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DRUGS > pharmacology > Flashcards

pharmacology Flashcards

1
Q

pharmacology

A

science of the properties of drugs and their effect on the body

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2
Q

therapeutics

A

branch of medicien that deals with different methods of treatment particularly drugs in disease

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3
Q

prescribing

A

give directions for the preparation and administration of a remedy to be used in the treatment of a disease

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4
Q

how many deaths per year in UK due to drug errors

A

700

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5
Q

key safety principles for prescribing

A

> Taking an accurate drug history
Checking for and acting on allergies and sensitivities, drug-drug and drug-disease interactions
Involving patients in prescribing decisions, where possible
Identifying and using reliable and validated sources of information when prescribing
Only prescribing within one’s own scope of practice, and seeking help where necessary
Taking responsibility for one’s own prescribing
Being receptive to feedback on prescribing errors
Employing timely and effective communication around prescribing, particularly on hospital discharge

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6
Q

4 examples of high risk drugs

A

insulin
opiates
warfarin
direct oral anticoagulants (DOACs)

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7
Q

what is magnapen?

A

a mixture of 2 penicillins

Ampicillin/flucloxacillin

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8
Q

diamorphine AKA

A

heroin

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9
Q

diamorphine vs morphine

A

diamorphine is 2-3 x more potent

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10
Q

antidote for diamorphine

A

naloxone hydrochloride

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11
Q

pharmacodynamics

A

the effect that a drug has on the body when it is administered

= why we might choose to prescribe it

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12
Q

pharmacokinetics

A

how the body absorbs, metabolises and excretes the drug

= the effect the body has on the drug

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13
Q

agonist

A

drugs that activate the receptor response

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14
Q

antagonist

A

drugs that block the receptor response

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15
Q

ways that drugs work

A

via receptors - activating or blocking

enzymes

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16
Q

pharmacodynamic interactions

A

when patient is treated with more than one drug for a single condition

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17
Q

PD interactions account for what percentage of adverse drug reactions?

A

30%

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18
Q

how to prevent harmful PD interactions

A

take care when patients are taking lots of drugs

think which other drugs they are taking which affect the same organ when prescribing

start low go slow

take care with older patients

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19
Q

ADME

A

the basic mechanism the body deals with medicines

Absorption
Distribution
Metabolism
Elimination

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20
Q

first pass metabolism

A

concentration of a drug, specifically when administered orally, is greatly reduced before it reaches the systemic circulation.

lost during absorption which is generally related to the liver and gut wall.

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21
Q

4 outcomes for first pass metabolism when drug reaches liver

A
  1. not metabolised before entering general circulation
  2. substantially metabolised, overcome by increasing dose
  3. completely metabolised = none enters circulation (has to be given via different route)
  4. uses first pass metabolism to convert to active form of drug
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22
Q

example of drug that is completely metabolised and hence is given bucally

A

GTN spray

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23
Q

effect of lipophilic vs hydrophilic drugs on distribution

A

lipophilic are widely distributed as a large proportion of our bodies are made of fat

hydrophilic are only distributed within the vascular circulation and muscle

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24
Q

example of a hydrophilic drug and what is difficult about this?

A

digoxin

tricky to get therapeutic window. e.g. if larger patient, not necessarily large dose since much of this may be fat.

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25
Q

what to do if you are unsure about dosage

A

seek advice from pahrmacist

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26
Q

how are hydrophilic drugs excreted

A

unchanged via the renal system or biliary tract

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27
Q

how are lipophilic drugs excreted

A

converted to water soluble in the liver via different enzyme systems before leave body

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28
Q

most significant system that converts lipophilic drugs to water soluble?

A

cytochrome P450 system

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29
Q

why are drugs metabolised by the cytochrome P450 system clinically significant?

A
  • narrow therapeutic window
  • if drug level too high or low can be catastrophic - undertreating or toxicity
  • old fashioned and arent designed to avoid significant interactions
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30
Q 
warfarin
theophylline
carbamazepine
phenytoin
oral contraceptive pill
A

examples of clinically significant drugs metabolised by the P450 system

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31
Q

examples of clinically significant drugs metabolised by the P450 system

A 
warfarin
theophylline
carbamazepine
phenytoin
oral contraceptive pill
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32
Q

if P450 system is induced what happens to clinically significant drugs metabolised by it?

A

metabolised more quickly
removed from body more efficiently
= lower drug level
= undertreatment of the condition it is treated

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33
Q

if P450 system is inhibited what happens to clinically significant drugs metabolised by it?

A

metabolised more slowly
removed from the body less efficiently
=higher drug level
= drug toxicity

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34
Q

why do you have to start carbamazepine and phenytoin at low dose?

A

induce their own metabolism

= start at low dose and gradually increase it as the enzyme system is induced until it reaches a steady state

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35
Q

drugs which are enzyme inhibitors and therefore affect drugs metabolised by the P450 system

A

cipro (or levo) floxacin

erythro (or clarythro) mycin

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36
Q

what can ciprofloxacin and erythromycin cause when taken with drugs metabolised by P450 system?

A

drug toxicity

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37
Q

drug where the excreted hydrophilic form is not inactive

A

opioids

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38
Q

drug excreted but not processed first (already hydrophilic)

A

digoxin

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39
Q

what form does a drug need to be in to be excreted?

A

hydrophilic

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40
Q

2 places drugs are excreted

A

kidneys or biliary tract

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41
Q

important in kidney disease or biliary tract obstruction to check

A

patients medications since this can lead to accumulation to toxic levels

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42
Q

therapeutic window

A

range in which drug is clinically effective without causing toxic side effects

43
Q

amoxicillin has a _____ therapeutic window

A

large

44
Q

phenytoin has a ______ therapeutic window

A

narrow

45
Q

drugs with narrow therapeutic window are more likely to be at risk of…

A

drug interactions

46
Q

what does a drugs half life depend on?

A
  • how quickly the drug is absorbed
  • whether the drug undergoes first pass metabolism
  • how the drug is distributed
  • metabolism of the drug
  • elimination of the drug
  • AMDE
47
Q

how many half lives does it take for a drug given regularly to reach a steady state?

A

4

48
Q

a way that you can figure out how often the patient takes te drug

A

look at the half life

49
Q

adensonine

A

cardiac arrhythmia treatment

50
Q

adensonine half life

A

10 seconds
= have to be given IV or else will be no longer effect

= good in emergency as frequency of administration would be impossible to maintain

51
Q

some drugs with short half lives can be given as

A

continuous IV infusions

52
Q

amiodarone half life

A

v long - 58 days

232 days to therefore reach steady state.

53
Q

what to do if drug has v long half life

A

give loading dose - higher level to speed up time to reach steady stead

given IV or orally depending on both drug and clinical scenario

54
Q

short half life - how often drug given?

A

more often

55
Q

what is preferred freq of drugs?

A

once a day

56
Q

MR

A

modified release

57
Q

SR

A

sustained release

58
Q

XL

A

extended release

59
Q

CR

A

controlled release

60
Q

when to prescribe with brand instead of generically?

A

when use specific slow release drugs due to short half life but wanting to give a singular dose a day

61
Q

common reasons for checking drug levels include

A

drugs with narrow therapeutic window

where symptoms may indicate drug toxicity

where patient may not be taking the drug

where you can’t accurately predict the dose the patient needs

62
Q
  • Digoxin
  • Lithium
  • Carbamazepine
  • Phenytoin
  • Theophylline
  • Certain intravenous antimicrobials such as gentamicin
  • Warfarin
A

drugs commonly monitored

63
Q

how is warfarin monitored?

A

monitor the effect on clotting levels by looking at the INR (international normalised ratio)

64
Q

what is important when taking a sample for drug monitoring?

A

timing - discuss with pharmacist

65
Q

what to take into account when choosing what to prescribe

A

allergies
comorbidities
potential pharmacodynamic drug interactions
pregnancy and breast feeding

66
Q

drugs most likely to interact

A

yellow box

enzyme inducers and enzyme inhibitors

67
Q

what is enteral administration?

A

administration via GI tract - including oral and rectal administration through a feeding tube

68
Q

what is parenteral administration?

A

any non enteral route - intravenous, intramuscular or subcutaneous

69
Q

why enteral administration?

A

easy for patients

cheap

70
Q

why parenteral administration?

A

gets into circulation most quickly

71
Q

what is topical administration?

A

anything prescribed topically - inc eye and ear drops, nasal sprays and nebulisers and topical creams

72
Q

why topical administration?

A

deliver high dose locally
avoid systemic side effects
or slow release into systemic - nicotine patches and analgesics

73
Q

compliance

A

the extent to which the patients behaviour matches the prescribers recommendations

74
Q

adherence

A

the extent to which the patients behaviour matches agreed recommendations from the prescriber

75
Q

concordance

A

the consultation process in which doctor and patient agree therapeutic decisions that incorporate their respective views

76
Q

% of patients non compliant with medication at some time

A

80%

77
Q

% of compliance in patients with chronic health condition

A

40-50%

78
Q

what does non compliance include?

A

receiving a prescription but not collecting the medicatin

taking medication at the wrong time or in the wrong dose

taking it more or less frequently than prescirbed

stopping medication before the end of the course

taking a drug holiday for a few weeks

79
Q

patient centred factors affected non-compliance

A

improves with age

psycho-social factors - health beliefs, religion etc

ethnicity - language barrier, cultural differences

the patient-prescriber relationship

80
Q

therapy centred factors affecting non-compliance

A

route of administration

duration of treatment - better with short courses

complexity of regime

side effects

systemic factors

81
Q

3 causes of medication related harm

A

side effects of medication

interactions between different medications

prescriber error - allergies and contraindications

82
Q

type A side effects

A

predictable from known pharmacology but may be exaggerated in some people

common and rarely fatal - managed by appropriate patient counselling or by reducing the dose

83
Q

type A side effect in beta blockers

A

bradycardia

84
Q

type B side effects

A

unpredictable (or bizarre)

much less common, can be fatal

cannot be predicted from the way the drug works

should not take that medication again

85
Q

type A side effect of warfarin

A

easy bruising

86
Q

type A side effect in anticholinergic medications

A

hallucinations

87
Q

type b side effect of penicillin

A

allergic reactions

88
Q

type B side effect of chloramphenicol

A

aplastic anaemia

89
Q

type C side effects?

A

medications that only cuaase side effects after a patient has been taking them for a long time

whether should be stopped depends on what is being treated

90
Q

type C side effect of steroids

A

cushings syndrome

91
Q

type C side effect of L-Dopa medications

A

dystonias

92
Q

type C side effect of bisphosphonates

A

osteonecrosis of the jaw

93
Q

type D side effects

A

delayed

uncommon and occur years after completing treatment

94
Q

example of type D side effect

A

people who have received certain types of chemotherapeutic agents are more at risk of secondary cancers later in life

95
Q

type E side effects

A

end of treatment effects

some medications cause problems when stopped abruptly

96
Q

drugs with withdrawal symptoms if stop abruptly

A

opiate
alcohol
benzodiazepine

97
Q

SSRI type E side effect

A

serotonin syndrome

98
Q

long term steroid type E side effect

A

addisonian crisis

99
Q

prescribing cascade

A

when a medication is given to treat a side effect of another medication

100
Q

example of intentional prescribing cascade

A

antiemetics in chemo

101
Q

example of unintentional prescribing cascade

A

prescriber fails to recognise that the symptom is a side effect of another medication

102
Q

amlodipine side effect

A

ankle oedema

103
Q

why can soluble paracetamol cause hypertension

A

high salt content

DRUGS (13 decks)

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