Week 6- Pharmacology Flashcards
What is pharmacolgy?
- Is the study of drugs, their actions, dosage, therapeutic uses and adverse effects
What is the leading cause of pt safety errors in healthcare?
- Medication errors
What are drugs?
- It’s a substance that alters biological activity in a person
What are some reasons drugs are prescribed?
- Promote healing (anti inflammatory)
- Cure disease (antibacterial)
- Prevent disease
- Control of slow the process (chemo)
- Decrease risk of complications (anticoagulants)
- Increase comfort (analgesic)
- Replacement therapy (insulin)
- Reduce excessive activity (sedative)
What 4 disciplines is it separated into?
- pharmacodynamics
- pharmacokinetics
- pharmacotherapeutics
- toxicology
What is pharmacodynamics?
- The study of biochemical and physiological effects of drugs and their mechanisms of action
What is pharmacokinetics?
- How the body interacts with administered substances for the entire duration of exposure
What is pharmacotherapeutics?
- The use of drugs for the prevention, treatment, diagnosis, and modification of normal functions. Ex. pregnancy prevention
What is toxicology?
- Study of the adverse effects of chemicals or physical agents on living organisms
What are the drug effects?
- Therapeutic= beneficial tx
- Side effects= unwanted rxns
- Toxic effects= dangerous side effects
- Hypersensitivity= allergic rxns
- Idiosyncratic= unusual rxn by an individual to a normally harmless substance
- Iatrogenic= negative effect caused by error or OD
- Teratogenic= harmful effects on fetus
What are the 4 interactions?
- Synergism
- Antagonism
- Potentiation
- Additive
What does synergism mean?
- When combined effect is greater than that predicted by their individual potencies, the combination is said to be synergistic
- Med A + Med B= ABCDE- too many side effects
What does antagonism means?
- Opposing action (half ass works)
What does potentiation mean?
- To increase the strength or effect
What does additive mean?
- Combining 2= the sum of each
- Tylenol & advil
What does absorption mean when it comes to meds?
- From its site of administration into the body to specific target organs and tissues
- Ultimate goal is reaching a therapeutic concentration in the bloodstream
What are the mechanisms of medication absorption?
- Active transport (moving against the gradient)
- Passive diffusion (doesn’t use energy)
Blood flow and medication absorption
- A properly functioning circulatory system greatly enhances the rate of meds absorbed
What does distribution mean?
- Process by which a med moves throughout the body
- Blood is the primary distribution vehicle
- Factors that change the way blood flows will change the way meds are transported
What does biotransformation mean?
- Manner in which the body metabolizes meds- first pass effect
- Chemical alteration by various bodily systems to create compounds that are more easily excreted from the body
What does excretion mean?
- Body eliminates the remnants of the drug
- Could be toxic or inactive metabolites
- Occurs primarily through the kidneys via 3 mechanisms (glomerular filtration, tubular secretion, partial reabsorption)
What is chronotropic effect?
- Changes HR
What is Inotropic effect?
- Changes the contractility of the heart
What does dromotropic effect?
- Affects the conduction speed in the AV node, and subsequently the rate of electrical impulses in the heart
What do Beta Blockers- Class 2 do?
- Reduce O2 demand of the heart muscle
- Affect the beta cells- B1 (cardiac) & B2 (bronchial)
How does Beta Blockers- Class 2 work?
- Blocks the effect of epi & norepi, therby reducing HR
- Dilates blood vessels, thereby reducing BP
- Can affect both B1 & B2 receptors or be selective and affect 1 only
What are some common beta blockers?
Ending in LOL
- Atenolol
- Metoprolol- lopressor
- Labetalol
- Propanolol- inderal
- Carvedilol- coreg
- Bisoprolol- monocor
What is the main action of Calcium Channel Blockers?
- Main action is to relax smooth muscle, decreasing peripheral resistance
- Used to tx HTN
- 1 Localizes the smooth muscles
- 2 Decreases cardiac workload, HR & cardiac contractions
Common calcium channel blockers?
Ending in ine
- Amlodipine
- Nicardipine
- Nifedipine
- Nimodipine
- Felodipine
How do diuretics work?
- Decrease BP by decreasing blood volume and sodium retention
- Increase the elimination of water, sodium, and electrolytes
- This then reduces BP by reducing peripheral resistance (by decreasing blood volume) and cardiac output
What are diuretics?
“Water Pills”
- Medication that acts on kidneys to increase diuresis
What are diuretics used to treat?
- HTN
- Edema (heart failure & pulmonary edema)
- Renal diseases
- Hepatic diseases
What are the 5 types of diuretics?
- Thiazide diuretics- hydrochlorothiazide
- Loop diuretics- lasix
- Potassium- sparing diuretics- spironolactone
- Osmotic diuretics- mannitol
- Carbonic anhydrase inhibtors- acetacolamide
What are loop diuretics?
- Inhibit Na+/ K+/ 2Cl (chlorine) transport proteins in the loop of henle
- This causes a reduction in the reabsorption of sodium which significantly increases diuresis
- Furosemide is the most common
What are potassium sparing diuretic?
- Increase diuresis but without causing potassium to leave the body
- Spironolactone- leaves some potassium behind
- Stops the entry of aldosterone into the nephron, which prevents sodium and water retention
What are thiazide diuretics?
- Act by inhibiting NaCl reabsorption into the distal convoluted tubule of the kidney
- Happens through the suppression of the sodium chloride contransporter
What are thiazide diuretics mainly used to treat?
- HTN
- Heart failure
- Kidney failure
- Diabetes
What are antihyperlipidemic agents?
- Cholesterol meds
- Used to lower the amount of LDL in the system
- Aids in assisting the excess levels of LDL back to the liver for removal, thereby lowering the levels in the system
What are some common cholesterol medication?
“STATIN”
- Pravastatin
- Simvastatin
- Ezetimibe
- Atorvastatin
- Rousvastatin
What are Antiplatelet medications?
- Interfere with the steps of clot formation
- Normally platelets enter the site of injury, activated by thrombin and collagen to increase clotting
- Bleeding is a common side effect of these medications
What are some common antiplatelet medications?
- ASA
- Dipyridamole
- Clopidogrel
- Trigrelor
What are anti coagulants?
Blood Thinners
- Used to make the blood less viscous
- Obtained by increasing the levels of antithrombin, which then inhibits clotting factors
What are the most common anti coagulants?
- Heparin and warfarin
- Heparin= works with antithrombin
- Warfarin= works to inhibit the vitamin K effects on clotting
What type of patients are on anti coagulants?
- Afib
- MI
- CVA
What are ACE inhibitors?
- Used to primarily treat HTN
- Lowers SBP and DBP by blocking the action of ACE
- Angiotension II levels rise= vasoconstriction, release of epi or norepi, Increased HR, Increased CO
- By inhibiting this release of angiotensin II and aldosterone, they decrease reabsorption of sodium in the kidneys, forcing it out of the system
What are some common ACE inhibitors?
“PRIL”
- Lisinopril
- Accupril
- Enalapril
- Ramipril
What are anti anginals?
- Used to increase blood and O2 supply to the heart while reducing workload of the heart
How do Anti Anginals work
- Can be accomplished by vasodilation or reducing vasospasm
- When the workload of the heart is decreased, the need for O2 decreases
- Reduction in cardiac workload is achieved by reducing HR
How does nitrates work?
- Dilate blood vessels and increase O2 supply to the heart
- Relax and dilate medium-large coronary arteries and veins- this increases O2 to the heart
- Reduces fluid backup in the ventricles, thereby reducing cardiac workload
What are Long Acting Beta Agonist and Corticosteroids?
- Taken daily to prevent asthma symptoms (controllers)- work by relaxing the muscle lining the airways
- LABA & Corticosteroids need to be used together
- Reserved for those pts whose symptoms can’t be controlled by short acting bronchodilators
What are steroids?
- Anti-inflammatory drugs
How do steroids work in relation to respiratory?
- Reduce the infiltration of mediators of the inflammatory response in the airway cells
- Reduce the creation of proinflammatory substances- prostaglandins, leukotriene, macrophages
What are common long acting beta agonist?
- Fluticasone= flovent
- Budesonide= pulmicort
- Advair= combo drug
- Symbicort= combo drug
What are Short Acting Beta Agonist?
- AKA relievers, rescue medications
- Provide short-term, rapid relief of asthma symptoms
How do Short Acting Beta Agonist works?
- Reverse bronchospasm and open airways
- Act on the B2 cells of the smooth muscle in the airways (relaxes the bronchial smooth muscle)
What are common Short Acting Beta Agonist?
- Ventolin
- Levalbuterol
- Ipratropium
- Sprivia
What are Proton Pump Inhibitors?
- Effective in treating GERD
- Decrease gastric acid levels
How do proton pump inhibitors work?
- Act by interfering with the final step in gastric acid production
What are common Proton Pump Inhibitors?
“ZOLE”
- Omeprazole
- Esomperazole
- Pantaprazole
- Lansoprazole
What are Histamine 2 Inhibitors?
- Also used to treat GERD
How do Histamine 2 Inhibitors work?
- Histamine stimulates acid secretion in the gastric cells- by production of pepsin
- Pepsin is a digestive enzyme found in the gut
- Secreted when food is present in the stomach
- These meds block this stimulation from happening
What are common H2 Inhibitors?
- Pepcid
- Ranitidine
How does Anti Nausea medication work?
- Primary goal is to either block the nausea sensation in the brain, or reduce the cause of the nausea
- Additionally, some meds work by blocking the transmission of nausea sensation from the GI system to the brain
What is nausea often caused by?
- Release of serotonin
- This is released during stress and if your gut senses something toxic
- Serotonin is produced to help expel whatever is in your system out- typically through vomiting
What are common anti nausea medications?
- Gravol- dimenhydrinate
- Ondansetron- zofran
How do laxatives work?
- Create an enzyme that swells in the presence of liquid
- Once it swells, the bowel gets the sensation that it’s full, causing them to evacuate
What are some common laxatives?
- Senna= senokot
- Bisacodyl= dulcolax
- Docusate= colace
- PEG 3350= miralax
How does epilepsy medication work?
- Goal of the meds is to reduce the instances of seizures by suppressing seizure activity
- Done by controlling the voltage- dependent sodium channel
- Drugs are aimed at delaying the movement of these ions- maintaining homeostatic balance
What are common meds for epilespsy?
- Dilantin
- Valproic acid
- Lamotrigine
- Carbamazepine
- Levetiracetam
What are opioids?
- Naturally occuring, from the poppy plant
- Opioids bind to the opioid receptors found at the base of the spinal cord, brainstem, thalamus, hypothalamus, and limbic system
What can opioids be classified as?
- Agonists= bind and stimulate the receptor, produce analgesia
- Antagonist= bind to the receptor but don’t activate it (ex. narcan)
What are common opioid meds?
- Morphine
- Hydromorphone
- Oxycodone
- Fentanyl
- Hydrocodone
- Codeine
- Tramadol
- Percocet
What are NSAIDS?
- Have anti-inflammatory, analgesic and antipyretic properties
How do NSAIDS work?
- Reduce the production of prostaglandins
- Chemicals that promote inflammation, pain and fever
- Cox-1 & Cox-2 are the main enzymes that create prostaglandins
- Cox-2 is responsible for clotting factors
What are benzodiazepines?
- Often used to treat anxiety, slow brain activity
- Given to treat sleeping disorders, seizure disorders and anxiety
How do benzodiazepines work?
- Depresses the limbic system
- This reduces emotions, anxiety, fear, pain, etc
- Works of GABA receptors in the brain, reduces the neuronal excitiability
What are common psych meds?
- Alprazolam= Xanax
- Clonazepam
- Lorazepam= Ativan
- Diazepam
- Midazolam
- Oxazepam
What are the 2 categories of antidepressants?
- TCI= tricyclic antidepressant (affect norepi lvls)
- SSRIs= Selective serotonin reuptake inhibitors (affect serotonin lvls)
How do antidepressants work?
- Alter the lvls of serotonin, dopamine, and noradrenaline- keeping them at normal, required lvls
- Most commonly used to treat general depressive disorders, OCD and anxiety
What are common antidepressant meds?
- Amitriptyline
- Nontriptyline
- Trazadone
- Mirtazapine
- Bupropion
- Paxil
- Zoloft
- Effexor
How do antipsychotics work?
- Aimed at blocking the lvls of dopamine being secreted and absorbed by the body
- At the medulla, brainstem and hypothalamus point
- Cross the blood brain barrier easily
Antipsychotics are often accompained by….
Sedative side effects
- Confusion
- Decreased ability to regulate body temp
- Weight gain
What are common antipsychotic meds?
- Olanzapine
- Quetiapine
- Risperidone
- Arpiprazole
How does oral diabetic medication work?
- Treats type 2 diabetes
- Works by stimulating insulin release from pancreatic beta cells
- Also decrease glycogenosis- process of converting glycogen to glucose
What are common oral diabetic meds?
- Metformin
- Januvia
- Glyburide
- Sitagliptin/ metformin
What is insulin?
- Used for all type 1 diabetics
- Since it’s a protein, it need to be administered IM
- Can be rapid-acting, short-acting
What are common insuline?
- Novolog
- Humalog
- Humulin
- Levemir
How does hyperthyroid meds work?
- Work by depleting excess thyroid hormones
- Measured by TSH- Thyroid Stimulating Hormone
What are common hyperthyroid meds?
- Methimazole
- Propylthiourcil
How do hypothyroid meds work?
- Work by stimulating the release of TSH
- Mimic the natural actions of the thyroid hormones produced by the body
What are common hypothyroid meds?
- Levothyroxine
