Pharm Unit 1 Flashcards
what criteria would the perfect drug have?
highly potent 100% selective for the part of the body being treated no side effects no drug interation universally affordable
What is MOA
Mechanism of Action (how the drug works)
what is another name for the class of a drug
MOA (mechanism of action)
basic pharmaceutical profile for drugs in a particular class?
absorption degradation & elimination potential drug-drug interactions monitoring requirements use in subpopulations (like pediatrics or pregnancy)
special patient populations to consider with drug selections
age sex reproductive status culture polypharmacy
patient education with certain drugs may include:
name of drug (brand name & generic) dose & dose interval length of treatment (acute or chronic)(refills?) need for monitoring and followup care signs & symptoms of toxicity goals of treatment help patient understand condition
change biologic functioning via chemical action on cells
drugs
study of how chemicals interact with living systems
pharmacology
drugs that are chemicals that our own bodies produce
endogenous substances
drugs administered to a person
exogenous substances
drug use in humans in order to treat and prevent disease, recreation, or religion/culture
pharmacotherapy
aka applied pharmacology, medical pharmacology, &pharmacotherapeutics
undesirable effects of chemicals on living systems
toxicology
harmful drugs and/or inorganic toxins
poisons
poisons of biological origin
toxins
what is the smallest part of matter?
atom
what is made up of only one type of atom?
element
what is made up of more than one type of atom?
molecule (compound)
total atomic weight of all atoms in a molecule
molecular weight (MW)
three states of matter that are determined by ambient temperature and pressure
solid
liquid
gas
what are the five elements that all ORGANIC COMPOUNDS are comprised of?
Carbon Hydrogen Oxygen Nitrogen Sulfur (some)
a solid substance that is dissolved in a liquid
solute
liquid (water) in which substances are dissolved
solvent
electrically charged particles in solution
ions
positively charged ion
cation
negatively charged ion
anion
ions in living systems are called . . .
electrolytes
what is something without an electrical charge?
neutral
scale that measures the acid in a solution
pH scale
chemicals that can accept a hydronium ion (H+) in solution
bases
chemical made up of a conjugate base and a hydronium ion (H+)
acid
what does the route of drug administration depend upon
physical state of the drug (chemical)
inhaled, oral, injected
type of drug that has a right or left orientation
racemic (aka chiral, isomers, dimers)
what is it called when one chemical attaches or associates with another?
bonding
kind of bond that is strong and usually not reversible
less common in drugs
covalent bonds
type of bond that is weaker in nature and is more reversible as drugs can dissociate away after initial bonding
weak bonds
two types of weak bonds
electrostatic bonds
hydrophobic bonds
type of substance that does not form bonds
inert substance
name of the concept that causes solute to passively diffuse from areas of high concentration to areas of low concentration with out any energy being required
Concentration Gradient
name for a water soluble substance
hydrophilic
name for a lipid soluble substance
lipophilic
substance that is both water and lipid soluble
amphiphilic
in the body, what is the “water compartment” that water soluble drugs travel through?
plasma in the bloodstream
what do lipid soluble drugs have to get through to get out of the bloodstream and into the tissues?
phospholipid cell membrane
type of protein that helps carry a drug across the cell membrane
transporter protein
what type of drug (by solubility) can cross the Blood Brain Barrier
lipophilic
two things that help to create the blood brain barrier
neuroglia
tight juctions
astrocyte cells that are supporting cells of the brain that help make up BBB
neuroglia
what areas of the brain do not have the BBB and why?
pituitary
hypthalamus
pineal
-because the brain needs to sample the body’s internal environment for regulation of body function
name some substances that can easily pass through the BBB
lipophilic substances (alchohol, and anesthetics)
water
gases (such as carbon dioxide)
name three things that have difficulty passing through the BBB
proteins
electrolytes
many therapeutic drugs
expected benefits of a drug
target outcome
the drug that should work the best, be the first-line therapy, have the least toxicity to the patient, and be effective when used alone
Drug of Choice (DOC)
a drug that is effective when it is used alone is called
monotherapy
the reason or medical condition that the drug is being used
indication
this is what the FDA has legally determined to be the clinical condition for which a drug should be used
label indications (label approved)
when a clinician prescribes drugs that are not label approved for a specific condition due to clinical evidence that it will work based on the science of the drug
Off label use
possible reasons such as age, sex, reproductive status, allergies or comorbidities to NOT use a drug on a particular patient
contraindications
when a patient is to NOT be given a certain drug under any circumstances
absolute contraindications
when the need for a drug is greater than the possibility of an adverse drug reaction, and a risk-benefit decision has to be made by the provider and the patient
relative contraindication
two classes of legal drugs
prescription
over the counter (OTC) and behind the counter (BTC)
book that is published by the FDA listing all approved drugs in the USA
The “Orange Book”
drugs that are further regulated by the Drug Enforcement Administration (DEA) due to their abuse potential are called . . .
controlled substances
another name for controlled substances that refers to the time constraints put on to how often a certain drug may be prescribed to or purchased by a single person
“Schedule drugs”
class of licit drugs that can be safely administered by a lay person who can also understand the directions, indications, and contraindications. they do not represent potential for loss of life, limb, or eyesight.
Over the Counter (OTC)
drugs that do not require a prescription, but are not kept out in the open because they still have to be regulated and have purchase limits.
Behind the Counter (BTC)
a drug that requires a prescription from a licensed provider in order to be obtained from a pharmacist
legend drug
a drug name that follows nomeclature rules
generic names
an FDA approved drug name that is owned by a drug company and used for marketing
brand name
who determines schedules for schedule drugs?
Drug Enforcement Agency (DEA)
this particular schedule of drug is considered illicit and is illegal in the USA
Schedule I
Schedules of drugs that are considered licit (legal) and require additional prescriptive authority from the federal government
Schedules II-V
a drug law that was passed in 1970
Controlled Substance Act
What does the term illicit mean?
use is subject to legal penalties (illegal)
schedule number of the drug that has a high potential for abuse, lack of safety for use in treatment, and no accepted medical use in treatment in the USA.
C-1
schedule of drugs with high potential for abuse that may lead to severe psychic or physical dependence
C-2 (vicodin, lortab, oxycodone, methadone…)
what schedule of drug to different depressants and stimulates fall under?
C-4
what class of drug has the lowest risk for abuse
C-5
what is a DEA code number?
4-digit number assigned to each CS (controlled substance)
two types of safe drug disposal
trash-mixed with non-drug substances
flushed down the toilet
kind of nutrition that maintains a healthy body and helps prevent illness
preventive nutrition
type of nutrition that is designed to help cure illness and alleviate symptoms
prescribed nutrition
what is it called when nutrition is prescribed and therefore charted?
Medical Nutrition Therapy (MNT)
food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease.
medical foods
actions of drugs on the body
pharmacodynamics
actions of the body on drugs (referring to the detoxification, inactivation, and excretion of drugs)
pharmacokinetics
strength of a drug to bind to a specific receptor
affinity
a chemical that binds to a receptor is called a _______
ligand
drugs that bind and activate the receptor to produce the desired biologic effect
agonists
when body’s endogenous substances inhibit or block the effect of an agonist, and they are competing for the same cell receptor binding site
antagonist
this means to speed up a reaction
catalyze
the name of an enzyme always ends in ___.
-ase
a sequential series of chemical reactions catalyzed by enzymes
metabolic pathway
prevent normal physiologic activity of cell pumps
pump poisoners
affects the water balance of the body’s compartments
osmotic effects
when a drug has affects on the body beyond what is expected from its MOA
pleiotropic effects
these naturally restore the balance of bacterial flora in the body
probiotics
drugs that are designed in a lab and are engineered to act at the micro-molecular biochemical level
designer drugs
results of placebo-controlled, double-blind, cohort matched randomized control trials tell us if drug claims are really true
evidence based medicine (EBM)
steps of the EBP process
Assess the patient Ask the question Acquire evidence Appraise the evidence Apply by talking with the patient Self evalutaion
substance given to a patient with no known drug effect
placebo
when a patient reports improvement or even objectively measured data improves even though they have not actually taken a drug
placebo effect
when both the investigator and the patient are unaware regarding who is receiving active drugs or placebos
double blind
when an investigator and their patients are aware of the therapy and know that they have received a placebo
open-label drug trial
trial of two drugs in the same class to see which one is better
head-to-head trial
comparison of generic drugs to brand name
bioequivalence
type of drug that requires a very consistent blood level and is therefore not allowed to be substituted with its generic brand
critical dose drug
medical conditions that the drug is FDA approved to treat
label indications
when a drug is label approved for one condition and then prescribed to treat another, with the support of a scientific basis
off-label prescribing
drugs that have limited uses for very rare diseases
orphan drugs
organization that aims to provide drug information to consumers with websites for drugs
Center for Drug Evaluation and Research (CDER)
summary of chemical and biological information on a drug, inlcluding data from RCT’s, warnings, prescribing guidance, how it’s supplied, dosing, ect.
Prescribing Information
where are vaccine-related injuries and/or adverse effects reported to?
Vaccine Adverse Effects Reporting System (VAERS)
put at the very top of the Prescribing Information for the drug to highlight a serious adverse effect risk
Black Box Warning (BBW)
what is it called when a patient just takes a medication as it is prescribed?
compliance
what is it called when a patient takes a medication as it is prescribed and follows through on other elements of the management plan (like diet and exercise)
adherence
when the continued administration of a drug results in decreased response to the same dose, thus a higher dose will be needed to achieve the same drug effect
tolerance
what is it called when tolerance develops rapidly?
tachyphylaxis
when a drug stops and a withdrawal syndrome developes
physical dependence
drugs in the same class that are used to prevent or relieve symptoms of withdrawal from another drug in the same class
cross-dependence (cross tolerance)
feeling of satisfaction and desire to repeat drug experience despite knowing that the drug us causing harm
psychologic dependence (addiction)
episodic drug use without dependence, often practiced within rituals & in company of others
recreational drug use
when drugs are marketed by a pharmaceutical company in a combined form (tablet, capsule) and a prescriber can use the combination of these two drugs with one prescription
fixed-drug (fixed-dose) combination
when all cell receptors are occupied by a drug
maximal response
dose at which 50% of the population studied will show the toxic effect
median toxic dose (TD50)
dose at which 50% of the population studied will die
median lethal dose (LD50)
drugs that are added to the primary drug to allow use of primary drug at lower dose to decrease toxicity
adjunctive drugs
dose at which 50% of the population exhibits the desired effect
effectiveness (ED50)
compares the TD50 (or LD50) with the ED50 to determine the margin of safety for a drug
therapeutic index (TI) (aka selective toxicity)
dose range that gives a benefit without toxicity
therapeutic window
a reaction that occurs that is not part of the expected therapeutic response to a drug
adverse drug reaction (ADR)
aka adverse event, adverse effect, adverse drug event
any mistake made in diagnosis or treatment
medical error
any mistake made in prescribing, transcribing, dispensing, or administering medication
medication error
a medical (or medication) error that has not caused harm
near miss
when a medical mistake causes harm
preventable adverse effect
three types of ADR’s
dose related (toxic)
predictable (side effects)
immunologic or idiosyncratic
ADR where as the dose increases, so does the ADR potential
dose related (toxic)
ADR that is really just a side effect of the drug
predictable ADR
and ADR that is unrelated to pharmacologic actions
idiosyncratic
an ADR that is an allergic reaction where an immune response has occured
immunologic
when serious and potentially life threatening symptoms occur, usually minutes after contact with an allergen
anaphylaxis
type I hypersensitivity
anaphylaxis
type III hypersensitivity
aka serum sickness
type IV hypersensitivity
contact dermatitis
rash eruptions that are independent of IgE effects
cutaneous drug reaction
“what the body does to the drug
pharmacokinetics
pharmacokinetics 4 steps (ADME)
absorption
distribution to tissues
metabolization (biotransformation & elimination)
excretion
when the response of combined drugs is additive (1+1=2)
addition
effect achieved by using combined drugs is greater than would be predicted than by simple additive effects often due to complementary effects of the drug MOA (1+1>2)
synergism
a drug with no effect will enhance the effect of another drug
potentiation
one drug inhibits the effect of another drug
antagonism
drug toxicity effect that causes loss of consciousness (LOC) and death.
named for the QT interval prolongation and tachycardia on the EKG
Long QT Interval Syndrome (LQTS)
amount of time needed for the plasma concentration to drop by 50% after the drug is discontinued. determines how long the drug remains in the system
half-life (elimination)
strategy to get a higher serum level immediately by using a larger dose for the first dose
loading dose
3 checks of medicine administration
1st: when you receive the med
2nd: when you prepare the med
3rd: when you bring the med to the patient
5 rights of medication administration
right patient right drug right dose right route right time
2 newly added rights of med administration
right reason
right documentation
examples of medication calculation
conversion between systems
pediatric dosing based on age, weight and ,surface area
dosage calculation formula for IV drips
drops/min= (mL of solution prescribed per hour x drops delivered per minute) / (60 min/hr)
four pediatric rules of dising
Fried’s rule (toddlers)
Young’s rule (children 1-12)
Clark’s rule (newborns & young infants)
body surface area calculations
Fried’s rule
child’s dose = ?
(age in months x adult dose) / 150
Young’s rule (children aged 1-12)
child’s dose = ?
(child’s age in years x adult dose) / (child’s age + 12)
Clark’s rule (newborns and young infants)
child’s dose = ?
(child’s weight in lbs x adult dose) / 150
Body surface area calculation (most common way)
child’s dose = ?
(child’s BSA / 1.73) x adult dose
reproductive and nursing status for drug administration includes:
last menstrual period
birth control
lactation history
pregnancy drug categories from least to greatest on risk of fetal harm
A, B, C, D, X
category that drugs are absolutely contraindicated in pregnancy or women who may become pregnant
Category X
at what point in her daily lactation cycle should a breastfeeding mother take he medications, just to be sure that it is cleared from her blood before her next feeding
30-60 minutes after nursing and 3-4 hours before her next feeding
list of medicines that are drug intolerances in children
Benzyl alcohol BP meds Arthritis meds Iron Aluminum tetracyclines & quinolone antibiotics
geriatric drug concerns may include:
aging physiology higher fall risk (sedatives) respiratory depression risk (opiods) renal toxicity polypharmacy
when multiple drugs are used daily, and there is an increased risk of drug interactions and toxicities
polypharmacy
what problems to these help reduce?:
medication disclosure
ID drugs by generic name & class
right drug for right reason
know side effects for each
ID risk of adverse effects
eliminate drugs with no benefit or indication
substitute for less toxic drugs if possible
try to avoid prescribing drugs to treat other drug side effects
try to have each drug to one dose per day
polypharmacy issues
someone with the ability to assess, test, diagnose, generate and implement a plan of care
provider
examples of medical prroviders
MD (medical doctor) MO (doctor of osteopthy) NP (nurse practitioner) PA (physician's assistant) DDS (dentist) DPM (podiatry)
healthcare member who dispenses drugs with an order from a licensed provider
pharmacist
healthcare member who administers drugs with an order from a provider
nurse
routes of drug administration
oral (withstand stomach acid)
oral disintegrating tablets ( straight to bloodstream)
sublingual
rectal (used in unconscious or vomiting people)
inhalational (lung or nasal sprays)
topical (usually dermatologic or ophthamlmologic)
transdermal (patches)
parenteral (intravenous, intramuscular, subcutaneous)
intrathecal (directly to CSF into brain ventricles)
epidural & spinal (injection to spaces surrounding spinal chord)
drug formulation with more rapid onset of action that also lasts a shorter period of time
immediate release
drug formulation with slower onset of action but more predictable release to body that last for a longer period of time
extended release
nursing medicinal responsibilities to prevent medication errors
assessment administration of ordered meds and therapy assessment of reaction to meds teaching assessment of teaching effectivness
patient education of the drugs they are prescribed includes:
name dose action administration timing storage and prep alternative therapies and drugs to avoid safety measures points about drug toxicity warnings about drug discontiuation
special warnings to give about drugs to patients:
drowsy warning alcohol diet drug interactions pregnancy refills
effect of medication and medical errors on a nurses life
“Second Victim Syndrome”
5 steps of the nursing process
clinical history assessment physical exam assessment nursing diagnosis intervention (plan of care) evaluation (was plan of care effective?)
Medication Administration Record includes:
patient name drug name, dosage, frequency & time & route of administration name of prescriber time given date of most recent order food & drug allergies
botanicals, recognized for medicinal effect, that are ingested, inhaled, or massaged into skin
herbal medicine (phytomedicine)
warnings about herbal medicine
may have interactions with OTC drugs
may have issues with purity and dosing variability
may have long term and short term issues
may affect an existing clinical condition
may have organ toxicity
may have an allergic reaction
type of juice that inhibits CYP3A4 enzyme path, causing drug to stay in the system for longer than they are supposed to and can cause drug levels to rise dangerously
grapefruit juice
4 types of food sensitivity reactions
food hypersensitivity & anaphylaxis (common reactions) food intolerance (gluten, lactose) food toxicity (poisoning -- additive, microbe toxins) food idiosyncrasy (MSG reactions)
when patients exhibit food reactions to herbal products within the same botanical families
(nuts, citrus, shellfish, melons & ragweed pollen, birch pollen & apples, latex & certain foods)
cross reactivity
if allergic to latex, one may have cross reactivity to foods such as:
bananas kiwis peanuts avocados chestnuts soybeans
common food additives that cause reactions
sulfites
MSG
dyes
5 injection sites
deltoid (upper arm) rectus femoris (anterior thigh) ventrogluteal (side hip) dorsogluteal (back of hip) vastus lateralis (side thigh)
