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Pathophysiology of ill-health > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Directly related to section X of assessment

A

section 2! 20%

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2
Q

Medicines management - Definition and Reference

How common are medication errors?

A

A term defined by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) as:

“The clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit from the medicines they need, while at the same time minimising potential harm.”

Medication errors are second most reported accident

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3
Q

Accountability? 2 x ref

A

Legal Accountability - medicines Act

Trust Policy / Employment - NMC as regulator

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4
Q

Medication Legistlation

A

Medicines Act 1868
Misuse of Drugs Act 1971
Safe custody act

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5
Q

What Medicines Management legislation is there?

A

Used to be NMC The Standards of Medicines Management 2007… (lots of things covered by NMC code of conduct)

…withdrawn in Jan 2019.

Replaced with:

Royal Pharmaceuticals Society’s:
- A competency framework for all Prescribers

NMC:
- Standards for Prescribing Programmes

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6
Q

What Medicines Management legislation in healthcare settings is there?

A

Professional Guidance on the Administration of Medicines in Healthcare Settings - Royal Pharmaceutical Society

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7
Q

NMC Code relating to medicines?

A
  1. 2 Manintain the knowledge and skills you need for safe and effective practice
  2. 5 Complete the necessary training….

18.2 keep to appropriate guidelines when giving advice on using controlled drugs…

….Many many

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8
Q

Aspects of Professional Practice

A

Recognition of role and responsibilities

Level of knowledge and experience…

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9
Q

What factors affect drug administration?

A 
Age
Weight
Underlying disease / pathology 
Amount of drug given
Absorption and excretion rate
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10
Q

Most drugs have 3 x names

A

Generic
Brand
Chemical

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11
Q

Pharmacology

A

Pharmakon - drug
ology - the study of

Looks at composition, effects and uses of drugs

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12
Q

Drug

A

Any chemical which affects living organism

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13
Q

Pharmacodynamics

A

Action of drug - qualitatively and quantitatively

Mechanism which drugs have on body -

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14
Q

Receptor Theory - what is it?

A

Lock and Key mechanism

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15
Q

Signal Pathway

e.g. how does adrenaline increase your heart rate

A 
Signal molecule (ligand)
Receptor
Intra-cellular signal
Target protein
Response
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16
Q

Adrenaline is key, lock is?

A

Alpha and beta receptors in the heart

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17
Q

Receptors

A

Glycoproteins that recognise and bind to ligands (e.g. adrenaline)

Ligands are smaller molecules which can attach to

Receptors change their shape in response to

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18
Q

signalling molecule Binding to receptor -?

A

Changes the shape of the receptor

Generates biochemical reactions inside the cell (Signal Transduction) leading to several reactions called ‘secondary messengers’ that is eventually translated into a biological response (e.g. muscle contraction, hormone sectretion)

The more receptors involved, the bigger the response

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19
Q

Pharmacokinetics

A

Movement of drugs inside the body.

ADME - Absorption, distribution, metabolism and excretion

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20
Q

ADME

A

Absorption
Distribution
Metabolism
Excretion

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21
Q

Drug absorption

A

Most drugs given orally

In most routes absorption has to happen for the drug to access body compartments

Exceptions are parental routes

Drugs have to cross membranes to gain access

chemical nature determines how absorption can occur

22
Q

Name as many routes of administration

A 
Sublingual
Oral
Intramuscular
Intravenous (quickest)
Ocular
Subcutaneous
23
Q

Absorption - Active Transport

A

Requires ATP to move drug from lower concentration to a higher concentration. Moves across cellular barriers against the concentration gradient.

24
Q

Absorption - Passive Diffusion

A

Moves from higher concentration to lower concentration

25
Q

What other drug factors impact absorption of drugs?

A

Chemical size
pH
Solubility of drug
Surface area for absorption (e.g. villi/microvilli of intestinal tract)
Vascularity
Presence or absence of food in stomach
Presence of enzymes, acidity, bacteria etc

26
Q

Most drugs are distributed by:

A

Diffusion - drug state must allow for this

Adolf Fick

27
Q

Drug distribution

A

Small molecules absorbes easier

Acid drugs in acid medium
Base drugs in base medicum
Cell membranes are mainly lipid (fatty) materials - only lipid-like substances (lipophilic) substances cross easily ad rapidly

Most drugs act on receptors - typically protein

28
Q

Distribution

Blood-tissues - depends on?

A

Factors needed for absorption

Affinity to bind with carrier/buffer proteins e.g. albumin and globulin-saturation-buffer

MORE MISSED

29
Q

Metabolism

A

Drug metabolising enzymes have evolutionary defense

CYP450 and enzymes - make drugs water soluable to be excreted in urine

Chemical modifications increase / decrease pharmacological activity and or half life

30
Q

Routes of elimination

A 
Hair
Saliva
Milk
Sweat
Skin
Alveolar
Bilary- ?
Renal
Faecal
31
Q

Agonist

e.g. drug?

A

When a drug stimulates a receptor
Binds to receptor protein
Produce confirmational change
Enhance biological response

e.g. adrenaline acts on beta 2 receptors in lungs, bronchodilator

32
Q

Antagonist

e.g. drug?

A

When a drug blocks a receptor
Binds to receptor
No confirmational change to initiate intracellular signal.

Morphine activates morphine receptors -kappa delta receptors

Naloxone blocks receptors for morphine

33
Q

Affinity

A

Tenancity with which a drug binds to a receptor

34
Q

Routes of elimination

A 
Hair
Saliva
Milk
Sweat
Skin
Alveolar
Bilary- ?
Renal
Faecal

Majority of drugs are excreted unchanged or as metabolites in urine or bile

e.g. alchol detected via breath

35
Q

Potency

A

Amount of drug required to produce an effect of given intensity

36
Q

‘First Pass’ Metabolism?

A

Relates to the liver

Most substances that are absorbed throughy GI tract are taken to portal system- includes drugs

The subs are taken to liver for processing, stoarge or metabolised

Some drugs metabolised so well that cannot be given orally - GTN (96% destroyed in liver)

LEARN MORE

37
Q

96% of this drug is destroyed in liver

A

GTN

broncho…?

38
Q

Blood Brain Barrier

A

400 miles of capillaries and veins safeguarded

epithelial cells between capillaries and brain - very tightly packed, creating a barrier

blocks movement of certain substances e.g. urea, creatinine

39
Q

Cerebral capillaries - how different from body capillaries?

A

Endithelial cells are close together creating barrier

Can’t pass - urea, creatinine, red cells, white cells, protein

Can - oxygen, glucose, alcohol, nicotine, lipid soluble
amino acids

40
Q

What opens up BBB?

A 
trauma
infection
microwaves
radiation
hypertension
41
Q

Other bodily barriers?

A

Placental - most drugs cross this

Testicular - little understood

42
Q

Drug Half Life

A

Time taken for concentration to decrease by half

Morphine has short half life

Adrenaline has very very smol half life -

43
Q

Bioavailability

A

The proportion of the drug which reaches the circulation

IV drugs - Bioavailability of 100%
Swallowed? - only a proportion
Has to pass through GI system, liver, before reaches circulatory system

44
Q

Bioavailability

A

The proportion of the drug which reaches the circulation

IV drugs - Bioavailability of 100%
Swallowed? - only a proportion
Has to pass through GI system, liver, before reaches circulatory system

45
Q

Steady State

A

Maintain a consistent concentration of a drug

Half life of 48 hours - 2 weeks to take a steady state
Half life of 2 hours - less than a day

‘Loading dose’ often used to achieve a steady state

For all drugs there is a minimum effective concentration and maximum safe concentration

e.g. taking antibiotics consistently to allow steady state

46
Q

Therapeutic Index

A

Ratio of a drug that produced toxicity to a dose that provides a clinically desired or effective response

Large index - wide margin to reach toxic levels e.g. penecillin
Small index - toxic levels reached very quickly e.g. warfarin

Individual patient variation more likely in drugs with a smaller index as effective and toxic plasma concentrations are similar

47
Q

Measuring drug levels frequently - why?

e.g.?

A

Likely to have a small therapeutic index

e.g. lithium, warfarin

48
Q

How do drugs work?

A

RECEPTOR THEORY - receptors that determine and detect presence of specific drugs and initiate or inhibit an action. This can be blocked by another drug or chemical

ANTIMETABOLITES - closely resemble substances required for cell metabolism and nutrition

ENZYME INHIBITOR - drugs interfere with action of body enzymes therefore preventing certain chemical processes and reactions from occuring

ACTION ON CELL MEMBRANES - interfere with chemical activity of cell membrane and function

REPLACEMENT OF DEFICIENCIES - here drugs replace a dietary factor or hormone essential for normal fucntion

CYTOTOXIC EFFECTS - used to kill bacteria or malignant cells without undue harm to other cells. Interference with cell activity may occur and multiplication stopped - antibiotics

49
Q

How do drugs work?

A

RECEPTOR THEORY - receptors that determine and detect presence of specific drugs and initiate or inhibit an action. This can be blocked by another drug or chemical

ANTIMETABOLITES - closely resemble substances required for cell metabolism and nutrition

ENZYME INHIBITOR - drugs interfere with action of body enzymes therefore preventing certain chemical processes and reactions from occuring

ACTION ON CELL MEMBRANES - interfere with chemical activity of cell membrane and function

REPLACEMENT OF DEFICIENCIES - here drugs replace a dietary factor or hormone essential for normal fucntion

CYTOTOXIC EFFECTS - used to kill bacteria or malignant cells without undue harm to other cells. Interference with cell activity may occur and multiplication stopped - antibiotics

50
Q

Total Body Clearance

A

Combo of liver and kidney action

Liver assists clearing by metabolising and or excreting drugs through bile. Drugs can therefore be excreted in faeces or reabsorhed within the liver to be excreted via the kidney.

In certain instances, lungs are the main organs for elimination

51
Q

Patients with kidney or liver problems?

A

Often take lower doses as the drugs remain in the system for longer than normal.

52
Q

Total Body Clearance

A

Combo of liver and kidney action

Liver assists clearing by metabolising and or excreting drugs through bile. Drugs can therefore be excreted in faeces or reabsorbed within the liver to be excreted via the kidney.

In certain instances, lungs are the main organs for elimination

Pathophysiology of ill-health (16 decks)

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