Quiz 1 Flashcards
what is pharamacology?
the study of medicines
what is pharmacon?
medicine/drugs
what is the purpose of pharmacone?
cure/relieve symptoms
what is pharmacotherapeutics?
utilization of medicine to heal or manage pain
what are the 3 types of pharmacotherapeutics?
- drugs, 2. biologic, 3. Natural health product
what is included under drugs?
chemical agents
what’s included under biologic?
naturally produced in animal cells - hormones/antibodies
what’s included in natural health product?
naturally occuring - minerals, vitamins
what organization monitors/evaluates drugs in canada?
Health canda in collaboration with canadian pharmaceutical assocaition
what is the process of approving new pharmacotherapeutic drugs?
- pricinical
- clinical trial - 3 phases
- new drug submission to health canada
- review & approval
- NOC & DIN issued
- Health canada continues monitoring
how can bias be eliminated in research?
by conducting 2 blinded search where the groups don’t know whether the treatment the patient is receiving the drug or placebo
what are the categories of pharmacotherapeutics drug classes?
- therapeutic
- pharmacological
what do therapeutic names specify?
name specifies treatment/therapy
What does pharmacological do?
based on the mechanism of action of drug
give examples of therapeutic drugs & their uses
- anti-coagulant = inhibits clotting
- anti-hypersensitive = lowers blood pressure
- anti-inflammatory = decreases inflammation
- anti-emetic = decreases vomiting
give examples of pharmocological drugs & their uses
- beta blockers = blocks beta receptors
- calcium channel blockers = blocks calcium channels
- Inhibits seratonin’s re-absorbtion at the synapse
what are the 3 types of pharmacotherpeutics drugs names?
- chemical
- generic
- brand/trade
what does chemical drug name ential?
the chemical composition of the drug
what does generic chemical drug name entail?
drug without a proprietery affiliation
what does brand/trade ential?
named by the manufacturing company
what’s the main differences between a brand name & generic name?
- cost is the main difference - generic is cheaper, brand is more expensive
what is prototype drug?
selection of a single drug form from a drug class to serve as a reference, usually the original drug of that kind
what are drug schedules?
these are classifications on where patients can access drugs, and who has the ability to dispense them
what is drug schedule 1 & what is included in this category?
available only via prescription
includes controlled drugs, narcotic drugs
what is drug schedule 2 & what is included in this category?
available only from a pharmacist, must be obtained in an area with no public access
what is schedule 3?
available via open access in a pharmacy
what is unscheduled drugs?
can be sold in any store without professional supervision
what category under nursing plan does pharmacotherapeuitcs fall under?
falls under intervention
what does the assessment process in nursing process include?
- subjective/objective data
- chief concern
- personal/social history
- review of systems in health history
- physical exam
what does the diagnosis process in nursing plan include?
synthesis of data - history & physical exam - lab & imaging results
what does the planning process in nursing plan include?
respond to the diagnosis - using interventions like pharmacotherapeutics, other therapeutics, surgery
what does implementing process in nursing plan include?
activating the plan & monitoring
what does evaluation process in nursing plan include?
review of diagnosis - reases
what factors affect choice of drug administration routes?
- drug to target tissues
- clinical setting
- medical situation
- drug dynamics
what is the characteristics of administering drugs via oral?
- it can be liquid, tablet, powder
- called enteral (passes through the gi tract)
- systemic effect
- challenge - acidic environmnet & undergoes 1st pass metabolism
what is the characterisitics of administering drugs via sublingual?
- under tongue
- capillary absorption into blood stream
- systemic effect
- bypasses 1st pass metabolism
- faster than PO
what are the characteristics of administering drugs via intranasal?
- into the nasal cavity
- capillary absorption
- localized or systemic effect
- difussion across mucosa & distribution along CNS nerve network
what are the characteristics of administering drugs via inhalation?
- breathed into lungs
- pulmonary capillary network = rapid effects
- localized or systemic (anesthesia drugs)
what does endotracheal administration entail?
- uses tube in ER/ICU
- use of epinephrine
what are the characteristics of administering drugs via topical route?
- applied directly to skin
- local effect
what are the characteristics of administering drugs via transdermal route?
- use of patch
- dermal capillary absorption
- sytemic effect
- long acting - slow & steady release absorption
what are example of transdermal patches?
- nitroglycerine patch
- nicotine patch
- morphine patch
what are the characteristics of administering drugs via rectal route?
- inserted into the lower GI, rectum
- local & systemic effect
- low 1st pass metabolism
what are the characteristics of administering drugs via intravenous route?
- requires needle-catheter into a vein
- immediate absorption = fast on-set of action
- dose given = dose reaching the tissue
- systemic effect
what are the characteristics of administering drugs via intramascular route?
- needle injection into muscle tissue
- cappilary bed absorption into bloodstream
- systemic effect
- painful
what are the sites of injection for intramascular route & where they are located?
- deltoid - on top of scapula
- vastus lateralis and rectus femoris - on top of thigh
- ventrogluteal (just below illiac crest)
what are the characteristics of administering drugs via subcutaneous route?
- injection into adipose tissue of hypodermis
- absorption via capillary bed
- systemic effect
what is pharmacokinetics?
kinetics = movement
pharma = medicine
- movement across cell membranes via lipid bilayer
what are the 4 phases of of pharmacokinetics?
A = absorption
D = distribution
M = metabolism
E = excretion
what are factors affecting pharmacokinetics?
- molecular characteristics
- membrane transport
explain how molecular characteristics affect kinetics?
- neutral atoms get converted to ionized
- base-to-base , acid-to-acid
- lipophilicity affects it = likes lipid
- hydrophillicity affects it = likes water
- size = smaller ones are easier to go across membranes
what are the 2 movement used in molecular transport?
- passive transport
- active transport
what is included in passive transport?
- passive transport -
- osmosis -
- facilitated diffusion
what is active transport?
movement of a
what is the barrier with lipid layer of plasma membrane?
it is lipophilic membrane which is impermeable to large molecules, ions, polar molecules
what are the 2 general ADME rules?
- for easy absorbtion = it has to be lipophilic, non-ionized, small
- for easy excretion = it has to be hydrophilic, ionized
What is the absorption process of pharmacokinetics?
time for drug to reach systemic circulation
what factors affect absorption?
- administration route
- molecular characteristics
what is the term used for systemic circulation?
bioavailability - systemic circulation (plasma) drug concentration
how is bioavailability measured?
via blood plasma
what does titrating to effect mean?
adjusting the dose level to achieve desired patient effect
what is 1st pass metabolism?
drugs absorbed from the stomach & small intestine first travel to the liver, where they may be inactivated before they ever reach their target organs
what is the comprehensive flow of first pass metabolism?
- oral drug administration
- drug absorbed across the intestinal mucosa stomach
- drug enters hepatic portal vein circulation
- travels to the liver (bio-transformed)
- on the first pass through the liver. drug is metabolized to less active forms.
what are the some drugs with extensive first pass metabolism?
- morphine
- meperidine
- diazepam
- midazolam
- lidocaine
- propranolol
- ETOH
what is therapeutic range?
the plasma drug concentration between minimum effective concentration and toxic concentration
what is minimum effective concentration?
the amount of drug required to produce a therapeutic effect
what is toxic concentration?
the level of drug that will result in serious adverse effects
what does a steady state level on the graph mean?
amount of drug administered has reached equilibrium with the amount of drug being eliminated
what is the loading dose?
give one dose after other without reaching toxic range to reach the therapeutic range rapidly
what is maintenance dose?
it is the amount given after loading dose to keep the plasma drug concentration in the therapeutic range
- usually regular recommended dose
what is the recommended dose?
aka ED 50
- this is the amount that elicits a therapeutic effect
- based on clinical trials
what is median toxicity dose?
dose at which substance is lethal - lethal dose (LD)
what is the therapeutic index?
difference/ratio between TD50:ED50 = TI (therapeutic index)
how is therapeutic index calculated?
LD50/ED50
what does smaller TI mean?
higher risk
what examples of drugs with narrow IT?
Diligent - Represents Digoxin (lanoxin)
Wizards - Represents Warfarin (coumadin)
Prefer - Represents Phenytoin (dilantin)
Taking Potions - Represents Tacrolimus (progaf, astagraf)
What is involved in the distribution process of pharmacokinetics?
involves the transport of drugs to target tissues
what are some factors affecting distribution?
- blood flow to the tissue - cardiac output, brain blood barrier, injury
- size of the tissue
- molecular characteristics - lipophilicity, size
- PBP
how does BBB affect distribution?
the capillaries within the CNS are lined by specialized endothelial cells that only allow only for selective transport of substance
what is the P-glycopreotein pump?
this is a pump that only allows selective materials to get into BBB
How does PPB affect distribution?
some drugs have high affinity for plasma carrier proteins thus binding with these plasma protein molecules with decreases dristribution rates, and space becomes competitive
what protein do acidic drugs bind to?
albumin
which protein do basic drugs bind to?
alpha-1-acid glycoprotein
what’s the distribution rule for PPB
unbound drugs are more effectively distributed compared to bound drugs
what are some drugs that are extensively bound?
We - Represents Warfarin
Need - Represents NSAID (Ibuprofen & Naproxen)
Fine - Represents Furosemide
Dining - Represents Digoxin
what is volume of distribution?
this estimates how extensively drug is distributed into tissues
how is VD calculated?
drug dose/measured drug plasma concentration
What is involved in the metabolism process of pharmacokinetics?
an enzymatic chemical conversion that prepares drug/substance for excretion
where is the primary organ where metabolism happens?
liver
what are the hepatic microsomal enzymes?
metabolism in the liver is accomplished through enzyme complex called the P450 system/microsomal enzyme system - made up of cytochome P450 (CYP)
what are the 2 main CYP 450 enzymes?
CYP 3A4 + CYP 3A5 = make up 50%
what are the 3 types of biotransformation results?
- active to inactive
- active to active
- inactive to active (prodrugs)
what are the 2 main phases of metabolism?
- phase 1
- phase 2
what process is involved in phase 1 of metabolism?
hydrolysis, reduction, oxidation
- use of cytochome 450 enzyme
- polar metabolite become ionized
what process is involved with phase 2 of metabolism?
- only some drugs require this
- involves conjugation & polarization
explain how acetaminophen is biotransformed?
phase 1 = acetaminophen becomes N-acetyl-p-benzoquinoneimine (hepatotoxic)
Phase 2 = N-acetyl-p-benzoquinoneimine becomes inactive metabolite using glutathione enzyme for conjugation
What is involved in the excretion process of pharmacokinetics?
this is the elimination of inactive substances & metabolites are eliminated
what is the primary organ of excretion?
kidneys
explain the filtration mechanism of kidneys
- uses glomerulus - write how
what are factors affecting renal excretion?
- molecular characteristics (ionization, hydrophilicity, small size)
- CO = renal blood flow
- renal function
how is GFR calculation done?
- Creatinine - bloodwork lab results
- Clearance -(rate of elimination of drug in an hour) requires calculation
what are the 2 types of clearance elimination kinetics & their meaning?
- 1st order = rate of elimination is equal to concentration of drug in the body
- zero - order = rate of elimination is constant regardless of drug’s concentration
how is the clearance rate for 1st order elimination calculated?
CL = elimination/peak plasma concentration
what is half life & how does it relate to excretion?
this is the amount of time for cmax drug plasma concentration to decrease by one half (by 50%)
what’s the formula for total half life?
to calculated for 90 % of drugs eliminated use:
4 X t1/2 = 90%
List of drugs with zero elimination
Every - Represents Ethanol
Artist - Represents Aspirin (ASA)
Paints - Represents Phenytoin (Dilantin)
explain how entero-hepatic process works
find how
List drugs that are absorbed in the stomach
All - Represents Alcohol
Artists - Represents Aspirin (ASA)
Create - Represents Caffeine
Wonderful - Represents Warfarin (Coumadin)
Drawings - Represents Dilantin (Phenytoin)
list of drugs with first pass metabolism
My - Represents Morphine
Mother- Represents Meperidine (Demerol)
Dislikes - Diazopem
Licorice - Represents Lidocaine
Even - Represents Ethanol (ETOH)
Professionally - Represents Propranolol
Made - Represents Midazolam
