Pharmacology Lesson 2 Flashcards
0
Q
What is a chemical name?
A
Drug’s chemical composition and molecular structure.
1
Q
What are three classifications of drug nomenclature?
A
- Chemical
- Genetic
- Trade
2
Q
What is a genetic name?
A
Non-proprietary name assigned by the United States Adopted Name Council.
3
Q
What is a trade name?
A
Proprietary name given by the developers of the drug. Drug trade names have a registered trademark.
4
Q
What is the difference between drug action and drug effect?
A
- Drug action–>cellular level (drug/cell interaction)
- Drug effect–>whole body (overall effect on the body)
5
Q
What are the 4 pharmacologic principles of pharmacokinetics?
A
(ADME)
- Absorption
- Distribution
- Metabolism
- Elimination
6
Q
What is pharmacokinetics?
A
What the body does with the drug.
7
Q
What is pharmacodynamics?
A
What the drug does to the body.
Biochemical and physiological effect of the drug on body tissue and microorganisms in/on the body
8
Q
What is pharmacotherapeutics?
A
The use of drugs and the clinical indications for drugs to prevent and treat diseases.
9
Q
What is absorption?
A
Movement of a drug from its site of administration into systemic circulation (blood).
10
Q
What are the factors that affect drug absorption?
A
- Status of patient’s circulation
- Co-administration of food or fluids
- Bioavailability of drug
- Route of administration
- Type of membrane transport
- Acidity of the stomach
- Status of GI motility
- Dosage form
- Concentration of drug
11
Q
What is distribution?
A
Delivery of drug from the blood to the end target.
12
Q
Drug moves from blood to ____ ______?
A
End target
13
Q
What areas of distribution will result in higher concentration of drug?
A
Areas of more RAPID distribution will result in higher concentration of drug.
14
Q
What are 3 major factors affecting distribution?
A
- Protein-binding properties
- Water soluble vs fat soluble
- Blood-brain barrier
15
Q
What are the 4 distribution patterns of pharmacokinetics?
A
- Drug stays within vascular system
- Drug distributes throughout body water
- Drug concentrates in specific tissue
- Drug distributes throughout body and tissue
16
Q
What are 2 factors that affect drug distribution?
A
- Rate of distribution
- Extent of distribution
17
Q
What affects the rate of distribution?
A
- Membrane permeability
- Blood perfusion
18
Q
What affects the extent of distribution?
A
- Lipid Solubility
- Plasma pH
- Plasma protein binding
- Intracellular binding
19
Q
Protein binding may be reversible or irreversible? (True or False)
A
True
20
Q
In what 2 forms do drugs exist in plasma?
A
- Bound
- Unbound (free)
21
Q
Only the unbound form of a drug has therapeutic action. This is known as ___________?
A
Bioavailability
22
Q
Only the unbound form of a drug will be metabolized and/or excreted. (True or False)
A
True
23
Q
What does reversible protein binding maintain for active drugs?
A
State of equilibrium
24
What are some variables affecting the unbound fraction of drugs
- [ ] of drug given
- Amount of plasma proteins
- Quality of plasma proteins
- Concomitant administration of other protein binding drugs
25
97% of the anticoagulant Warfarin is protein bound. What percent of Warfarin is biologically active and will be metabolized and/or excreted?
3%
26
What are 4 plasma proteins that drugs bind to?
- Serum albumin (most significant)
- Lipoprotein
- Glycoprotein
- Globulins
27
Diminished quantity of plasma proteins may lead to excess free (unbound) drug. (True or False)
True
28
When a drug concentration is too high or number of plasma proteins are too low, all binding sites on protein become _____________.
Saturated
29
Excess drug remains unbound (free) and ____________.
Biologically active
30
What are 4 contributing factors to reduced plasma protein?
- Malnutrition
- Renal disease
- Liver disease
- Catabolic state
31
What is displacement?
When one drug pushes another drug off of the binding site on a protein.
32
Administering two or more protein-binding drugs together can dramatically alter the _____________ effect of one or more drugs.
Therapeutic
33
Majority of drugs are ___________, in turn creating continuous state of equilibrium.
Reversible
34
Acid drugs will generally bind to what kind of protein?
Albumin
35
Basic drugs will generally bind to what kind of proteins?
Glycoproteins and globulins
36
Drug metabolism is also know as ____________?
Biotransformation
37
What 3 things can drug metabolism biologically transform a drug into?
- Inactive metabolite
- More soluble compound
- More potent metabolite
38
What is bioavailability?
The fraction of unchanged drug (therapeutically active) that reaches systemic circulation and is available at target site.
39
What is the main site of drug metabolism?
Liver
40
What does decreased drug metabolism result in?
- Accumulation of drugs
| - Prolonged action of the effects of the drugs
41
What does increased drug metabolism result in?
Diminished pharmacologic effects
42
What factor might affect increase and/or decrease of drug metabolism?
Drug/drug interaction
43
What is the definition of First-Pass Effect?
Metabolism of a drug by the liver and its passage from the liver into the circulation.
44
A specific drug can be given orally and through IV. Which route bypasses the liver and avoids First-Pass effect?
IV
45
What administration routes avoid First-Pass effect?
- Sublingual
- Buccal
- Intramusvular
- Intravenous
- Subcutaneous
- Intranasal
- Inhalation
- Transdermal
- Intraosseous
- Vaginal
46
Which route has a "special situation"?
Rectal route
47
Drugs administered to the ________ portion of the rectum are absorbed directly into the ________ _____ _____ and avoid ______ _____ thus avoiding First-Pass effect.
Lower; inferior vena cava; portal veins
48
Drugs administered to the ________ portion of the rectum are absorbed rapidly into the ______ ____ and undergo a higher degree of First-Pass Metabolism.
Upper; Portal veins
49
Drugs given via oral route may be ___________ ___________ before reaching the systemic circulation. (High first-pass effect)
Extensively metabolized
50
Extensive (increased) drug metabolism results in a diminished bioactive drug effect. (True or False)
True
51
Decreased drug metabolism results in what 2 things?
- Accumulation of drugs
| - Prolonged action of the effects of the drug (potentially toxic)
52
What is the definition of excretion?
Elimination of drugs from the body
53
what is the main organ involved in excreting drugs?
The kidneys
54
What is another way drugs are excreted?
Breast milk
55
Increased metabolism = ___________ bioactive effect
Decreased
56
Decreased metabolism = ___________ concentration of drug; Which in turn will __________ bioactive effect.
Increased; Increase
57
Majority of drugs excreted through _________ system.
Renal
58
What is the main factor affecting renal drug clearance?
Adequacy of renal function
59
What are 2 major conditions that impair kidney (renal) function?
- Hypertension
| - Diabetes
60
How can renal function be tested prior to prescribing drugs?
Serum creatinine OR urine creatinine clearance
61
What is creatinine clearance?
Volume of serum or plasma that is cleared of creatinine in one minute via urinary excretion.
62
What is the formula used to calculate creatinine clearance?
(140-age in yrs) (weight in kg) / (72 x serum creatinine in mg/dL)
**Multiply weight by 0.85 for women**
63
What are the normal creatinine levels for men and women?
Men: 91 - 137 ml/min
Women: 88 - 128 ml/min
64
What is the definition of half-life?
The time it takes for 1/2 of the original amount of the drug to be removed from the body.
65
Half-life is a measure of the rate of _____ _________ from the body.
Drug elimination
66
Half-life is significant when considering what 3 factors?
- Steady state of drug
- Toxicity of drug
- Sub-therapeutic drug levels
67
What is mechanism of action (MOA)?
The ways by which drugs produce therapeutic effects
68
What is the definition of onset?
Time needed for the drug to elicit a therapeutic response
69
What is the definition of peak?
Time needed for a drug to reach its maximum therapeutic response.
70
What is the definition of duration?
Length of time that a drug concentration is sufficient to elicit a therapeutic response.
71
what are the 6 types of therapy and what do they mean?
- Acute therapy: right now or very serious
- Maintenance therapy: ongoing
- Supplemental therapy: addition to
- Palliative therapy: controlling symptoms
- Supportive therapy: psychotherapy
- Prophylactic therapy: preventive
72
What is the significance of drug treatment?
The more the patient knows and understands about how to take the medication and why it is prescribed... The greater the chances that the drug treatment will be successful.
73
What are the 3 main factors of drug monitoring?
- Evaluating the effectiveness of drug therapy
- Observing for any adverse drug effects
- Making adjustments as needed
74
What are the 6 considerations in drug monitoring?
- Therapeutic index
- Drug concentration
- Patient's condition**
- Tolerance and dependence
- Interactions
- Side effects/adverse drug effects
75
What is therapeutic index?
The ratio between a drug's therapeutic benefits and its toxic effects.
76
What is the definition of tolerance?
A decreasing response to repetitive drug doses.
77
What is the definition of dependence?
A physiologic or psychological need for a drug.
78
_______ _____ ______ are human medication errors that result in patient harm. All are ___________.
Adverse drug events; Preventable
79
________ _____ _______ are any unexpected drug reaction that is NOT desired that occurs with normal therapeutic dose. These are ____ __________.
Adverse drug reactions; Not preventable
80
What are the 4 adverse drug reactions?
- Idiosyncratic (unusual)
- Hypersensitivity
- Drug/drug interactions
- Drug/food interactions
81
What are some drug/drug interactions to consider?
- Other prescribed drugs
- OTC medications
- Herbal therapies
82
What are the 4 different ways drug interactions can effect the body?
- Additive effect: Possibly toxic
- Synergistic effect: Drugs that work well together
- Antagonistic effect: Drugs negate each other
- Incompatibility effect: One drug might alter the effect of another drug
83
What is the definition of side effects?
Expected well-known reactions that result in little or no change in patient management.
84
what is the definition of iatrogenic responses?
Unintentional adverse effects that are treatment induced.
85
What are some other drug-related unwanted effects?
- Teratogenic: Effect baby during pregnancy
- Mutagenic: Can alter DNA
- Carcinogenic: Can cause cancer
86
How are drug forms classified?
By physical state (liquid, solid) and chemical composition.
87
What influences rate of dissolution and absorption?
Drug form
88
Why are some tablets enteric-coated?
To protect the gastric mucosa.
89
How do buffered tablets prevent stomach irritation?
By combining drug with a buffering agent that decreases acidity of drug.
90
Buffered and/or enteric-coated tablets can be crushed and/or dissolved. (True or False)
FALSE: Buffered and enteric-coated tablets should NEVER be crushed or dissolved.
91
What type of tablet can be cut in half?
Only scored tablets
92
_________________ capsules dissolve at a predetermined rate over longer period of time.
Sustained-release (SR)
93
What are suspensions?
Insoluble drug contained in a liquid.
94
What is needle length/gauge based on for parenteral medications?
Based on drug characteristics and individual factors
95
What is syringe size/length based on for parenteral medications?
Type and amount of medication.
96
What are specialty syringe units (Epi-pen, Novo-pen) designed for?
Quick and easy administration of drug in emergency and/or self-injection.
97
What are the 3 major categories of drug routes?
- Enteral: Drug absorbed into systemic circulation through alimentary canal (mouth to anus)
- Parenteral: Needle and/or catheter required for administration
- Topical: Drug applied to skin or mucosa or inhaled
98
What are the 6 types of enteral routes?
- Oral: swallowing
- Sublingual: under tongue
- Buccal: between tongue and cheek
- Via nasogastric tube
- Via gastrostomy feeding tube
- Rectal: inserted into rectum
99
What is an advantage or sublingual and buccal?
Rapid absorption --> fast onset
100
What is an example of oral administration?
Cost lower compared to other parental routes.
101
What are some disadvantages to oral route?
- Subject to first-pass effect
- Effect too slow for emergencies
- Can't use in unconscious patients
102
What are some advantages of the rectal route?
- Patients with nausea/vomiting
- Patients who are unconscious
- Infants/young children who can't swallow pills
103
No single method of drug administration is ideal for all drus in all circumstances. (True or Flase)
True
104
What are the 7 parenteral routes?
- Intravenous ** fastest delivery to blood stream
- Intramuscular
- Subcutaneous
- Intradermal
- Intrathecal
- Intraarticular
- Intraosseous
105
What are some advantages to Intravenous (IV) route?
- Avoids first-pass (100% bioavailability)
- Rapid onset
- Precise and accurate dosing
- Can give large quantities of meds
- No pain of repeated injections
106
What are some risks with IV route?
- Infection
- Fluid overload
- Electrolyte imbalance
- Phlebitis (irritaion/inflammation without infection)
- Extravasation (accidental infusion of IV meds/fluids into surrounding tissue instead of vein)
- Embolus (Air, blood, or catheter)
107
What are some advantages to Intramuscular (IM) route?
- Avoids first-pass
- Avoids GI side effects
- May be appropriate for non-compliant patients
- Can inject fairly large amount of meds (in larger muscles)
108
What are the 5 IM injection sites?
- Deltoid
- Dorsogluteal (Gluteus Medius)
- Ventrogluteal (Gluteus Medius)
- Rectus femoris
- Vastus lateralis
109
What IM administration site should you avoid in infants?
Gluteals... Because the muscle is not well-developed until they have been walking for one full year.
110
What IM administration site is best for infants and young children?
Vastus Lateralis... Because it is well-developed and there are no large blood vessels or nerves.
111
What are some advantages to subcutaneous (SubQ) route?
- Site easily accessed
- Can be self-administered
- Wide selection of sites
- Relatively convenient and portable
- Emergency administration of epinephrine anywhere
112
What is an advantage to Intradermal route?
Provides a wide field for allergy testing
113
What are the 6 ares of topical routes?
- Skin
- Eyes
- Ears
- Nose
- Lungs (inhaled)
- Vagina
