Term
| Define: Pharmatherapeutics |
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Definition
| The achievement of the desired therapeutic goal from drug therapy. It is the clinical purpose and indication for giving a drug |
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Term
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Definition
| The effect of the body on the drug |
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Term
| Name the four phases of pharmacokinetics |
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Definition
absorption
distribution
metabolism
excretion |
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Term
| Name 3 ways in which drugs cross cell membranes |
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Definition
Through channels or pores
through a transport system (enzymes, energy)
direct penetration of the membrane itself (lipophilic (non-polor and non-ionized molecules |
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Term
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Definition
| movement from site of administration into bloodstream |
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Term
| movement from site of administration into bloodstream |
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Definition
other drugs
food
route of administration
rate of dissolution of drug
body surface area
blood flow
lipid solubility
pH of drug
GI emptying time
physiologic condition of patient |
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Term
| Would medicine be absorbed faster in the small intestine or in the stomach? |
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Definition
| Small intestine due to the increased surface area |
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Term
| ______ blood flow leads to faster rates of absorption |
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Definition
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Term
| What are some factors that will decrease the rate of drug absorption? |
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Definition
disease that alters the stomach and small intestine lining
high drug concentration in the circulatory system
drug administered by subq route verses the IM route |
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Term
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Definition
| movement of the drug through the bloodstream, into the tissues, and eventually into the cells. |
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Term
| 4 factors that affect distribution |
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Definition
blood flow
protein binding
blood-brain barrier
placental membrane |
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Term
| hypoalbuminia=less drug to bind=? |
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Definition
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Term
| what protein affects the dosage of medication |
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Definition
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Term
| Define:blood brain barrier |
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Definition
| cells in capillary walls packed tightly together |
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Term
| what is the purpose of the blood brain barrier? |
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Definition
| to keep toxins and poisons from reaching the brain |
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Term
| name an advantage and disadvantage of the blood brain barrier |
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Definition
Advantage: prevent CNS damage
Disadvantage: cannot treat bacterial meningitis |
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Term
| What are some differences in the blood brain barrier of a newborn? |
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Definition
| it is not fully developed and there is an increased risk of CNS toxicity |
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Term
| what kind of drugs can pass through the blood brain barrier? |
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Definition
| lipophilic or lipid soluble |
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Term
| what kinds of drugs can pass through the placenta? |
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Definition
| lipophilic, nonionized, not protien bound, and water soluble. |
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Term
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Definition
| the conversion of the drug into another substance or substances (metabolites |
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Term
| Name 5 sites of metabolism |
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Definition
liver-main site
GI tract
lungs
kidneys
skin |
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Term
| lipophilic -> metabolism -> |
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Definition
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Term
| why is it important for a drug to be metabolized into a hydrophilic substance |
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Definition
| so that it can be excreted through the GI tract |
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Term
| What effect does an inactive metabolite have on the body? |
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Definition
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Term
| What effect does an active metabolite have on the body? |
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Definition
| therapeutic or adverse effect |
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Term
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Definition
| an inactive drug that have little or no value until metabolized into an active form |
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Term
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Definition
| What occurs when the drug passes through the liver the first time and loses its effectiveness before it even reaches the general circulation |
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Term
| How can you avoid a first pass effect? |
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Definition
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Term
| What must you do if you are giving an oral medication with a high first pass effect? |
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Definition
| increase the dose in order to receive a therapeutic level |
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Term
| metabolism of drugs are predominately acheived by specfic enzymes called ____. specifically ___, ___, ___. |
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Definition
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Term
| 2 sites of metabolism through the p-450 system? |
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Definition
liver (primary)
small intestine |
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Term
| name some things that will induce the P-450 system |
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Definition
| charcoal-broiled foods, cruciferous vegetables, cigarette smoke, st. johns wort, alcohol, nicotine |
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Term
| When inducing the P-450 system, an increase in metabolism results in... |
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Definition
| a decrease in the amount of circulating active drug |
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Term
| name some things that would inhibit the P-450 system |
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Definition
| grapefruit juice, infants, old age. |
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Term
| when inhibiting the P-450 system, a slower metabolism results in... |
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Definition
| an increase in the amount of circulating active drug |
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Term
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Definition
| removal of the drug or its metabolites from the body |
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Term
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Definition
| urine, bile, expired air from lungs, breast milk, sweat, saliva |
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Term
| 3 processes involved in renal excretion |
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Definition
glumerular filtration
passive tubular reabsorption
active tubular secretion |
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Term
| 6 factors affecting excretion |
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Definition
Renal dysfunctin
decreased cardiac output
hepatic dysfunction
age
drug interactions
enterohepatic recirculation |
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Term
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Definition
| amount of time needed to reduce the amount of drug in the body to 50%. |
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Term
| How many half-lifes does it take to achieve a steady state? |
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Definition
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Term
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Definition
| a point at which the amount of drug being administered and the amount being eliminated balance off |
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Term
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Definition
| the biological, chemical and physiological actions of a particular drug within the body |
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Term
| drugs cannot create new responses in the body. they can only... |
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Definition
turn them on
turn them off
promote (agonist)
block (antagonist) |
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Term
| what does the minimum effective concentration (MEC) produce? |
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Definition
| pharmacotherapeutic effect (clinical purpose or indication for giving a drug |
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Term
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Definition
| the amount of a drug that must be given in order to produce a particular response |
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Term
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Definition
| how well a drug produces its desired effect. has a high intrinsic activity |
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Term
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Definition
| the dose that produces therapeutic responses to 50% of the population. It is the standard and starting dose. |
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Term
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Definition
| the dose that is chosen and administered consistently over time |
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Term
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Definition
| dose that is given when a patients medical condition warrants a drugs immediate and full effect in order to maintain health or life. given in 2-3 portions |
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Term
| Define: therapeutic index |
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Definition
| measurement of safety of drug. Relation of lethal dose to effective dose. |
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Term
| Define: narrow therapeutic index |
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Definition
| not much of a difference between therapeutic and lethal levels. much monitor pt for adverse effects and serum levels |
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Term
| Define: therapeutic range |
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Definition
| above MEC but below adverse effects |
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Term
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Definition
| undesirable effect other than intended therapeutic effect |
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Term
| 3 causes of adverse effects |
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Definition
normal drug dose
to much of a therapeutic effect
other pharmocodynamics effect the drug |
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Term
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Definition
drowsiness, auditory and visual disturbances, restlessness, nystagmus, tonic-clonic seizures
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Term
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Definition
| hapatitis, jaundice, elevated liver enzyme levels, fatty infiltration of the liver |
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Term
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Definition
| decreased urinary output, increased BUN, increased serum creatinine, altered acid-base balance, electrolyte imbalances |
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Term
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Definition
| based on 2 or more like drugs |
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Term
| Define: synergistic effect |
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Definition
| based on 2 or more unlike drugs |
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Term
| Define: potentiated effect |
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Definition
| 2 drugs combined one enhances the other |
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Term
| Define: antagonistic effect |
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Definition
| 2 or more drugs decreases the therapeutic level. good for toxicity |
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Term
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Definition
| controlled human studies fail to demonstrate risk to fetus |
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Term
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Definition
| No human studies but animal studies fail to demonstrate fetal risk |
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Term
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Definition
| Animal studies demonstrate fetal risk, but there are no controlled human studes. Give if benifit outweighs risk. |
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Term
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Definition
| human studies show fetal risk. may give in life threatening situations if benefit outweighs risk |
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Term
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Definition
| contraindicated. human studies show fetal risk and outweigh the benefits. |
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Term
| Side/Adverse med effects on CNS |
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Definition
CNS stimulation: may be at risk for seizure
CNS depression: advise not to drive/participate in dangerous activities
Extrapyramidal symptoms EPS: involuntary fine motor tremors, rigidity, restlessness, spastic movements within hrs or months: often associated with meds affects CNS like mental health |
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Term
| Side/Adverse med effects of anticholinergics/cardiovascular |
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Definition
Anticholinergic: block muscarinic; effect mainly eye, smooth muscle, exocrine glands and heart: teach liquid use for dry mouth, sunglasses for photophobia; urinating before medicine to help urinary retention
Cardiovascular: Antihypertensives can cause orthostatic hypotension: teach signs of postural hypotension and sit or lie down/move slowly |
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Term
| Side/Adverse med effects of GI/Hematologic |
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Definition
GI: irritation of tract, vomiting can cause adverse effects; NSAIDs can cause this and should be taken with food
Hematologic: can be life threatening with some groups of beds: bone marrow depression/supression with anti cancer meds; hemorrhagic disorders with anticoagulants and thrombolytics.
-Educate on s.s. of bleeding (bruising, discolored urine/stool, bleeding gums) |
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Term
| Side/Adverse med effects of Hepatotoxicity/Nephrotoxicity |
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Definition
Hepatotoxicity: damage to liver cells impairs metabolism causing accumulation, producing adverse effects: 2 or more hepatotoxic increased liver damage risk, intitial and periodic liver tests
Nephrotoxicity: NSAIDs often cause; kidney damage causes accumlation due to lack of excretion: Aminoglycosides may cause renal damage; monitor serum creatinine and BUM levels |
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Term
| Side/Adverse med effects of toxicity/allergic reaction |
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Definition
Toxicity: excessive dose and sometimes at TL; liver damage with tylenol overdose or chronic alc use; antidote acetylcysteine (Mucomyst) may be used to minimuze liver damage
Allergic reaction: immune response; mild rashes/hives: benadryl; before administering any meds, obtain complete med history |
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Term
| Side/Adverse med effects of anaphylactic reaction and immunosuppression |
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Definition
Anaphylactic: life threatening immediate allergic reaction causing resp distress, severe bronchospasm, cardiovascular collapse: treat with epinephrine, bronchodilators and antihistamines; notify and prove resp support
Immunosuppression: decreased or absent immune response: glucocorticoids depress immune response and increase infection risk; monitor clients and check for s.s. |
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Term
| Children med administration |
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Definition
Pediatric dosages are based off body weight or body surface area! BSA
1m-12m: immature liver/kidney, alkaline gastric juices, immature blood brain barrier, decreased serum protein binding sites
Children
-Decreased gastric acid production and slower gastric emptying
-decreased first pass
-increased absorption of topical meds
-lower BP (more flow to liver/brain, less to kidneys)
-Higher body water content (dilutes water soluble)
Most meds arent tested on children and may require dilution, calculation, preperation and very small doses; limited IV sites |
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Term
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Definition
Pregnancy: meds are distributed to the fetus as well; all should be considered as potentially harmful; weight risks.
Meds common: nutritional supplements and nausea/vomiting/gastric acidity and mild discomfort treatment.
Chronic conditions like DM and hypertension must be managed with careful maternal fetal monitoring.
Live virus vaccines are contraindicated-teratogenic effects (MMR, polio, yellow fever)
Lactation: meds are secreted in breast milk; avoid drugs with extended half life and take meds immediately after breastfeeding if safe to minimize med concentration in feeding |
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