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Pharm review 1
review for test 1
| Question | Answer |
|---|---|
| 3 most important properties of an Ideal Drug? | Effectiveness, Safety, and Selectivity |
| 3 examples of causes of medication errors | bad handwriting, nurses in a hurry, and banned abbreviations |
| what is pharmacokinetics? | what happens to a drug once inside the body |
| 4 major pharmacokinetic processes | absorption, distribution, metabolism, and excretion |
| Factors that affect Absorption... | rate of dissolution, surface area, blood flow, lipid solubility, and ph partitioning |
| why is IV administration faster than IM or subcutaneous? | IV bipasses the cell membrane and goes straight into the blood |
| what are some risks of IV administration? what about risks for IM? | IV:fluid overload, possible risk for infection, infiltration, IM: nerve damage |
| what is the 1st pass effect? | all drugs pass through the liver before entering the circulation - so in liver, drug gets broken down quickly so dose needs to be increased |
| Distribution is determined by what 3 factors? | blood flow to tissues, ability of drug to exit the vascular system (Blood brain barrier, placental drug transfer, and protein binding), and ability of a drug to enter the cells |
| how can blood flow to tissues be affected? | abscess will decrease blood flow to area |
| What does the Blood Brain Barrier due to prevent drugs from affecting the CNS system? | BBB causes CNS capillaries to block distribution to the brain |
| what happens with protein binding? | meds that bind to albumin stay in blood and never reach sites of action - causes increased drug concetration in the blood |
| what are some special considerations in drug metabolism? | Age - elderly and very young start at lower doses. children have high metabolism so dosages need to be increased. induction of drug-metabolizing enzymes - may be needed for malnourished, first-pass effect,nutritional status,competition between drugs |
| what organ excretes drugs? | kidneys |
| Factors affecting drug excretion | acute or chronic renal failure,changes in ph,competition for transport,age - infants have decreased excretion due to underdeveloped kidneys. elderly take more drugs and are more likely to have chronic disease that affects excretion |
| what is a loading dose? | high initial dose - med amount to avoid initial lag |
| what is a maintenance dose? | amount that keeps level in therapeutic range; routine small doses |
| what is a peak? | maximum dose after initial that is within therapeutic level but nontoxic |
| what is a trough? | lowest dose within therapeutic level but not in minimal effectiveness dose/range - before next dose |
| what is pharmacodynamics? | what the drug does to the body |
| what is potency? | amount of a drug that must be given to elicit a response - need more med to get same effect (x axis of curve) |
| what is efficacy? | largest effect that a drug can produce (height of curve) |
| Half-life | time required for the amount of a drug in the body to decrease by 50 % longer the half life the more likely it is for the drug to accumulate |
| plateau | when amount of drug eliminated between doses equals the dose administered -about 4 half lives |
| what are agonists? | mimic body's own regulations and activate receptors |
| what are antagonists? | drugs that block actions of agonists |
| what is intrinsic activity? | ability of a drug to activate the receptor following binding |
| affinity | strength of the attraction between a drug and its receptor |
| LD 50 | amount that would kill 50% of the population |
| ED 50 | therapeutic response to 50% population |
| tolerance | state where more med needed to get same effect; example: opiates |
| placebo effect | psychologic/suggestion power effect |
| -april endings are for what class of drugs? | ace inhibitors |
| -olol endings are for what class of drugs? | beta blockers |
| what do generic names define? | class; they never change |
| types of drug interactions: | drug-drug,drug-food,drug-herb |
| How to minimize drug-drug interactions: | minimize # of drugs pt taking,take a thorough drug history ** IMPORTANT**be aware of the need for adjustment,careful monitoring for signs of toxicity |
| Noncompetitive antagonists | bind irreversibly to receptors,decrease max response |
| competitive antagonists | are reversible;inhibition is surmountable |
| what is a side effect? | unavoidable secondary drug effect produced at therapeutic level; example: drowsiness |
| toxicity | overdose |
| allergic reaction | immune response |
| idiosyncratic effect | unexpected genetic effect |
| iatrogenic effect | caused by healthcare treatment |
| physical dependence | withdrawals when drugs are stopped |
| carcinogenic effect | cancer causing |
| teratogenic effect | affects fetus causing birth defects |
| Central Nervous System is composed of: | brain and spinal cord |
| Peripheral Nervous System is composed of: | somatic motor - skeletal movement;autonomic - parasympathetic and sympathetic |
| what are the functions of the autonomic nervous system? | regulation of heart, regulation of secretory glands, regulation of smooth muscles |
| is autonomic nervous system voluntary or nonvoluntary? | nonvoluntary. emotions can affect |
| Parasympathetic Nervous System Functions: | slow heart rate, increase gastric secretion empty bladder, empty bowel, focus eye for near vision, constrict pupil,contract bronchial smooth muscle |
| Sympathetic Nervous System Functions: | regulate cardiovascular system,regulate body temp, implementation of 'flight or fight' response -increase heart rate and BP -shunt blood away from the skin and viscera - dilate bronchi - dilate pupils - mobilize stored energy |
| what is the baroreceptor reflex? | allows for rapid change of blood pressure by triggering parasympathetic and sympathetic |
| what receptors are activated by epinephrine? | all alpha and beta receptors(not dopamine) |
| what receptors are activated by norepinephrine? | alpha 1, alpha 2, and beta 1 (not dopamine or beta 2) |
| what receptors are activated by dopamine? | DOPAMINE, alpha 1, and beta 1 |
| cholinergic receptors are mediated by... | acetylcholine |
| what are the 2 subtypes of cholinergic receptors? | -nicotinic (indirect) -muscarinic (direct) |
| cholinergic drugs mimic which nervous system: parasympathetic or sympathetic? | parasympathetic |
| epinephrine and norepinephrine mediate which receptors? | adrenergic subtypes: alpha 1 and 2 beta 1 and 2 dopamine |
| what are the 2 types of cholinergic drugs? | muscarinic (direct acting) cholinesterase inhibitors (a agonist) |
| anticholinergic drugs mimic the nervous system: | sympathetic |
| anticholinergic drugs can be an antidote for.. | cholinergic drugs |
| type of anticholinergic drugs: | muscarinic antagonists |
| an example of a neuromuscular blocker is... | succinocholine which depolarizes and causes respiratory depression and hypotension |
| what effect does neuromuscular blockers have on transmission? | blocks nicotinic cholinergic transmission |
| 2 major classes of adrenergic agonists... | catecholamines and noncatecholamines |
| how can catecholamines be administered? | NO ORAL FORM - mostly given IV, epinephrine can be given iv or im |
| effect of inotrophic | strength |
| effect of chronotrophic | rate |
| what are receptors? | sites on postsynaptic cell which binds to transmitter molecules |
| how does parasympathetic affect heart rate? | slows down heart rate |
| how does sympathetic affect heart rate? | accelerates heart rate |
| what is a ganglion? | group of nerve cell bodies |
| where does preganglionic cells and post ganglionic cells attach? | pre- spinal cord to parasympathetic ganglia post-ganglia to effector organs |
| somatic motor system is a pathway from ____ to _____. | spinal cord to muscle |
| what does nicotinic n (neuronal) promote? | ganglionic transmission and release of epinephrine |
| what does nicotinic m (muscle) promote | contraction of skeletal muscle |
| alpha 1 receptors stimulate | vasoconstriction pupil dilation ejaculation contraction of bladder |
| what does alpha 2 receptors do? | located on nerve terminals and regulate transmitter release |
| where are beta 1 located and what do they do? | located in kidney and heart; increases heart rate, force of contraction, and velocity of impulse conduction through av node |
| what are beta 2 receptors responsible for? | FIGHT OR FLIGHT! bronchial dilation, relaxation of uterine smooth muscle, vasodilation and increased blood flow to organs, increased Oxygen |
| what organ does dopamine receptors primarily affect? | kidneys (renal system); dilates renal blood vessels |
| best known muscarinic antagonist | atropine |
| what is cholinergic crisis? | excessive muscarinic stimulation and depolarizing neuromuscular blockade - can result in paralysis followed by death from apnea |
| what is myasthenia gravis? | a neuromuscular disorder characterized by: fluctuating muscle weakness and predisposition to fatigue (rapid) |
| symptoms of myasthenia gravis: | ptosis (drooping eyelids) difficulty swallowing weakness of skeletal muscles |
| usual treatment for myasthenia gravis: | reversible cholinesterase inhibitors which prevent ACh inactivation causing increased muscle strength |
| what can noncatecholamines do that catecholamines cannot? | cross blood brain barrier (BBB) |
| what is selectivity? | elicits only the response for which it was given |
| polar molecules pass Easily or Difficultly through cell membranes | easily |
| do large ionized (charged) or small nonionized (uncharged) drug molecules pass readily across cell membrane? | small nonionized (uncharged) |
| large ionized drug molecules are ____ soluble | water |
| small unionized drug molecules are _____ soluble | lipid |
| what is bioavailability? | if the drug they contain is absorbed at the same rate and to the same extent |
| therapeutic drug range | the rate of drug elimination equals the rate of drug administration |
| therapeutic index | margin of safety... either TD 50 or ED 50 the lower the index the more unsafe the drug is...closer ratio to 1 the greater possibility for toxicity |
| tolerance | decreased response to same dose...need more to achieve same effect |
| nicotine acts on... | skeletal muscles (contraction) |
| muscarine acts on... | cilliary muscles (contraction)- located in eye focuses eye for near vision |
| alpha 1 receptors are responsible for.. | vasoconstricion, ejaculation, bladder contraction |
| alpha 2 receptors are responsible for... | inhibition of transmitter release |
| beta 1 is responsible for... | increased heart rate, increased force of contraction |
| beta 2 is responsible for... | glycogenolysis (breakdown of glycogen into glucose), vasodilation, bronchodilation, relaxation of uterine smooth muscle |
| dopamine dilates which vessels? | renal blood vessels |
| what are 2 muscarinic agonists? | bethanechol and cholinesterase inhibitors:pheostigmine |
| what is an example of muscarinic antagonist? | atropine |
| what is an example of nicotinic n agonist? | nicotine, cholinesterase inhibitors |
| what is an example of nicotinic n and m antagonist? | mecamylamine |
| what are some examples of nicotinic m antagonist? | tubocurarine and succinylcholine |
| mydriasis is... | pupil dilation |
| what is ptosis? | drooping eyelids |
Created by:
bkelly987
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