quiz 2 Flashcards
controlled substance
medications that can produce a toxic and potentially fatal adverse effects
-officials must ensure that patients with medical needs have access while keeping the drugs away from the people who would abuse them
united states code- controlled substance act of 1970
congress gave the united states drug enforcement administration (DEA) authority to
-set the schedule of controlled substances
-control and enforce laws related to these substances
controlled substances are divided into categories/schedules, what are these based on
drugs acceptable medical use, drugs potential for abuse and drugs safety or dependence liability
schedule 1 substance
the most addictive and most potential for abuse
-no currently acceptable medical use with a high potential for abuse
-severe psychological and or physical dependence
-examples include heroin, LSD and extasy
schedule 2 substance
can potentially lead to severe psychological or physical dependence and are also considered dangerous
-examples include morphine, fentanyl and adderall
schedule 3 substance
moderate to low potential for physical and psychological dependence
-examples include ketamine, anabolic steroids and cannabis
schedule 4 substance
defined as drugs with a low potential for abuse and low risk of dependence
-examples include xanax, valium and tramadol
schedule 5 substance
lowest potential for abuse
-preparations containing limited quantities of certain narcotics
-generally used for antidiarrheal, antitussive and analgesic purposes
-examples include lomotil, lyrica and cough presentations
adverse drug reactions (ADRs)
any undesirable action (side effect) and can also include toxicity reactions
undesirable actions can include ….
undesired effects, generally reversible upon drug discontinuation and they are dose related
toxicity reactions can include …
cell and tissue damage or permanent/generally intolerable reaction
what are some factors that can increase the risk of ADRs
increasing age of child, increasing number of drugs and oncological treatment
GA agents and opiate analgesics were found to be a ____________
significant cause of ADRs
reporting of ADRs
requires all to be included within the monograph (inserts that accompany prescription drugs in the pharmacy inventory)
-reported by systems/organs affected and the percentage of population affected
how are ADRs categorized
by the body/organ system affects and by the general side effects that affect the whole body
how can the skin be impacted with ADRs
drug induced itching and redness, acne, alopecia, herpes simplex, sweating, hives (ultricaria), skin ulcers and steven johnson syndrome
how can the nervous system be impacted with ADRs
dizziness, drowsiness, confusion, depression, delusions, hallucinations, decreased mental acuity, delayed reaction time and headaches
how can the eyes be impacted with ADRs
blurred/double vision, increased ocular pressure, damage to retina and optic nerve and erythema multiforme
what is erythema multiforme
allergic reactions to some antibiotics, NSAIDs and infections
-involves mucous membranes, skin and eyelids
-produces variety of skin lesions from bumps, plaques to blisters
-the most severe for is stevens johnson syndrome
how can the auditory vestibular system be impacted with ADRs
dizziness, vertigo, balance disorders, HL and tinnitus
-tinnitus and dizziness are the most common side effects
common side effects that impact the whole body
malaise, fatigue, body pain and lower extremity pain such as back pain
explain the various components of the immune system
parts are antigen-specific, parts are systemic and parts have memory
how is self/non-self recognition accomplished
based on having the major histocompatibility complex (MHC)
major histocompatibility complex (MHC)
every cell of the body will have this
-these are a group of genes that code for cell surface proteins essential for the immune system
what occurs when the immune system attacks the body’s own cells
can cause autoimmune diseases
-such as multiple sclerosis or sudden sensorineural hearing loss
what can happen when there is an overwhelming immune response
allergies
-a substance elicits this response
main fluid systems of the immune system
hematopoietic (blood system) and the lymphatic system
hematopoietic (blood system)
this contains erythrocytes or red blood cells, leukocytes or white blood cells and thrombocytes or platelets
-RBCs carry oxygen
-WBCs fight infections
-platelets help control bleeding
what are WBCs further divided into
granulocytes and agranulocytes
-most plentiful are granulocytes
-agranulocytes consist of B cells, T cells and monocytes
where do the cells of the blood system develop
within the bone marrow, from the pluripotent hematopoietic stem cell
-through hematopoietic growth factors in how they become individualized
lymphatic system
lymph flows alongside the blood vessels, tissues and organs in order to act as a fighting mechanism
-lymph nodes act as filters
what are the main cells of the lymphatic system
T cells : involved with cell mediated immunity, mature within the thymus gland but produced in bone marrow
B cells : involved in humoral immunity, antibodies are produced here, produced in bone marrow
antibodies or immunoglobulins (Igs)
used by the immune system to identify and neutralize foreign objects such as bacteria and viruses
-recognizes unique molecule of the pathogen called an antigen
-secreted by plasma and are offsprings of primed B cells
development of antibodies or Igs
B lymphocyte is stimulated to maturity and when an antigen binds to the surface receptor the B cell becomes sensitized or primed and undergoes clonal selection reproducing by mitosis. most of these clones will become plasma cells.
-after a initial timeframe of up to 14 days, highly specific antibodies will be produced (primary immune response)
-other B cells become long lived memory cells (secondary immune response
secondary immune response is ……
quicker and more effective
B cells that become long lived memory cells and the interaction of the same antigen will do ….
they have been identified and they know to then go against that antigen
what are the various types of gamma globulin’s
IgG, IgA, IgM, IgD, and IgE
which globulin is the most dominant in the body
IgG
which globulin dominates the secondary immune response
IgG
which globulin crosses the placental barrier to the fetus
IgG
-responsible for the immune protection to newborns
which globulin dominates in primary immune responses
IgM
how do vaccines work
-activates T cells that detect the presence of a virus (peak of 10-18 days after the shot)
-instructs B cells to create antibodies that block the virus from being able to replicate and the T killer cells will destroy the infected cells
when ________ is released at a too high quantity, this causes hypersensitivity and allergies
histamine
what are the target cells of immediate type reactions
mast cells and basophils (WBCs)
-both containing histamine (important for fighting infections)
what causes hypersensitivity or allergies
antigens combine with molecules of IgE antibodies that have become attached to the mast or basophil cells surface which causes the release of histamine resulting in an allergic reactions
types of allergic reactions and the type of globulin associated with it
-type 1 (mediated by IgE)
-type 2 (mediated by IgG and IgM)
-type 3 (mediated by IgG)
what type of allergic reaction is the most severe and can lead to anaphylaxis
type 1
-can also show asthma syndrome and dermatitis
what do type 2 reactions lead to
hemolysis of RBCs (breaking down)
what do type 3 reactions lead to
arthralgia (muscle or joint pain) or fever, lymphadenopathy (swollen lymph glands)
anaphylaxis
severe, progressive, whole body allergic reaction to a chemical that has become an allergen
-typically within the second reaction and can be life threatening
risks of anaphylaxis
history of any type of allergic reaction but can occur with no known cause during a first exposure
symptoms of anaphylaxis
abdominal pain, anxiety, chest discomfort, dizziness, cough and difficulty breathing, nausea/vomiting
treatment of anaphylaxis
epinephrine to reduce the body’s allergic response, oxygen to help breathing, IV antihistamines and cortisone to reduce inflammation and swelling
common teratogens and fetal development
drugs (isotretinoin and thalidomide) infections (rubella) and environmental factors (radiation)
drugs may still be approved by the FDA if there are any teratogens if ….
therapeutic benefits outweigh the risk, physician labeling clearly contraindicated use during pregnancy and the FDA requires testing of all new drugs for teratogens during toxicity trials with animal studies
pharmacogenomics
study of the role of the genome in drug response, a combination of pharmacology and genetics
-interindividual differences can exist
single nucleotide polymorphism (SNP)
when one nucleotide in a specific position is exchanged with another nucleotide
-variations can affect protein amount or function by altering coding sequence of transcription or mRNA translation
examples of polymorphisms
the inherited variation of enzymatic hydrolysis of short acting muscle relaxant by the enzyme serum cholinesterase and cytochrome P450 (CYP) liver enzyme
explain the cholinesterase enzyme
one of these enzymes function is to metabolize the muscle relaxant succinylcholine however, the altered enzyme has a decreased affinity for this causing decreased metabolism, slow elimination and prolonged circulation
explain the CYP enzyme
genetic variations can cause less active/inactive forms of CYP that can then alter drug metabolism for drugs leading to overdose
-both in phase 1 and 2 liver enzymes
-results in significant drug efficacy and toxicity for individuals with these compared to those without
potential benefits of pharmacogenomics
development of drugs to target specific disease based on genetic information, establishing gene phenotype prior to the use of certain medications, matching the right drug/dose to patients genotype, removing the need to experiment with medication, advanced screening for disease susceptibility to monitor conditions and maximize therapy, developing better vaccines and decreasing overall health care costs
barriers present with pharmacogenomics
very complex/time consuming, knowing a genetic make up will not be helpful if the two drugs are contraindicated, little incentive for drug manufacturers to spend high amounts of money and development of the start of the art technologies to detect and analyze DNA sequencing data and translate that knowledge to the clinic
