMACO -KINETICS

A

The process of the drug moving (kinetics) through the body that results in drug action.

  • Absorption
  • Distribution
  • Metabolism (Biotransformation)
  • Excretion (Elimination)

ADME

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19
Q

What is ABSORPTION?

A

How the medication gets into the body.

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20
Q

List Ways Body Absorbs Medications?

A
  1. Oral meds absorbed by GI tract, with help of LOW GI pH (acidic)
  2. Local Effect -Eye drops, ear drops, and inhalers
  3. Enteric-coated drugs - dissolve in small intestine, more alkaline, prevent damage to gastric mucosa
  4. EXCIPIENTS /fillers/inert. Give drug its shape and helps drug to dissolve (ie suppositories, Na+ and K+ In penicillin sodium. With an MI - Do NOT give enteric coated, 325 mg of regular aspirin

SubQ, Rectal, Oral/PO, IV

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21
Q

Name 3 ways ABSORPTION OCCURS IN THE SMALL INTESTINE

A
  • Active Transport
  • Passive Transport
  • Pinocytosis - cell drinking
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22
Q

List 7 factors that influence ABSORPTION

A
  • Blood flow (inc blood flow, inc absorption)
  • Pain
  • Stress
  • Hunger
  • Fasting
  • Food (can make it slower OR faster)
  • pH (acidic or alkaline)
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23
Q

What ROUTE of Meds ABSORB the SLOWEST

A

Rectal

24
Q

Which muscles will IM DRUGS be ABSORBED in Faster and give an example?

A

Muscles with increased blood flow.

Deltoid

25
Q 
List in order of fastest to slowest ABSORPTION
SC
IM
IV
Oral (PO)
Rectal
A

IV, IM, SC, Oral (slow), Rectal (very slow)

26
Q

EXPLAIN ABSORPTION IN FIRST-PASS Effect (oral meds)

A
  1. Oral Meds enter the….
  2. GI tract… then
  3. Via portal vein to the LIVER (can also happen in lungs, vasculature, Gi Tract and other metabolically active tissues in the body.
  4. Liver will metabolized some 100% (Lidocaine) so never given orally.
27
Q

What is the LEAST reliable route of ABSORPTION?

A

Oral

28
Q

What is BIO-AVAILABILITY of a drug

as related to ABSORPTION?

A

The amount of the drug that will be available to the cells.

29
Q

Same medication, which route would have the HIGHEST absorption,
and therefore the LOWEST dose NEEDED?

IV or PO

A

IV

30
Q

EXAMPLES OF ABSORPTION. ADME

A

ABSORPTION

  • The patient has been prescribed an enteric-coated aspirin.
  • The oral route often provides the lowest amount of bioavailability.
  • The patient has medication ordered via the subcutaneous route.
  • The patient has severe pain post operatively and an IV pain med is ordered.
  • The patient has difficulty swallowing PO medications.

Enteric Coating, Oral/PO, SubQ, IV,

31
Q

Define drug DISTRIBUTION.

A

Drug DISTRIBUTION is the movement of drugs to body tissue.

32
Q

Name common blood proteins that drugs bind to in DISTRIBUTION?

A
  • Serum Albumin
  • Lipoproteins
  • Glycoproteins
  • Alpha, beta and Y globulins
33
Q

Are DRUGS attached to proteins

ACTIVE or INACTIVE (Distribution)?

A

INACTIVE

When a drug attaches to a protein it becomes INACTIVE.

34
Q

What are FREE DRUGS? (distribution)

A

Drugs that are UNBOUND to proteins and that can cause a pharmacologic response.

35
Q

What could happen if the patient has a low plasma level and takes a medication?
What populations would have a LOW plasma level?

A

There will be INCREASED free/unbound drugs
and INCREASED free drug distribution.

Who has LESS serum protein?
Elderly and those with liver and kidney disease.

That is why these populations may be given lower doses.

36
Q

What happens when 2 drugs that are highly protein bound compete for sites?

A

There could be drug Toxicity as there is not enough protein to bind them.

This will mean that there is
MORE unbound/free drugs.

37
Q

What prevents the DISTRIBUTION of drugs to the brain?

A 
The BBB (Blood brain barrier) - it has a tight endothelial lining.
It prevents 98% of drugs from entering the brain.
ETOH is an exception.
38
Q

What happens if meds cross (DISTRIBUTION) the placental”

A

Can effect the fetus detrimentally or fatally.

39
Q

Can medications pass from mother to infant through breast milk?
(DISTRIBUTION)

A

Yes

40
Q

Is it ok for PG or nursing mothers to take RX or OTC medications?

A

Need to check with HCP first.

41
Q

Give 5 examples of DISTRIBUTION

A

DSTRIBUTION

  1. Patient is receiving chemotherapy for multiple myeloma which alters the amount of circulating plasma proteins.
  2. Digoxin and Warfarin are highly-protein bound drugs and compete for proteins.
  3. A pregnant woman is taking Zofran which easily crosses the placenta.
  4. The patient has a high amount of unbound proteins in his system.
  5. A patient was involved in a MV accident and suffered from cerebral ischemia. This has affected the patency of the BBB.

Think - proteins, placenta, BBB

42
Q

What is METABOLISM or biotransformation of medications?

A

The process by which the body chemically changes drugs into a form that can be excreted.

43
Q

What is the primary site for METABOLISM of drugs?

A

The LIVER - where the drug is converted to an excretable form.

44
Q

What does the LIVER convert (METABOLISM) a LIPID to ?

Once converted, where does it go?

A

The LIVER converts lipids to water soluble forms so they can be excreted through the kidneys.

45
Q

What is a STEADY STATE for a drug?

A

When the amount of a drug being administered equals the amount that is being eliminated.

Some drugs needs a steady state to be a therapeutic dose.

46
Q

What is a LOADING DOSE of a drug?

A

A loading dose is HIGHER than a maintenance dose. It is used to achieve a THERAPEUTIC effect before a STEADY STATE can be reached.

47
Q

How much Tylenol (200 mg) , which has a half-life of 2 hours, will be left at 12 hours?

A

3.125 mg will be left in 12 hours with a half life of 2 hours and a dose of 200 mgs.
As long as no additional Tylenol is taken.

Starting dose 200 mg→ 
100 mg in 2 hours→ 
50 mgs in 4 hours→ 
25 mgs. in 6 hrs→  
12.5 mgs in 8 hrs→ 
6.25 mgs in 10 hrs→ 
3.125 mgs in 12 hours
48
Q

List examples of METABOLISM

A

METABOLISM

  1. The patient suffers from a disease that increases the half-life of a drug
  2. The patient suffers from cirrhosis of the liver and has elevated liver function tests on his lab work.
  3. A patient is scheduled for a liver transplant and has been advised not to take Tylenol.
  4. The patient has been prescribed a loading dose of Dilantin after being hospitalized for a seizure.
  5. The patient has been prescribed a loading dose of Coumadin to achieve a therapeutic effect.

THINK- LIVER. LOADING DOSE. HALF-LIFE

49
Q

What is the main route of EXCRETION/ELIMINATION?

A

KIDNEYS, but also-

BILE, 
LUNGS, 
SALIVA, 
SWEAT, and 
BREAST MILK
50
Q

What is the MAIN FACTOR influencing how well a drug is EXCRETED

A

Renal Function

51
Q

Renal function

PreRenal Factors:

A

Dehydration
Hemorrhage
Reduced renal blood flow

How much water and blood will enter the kidney

52
Q

Renal Function

Intra-renal Factor

A

Decreased glomerular filtration

GFR

53
Q

List examples of EXCRETION/ELIMINATION

A

EXCRETION
1. The patient has been admitted to the hospital with severe dehydration, and elevated BUN/Creatinine, and a UTI. the patient was prescribed abx.
2. The patient has BPH and a decreased urine output.
3. The patient is a 28 year old female with an URI who was prescribed abx and receives hemodialysis three times a week.
4. The patient is elderly and has decreased renal function.
5. The patient has a decreased GFR.
IF BUN and CR Elevated NOT Excreting properly.

RENAL FUNCTION

54
Q

Renal Function

Post-Renal Factors

A

BPH (benign prostatic hypertrophy)
Calculi
Neurogenic Bladder

Factors that affect the urine exiting the kidney

55
Q

What do you assess to prevent drug TOXICITY?

A

Renal function

BUN/Creatinine
GFR

Test for Peak and Trough -esp ABX

56
Q

Define SIDE EFFECTS

A

PREDICTABLE secondary effects of drug therapy.
Range from mild to severe.
Can lead to non-compliance with medications.
Some drugs are used for their side effects.
ie Minoxidyl was originally used to treat HTN, now used to increase hair growth.

Do not stop drug, just because patient is uncomfortable with side effects. Stay on it unless it is severe.

Pharm 1 Final (8 decks)

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