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Pharm class 1 & 2

1st and 2nd lecture notes

The study of the effects of chemical substances on living tissues. Pharmacology
What is the objective of drug therapy? provide maximum benefit with minimum harm
What are the three most important characteristics for a drug? 1. effectiveness 2. selectivity 3. safety
What are the three phases of drug action? 1. Pharmaceutic 2. pharmacokinetic 3. pharmacodynamic
What is drug movement called? pharmacokinetics
What are the 4 components of pharmacokinetics 1. absorption 2. distribution 3. metabolism (biotransformation 4. excretion (elimination)
What is drug action called pharmacodynamics
The study of drug concentration, onset, peak, duration of action & effect of the body is called? pharmacodynamics
What are the components of pharmacodynamics? 1. drug concentration 2. onset 3. peak 4. duration of action 5. effect on the body
List some sources of drugs. 1. plants 2. animals 3. minerals 4. synthetic chemical compounds 5. biotechnology
Give some examples of drugs that come from plants. Morphine sulfate (poppy), digitalis (foxgloves)
What drugs come from animals they use to get insulin from cows and pigs (now get armour thyroid from pigs)
Give examples of mineral used in drugs? iron, calcium and Potassium (K)
What are some advantages to using synthetic drugs over drugs from plants/animals? 1. more standardized in chemical characteristics 2. more consistent in their effects 3. less likely to produce allergic reaction
An important drug source, involves manipulation of DNA and RNA and recombining genes in hybrid molecules Biotechnology
Give examples of drugs used in biotechnolgy. 1. Epogen-erythropoetin (given for anemia or for patients with renal failure) 2. insulin from recombinant E. Coli DNA 3. recombinant yeast DNA technology (human hepatitis B vaccine)
what is neupogen? it is a biotechnology product using E. Coli to aid in stimulating the proliferation of of granulocytes
What is humulin? it is insulin made by biosynthesis using E. Coli
How are drugs classified? 1. effect on particular body system 2. therapeutic use 3. their chemical characteristics (e.g. MS - opiate)
an individual drug that represent groups of drugs and standard by which others are compared prototype
What are the 4 different drug naming categories? 1. generic name 2. trade or brand name 3. official name 4. chemical name
the nonproprietary name is also called the generic name
What is the name that is assigned to a drug when first manufactured (nonproprietary name) generic name
what is the generic name for tylenol? acetaminophen
Can anyone own the generic name of a drug? no
What range does the peak serum concentration and plasma concentration curve of the generic drug have to fall within? 80-125% of the brand name drug
How would the generic drug be different than the trade or brand name drug? generic may have inert fillers and binders (may be slightly less effective)
What is the name for inert fillers and binders excipients
proprietary name is called the trade or brand name
a name that is designated and copyrighted by the manufacterer is called Trade or Brand name
How is the trade or brand name usually typed? Beginning letter is capitalized (generic drugs do not capitalize first letter)
what drug name is assigned by the FDA official name
True or False the official name of a drug is often times the generic name. TRUE
The name of the drug that describes the chemical or molecular structure chemical name (e.g. N-Acetyl-para-aminophenol)
List 6 sources of drug information. 1. pharmacology textbooks 2. drug reference books 3. journal articles 4. internet sites 5. United States Pharmacopeia National Formulary (USP-NF) 6. Drug Facts & Comparisons book
What does USP-NF stand for? United States Pharmacopeia National Formulary
How often is the USP-NF revised? every 5 years
The Drug Facts and Comparisons book is kept current how? by publishers with regular updates
Is a pharmaceutical sales rep a reliable source for drug information? NO absolutely not they are extremely biased
List all the drug laws and standards from earliest time to present time 1. Pure Food & Drug Act 1906 2. Food, Drug, & Cosmetics Act-1938 3. Kefauver-Harris Act-1962 4. Controlled Substance Act 1970 5. Drug Regulation Reform Act 1978 6. 1994 Dietary Supplement Health & Edu. Act 7. HIPPA (2003) 8. Pediatric Research Equity Act
First set of standards for quality and purity of drugs Pure Food and Drug Act of 1906
What was wrong with the Pure Food and Drug Act of 1906 it was a weak law that just required that drugs be free from adulterant (impurities). It did not include effectiveness and safety of drug
What agency was formed by the Food, Drug and Cosmetics Act of 1938? FDA (Food and Drug Administration)
What law regulates the manufacture, distribution, advertising, and labeling of drugs to ensure safety effectiveness? Food, Drug and Cosmetics Act of 1938 (also established FDA)
What law/act was created in response to the thalidomide tragedy in Europe in 1950's? Kefauver-Harris Act of 1962
What is the thalidomide tragedy that occurred in Europe and why did it not occur her in US? Women took thalidomide when pregnant to control nausea and it caused severe birth defects (undeveloped arms, etc) FDA had not approved the drug here in US (but 17 babies born here with defects)
The sedative/hypnotic drug given to pregnant women in Europe that caused gross birth defects is called thalidomide
The controlled substance act use to be called what? Comprehensive Drug Abuse Prevention and Control act of 1970
what law regulates distribution of narcotics and other drugs of abuse and categoriezes drugs according to therapeutic usefulness and potential for abuse Controlled Substance Act
what law shortened time in which new drug could be developed and marketed? 1978 Drug Regulation Reform Act
what law created a special category for nutritional supplements that exempts them from meaningful FDA regulation? 1994 Dietary Supplement Health and Education Act
What is wrong with the 1994 Dietary Supplement Health and Education Act? a manufacturer can produce a product and call it by another name (dietary supplement) and the product can avoid more rigid FDA regulations
What does HIPAA stand for Health Insurance Portability and Accountability Act
establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addressed the security and privacy of health data. HIPAA
what law was the FDA authorized to require testing of drugs for their safety and effectiveness in children? 2003 Pediatric Research Equity Act
What law set standards of nursing and nursing practice Nurse Practice Acts
True of False Each state passes their own Nurse Practice Acts. TRUE
What law states that nurses cannot prescribe or administer drugs without MD/health care provider's order? Nurse Practice Act
What law states that nurses must follow their specific institution policies regarding medication administration Nurse Practice Act
what law states the 5 rights of medication and provide standards of safe practice and are never to be ignored? Nurse Practice Act
What law states that the Nurse has the right to refuse to participate in any treatment aspect of patient care that violates personal ethical principles (but must still not desert the patient) Nurse Practice Acts (don't have to participate in unethical procedure but must still never abandon the patient)
What law states that it is the nurse's responsibility for safe and prudent decision making in the care of their patients, including provision of drug therapy. Nurse Practice Act
What does misfeasance mean negligence (performing a legal act but doing something wrong that results in injury or death)
Give an example of a nurse and misfeasance giving wrong drug or dose which results in injury or death
What is nonfeasance omission of drug dose (resulting in injury or death)
What is malfeasance correct drug but wrong route - results in injury or death
giving wrong drug or dose misfeasance (negligence)
ommission of drug dose nonfeasance
correct drug but wrong route malfeasance
List 2 basic client/patient rights 1. informed consent: research, medication, side effects, etc 2. always have the right to refuse treatment or medication
What is basic Principle 1 of pharmacology drugs do not create functions but modify existing functions
What is the basic principle 2 of pharmacology no drug has a single action
What is the basic principle 3 of pharmacology drug action is determined by how drug interacts with the body
What are the three most important ways by which drugs cross cell membranes? 1. passage through channels or pores 2. passage with the aid of a transport system 3. direct penetration of the membrane itself
Most drugs cross the cell membrane by? penetration of the membrane itself (lipid soluble drugs)
TRue or False Most drugs are lipid soluble? true
What is the most common mechanism of drug movement passive diffusion (lipid soluble drugs)
Movement of a drug from area of higher concentration to area of lower concentration is called passive diffusion
passive diffusion occurs until what happens until a state of equilibrium is reached between amount of drug in tissues and the amount in the bloodstream
List the factors that influence rate of passive diffusion through lipid portion of cell membrane? 1. concentration gradient 2. surface area for absorption 3. lipid solubility of the sunstance 4. molecular size 5.degree of ioniztion 6. thickness of cell membrane and how close the endothelial cells are to each other (BBB) 7. body temperature
Drug molecule combine with a carrier substance and move from higher to lower concentrations facilitated diffusion
does facilitated diffusion use the concentration gradient? yes
Drug molecules are moved from an area of lower concentration to higher concentration active transport (requires ATP)
What two things are required with active transport? 1. energy (ATP) 2. carrier substance
Oral drugs must pass through what 3 membranes to to reach the bloodstream? 1. membranes lining intestines 2. membranes lining the lymphatic system 3. capillary wall
Cell membranes complex structures are composed of what? phospholipids and cholesterol with embedded proteins
The proteins in the cell membrane provide ________ strength? structural
Lipids in the cell wall act as cellular protectors. How? they prevent passage of undesired stuff into cells (excessive water and water soluble stuff)
How do lipid soluble drugs cross cell membranes? by dissolving in lipid bilayer
How do water soluble drugs cross the cell membrane? they cross through pores of channel openings
True or False Lipid soluble drugs cross cell membrane more easily than water soluble drugs? true (this is why most drugs are lipid soluble)
What affects the ability of a drug to cross the cell membrane. ionization
Ionization of a drug is affected by _____ of the surrounding fluid. pH
Weak acid drug will be absorbed better in what kind of environment? acid environment (stomach)
weak base will be absorbed better in what type of environment? more alkaline environment (like the small intestine)
What make the small intestine more alkaline than the stomach? the bile coming from the gall bladder and the enzymes coming from the pancreas
will a weak acid drug ionize in the acidic stomach no
will a weak base drug ionize in the stomach yes
The study of drug movement through the body is called pharmacokinetics
Knowledge of a drug's pharmacokinetic patterns help (list 5 things) 1. determine proper dosage 2. determine route of drug administration 3. optimum times for administration 4. timing of potential toxic reactions 5. avoid drug/food or drug/drug interactions
the movement of a drug from its site of administration into the blood absorption
List 5 factors that affect drug absorption. 1. rate of dissolution 2. surface area 3. blood flow 4. lipid solubility 5. pH partitioning
Why would you want to take a full glass of water with an oral medication? help with dissolution (meds need liquids to dissolve)
Drugs must first be ___________ before they can be absorbed. dissolved
If medication does not dissolve it will not be _____________. bioavailable
Why might you have a problem with bioavailablity of medication being given via the rectal route? not enough moisture to dissolve the medication
The _________ the surface area the faster the absorption will be. larger
Orally administered medications are usually absorbed where? from the small intestine
what makes the small intestine a great place for absorption of medications large surface area because of microvilli
Drugs absorb more rapidly from sites where blood flow is ________. high
why do drugs absorb more rapidly from sites where blood flow is high? greater concentration gradient exists
Why would you not put a heating pad over a fentanyl patch? the patch is suppose to secrete small amounts of medicine over a period of 3 days. Heating pad will dilate the blood vessels increasing absorption rate of medicine (could be toxic)
Should you go into a hot tub with a medicine patch on? no, heat increases blood flow to patch which in turn causes rapid absorption of medicine that is suppose to be absorbed slowly over time
True or False Lipid soluble drugs can readily cross the membrane that separate them from the blood. true
Acid drugs will accumulate on a ________ side. alkaline
Alkaline drugs will accumulate on a _______ side. acid
Drugs absorb faster when the pH at the site of administration _______________ cause ionization but the pH of the plasma _______ cause ionization. doesn't; would (in other words drugs won't absorb well if ionized before they hit the bloodstream)
The process that occurs between the time a drug enters the body and the time it enters the bloodstream to be circulated is called absorption
Rate and extent of absorption is affected by (list 4 things) 1. dosage form of drug 2. route of administration 3. gastrointestinal function
portion of dose that reaches the systemic circulation and is available to act on body cells bioavailability
What is the term that is used to quantify the extent of drug absorption bioavailability
When an immediate drug response is desired what is given? a loading dose
what is a loading dose? a large initial dose given to achieve a rapid minimum effective concentration in the plasma
When is a loading dose needed? for drugs that are eliminated from body slowly. They need only a low maintenance dose to keep the amt of drug in the body at the appropriate level, but without an initial higher dose, it would take a long time for the amt of the drug to reach that level.
List three drugs that may need loading doses? digoxin, lidocaine or aminophylline
which route of administration is fastest IV route fastest (injected directly into the bloodstream)
True or False There is no absorption phase for IV medication true (already into bloodstream, doesn't need to be absorbed)
List in order the routes of administration from fastest absorption to slowest 1. IV route 2. Mucous membranes of mouth, nose and respiratory tract 3. injected meds 4. oral routes 5. topical route
What would determine the rate of absorption of injected meds? vasoconstriction or dilation, scarring at the injection site
What affects the rate of absorption for oral routes? affected by dose form (pill or liquid) and GI tract conditions
If someone is in shock, how would you give them their medications? IV (because their blood pressure will be low which would slow down the distribution of meds given by other injections or oral)
What route of administration has the slowest absorption rate? topical route (because skin is natural barrier)
What are some advantages to the topical route of administration? 1. not as much peaking and troughing 2. don't have to remember to take the medication
What is one disadvantate to transdermal route (topical route)? medication very expensive
What are some examples of medication give via the topical route? duragesic Patch, contraceptive patches, nicotine patches
What is another name for topical route transdermal delivery
What absorbs faster liquid drugs or pills? liquid because it eliminates the step of disintegration & dissolution
What dissolves almost as quickly as liquids? capsules (protein capsules)
True or False Capsules absorb quicker than tablets. TRUE
What is the slowest oral form of medication and why? oral tablets because they have to first disintegrate and then dissolve before absorption
drug covered in substance that resists disintegration in gastric acid Enteric Coated
Why should you not crush enteric coated drugs? the sustained activity may be destroyed and side effects increased (also medication may irritate the stomach)
What are the types of drugs you would not crush? CR- controlled release DA-delayed absorption, DR - delayed release EC-enteric coated, ER-enteric release PC-protective coating, SR-slow release, SSR sustained release
What are some problems with enteric coated meds? less reliable - time of onset, if gastric emptying time is increased medication can remain in stomach for hours, sometimes coating doesn't dissolve & goes through whole to feces
would you use an enteric coated medication if an immediate effect was needed? No - not used if immediate effect is needed (example - don't use enteric coated aspirin if someone is having heart attack)
What would be the fasted way to give someone aspirin if they were suffering from a heart attack? (non enteric) crushed and put under tongue for sublingual route
Why would you not eat a fatty meal when taking an enteric coated medication? fat delays gastric emptying time and medication may remain in stomach (unabsorbed) a very long time
Why would you not crush sustained release drugs? they contain more medicine than single dose tablet and would become toxic if crushed
What are some abbreviations that stand for sustained release medications. SR, ER, LA, XL (sustained release, extended release, long acting, ???)
What is gastic emptying time also known as GI motility (how fast contents move through the GI)
decreased gastric emptying (time) will cause ________ drug absorption increased (by allowing for more contact with absorptive mucous membranes in small intestine)
increased gastric emptying (GI motility) will cause ________ drug absorption decreased (because drug moves to fast to be absorbed)
What delays gastric emptying time fat
True or False the position of the patient can influence gastric emptying time true
when patient is on the left side what happens to gastric emptying time increased gastric emptying time
when patient is lying on the right side what happens to gastric emptying time decreased gastric emptying time (because the pyloric sphincter is above the stomach in this position and does not feel the pressure of the stomach contents)
In most cases the presence of food ______ the rate of absorption slows
When does the presence of food increase rate of absorption (which drugs) HIV anti-virus drugs: Ritonavir, Saquinavir, viracept
What does it mean to administer a drug on an empty stomach either 1 hour before a mean or 2 hours after a meal
What happens when you take aluminum containing antacids with citrus beverages? excessive absorption of aluminum
Orange juice with iron supplements _______ the absorption of iron when treating anemia increases
Transport of drug molecules within the body. Distribution
When drug is absorbed into bloodstream it is carried by what two things to its sites of pharmacological action, metabolism and exretion? blood and tissue fluids
How long does it take for the brain to receive a medicine from an IV push into the antecubital vein? 15 seconds
Drug molecules enter and leave the bloodstream through what? capillaries
If you are anemic you should take iron supplements with what? orange juice (citrus drink)
Distribution of a drug depends largely on the adequacy of _______ ___________. blood circulation
Organs of large blood supply receive drugs (quickly or slowly) quickly
What organs have large blood supply and would receive drugs quickly. heart, liver, kidney
What areas in the body have very poor blood supply and it is difficult to get drugs to them? cornea of eye and bone
Vasoconstriction __________ distribution of RX. decreases
List three things that can cause vasoconstriction. 1. hypothermia 2. drugs 3. shock
What is done therapeutically to help contain local anesthetic in the tissue when being sutured. mix epinephrine with novacaine/lidocaine (vasoconstrictors - slows distribution of the drug out of the site where needed)
Vasodilation _____________ distribution increases
A person with PVD or narrowing of the arteries to the extremeties would have a problem with what when taking a drug. distribution of drug to peripheral arteries and capillaries (e.g. antibiotic to infected diabetic toe)
True or False Most drugs form a complex with plasma proteins true
what plasma protein do most drugs bind to? albumin
Where is albumin made in the liver
a drug bound to albumin is active or inactive inactive (unable to be used in the tissue)
Some drugs bind mostly to globulins. What are they? lidocaine and quinidine (antiarrhythmic)
What are the two main serum proteins? globulins and albumin
Only ______ ________ drugs can act on body cells free unbound
what happens to the bound drugs when the drug levels decrease in the blood they get released from protein and then can act
Why do the protein-bound drugs get released when blood levels decrease this is a way to keep the drug levels more constant and decreases the chance of toxicity
When two highly protein bound drugs compete for binding sites what happens more free drug is released into blood stream
What conditions might cause a low albumin serum level? nutritional deficiency, kidney or liver disease
Lower albumin serum level leads to more ______ ______ which leads to _______ drug effect. free drug levels; increased
highly protein bound drugs > 89% bound to protein
Moderately highly protein bound 61-89% bound to protein
Low protein-bound drugs < 30% < 30% bound to protein
Why is it hard to treat CNS problems with drugs? most drugs cannot cross blood brain barrier
True or False Many drugs cross the blood/placenta barrier which affect the fetus and may be secreted into the milk true (must always check for this with pregnant or nursing moms
drugs that cross the blood/placenta barrier are at risk for having a teratogenic potential
The method by which drugs are inactivated or biotransformed by the body to a less potent substance. metabolism
where does most drug metabolism occur in the liver
Most of the drug metabolism that occurs in livers is done by the P-450 system (cytochrome P-450 system of enzymes)
the time it takes for one half of the drug concentration to be eliminated half-life (t1/2)
A drug goes through ________ half lives before more than 90% of the drug is eliminated several
A short t1/2 is how long 4-8 hours
a long t1/2 is 24+ hours
What is it called when the intake of the drug = the amount metabolized and excreted steady state
how long does it take for a drug to reach a steady state in the body administration of drug for 3-5 half lives (t1/2)
A group of enzymes called the CYP3A4 (isozyme) act in the ________________ and ____________. small intestine and liver
CYP3A4(isozyme) enzymes do what to some drugs before they even get a chance to be absorbed by the body metabolize them (located both in small intestine and liver)
What does grapefruit juice do to the CYP3A4 (isozyme) enzymes inhibits these enzymes which results in more drug available for absorption
One glass of grapefruit juice can inhibit CYP3A4 (isozyme) for how many hours 12-36 hours
Created by: kellyaem