Vol.1-Ch.13 "Emergency Pharmocology" Flashcards
Chemical name VS generic name VS official name VS brand name
- Chemical name: chemical composition and molecular structure
- Generic name: suggested by manufacturer
- Official name: listed in United States Pharmacopeia (USP)
- Brand name: manufacturer gives drug name (trade or proprietary name)
Schedule I type drug and examples:
High abuse potential; may lead to severe dependence; no accepted medical indications; used for research, analysis, or instruction only
Examples: Heroin, LSD, mescaline
Schedule II type drug and examples:
High abuse potential; may lead to severe dependence; accepted medical indications
Examples: Opium, cocaine, morphine, codeine, oxycodone, hydrocodone, methadone, secobarbital
Schedule III Type drug and examples:
Less abuse potential than Schedule I and II; may lead to moderate or low physical dependence or high psychological dependence; accepted medical indications
Example: Limited opioid amounts or combined with noncontrolled substances; acetaminophen with codeine, buprenorphine
Schedule IV type drug and examples:
Low abuse potential compared to Schedule III; limited psychological and/or physical dependence; accepted medical indications
Examples: Diazepam, lorazepam, phenobarbital
Schedule V type drug and examples:
Lower abuse potential compared to Schedule IV; may lead to limited physical or psychological dependence; accepted medical indications
Examples:Limited amounts of opioids; often for cough or diarrhea
4 phases of human drug studies
Human studies: four phases.
Phase 1: drug’s pharmacokinetics, toxicity, safe dose.
Phase 2: test on limited population.
Phase 3: refine therapeutic dose; collect data on side effects.
Phase 4: postmarketing analysis during conditional approval
Six Rights of Medication Administration
Six Rights of Medication Administration Right medication Right dose Right time Right route Right patient Right documentation
4 things to consider when treating a pregnant Pt?
Pregnant patients; treating two patients.
Drugs that affect mother affect fetus.
Changes in mother’s anatomy and physiology.
Potential for drugs to harm fetus
What is a Broselow tape used for?
Broselow tape: approximation for children of average height/weight ratio. Helps find drug dosages for kids
Newborn’s metabolic rates _____ than adult’s; which makes them at _____ risk for toxic interactions.
Newborn’s metabolic rates lower than adult’s; which makes them at higher risk for toxic interactions.
4 things to consider with geriatric Pts
Absorb oral medications slower.
Aging alters distribution of drugs.
Likely to be on multiple medications; multiple underlying disease processes.
Medication interactions can have severe impact
Pharmacokinetics VS pharmacodynamics
Pharmacokinetics: how drugs transported into and out of body.
Pharmacodynamics: drug effects once they reach target tissues.
Do drugs create new cell properties or modify/exploit existing cell properties?
Drugs do not confer new properties on cells or tissues; modify/exploit existing functions.
4 processes of pharmacokinetics?
Processes:
- absorption
- distribution
- biotransformation
- elimination.
Passive VS Active Transport?
- Active transport: use of energy to move a substance; achieved by breakdown of high-energy chemical bonds.
- Passive transport: movement of substance without use of energy.
Diffusion VS Osmosis VS Filtration
Diffusion: movement of solute in solution.
Osmosis: movement of solvent.
Filtration: movement of molecules across membrane down pressure gradient; area of high pressure to lower pressure.
If drug is not soluble in water than…?
If drug not soluble in water, it will have difficulty being absorbed.
Rate of drug absorption is directly related to _____?
Rate of absorption directly related to amount of surface area available for absorption.
Ionized drugs do not _____; most drugs do not fully ionize.
Ionized drugs do not absorb across membranes of cells; most drugs do not fully ionize.
A drugs concentration affects _____; _____ concentration, more rapidly the body will absorb them.
A drug’s concentration affects absorption; higher concentration, more rapidly the body will absorb them.
Loading dose is?
Loading dose: larger dose of same concentration of drug.
Bioavailability means?
Bioavailability: measure of amount of drug still active after it reaches target tissue.
Once drug enters bloodstream, it must _____
Distribution: once drug enters bloodstream, it must be distributed throughout body
Passes from bloodstream, through _____, into target cells
Passes from bloodstream, through interstitial spaces, into target cells
Certain organs can _____ some drugs from distribution.
Certain organs can exclude some drugs from distribution.
Chief proteins in blood for binding with drugs?
Albumins
What can affect protein-binding action of drug?
- Changing bloodstream’s pH can affect protein-binding action of drug.
- Presence of serum protein-binding drugs can affect drug-protein binding.
What is biotransformation?
What is a metabolite?
What is a prodrug or “parent drug”
Why are these important?
- Biotransformation: metabolism of drugs.
- Transforms drug into more or less active metabolite; makes drug more water soluble to facilitate elimination.
- Prodrugs (parent drugs) not active when administered; biotransformation converts them into active metabolites.
Where does most biotransformation occur?
Phase 1 = ?
Phase 2 = ?
Liver
Phase I: nonsynthetic reactions.
Phase II: synthetic reactions
Renal Excretion includes? (2)
Renal excretion: glomerular filtration and tubular secretion.
Changing urine pH affects _____?
Changing urine pH affects reabsorption in renal tubules.
Most drugs are secreted via _____?
Other routes include? (5)
Urine
or
Drugs excreted through expired air, feces, sweat, saliva, breast milk.
Enteral Routes VS Parenteral Routes (drug admin)
Enteral routes deliver medications by absorption through gastrointestinal tract.
Parenteral routes: needles to inject medications into circulatory system or tissues.
What dictates how drugs are stored?
Guidelines
What properties of the drug and environment may effect stored drugs?
Temperature, light, moisture, shelf life.
4 actions of drugs?
Actions of Drugs
- Bind to receptor site.
- Change physical properties of cells.
- Chemically combine with other chemicals.
- Alter normal metabolic pathway.
Affinity VS Efficacy
Affinity: force of attraction between drug and receptor.
(greater the affinity, stronger the bond)
Efficacy: drug’s ability to cause expected response
Most drugs bind to _____.
Almost all drug receptors are _____ on _____ cells
Most drugs bind to receptor.
Almost all drug receptors are protein molecules on surfaces of cells
Drugs _____ or _____ cell’s normal biochemical actions.
Drugs stimulate or inhibit cell’s normal biochemical actions.
Down-Regulation VS Up-Regulation
Down-regulation: decreased responsiveness of target cell to drug as number of active receptors decreases.
Up-regulation: drug causes formation of more receptors than normal; increases target tissue’s sensitivity to particular drug or hormone
Agonist VS Antagonist
Agonists: bind to receptor site; cause it to initiate expected response.
Antagonists: bind to site; do not cause receptor to initiate expected response.
(Agonist-antagonists may do both)
Receptor-mediated drug actions work like a lock (_____) and key (_____).
Receptor-mediated drug actions work like a lock (receptor) and key (agonist).
Drug-response relationship correlates?
Drug-response relationship: correlates different amounts of drug to clinical response.
Plasma-level profiles: include? (3)
Define each profile?
Plasma-level profiles: lengths of onset, duration, termination of action.
Onset of action: time from administration until medication reaches its minimum effective concentration.
Duration of action: length of time amount of drug remains effective.
Termination of action: drug’s level drops below minimum effective concentration.
Therapeutic index?
Therapeutic index: drug’s margin of safety.
Biologic half-life means?
Biologic half-life: time body takes to clear one-half of drug.
Drug interactions occur when?
Two drugs compete _____.
Occur whenever two or more drugs are available in same patient.
- Two drugs compete for plasma protein binding.
What are some things that occur when 2 drugs are in the system at the same time? (5)
- One drug alters rate of intestinal absorption.
- One drug alters the other’s metabolism.
- One drug’s action at receptor site may be antagonistic or synergistic to another’s.
- One drug alters the other’s rate of excretion through kidneys.
- One drug alters balance of electrolytes necessary for other drug’s expected result.
Ways to classify drugs? (3)
- Body system they affect, Mechanism of action, indications.
- Source or by chemical class.
- According to their uses
Prototype?
Prototype: drug that demonstrates class’s common properties and illustrates its particular characteristics.
CNS VS PNS?
Somatic nervous system VS autonomic nervous system?
- Central nervous system: brain and spinal cord; all nerves that originate and terminate within brain or spinal cord
- Peripheral nervous system: everything else
- Somatic nervous system: voluntary (motor) functions
- Autonomic nervous system: involuntary (automatic) functions.
Peripheral NS = Somatic NS + Autonomic NS
Autonomic NS = Sympathetic + Parasympathetic
Sympatheic VS Parasympathetic
Sympathetic = Fight or Flight Parasympathetic = Feed or Breed
Analgesics: ?
Analgesia: ?
Anesthesia: ?
Analgesics: medications that relieve sensation of pain.
Analgesia: absence of sensation of pain.
Anesthesia: absence of all sensation
Opioid antagonists?
Opioid antagonists: reverse effects of opioid analgesics.
Adjunct medications: ?
Adjunct medications: enhance effect of other analgesics.
Prototype opioid drug: ?
Prototype opioid drug: morphine
4 common opiodes?
Morphine (Duramorph)
Hydromorphone (Dilaudid)
Fentanyl (Sublimaze)
Meperidine (Demerol)
4 Common non-opioid analgesics?
Acetaminophen (tylenol)
Ibuprofen (Motrin, Advil)
Ketorolac (Toradol)
Asprin
2 common opioid antagonists?
Naloxone (Narcan)
Nalmefene (Revex)
2 common opioid agonist-antagonists?
Nalbuphine (Nubian)
Butorphanol (Stadol)
Anesthetics depress what 3 systems?
Given route?
Usually given via _____ outside operating room
Anesthetics: cause respiratory, central nervous system (CNS), cardiovascular depression.
Given by inhalation or injection.
Most anesthetics used outside operating room given intravenously.
Given locally to block sensation
Acetaminophen (tylenol):
Class? Action? dosage? indication? contraindications? route?
- Nonnarcotic, analgesic, antipyretic
- Uncertain; felt to inhibit cyclooxygenase
- 325-650mg
- Mild Pain, Fever
- sensitive to drug, alcoholism, chronic liver disease
- PO, IV
(can be liver toxic so use minimal dosage necessary)