Pharmo & Path

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303703
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Pharmo & Path
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2015-06-07 18:15:13
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pharmacology
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path & pharm EXAM 1
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  1. Pharmacology
    the study of biological effects of chemicals
  2. Drug
    ANY chemical that can affect living processes
  3. Legal guidelines placed on manufacture, testing and use of drugs is recent.  What was the first law
    • Federal Pure Food and Drug Act 1906
    • weakly required that drugs be free of adulterants (nothing about safety or effectiveness)
  4. what is another name for Pharmacotherapeutics?
    clinical pharmacology- the branch of pharm that uses drugs to treat, prevent and diagnose disease
  5. List three common natural sources of drugs
    PLANTS eg digitalis (foxglove) to treat cardiac disorders, poppy seed for sedatives (opium, morphine, codeine)

    ANIMAL- although we've replaced most with synthetic versions (eg insulin not from cows, it's genetically engineered)

    INORGANIC COMPOUNDS-- salts, aluminum, iron, fluoride and even gold
  6. Who evaluates drugs before going to market?
    FDA
  7. What are the steps for drug trials
    Phase I - normal volunteers to evaluate drug metabolism & human effect

    Phase II & III - patient tested

    Phase IV - released with cont. reports
  8. What is a randomized controlled trial?
    • some peeps are given drug & some not
    • randomly assigned to either group
    • blind (don't know if they're getting the drug) or double blind (don't know & there is drug & placebo)
  9. What is some common criticism of drug trials?
    lack of pediatric, geriactric and female trial inclusion
  10. what is a fast track program?
    • '92 FDA developed- while med is under review, a single definitive trail that shows strong evidence & with minimal assurance of safety
    • BUT
    • Md must closely monitor and report to FDA pertinent experiences like side effects and efficacy
  11. What is the Orphan Drug Act?
    • Congress finds that:
    • rare diseases don't have drugs being developed for them.  a Pharm comp that develops an ORPHAN DRUG will lose $

    • ther's reason to believe that some promising orphan drugs will not be developed
    • unless changes are made in the applicable Federal laws to reduce the costs of
    • developing such drugs and to provide financial incentives to develop such
    • drugs
  12. So what section of the FDA is fulfilled with the task of developing drugs for rare diseases?
    Orphan Products Development (OOPD)
  13. What does teratogenic?
    causes adverse effects to the fetus
  14. What are the benefits in adherence to medication?  When is there high adherence?
    • you obtain full benefit of the drug
    • high adherence with ACUTE ILLNESS
  15. When do people typically stop taking meds when they have chronic illness?
    adherence drops after 6 months
  16. What are the methods (direct and indirect) to test adherence?
    Direct- Blood levels of meds or metabolites

    Indirect- assess pt or their clinical response, obtain info on refill dates, pill counts, pt. questionnaire, physiological markers, electronic markers
  17. Best way to ensure adherence?
    Try to prescribe something that a person only has to take ONCE (if possible/available)
  18. What is pharmacokinetics?
    WHAT THE BODY DOES TO THE DRUG: 

    absorption, distribution, metabolism, and excretion of drugs
  19. What is the difference between pharmacodynamics and pharmacokinetics?
    Dynamics= how the drug affects the body

    Cokinetics= the body acts on the drug
  20. In clinical practice, pharmacokinetic considerations are?
    • onset of drug action
    • drug half-life
    • timing of peak effect
    • duration of drug effects
    • metabolism or biotransformation of the drug
    • site of excretion
  21. What is loading dose?
    drugs given in higher dose that usual for treatment (usually due to critical situation and it's a drug that takes a prolonged period to reach concentration)
  22. Pharmacodynamics- how drug affects body

    Drugs usually work in 1 out of 4 ways.  List the 4 ways...
    • 1. to REPLACE (or act as substitutes) for missing chemicals
    • 2. to STIMULATE (or increase) certain cellular activities
    • 3. to DEPRESS (or SLOW) cellular activitiy
    • 4. to INTERFERE with functioning foreign cells, such as invading microorganisms or neoplams

    drugs can ACT in different ways to achieve these results
  23. Pharmacodynamics- how drug affects body

    When a drug INTERFERES with functioning foreign cells, they are (generally) called...?
    Chemotherapeutic agents
  24. Pharmacodynamics- how drug affects body

    What are receptor sites?
    specific areas on cell membranes that react with certain chemicals, leading to an effect in the cell

    In many situations, nearby enzymes break down these chemicals and open the receptor site for more stimulation
  25. Pharmacodynamics- how drug affects body

    What is selective toxicity?
    the ability of a drug to attack only the systems found in foreign cells (not harming the human's cells)

    eg Penicillian, it affects an enzyme system unique to bacteria, cause bacteria cell death without disrupting normal human cell functioning
  26. Pharmacodynamics- how drug affects body

    Most chemotherapeutic (drugs that interfere with foreigners) also destroy human cells, causing many AEs.  

    Cells that reproduce rapidly (bone marrow, GI, hair) are MORE or LESS affected by these type of drugs?
    MORE affected
  27. What is pharmacokinetics?  What are the 4 specific ways to study it?
    how the BODY ACTS ON THE DRUG

    • Absorption
    • Distribution
    • Metabolism (biotransformation)
    • Excretion
  28. In clinical practice, PHARMACOKINETICS consider what 6 items?
    • ONSET of drug action
    • HALF-LIFE of the drug
    • PEAK EFFECT- the timing
    • DURATION of drug effects
    • METABOLISM or biotransformation of the drug
    • EXCRETION, what's the site
  29. Pharmacokinectics - what body does to drug

    after drug is administered, body must absorb it.  then make it's way to tissues, but it needs to have a therapeutic effect, therefore it needs the right concentration levels....  this amount is referred to as?
    Critical Concentration
  30. drugs given in higher dose than usual for treatment (usually due to critical situation and it's a drug that takes a prolonged period to reach concentration)
    loading dose

    eg digoxin =increases strength of heart contractions, many xanthine bronchodilatores
  31. What are the various routes of absorption in the body?  What is the fastest? what is the slowest?
    • PO (oral) - most frequent, less $ and generally the safest.  Slower, due to it passing through GI track
    • IV - fastest absorption (skips the first pass, gets injected directly to the bloodstream)

    • Other routes:
    • IM (muscles), Subcutaneous, PR (rectal), sublingual, buccal, topical, inhalation

    Generally drugs given oral route are slower than those given parenterally (given outside of digestion track)
  32. Pharmacokinetics -what Body does to drug

    What is absorption?
    refers to what happens to a drug from the time it's introduced until it reaches circulating fluids and tissues
  33. What are the three processes of absorption?
    passive diffusion- no ATP required, flows from high to low concentration gradient

    active transport- requires ATP, large or usually against the concentration gradient, hence need for energy

    filtration- movement thru pores, either down concentration gradient or result of the pull of plasma proteins
  34. Pharmacokinetics - what Body does to drug

    What is distribution?
    movement of a drug to the body's tissues

    * just like with absorption, the drug's lipid solubility and ionization and perfusion of reactive tissue affects this movement.
  35. what is perfusion?
    the process of a body delivering blood to a capillary bed in its biological tissue
  36. Pharmacokinetics - what Body does to drug

    what is it that drugs are commonly bound to? 

    hint: it prevents them from entering blood brain barrier
    Proteins!  Many drugs bind to proteins and are NOT lipid soluble.  Therefore they can't be distributed to CNS, b/c blood-brain barrier is highly selective
  37. What type of drugs are able to pass thru blood-brain barrier?
    lipid soluble

    fun fact: it's difficult to tx brain infections b/c almost all antibiotics are not lipid soluble!
  38. What is the most important site of drug metabolism?
    The liver.

    many enzymes in the liver, in many cells, lining of GI tract and even circulating the body detoxify/breakdown foreign chemicals.
  39. What is the best way to think of the liver in regards to drug metabolism?
    a sewage treatment plant.  everything absorbed from the GI tract enters the liver to be "treated".
  40. In metabolizing a drug, what is the first-pass effect?
    the concentration of the drug is greatly reduced before reaching systemic circulation.
  41. Once a drug is administered orally, list steps of absorption & distribution:
    Absorption occurs in small intestine directly to portal venous system.  Portal veins deliver drug molecules to liver.  Liver breaks them down into metabolites, some are deactivated and excreted, others are active and cause effects on body.  Large % of drug gets destroyed (this is 1st pass effect).

    Drugs that can survive 1st pass get delivered to circulatory system for transport thru/out body.
  42. Why are oral meds recommended at a higher dose than parenteral drugs?
    first-pass effective

    IV meds and such don't have to go thru stomach/GI tract (where breakdown/ high acidity occurs).  they have a chance to reach tissues before reaching the liver.
  43. The hepatic enzyme system (cells lined with enzymes packed together aka hepatic microsomal system), breaks down the drug in 2 phases.... list/describe them!
    Phase I - oxidation, reduction, or hydrolysis of the drug via cytochrome P450

    Phase II - conjugation reaction that makes drug more polar and more readily excreted by kidneys
  44. What is enzyme induction?
    this refers to the presence of a chemical that's metabolized by a particular enzyme, often increases the activity of that enzyme system.

    AKA increased activity in liver enzyme system, speeds metabolized of the drug that caused enzyme induction, as well as any other drug that uses that system-- this explains why some drugs cannot be taken together effectively.  


    **One drug can speed up the metabolism of another**
  45. What is excretion?  What are some routes used to do this?  What is most important route?
    removal of drug from the body

    skin, saliva, lungs, bile, and feces

    KIDNEYS PLAY MOST IMPORTANT ROLE
  46. Drugs that have been made water soluble in liver are often readily excreted from the kidneys by.....?
    glomerular filtration = the passage of water/water soluble components from plasma into the renal tubule.
  47. In the renal tubules, active transports systems move the drug in exchange for what?  Why is this important in regards to urine?
    • acid or bicarbonate molecules.  
    • Urine acidity can be an important factor when trying to clear a drug rapidly from system or trying to understand why a drug is being given at usual dose, but is reaching toxic levels of the drug in the body bc it's not being excreted
  48. What is half-life?
    the time it takes for the amount of drug to decrease to one half of the peak level it previously achieved.
  49. What is taken into consideration for manufacturers to calculate the half-life?



    *hint: process of pharmacokinetics
    absorption rate, distribution to tissues, speed of metabolism, how fast drug is excreted
  50. What are common factors that affect a body's response to a drug?
    • Weight
    • Age
    • Gender
    • Physiological factors (electrolyte balance, acid-base balance)
    • Pathological factors (disease, low BP, GI dysfunction, vascular disorders)
    • Genetic factors
    • Immunological factors
    • Psychological factors (placebo effect, compliance)
    • Environmental factors (temp, light, noise)
    • Drug tolerance
    • Cumulation effects
    • Interactions
  51. Which common juice should be avoided while taking certain medications? Why?
    Grapefruit!  it's been found to affect liver enzymes for up to 48 hours, resulting in increased or decreased serum levels of certain drugs.  B/C it's can affect for up to 48hrs, must avoid grapefruit the ENTIRE time you're on the med
  52. What are the types of AEs?
    • primary actions- drug is being too effective, eg overdose
    • secondary actions- effects alongside the intended effect, eg antihistamines cause drowsiness
    • hypersensitivity reactions-pt.s who are excessively responsive to either primary or secondary effects
  53. what is a drug allergy?
    when the body forms antibodies to a particular drug --> causing immune response when person is reexposed to drug
  54. What are the four main drug allergy classifications?
    anaphylactic- causes immediate rx of mucous membrane swelling & constricting bronchi, leads to respiratory distress or even arrest

    cytotoxic- antibodies in blood and attack antigens (the drug) on cell sites, leading to cell death, not immediate.  Decreased hematocrit

    serum sickness- cause damage to various tissues by depositing in blood vessels, not immediate, up to 1 wk

    delayed reactions- antibodies bound to specific white blood cells, occurs several hours after exposure
  55. What are superinfections?
    Infections caused by organisms that are usually controlled by normal flora
  56. what is blood dyscrasia?
    • bone marrow suppression caused by drug effects.  (recall bone marrow makes RBC, WBC, and platelets) 
    • occurs when drugs that cause cell death (antineoplastics, antibiotics) are used
  57. what is poisoning?
    overdose of a drug damages multiple body systems
  58. what is hypokalemia?
    • low potassium levels
    • Signs/Symptoms: weak, numbness/tingling in extremities, muscle cramps, nausea, vomiting, diarrhea, decreased bowl sounds, irregular pulse, weak pulse, orthostatichypotension, disorientation

    potassium is essential for nerve and muscle functioning
  59. what is hyperkalemia?

    normal range is 3.5-5.1 mEq/l
    high potassium levels 

    Signs/Symptoms: weakness muscle cramps, diarrhea, numbness & tingling, slow heart rate, low BP, decreased urine output, diff. breathing

    potassium is essential for action potential, which is needed for cell membrane stability.  Heart cells become irritated & rhythm disturbances occur
  60. What are the 8 steps to safe med administration?
    • 1. Right Patient
    • 2. Right Drug
    • 3. Right Storage
    • 4. Right Route
    • 5. Right Dose
    • 6. Right Preparation
    • 7. Right Time
    • 8. Right Recording

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