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Pharmacology
study of drugs and their actions on living organisms.
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Therapeutic Methods--
Drug therapy
tx c meds
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Ther. Methods--
Diet
tx by manipulation of diet
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Ther. Meth.--
Physiotherapy
tx c natural resources (heat, light, h2o)
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Ther. Meth.--
Psychological therapy
tx by identifying stressors and stress reduction tech. "talk therapy"
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Drug
chem substance that has an effect on living tissues
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Medicine
therapeutic drug used in prevention/tx of disease
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Meds from plany sources
opiates (morphine, codeine, for pain); from white poppy plant & digitalis (tx of chf/arrythmias) from leaves of purple foxglove flower.
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meds from animal sources
insulin and thyroid hormones from pig/cattle
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chemical name
chem structure of drug - exact molecular makeup; most important to chemist.
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generic name
simple, common, provided by USAN. Not capitalized
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Official name
name as listed by FDA. usually same as generic followed by usp
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brand/trademark
name given by manufacturer. R symbol. registered and only used by owner. Capitalize.
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FDA
US Food and Drug Administration -- federal agency that tests and determines if drugs are safe for humans. Granted to name drugs.
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USP US Pharmacopeia/National Formulary NF
standards to id, quality, strength, purity, single vol., revised annually
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USP Dictionary of USAN and International Drug names
usan name, pronunciation, chem formula, chem name, brand name, manufacturers, reg #, over 1000 drugs. annually.
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American Drug Index
All meds in US, by Facts and Comparisons, edit yearly, info on gen/brnd/chem names.
most useful for quick comparison of brand/generic name & availability of streghts and dosage forms
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American Hospital Formulary Service, Drug Info
official reference for major organization, (public health service, dept of vets, and American Hosp Association.
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Drug Interaction Facts
Most useful for drug interactions
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PDR Drug Facts and Comparisons
inclusion of most current FDA-approved package insert info and for cross comparison tables of similar drugs
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Handbook on Injectable Drugs
Comprehensice reference for compatibility of inj drugs.
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Handbook for Nonprescription Drugs
comprehensive book on nonrx otc drugs; 3 major advantages, includes qs to ask pts to determine if tx is needed, product selection guides, pt teaching info
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Martindale- The complete drug reference
text for info on drugs in current use throughout the world, includes herbs
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Natural meds comprehensive database
gold standard reference for over 1000 herbal meds
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Physicians Desk Reference PDR
- 1-g-manufacters index
- 2-w-brand/gen name
- 3-g-product category
- 4-g-product id
- 5-w-product info
medwatch forms (voluntary reporting of drug a/e)
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Medical Letter
brief comments on newly released drugs and findings
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package inserts
fed law requiring info by approved by FDA before released, insert w ea package, new website all info
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nursing journals
articles, dated, not as reliable
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electronic database
growing, cd, mobile, etc, eg: Davis, National Library of Medicine
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Nursing Drug Handbooks
found most nsg stations, concise, compact and redily available, source used most frequently by nsg
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us pharmocopeia dispensing information USPDI
- 3 vol set,
- 1- health professional
- 2-info for pt
- 3- list of fda approved drugs
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tyler's honest herbal
current, lay terms
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federal food, drug, and cosmetic act
durham-humphrey amendment
1952 -- tightened control by restricting refills, distinguised rx/otc. tightened drug distribution and mandated licensure to dispense meds
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def food, drug, and cosmetic act
Kefauver-harris amendment
- 1962 -- passed because of thalidomide tragedies (imcompletely tested drug apprived for preg, caused serious birth defects). Increased importance on clinical testing of drugs, control of distribution
- 1- drug proven safe and effective before released
- 2- truth in advertising
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Harrison Narcotics Act
1914 -- 1st narcotic control act, regulated import, manufacture, sale and use of all opiates. "narcotics". limited use of these drugs=less drug abuse. Replaced by controlled substances act.
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Controlled Substances Act
1970 - replaced 50 other laws, 5 schedules, improved reg, man, distr, prevention of drug dependence. DEA enforced. Attorney General has right to shed/resched a drug after public hearings. Manufacturers must register. rx must have..., double lock and key, med count, sgin out
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dea -- drug enforcement agency
federal bureau of department of justice, enforce acts and train/conduct research related to dangerous drugs/abuse. Manufacturers must register.
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schedule I description
high potential for abuse
no acceptable medical use
lack of safety
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sched I eg
all illegal drugs
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sched II def
- high potential for abuse
- accepted us med use
- dependence
- no refills, to emergency, written script
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sched II eg
morphine, demerol, codeine
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sched III def
high abuse, accepted in us, mod dependency, refills up to 5x 6mo, t/o
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sched III eg
tylenol c codeine, vicodin, lortab
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sched IV def
less pot. abuse, lower dependency, refill 6x per 6 mo, t/o
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Sched V def
min abuse/dependency, no restrictions refill
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sched V eg
robitussin, lyrica, lomotil
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sched IV eg
valium, xanax, ativan
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possession for nsg
- nsg must:
- 1 be administering to rxed pt
- 2 responsible for supply
- 3 or valid rx
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possession unused
returned to pharmacy, another witness and sign inventory sheet to verify it was discarded
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4 steps of new drug
- 1 - preclinical research and development 1.5 yrs
- 2 - clinical research and dev *5 yr
- 3 - new drug application (NDA) review *2 yr
- 4 - post-marketing surveillance
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new drug time and money
8-15yrs, 1 billion
only 1/10,000 make the cut
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orphan drug act
1983 -- research money to companies that seek to develop drugs for "health orphans" (rare diseases affecting less that 200,000 persons in us, eg: cystic fibrosis)
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pregnancy category D
risk to fetus. benefits outweigh the risks
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pregnancy cat X
fetal abnormalities, not advised for women who are or may become pregnant.
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agonist receptors
drug that interacts w receptor to stimulate response
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partial agonist
stimulates some responses/inhibits others
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antagonist
- attaches to receptor, no stimulate response
- (fill the space---inhibit)
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drug action in the bd ADME
absorption, distribution, metabolism, excretion
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enteral administration route
directly into gi tract
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enteral eg
po, pr, ng, peg, jtube
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parenteral administration route
bypass gi tract
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parenteral eg
id, sc, im, iv
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percutaneous administration route
through skin/mocous membranes
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percutaneous eg
topical, inhale, sl, buccal, opthalmic, otic, nasal
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decreased acidity=
increased absorption
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increased acidity=
decreased absorption
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taking meds w food=
slows
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emotional state=
decreased absorption rate
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id and sc injection absorption rate
slower
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im absorption rate
increased due to increased bloodflow
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iv absorption rate
fastest
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cold/hot to injection site
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primary protein carrier through bloodstream
albumin
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primary site for metabolism
liver
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primary routes of drug excretion
gi tract, renal tubes (feces and urine)
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half-life of drug def
amount of time required for 50% of drug to be eliminated from bd
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half-life calculation
- 200 mg of 2 hrs: @ 2 hrs 100mg left, @4h=50mg, @6h=25mg, @8h=12.5.
- divide by 2 every 2 hrs
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idiosyncratic reaction
rare, unusual, when drug first given, inability to metabolise drug
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allergic reaction
hypersensitivity reation; 6-10% of pt; develops antibodies to drug in immune system, reexposed to drug and causes reaction
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anaphylactic reaction
life threatening stat code blue, occur at any dose
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carcinogenic effect
ability of drug to induce mutation of living cells and become cancerous.
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teratogenic effect
ability to cause birth defects, greatest risk in first trimester
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side effect
undesirable but tolerable
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adverse effect
harmful such as shock
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smoking
- chronic smoking enhances metabolism of some drugs
- smoker may need to up the dose
- r/t increased metabolic effects of nicotine
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tolerance
person requires higher doses to produce same effects that lower doses once provided; dependence or increased metabolism of drug
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cumulative effect
when drug accumulates in bd when a new dose is administered before old dose excretes. drunken state
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synergistic effect
combined effect of 2 drugs is greater than effect of ea drug given alone
eg tylenol codeine
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