Term
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Definition
| the treatment of a disease – giving the right drug to the right patient at the right time. |
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Term
| 2 branches of therapeutics |
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Definition
| 1. Pharmacological and 2. non-pharmacological –Both branches are to be considered when the concern is selecting the right drug(s) and making the decision about which drug(s) to use for a particular patient. |
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Term
| Why should Tylenol(aspirin) not be given to a child with a viral fever (eg. chicken pox, herpes zoster) |
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Definition
| Can cause reye syndrome -sudden (acute) brain damage (encephalopathy) and liver function problems of unknown cause. |
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Term
| Can aspirin be used in patients with gout? |
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Definition
| Relative contraindication. Yes, however not in low doses because low dose aspirin interacts with gout |
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Term
| Drug Utilization Review (DUR) |
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Definition
| as review of drugs used in a population (a state, a country, an age group, or subscribers of a health insurance plan) to determine effectiveness, potential dangers, problems with drug interaction, and other issues |
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Term
| Types of drug interactions |
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Definition
| drug-drug, drug-food, drug-lab |
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Term
| Major components of Drug monitoring |
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Definition
| Indication, dosage, allergies, contraindications, compliance/adherence, adverse drug reactions (ADRs)/side effects, drug interaction, response to therapy, cost, cause & effect, |
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Term
| Factors affecting absorbtion |
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Definition
1. pH
Some drugs require acidicity in order to absorb.
Parietal cells produce acid in the stomach by using the HCl in the stomach to activate pepsinogen into pepsin.
2. Binding
Drug binding can be avoided by separating administration by 2 hrs allowing time for gastric emptying (2-4hrs).
3. Hydrolysis (acid hydrolysis)
Penicillin G is used intravenously and never orally because it is hydrolyzed completely; as an alternative Penicillin V is used orally. |
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Term
| Major factor affect distribution |
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Definition
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Term
| Factors affecting metabolism |
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Definition
1. Inhibition of enzymes
CYP450 enzyme system metabolizes drug. Inhibition of this system can cause an increase of a drug in the bloodstream leading to toxicity.
2. Induction/stimulation of enzymes
CYP450 enzyme system metabolizes drug. Induction of this system can cause a decrease of a drug in the bloodstream leading to improper therapeutic response. |
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Term
| Antibiotic cause diarrhea by 2 mechanisms |
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Definition
1. Enterohepatic circulation (if exhibited in the first few doses)
2. Destruction of normal flora |
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Term
| Gastroesophageal Reflux disease (G.E.R.D.) |
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Definition
| Condition in which the lower esophageal sphincter L.E.S. is incompetent & does not close properly |
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Term
| Precipitating factors of GERD "WHAT MAKES IT WORSE" |
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Definition
1. Timing of meals relative to sleeping (3hrs)
a. Can be avoided by allowing the contents of the stomach to empty
2. Acidic foods
3. Irritating drugs
a. Take with food to reduce irritation to avoid
4. Chocolate, caffeine, and mint affects the L.E.S.
5. Alcohol is irritating
6. Smoking (nicotine)
7. Fatty foods –delay gastric emptying |
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Term
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Definition
1. Heartburn
a. Especially after experiencing precipitation factors
2. Regurgitation of food products
3. Dysphagia (difficulty swallowing)
a. Result of U.E.S. contracting to keep the contents of the stomach from regurgitating
4. Acid related problems in the oral cavity
5. Coughing
a. Especially at night because that is when the parasympathetic nervous system takes over which is responsible for acid production
6. Chest pain |
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Term
| Treatment option for GERD |
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Definition
| Antacid, H2 Antagonist, Proton pump inhibitors |
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Term
| Antacid: Sodium Bicarbonate (NaHCO3)or baking soda properties |
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Definition
SHOULD NOT BE USED ON A CHRONIC BASE may cause hypernatremia. Avoid chronic use also in Pt. with CHF, BP problems or in an edematous state
Reaction: NaHCO3 + HCl NaCl + H20 + CO2 (causes fizzing) |
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Term
| Antacid: Calcium Salts (eg. Calcium Carbonate Tums(R) |
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Definition
| a. Can also be used for bones in treatment of osteoporosis ; use caution because of risk of hypercalcemia which can eventually lead to the formation of kidney stones. May eventually lead to c. Metastatic calcification is when kidney stones circulates in the blood, brain, etc. Cause constipation |
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Term
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Definition
The magnesium salt of choice will be something that contains magnesium hydroxide -Mg(OH)2. Mg (OH)2 is aka milk of magnesia.
Mg(OH)2 has 2 functions: It can be used as an antacid or laxative
Byproducts of Mg(OH)2 + HCl are MgCl + H2O. MgCl is created to neutralize the acid.
a. A person with a normal functioning renal system can handle the production of MgCl
b. If a pt has reduced kidney fx, you cannot use Mg(OH)2 because the Mg will accumulate. If CrCl < 30, you cannot use Mg(OH)2
c. Example: If a pt presented with GERD, you can recommend a drug with Mg in it as long as CrCl > 30
Combinations of Mg that are most commonly used are:
a. Mg(OH)2 + Al(OH)3 -----> This combo is Maalox (Regular)
b. Mg(OH)2 + Al(OH)3 + Simethicone -----> This combo is Mylanta (Regular)
i. Note: The difference b/t Maalox & Mylanta is Mylanta has Simethicone. Simethicone is used for gas. When a person has gas, they have a lot of discomfort because of all the air pockets throughout the intestinal tract. Simethicone works by coalescing (combining) the gas bubbles into one. When the pt burps or passes gas, all of the gas comes out at once instead of small amounts gradually coming out.
ii. Simethicone is a standard drug that is given to pt’s in hospitals after surgery
Magnesium causes diarrhea. |
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Term
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Definition
Al(OH)3 is also an antacid
Don’t need to know this for test:
a. Maalox plus is the same as Mylanta
b. Maalox TC is a more concentrated Maalox
c. Mylanta II is a more concentrated Mylanta
Al salts cause constipation |
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Term
| Theory behind combination Al and Mg antacid |
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Definition
| To counter balance diarrhea (Mg) with Constipation (Al). However more often Pts exhibit more diarrhea |
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Term
| Antacid Drug interactions |
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Definition
i. Antacids + Tetracycline: This applies to the older tetracyclines like tetracycline HCl only. Divalent and trivalent ions will chelate(bind) with tetracycline and decrease absorption of tetracycline. To avoid this, space drugs out by a few hours. This is an example of relative contraindication.
ii. Antacids + Digoxin (Mg ions). Antacids bind to Mg ions in digoxin.
iii. Changes in urine pH caused by NaHCO3. |
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Term
| How to determine if a drug is a weak acid/base |
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Definition
i. Sodium Phenobarbital: This is a weak acid because the sodium is coming from NaOH. Since NaOH is a strong base, sodium Phenobarbital is a weak acid.
ii. Quinidine SO4: This is a base. A salt is a conjugate base of an acid. The SO4 is a parent base because SO4 comes from sulfuric acid. Since sulfuric acid is a strong acid, Quinidine SO4 is a base. Acid + base = salt.
iii. If you see a compound with Cl, know that the Cl came from HCl. Since HCl is a strong acid, the compound is a weak base.
iv. Sulfuric acid and HCl are often times your acid. |
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Term
| List of OTC H2 Antagonists |
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Definition
Cimetidine (Tagamet HB)
a. Cimetidine was the 1st H2 Antagonist produced. It’s not used as much because it has more drug interactions than the other H2 antagonists. It inhibits Cytochrome P450, 3A4.
b. Example: A pt is taking the drug “Dilantin” for seizures and Dilantin is metabolized by 3A4. If the pt begins taking Cimetidine, the concentration of Dilantin will increase.
Famotidine (Pepcid AC)
Ranitidine (Zantac)
Nizatidine (Axid)
Note: The above drugs block acid production equally. The difference between them is the cost & availability. |
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Term
| Difference between H1 and H2 receptors |
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Definition
a. H1 receptors are associated with allergies
b. H2 receptors are associated with gastric acid production. Histamine act on H2 receptors, which are located on the parietal cells in the stomach |
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Term
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Definition
| H2 antagonists block the effect of histamine by blocking the H2 receptor. Histamine will not be able bind to the H2 receptor because H2 antagonist is already there. |
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Term
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Definition
Strongest relievers of GERD symptoms.
Completely shuts off pump that secreted acid. Can be taken every day once daily. Has very limited side effects. Omeprazole (Prilosec ®)
U can use drug for 14 days before you need to see a physician. This restriction is in place so people will not take drug for more than 14 days if they have not gotten their condition diagnosed. |
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