Pharmacokinetics: CH.35 Flashcards
1
Q
Med Names (3)
A
Chemical, Brand/Trade, Generic
2
Q
Chemical name
A
description of med’s molecular structure (e.g. N-acetyl-para-aminophenol)
3
Q
Brand/Trade name
A
marketed under the manufacturer (e.g. tylenol)
4
Q
Generic name
A
given by manufacturer that FIRST develops the med (acetaminophen)
5
Q
Meds approved in Canada have an 8-digit DIN. What does DIN stand for? and what is it’s purpose?
A
drug identification number; to track med info in Canada
6
Q
ISMP
A
Institute for Safe Medication Practices
7
Q
What does the ISMP do?
A
publishes a list of med pair names that “look alike and sound alike”; provides info to prevent those incidents
8
Q
LASA
A
“look alike and sound alike” (from ISMP)
9
Q
Classification
A
indicates effect/action of med on body system
10
Q
Can meds belong to more than one class?
A
Yes (e.g. aspirin = antipyretic, analgesic, anti-inflammatory)
11
Q
Why are there different med forms?
A
their compositions enhance its absorption + metabolism
12
Q
Types of Oral Route (solid forms) (5)
A
Capsule, tablet, EC, pill, sustained release
13
Q
Capsule
A
powdered med in gelatin shell
14
Q
tablet
A
compressed powder med w/binders + fillers
15
Q
EC
A
coated to dissolve in intestines NOT stomach
16
Q
pill
A
general term for solid meds
17
Q
sustained release
A
tab/capsule w/coated particles for extended release
18
Q
Types of Oral route (liquid forms) (7)
A
elixir, extract, oral solution, oral suspension, syrup, lozenge (troche), aerosol
19
Q
elixir
A
clear fluid w/medication, water, alcohol +/sweetener
20
Q
extract
A
concentrated med syrup or dried form
21
Q
oral solution
A
med dissolved in water
22
Q
oral suspension
A
fine particles in a liquid require shaking
23
Q
syrup
A
med in concentrated sugar sol
24
Q
lozenge (troche)
A
dissolves in the mouth, not swallowed
25
Aerosol
sprayed/inhaled liquid, absorbed in mouth + airway
26
Topical Route (4)
ointment, lotion, paste. transdermal patch
27
ointment
semisolid, protective film w/no water
28
lotion
thin, liquid suspension w/high water content
29
paste
thick, breathable, slowly absorbed (e.g. diaper rash treatment)
30
transdermal patch
adhesive patch for controlled med release
31
parenteral route (2)
solution, powder
32
solution (parenteral)
sterile liquid w/dissolved compounds
33
powder
solid, sterile medication to be dissolved before use
34
parenteral route meaning
Route that to bypass GI system
35
types of parenteral routes (4)
subcutaneous (SC/SQ), intravenous (IV), intradermal (ID), Intramuscular (IM)
36
installation into body cavities (route)
solution, intraocular disc, supp.
37
solution (installation into bod cavities)
liquid med dissolved into water/other liquid
38
intraocular disc
flexible oval disc that slowly releases meds
39
supp
solid gelatin-based med, melts at bod temp
40
Adulteration act
- (1884) set conditions for which meds could be adulterated
- this was the start of regulation in Canada
41
food + drug act
- replaced the adulteration act
- fed gov could control the manufacture + sale of all meds (except opioids), food, cosmetics, + med devices
42
opium act
when gov first began to control opioids
43
narcotic control act
controls manufacture, distribution + sale of opioids
44
controlled drugs + subs act
replaced narcotic control act
45
what aspects of natural health products does the federal legislature regulate?
manufacture, sale, content, packaging, labelling, distribution and storage of herbs + other natural health products
46
Canadian formulary
- type of official publication
- set standards for med strength, quality, purity, packaging, safety, labelling and dosage forms
47
purity standard
standard quantity of active sub/drugs in a med product
48
potency standard
concentration of active sub/drug in med affects its strength (potency)
49
bioavailability standard
ability of the active sub/drug to be released, dissolved, absorbed + transported by the body to site of action
50
efficacy standard
lab studies demo med action + effectiveness
51
safety standard
all meds need to be cont. evaluated to determine risk for adverse effects
52
Which federal branch administers the Food and Drugs Act and the Controlled Drugs and Substances Act in Canada?
The Health Protection Branch (HPB) of the federal government.
53
What are the key steps before a new medication can be sold in Canada?
- undergo intensive human testing for safety + effectiveness
-followed by HPB approval
- grants a DIN + notification of compliance
54
How is a new medication regulated after approval in Canada?
- stringent controls apply until enough safety data is collected
- ongoing monitoring tracks adverse effects, safety concerns + changes in use
55
Do provincial and territorial governments regulate the manufacture and sale of medications?
-No
-but they have legislative responsibility for health care, which indirectly affects the use and sale of medications.
56
How do provinces and territories regulate health care providers in relation to medications?
- have legislation governing medical, dental, pharm, + nursing practices
- includes prescribing, dispensing + admining meds
57
How do health care institutions regulate medication use beyond government controls?
- set policies that align w/ regulations, but are more restrictive than government controls to ensure safety, quality,
- e.g. automatic discont. of antibiotics after a set number of days
58
What regulations must nurses in Canada be familiar with regarding med admin?
BOTH federal + prov/terri. regulations for RNs + LPNs in their practice areas
59
Do med admin rules for LPNs vary across provinces?
-Yes
-e.g. in New Brunswick --> LPNs can admin meds by all routes EXCEPT IV push, under RN supervision
60
Who sets standards for med admin by nurses in Canada?
Nursing regulatory bodies e.g. BCCNM
61
controlled substances or drugs
meds that affect the mind/behaviour
62
punishment of violating controlled drugs + subs act?
fines, imprisonment, loss of nursing license
63
What accreditation standards must health care institutions meet for med management?
follow stringent policies for the storage, dispensing, and admin of controlled subs (such as opioids)
64
opioids
- natural, synthetic or semisynthetic chemicals
- reduce the intensity of pain by interacting w/nerve cell opioid receptors
65
high-alert meds
- Meds w/ increased risk of harm if used inappropriately
- require strict safety measures
66
examples of high-alert medications? (5)
- adrenergic agonists (epinephrine)
- anesthetics (propofol)
- Antithrombolitics (heparin)
- antiarrhythmics (amiodarone)
- insulin
67
What strategies improve the safe use of high-alert medications?
Standardized processes for prescribing, storing, preparing, and admining meds
68
What additional safety measures are used for high-alert medications?
Limiting access, automated alerts & bright-coloured labels, and improving provider access to medication information.
69
pharmacokinetics
study of how the body affects meds
70
4 stages of pharmacokinetics
absorption, distribution, metabolism, excretion
71
absorption
passage of med molecules into the blood from site of admin
72
what affects absorption? (5)
- route of admin
- ability of med to dissolve
- blood flow to site of admin
- body Surface Area
- lipid solubility of med
73
route of admin (fastest to slowest absorption)
- IV (directly enters bloodstream)
- Mucous membranes + resp airways (rapid b/c of high vascularization)
- Oral (GI tract --> slow passing through digestion)
- Skin (topical --> minimal absorption
74
What affects the ability of med dissolution for oral meds? (2)
- form/prep: E.g. liquid meds absorb faster than tabs or capsules
- acidity/pH:
--> Acidic meds absorb quicker in the stomach
--> Alkalotic meds absorb in the intestine
75
How does blood supply affect the absorption rate of meds?
- meds absorb quicker when admined at highly vascularized sites
--> come into contact w/blood quicker
76
effects of body surface area
- meds absorb faster when in contact w/LARGER surface area
-e.g. small intestine
77
how does lipid sol affect med absorption?
lipid sol meds can easily cross cell membranes b/c of lipid layer allowance = absorbed more quickly
78
How does food in the stomach affect medication absorption?
- Food can alter the structure of medications and impair their absorption
79
Distribution
when in the bloodstream, it gets distributed throughout body tissues + organs TO site of action
80
factors affecting distribution (3)
circulation, membrane permeability, protein binding
81
how do circulation conditions affect distribution?
- inhibit/slow dist. of med
- efficacy is delayed/altered/increased
- can cause med to be absorbed at site it wasn't intended to
82
if someone had poor circulation to their feet and took an oral antibiotic for their foot fungal infection, what happens to the med? what can be done to help the infection?
- med wouldn't be distributed to the proper site of action
- may require a prolonged course of antibiotics and an additional topical med applied directly to site of A
83
how membrane permeability affects med distribution
- meds must pass through biological membranes to reach target organs
84
types of membrane permeability (3)
- fat-soluble meds easily cross barriers (e.g. BBB) = CNS treatment requires this BUT also causes side effects e.g. confusion
- placental membrane allows both fat-soluble + non-fat-soluble meds to cross = fetal deformities
- highly-ionized meds can't cross certain barriers e.g. placental
85
what type of proteins are involved in protein binding as a factor of distribution?
serum proteins (e.g. albumin)
86
When is a medication active vs inactive?
- inactive when bound to a protein
- active when unbound/free
87
what can the decreased albumin binding ability cause?
increased toxicity
88
Metabolism
when the med metabolizes into a less active/inactive form for easier elimination
89
biotransformation
occurs when enzymes detoxify, degrade (break down) + remove the biologically active sub or drug
90
where does most biotransformation occur ?
liver
91
How the liver metabolizes meds
liver oxidizes + transforms toxic subs
- degrades harmful chemicals before being distributed to the tissues
92
Sites of elimination (5)
- kidneys
- liver
- bowel
- lungs
- exocrine glands
93
chemical makeup of a med paired with site of elimination
- lungs: gaseous + volatile meds
- exocrine glands: lipid-soluble meds
- bowel: meds that increase peristalsis (laxatives, enemas) speed up elimination here
- liver: meds that need to be broken down by liver and eliminated into bile
- kidneys: main elimination method
--> some meds skip extensive metabolism and exit in urine unchanged
94
toxicity
develops after prolonged intake of med OR after med accumulates in blood from impaired metabolism/elimination
95
allergic rxns
unpredictable responses to a med
96
synergistic effect
when the combined effect of two meds is greater than the effect of the meds given separately
97
precipitation rxn
when two incompatible drugs/ a drug + a solution chemically react to form a solid precipitate
98
when do precipitate rxns occur? what does it lead to other than a formation of precipitate?
- when meds are mixed in an IV line, syringe or solution
- drug inactivation, reduced efficacy, potential harm
99
pruritus
- type of allergic rxn
- itchiness, accompanies most rashes
100
rhinitis
- inflammation of mucous membranes lining nose
- causes swelling + clear, watery discharge
101
serum half-life
The time it takes for the serum concentration of a medication to be eliminated by half.
102
Why are medications given at regular, fixed doses?
To maintain a therapeutic concentration or plateau in the bloodstream.
103
When is the next dose of medication typically given?
When the previous dose reaches its half-life, ensuring consistent drug levels.
104
onset
length of time for med to produce response
105
peak
time for med to reach its highest effective concentration
106
trough
- min level of med blood serum concentration
- typically reached just before next scheduled dose
107
duration
length of time a med produces a response
108
plateau
therapeutic level of med blood serum concentration, reached + maintained after repeated doses
109
sublingual
med dissolves under tongue
110
parenteral
- injection
- ID, sub-Q, IM, IV
111
epidural
med delivered into epidural space via a catheter
112
intrathecal
- med delivered into subarachnoid space/brain ventricles
- used for CNS infections
113
intraosseous
- infused into the bone marrow
- used in emergencies + for infants/toddlers
114
intrapleural
- injected into pleural space
- common in chemo
115
intra-arterial
delivered via catheter into an artery
116
mucous membrane
med applied to eyes, ears, nose, vagina, rectum or ostomy
117
intraocular
med in a disc placed in eye (like a contact lens)
