Pharmacology Chapter 3

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servinggod247
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260296
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Pharmacology Chapter 3
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2014-02-04 21:26:45
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pharmacology exam
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pharmacology exam 1
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  1. Types of Adverse Effects
    • Pharmacologic reaction 
    • Allergic reaction
    • Idiosyncratic reaction 
    • Drug interactions
  2. Pharmacologic reaction
    had the effect wanted, but to a larger degree than expected
  3. Allergic reaction
    immune response to drug. Can occur at any time, even if drug was taken successfully in the past
  4. Idiosyncratic reaciton
    unexpected abnormal response. Almost always genetically and liver related
  5. Drug interactions
    adverse effects related to taking two or more drugs
  6. Drug allergy
    • happens second time taken. First time develops antibodies, Second time develops reaction. 
  7. Types of drug allergies
    • Anaphylaxis
    • Cytotoxic
    • Serum Sickness
    • Delayed Hypersnesitivity
  8. anaphylaxis
    • antibody response with immune reactivity and release of histamine with resulting signs and symptoms  Most likely to happen after an injection instead of oral. 
  9. cytotoxic
    • circulating antibodies attach the drug on cell sites and cause cell death.  See drop in HCT and WBC, elevated LFT, elevated BUN/Creat.  Tends to be delayed and seen over a few days.
  10. Serum Sickness
    • immune complexes deposit in blood vessels.  Cause rash, fever, lymphadenopathy, swollen joints, impaired renal function, splenomegaly.  Occurs 1-3 weeks after exposure.
  11. Delayed hypersensitivity
    • with reaction of sensitized T lymphocytes and macrophages. 
  12. High Alert Medications
    medications that associated with errors and have a high risk of adverse effects

    • Potassium
    • Insulin
    • Narcotic
    • Chemoatherapy 
    • Heparin/anti-coagulants

    • Potassium
    • Antiocogulants
    • Narcotics
    • Insulin
    • Chemotherapy
  13. what percent of adverse drug affects in the elderly are related to anti-coagulants and insulin?
    67%
  14. Narrow theraputic index
    not a big difference between effective concentration and toxicity Ex. 10 mg good, 20 mg kill you
  15. Wide theraputic index
    • Wider range between effective concentration and toxicity Ex. 10 mg good, 500 mg kill you
  16. Critical periods for drug effects on fetus is
    first two weeks of rapid cell proliferation and weeks 3-12 during organogenesis
  17. physiologic changes in pregnancy that impact pharmacokinetics include
    • ·      delayed gastric emptying and decreased motility
    • ·      increased pulmonary ventilation and increased blood flow and surface area
    • ·      increased GFR and renal blood flow
    • ·      decreased hepatic enzyme activity
    • ·      change in body mass and fluid distribution
  18. Majority of drugs pass by ________ with fetal serum levels equal to maternal levels, but may actually be higher
    simple diffusion
  19. tranfer across the placenta depends on
    • lipid solubility 
    • protien binding
    • other drug properties
  20. Label prescribing
    FDA approved for that use and in that age group
  21. Off label prescribing
    drug is being used that the FDA has not approved for that use or use in that age group
  22. what percent of drugs used in children have not been tested in children
    75%
  23. Neonates
    • separate category due to thin permeable skin, lack of stomach acid, poor temperature regulation, propensity for dehydration, immature liver and kidneys and lungs
  24. Breastfed infants
    • receive almost all forms of drugs that are in maternal circulation although usually at lower doses due to maternal biotransformation.  High lipid soluble drugs will be more concentrated in breast milk, low serum protein results in more free drug, slower metabolic reactions by liver, delayed drug excretion due to immature kidneys.
  25. Age 1
    • most pharmacokinetic patterns (other than hepatic) are similar to those in an adult.  Liver enzymes are increased due to larger liver size in proportion to body weight.  So drugs that are eliminated by hepatic mechanisms may need more frequent dosing or change in dosing.  Liver function advances rapidly with ability to excrete medication mature at about 1 year.  
  26. Later childhood
    • renal system may excrete more rapidly than adults.  Due to increased percentages of  body  water and less fat, water soluble drugs may be administered in larger doses to infants.  Thin skin and large surface area in proportion to weight enhances action of topical medications.
    • Little research on exact therapeutic dosages in pediatrics, often by off label use.  Use Body Surface Area (based on weight and height).
  27. Drug induced or Organ specific damage
    • dermatologic
    • stomatitis
    • superinfections
    • blood dyscrasias
    • toxicity with liver or renal injury
    • poisoning
    • altered glucose metabolism
    • electrolyte imbalance
    • sensory
    • neruologic
    • teratogenicity
  28. BEERS criteria
    • 1)Avoid in all elderly 2) Avoid in adults with certain conditions 3)Use this medicine with caution 
  29. Elderly
    • ·      increased use of multiple medications (polypharmacy)
    • ·      multiple chronic conditions including deficits in hepatic and renal systems that affect pharmacokinetics
    • ·      lower body weights may necessitate use of children’s dosages
    • ·      reduced gastric acidity and motility alters absorption
    • ·      increases in body fat with resulting increase in fat storage of medications
    • ·      less total body water so more risk of toxicity in water soluble drugs
    • ·      decreased serum albumin results in less protein binding and more free drug
    • ·      alteration in blood flow due to CHF impacts functioning  of liver and kidneys as well as transport of drug from site of administration
    • ·      overall changes may result in higher blood and tissue levels of drug with increased adverse effects and likelihood of toxicity
    • ·      altered numbers or sensitivity of receptors may occur

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