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the study of biochemical and physiologic effects of drugs and the molecular mechanisms by which those effects are produced.
Most drugs, the dose response relationship is graded. What does this mean?
That the response gets more intense with increasing dosage.
Potency and efficacy are independent qualities. Give an example:
Drug A can be more effective than drug B even though drug B may be more potent. Also, drugs A and B can be equally effective, although one may be more potent than the other.
A receptor can be defined as:
any functional macromolecule in a cell to which a drug binds to produce it's effects.
The receptors to which drugs act are:
normal points of control for physiologic processes.
What are the four primary families of receptors:
- cell membrane embedded enzymes
- ligand gated ion channels
- g protein coupled receptor systems
- transcription factors
If a drug interacts with only one type of receptor, and if that receptor type regulates just a few processes, then:
the effects of the drug will be relatively selective.
If a drug interacts with only one type of receptor, but that receptor type regulates multiple processes, then:
the effects of the drug will be nonselective.
If a drug interacts with multiple receptors, its effects will be:
The term affinity refers to:
the strength of the attraction between a drug and it's receptor.
Drugs with high affinity have:
High relative potency
. The term intrinsic activity refers to:
the ability of a drug to activate receptors.
Drugs with high intrinsic activity have:
molecules that activate receptors
In terms of modified occupancy theory, agonists have both affinity and high intrinsic activity. What does this do?
Affinity allows them to bind to receptors while intrinsic activity allows them to activate the receptor after binding.
Antagonists are drugs that:
prevent the receptor activation by endogenous regulatory molecules and by other drugs.
Continuous exposure of cells to agonists can result in:
receptor desensitization, where as continuous exposure to antagonists can result in hypersensitivity.
ED50 is defined as:
the dose required to produce a defined therapeutic response 50% of the population.
An average effective dose (ED50) is:
perfect for some people, insufficient for others, and excessive for still others.
The therapeutic index--- defined as the LD50ED50 ratio--- is:
a measure of a drugs safety. Drugs with a high therapeutic index are safe. Drugs with a low therapeutic index are not safe.
Drug-drug interactions may result in:
- intensified effects
- diminished effects
- or an entirely new effect
Potentiative interactions are beneficial when:
they increase therapeutic effects and detrimental when they increase adverse effects.
Drugs that induce hepatic drug-metabolizing enzymes can
accelerate the metabolism of other drugs
When an inducing agent is added to the regimen, you may need to:
increase the dosage of other drugs
A drug that inhibits the metabolism of other drugs will:
increase their levels. This can be beneficial but usually detrimental.
Drugs that act as antagonists at a particular receptor will:
diminish the effects of drugs that act as agonists at that receptor. The result may be beneficial (If the antagonist prevents toxic effects of the agonist) or detrimental (if the antagonist prevents therapeutic effects of the agonist).
We can help reduce the risk of adverse interactions by:
minimizing the number of drugs the patient is given and by taking a thorough drug history.
Grapefruit juice can inhibit the intestinal metabolism of certain drugs, in turn, what does this do?
thereby increasing their absorption, which in turn increases their blood levels.
When the medication order says to administer a drug on an empty stomach, this means administer it either:
1 hour before or 2 hours after
Conventional drugs can interact with dietary supplements. The biggest concerns are:
increased toxicity and reduced therapeutic effects of the conventional agent.
An adverse drug reaction can be defined as:
any noxious, unintended and undesired effect that occurs at normal drug doses
Patients at increased risk of adverse drug events are:
the very young, the elderly, the very ill, and those taking multiple drugs.
An iatrogenic disease is:
a drug or physician induced disease
An idiosyncratic effect is:
an adverse drug reaction based on a genetic predisposition.
A carcinogenic effect is:
a drug induced cancer.
A teratogenic effect is:
a drug induced birth defect.
The intensity of an allergic drug reaction is:
based on the degree of immune system sensitization---not on drug dosage.
Drugs are the most common cause of:
acute liver failure, and hepatotoxicity is the most common reason for removing drugs from the market.
Drugs that prolong the GT interval pose a risk of torsades de pointes, this is a:
dysrhythmia that can progress to fatal ventricular fibrillation.
Measures to minimize adverse drug events include:
avoiding drugs that are more likely to harm a particular patient, monitoring the patient for signs an symptoms of likely adverse effects, educating the patient about possible adverse effects and monitoring organs that are vulnerable to a particular drug.
The three most common types of fatal medication errors are:
- giving an overdose
- giving the wrong drug
- and using the wrong route.
The three most common causes of fatal medication errors are:
human factors, miscommunication, and confusion caused by similarities in drug names.
Effective measures for reducing medication errors include:
- 1. using a safety checklist for high alert drugs
- 2. replacing handwritten medication orders with a computerized order entry system.
- 3. having clinical pharmacist accompnay ICU physicians on rounds
- 4. Avoiding error prone abbreviations
- 5. helping and encouraging patients and their families to be active, informed participants in the health care team.
- 6. Using a computerized barcode system that:
- A. identifies the administering nurse
- B. Ensures that the drug is going to the right patient and the adverse interactions are unlikely.