Pharmacology Flashcards
MEDICATION vs DRUG
Medication refers to a substance used to treat an illness or condition.
Drug is any substance that produces a physiologic effect (whether therapeutic or not) when used in a clinical sense.
EVERY MEDICATION IS A DRUG, NOT EVERY DRUG IS MEDICATION.
PHARMACOLOGY
Scientific study of how various substances interact with or alter the function of a living organism.
Pure Food and Drug Act (1906)
Prohibited altering or mislabeling medications
Opium Exclusion Act (1909)
Opium was prohibited from being imported
Harrison Narcotics Act (1914)
Restricted the use of various opiates and cocaine
Food, Drug, and Cosmetic Act (1938)
FDA was given enforcement authority for rules requiring that new drugs were safe and pure
“off-label”
purpose not approved by the FDA
Controlled Substances Act (1970)
classifies certain medications with the potential of abuse into five categories (schedules)
Schedule I
may not be prescribed, dispensed, used, or administered for medical use. High abuse potential; no recognized medical purpose
Schedule I Examples
Heroin, Marijuana***, LSD
***CONTROVERSIAL
Schedule II
High abuse potential; legitimate medical purpose
Schedule II Examples
Fentanyl (sublimaze), methylphenidate (ritalin), cocaine
Schedule III
lower potential for abuse
Schedule III Examples
Hydrocodone (vicodin), acetaminophen with codeine (tylenol with codeine #3), ketamine
Schedule IV
lower potential for abuse than Schedule III
Schedule IV Examples
diazepam (valium), lorazepam (ativan)
Schedule V
lower potential for abuse than Schedule IV drugs
Schedule IV Examples
narcotic cough medicines
Sources of Medication
Plant
Animal
Microorganism
Mineral
Synthetic (made in laboratory setting)
Semisynthetic (made from chemicals derived from P, A, or M sources then modified in lab setting)
Genetic Engineering
Plant Sourced Medications
Atropine, aspirin, digoxin, morphine
Animal Sourced Medication
Heparin, antivenom, thyroid preparations, insulin
Microorganism Sourced Medications
streptokinase, numerous antibiotics
(bacteria, fungi, mold)
Mineral Sourced Medications
iron, magnesium sulfate, lithium, phosphorus, calcium
Class of Medication
grouping to which a medication belongs
Three names of medication
Chemical, Generic, Brand
Indication
a sign/symptom; reason for giving a medication
Mechanism of Action
the way in which a medication produces the intended response
Onset
estimated time it will take for medication to take effect
Peak
estimated amount of time it will take for medication to have greatest effect
Duration
estimated amount of time that the medication will have an effect
Medication Monograph
profile including medication information
Affinity
ability of a medication to bind with a particular receptor site
Efficacy
ability to initiate of alter cell activity in a desired manner
Harmful environmental effects to medication
direct sunlight, extreme heat or cold, physical damage
Pharmacodynamics
process of a medication altering a function or process of body
Side Effect vs Adverse Effect
Side Effect usually expected reaction to medication
Adverse Effect an unexpected/undesired response to a medication
Pharmacodynamics
biochemical and physiologic effects and mechanism of actions of a medication
Pharmacokinetics
activity of medications in the body over time, such as absorption, distribution, and elimination
Processes of Medication Administration
- Absorption
- Distribution
- Biotransformation (metabolism)
- Elimination
Agonist Medications
initiate or alter a cellular activity by attaching to a receptor site
(prompts cell response)
Antagonist Medications
prevent endogenous or exogenous agonist chemicals from reaching cell receptor sites and initiating or altering a particular cellular activity
(BLOCKS a certain response)
Beta 1
One Heart
P-450
alters the chemical structure of a medication
(mainly liver)
Define Pharmacology
scientific study of how various substances interact with/alter the function of living organisms
Define Medication
substance used to treat an illness or condition
Paramedics are likely to carry and administer which schedules of drugs
Schedule II and Schedule IV
Medications are either _____ or _____ (pertaining to sources)
synthetic or semisynthetic
Semisynthetic medications are derived from (4 things)
plants, animals, minerals, microorganisms
Med names are either ____ (3 names)
Generic, chemical, brand
Define Indication
circumstance that points to/shows cause, pathology, treatment, or issue of an attack or disease
albuterol is indicated for broncho-constriction
Define Mechanism of Action
way in which a medication produces the intended response
Define Contraindicated
any condition, especially a disease, that renders some particular line of treatment improper or undesirable
Most basic concern regarding medication storage is the ______
integrity of the medication container
USP-NF recommended temp range for medication storage is…
15-30 degrees C
Define Absorption
process by which molecules of substance are moved from the site of entry/administration into systemic circulation
Define Distribution
movement and transportation of a medication throughout the bloodstream to tissues and cells, and ultimately to its target receptor
Biotransformation
process with 4 possible effects of how a medication can be absorbed into the body
Define Elimination
ability of a medication to bind with a particular receptor site
Define Affinity
ability of a medication to bind with a particular receptor site
Threshold Level
concentration of medication at which initiation or alteration of cellular activity begins
Define Potency
concentration of medication required to initiate a cellular response
Define Efficacy
ability to initiate/alter cell activity in a therapeutic/desired manner
Diuretic
chemical that increases urinary output
Agonist Medication
initiate/alter cellular activity by attaching to receptor sites
Partial Agonist
binds to receptor site but do not initiate as much cellular activity or change as do other agonists
Full agonist
binds to a receptor site and initiates all activity the receptor is responsible for
Antagonist
binds to receptor site to prevent a cellular response to agonist chemicals
block a certain response
Competitive Antagonist
TEMPORARILY bind with cellular receptor sites, displacing agonist chemicals
Noncompetitive Antagonist
PERMANENTLY bind with receptor sites and prevent activation by agonist chemicals
Effects of noncompetitive antagonist medication continue until ____
new receptor sites or new cells are created
Define analgesia
state of being insensible to pain while still conscious
_____ (drug we give) is an opiate antagonist
Narcan (Naloxone)
Alpha 1 effects…
vasoconstriction of arteries and veins
Beta 1 effects…
Heart
- increased heart rate (chronotropic effect)
- increased myocardial contractility (lontropic effect)
- increased myocardial conduction (dromotropic effect)
- renin secretion from urinary retention
Beta 2 effects…
lungs
- bronchus and bronchiole relaxation
- insulin secretion
- uterine relaxation
- arterial dilation in certain key organs
Dopaminergic receptor effects…
vasodilation of renal and mesenteric arteries
Nicotinic receptor
present at neuromuscular junction, allowing ACj to stimulate muscle contraction
Muscarinic receptor
present in the heart, activated by ACj to offset stimulation of the sympathetic nervous system.
decreases HR, contractility, and electrical conduction velocity
Opioid receptor
present in CNS and PNS, bowels, and various tissues.
activated by opioid substances to produce analgesia, euphoria, respiratory depression
Most prominent opioid receptor
Mu
Factors affecting response to medications
- age
- weight
- environment
- genetics
- pregnancy
FDA Pregnancy Category A
controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, possibility of fetal harm appears remote
FDA Pregnancy Category X
studies in animals and humans have demonstrated fetal abnormalities. risk of the use of the drug cleary outweighs the benefit
Define Cumulative Action
several smaller doses of a particular medication capable of producing the same clinical effects as a single larger dose of the same med
Define Untoward effects
a clinical change caused by a medication that causes harm or discomfort to a Pt
AKA adverse effect
Define Stevens-Johnson Syndrome
a severe, possibly fatal reaction that mimics a burn
may be due to a medication
Define Therapeutic Index
the relationship between the median effective dose and the median lethal dose OR median toxic dose
AKA therapeutic ration
Define Tolerance
condition that develops following repeated use by a PT of a medication that results in decreased efficacy or potency
Define Habituation
the unusual tolerance to the therapeutic and adverse clinical effects of a medication or chemical
Define Dependence
the physical, behavioral, or emotional need for a medication or chemical to maintain “normal” physiologic function
Addition or Summation
2 meds with a similar effect combine to produce an effect equal to the sum of the individual effect of each med
Synergism
2 meds with a similar effect combine to produce an effect greater than the sum of one of the meds effect
Potentiation
effect of 1 med is greatly enhanced by the presence of another med, which doesn’t have the ability to produce the same effect on its own
Altered Absoption
the action of 1 med may increase or decrease the ability of another med to be absorbed by the body
Altered Metabolism
the action of one medication increases or decreases the metabolism of another medication within the body
Altered Distribution
the presence of one medication alters the area available for the distribution of another medication in the body
When would altered distribution become important?
when both medication are bound for the same site, such as plasma proteins
if proteins are already occupied by one med, ____ of the other med may develop
toxic levels
Physiologic Antagonism
2 meds–each producing opposite effects–are present simultaneously, resulting in minimal or no clinical change
Neutralization
2 meds bind together in the body, creating an inactive substance
Diagnostic Error
- error/delay in diagnosis
- failure to employ indicated tests
- failure to act on results of monitoring or testing
Treatment Error
- error in the performance of an operation, procedure, or test
- error in administering treatment
- error in the dose/method of using a drug
- inappropriate care
Preventative Error
- failure to provide prophylactic treatment
- inadequate monitoring or follow-up of treatment
other medical errors
- failure of communication
- equipment failure
- other system failure
First Order Elimination
the rate of elimination is directly influenced by plasma levels of a substance
Zero Order Elimination
fixed amount of a substance is removed during a certain period, regardless of the total amount in the body
Half-Life
the time needed in an average person for metabolism/elimination of 50% of the substance in plasma
Most biotransformation of drugs occurs in the ___
liver
Elimination occurs in ____
the kidneys and excreted into urine
10 rights of medication administration
- Right Patient
- Right Medication
- Right Dose
- right route
- right time
- right education
- right documentation
- right assessment
- right evaluation
- right to refuse
Angioedema
localized areas of swelling beneath the skin
Components of Medication Profiles
- medication name
- category or class
- use/indication
- mechanism of action
- pregnancy risk factor
- contraindications
- available forms
- dosage
- administration/monitoring considerations
- potential incompatibilities
- adverse effects
- pharmacokinetics
Anticoagulant
reduce efficacy of clotting factors present in blood
Antidysrhythmics
prevent or control various cardiac dysrhythmias
Antiemetics
treat or prevent nausea and vomiting
Beta-Agonist
bronchodilation
Beta-Blocking Agents
reduce heart rate and blood pressure
Calcium Channel Blockers
reduce heart rate and blood pressure
Cholinergics
activate secretory glands in eyes and GI tract; improve muscle weakness
Corticosteroids
decrease inflammation; immunosuppressant
Diuretics
promote excretion of urine; manage fluid overload
Narcotic Analgesics
relieve pain and relieve/suppress cough
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
treat pain and inflammation
Class I Antidysrhythmic
slow movement of sodium through channels in certain cardiac cells
Class II Antidysrhythmics (Beta Blockers)
competitively inhibit catecholamine activation of beta receptor sites
Class III Antidysrhythmic
increase the duration of phases 1, 2, and 3 of the cardiac cycle. These meds prolong the absolute refractory period
Class IV Antidysrhythmics (calcium channel blockers)
displace calcium @ certain receptor sites or enter smooth muscle cells in place of calcium. this action relaxes smooth muscle present in the heart, blood vessels, GI tract, and uterus.
they also slow conduction through the AV node
Define Orthostatic Hypotension
a fall in blood pressure that occurs when moving from a recumbent to a sitting or standing positions
- diastolic falls by 20mmHg
- systolic rises by 10mmHg
- pulse increases by 20bpm
Beta Blockers end in…
-olol or -lol
ACE inhibitors end in…
-pril
Anticoagulants
impair the function of blood clotting or coagulation chemicals in the bloodstream
Antiplatelets
reduce platelet aggregation (clumping), preventing new thrombus formation, or the extension of an existing thrombus
____ is a common example of an antiplatelet
Aspirin
Inotropic Effect
force of cardiac contraction
Dromotropic Effect
rate of electrical conduction
Chronotropic Effect
change in heart rate
Sterile Technique
the destruction of all living organisms and is achieved by using heat, gas, or chemicals
Antiseptic
chemicals used to cleanse an area before performing invasive procedure
ie isopropyl alcohol or iodine
Disinfectant
chemicals used on non-living objects to kill organisms; toxic to living tissues
Disposal in…
sharps
Crystalloid Solutions
solutions of dissolved crystals (ie salts or sugars) in water; contain compounds that quickly dissociate in solution
Colloid Solutions
solutions that contain molecules (usually proteins) that are too large to pass out of the capillary membranes and, therefore, remain in the vascular compartment
Isotonic Solution
a solution that has the same concentration of sodium as does the cell. water does not shift, and no chance in the cell shape occurs
0.9% sodium chloride (normal saline), LR
Hypertonic Solution
a solution that has a greater concentration of sodium than does the cell; increased osmotic pressure can draw out water from the cell and cause it to collapse
3% saline, blood products, albumin
Hypotonic Solution
a solution that has a lower concentration of sodium than does the cell; increased osmotic pressure lets water flow into the cell, causing it to swell and possibly burst
5% dextrose in water (D50)
Macrodrip Set
an administration set named for the large orifice between the piercing spike and the drip chamber; allows for rapid fluid flow into the vascular system
10 or 15 gtts/mL
Microdrip Set
an administration set named for the small orifice between the piercing spike and the drip chamber; allows for carefully controlled fluid flow and is ideally suited for medication administration
60 gtts/mL
Initial IV insertion angle: ___, then drop to ___
45 degrees, about 15 degrees
Helpful hints when giving IV
- allow arm to hang off stretcher
- pat/rub area without being too vigorous
- apply wrapped chemical heat pack for about 60 sec
- if you meet resistance from valve, elevate extremity after 2 misses, let partner try
- never pull catheter back over needle
When documenting IV, include:
- gauge
- IV attempts vs success
- the site location
- type of fluid
- rate @ which fluid is running
Infiltration
escape of fluid into the surrounding tissue, causes localized edema.
- discontinue IV line and reestablish on opposite extremity or in more proximal location.
- direct pressure over swollen area
Occlusion:
Physical blockage of a vein or catheter
- Sign: decreasing drip rate or presence of blood in tubing
- use syringe with clean IV fluid to add pressure to line to disrupt occlusion
Thrombophlebitis
inflammation of a vein.
- common in regular IV drug users and Pts who receive long-term IV therapy
- pain/tenderness along the vein and redness/edema @ site
- easier to prevent than treat
Hematoma
- accumulation of blood in the tissues surrounding IV site
- blood can be seen rapidly pooling around IV site, leading to tenderness and pain
- if occurs while attempting, stop and apply direct pressure
Nerve/tendon Damage
- improper identification of IV site
- Pt will experience sudden and severe shooting pain
- numbness and tingling common
Arterial Puncture
- accidentally puncture artery
- immediately withdraw catheter, apply direct pressure for at least 5 min or until spurting stops
Pyrogenic Reaction
a reaction characterized by an abrupt temperature elevation (as high as 106 degrees F [41 degrees C]) with severe chills, backache, headache, weakness, nausea, and vomiting
When a medication binds with a receptor site, one of four actions will occur…
- channels permitting the passage of ions (charged particles) in cell walls are opened or closed
- a biochemical messenger becomes activated, initiating other chemical reactions within the cell
- a normal cell function is prevented
- a normal or abnormal function of the cell begins
Endogenous
occurring naturally within the body
Exogenous
from outside the body
Medications distribute into three primary types of body substances…
water, lipids/fat, protein
Medication metabolism in the liver is affected by the…
cytochrome P-450 system
Paradoxical medication reaction
patient experiences effects opposite from the intended effect
the percentage of EBC/s in the intravascular space is known as…
hematocrit
Median Lethal Dose (LD50)
weight-based dose of a medication that causes death in 50% of the animals tested
Median Toxic Dose (TC50)
50% of the animals tested had toxic effects at or above this weight-based dose
Down-regulation
reduced available cell receptors for a particular medications
AKA tolerance
Repeated doses of medication within a short time rapidly cause tolerance, making medication virtually ineffective
Tachyphylaxis
Two Parts of the Autonomic Nervous System
Sympathetic and Parasympathetic Nervous Systems
Mydriasis
Pupil Dilation
Neurotransmitter for SNS is…
norepinephrine
Neurotransmitter for PNS…
Acetylcholine
