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INP part 1 revision slides > Pharmacodynamics > Flashcards

Pharmacodynamics Flashcards

1
Q

Definition of pharmacodynamics

A

study of the mechanism of action of a specific drug - “How a medicine brings about its therapeutic effect”

• To study how it behaves in our body to produce biochemical or physiological changes to the body

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2
Q

Mechanism of action

A

The way a drug produces a therapeutic effect.
Once the drug hits its “site of action”, it can modify the way a cell or tissue functions.

• Involves interaction of the drugs with receptors or enzymes

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3
Q

what are the 4 mechanism of action of drugs interactions

A
  1. Drug- Receptor Interaction
  2. Drug Enzyme Interaction
  3. Drug- Drug Interaction
  4. Drug –Food Interaction
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4
Q

what is a drug receptor

A

specialized macromolecule to which a specific group of drugs or naturally occurring substances (endogenous) can bind

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5
Q

what are endogenous substances

A

substances that originate within a system eg. hormones

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6
Q

Pharmacodynamics vs Pharmacokinetics

A

pharmacodynamics : What the drug does to the body

pharmacokinetics : What the body does to a drug

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7
Q

drug receptor interactions

A

Drug molecule binds to a reactive site on the cell (Receptor)

Once the substance binds to and interacts with the receptor, a pharmacologic response is produced

Formula :
Drug + Receptor = Drug effect
(therapeutic effect /pharmacological response)

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8
Q

definition of receptor

A

reactive site on a cell or tissue

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9
Q

2 classifications of drug receptor interactions

A

When a drug binds to a receptor, classified as

  1. agonist
  2. antagonist
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10
Q

agonist

A

Mimics effect of the endogenous substance that normally binds to the receptor and produces the response

Drug (agonist)+receptor –> Produces a response

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11
Q

example of agonist

A

epinephrine (adrenaline) neurotransmitter, at the adrenergic synapses.

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12
Q

agonist are produced by

A

adrenals

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13
Q

agonist response to drugs

A

binds to the receptor and there is a response for our fight and flight

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14
Q

adrenaline medication

A

mimics the endogenous substance- which is the adrenaline neurotransmitter.

When delivered into the patient, it binds to the adrenergic receptors and stimulates the sympathetic response- FIGHT AND FLIGHT

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15
Q

antagonist

A

Drug occupies the receptor and prevents the endogenous substance from binding

• Drug binds to receptor prevents binding of agonists

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16
Q

-lol drugs

A

anti hypertensive medications

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17
Q

example of beta blockers

A

Atenolol, metoprolol, propranolol, bisoprolol, esmolol, labetalol

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18
Q

alpha-1

A

(blood vessels)

Stimulates α1 adrenergic receptors of vascular smooth muscle, resulting in vasoconstriction, increasing systemic bp

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19
Q

β1

A

(cardiac)
Stimulates β1 adrenergic receptors of heart —> increased heart rate (chronotopic) and myocardia contractibility (inotropic)

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20
Q

β2

A

(lungs)
Stimulates β2 adrenergic receptors of vascular smooth muscle and bronchial smooth muscle, resulting in vasodilation and bronchodilation.

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21
Q

mechanism of action of beta blockers

A

Blocks beta receptors —> results in decreased heart rate and force of contraction of the heart

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22
Q

indication of beta blockers

A

hypertension
angina
arrhythmia
heart failure

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23
Q

contra-indication of beta blockers

A
  • Hypersensitivity to beta blocker

* Bradycardia, Heart block

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24
Q

Route of administration of beta blocker

A

PO, IV

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25
Q

Adverse effects of adrenergic agonist

A

• CNS: lethargy, drowsiness
• CVS: Bradycardia, hypotension & heart block
• Respiratory system: bronchoconstriction, may worsen
asthma/COPD (due to β2 blocking effect)

26
Q

drug enzyme interactions

A

Enzyme inhibitors (blocks) - Inhibits action of enzymes:

The enzyme is “fooled” into binding to drug instead of
target cell
Protects target cell from enzyme’s action (ACE Inhibitors)
ACE Inhibitors – reduced blood pressure
( Angiotensin converting Enzyme Inhibitors)

27
Q

drug drug interactions

A

changes in a drug’s effect caused by presence of another drug taken during the same time period

28
Q

when do drug drug interactions happen

A

May be due to taking other prescribed drugs, over-the-counter medications or herbal therapies

E.g. Tetracycline not to be taken with Calcium tablet at same time - forms chelation, no absorption of drug.

29
Q

Types of drug-drug interactions

A

Duplication
Opposition (antagonism)
Alteration

30
Q

DUPLICATION

A

two drugs with the same effect are taken, their therapeutic effects and their side effects may be intensified

31
Q

example of duplication

A

person may take a cold remedy and a sleep aid, both of which contain diphenhydramine and causes severe drowsiness

a cold remedy and a pain reliever, both of which contain paracetamol

32
Q

opposition

A

Two drugs with opposing actions can interact, thereby reducing the effectiveness of one or both

33
Q

example of opposition

A

Nonsteroidal Anti-inflammatory Drugs, (NSAIDs) ibuprofen (pain reliever), may cause the body to retain salt and fluid; diuretics, such as hydrochlorothiazide and furosemide, help rid the body of excess salt and fluid.
If a person takes both types of drug, the NSAID may reduce the diuretic’s effectiveness.

34
Q

ALTERATIONS

A

One drug/ chemical - may alter how the body absorbs, distributes, metabolizes, or excretes another drug.

35
Q

example of alterations

A

Ex: Chemicals in cigarette smoke can increase the activity of some liver enzymes. smoking causes increase activity of these enzymes, it increases the rate of metabolism of drugs.

36
Q

DRUG FOOD INTERACTIONS

A

changes in a drug’s effects caused by food (including beverages) consumed during the same time period.

Like food, drugs taken by mouth must be absorbed through the lining of the stomach or the small intestine.

37
Q

How does presence of food affect drug

A

Reduce absorption of drug

38
Q

How to avoid drug and food interaction

A

take the drug 1 hour before or 2 hours after eating.

39
Q

Anticoagulants(warfarin) + vitamin k (broccoli, spinach, kale) =

A

reduce the effectiveness of anticoagulants, increasing the risk of clotting.

Intake of such foods should be limited, and the amount consumed daily should remain constant

40
Q

Tetracycline + Calcium foods (milk, dairy foods) =

A

reduce the absorption of tetracycline, which should be taken 1 hour before or 2 hours after eating

41
Q

Tetracycline + Calcium, iron, magnesium From Foods =

A

Insoluble complex.

Tetracycline binds readily with elements (iron, calcium, magnesium) in the stomach, so its absorption is reduced.

• Therefore, when administered orally, to take tetracycline with empty stomach and to separate 2 hours apart from calcium, Iron and magnesium.

42
Q

Statins (Anticholesterol medication) + Grapefruit =

A

Grapefruit contains substance that affects the intestinal absorption of drugs such as statins

43
Q

DRUG-MEDICINAL HERB INTERACTIONS

A

drugs interact with certain medicinal herbs or supplements taken by patients at the same time.

44
Q

Chamomile (tea) + Anticoagulants (such as warfarin) =

A

Chamomile taken with anticoagulants increase the risk of bleeding (decrease clotting??)

45
Q

Ginseng + Drugs that decrease blood sugar levels (hypoglycemic drugs) =

A

Ginseng may intensify the effects of these drugs, causing an excessive decrease in blood sugar levels (hypoglycemia)

46
Q

Ginseng + Anticoagulants (such as warfarin), aspirin and other NSAIDs =

A

Ginseng taken with anticoagulants or with aspirin or other NSAIDs may increase the risk of bleeding

47
Q

Gingko Biloba (Improve blood circulation and cognitive function) + Anticoagulants =

A

Gingko Biloba taken with anticoagulants may increase the risk of bleeding

48
Q

Gingko Biloba (Improve blood circulation and cognitive function) + Antiepileptic drugs =

A

Gingko Biloba taken with anti-epileptic may increase the risk of seizures

49
Q

aims of Electronic Medication Record (EMR)

A 
▶ improve Quality, Outcomes, and Safety
▶ improve Efficiency, Productivity
▶ improve Service and Satisfaction
▶ enhance time saving
▶ enhance cost reduction
50
Q

features of EMR system that aids to minimize error

A

wrong patient: scan patient’s wristband with barcode before and after administration

Wrong medication: barcodes on medication

Wrong dose/route/time : linked to orders which is also linked to patient’s medical condition

51
Q

three forensic classes under singapore drug classification

A

Prescription Only Medicine (POM)
Pharmacy only medicine (P)
General Sale List medicine (GSL)

52
Q

How does the authority decide the way these 3 groups are formed

A

main determinants include :

  • risk profile of the product
  • local experience with the product or similar products
  • public health considerations
  • seriousness of the medical condition for the product’s proposed indications
53
Q

POM

A
  1. To Obtain Pom, an order must be given authorizing the patient to receive drug
  2. Pom must be ordered by medical practitioner, dentist, veterinary surgeon
54
Q

advantage of prescription drugs

A

• Opportunity for physician to examine patient
• Proper determination of diagnosis and treatment
• Practitioner can maximize therapy
-To order drugs appropriate for patient’s condition
-To control amount and frequency dispensed
• Patient education on use and adverse effects

55
Q

disadvantage of prescription drugs

A

difficulty in obtaining continuous supply

56
Q

advantage of otc drugs (gsl + pharmacy)

A
  • Patient can self-treat minor ailments

* Decreases physician and pharmacists’ dispensing costs
• Increases patient’s responsibility of his/her own health

57
Q

disadvantage of otc drugs (gsl + pharmacy)

A

If patients do not follow the written leaflet instructions, OTC drugs can have serious adverse effects (e.g. liver damage in paracetamol overdose)
• Delay in seeking medical care
• Increased out-of-pocket costs
• Deficient knowledge in use of medication
-Drug–drug, drug–food, drug–herb interactions
-Can impair body functions
-Ineffective in treating disease
-May worsen disease progression

58
Q

Storage of POM

A

a) Drugs must be stored in cabinets or shelves meant solely for storage of drugs
b) Drugs for oral use should be stored separately from lotions and other external preparations
c) Drugs must be stored in a locked area
d) The storage areas of drugs must be accessible to the medical/nursing staff only
e) Controlled drugs – All controlled drugs must be kept separately from other drugs and be under lock and key at all times. The key to the controlled drugs must be in the personal possession of the staff nurse in-charge at all times. There should be a controlled drug cabinet.

59
Q

Prescriptions must be in :

A
  • be in ink
  • be signed by the doctor with his/her usual signature
  • be dated
    • be written personally by the doctor
  • have the name and address of the patient and doctor
  • specify the dose to be taken and the total quantity to be dispensed
  • specify the number of instalments, the interval between the instalments and the amount to be dispensed at each interval (for prescriptions to be dispensed in intervals)
  • prescriptions cannot be written in code
60
Q

OVER-THE-COUNTER DRUGS

A

• Includes GSL and pharmacy-only medicines
• Do not require a doctor’s prescription
• Indications for use:
- Consumer must be able to diagnose condition and monitor effectiveness
-Safety profile of drug
-High margin of safety and must adhere to guidelines
-Limited drug interaction profile
-Low potential for abuse
-Practical aspect for over-the-counter (OTC) drugs
-Easy to use and monitor

INP part 1 revision slides (1 decks)

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