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Pharmacology
Weeks 1-4
| Question | Answer |
|---|---|
| biologics, 5 examples | hormones, monoclonal antibodies, natural blood products, interferon, vaccines |
| pharmacopoeia | medical reference summarizing standards of a drug’s purity, strength and direction for synthesis |
| 4 stages of approval for therapeutic and biologic drugs | 1) preclinical investigation 2) clinical investigation 3) review of new drug application (NDA) 4) post-marketing surveillance |
| therapeutic classification of drug is based on what the drug does _____ | clinically, i.e. anticoagulants, antidepressants, antihypertensives |
| pharmacologic classification of drugs is based on the drug’s ___ ___ ___ | mechanism of action at a molecular, tissue or body-system level, i.e. diuretics, calcium-channel blockers, adrenergic antagonists |
| anaphylaxis | severe allergic reaction involving massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life-threatening shock |
| CNS and hypertensive drugs are best administered when? | bedtime |
| What is first-pass metabolism? | inactivation of drug by processing in the liver |
| Does the transdermal delivery system avoid first-pass effect of the liver and enzymes? | yes |
| Does the nasal administration delivery system avoid first-pass effect of the liver and enzymes? | yes |
| Does the rectal administration delivery system avoid first-pass effect of the liver and enzymes? | yes |
| Parenteral drugs are administered via ___? | needle |
| define intradermal, subcutaneous | dermal layer of skin, deepest layers of skin |
| define intramuscular, intravenous | specific muscles, directly into bloodstream |
| Do the intradermal and subcutaneous administration delivery systems avoid first-pass effect of the liver and enzymes? | yes |
| name 4 common intramuscular injection sites | ventrogluteal, deltoid, dorsogluteal, Vastus Lateralis |
| IV (intravenous administration) produces the fastest drug onset action but also is unfortunately the most ___ method. | dangerous (contaminations, swift, adverse reactions) |
| What are the 3 types of IV administration? | large volume, intermittent fusion, IV bolus (push) |
| pharmacokinetics is the study of drug...? | movement through the body |
| name the 4 categories of pharmacokinetics | absorption, distribution, metabolism, excretion |
| absorption is the primary factor in determining the length of time for the ___ of the drug to occur | effect |
| What are some factors that affect drug absorption? | route of administration, drug formulation, drug dose, digestive motility, digestive tract enzymes, blood flow at administration site, drug-drug or drug-food interaction, pH of surrounding environment |
| biotransformation is also known as | metabolism |
| The hepatic microsomal enzyme system (P-450 system) can ___ a drug or ___ drug excretion. Some agents known as ___ have no pharmacologic activity unless first metabolized to an active form by the body. | inactivate, accelerate, prodrugs |
| term that describes how much of a drug is available to produce a biologic response | bioavailability |
| certain tissues such as ___ ___, ___, ___ and ___ ___ have a high affinity (attraction) for certain medications | none marrow, eye, teeth, adipose tissue |
| When a drug is highly bound to protein complexes, what is the effect on the patient? | Drugs bound to protein are not available for distribution to body tissues and cannot cross capillary membranes. |
| primary site of excretion of drugs | kidneys |
| sites of excretion (excluding kidneys) are | respiratory system, glands, biliary system |
| In the enterohepatic recirculation of drugs, drugs are excreted in ___, which recirculates to the liver. This prolongs the activity of a drug (may last even after discontinuation) | bile |
| The concentration of medication in target tissue is often impossible to measure. It must be measured in ___. | plasma |
| amount of drug required to produce a therapeutic effect | minimum effective concentration |
| level of drug that will result in serious adverse effects | toxic concentration |
| plasma drug concentration between the minimum effective concentration and the toxic concentration | therapeutic range |
| The plasma half-life (t1/2) of drugs is the length of time needed to decrease drug ___ concentration by one half. The greater the 1/2 life, the longer it takes to ___. This half-life also determines drug ___ and ___. | plasma, excrete, frequency, doses |
| What kind of dose reaches plateau faster and quickly produces a therapeutic response? | loading dose |
| a ___ dose keeps plasma-drug concentration in a therapeutic range | maintenance |
| unpredictable and unexplained drug reactions are called | idiosyncratic |
| occupies a receptor site and prevents endogenous chemicals from acting | an antagonist |
| produces the same type of response as the endogenous substance | an agonist |
| a medication that produces a weaker response than an agonist | partial agonist |
| A narrow therapeutic index indicates that there is only a small amount of difference between the dosage needed to be ___ and the dosage that will be ___. | effective (ED50), toxic (LD50) |
| Extra caution should be taken with drugs with a narrow ___ index to avoid giving an excessive dose and to ensure patient safety. | therapeutic |
| how a medicine changes the body | pharmacodynamics |
| middle of frequency-distribution curve is the ___ ___ dose | median effective |
| median effective dose produces a ___ response in 50% of a group | therapeutic |
| the ___ ___ dose is used to assess safety of a drug, is determined in preclinical trials, is the lethal dose in 50% of group of animals and cannot be experimentally determined in humans | median lethal |
| the ___ ___ dose is needed because the median lethal dose cannot be tested in humans and is the dose that will produce given toxicity in 50% of a client group | median toxicity |
| therapeutic index measures a drug’s ___ ___, the higher the value-the ___ the drug | safety margin, safer |
| from a pharmacotherapeutic perspective, ___ is almost always more important than potency | efficacy |
| agonists bind to ___ and produce same response as ___ substance | receptor, endogenous |
| partial antagonists bind to ___, but produce ___ response than agonist | receptor, weaker |
| antagonists ___ receptor, prevent ___ chemical from acting and often compete with an ___ for receptor | occupy, endogenous, agonist |
| functional antagonists inhibit effects of an ___ by changing pharmacokinetic factors | agonist |
| Macromolecules bind to ___ molecules and are associated with ___ ___ or intracellular molecules. Medication binds to macromolecules in order to initiate effects. | endogenous, plasma membrane |
| two basic receptor types | alpha, beta |
| A drug is a chemical agent capable of producing _________responses within the body. | biologic |
| Active agent? | morphine |
| Alternative therapies are? | herbs, natural plants extracts, vitamins, minerals, & dietary supplements |
| substances that produce biologic responses within the body; they are synthesized by cells of the human body, animal cells, or microorganisms, hormones, monoclonal antibodies, natural blood products & components, interferon and vaccines | Biologics |
| Biologics Control Act 1902 | standardized serum and blood related products |
| Biologics Control Act? | drug regulation |
| Clinical Investigation | second stage of drug testing that involves clinical phase trials |
| Clinical phase trials | testing of a new drug in selected patients |
| Complementary and alternative therapies | treatments considered outside the realm of conventional Western medicine |
| Dietary Supplement Health and Education Act, 1994 | controls misleading claims |
| define Drug | general term for any substance capable of producing biologic responses in the body |
| Drug from Canada comply with? | standards established by recognized formularies in the U.S. and are safe |
| During the FDA drug approval process, what is the main concern? | whether the drug is effective |
| FDA critical path initiative is? | 1990's initiated to modernize the sciences to enhance the use of bioinformation to improve the safety, effectiveness, and manufacturability of candidate medical problems |
| FDA's Critical Path Initiative | national strategy for transforming the way FDA-regulated products are developed, evaluated, manufactured and used |
| U.S. agency responsible for the evaluation and approval of new drugs | Food and Drug Administration (FDA) |
| prevented sale of drugs that had not been thoroughly tested | Food, Drug and Cosmetic Act of 1938 |
| Food, Drug, and Cosmetic Act (1938) and amendments | thorough testing of drug, proof of safety and efficacy of drug |
| list of drugs and drug recipes commonly used by pharmacists | Formulary |
| Hormones are? | biologics |
| How is the phase post-marketing surveillance best described as? | the final stage of the approval process |
| If a client has a documented disease what clinical trial phase would she be eligible to participate in? | Phase II |
| If a healthy person enrolls in a clinical drug research study which phase of trials is she involved in? | clinical investigation |
| If drug produces an undesirable response? | adverse |
| If drug produces desirable response? | therapeutic |
| In Canada, drug testing and risk assessment fall under the? | Health Products and Food Branch (HPFB), |
| In the 20th century chemists and pharmacologists learned to _____ their own drugs in the laboratory. | synthesize |
| Interrelated Subject areas to pharmacology | anatomy & physiology, chemistry, microbiology & pathophysiology |
| Investigational New Drug Application (IND) | application to the FDA that contains all the animal and cell testing data |
| List of drugs? | formulary |
| Medication | drug after it has been administered |
| NDA review | third stage of new drug evaluation by the FDA |
| Nontherapeutic? | sunscreen |
| OTC medications can have what disadvantages? | self-treatment might be ineffective, and they can have serious side effects |
| the study of medicines; the discipline pertaining to how drugs improve or maintain health | Pharmacology |
| Pharmacology is an expansive subject encompassing: | how drugs are administered, where drugs travel in the body, responses drugs produce |
| Pharmacology is defined as the study of? | medicine |
| Pharmacopoeia | medical reference indicating standards of drug purity, strength, and directions for synthesis |
| Pharmacotherapeutics is the application of drugs for the purpose of disease ______ and treatment of ________. | prevention, suffering |
| Pharmacotherapy | treatment and prevention of disease by means of drugs |
| Postmarketing surveillance | evaluation of a new drug after it has been approved and used in large numbers of patients |
| procedure implemented after a drug has been licensed for public use, designed to provide information on use and on occurrence of side effects. | Preclinical Investigation |
| Prescription Drug User Fee Act, 1992 | established five year trial, doubles the number of drugs approved, review times cut by half |
| Prior to the 19th century what where the guidelines? | very few guidelines, and some drugs contained hazardous levels of dangerous substances & addictive substances |
| Pure Food and Drug Act 1906 | government controls labeling of medicines |
| Pure Food and Drug Act of 1906 | control drug labeling |
| Sherley Amendment 1912 | prohibited drugs labeled with false therapeutic claims |
| The central purpose of pharmacology focuses on improving the? | quality of life |
| the branch of medicine concerned with the treatment of disease and treatment of suffering | Therapeutics |
| Therapeutics is the branch of medicine concerned with the prevention of? | disease |
| USP label? | exact amount of ingredients |
| What advantage is there to buying OTC drugs? | easier access |
| What are the characteristics of each drug? | therapeutic applications, interactions, side effects & mechanism of action |
| What drug types must obtain FDA approval before being marketed? | vaccines, laboratory-created drugs, and biologics |
| What is longest stage of clinical stages? | clinical investigation, tests on healthy humans first and then those with the target ailment |
| What is next step after clinical investigations? | NDA- new drug application, average time 17-24 months |
| What is the purpose of the postmarketing surveillance stage? | survey for harmful effects in a large human population |
| What is the purpose of the prescription drug user fee act? | to provide yearly user fees to the FDA |
| What is the work of Health Canada? | if is a federal department working to ensure proper management of health and safety issues |
| What type of drugs do not require a physician's order? | OTC |
| When did modern pharmacology begin? | early 1800's |
| When was the FDA established? | 1988 |
| Where are traditional medication made? | synthesized in a laboratory |
| Which phase of drug approval produces inconclusive therapeutic results? | preclinical investigation |
| Who is the father of American pharmacology? | John Jacob Abel |
| Who wrote the first recorded reference to pharmacology? | Samuel Dale in 1693 |
| Why is pharmacology important to nurses? | nurses are involved in direct care and is a long, challenging and continual process |
| A _____ drug is the original, well- understood drug model from which other drugs in a particular class have been developed. | prototype |
| A drug's trade name is assigned by whom? | developing pharmaceutical company |
| active ingredient | generic name |
| antihypertensive | therapeutic classification |
| Bioavailability | ability of a drug to reach the bloodstream and target tissues |
| calcium channel blocker | example of pharmacologic classification |
| Chemical name | Strict chemical nomenclature used for naming drugs established by the International Union of Pure and Applied Chemistry (IUPAC) |
| Combination drug | drug product with more than one active generic ingredient |
| Controlled substance | In the United States, a drug whose use is restricted by the Comprehensive Drug Abuse Prevention and Control Act; in Canada, a drug subject to guidelines outlined in the Canadian Narcotic Control Act |
| Dependence | Strong physiological or psychological need for a substance |
| Drugs organized by _______ classifications are categorized based on how they produce their effect in the body. | pharmacologic |
| Drugs with more than one active ingredient? | combination drugs |
| Generic name | Nonproprietary name of a drug assigned by the government |
| How are drugs classified? | potential for abuse and addiction |
| In Canada, what drug is not restricted? | antidepressants |
| In order to understand a drug's mechanism of action, you would check the? | the pharmacological classification |
| In the U.S. which low restricts the use of controlled substances? | Controlled Substance Act |
| Is a folic acid antagonist therapeutic or pharmacologic? | pharmacologic |
| Is a laxative therapeutic or pharmacologic? | therapeutic |
| is an antianginal agent therapeutic or pharmacologic? | therapeutic |
| Is beta-adrenergic blocker therapeutic or pharmacologic? | pharmacologic |
| Is oral contraceptive therapeutic or pharmacologic? | therapeutic |
| Mechanism of action | The way in which a drug exerts its effects |
| One of the main arguments against substituting generic drugs for brand name drugs is differences in? | bioavailability |
| Pharmacologic classification | method for organizing drugs on the basis of their mechanism of action |
| Prototype drug | well understood model drug with which other drugs in a pharmacologic class may be compared |
| Scheduled drugs | in the U.S., a term describing a drug placed into one of five categories based on its potential for misuse or abuse |
| The description give to a drug by the International Union of Pure and Applied Chemistry (IUPAC) is its _______ name. | chemical |
| The nurse can predict the actions and adverse effects of other drugs int he same pharmacologic class by understanding which of the following? | prototype drug |
| Therapeutic classification | method for organizing drugs on the basis of their clinical usefulness |
| Three types of drug names are? | chemical, generic and trade |
| Trade name | proprietary name of a drug assigned by the manufacturer; also called the brand name or product name |
| trade name | brand name |
| What classification has the highest potential for abuse? | Schedule I |
| What classification has the sole purpose of use a research agent? | Schedule I |
| What is a prototype drug, how does it differ from other drugs in the same class? | prototype drugs exhibit typical or essential features of the drugs within a specific class |
| What is a Schedule G drug? | a controlled substance |
| What is the advantage of generic drugs? | cost savings, only one name is assigned for the drug (less complicated and easier to remember) |
| What is the difference between therapeutic and pharmacologic classifications? | therapeutic classification- method of organizing drugs based on their therapeutic usefulness in treating a particular disease, pharmacologic classification- refers to how an agent works at the molecular, tissue and body system levels |
| What is the disadvantage of generic drugs? | formularies may be different, the inert ingredients may be somewhat different and may affect the ability of the drug to reach the target cells and produce an effect. |
| What is the key to the therapeutic classification of a drug? | link the disorder to the drug's clinical usefulness |
| What is the law concerning refills for Schedule II drugs? | patient must seen by a health provider each time |
| Which scheduled drug has the highest risk for abuse and dependence? | Schedule I drugs |
| Why is a drug classified as a scheduled drug? | the drug can cause dependency |
| Why would a drug be placed on the negative drug formulary list? | generic drug bioavailability is different from the brand name and affects patient outcomes |
| With _____ classifications, drugs are organized on the basis of their usefulness in treating a particular disorder. | therapeutic |
| Withdrawal | physical signs of discomfort associated with the discontinuation of an abused substance |
| 1kg | 2.2 pounds |
| 1L | 4 glasses or 4 cups or 1 quart |
| 1mL | 15-16 drops |
| 4-5 mL | 1 teaspoon or 60 drops |
| 15-16 mL | 1 Tablespoon or 3-4 teaspoons |
| 30-32 mL | 2 Tablespoons |
| 240-250 mL | 1 glass or cup |
| 500 mL | 2 glasses or 2 cups |
| ac | Order for medication to be given before meals. |
| adlib | Order for medication to be given as desired/directed. |
| Allergic reaction | A acquired hyperresponse of body defenses to a foreign substance (allergen) |
| AM | Order for medication to be given in the morning. |
| Anaphylaxis | A severe type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life threatening shock. |
| Apothecary & Household systems | Older systems of measurement. |
| ASAP order | A medication that should be given within 30 minutes of the written order. |
| Astringent effect | Shrink swollen mucous membranes or loosen secretions and facilitate drainage. |
| bid | Order for medication to be given twice per day. |
| Buccal | Between gum and cheek. |
| cap | Capsule |
| Compliance | Taking a medication in the manner prescribed by the health care provider. |
| gtt | Drop. |
| h or hr | Hour. |
| IM | Intramuscular. |
| Intradermal (ID) | Injection administered to the dermis layer of the skin. |
| Intramuscular (IM) | Injection delivered to specific muscles. |
| Intravenous (IV) | Injection delivered directly to bloodstream. |
| IV | Intravenous. |
| Metric system of measurement | The most common system of drug measurement. |
| Nasogastric & gastrostomy | Nose or stomach |
| no | Number |
| Opthalmic | In or on the eye. |
| Otic | In the ear. |
| Parenteral route | Dispensing medications by routes other than oral or topical. |
| pc | Order for medication to be given after meals/after eating. |
| PM | Afternoon. |
| PO | By mouth. |
| PRN order | A medication that is to be given as required by the patients condition. Nurse makes the judgement. |
| q2h | Every 2 hours (even or when first given) |
| q4h | Every 4 hours (even) |
| q6h | Every 6 hours (even) |
| q8h | Every 8 hours (even) |
| q12h | Every 12 hours. |
| qid | Four times per day. |
| Routine order | Medications that are not ordered as STAT, ASAP, NOW or PRN. |
| Rx | Take. |
| Single order | A medication that is to be given only once and at a specific time (such as preoperative). |
| Standing order | An order that is written in advance of a situation that is to be carried out under specific circumstances (ie. postoperative patients might all get tylenol) |
| STAT order | A medication that is to be given immediately and only for one dose. |
| Subcutaneous | Injection delivered to the deepest layers of the skin |
| Sublingual | Under the tongue. |
| tab | Tablet. |
| The rights of drug administration | 1. Right patient 2. Right medication 3. Right dose 4. Right route of administration 5. Right time of delivery |
| Three checks of drug administration | 1.Check the drug with the MAR when removing it from the medication drawer, refrigerator, or controlled substance locker.2.Checking the drug when preparing it, pouring it, taking it out.3.Checking the drug before admin. |
| tid | Three times per day. |
| Transdermal | Through the skin (ie. patch) |
| 3 Categories of drug administration | enteral, topical, parenteral |
| 5 Rights of Drug Administration | 1) Right patient 2) Right medication 3) Right dose 4) Right route of administration 5) Right time of delivery |
| Additions to Rights of Drug Administration | - Right to refuse medication - Right to receive drug education - Right preparation - Right documentation |
| ASAP order | within 30 minutes |
| Astringent effect | shrinks swollen mucous membranes or loosen secretions and facilitate drainage |
| Buccal Route | tablet is placed in the oral cavity between the gum and the cheek; slower absorption |
| Dermatologic preparations | drugs applied to the skin; creams, lotions, gels, powders, sprays |
| Enteral Route | drugs given orally and those administered through nasogastric of gastronomy tubes; safest route; overdose - induced vomiting |
| Enteric Coated Tablets | designed to dissolve in the alkaline environment of the small intestine |
| Factors that Influence Drug Compliance | - Drug too expensive / not approved by insurance - Patient forget doses - Discontinue use b/c of annoying side effects - Believing more is better - Half dose in fear of dependency |
| GTube | gastronomy tube: surgically placed directly into the patients stomach |
| Inhalations | drugs applied to respiratory tract by inhalers, nebulizers, or positive pressure breathing apparatuses |
| Instillations and Irrigations | drugs applied into body cavities or orifices (eyes, ears, nose, bladder, rectum, vagina) |
| Intermittent infusion | small amount of IV solution that is arranged tandem with or piggy backed to the primary large volume infusion |
| Intradermal (ID) Injection | administered into dermal layer of skin |
| Intramuscular (IM) injections | delivers medication into specific muscles; rapid onset of action; receive large volume of meds |
| Intravenous (IV) medication & fluids | administered directly to the bloodstream and are immediately available for use by the body; very rapid onset of action; most dangerous |
| IV Bolus (Push) Administration | concentrated dose delivered directly to the circulation via syringe to administer single dose meds |
| Large-volume infusion | for fluid maintenance, replacement, or supplementation |
| Nasal route | used for systemic and local drug administration; avoids first-pass effect and digestive enzymes |
| NG Tube | nasogastric tube: soft, flexible tube inserted by way of the nasopharynx with the tip lying in the stomach |
| Ophthalmic route | used to treat local conditions of the eye and surrounding structures; eye irrigations, drops, ointments, medicated discs |
| Otic route | used to treat local conditions of the ear, including infections and soft blockages of the auditory canal; eardrops and irrigations |
| Parenteral route | delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles, or veins; aseptic technique |
| PRN | when needed/necessary |
| Rectal route | used for local or systemic drug administration; safe and effective for comatose patients or those nauseous/vomiting; usually in suppository form |
| Standing order | written in advance of a situation that is to be carried out under specific circumstances (ex: set of prescriptions for all patients who undergo a specific surgical procedure) |
| STAT order | needed immediately, given only once, within 5 minutes |
| Subcutaneous injection | delivered to the deepest laters of the skin (insulin, heparin, vitamins) |
| Sublingual Route | medication is placed under the tongue and allowed to dissolve slowly; rapid onset of action |
| Sustained- Release Tablets | designed to dissolve very slowly |
| Topical Drugs | applied locally to the skin or membranous linings of the eye, ear, nose, respiratory tract, urinary tract, vagina, and rectum |
| Transdermal delivery | transdermal patches; changed on a regular basis |
| Vaginal route | used to deliver medications for treating local infections and to relieve vaginal pain and itching; suppositories, creams, jellies, or foams |
| Advantages of Intramuscular administration | -The only barrier to absorption is the capillary wall. The rate of absorption can be fast or slow depending on drug solubility and blood flow to the site of injection-good for Poorly soluble drugs-drug absorbed gradually over time |
| Advantages of oral administration | Easy, convenient, inexpensive No risk of fluid overload, Can more easily be reversed if overdosed activated charcoal absorption of drugs |
| Biotransformation | Enzymatic alteration of drug structure |
| Catharsis | rapid emptying of small intestine and bowel before absorption |
| Disadvantages of intramuscular injection | Discomfort Inconvenience Local infection Nerve damage |
| Disadvantages of oral administration | Variability of absorption Inactivation by proteases and acid Can't be given to comatose or non- cooperative patients Inflammation of the GI tract and irritation |
| Emesis | vomiting |
| Factors affecting drug absorption | Rate of dissolution Surface area, Blood flow, Lipid solubility pH partitioning |
| Factors affecting the rate of absorption from oral administration | Solubility and stability, Gastric and intestinal PH, Gastric emptying time, Food in the gut Co-administration of other drugs Capsule (coating) around the drug |
| Factors influencing drug distribution | 1) Blood flow to the tissue 2)Ability of the drug to exit the vascular system (the blood brain barrier) 3)Ability of the drug to enter the cell |
| Factors that modify renal drug excretion | PH dependent ionization, Competition for active tubular transport, Age-kidneys of newborns not fully developed, and kidneys of aged not fully functional. |
| How are drugs excreted from the kidneys? | Glomerular filtration. Passive tubular reabsorption-water and lipid soluble drugs may be reabsorbed back into the blood. Active tubular secretion-active transport of drugs from the blood to the urine in tubules. |
| How does a drug cross a cell membrane? | One of three ways:Through channels or pores (very few drugs cross this way), With the aid of a transport system (such as a carrier protein), Direct penetration of the membrane (this is the most common method) |
| How is the therapeutic objective achieved? | The time course of dry response must be regulated.-the time at which the drug responses start -the time they are the most intense-The time they cease |
| Implications of drug metabolism | 1) accelerated renal drug excretion 2) Drug inactivation 3) Increased therapeutic action 4) Activation of pro-drugs 5) Toxicity variations |
| Advantages and disadvantages of Intravenous administration | pro: No barrier to absorption, rapid onset, use of large fluid volumes, use of irritant drugs con: High cost, inconvenience, difficult to admin, irreversible, possible fluid overload, infection, embolism, clot, hypotonic/hypertonic death of RBC's |
| Minimum effective concentration | The plasma drug level below which therapeutic effects will not occur. |
| Must get through the epithelial cell barrier of GI tract and capillary wall. Must pass through cells not between them! | Oral administration |
| Other ways to deliver drugs | Topical Transdermal patches Inhalation Rectal/vaginal suppositories Direct injection into specific tissue/organ |
| P450 system | microsomal enzyme system of the liver. -12 related enzymes -the first 3 groups of these enzymes are composed of other enzymes in the group, while the other 9 metabolize endogenous compounds. |
| Placental Drug transfer | Some drugs can cause: Birth defects Drug dependent babies Respiratory depressants |
| Plasma levels of a drug | can be measured and adjusted up or down by changing dosage, the timing of administration, or both. |
| Preparation for oral administration | Tablet, Enteric-coated preparations, Sustained-release |
| Primary site of drug metabolism | The liver. |
| Protein binding | Competition btw drugs for binding and displacement of one drug by another may cause level of one drug to rise and cause a toxic response. |
| Special considerations in drug metabolism | Age, First pass effect (rapid hepatic inactivation of certain oral drugs), Nutritional status, Competition between drugs |
| Therapeutic range | Range of dry concentrations falling between MEC and toxic concentration that is the therapeutic range. |
| Toxic concentration | occurs when the plasma level of the drug gets too high. |
| True/false: Ionized drugs can easily cross the membrane. | False. Polar molecules,ions and charged molecules CANNOT cross the membrane. |
| two major groups of administration | Enteral and Parenteral |
| What are the 4 basic pharmacokinetic processes? | Absorption, distribution, metabolism, excretion |
| When a drug is administered repeatedly in the same dose, plateau will be reached in how many half lives? | four. |
| 4 kinds of receptors | may be found on the membrane, within the membrane, on the inner surface of the membrane, in the cytoplasm, or in the nucleus. |
| Agonist | A molecule that activates receptors (mimicry). -has high affinity and high intrinsic activity |
| All-or-none dose response | The response produces only one intensity of response and can't be tailored to fit individual person. It may be too weak or too strong for the individual. |
| Antagonist | Produces effects by preventing receptor activation by endogenous regulatory molecules and drugs.-has high affinity for receptor but no intrinsic activity. |
| Basic features of dose- response | Dose response could be graded vs. all-or-none |
| Basic features of the dose response | 1:low doses. curve flat too low to measure. 2:ride in doses elicits increase in response. As dose continues to increase, a max is reached where further increase in dose will have no effect. 3:high dose does not increase response, and may elicit activity. |
| Competitive antagonist | Produce blockade by competing with agonist for receptor binding. REVERSIBLE. |
| Dose- response relationship | The relationship btw the size of the dose given and the intensity of the response produced, min amount of drug that can be used, max response that drug can elicit, how much you need to increase dosage to produce the desired response |
| drugs that do not involve binding to receptors | antacids, antiseptics, laxatives, and chelating agents. |
| ED50 | The dose required to produce a defined therapeutic response in 50% of the population. |
| Graded dose response | As dosage is increased, the response becomes larger, and drug dose can be tailored for each individual by increasing or decreasing the dosage. |
| If a drug is selective for one receptor, can it still produce nonselective effects? | Yes, if a single receptor is responsible for several physiologic processes. |
| Maximal efficacy | The largest effect that a drug can produce. One drug may have a greater maximal efficacy than another, no matter how much of the second is given. |
| Modified occupancy theory | Affinity binding-the strength of the attraction between the drug and receptor. Intrinsic activity-The ability of a drug to activate its receptor. |
| Noncompetitive antagonist | Reduces the maximal drug response by decreasing the number of receptors available for activation by the agonist. IRREVERSIBLE. |
| Partial agonists | Has moderate intrinsic activity and therefore the maximal effect that a partial agonist can produce is lower than that of a full agonist.Can act as an antagonist as well as an agonist. |
| Pharmacodynamics | The study of biochemical and physiological effects of a drug and the molecular mechanisms by which those effects are produced. |
| Receptor | Any functional molecule in a cell to which a drug binds to produce its effects. |
| Receptor families | Any functional molecule in a cell to which a drug binds to produce its effects. |
| Relative Potency | Refers to the amount of drug we must give to elicit an effect. |
| Selectivity does not guarantee ____________. | Safety |
| Simple occupancy theory | Not able to explain why one drug is more potent than another if they bind to the same receptor and both bind maximally to all receptors. |
| Therapeutic index | A measure of a drug's safety. Defined as the ratio of a drug's LD50 to its ED50. |
| Assessment phase | Appraisal of a patient's condition that involves gathering and interpreting data. |
| Baseline data | Patient information that is gathered before pharmacotherapy is implemented. |
| Evaluation phase | Objective assessment of the effectiveness and impact of interventions. |
| Goal | Any object or objective that the patient or nurse seeks to attain or achieve. |
| Implementation phase | When the nurse applies the knowledge, skills, and principles of nursing care to help move the patient toward the desired goal and optimal wellness. |
| Nursing diagnosis | Clinically based judgment about the patient and his or her response to health and illness. |
| Nursing process | Five-part decision-making system that includes assessment, nursing diagnosis, planning, implementation, and evaluation. |
| Objective data | Information gathered through physical assessment, laboratory tests, and other diagnostic sources. |
| Outcome | Objective measurement of goals. |
| Planning phase | Linkage of strategies or interventions to established goals and outcomes. |
| Subjective data | Information gathered regarding what a patient states or perceives. |
| mixture of a drug plus binders and fillers compressed together. If made by different companies it can differ in rates of disintegration and dissolution | Tablets |
| Drugs covered with material designed to dissolve in the intestine but not in the stomach (composed of fatty acids, shellac, waxes) | Enteric-coated preparations |
| Capsules filled with tiny spheres that contain drug. Spheres have coatings that dissolve at variable rates. Drug is released at steady rate over number of hours. | Sustained-release |
| Protein binging strong, weak and penicillin: | strong attraction b/w warfarin and albumin. 99% binds and is neutralized. -Weak attraction b/w Gentamicin. 10% binds to albumin.-Penicillin-binds to albumin and creates allergic reaction. |
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