pharmaco

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Author:
kodak168
ID:
234784
Filename:
pharmaco
Updated:
2013-09-14 14:49:13
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basic principle
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Description:
nursing pharmaco
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  1. Drug
    Any chemical that affects living processes
  2. Pharmacology
    The study of drugs and their interactions with living systems
  3. Clinical pharmacology
    The study of drugs in humans
  4. Pharmacotherapeutics/therapeutics
    The use of drugs to diagnose, prevent,or treat disease or to prevent pregnancy
  5. Properties of an Ideal Drug
    • • Effectiveness (1)
    • • Safety (2)
    • • Selectivity (3)
    • • Reversible action
    • •Predictability
    • •Ease of administration
    • • Minimal drug interactions
    • • Low cost
    • • Chemical stability
    • • Possession of a simple generic name
  6. Generic     VS       Trade
    • Same dose

    • Inert ingredients can differ

    • Preparation can differ

    • Therefore absorption rate (onset) can differ

    • Bioequivalent-equal time to onset

    – Bioavailability

    • ability to reach the circulation from

    the site of administration.

    • Cost-varies-but is usually considerable
  7. Pharmacogenomics
    •study of how genes affect individual drug responses
  8. Toxidromes
    •a group of signs and symptoms and/or characteristic effects associated with exposure to a particular substance or class of substances.
  9. Drug Schedules (control of drugs)
    • 1-no use in US• heroin, mescaline, LSD– (highest potential for abuse)
    • 2-5-progressively less potential for abuse
  10. Intensity of Drug Responses
    • Factors influencing drug response
    • –Administration
    • –Pharmacokinetics
    • –Pharmacodynamics
    • –Individual variations
  11. Administration
    • Route
    •     Parenteral 
    •     Enteral
    •     Topical
    • Timing
    • Dosage
    • ComplianceErrors
  12. Pharmacokinetics
    • Absorption

    – Get in

    • Distribution

    – Get around

    • Metabolism

    – Get to work

    • Excretion

    – Get out
  13. Drug absorption &movement into blood (factors affecting drug absorption)
    • •Rate of dissolution–faster is better
    • •Surface area–more is better
    • •Blood flow–high is good
    • • Lipid solubility–high solubility more absorbed
    • • pH partitioning
    •     –Ion trapping
    •    –environment promotes ionization
  14. drug distribution  alters in response to changes in what blood component
    altered plasma pH.
  15. Drug distribution
    • movement through the body
    • • Blood flow to tissue
    • • Exiting the vascular system-cap bed
  16. The blood-brain barrier (bbb)
    • –only lipid soluble or direct transport mechanism
    • • Placental drug transfer-not a barrier
  17. 3 ways by which drugs cross cell membranes
    • (1)Direct penetration
    • Most common
    • Lipid-soluble
    • (2)Channels & Pores
    • Very small Activate a receptor
    • (3)Transport Systems
    • Specific structure
    • P-glycoprotein Trans-membrane protein that transports drugs out
    • Decreases absorption and drug access to tissues
    • Liver, kidney, placenta,intestine, brain
  18. receptor
    any functional macromolecule in a cell to which a drug binds to produce its effects
  19. the four main receptor families
    • Cell membrane–embedded enzyme receptor
    • Ligand-gated ion channels
    • G protein-Coupled Receptor
    • Transcription factors
  20. Cell membrane–embedded enzyme receptor
    • Most common
    • Send signal through the cell membrane
    • Activate internal enzyme systems
  21. Ligand-gated ion channels
    Specific protein needed to open ion channel
  22. G-protein coupled receptor
    • Drug activates receptor
    • Receptor activates G-protein
    • G-protein activates internal mechanism
  23. Transcription factors
    On DNA of nucleus-regulate protein synthesis
  24. Biotransformation
    Drug metabolism
  25. Drug metabolism/biotransformation
    Enzymatic alteration of drug structure (useable)
  26. primary site of drug metabolism
    Liver
  27. Hepatic microsomal enzyme system
    • P450 system (cytochrome P450)
    • 12 related enzyme families
    • CYP1, CYP2, CPY3-metabolize drugs
    • Others metabolize endogenous compounds
    •    Fatty acids, steroid hormone
  28. Actions of P450
    • – Inactivate a drug
    • – Increase therapeutic action
    • – Activate prodrugs
    • – Accelerate renal excretion
    • – Increase or decrease toxicity
  29. First-pass effect
    – Deactivation by the liver after GI absorption
  30. Special considerations in drug metabolism
    • • First-pass effect
    •  – Deactivation by the liver after GI absorption
    • • Induction of drug-metabolizing enzymes
    •   – Some drugs cause an increased production of drug metabolizing enzymes in the liver
    •    • Increase self-metabolism (and of other drugs)
    • • Nutritional status
    •    • malnourished decreases liver enzymes
    • • Competition between drugs
    •    • same metabolic path compete for metabolism
  31. Drug Half Life
    • – Time for drug levels to decrease by 50% • Morphine-half life 3 hours
    • • 5 half-life rule
  32. – Loading dose
    • drugs with short half life get large initial doses to reach therapeutic range
  33. Maintenance dose
    • small doses to maintain therapeutic range
  34. Pharmacodynamics:
    The impact of drugs on the body at the action site
  35. Dose-response relationships
    size of the dose controls the response
  36. Maximal efficacy
    • largest response the drug can produce regardless of dose
    •  Dopamine 20 mcg/kg/min
    •  Levophed 25 mcg/min
  37. Relative potency
    • -dose of drug required to produce an effect
    • MSO4- 4 mgs (more potent)
    • Meperidine 50mgs
  38. Agonist
    • molecules that activate receptors
    • mimic the action of endogenous molecules
  39. Antagonist
    -prevents receptor activation
  40. Competitive
    -binds reversibly by highest concentration
  41. Noncompetitive
    -binds irreversibly
  42. Partial agonist-(partial antagonist)
    • achieves less than the effect of an agonist,
    • but can compete for agonist sites pentazocine/meperidine(talwin/demerol)
  43. Minimum effective concentration (MEC)
    • • Level below which effect will not occur
    • doses
  44. – Toxic concentration
    -causes harm–
  45. Therapeutic range-between MEC & Toxic
    • Therapeutic effects, no toxicity
  46. – Maintaining therapeutic range
    • • Peak and trough
    • • Timing of doses
  47. Excretion:  drug removal
    • Glomerular filtration

    –Non-protein bound drugs are removed

    • Passive reabsorption

    – Lipid soluble drugs move back into the

    blood

    • Active Transport

    – Pumps remove drugs from blood to the

    urine

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