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Chap - 3


any chemical substance taken into the body for the purpose of affecting body function drug
were the primary source of drugs used on the human body plants
four ways that drugs are obtained source of drugs
iron, sulfur, potassium, silver, & gold are some of the ___ used to prepare drugs minerals
research lead to the use of substances from ___ as effective drugs animals
substances lacking in the human body can be replaced with similar substances from the glands, organs & tissues of animals
origin of drugs from an animal source even now includes ___ ___ human extractions
can be used to make a drug for treatment of growth disorders pituitary gland from cadavers
chemists use __ __ to make drugs to market for human consumption synthetic sources
evolved with human skills in labs & advanced understanding of chemistry; most actively pursues source of drugs by major companies today synthetic (manufactured) sources
produced from artificial rather than natural substances drug compounds
numerous antibiotics are synthetic or semisynthetic
1990s, development of drugs for treatment of life-threatening or other various conditions investigational new drugs (INDs)
slows progression of HIV infection in some patients; IND of 1990s Zidovudine (AZT) (Retrovir)
used to treat many different malignancies & also management of AIDS-related Kaposi's sarcoma; IND of 1990s Interferon (Roferon A)
used to slow progression of dementia in some Alzheimer patients; IND of 1990s Tacrine (Cognex)
combines Norvasc & Lipitor for simultaneous treatment of high blood pressure & high cholesterol; 1st to treat these 2 conditions with a single tablet; 21st century IND Caduet
first-line treatment for metastatic colorectal cancer; prevents formation of new blood vessels denying necessary nutrients needed for growth & metastasis; 21st century IND Avastin
physiological changes that occur in response to a drug effect of drug
reaches widespread areas of the body systemic effect
limited to area of body where administered local effect
four biological changes drugs undergo in the body drug processes
drug gets into the blood stream absorption
drug moves from bloodstream into tissues & fluids of the body distribution
physical & chemical alterations that a substance undergoes in the body metabolism
eliminating waste products of drug metabolism from the body excretion
if any of the four drug processes is hampered the drug __ and __ will be hampered actions; effects
mucosa of stomach, mouth, small intestine, or rectum; blood vessels in muscles/subcutaneous tissues; or dermal layers are the primary site of absorption
circulatory system, through capillaries & across cell membranes are the primary site of distribution
liver is the primary site of metabolism
kidneys, sweat glands, lungs, or intestines are the primary site of excretion
specific directions that accompany each drug are given to __ the absorption, distribution, metabolism, & excretion of the drug enhance
varies according to pH, lipid solubility, & presence/absence of food in the stomach site of absorption of a drug
drugs of a slightly acidic pH are absorbed well through the stomach mucosa
drugs of an alkaline pH are readily absorbed in the small intestine
given on an empty stomach so that the pH is not altered; if dairy, milk or antacids present it will not properly be absorbed tetracycline
oral medication for infants may not be absorbed well after feeding because the milk or formula ___ the acidity of the stomach acidity
substance ___ in lipid solubility are easily absorbed through the mucosa of the stomach high
alcohol and substances containing alcohol are soluble in lipids
substances soluble in lipids are rapidly absorbed through the __ __ GI tract
substance ___ in lipid solubility are absorbed best when given by means other than the GI tract low
not lipid soluble but given orally for suppression of intestinal bacteria before intestinal/bowel surgery or in treatment of bacterial diarrhea neomycin
food in the stomach tends to slow absorption due to a slower emptying of the stomach
if a fast drug effect is desired, an __ __ will facilitate quicker absorption empty stomach
medications that are irritating to the stomach can be buffered by the presence of food
reaching sites beyond the major organs may depend of the drugs ability to cross a lipid membrane
composed of high-density cells restricting passage of substances from the bloodstream much more than endothelial cells in capillaries elsewhere in the body blood-brain barrier
affinity/attraction of a drug to a specific organ/cell selective distribution
selective distribution to CSF amphetamines
selective distribution to the ovaries, as a fertility drug human chorionic gonadotropin (hCG)
by virtue of their properties some drugs are distributed __ __ than others more slowly
2 drugs categorized in the same classification may be known to act on the cells & achieve the effect more quickly
biotransformation means transformed in the liver
drug is broken down to more water-soluble by-products, making it more easily secreted by the kidneys, during biotransformation
a patient may exhibit toxic effects of drug if hepatic disease is present
it is possible for some drugs to by pass the process of metabolism
drugs that are able to by pass the process of metabolism reach the kidneys unchanged and may later be detected in the urine
most drugs are excreted by the kidneys
refers to a condition that results from exposure to either a poison or a dangerous amount of a drug that is normally safe when given in a smaller amount toxicity
increased effect of a drug demonstrated when repeated doses accumulate in the body cumulative effect
cumulative effect may build to a dangerous/toxic level & can be of particular concern in older adults
to give just enough of the drug to cause the desired/therapuetic effect while keeping the amount below the level where toxic effects are observed goal of drug therapy
cardiac drug that must be given cautiously because of its potential for causing a cumulative effect Digoxin
must be adequate or digoxin will accumulate, leading to digoxin toxicity circulation & renal function
factors that affect speed & efficiency of drugs processed by the body variables
are slower in older adults, so attention must be paid to possible cumulative effects metabolism & excretion
have a lower threshold of response and react more rapidly/in unexpected ways; frequent assessment is imperative children
many drug dosages are always calculated on the basis of the patient's weight
because the ratio of fat per body mass differs and so do hormone levels women respond differently than men to some drugs
most drugs are contraindicated or dosage must be adjusted, if the female is pregnant or nursing
the more positive the patient feels about the medication, the more positive the physical response
beneficial effect in patient following particular treatment arising from patient's expectations about the treatment rather than from the treatment itself placebo effect
inactive substance that resembles a medication, although no drug is present (i.e. a sugar tablet or saline injection) placebo
attitudes towards medicines can be influenced positively/negatively by cultural or religious beliefs
when more than one medication is taken combination
combination may __ alter the normal expected response of each individual drug alter
action of 2 drugs working together in which one helps the other simultaneously for an effect that neither could produce alone synergism
action of 2 drugs in which one prolongs/multiplies the effect of the other potentiation
opposing action of 2 drugs in which 1 decreases/cancels out the effect of the other antagonism
important for prescribing physician to know all medications a patient is taking in order to prevent undesirable drug interactions
by giving small amounts of 2 drugs together effect can be achieved more safely than by giving a larger amount of one/other by itself, would be desired synergism
2 drugs given in combination can depress the CNS to dangerous levels, depending on strengths of each would be undesirable synergism
building up a high/safe level of an antibiotic in the blood, then simultaneously giving a drug that slows the kidney's excretion rate desirable potentiation
toxic effect that may result from a drug potentiating the level of another drug's concentration in the blood undesirable potentiation
narcotic antagonist cancels out effects of an overdoes of narcotics desirable antagonism
a drug that lowers the pH and prevents absorption of another drug undesirable antagonism
may bring about variations in speed of drug action or effectiveness drug dosages
amount of drug given for particular therapuetic or desired effect dosage
smallest amount of a drug that will produce a therapuetic effect minimum dose
largest amount of a drug that will produce a therapuetic effect without producing symptoms of toxicity maximum dose
initial high dose used to quickly elevate the level of the drug in the blood loading dose
the initial high dose, of a loading dose, is often the maximum dose
the initial dose, of a loading dose, is often followed by a series of lower maintenance doses
dose required to keep the drug blood level at a steady state in order to maintain desired effect maintenance dose
amount of drug that will produce harmful side effects or symptoms of poisoning toxic dose
dose that causes death lethal dose
customarily given based on adult body weight of 150 lb; adjusted according to variations from the norm therapuetic dose
most significant factor in the speed of drug action route of administration
sometimes based on degree of speed, cost, or safety the route of administration
some medications can be given only by one route because absorption occurs by that route only
some medications, given by one route only, can be ___ or ___ when given by another route dangerous; toxic
oral (PO), nasogastric tube (NG), and rectal (R) are GI tract routes
include any route of administration other than gastrointestinal tract parenteral routes
sublingual (SL)/buccal, Injection, topical, & inhalation are all parenteral routes of administration
intravenous (IV), intramuscular (IM), subcutaneous (subQ), intradermal (ID), intracardiac, intraspinal, intracapsular are all injection routes of administration
dermal (D) & mucosal topical (T) routes of administration
may depend on (1) desired effect, (2) absorption qualities, & (3) how supplied doctor's choice of route of administration
is easiest, but effects are slower due to time required for disintegration of drugs in alimentary canal before absorption oral route of administration
fastest, given in small amounts, effects immediate, dangerous if given in amounts intended for other routes; administered by IV push or bolus, or diluted solutions infused by IV drip IV route of administration
concentrated drug solution bolus
administered by a physician, RN, or paramedic IVs
IVs are the best route for treatment of emergencies because of speed of action
when a patient can take nothing by mouth or the drug is not suitable for GI absorption it is given parenterally
because the muscles are highly vascular the __ __ is fairly rapid intramuscular route
any unexpected or dangerous reaction to a drug; unwanted effect; onset may be sudden or develop over time adverse drug effects
effect from maternal drug administration that causes development of physical defects in a fetus teratogenic effect
unique, unusual response to a drug idiosyncrasy
opposite effect from what is expected paradoxical
decreased response to drug that develops after repeated doses are given; drug dosage must be increased or drug replaced, in order to achieve desired effect tolerance
acquired need for drug that may produce physiological/physical symptoms of withdrawal when drug discontinued dependence
no physical symptoms of withdrawal other than anxiety; craving physiological dependence
when cells actually have a need for the drug; withdrawal symptoms include retching, nausea, pain, tremors, & sweating physical dependence
immune response to a drug; may be of varying degrees hypersensitivity
hypersensitivity may develop after previous __ __ of a drug uneventful uses
hypersensitivity more likely to exist in patient with other known allergies
nausea, vomiting, & diarrhea are not considered signs of allergies
severe, possibly fatal, allergic response anaphylactic reaction
include itching, uticaria, hyperemia, vascular collapse, shock, cyanosis, laryngeal edema, & dyspnea signs of anaphylactic reaction
includes CPR if indicated & drugs as required, such as epinephrine to raise blood pressure, corticosteroid to reduce inflammation and body's immune response, or antihistamine to reduce redness, itching & edema treatments for anaphylactic reaction
antibiotics especially penicillin; x-ray dyes containing iodides; & insect stings have been noted often to cause anaphylaxis
knowledge of adverse drug reactions should be included in the patient's history
getting accurate drug history & listing known allergies is a __ __ of the health care worker critical function
absorption is the __ biological change process that drugs undergo when they are ingested initial
drugs whose actions are limited to a __ __ of the body have local effects specific location
the pharmacokentic affect of a medication taken with food is that food tends to slow drug absorption
age, weight, psychological state, & sex are the __ __ that affect the speed & efficiency of drug processing major variables