PHARMA prelim Flashcards
Study of drugs and their actions on living organisms
Pharmacology
Pharmacology greek origin and meaning
Pharmakon - drugs
Logos - science
Chemical substances that have an effect on living organisms
Drug
Chemical constitution of the drug
Chemical Name
Common name; Name listed in the US Food
and Drug Administration
Generic Name
Name given by the manufacturer
Brand Name
Identify the source of drugs:
○ Digitalis, Morphine, Codeine
Plants
Identify the source of drugs:
insulin, thyroid drugs
Animal Products
Identify the source of drugs:
○ aluminum -> antacid
○ Fluoride -> prevent dental cav
○ Gold -> rheumatoid arthritis
○ Iron -> anemia
Inorganic Compounds
Identify the Classification of drugs:
● Those given by injection
● Hypnotic Drugs
● Narcotics
● Habit-forming Drugs
● Drugs that are unsafe unless administered under the supervision of
a licensed practitioner
● New drugs that are investigated
Prescription drugs
Identify the Classification of drugs:
● Available without prescription
○ Category I = safe and effective
○ Category II = either unsafe or ineffective
○ Category III = insufficient data to classify
Over the Counter Drugs
Identify the Classification of drugs:
● Discovered but are not financially viable and not yet adopted by
any drug company
● Treat rare disease
Orphan Drugs
Identify the Drug Evaluation:
● Chemicals are tested to determine whether they have effects
● Evaluate adverse effects
Preclinical Trials
Identify the Drug Evaluation:
● Healthy volunteers to test drugs
Phase I Studies
Identify the Drug Evaluation:
● Try drugs to patients who have the disease
● Performed at various studies
Phase II Studies
Identify the Drug Evaluation:
● Use of drug in vast clinical market
● NOTE: After phase III, there would be a continuous evaluation
Phase III Studies
Identify the Drug Evaluation:
● Lack therapeutic activity
● Too toxic, teratogenic
● Small safety margin, produce unacceptable side effects
● Have a low benefit to risk ratio
● Not as effective as available drugs
Drug Dropped from the study
Identify the Pregnancy Categories:
No risk to fetus in the 1st trimester and later
Category A
Identify the Pregnancy Categories:
Animal studies = no risk to fetus
No adequate studies in pregnant women have shown
an adverse effects Little to NO RISK to the fetus in the
1st trimester
Category B
Identify the Pregnancy Categories:
Animal studies = no risk to fetus
May be acceptable
No adequate studies on humans
Category C
Identify the Pregnancy Categories:
Human fetal risk
Benefit vs. risk
Life threatening situation
Weigh, explain properly through therapeutic
communication, and discuss the benefits and risk for
both the mother and the baby
Category D
Identify the Pregnancy Categories:
Human fetal risk proven
Risk on use of pregnant women
Category X
Identify the Controlled Substances:
High abuse potential drugs
No accepted medical use
● Ex: Heroin, marijuana, LSD
Schedule I (C-I)
Identify the Controlled Substances:
High abuse potential
Accepted medical use
Severe dependence liability
● Ex: Narcotics, barbiturates
Schedule II (C-II)
Identify the Controlled Substances:
Less abuse potential
Moderate dependents
Medically accepted drugs
● Ex: Nonamphetamine stimulants, codeine
preparations, paregoric, nonnarcotic drugs
Schedule III (C-III)
Identify the Controlled Substances:
Less abuse
Limited dependence
Antianxiety, sedative
Medically accepted drugs
● Ex: Phenobarbital (luminal),
benzodiazepines
Schedule IV (C-IV)
Identify the Controlled Substances:
Limited abuse potential
Medically accepted drugs
● Ex: Opioid-controlled substances for
diarrhea and cough
Schedule V (C-V)
Nurses CANNOT prescribe
True
COMPREHENSIVE DANGEROUS DRUG
ACT OF 2002
● Practitioner, who shall prescribe any dangerous drug to any person
whose physical or physiological condition does not require the use
● Imprisonment ranging from 12 years and 1 day to 20 years and a
fine ranging from P100,000.00 to P500,000.00 and the additional
penalty of the revocation of his/her license to practice
RA ACT 9165
GENERICS ACT OF 1988
● Generic Name
○ identification of drugs with scientifically and internationally
recognized active ingredients
○ promote, encourage and require the use of generic terminology
in the importation, manufacture, distribution, marketing,
advertising and promotion, prescription and dispensing of drugs
○ ensure the adequate supply of drugs with generic names at the
lowest possible cost and endeavor to make them available for
free to indigent patients
RA ACT 6675
- GENERICS ACT OF 1988
● Essential Drug List
○ List of drugs prepared by DOH on the basis of health conditions
in the Philippines as well as internationally accepted criteria
RA ACT 6675
NARCOTIC DRUG ACT
● Registration and imposition of license on all persons who deal with
narcotic drugs and the control of the legal traffic in narcotic drugs
RA 953
drugs which produces insensibility, stupor,
melancholy or dullness of mind, habit forming
Narcotics
drugs with opium, cocoa leaf, heroine,
morphine, LSD
Prohibited Drugs
self-inducing sedatives, secobarbitals,
hypnotic drugs
Regulated Drug
EXPANDED SENIOR CITIZENS ACT gives privileges to elderly Filipinos 60 years and
above.
● Entitled to 20% discount and exempted from VAT ( value added tax)
● For medicines, generic and branded, vitamins and mineral
supplements with doctor’s prescription
Republic Act 9994
Name the steps of pharmaceutic phase
Tablet - Disintegration - Dissolution
Process of drug movement to achieve drug action
Pharmacokinetics
Four Processes of pharmacokinetics
○ Absorption
○ Distribution
○ Metabolism
○ Excretion
Movement of drug particles from the GI tract to body fluids by
PASSIVE, ACTIVE absorption or pinocytosis.
Absorbtion
occurs by diffusion
Passive absorption
requires carrier, thus energy to transport
Active absorption
cells engulfing the drug particles
Pinocytosis
■ “Hepatic First Pass”
■ Drug passes to the liver first
Absorption Principles
percentage of the drug that reaches the systemic
circulation
Bioavailability
Process when drug becomes available to body fluids and tissues
Distribution
■ Drugs bind to protein; the portion that is bound is INACTIVE,
while the portion that is unbound is ACTIVE or FREE drug.
■ two or more highly protein-bound drugs are given at the same
time - free drug in the circulation - toxicity protein level -
protein binding sites - free drug – drug accumulation/toxicity
Protein-binding Effect
■ allows only lipid-soluble drugs
■ Factors that affects Protein Levels:
● Nutrition
● Age
● Liver and Kidney Disease
Blood-brain Barrier
● “biotransformation”
● Process by which body inactivates the drug
● GI tract, LIVER
Metabolism
The time it takes for one half of the drug concentration to be eliminated
Half-life
What is considered a short half life
4-8 hours
What is considered a long half-life
24, 36 and longer
○ In 12 hours, half of the 50 mg (25mg) would remain.
○ In another 12 hours (24 hours), half of 25mg (12.5mg)
remains.
■ After 36 hours = 6.25mg
■ After 48 hours = 3.125mg
■ After 60 hours = 1.56mg
■ After 72 hours = 0.78mg
■ After 84 hours = 0.39mg
■ After 86 hours = 0.195mg
■ After 108 hours = 0.097mg
● IT WOULD TAKE 4 1⁄2 to 5 DAYS TO CLEAR THE DRUG
WITH A HALF-LIFE OF 12 HOURS.
In excretion this Filters free unbound protein and water soluble drugs;
○ Laboratory results that decipher that kidneys are excreting
correctly:
Excretion
Study of drug concentration and its effects on the body
Pharmacodynamics
Desirable effects
Primary Effect
Desirable of undesirable effects
Secondary Effects
Time it takes to reach the minimum effective concentration
Onset
Drug reaches its highest blood concentration
Peak
Time the drug has its pharmacologic effect
Duration
Drug works to initiate a response
Agonists
Drugs works to block a response
Antagonists
Receptor produces a variety of
effects on different organs
Nonspecific Drug Effects
Affects different receptor sites
Non-selective drug effects
Drug action which increases production
Stimulation
Drug action which reduces production
Depression
Drug providing something lacking
Replacement
Static of production or killing
Inhibition or killing of organisms
Measures the margin of safety of a drug
It is the ratio that measures the effective therapeutic dose and the lethal dose
Therapeutic index
Narrow margins of safety
Increased TI (safe)
Wide margins of safety
Decreased TI (toxic)
when immediate response is desired. After
loading dose, a prescribed daily dose is ordered
Large initial dose
Response to the drug tolerance to narcotics
Tolerance/ tachyphylaxis
physiologic effects not related to desired drug
effects
Side effects
more severe that side effects =
anaphylaxis, cardiovascular collapse
Adverse reactions
- toxicity due to overdosing or drug accumulation
Toxic effects
- diurnal rhythm of CNS and endocrine,
acid-base balance, hydration, electrolyte
Physiologic Factors
Identify the Pathological Factor:
affect absorption
GI disorders
Identify the Pathological Factor:
affect distribution
Vascular problem
Identify the Pathological Factor:
affects metabolism and excretion
Liver and kidney dose
Allergies
Immunological Factors
Placebo effect, nocebo
Psychological aspects
Consider cold/hot weather
Environmental factors
Alcohol ingestion, food integration
Cumulative Effects
■ Distribution (Aspirin vs methotrexate for protein binding sites)
■ Biotransformation (Warfarin [coumadin] - metabolize quickly
with barbiturates, rifampin
■ Excretion (Digoxin vs. quinidine)
Drug-to-drug interactions
■ Oral drugs - empty stomach
■ Tetracycline vs. iron and calcium products
■ MAO Inhibitors vs. cheese, wine, organ meat, beer, yogurt,
sour cream, bananas
■ Nitrofurantoin (Macrodantin), Metoprolol (Lopressor),
Lovastatin (Mevacor) = mealtime
Drug-to-food interactions
■ Delteparin (Fragmin) on AST and ALT
■ ↓K, ↓Mg, ↑ Ca levels = digitalis toxicity
■ TDM (Therapeutic Drug Metabolism)
Drug-laboratory test interactions
drug form, route of drug administration, multiple
drug therapy, drug interactions
Administration
- synergistically working
Adjunct Drugs
onset, peak, duration, therapeutic range,
side effects, adverse reactions
Pharmacodynamics
age, weight, present health disorder, other
clinical entities, client drug compliance
Clinical Factors
■ Development of adverse effects from simple over dosage
■ Example: anticoagulant therapy→ bleeding
Primary Action
■ Excessive response to drugs
■ Kidney problems, other underlying problem
Hypersensitivity
○ when body forms antibodies to a particular drug inducing a
response in the subsequent exposure
○ Hives,rash, difficulty breathing, increased BP
Drug Allergy
adverse effects in various tissues, structures, and organs
Drug-Induced Tissue and Organ Damage
○ Rashes, Hives
■ Intervention:
● Frequent skin care
● Instruct to avoid rubbing, tight or rough clothing and harsh
soaps
● Administer antihistamines as appropriate.
○ Stomatitis
■ Intervention:
● Frequent mouth care.
● DAT (Diet as Tolerated) with small, frequent feeding.
○ Liver Injury
■ Intervention:
● Discontinue the drug.
● Notify the physician.
○ Renal Injury
■ Intervention:
● Discontinue the drug.
● Notify the physician.
○ Pancytopenia
■ Condition in which the person’s body has too few RBCs,
WBCs and platelets.
■ Intervention:
● Discontinue the drug.
● Notify the physician.
Two drugs with similar action
Additive Drug Effect
Two or more drugs, one drug potentiates the other
Synergistic Drug Effect or Potentiation
Two drugs have opposite effects → each drug cancel the
effect of the other
Antagonistic Drug Effect
● aa = of each
● ac = before meals
● ad lib = as much as desired
● bid = 2x a day
● caps = capsules
● hs = at bedtime
● od = right eye
● os = left eye
● ou = both eyes
● pc = after meals
● prn = as needed
● q= every
● qd = once daily; OD
● qid = 4x a day
● ss = 1⁄2
● stat = at once
● tid = 3x a daY
● ut dict. = as directed
10 R’s
Identify the categories of drug order:
Dr.’s order upon admission, continual unless ordered
Standing
Identify the categories of drug order:
Demerol 100 mg IM to be given 10minutes prior to surgery
One-time
Identify the categories of drug order:
○ Paracetamol 500 mg q4h as needed for headache
○ Medication as needed
PRN
Identify the categories of drug order:
To be given now
Stat
Oral meds are NOT given to clients who are vomiting, lack a
gag reflex, or who are comatose.
○ Do not mix in infant formula.
○ Do not mix with a large amount of food or beverage.
○ Enteric-coated and timed-release capsules must be swallowed
whole to be effective.
Tablets and capsules
Provide gradual but continuous release of
the drug
Times-release capsule
Flat disks; flavored base
Lozenges
Clear liquids dissolved in alcohol and water
Elixirs
Water-in-oil; oil-in-water; gelatin
Emulsion
Liquid that contain solid, insoluble drug particles,
has granules – needs to be shaken
Suspensions
Dissolved in sugar
Syrups
○ Read labels → dilute? Shake?
○ Refrigerate
Liquids
○ Do not cut patches.
○ Remove patches with metallic components prior to MRI.
○ Remove the old patch prior to applying the new one.
Transdermal
