Shared Flashcard Set

Details

Pharm Exam 1
Exam 1
349
Pharmacology
Undergraduate 3
02/18/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
Absorption, distribution, metabolism, and excretion
Definition
Pharmacokinetics
Term
Science that studies the effects of drugs within a living system and about the knowledge of the pharmacokinetic properties
Definition
Pharmacology
Term
Biochemical and physical effects and mechanism of action
Definition
Pharmacodynamics
Term
Science of harmful effects
Definition
Toxicology
Term
Clinical indications, prevention, diagnosis, and treatment of a living organism
Definition
Pharmacotherapeutics
Term
Medical use of drugs
Definition
Therapeutics
Term
No accepted medical use, high abuse potential
Definition
Schedule I
Term
Accepted medical use, but high potential for abuse and/or dependence
Definition
Schedule II
Term
Less abuse potential, moderate dependence possible
Definition
Schedule III
Term
Lower abuse potential with limited dependence
Definition
Schedule IV
Term
Low abuse potential, limited dependence, may require prescription or may be OTC
Definition
Schedule V
Term
Sole legal drug enforcement agency in US
Definition
DEA
Term
In Colorado, MDs and PAs can order which schedules of drugs?
Definition
II-V
Term
When can a nursing student take a verbal order for a medication?
Definition
Never
Term
Who is legally responsible if the doctor writes an order for the wrong drug and the nurse gives it?
Definition
ALWAYS THE NURSE. THE NURSE IS ALWAYS WRONG :)
Term
5 Areas in Patient Teaching in Drug Therapy
Definition
  • Oral followed by written material
  • Reason for use
  • How to take it (frequency, dosage, what to avoid)
  • Possible adverse reactions
  • When to call or return to providor
Term
Pregnancy category with adequate studies and no fetal risk
Definition
Schedule A
Term
Pregnancy category with adequate animal studies and no well-controlled studies in pregnant women
Definition
Category B
Term
Pregnancy category with adverse fetal effects in animal studies, but benefits may be acceptable in humans despite risks
Definition
Category C
Term
Pregnancy category with human fetal risk, but benefits may be acceptable despite risks
Definition
Category D
Term
Pregnancy category with known animal and human fetal abnormalities, and should not be used in pregnant women
Definition
Category X
Term
7 Drugs Considered Safe During Pregnancy
Definition
  • Tylenol
  • Anti-asthmatics
  • Heparin
  • Insulin
  • Anti-emetics
  • Aldomet, Digoxin
  • Selected Antibiotics
Term
Elderly constitute 12% of the US population but use ____% of the nation's prescribed drugs
Definition
31%
Term
4 Principle Factors Underlying Drug Problems in Elderly
Definition
  • Altered pharmacokinetics
  • Multiple and severe illnesses
  • Multiple-drug therapy
  • Poor adherence
Term
Drug list that identifies drugs with a high likelihood of causing adverse effects in the elderly
Definition
Beers List
Term
Elderly (mostly) patients taking multiple drugs
Definition
Polypharmacy
Term
Polypharmacy makes it more likely to have what?
Definition
Drug-to-drug interactions
Term
As many as ______% or more of elderly patients fail to take their medications as prescribed
Definition
40%
Term
Nonadherence can result in what two things?
Definition
  • Therapeutic Failure (underdosing)
  • Toxicity (overdosing)
Term
Is therapeutic failure or toxicity more common in the elderly?
Definition
Therapeutic Failure (90%)
Term
4 Contributing Factors to Unintentional Nonadherence
Definition
  • Forgetfulness
  • Failture to comprehend instructions
  • Inability to pay for drugs
  • Use of complex regimens
Term
3 Contributing Factors to Intentional Nonadherence
Definition
  • Patient belief that the drug is simply not needed in dosage prescribed
  • Unpleasant side effects
  • Expense
Term
Factors that Contribute to Poor Adherence in the Elderly
Definition
  • Multiple chronic disorders
  • Multiple Rx medications
  • Multiple doses/day for each med
  • Multiple prescribers
  • Cahnges in regimen
  • Cognitive or physical impairment
  • Living alone
  • Recent discharge from hospital
  • Low literacy
  • Inability to pay for drugs
  • Personal conviction drug is unnecessry or dosage is too high
  • Presence of side effects
Term
A drug that has strict prescribing and availability criteria because of its potential for addiction or abuse
Definition
Scheduled Drug
Term
Prescription-only Drug
Definition
Legend Drug
Term
3 Steps in Case of Medication Error
Definition
  • Inform supervisor and provider STAT
  • Complete incident report (not filed in patient chart)
  • Provider typically informs patient/family of error
Term
How to Report a Medication Error
Definition
Medication Errors Reporting (MER) Program
Term
"What the body does to the drug"
Definition
Pharmacokinetics
Term
"What the drug does to the body"
Definition
Pharmocodynamics
Term
What does ADME stand for?
Definition
  • Absorbed into body fluids
  • Distributed to sites of action or storage
  • Metabolized or biotransformed
  • Excreted from body
Term
What physiochemical properties affect ADME?
Definition
  • Drugs are typically weak acids or weak bases
  • Acids are absorbed in acidic stomach
  • Bases are absorbed in alkaline intestine
Term
What chemical properties affect ADME
Definition
  • Ionized (polar) form is usally water soluble
  • Non-ionized (nonpolar) form is more lipid soluble
Term
Which form is more apt to cross cell membrane, ionized or non-ionized?
Definition
Non-ionized/nonpolar
Term
Are most weak bases polar or nonpolar?
Definition
Polar/Ionized
Term
Process involving movement of drug molecules from site of entry into the circulating fluids
Definition
Absorption
Term
5 factors that affect absorption
Definition
  • Absorbing surface
  • Blood flow to site of administration
  • Ionization (ionized solutions don't cross cell membrane easily)
  • Stability of drug in the acid/alkaline environment
  • pH of local environment enhances or retards absorption
Term
How are water-soluble drugs absorbed in the GI tract?
Definition
Must first be dissolved in water
Term
What 3 factors that affect absorption can be changed?
Definition
  • Alcohol in stomach (changes dissolving)
  • Nicotine (lowers plasma enzymes and can increase or decrease metabolism)
  • Caffeine (increases stimulation including gastric motility)
Term
What environmental impact changes absorption?
Definition
Drug Storage
Term
When a medication error is reported, where is the information forwarded?
Definition
  • FDA
  • ISMP
  • Product Manufacturer
Term
What kind of drugs are most likely to cross the blood-brain barrier?
Definition
Nonpolar/Non-ionized (more lipid soluble)
Term
Heat, cold, massage, vasoconstriction, and vasodilation affect what?
Definition
Absorption
Term
Transport from bloodstream to body tissues and site of action
Definition
Distribution
Term
Easier than absorption and more rapid
Definition
Distribution
Term
Route of distribution
Definition
  • Major organs
  • Muscles
  • Fat
Term
Allow drug accumulation to occur
Definition
Drug Reservoirs
Term
Drug that is available to body at cellular level
Definition
Free Drug
Term
Reservoir drug that becomes free slowly
Definition
Bound Drug
Term
Drugs attach mainly to this protein
Definition
Albumin
Term
How does low albumin affect drug distribution?
Definition
The drug is used up faster, because there is more free drug, which makes it more toxic to cell. It might need to be given more frequently and in lower doses.
Term
The process of chemically altering a drug for use or inactivating a drug into a metabolite that can be excreted
Definition
Metabolism
Term
What kind of drug can be metabolized?
Definition
Free Drug
Term
Inactive substance that must be converted to an active form
Definition
Pro-drug
Term
Liver Phases in Metabolism
Definition
  • Phase I - Oxidation
  • Phase II - Conjugation
Term
Where O2 attaches to molecule in liver
Definition
Oxidation
Term
In liver when another chemical group attaches to the drug and changes it into a different compound or more polar, making it excretable by the kidney
Definition
Conjugation
Term
Portal circulation from the GI tract that is only in effect for oral/enteral drugs
Definition
First Pass Effect
Term
For many drugs ___% is gone in the first pass
Definition
90%
Term
2 ways to bypass first pass effect
Definition
  • Increase Dose
  • Increase Frequency
Term
Enzyme system in the liver involved in drug metabolism
Definition
CYP450 Cytochrome Enzyme System
Term
How many channels and isoenzymes involved in CYP450?
Definition
12 channels with several subchannels and 50 isoenzymes
Term
How many channesl are typically used in CYP450?
Definition
6
Term
What percent of drugs go through only 6 channels of CYP450?
Definition
90%
Term
How does CYP450 affect drug metabolism?
Definition
If more than 1 drug competes for the same channel, there can be competition to get through
Term
What is the most common type of CYP450 drug?
Definition
Inhibitors
Term
How do inhibitors affect drug-drug interactions in CYP450?
Definition
  • Slows metabolism
  • 2nd drug accumulates toxic levels
Term
How do inducers affect drug-drug interactions in CYP450?
Definition
  • Drugs stimulate production of enzymes
  • Increases rate of metabolism
  • Clears 2nd drug out of the system faster
Term
Can a drug be an inducer and inhibitor at the same time?
Definition
Yes, it can inhibit one channel and induce another
Term
8 factors that affect metabolism
Definition
  • Age
  • Nutrition status (especially protein status)
  • Liver disease
  • Presence of other drugs
  • Alcohol (induces CYP2E1)
  • Smoking (induces CYP1A)
  • Change in fluid levels and hormone interactions
  • Time of day (circadian rhythms)
Term
Metabolism can affect ___ of drug and may require adjustment of dosage and freqency
Definition
Half-life
Term
Process by which drugs and metabolites are removed from the body
Definition
Excretion
Term
Most important route of excretion
Definition
Kidneys
Term
How are water-soluble drugs excreted?
Definition
Kidneys
Term
How are lipid-soluble drugs excreted?
Definition
Reabsorbed by teh tubules and re-enter systemic circulation. Must leave the body via other routes, or get another chance at becoming water-soluble during liver processing.
Term
5 Excretion Sites (other than kidneys)
Definition
  • GI Tract (bile, feces)
  • Lungs (volatized in intact form)
  • Sweat and Salivary Glands
  • Mammary Glands (breast milk)
  • Hemo-dialysis (Filters the blood)
Term
In mechanisms of drug action, _____ or _____ are not the determing factor for creating a response
Definition
Volume or Weight (compare typical doses of each druginstead)
Term
How do generic drugs affect bioavailability?
Definition
The drug does not have to be evenly distributed throughout the tablet, and this can be an issue when splitting pills
Term
Time from administration to first appearance of drug effect
Definition
Onset of Action
Term
Time from administration to peak effect of drug
Definition
Time to Peak
Term
Time from first to last measurable effect
Definition
Duration of Action
Term
Lowest plasma concentration that still produces an effect
Definition
Minimum Effective Concentration
Term
The maximum ability of a drug to initiate biologic activity as a result of binding
Definition
Efficacy
Term
Maximum strength per mg of drug
Definition
Potency
Term
Accumulation of doses to keep fairly constant concentration (what is taken in replaces what is eliminated)
Definition
Steady State
Term
Proteins on the surface of cell membranes which, when stimulated, create a response
Definition
Receptors
Term
Chemical attraction to binding
Definition
Affinity
Term
Drugs which bind with receptors and produce and effect
Definition
Agonist
Term
Agonists have affinity and ______
Definition
Efficacy
Term
Drugs which interact with receptors but do not create a response
Definition
Antagonist
Term
Antagonists have affinity but ______
Definition
No efficacy
Term
Some portion of the drug combines with some molecular structure on teh cell membrane, producing a biological effect
Definition
Drug-receptor Interaction
Term
Enzyme combines with drug instead of the normal substrate molecule
Definition
Drug-enzyme Interaction
Term
Interaction that produces a more general effect on cell membranes
Definition
Nonspecific Drug Interaction
Term
The amount of time it takes to reduce the amount of unchanged drug by 50%
Definition
Half-life (T 1/2)
Term
How does a short t 1/2 affect dosing?
Definition
Short t 1/2 means more frequent dosing or larger dosing so it lasts longer
Term
Dose needed for drug to be effective for 50% of population
Definition
ED50
Term
Lethal dose for 50% of population
Definition
LD50
Term
The ratio between the lethal dose and the dose needed for an effect
Definition
Therapeutic Index (TI)
Term
Formula for TI
Definition
LD/ED (Lethal Dose/Effective Dose)
Term
What TI shows the greatest danger?
Definition
The closer to 1, the greater the danger
Term
The time when dosing is effective by not toxic
Definition
Therapeutic Window (Therapeutic Range)
Term
What happens with twice the dose half as often?
Definition
High fluctuations in blood levels, could be from ineffective to toxic in peaks and troughs
Term
What happens with half the dose twice as often
Definition
Low blood levels, could be below min effective concentration and min inhibition concentration
Term
80% of drugs are given this way
Definition
Oral
Term
Nasogastric or gastric tube or rectal administration
Definition
Enteral
Term
Administration using SC, IM, IV, intrathecal, epidural, other fluids
Definition
Parenteral
Term
Gas, mist administration
Definition
Pulmonary
Term
Skin, eyes, ears, nose administration
Definition
Topical
Term
1-2 hours after oral delivery or 30 minutes after IV delivery
Definition
Peak drug level
Term
Residual amount right before next delivery
Definition
Trough Level
Term
Another term for steady state
Definition
Plateau Principle
Term
A constant dose given at regular intervals to produce blood concentrations at relatively constant levels
Definition
Plateau Principle
Term
How many t 1/2 does it take to reach a steady state?
Definition
4-5
Term
Large initial dose to bring blood levels to desired concentration
Definition
Loading Dose
Term
Amount needed to achieve desired therapeutic response
Definition
Maintenance Dose
Term
How much drug is present over repeated dosing
Definition
Accumulation
Term
Decreased response that occurs after repeated drug administration
Definition
Tolerance
Term
Physical or psychological cravings for a drug
Definition
Dependence
Term
An abnormal response thought to be related to genetic enzymatic deficiencies
Definition
Idiosyncrasy
Term
When drug effects are modified by another substance
Definition
Drug Interaction
Term
How does drug competition for protein binding affect concentrations and effects of drugs?
Definition
The drug with a greater affinity for binding will have more drug reservoir and less free drug. The 2nd drug will have more free drug, which could lead to toxicity or greater effects (unintended) of the 2nd drug and fewer effects of the bound drug.
Term
Unexpected, undesired, excessive response to a medication that leads to harm, disability, hospital stay, etc.
Definition
Adverse Drug Reaction
Term
4 Types of Adverse Drug Effects
Definition
  • Dose-related (toxic) Reactions
  • Drug-drug and Drug-food Interactions
  • Hypersensitivity (allergic reactions)
  • Idiosyncratic Reaction
Term
Can be an allergic or non-allergic reaction
Definition
Hypersensitivity Reaction
Term
Symptoms of allergic reactions
Definition
  • Urticaria (hives)
  • Pruritis (itching)
  • Bronchospasm
  • Wheezing
  • Vomiting
  • Diarrhea
  • Anaphylaxis
Term
Timing of allergic reaction
Definition
Minutes to hours after exposure
Term
Timing of non-allergic hypersensitivity reaction
Definition
2 days to 3 weeks after exposure
Term
Symptoms of non-allergic hypersensitivity reaction
Definition
  • Hemolytic anemia
  • Glomerulonepthritis
  • Lymphadenopathy
  • Thrombocytopenia
  • Neutropenia
  • Arthralgia
  • Toxic epidermal necrolysis
  • Steven's Johnsons symdrome
Term
4 Types of Drug-drug Interactions
Definition
  • Potentiation
  • Interference
  • Displacement
  • Antagonism
Term
Drugs with similar actions cause an additive effect
Definition
Potentiation
Term
Example of Potentiation
Definition
Coumadin and aspirin taken together cause excessive bleeding
Term
One drug accelerates or slows the metabolism or excretion of another drug through the CYP450 system
Definition
Interference
Term
Example of Interference
Definition
Eythromycin taken with Digoxin elevates blood levels of digoxin and with coumadin elevates blood levels of coumadin
Term
Two drugs compete for protein binding sites
Definition
Displacement
Term
Example of Displacement
Definition
One drug wins and is bound to protein, while the other is free in higher levels in the body
Term
One drug decreases the effectiveness of another drug because of divergent actions
Definition
Antagonism
Term
Example of Antagonism
Definition
Oral ketoconazole is absorbed in an acidic environment. H2-receptor antagonists or proton pump inhibitors decrease acidity in stomach, changing the effectiveness of ketoconazole.
Term
Effect of Grapefruit Juice and CYP System
Definition
Grapefruit juice inhibits CYP450 by binding to an isoenzyme and decreasing the first pass effect. This allows less medication to be metabolized, leading to more drug circulating in the body. This can increase the therapeutic and toxic effects of the drug. (especially with calcium blockers)
Term
MAOs can't be taken with what food?
Definition
Tyramine (hypertension and intracranial bleeding)
Term
Oral anticoagulants can't be taken with what food?
Definition
Vitamin K (antagonistic effect)
Term
Tetracycline can't be taken with what food?
Definition
Dairy Products (cause the antibiotics to not be absorbed)
Term
Iron taken with what food causes an increase in absorption?
Definition
Acidic Foods
Term
If the doses of IV and oral meds are different, why is the duration of action the same?
Definition
Impact at cellular level is the same
Term
Why do we know so little about gender differences in drugs?
Definition
Until recently, most studies were conducted on men
Term
What is the gender difference with digoxin?
Definition
When used to treat heart failure, may increase mortality in women, while having no effect on mortaility in mend
Term
What is the gender difference with alcohol?
Definition
Alcohol is metabolized more slowly by women than men. So, if a man and woman drink the same amount (based on weight), the woman will become more intoxicated.
Term
What is the gender difference in opioid analgesics?
Definition
They are more effective in women than men, so lower doses can be used in women
Term
What is the gender difference with quinidine?
Definition
It causes greater QT interval prolongation in women. As a result, women are more likely to develop torsades de pointes, a potentially fatal cardiac dysrhythmia
Term
When do you administer pain medication?
Definition
Before pain reaches it peak to maximize effectiveness
Term
Anesthetics work by depressing the ______
Definition
Central Nervous System
Term
3 Types of Anesthetics
Definition
  • General
  • Regional
  • Local
Term
Anesthetic on small body region, procedural area
Definition
Local
Term
Anesthetic that causes state of unconsciousness, used for surgery
Definition
General
Term
Anesthetic used on larger body region that targets nerves
Definition
Regional
Term
Reduce undesirable effects of anesthesia, reduce apprehension
Definition
Pre-anesthetics
Term
2 Classes of Anesthetics
Definition
  • Inhalation (gas/liquid)
  • IV Agents
Term
Anesthetic can be given _____ or _____
Definition
Pre-op or Intra-op
Term
Involves a combination of drugs, each with a specific effect
Definition
Balanced Anesthesia
Term
Stages of General Anesthesia
Definition
  • Stage 1 - Analgesia
  • Stage 2 - Excitement
  • Stage 3 - Surgical Anesthesia
  • Stage 4 - Medullary Paralysis
Term
Stage of anesthesia with loss of consciousness
Definition
Stage 1 Analgesia
Term
Stage of anesthesia where reflexes are still present and they may be exaggerated
Definition
Stage 2 Excitement
Term
Stage of anesthesia that can be toxic and involve respiratory arrest and vasomotor collapse
Definition
Stage 4 Medullary Paralysis
Term
Stage of anesthesia with increasing depth of anesthesia, affect on respiration, loss of reflexes, flaccidity, and lower body temperature
Definition
Stage 3 Surgical Anesthesia
Term
Inhalation anesthetic used by dentists
Definition
NitrOUS Oxide
Term
ecreted?
Definition
100% through lungs
Term
Why is nitrous oxide a popular drug?
Definition
High analgesia but with low anesthesia
Term
3 volatile inhalation anesthetics that can be mixed with O2 or nitrous
Definition
  • Halothane
  • Isoflurane
  • Ethrane
Term
Are IV anesthetics used alone?
Definition
Seldom
Term
The exception to the clear IV rule
Definition
Propofol (Diprivan)
Term
Side effects of Propofol
Definition
Profound respirations and hypotension
Term
What is the allergy risk with propofol?
Definition
Egg Allergies
Term
Why does propofol cause an increased risk of bacterial infection?
Definition
Thicky and sticky, which makes it hard to flush the IV line and bacteria love living in that environment
Term
Use propofol with caution in what two conditions?
Definition
  • Hypovolemia
  • CVD
Term
In spinal anesthesia, patients can awake with _____, which might be suggestive rather than causative
Definition
Headaches
Term
Headaches in spinal anesthesia usually only occur with larger __________
Definition
Loss of Fluid
Term
How long is bedrest with spinal anesthesia?
Definition
12 hours
Term
After spinal anesthesia, release will not happen until what happens?
Definition
You can void
Term
Stabilizes or elevates threshold of excitation of nerve cells, prevents depolarization and transmission of nerve impulses
Definition
Regional and Local Anesthetics
Term
What is the effect of local and regional anesthetics?
Definition
Loss of sensation without skeletal muscle involvement
Term
Affects distal nerve endings
Definition
Topical Anesthetic
Term
Topical anesthetic with short duration
Definition
Lidocaine (1/2-1 hour)
Term
Topical anesthetic with long duration
Definition
Marcaine (3-10 hours)
Term
Where is epi not used?
Definition
  • Fingers
  • Ears
  • Nose
  • Toes
  • Ohs
Term
Local anesthetics mixed with ____ can cause ischemia
Definition
Epinephrine
Term
Local anesthetics can be mixed with what for dual action?
Definition
Anti-inflammatory
Term
How often do you take VS during recovery from anesthesia?
Definition
Every 15 minutes or sooner
Term
What two areas are critical to monitor with anesthesia patients?
Definition
RR and Airway
Term
What drug can be given for shivering after surgery?
Definition
Demoral
Term
What 3 drugs are most commonly used in balanced anesthesia?
Definition
  • Barbiturates (for induction)
  • Neuromuscular Blocking Agents (for muscle relaxation)
  • Opioids and Nitrous Oxide (for analgesia)
Term
Index of inhalation anesthetic potency
Definition
MAC (Minimum/Median Alveolar Concentration)
Term
How is it suspected inhalation anesthetics work?
Definition
Selctive alteration of synaptic transmission
Term
6 Adverse Effects of Inhalation Anesthetics
Definition
  • Respiratory/Cardiac Depression
  • Sensitization of the Heart to Catecholamines
  • Malignant Hyperthermia
  • Aspiration of Gastric Contents
  • Hepatotoxicity
  • Toxicity to Operating Room Personnel
Term
Most Significant Adverse Effect of Spinal Anesthesia
Definition
Hypotension
Term
2 categories of analgesic meds
Definition
  • Narcotic
  • Non-narcotic
Term
Narcotics act on which nervous system?
Definition
Central (CNS)
Term
Non-narcotics act on which nervous system?
Definition
Peripheral (PNS) - Voluntary and Autonomic
Term
A drug that produces a response
Definition
Agonist
Term
A drug that produces a partial response
Definition
Partial Agonist
Term
A drug with mixed effects on receptors
Definition
Agonist-Antagonist
Term
Difference between tolerance and addiction
Definition
  • Tolerance - body builds up a tolerance to the drug and increasing amounts must be used to produce THERAPEUTIC effect
  • Addiction - person requires increasing amounts for RECREATIONAL effect and would change lifestyle to procure it
Term
Why is tolerance to respriratory depression good?
Definition
When higher doses of drug are needed, the risk remains relative
Term
Why are higher doses needed with physical dependence and addiction?
Definition
Dopaminergic reward system never reaches original high
Term
2 Life-threatening Side Effects of Narcotics
Definition
  • Respiratory Depression (increase in CO2 levels, decrease in respirations)
  • Decrease in Blood Pressure
Term
3 Interventions with Narcotic Side Effects
Definition
  • Bag Valve Mask and Supplemental O2
  • Reversal Drugs
  • Protect Airway (suction and positioning)
Term
Narcotic Overdoe Symptoms
Definition
  • Pinpoint Pupils
  • Bradypnea (less than 8 respirations)
Term
Opiates increase the effects of what 5 meds?
Definition
  • Alcohol
  • Sedatives
  • Hypnotics
  • Antipsychotic Meds
  • Muscle Relaxants
Term
Drug for overdose of narcotic
Definition
  • Narcotic Antagonist
  • Example - Narcan (Naloxone)
Term
How does a narcotic antagonist work?
Definition
  • Blocks receptor site and displaces narcotic
  • These drugs have a higher affinity to the opiate receptor site thanthe narcotic taken
Term
How does the t 1/2 of narcan affect dosing?
Definition
Usually shorter than t 1/2 of narcotic, so the dose must be repeated
Term
What is an off-label use of Lomotil?
Definition
Managing Diarrhea
Term
What is an off-label use of Codeine and hydromophone?
Definition
Antitussive (effective, but have abuse potential)
Term
What is an off-label use of Dextromethorphan?
Definition
Antitussive (chemically related to opiates, but few effects other than antitussive, so it's in a lot of OTC cold meds)
Term
What is an opioid-like analgesic that is synthetic, but binds to mu receptors and has an effect on moderate to severe pain?
Definition
Tramadol (Ultram)
Term
When is tramadol contraindicated?
Definition
Patients with narcotic dependence or addiction
Term
What doees NSAID stand for?
Definition
Nonsteroidal Anti-inflammatory Drugs
Term
How do NSAIDS reduce pain?
Definition
  • Inhibiting chemical mediators
  • Inhibit prostoglandins by interacting with cyclooxygenase
Term
NSAIDS are not only analgesics, but also ________
Definition
Antipyretics
Term
NSAIDS work by inhibiting what?
Definition
COX1
Term
Most famous COX1 inhibitor
Definition
Aspirin
Term
Pros of COX1 inhibitors
Definition
  • Inhibition of platelet aggregation
  • Antipyretic
  • Anti-inflammatory
  • Don't need to use opioids
Term
Cons of COX1 inhibitors
Definition
  • Gastric ulcers that can bleed to death
  • Gastritis issues
Term
Aspirin decreases the stickiness of platelets for how long?
Definition

7 days (the entire life of the platelet)


this effect is permanent. Will not have the proper effect of platelets until new ones are formed.

Term
Aspirin helps to prevent what 2 things?
Definition
  • Colon Cancer
  • Prophylaxis of recurrent MI or stroke
Term
What dose of aspirin is taken for MI and stroke prevention?
Definition
81 mg
Term
Why is aspirin never given to children?
Definition
Reye's Syndrome
Term
What age should never be given aspirin?
Definition
Children under 19
Term
Can alcohol and aspirin be mixed?
Definition
No, both are ulcerogenic
Term
Drug-drug Interactions of ASA
Definition
  • Heavily Protein-bound
  • Anti-coagulants
  • Alters pH (metabolic acidosis)
  • Gastric Irritation
  • Alcohol
Term
Symptoms of mild toxicity of ASA
Definition
  • Tinnitus
  • Headache
  • Dizziness
  • Drowsiness
  • Confusion
  • Paresthesias
  • Ventilatory Stimulation
  • GI Distress
Term
Symptoms of Salicylate Poisoning
Definition
  • Alterered respirations (increased, then depression)
  • Altered fluid/lytes and acid-base balance (alkalosis to acidosis)
Term
What is the antidote to ASA poisoning?
Definition
There isn't one
Term
What is the treatment for ASA poisoning?
Definition
  • The sooner the better
  • Can give something basic, like Sodium Bicarb
  • Ventilatory support
  • Correct acid-base imbalance
  • Hasten excretion
  • Watch for GI bleeding
  • Expect effects of severe anticoagulation
  • Renal failure if already renal insufficiency
Term
Generic name for ASA
Definition
Acetylsalicylic Acid
Term
Are other NSAIDS salicylates?
Definition
No, but share many common side effects
Term
Side effects of Ibuprofen
Definition
  • Sodium and water retention
  • Caustic to stomach and intestinal lining
  • Massive GI bleeds
  • Renal damage
Term
What is the effect of NSAIDS on muscle injuries?
Definition
In a strain, it had no greater effect than a placebo, and in animal studies it delayed healing
Term
What is the effect of NSAIDS on contusions?
Definition
No studies in humans, but equivocal at best or slow adaptation to training
Term
What is the effect of NSAIDS on ligament injuries?
Definition
Beneficial if it promotes a little bit of mobilization, but can be detrimental if it promotes too much mobilization and you overdo it
Term
What is the effect of NSAIDS on bone injuries?
Definition
Marked association between non-union and delayed healing (it inhibits ossification after hip fracture and total hip replacement)
Term
Prototype COX2 Inhibitor
Definition
Celecoxib (Celebrex)
Term
Most famous COX2 inhibitor
Definition
Tylenol
Term
How is a COX2 inhibitor different from a COX1?
Definition
  • No anti-inflammatory action
  • Does not inhibit platelet aggregation
  • Rare gastric irritation
  • Not likely to cause bronchioconstriction in patients allergic to ASA
  • Fewer drug-drug interactions
  • No risk of Reye's
Term
Just 1 tablet of COX2 inhibitor celecoxib can increase CV risk for how long?
Definition
3 months
Term
How does celecoxib increase risk of CV effects?
Definition
  • It does not suppress platelet aggregation, because it doesn't block COX1
  • It blocks COX2, which can cause increased vasoconstriction
  • The combination of these two increase the likelihood of vessel blockage once thrombosis has begun
Term
Treatment for overdose of tylenol
Definition
  • Give N-acetylcysteine (Mucomyst)
  • It interacts with toxic metabolite and protects liver cells
  • Best if given within 10-12 hours after ingestion
Term
Generic name for Tylenol
Definition
Acetaminophen
Term
Symptoms of Tylenol overdose within 12-24 hours
Definition
  • GI Cramping
  • Nausea
  • Vomitting
Term
Symptoms of Tylenol overdose on 2nd day
Definition
  • No obvious signs
  • Relief
  • Urine output drops
  • Hematuria
  • Pain in upper right quadrant
Term
Symptoms of Tylenol overdose at 3-5 days
Definition
Irreversible Hepatic Necrosis
Term
T 1/2 of single dose of ASA
Definition
15 minutes
Term
Is there physical dependence risk with ASA?
Definition
No
Term
Does ASA work for visceral pain?
Definition
No
Term
3 main classes of opioid receptors
Definition
  • Mu
  • Kappa
  • Delta
Term
Responses to this receptor include analgesia, respiratory depression, euphoria, sedation, physical dependance, decreased GI motility
Definition
Mu
Term
Responses to this receptor include analgesia, sedation, and decreased GI motility
Definition
Kappa
Term
Pure opioid agonists activate which receptor(s) to produce analgesia and other effects?
Definition
  • Mu
  • Kappa
Term
How do agonist-antagonist opioids pentazocine, nalbuphine, and butorphanol affect mu receptors?
Definition
Antagonist
Term
How do agonist-antagonist opioids pentazocine, nalbuphine, and butorphanol affect kappa receptors?
Definition
Agonist
Term
How do agonist-antagonist opioid buprehorphine affect mu receptors?
Definition
Partial agonist
Term
How do agonist-antagonist opioid buprehorphine affect kappa receptors?
Definition
Antagonist
Term
How do pure opioid antagonists affect mu and kappa receptors?
Definition
Antagonists that do not produce analgesia or any other effect of agonists, but instead work to reverse respiratory and CNS depression
Term
Which antagonist is used to treat opioid-induced constipation?
Definition
Methylnaltrexone
Term
Routes of administration for morphine
Definition
  • Oral
  • IM and SubQ
  • IV
  • Epidural and Intrathecal
Term
Strong opioid analgesic with 100x potency of morphine (not remifentanil)
Definition
Fentanyl (Sublimaze, Duragesic, Fentora, Actiq, Ionsys)
Term
Routes of administration of fentanyl
Definition
  • Parenteral
  • Transdermal
  • Transmucosal
  • Buccal Tablets
Term
The first needle-free patient-activated system for on-demand delivery of analgesia
Definition
Transdermal Iontophoretic System (Ionsys)
Term
About 10x more potent than morphine
Definition
Alfentanil (Alfenta)
Term
About 1000x more potent than morphine
Definition
Sufentanil (Sufenta)
Term
Similar to fentanil, in that it is 100x more potent that morphine
Definition
Remifentanil (Ultiva)
Term
How does meperidine differ from morphine?
Definition
  • Short t 1/2
  • Interacts adversely with a number of drugs
  • Accumulation of toxic metabolite
Term
Oral med similar to morphine with a long duration of action, but  may cause a fatal dysrhythmia
Definition
Methadone (Diskets, Dolophine, Methadose)
Term
Drug similar to morphine that is no better that other strong opioids, but has a very high abuse potential, so it is banned in the US
Definition
Heorin
Term
What is the limiting factor with codeine?
Definition
Dose remains low to prevent side effects, which means pain relief achieved safely is quite low
Term
Codeine provides pain relief equivalent to how much ASA or Tylenol?
Definition
325 mg
Term
Moderate to strong opioid frequently abused through snorting, crushing, IV, etc.
Definition
Oxycodone
Term
This pain reliever is only available in combination with other meds (usually ASA and Tylenol)
Definition
Hydrocodone
Term
Prototype for Agonist-Antagonist Opioid
Definition
Pentazocine (Talwin)
Term
Tylenol can not be taken with what 2 drugs?
Definition
  • Alcohol (can cause fatal liver damage)
  • Warfarin (can accumulate to dangerous levels and increase risk of bleeding)
Term
Topical Local Anesthetics
Definition

Lidocaine

Tetracaine

Cocaine

Term
General Anesthetics
Definition
Drugs that produce unconciousness and a lack of responsiveness to al painful stimuli
Term
Injectible Local Anesthetics
Definition

Nerve Block

Shorter procedures: lidocaine or mepivacaine

Longer procedures: bupivacaine

 

IV Regional: Lidocaine w/o epi

 

Epidural: lidocaine or bupivacaine

 

 

 

Term
Local Anesthetics
Definition
Drugs that do not reduce conciousness and they blunt sensation only to a limited area
Term
How do local anesthetics work?
Definition
Stop nerve conduction by blocking sodium channels in the axon membrane
Term
2 classes of local anesthetics
Definition

ester-type anesthetics: (procaine) occasionally cuase allergic reactions and are inactivated by esterase in the blood

 

amide-type anesthetics: (lidocaine) rarely cause allergic reactions and are inactivated by enzymes in the liver

Term
Types of General Anesthetics
Definition

Inhalation Anesthetics

 

Intravenous Anesthetics

 

Term
Analgesia
Definition
Refers speciically to loss of sensibility to pain
Term
Anesthesia
Definition
Refers not only to loss of pain but to loss of all other sensations as well (eg, touch, temp, taste)
Term

Minimum Alveolar Concentration

(MAC)

Definition
As the minimum concentration of drug in the alveolar air that will produce immobility in 50% of patients exposed to a painful stimulus.

Low MAC = high potency
Term
Balanced Anesthesia
Definition
Th use o a combination of drugs to accomplish what we cannot achieve with one anesthetic alone
Term
Classifications of Inhaled Anesthetics
Definition
gasses
volatile liquids
Term
Types of IV Anesthetics
Definition
Opioids
Barbituarates
Benzodiazepines
Term
PCA
Definition
Patient Controlled Analgsia
Term
PCA Pump
Definition
electronically controlled infusion pump that can be activated by the patient to deliver a preset bolus dose of an opioid, which is delivered though an indwelling catheter
Term
Ionsys Pump
Definition
Delivers opioid (fentanyl) through transdermal dosage not a pump
Term
Most common drug used in a PCA pump
Definition
morphine
Term
BVM
Definition
Bag Valve Mask
Term
Epinephrine effects on vessels in anestetics
Definition

vasoconstrictor: decreases local blood flow and delays systemic absorption of anesthetic

 

Prolongs anesthesia and reduces risk of toxicity

Term
Analgesics
Definition
Drugs to reduce pain
Term
Antiemetic
Definition
Drugs to reduce nausea and vomiting
Term
3 Phases Drugs go Through
Definition

Pharmaceutical

Pharmacokinetic

Pharmacodynamic

Term
ADME
Definition

Absorbing

Distributing

Metaolizing

Excreting

Term
Pharmacodynamics
Definition
The chemical and physiologic changes that the drug causes
Term

3 Phases of Action

 

Pharmaceutical Phase

Definition
Dissolves or disintegrates
Term

3 Phases of Action

Pharmacokinetics

Definition
ADME
Term

3 Phases of Action

Pharmacodynamics

Definition
Interaction with receptors
Term

Pharmaceutical Phase

 

How does the dissolution rate of a drug effect the rate of the compound crossing the cell membrane?

Definition
The faster the dissolution rate the quicker the compound crosses the cell membrane
Term
What type of drugs absorb better in the stomach?
Definition
weak acids
Term
What type of drugs absorb better in the intestine?
Definition
Weak bases
Term
What does rate of absorption depend upon?
Definition
When the drug becomes bio-available to exert it's action. It has to fit into the specific receptor.
Term
Factors that affect absorption
Definition
  • ionization - ionized solutions don't cross membranes easily
  • stability of the drug in acid / alkaline environment
  • pH - local environment enhances or retards diffusion of acid/base drugs
Term
Outside Factors that impact absorption
Definition
  • Alcohol in the stomach (changes dissolving)
  • Nicotine (lowers plasma enzymes and can increase or decrease metabolism)
  • Caffeine (increases stimulation including gastric motility)
Term
3 Drug Storage Environmental Impacts
Definition
  • Temperature - store at toom temp, some need refrigeration
  • Light sensitivity - some are light sensitive and need to be storeed in dark color containers
  • air/humidity sensitive - some require tight sealed containers
Term
5 Routes of Administration
Definition
  • Oral (80% of drugs - swallowed, buccal, sublingual)
  • Enteral (nasogastric or gastric tubes, rectal)
  • Parenteral (SC, IM, IV, intrathecal, epidural, other fluids)
  • Pulmonary (gasses, mist)
  • Topical (skin, eyes, ears, nose)
Term
Oral cavity pH
Definition
slightly acidic
Term
Stomach pH
Definition
pH 1.4 Highly acidic
Term
pH upper portion of small intestine
Definition
pH 7-8 highly alkaline
Term
Blood-brain barrier, what type of drugs can cross and why?
Definition
Lipid soluble because BBB is heaby in lipids composition
Term
Where do pulmoary drugs have to reach to be effective?
Definition
Alveolar level
Term
What effects percutaneous absorption? (topical)
Definition
  • massage (enhances)
  • heat (can increase)
  • sweat or friction (can wash away)
  • capillary system not intact
Term
3 things distriution of drug depends upon
Definition
  • permeability of capillaries to drug molecule
  • cardiac output
  • regional blood flow
Term
Drug Reservoirs (in general)
Definition

accumulation of drug occurs

  • attach to items: plasma protein binding and tissue binding

Creates a reservoir, is reversible

  • as more free drug is metabolized, more bound molecles become unbound
  • must be free to work
Term
Barriers to drug distribution
Definition

blood-brain barrier - only lipid soluble

placental barrier - limited protection

Term
metabolism
Definition
process of chemically altering a drug for use or inactivating a drug into a metabolite that can be excreted
Term
Only a __________ drug can be metabolized
Definition
free
Term
Pro-drug
Definition
inactive substance that must be coverted into an active form
Term
Liver Phases
Definition

Phase I: Oxidation

Phase II: Conjugation

Term
What happens in liver Phase I?
Definition
Oxidation: O2 attaches to molecule
Term
What happens in liver phase II?
Definition

Conjugation

another chemical group attaches to the drug

changes it into adifferent compound or more polar makingit excretable by the kidney

Term
First Pass effect
Definition
Most oral/enteral drugs lose ~90% in first pass through the liver. Oral/enteral drugs must be given in higher doses and more often to get effective amount of drug into system for prolonged amount of time.
Term
CYP450: general
Definition
  • 12 channels with several subhannels with 50 isoenzymes
  • 90% of drugs go through only 6 of the channels
Term
Why would CYP450 effect drug, if 2 or more drugs are taken at same time?
Definition

90% of drugs go through 6 of the 12 channels. So if they have the same receptors, the one that gets there first wins and the other is slow to metabolize and toxic lvels of the drugs accumulate

 

Watch drug-drug interactions!!!

Term
Induction
Definition

chromic exposure to one drug may get more enzymes produced

(drug doesn't last as long as it did initially)

Term
Intentional use of interactions
Definition

Drugs given on purpose together because of reactions.

ie. drug 1 and drug 2 are given together. They fight for the same receptors. Drug 1 will win and this will allow drug 2 to take longer to metabolize. Without drug 1, drug 2 will metabolize too quickly and will not be effective.

 

 

Term
9 Factors Affecting Metabolism
Definition
  • age
  • nutritional status (especially protein)
  • liver disease
  • presence of other drugs (compete for enzymes or toxic effect on liver cells)
  • Alcohol
  • Smoking
  • fluid levels
  • hormone interactions
  • time of day
Term
Most important route for excretion of drugs and metabolites
Definition
Kidneys
Term
What type of drugs do the kidney's not eliminate?
Definition
Lipid soluble - they are reabsorbed b tubules and reenter the systemic circulation. Leave body via other routes or get another chance at becoming water soluble during liver processing
Term
How does urine pH effect excretion of drugs?
Definition
  • Urine pH varies between 4.6-8.2
  • weak acids more readily excreted in alkaline urine
  • Weak bases are more readily excreted in acidic urine

 

Term
Other than the kidney, name 5 sites for excretion of drugs
Definition
  • GI tract
  • Lungs
  • Sweat/salivary glands
  • Mammary glands
  • Hemodialysis
Supporting users have an ad free experience!