contraindications: increased susceptibility to the sun
used to treat severe acne when other methods have failed
decreases sebum production which decreases the skins population of the microbe P. acnes, sebaceous gland size, inflammation, and keratinization all decreased
side effects: nosebleeds, inflammation of lips/eyes, dryness or itching, pain or tenderness in the joints, sensitization to the sun, cataracts and other eye ds, elevated trigylceride levels, depression
contraindications: pregnant woman (highly teratogenic risk category X), avoid the use of alcohol
requirements for users: register with iPLEDGE, 2 pregnancy tests prior to initial prescription, 1 negative pregnancy test required for montly refills, use of 2 effective forms of birth control, patient education
the study of drugs that alter processes controlled by the nervouse system
What are the 2 categories of neuropharmacologic agents?
peripheral nervous system drugs
central nervous system drugs
What are the basic mechanisms of neuropharmalogical agents?
information is carried acorss the neuron gap and the postsynaptic cell
most neuropharmacologic agents act by altering synaptic transmission and can produce effects that are more selective
action potential is carried down the axon
not very selective
conduction will take place in all nerves to which it has access
ex. local anesthetics
Five steps in synaptic transmission
1. transmitter synthesis: drugs can increase or decrease transmitter synthesis, can enhance effect of transmitter by making super transmitter
2. transmitter storage: stored until released from the vesicle
3. transmitter release: release after triggered by action potential
4. receptor binding: neuropharmacologic drugs that act directly on the receptors and bind can cause activation, prevent activation, or enhance activation
5. termination of transmission: by reuptake, enzymatic degradation, diffusion
What are the 2 divisions of the nervous system? How are they linked?
central nervous system (brain and spinal cord)
peripheral nervous system- somatic motor and autonomic (ANS) (parasympathetic and sympathetic)
linked by cranial nerves and muscle fibers
What are the priniciple functions of the ANS?
regulation of the heart
regulation of the secretory glands (salivary, sweat, gastric, bronchial)
regulation of smooth muscle (muscles of bronchi, blood vessels, urogenital system and gastrointestinal tract)
What are the principle transmitters of the PNS?
What are cholinergic and adrenergic receptors of the PNS mediated by?
cholinergic mediated by Ach
adrenergic mediated by NE and Epi
What is the function of the cholinergic receptor nicotinic n?
promotes ganglia transmission
promotes release of epi
What is the function of the cholinergic receptor nicotinic m?
contraction of the skeletal muscles
What is the function of the muscarinic cholinergic receptor?
What are the main functions of the SNS?
regulation of cardiovascular system
regulation of body temperature
implementation of "fight or flight" response
What is the function of alpha 1 adrenergic receptor?
contraction of trigon and sphincter in bladder neck and prostate capsule
What is the function of beta 1 adrenergic receptor?
in heart: increases heart rate, contraction, and velocity of conduction in AV node
in kidney: renin release
What is the function of beta 2 adrenergic receptor?
What is the function of the dopamine receptor?
dilates renal blood vessels
Epi activates which receptors?
alpha 1 & 2, beta 1 & 2
NE activates which receptors?
alpha 1 & 2, beta 1
dopamine activates which receptors?
can also activate beta 1 receptor
What are the 4 phases of pharmacokinetics?
the study of drugs "movement" throughout the body from the time it enters until its excreted
the process by which a drug moves from its site of administration, across the cell membranes, and enters into the blood
the rapid inactivation of some oral drugs as they pass through the liver after being absorbed
first pass effect
movement of a drug throughout the body to gain access to its target cell and allow the drug to exit the vascular system for elimination
the site of action where the drug response occurs
the biological transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite
What organ is responsible for most of a drugs metabolism?
liver (enzyme P450)
the removel of drugs from the body
What organ is the primary site for excretion?
drugs in the bile are secreted into the intestine, some is reabsorbed into the blood, the rest is secreted in the feces
time interval between administration of a drug and the first sigh of action
onset of action
the lowest plasma concentration that will produce a therapeutic effect
minimal effective concentration (MEC)
the highest plasma concentration attained from a single dose
peak plasma effect
time interval between onset of action and termination of action
duration of action
the range of plasma concentration in which the drug effect is produced without producing toxicity
The wider the therapeutic range....
more safe the drug is to use
The narrower the therapeutic range....
the more difficult a drug is to use safely
the plasma concentration of a drug that results in dangerous adverse effects
period of time in which the drug effect is no longer seen
the time required for the amount of drug in the body to decrease by 50%
The half-life of a drug determines...
How many half-lives does it take for a drug to reach a steady state?
the concentration of a drug in the blood which correlates to a drug's response
plasma drug levels
When should a nurse measure the peak and trough plasma drug levels?
peak-1.5 hours after initial administration
trough-30 minutes prior to next dose
How do you reduce fluctuations in plasma drug levels?