PHARM EXAM
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| • Charachteristics of Drugs | o Effectiveness**** most important
o Safety
o Selectivity
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| • Side effect | o nearly unavoidable secondary drug effect produced at therapeutic doses *generally predictable (An effect that we know is going to happen )
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| • Adverse reaction | o Any noxious , unintended, and undesired effect that occurs at normal drug doeses
o More intense than side effect (mild to severe
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| • Med error | Overdose, wrong drug, wrong route; the cause of this is due to human factors, communication mistakes and name confusion. Major cause of morbidity (sickness) and mortality (death).
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| • Allergic reaction: | o Immune response
o *must be prior sensitization of the immune system first, so the reexposure can trigger the allergic response
o *based on DEGREE of immune system sensitization (not drug dose)
o Itchy, swelling rash, fever)- minor
o Anaphylaxis- maj
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| • Dependent |
o Psychologic: Intense subjective need
o Physical: state in which abstinence syndrome will occur
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| • Tolerance | Results from regular drug use. A state in which a particular dose elicits a smaller response than it did with initial use.
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| • Potency | o The AMOUNT of drug needed to produce effect
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| • o Chemical name | (the chemical properties it consists of)
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| o Generic name | equivalent to brand name counterpart/cheaper/basically a copy of the brand name but names differently) (i.e. acetaminophen)
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| o Trade name | (propriety or brand name/identifies it as the exclusive property of a particular company/simply a shortened version. Multiple trade names for a single drug=confusing) (Tylenol example- everyone knows this name)
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| • Parenteral | o absorbed through IV, straight into circulatory, FAST
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| • Enteral | o goes through GI, slower
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| • (Intrinsic activity) | ability for drug to activate following binding
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| • Affinity | The attraction to a receptor site
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| • Agonist | o Activates receptor
o Has affinity and intrinsic factor
o (mimics)
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| • Antagonist | o Blocker
o Prevents receptor activation by endogenous regulatory molecules and drugs
o Has affinity but NO intrinsic factor (can bind to receptors but does NOT activate)
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| • Receptor | o Any functional macromolecule in a cell to which a drug binds to produce its effects
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| Pharmacokinetics | how MUCH of dose to site of action (body impact on drugs)
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| o Absorption | (into bloodstream)
Movement of drug from site of administration into blood
(important determinants of drug response, dosage size, and route)
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| o Distribution | The movement of drugs throughout the body into cells/tissues; poor blood flow or a solid mass can affect distribution.
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| o Metabolism | o Metabolism
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| o Elimination | Excretion of the drug. Kidney disease can decrease this action.
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| • Beta lactam | o The ring attached to the antibiotic (penicillins and cephalasporins are in this category- also bacteriocidal which weaken the cell wall and kill the virus (PROTECTS THE ANTIBIOTIC)
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| • Beta-lactamase | : Breaks down the beta lactam ring that is around the antibiotic making it not work
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| Narrow therapeutic index (range): | A small range where one will see therapeutic effects. It is very easy to reach toxic concentrations or minimum effective concentrations. Monitoring frequently is very important. (ex: Dilantin has a very narrow therapeutic range)
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| • Glucocorticoid | Cortisol is the most important glucocorticoid. Highly effective in relieving pain for short term use for inflammation. They increase the availability of glucose.
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| • B2 agonist | Activate beta₂ receptors (primarily selective to the lungs and used for asthma).
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| • Bronchoconstriction: | The constriction of the airway and the lungs due to tightening of surrounding smooth muscle. (cholinergic effect)
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| o Surfactant | Pulls water back in makes fecal matter SOFT
Non drug of choice with people with bad peristalsis
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| o Osmotic | Nonabsorbed salts
FAST
Dehydration risk
Pull in water and electrolytes
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| o Bulk forming | Like fiber
Creates bulk by stretching lumen and creates peristalsis
DRINK WATER
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| o Stimulant | Usually with Opioids*
Stimulating peristalsis
A day or so Senokot-s
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| • Neuroleptic malignant syndrome DEFINISTION | o Initiation or increase in antipsychotics; drugs cause an inability to regulate body temperature/autonomic function; elevated CPK levels (muscle breakdown and acidosis) [What can happen when you start someone on antipsychotics or increase their dose]*
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| • Neuroleptic malignant syndrome S/S | o s/s include high fever, muscle cramps “lead pipe rigidity”, tachycardia, tachypnea, fluctuating BP, delirium
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| o Acute attack | Beta 2 agonist (albuterol)
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| o Maintenance | Glucocorticoid (Prednisone)
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| In between drug... allergy | o Leukotrienes (signgulair)
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| o Exercise induced asthma | - Cromolyn
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| • Why is “fat soluble” important | o It crosses the BBB and any part of the body more effectively (GETS ACROSS ANY PART OF BODY EASIER)
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| • Purpose general anesthetics | o Unconsciousness
o Lack of response to painful stimuli
o Skeletal muscle relax
o Amnesia
[ULSA]
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| What are the side effects of anticholinergics? | Dry mouth, chronic thirst, blurred vision, dry eyes, sedation, urinary retention, constipation
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| Bacteriostatic | - slows growth
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| v Bacteriocidal | kills
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| What is included in a complete drug history?: | Do you drink?
Do you take any OTC meds?
Do you take any herbal meds?
Do you take any street drugs?
Do you take any prescription drugs? Do you know the exact dosage?
Are you pregnant?
Do you smoke?
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| • Effect grapefruit Juice with drugs? With CYP450 | o It can inhibit intestinal metabolism thereby increasing absorption which increases the drug blood level
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| • Purpose clinical drug testing | DETERMINE EFFECTIVENESS
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| PRotein binding | EX: If there is a drug taken that is 50% protein bound and another drug taken that is 95% protein bound, the 95% protein bound drug will take up all the albumin sites leaving the 50% protein bound as free drug floating in the blood.
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| Mucomyst | reverses the effects of tylenol
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| Narcan | used to reverse respiratory depression (because of opioids)
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| Protamine | reverses the anticoagulating effects of heprin
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| Vitamin K | reverses the anticoagulating effects of Coumadin
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| Fever (which nsaids) | NSAIDS, ASA, Tylenol
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| Pain | NSAIDS, ASA, Tylenol
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| Inflammation | NSAIDS, ASA
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| • MAOI – what food to avoid | Yeast, cheese, wine, *processed meats and stuff
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| • HypOkalemia | o Muscle weakness
o Muscle cramps
o Diminished refelexes
o **digoxin risk
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| • HypERkalemia | o Dysrthythmias
o Palpitations
o Diarrhea
o Weakness/fatigue
o Nausea/vomiting
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| • Hypoglycemia | o Diaphoresis
o Confusion
o palpitations
o Jittery
o hunger
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| • Hyperglycemia | o Dry
o Irritable
o Lethargic
o Tachycardia
o Thirst
o hypotension
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| Losartan | ARB, does not affect heart rate
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| Nipelipine | CCB
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| Metoprolol | selective beta blocker, affects heart rate decreases it
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| Captopil | ACE
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| Propanolol | non selective beta blocker, decrease HR
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| • CO (cardiac output): | The amount of blood pumped out of the ventricles at any given time. SVxHR=CO
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| • Afterload | The force that the ventricles have to overcome to eject blood out of the heart (left side)
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| • Preload | The amount of tension applied to the heart muscle prior to contraction (heart is stretching and filling up) (right side)
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| • Stroke volume | The volume of blood that is ejected out of a ventricle during a single contraction
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| • Baroreceptors | Located in the carotid sinus and aortic arch that monitors changes in blood pressure and send this information to the brain
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| • B1 receptors are selective for: | o Heart- increase heart rate, increase conductivity, constrict arterioles
o Kidney- release renin, increase blood pressure
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| • B2 receptors | o Lungs- vasodilation
o Arterioles- vasodilation
o Uterus- relaxed muscle
o Liver- gluconeogenesis (conversion of glycogen to glucose)
o Skeletal muscle- gluconeogenesis (conversion of glycogen to glucose)
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| o Benefits (Estrogen) | - helps with osteoporosis
- menopause,
- polycystic ovarian disease
- growth in breasts, acne
- thickens vaginal epithelium
- helps with proliferation of uterun epithelium (period)
- stimulates uterun blood flow
- hormone replacement theory
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| o Risks | - increase breast cancer
- possible cardiovascular problems for MI and stroke
- uteran cancer
- ovarian cancer
- nausea
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| • How do OC’s work? | o Prevent/inhibit ovulation, thicken cervical mucus and thin the endometrial lining
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| • What is an “antabuse reaction”? why would you have this? | o Given in treatment to those that are dedicated to stop drinking alcohol. If any type of alcohol is ingested, the client will become violently ill
o LASTS FOR TWO WEEKS….
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| Teratogenesis? What is it/when significant? | Consuming a substance that will cause abnormalities to an unborn child. This is significant when a female is pregnant in first trimester (ex: fetal alcohol syndrome)
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