Term
| WHAT IS THE PERFECT DRUG?? |
|
Definition
• highly potent
• 100% selective for the part of the body being treated
• completely safe
• have no side effects or drug interaction • be universally affordable. |
|
|
Term
| What to think about when giving drugs: |
|
Definition
1) What are the available medications on the market that will achieve the desired therapeutic
effect ?
2) mechanism of action (MOA)
3)basic pharmacological profile for the drugs in a particular class?
4)safety profile of the drug or drug class?
5) What NON-pharmacologic interventions might be included in treating this condition?
6) Selection of drugs for special patient populations
7) patient education |
|
|
Term
| mechanism of action (MOA)? |
|
Definition
how the drug works
labeled as the “CLASS” of drug |
|
|
Term
| basic pharmacological profile for the drugs in a particular class refers to what? |
|
Definition
• absorption
• degradation & elimination
• potential drug-drug interactions
• monitoring requirements
• use in subpopulations like pediatrics and pregnancy |
|
|
Term
| Choosing drugs based on what kind of population? |
|
Definition
• age, sex, reproductive status
• comorbidities, medication history, allergies • cultural issues
• polypharmacy |
|
|
Term
| What should you educate the patient? |
|
Definition
• name of drug – brand name & generic
• dose & dose interval
• length of treatment – acute or chronic (? refills)
• need for monitoring and followup care (physical exam, laboratory/imaging studies) • signs & symptoms of toxicity
• goal of treatment – what to expect & when – contact the healthcare team if goals
not met?
• when to contact the healthcare team if signs/symptoms of toxicity AND what to do
immediately in case of signs/symptoms of toxicity
• helping the patient to understand the disease/condition |
|
|
Term
|
Definition
| the study of how chemicals interact with living systems (cells, organs, organisms) |
|
|
Term
|
Definition
Chemical drugs that our own body makes
our bodies make endogenous cortisone every day |
|
|
Term
|
Definition
drugs administered to a person
we use exogenous prednisone as a drug |
|
|
Term
What is...
Applied pharmacology
medical pharmacology
pharmacotherapeutics
pharmacotherapy |
|
Definition
o drug use in humans
o to treat & prevent disease
o sometimes for recreational or religious/cultural use |
|
|
Term
What are the differences between the following:
toxicology
poisons
toxins |
|
Definition
• Toxicology = undesirable effects of chemicals on living systems.
• Poisons are harmful drugs and/or inorganic toxins
• Toxins are poisons of biologic origin (organics). |
|
|
Term
|
Definition
are elements other than CHONS
o may be BULK inorganics (e.g. calcium, sodium)
o may be TRACE inorganics (e.g. selenium, boron) |
|
|
Term
| HOW BIOCHEMISTRY AFFECTS DRUG ACTIVITY: |
|
Definition
1. Physical state of the chemical (drug):
2. Size & shape of the chemical (drug) – the Molecular Weight (MW)
3.Some drugs are “Racemic” (also called chirality, chiral drugs, stereoisomerism, enantiomer, isomers, dimers, racemes)
4. Bonding
5. Diffusion |
|
|
Term
| Weak bonds more commonly used by drugs; more reversible in action as drug can dissociate (separate) away after the initial bonding |
|
Definition
o Electrostatic bonds rely on electrical attraction
o Hydrophobic (water hating) bonds are very weak |
|
|
Term
| Drug selectivity and bonding |
|
Definition
o sometimes the specific actions of a drug rely on the “fit” into a cell’s enzymes or receptors
o the better the “fit” using these weak bonds allows for a more specific drug action |
|
|
Term
|
Definition
| substances do not bond, but can still have clinical effects, e.g. some anesthetics |
|
|
Term
|
Definition
covalent
weak
drug selectivity and bonding
inert substances |
|
|
Term
|
Definition
| 1. laws of thermodynamics promote entropy (disorganization) of substances 2. Concentration differences (gradients) causes solute to passively diffuse from high to low concentration areas without any energy being required |
|
|
Term
| Clinically: Water solubility |
|
Definition
drugs need to get into the “water compartment” (the plasma
in our bloodstream) in order to travel to their location of activity in the body |
|
|
Term
| Clinically: Lipid solubility |
|
Definition
drugs need to get past the phospholipid cell membrane to get
out of the bloodstream and into the tissues |
|
|
Term
| Clinically: Transport proteins (TP) |
|
Definition
SOME drugs that are more hydrophilic are still able
to get across cell membranes due to the presence of a transporter protein (TP) molecule embedded in the cell membrane that carries the drug into the cell |
|
|
Term
| Transport proteins (TP)EXAMPLE |
|
Definition
| the very hydrophilic statin drug, pravastatin (Pravachol), needs a special TP to get into the liver cell and do its work |
|
|
Term
|
Definition
| if the drug is able to enter a part of the body where it has the potential to do harm, there is a theoretical increased risk of adverse effect from this solubility |
|
|
Term
| Lipophilic drugs can cross the Blood Brain Barrier (BBB) |
|
Definition
| Lipophilic drugs can cross the Blood Brain Barrier (BBB) |
|
|
Term
| Which type of drug cannot enter the BBB |
|
Definition
|
|
Term
| Which type of drug CAN enter the BBB? |
|
Definition
|
|
Term
| Which condition is affected by the BBB membrane characteristics? |
|
Definition
| meningitis: the antibiotic needs to be able to enter the BBB |
|
|
Term
| Why does TRAPPING of drugs occur? |
|
Definition
| not all body fluids are the same pH (urine, semen, breast milk) |
|
|
Term
| How can TRAPPING of drugs be beneficial? |
|
Definition
| we can use this to our advantage by choosing drugs that concentrate in the urine and thus can be used to treat urinary tract infections (UTI) |
|
|
Term
DRUG-DRUG INTERACTIONS WITH OTC MEDICATIONS
ANTIACID |
|
Definition
| interfere with absorption of tetracyclines, fluoroquinolones, biphosphanates; & impair absorption of iron. |
|
|
Term
If a patient was given a tetracycline, what should you NOT give the patient or advise them NOT to take?
and why? |
|
Definition
| Antiacid because it interferes with it's absorption |
|
|
Term
DRUG-DRUG INTERACTIONS WITH OTC MEDICATIONS
sodium bicarbonate |
|
Definition
| alkalinizes stomachic pH, reducing absorption of keoconazole, increases renal clearance of Lithium & aspirin |
|
|
Term
| If a patient is given keoconazole, what should you advise the patient NOT to take? |
|
Definition
| sodium bicarbonate because it reduces the absorption |
|
|
Term
DRUG-DRUG INTERACTIONS WITH OTC MEDICATIONS
ibuprofen & naproxen |
|
Definition
| interfere with antihpertensive effectiveness of beta-blockers, may also increase serum Lithium level, and interfere with the cardio-protection of low-dose aspirin |
|
|
Term
|
Definition
|
|
Term
What is anise tea used for in latino culture?
What can also occur with too much anise tea? |
|
Definition
To induce abortion in an unwanted pregnancy
Renal failure |
|
|
Term
|
Definition
| astrocyte cells that are supporting cells; that selectively absorb substances from the blood (used in blood brain barrier) |
|
|
Term
| What are tight junctions? |
|
Definition
| between endothelial cells that make up the brain capillaries ( makes brain capillaries less leaky) |
|
|
Term
What areas of the brain are without the BBB?
And why? |
|
Definition
Pituitary, hypothalamus, pineal
Because the brain needs to sample the body's internal environment |
|
|
Term
|
Definition
| lipid soluble, water and gases |
|
|
Term
| many herbals are now prohibited in Europe from OTC availability and must be prescribed |
|
Definition
| many herbals are now prohibited in Europe from OTC availability and must be prescribed |
|
|
Term
| In America, what are herbal medicines classified as? |
|
Definition
supplement and not as drugs
o therefore NOT under Food and Drug Administration (FDA) control.
o No guarantee of purity, dosage or even contents as labeled |
|
|
Term
| Give an example of a supplement in the USA that was NOT pure |
|
Definition
Dolomite, a calcium supplement, was found to have
arsenic impurities on testing, since other metals are often found when gathering calcium from earth sources |
|
|
Term
| What is the Drug of choice? |
|
Definition
This drug will:
work best
be effective when used alone (monotherapy)
will have the least toxicity to the pt |
|
|
Term
|
Definition
| This is when clinicians will prescribe drugs that are not label approved for a specific condition because the science of the drug and the available clinical evidence has demonstrated the drug will work |
|
|
Term
| What is absolute contraindication? |
|
Definition
| do not give the drug under any circumstance |
|
|
Term
| What is relative contraindication? |
|
Definition
| the need for the drug is so great as to overcome the possibility of an adverse drug reaction |
|
|
Term
|
Definition
| approved drugs in the USA |
|
|
Term
| Drugs with abuse potential are further regulated under the restrictive authority of who? |
|
Definition
|
|
Term
| Controlled substances are also called? |
|
Definition
|
|
Term
| What did the controlled substances act do? |
|
Definition
| creates the scheduled drugs, control substances |
|
|
Term
| What is the Behind the counter drug? |
|
Definition
It has limitations on drugs purchases.
example: decongestants such as psuedo-ephedrine ( can only purchase limited amounts |
|
|
Term
| What is a "nutritional supplement"? |
|
Definition
| Nutritional supplements only need to "promote" or "maintain" the normal structure and/or functions of the body |
|
|
Term
| The FDA is very specific about the languages that can be used for advertisement. What are some words that are allowed? |
|
Definition
“supports” or “promotes”
"tension & mood" remedy containing St. John's wort.
allowed some claims for risk reduction or treatment of illness |
|
|
Term
| Major health-care concerns with supplemental drugs? |
|
Definition
• lack of knowledge regarding dosage & adverse drug effects (AEs, ADRs)(side effects).
• sterility and purity of the preparation
• lack of RCT evidence base for efficacy, safety, dosing
• contamination with pesticides
• Common drug interaction |
|
|
Term
| What is the MOST COMMON drug interaction? |
|
Definition
COUMADIN
(ANTICOAGULANT EFFECT)
• reduced levels of co-administered therapeutic drugs (may cause failure of
therapeutic drug)
• increased levels of co-administered therapeutic drugs (may cause toxic levels
of therapeutic drug)
• direct organ toxicity due to drug-herbal interactions |
|
|
Term
|
Definition
| That there is at least 80% of the amount stated in each cap/tab, & minimal variability. |
|
|
Term
|
Definition
Good Manufactured Product
Indicates higher quality standards |
|
|
Term
| Why may a herbalist not endorse standardization? |
|
Definition
Many herbalists feel that purified product with only one chemical is less helpful than an extract of whole herb. Herbalists often feel that the plant source contains therapeutic substances that act synergistically to
provide increased benefit to the primary ingredient. |
|
|
Term
|
Definition
| in the USA a person needs a prescription from a licensed provider to obtain the drug |
|
|
Term
|
Definition
| changeable, it is the trademark name owned by the drug company |
|
|
Term
| What is Tall mans letter? |
|
Definition
| a way to draw attention to look alike drug names |
|
|
Term
| What control substance is illegal? |
|
Definition
C-1
examples: LSD, PCP, mescaline, heroin, marijuana, opium derivitives, hallucinigens, depressents, stimulants |
|
|
Term
|
Definition
drugs with high potential for abuse, medical use with severe restrictions.
examples: narcotics: mathadone, meperidine, hydromorphone, oxycdone,
non narcodics: amphetamines, barbiturates
No telephone prescriptions or refills aloud by any provider |
|
|
Term
|
Definition
potential for abuse
narcodic examples: combined codeines, hydrocodone, vicodin, Lortab |
|
|
Term
|
Definition
drugs with less potential abuse
ex: Depressents (xanax, Valium, phenobarbital), stimulants (Fenfluramine), narcodics (propoxyphene)
Telephone prescription is usually permitted |
|
|
Term
|
Definition
drug with low potential for abuse
ex: tylenol 3 with codiene elixir, Novahistimine, Lomotil |
|
|
Term
| What is a “qualified health claim” for foods? |
|
Definition
claims approved by the FDA for supplements.
EX: green tea and tomatoes |
|
|
Term
Which supplement claims to reduce cardiac risk?
It contains at least 0.75 gm of fat-soluble fiber and is part of a low saturated fat and low cholesterol diet. |
|
Definition
|
|
Term
| This type of supplement protect against retinopathy? |
|
Definition
| Omega-3 (PUFA) fatty acids |
|
|
Term
| A high intake of this supplement will reduce the risk of colorectal cancer: |
|
Definition
| Dietary fiber: high fiber intake not associated with reduced risk of colorectal cancer |
|
|
Term
|
Definition
naturally occurring bacteria & yeasts
• such as: Lactobacillus & Saccharomyces species
found in active-culture yogurt, buttermilk as well as supplements
may prevent diarrhea with antibiotics
may prevent yeast vaginitis.
may improve symptoms of irritable bowel syndrome (IBS) |
|
|
Term
| Give an example of a probiotic |
|
Definition
lactobacillus
saccharomyces species |
|
|
Term
| What does the letter N mean next to a CS? |
|
Definition
| It means that it is a non-narcotic |
|
|
Term
| What is the DEA code number? |
|
Definition
| A four digit number for a CS assigned by the DEA |
|
|
Term
| What is the special license prescribers need to administer CS? |
|
Definition
|
|
Term
| What is botulinum toxin A used for? |
|
Definition
• induces muscle paralysis via blockade of Acetylcholine release.
• Anal fissure therapy: injection with botulinum toxin helps heal chronic anal fissure &
prevent recurrence.
• Cosmetic dermatology: injection into the forehead reduces frown lines.
• Hyperhidrosis: also indicated for axillary hyperhidrosis (excessive sweating)
Can also be used for:
1. injection to prevent head and voice tremors
2. relief of contractures in stroke or MS patients
3. relief of hyperhidrosis with intradermal injections
4. treat chronic migraine headaches |
|
|
Term
|
Definition
| Aspirin is from white willow bark and meadowsweet (Spirea) |
|
|
Term
|
Definition
Opium poppy
This is why there is a positive drug screen when you eat poppy seeds. |
|
|
Term
| What is mexican yam (Dioscorea villosa) used for? |
|
Definition
| ORIGINAL hormonal components of the first tested oral contraceptives |
|
|
Term
| What can be used as chemotherapy for cancer? |
|
Definition
Vinca (periwinkle):
* vincristine
* vinblastine
Both for breast cancer
Yew tree:
* taxol |
|
|
Term
| What can be given as a "cardiac tonic" for heart failure (in the past) & cardiac arrhythmias? |
|
Definition
|
|
Term
| This supplement can be given to reduce pain and inflammation: |
|
Definition
| Chili (Cayenne) peppers (Capsaicin)(Zostrix cream) |
|
|
Term
| What are the uses for Chili (Cayenne) peppers (Capsaicin)(Zostrix cream)? |
|
Definition
It's a naturally derived plant product depletes substance P from skin nerve endings, causing reduced pain & inflammation
• Usefulness:
1. small areas of inflammation in small joints.
2. Other applications include post-herpetic neuralgia (PHN), RA, DJD (osteoarthritis), diabetic neuropathy.
• Formulations: Zostrix cream, Qutenza (8% patch)
• Dose: cream used TID - QID (may need to be used for weeks before effect is noted)
---can cause severe burning sensation with initial use (resolves with continued use) |
|
|
Term
|
Definition
Specific dietary management of a disease or conditions or diease for which distinctive nutritional requirement
ex:
flavocoxid: arthritis
phenyl-free-1 for PKU babies
ProPhree: celiac disease ( no wheat)
Ketonex: for maple syrup disease |
|
|
Term
| What are pharamodynamics? |
|
Definition
| the drugs affect on the body |
|
|
Term
| What are pharmacokinetics? |
|
Definition
| the bodys affect on the drug |
|
|
Term
|
Definition
bind and activate the receptor to produce the desired outcome
ex. oral hypoglycemic agents are secretagogues that induce the pancreas to produce insulin by interacting with pancreatic receptors that would normally respond to food stuff |
|
|
Term
| What are antagonist drugs? |
|
Definition
| drugs that block the effects of the agonist |
|
|
Term
| St. John's Wort is a commonly used herbal that will have clinical implications, what are the claimed usefulness? |
|
Definition
| mild SSRI-type antidepressant & for premenstrual syndrome (PMS) |
|
|
Term
| St. John's Wort is a commonly used herbal that will have clinical implications, what are the active ingredients? |
|
Definition
---active ingredient is hypericin
---Active ingredient is removed by alcohol extraction of the above-ground part of the plant (just before or during flowering) to obtain USP Hypericum perforatum L |
|
|
Term
| St. John's Wort is a commonly used herbal that will have clinical implications, what is the MOA? |
|
Definition
| This has SSRI effects, thus is a serotonergic agent |
|
|
Term
| St. John's Wort is a commonly used herbal that will have clinical implications, what should you be cautious about when ingesting this drug? |
|
Definition
o Possibility of serotonin syndrome:
o Induction of CYP3A4 biotransformation pathway:
• protease inhibitors (for HIV – develop complications of AIDS)
• oral contraceptives (OCs, OCPs — unplanned pregnancy)
• cyclosporine (organ transplant rejection)
• theophylline
• reduced digoxin level
• reduced warfarin levels (clotting)
o Glycoprotein transporter interactions:
o Photosensitivity – recommend sunblock & avoid UVR
o Cataracts – recommend avoid UVR & wear dark sunglasses
|
|
|
Term
| What are competitive receptors antagonist? |
|
Definition
may block the bodys endogenous substances from exerting their normal effects
ex. beta blocking beta recpetors from the endogenous catecholamines(epinephrine, norepinephrine) from exerting their effects |
|
|
Term
| What are inert binding site? |
|
Definition
They are when endogenous chemicals bind to other chemicals, they DO NOT change the physiology of the cell, but still have an effect on the drug
ex. albumin binds drugs in the blood stream, reducing the amount of free circulating drug, this reduces the drugs bioavalabiity |
|
|
Term
| What makes chemical reactions catalyze or speed up? |
|
Definition
enzymes
ex. some drugs are enzyme inhibitors such as the cardiovascular class of drugs called ACE-inhibitors |
|
|
Term
| What are the effects on metabolism and metabolic pathways? |
|
Definition
| the product of one enzyme becomes the substrate of the next enzyme in the sequence. drugs may end up blocking reaching the final product |
|
|
Term
|
Definition
| prevent normal physiologic activity of cell pumps. Proton pump inhibitors prevent the release of H+ from gastric parietal cells and are therefore useful in treating gastric acid conditions like peptic ulcer disease. |
|
|
Term
| How can St. John's wort affect the serotonin levels? |
|
Definition
Excessive activation of serotonin receptors due to combination of two serotonergic drugs (e.g. St. John’s wort plus SSRI med or other serotonergic agent)
DO NOT use with MAO inhibitors or othr SSRI agents and also some TCA antidepressants |
|
|
Term
| How does St. John's wort affect the CYP3A4 biotransformation pathway? |
|
Definition
This causes REDUCED efficacy of drugs that also use this pathway
Examples of reduced efficacy of other primary therapeutic drugs:
• protease inhibitors (for HIV – develop complications of AIDS)
• oral contraceptives (OCs, OCPs — unplanned pregnancy)
• cyclosporine (organ transplant rejection)
• theophylline
• reduced digoxin level
• reduced warfarin levels (clotting) |
|
|
Term
| How does St. John's wort affect the glycoprotein transporter interaction? |
|
Definition
Affects the GP transporter, needed to absorb many drugs and also affects hepatic absorption of many drugs
Many drug interaction possibilities, including critical dose AIDS drugs |
|
|
Term
| UNLESS you are an expert in herbal medicine, if a patient asks your advice regarding the use of these products ALWAYS warn: |
|
Definition
1) may have INTERACTIONS with prescribed and OTC drugs (e.g. warfarin anticoagulant and many herbals, grapefruit/pomegranate juice & many drugs)
2) may have issues with purity and dosing variability
3) may have issues with long-term (e.g. zinc) use AS WELL as short-term use (e.g.
echinacea)
4) may affect a clinical condition (e.g. cinnamon & glucosamine and blood sugar levels in diabetes
5) may have organ toxicity (e.g. hepatitis with black cohosh)
6) may have allergic reaction (e.g. echinacea, chamomile and daisy allergy) |
|
|
Term
| GRAPEFRUIT JUICE AND DRUG INTERACTIONS: What is it used for? |
|
Definition
| Often sold in combination with other herbs to promote weight loss. |
|
|
Term
|
Definition
affect the water balance of the body's compartments ex. swollen feet in diabetics
ex. osmotic diuretics that draw water into the bloodstream ( pee more) |
|
|
Term
| What are Pleiotrophic effects? |
|
Definition
the drug may have effects on the body beyond what is expected from its MOA
ex. statin drugs have a MOA that prevents synthesis of cholesterol in the liver, but other effects include beneficial effects o the body's blood vessels and stabilizing atherosclerotic plaque |
|
|
Term
|
Definition
naturally restore the normal balance of of the bactrial flora in the body. It is usually given with antibiotics to prevent associated diarrhea
ex. Lactobacillus and Saccharomyces ( found in supplements as well as natural sources like buttermilk and active culture yogurt. |
|
|
Term
|
Definition
most drugs originated in some form in nature
designed totally in the lab |
|
|
Term
| What is the MECHANISM OF INTERACTION for grapefruit juice? |
|
Definition
o Grapefruit inhibits the CYP 3A4 enzyme path for a long time (hours to full day), so
it doesn't help to separate the grapefruit from the drug by a few hours.
o Even as little as 200 mL per day (4-6 ounces) will cause significant clinical changes
in serum amounts of drugs affected by CYP3A4, mostly due to intestinal inhibition
(thus affects drugs that have low bioavailability due to low absorption)
o Larger amounts (> 1 quart) affect liver CYP enzymes
|
|
|
Term
| What is a randomized control trial? |
|
Definition
both the investigator and the pateint are unaware of who is getting the placebo and the active drug. (double blind)
subject cohort groups are matched by age, sex, and other clinical criteria
statistical analysis tells us if we can trust the results |
|
|
Term
| What is statistical significance? |
|
Definition
| it is .05 or less (results are less then 5% due to chance- difference int he treatment group actually exists. |
|
|
Term
| What is a confidence interval? |
|
Definition
| of 95+%, the process is right 95% of the time- gives you a more narrow range of those needed to treat to arrive at the result |
|
|
Term
| What is the Pediatric rule? |
|
Definition
| FDA allows for drugs to be tested on kids |
|
|
Term
|
Definition
True Randomized control testing fails to show evidence of actually benefits in herbal products.
ex. Echinachea is used to prevent Rhinovirus (common cold) failed to show this benefit |
|
|
Term
| what are some examples of statin drugs that will have an adverse effect with grapefruit juice? |
|
Definition
1. lovastatin (Mevacor)
2. simvastatin (Zocor)
3. atorvastatin (Lipitor) |
|
|
Term
| What kind of effect does statin drugs have with grapefruit juice? |
|
Definition
causes increased chance of serious AEs such as rhabdomyolysis & myopathy (toxic side effects of these drugs)
--- drug levels are raised from CYP 3A4 interaction |
|
|
Term
| What are drugs that have AE with grapefruit juice? |
|
Definition
1. lovastatin (Mevacor)
2. simvastatin (Zocor)
3. atorvastatin (Lipitor)
4. nefedipine (Procardia)
5. other DHP CCBs
6. triazolam (Halcion)
7. cyclosporine
8. imipramine
9. caffeine |
|
|
Term
| What recommendations would you give to patients taking grapefruit juice? |
|
Definition
1. shouldn't eat grapefruit or drink grapefruit juice if taking ANY drug metabolized by the 3A4 enzyme path of the CYP 450 system (many, many drugs)
2. don’t even offer grapefruit juice as a choice on the diet
menu |
|
|
Term
| Pomegranate juice has the same concern as grapefruit juice |
|
Definition
| Pomegranate juice has the same concern as grapefruit juice |
|
|
Term
| cross-reactions to food allergies |
|
Definition
| may be a cause to allergic reactions to herbal medicine |
|
|
Term
| What are some types of food reactions? |
|
Definition
1. Food hypersensitivity & food anaphylaxis
2. Food intolerance
3. food toxicity
4. Food idiosyncrasy |
|
|
Term
| Give an example of Food hypersensitivity & food anaphylaxis |
|
Definition
strawberries
wine
egg whites
tomatoes
citrus |
|
|
Term
| Give an example of food intolerance |
|
Definition
malabsorption syndromes:
gluten sensitive enteropathy of celiac sprue
lactose intolerance |
|
|
Term
| Give an example of food toxicity |
|
Definition
posioning
-food, additive, toxins from microbes |
|
|
Term
| examples of food idiosyncrasy |
|
Definition
| reaction to MSG in Chinese restaurant syndrome |
|
|
Term
| What is an Open-label drug trial? |
|
Definition
investigator and pt are aware of the therapy (not blinded)
this may create a bias
usually a head-to-head trial of two drugs for the same symptom to see which one works better |
|
|
Term
| What comes first the brand name or the generic name? |
|
Definition
|
|
Term
| Who sets the bio equivalence of generic standards for drugs? |
|
Definition
| United States Pharmacopeia (USP) |
|
|
Term
| Clinically, how do they test for allergy? |
|
Definition
| skin tests are gold standard |
|
|
Term
| Note: Food allergen labeling now required by the FDA |
|
Definition
• Passage of Food Allergen Labeling and Consumre Protection Act (FALCPA) in 2004
• Will label with scientific as well as common names (e.g. use “casein” and “milk”) so that consumers (especially children) can read labels and avoid allergens
• Will include the 8 major food allergens that account for 90% of reactions |
|
|
Term
| What are the early clinical findings in food or herbal allergies? |
|
Definition
| itchy swollen lips/mouth/tongue, rhinorrhea, itchy eyes |
|
|
Term
| What are the progressive clinical findings in food or herbal allergies? |
|
Definition
dysphagia
abdominal cramps
diarrhea
hives
angioedema |
|
|
Term
| What are the severe clinical findings in food or herbal allergies? |
|
Definition
stridor
bronchospasm
nausea
vomiting
hypotension
death |
|
|
Term
| What are treatments for food/herbal allergies? |
|
Definition
1. symptomatic relief & respiratory/cardiovascular support.
2. Pharmacologic treatment includes:
1. high-dose antihistamines
2. bronchodilators
3. corticosteroids
4. fluid bolus
5. epinephrine
6. vasopressor support |
|
|
Term
| What is a critical dose drug? |
|
Definition
| a very consistent blood level is required for this drug that cannot vary, usually substitution is denied |
|
|
Term
| When is off-label drug use? |
|
Definition
When there is no label-approved drug
No label approved drug for that age group
also called unlabeled indications or unapproved.
NOT MALPRACTICE |
|
|
Term
| What must a provider do with off label prescribing? |
|
Definition
disclosure to pt: "this drug is for pain but im giving it to you for your cough"
carefully document
ex. Nifedipine ( a calcium channel blocker) is used to prevent Raynauds since it is a peripheral vasodilator |
|
|
Term
| What are the 4 phases used for new drug development? |
|
Definition
pre phase: animal testing
Phase 1: only in healthy individuals
Phase 2: in pts diagnosed with the disease
Phase 3:larger number of pts, and then new drug is filed for approval from FDA
Phase 4: post-marketing, ethical requirement to report any drug problems to FDA |
|
|
Term
| Is there a cross reactivity of foods, herbals, and nutritional supplements? |
|
Definition
| YES, there IS cross-reactivity within the botanical families |
|
|
Term
| cross reactivity of foods, herbals, and nutritional supplements, LIST some examples: |
|
Definition
--plants in same botanical family (legumes, real nuts, citrus)
-- marine animals of same family (crustaceans, mollusks, bony fish)
-- birch pollen & apple
-- ragweed pollen & melon
-- latex & many foods (banana, avocado, kiwi, chestnut, soybean, peanut)
-- if allergic to ragweed or daisies may suffer hypersensitivity reactions to Echinacea or Chamomile herbal products because these are daisies! |
|
|
Term
| What does cross-reactivity mean? |
|
Definition
| Cross-reactivity means that if you are allergic to one thing, there is a very good chance you will be allergic to other, related chemicals |
|
|
Term
| What are some foods you must ask the patient about if they have a latex allergy? |
|
Definition
***banana, avocado, kiwi or chestnuts***
The following foods can cross-react and may cause symptoms in patients with latex allergy:
Avocado
Banana
Celery
Cherry
Chestnut
Fig
Grape
Hazelnut
Kiwi
Melon
Nectarine
Potato
Papaya
Pineapple
Peach
Plum
Rye
Strawberry
Tomato
Wheat |
|
|
Term
| What are some food additives? |
|
Definition
1. sulfites
2. MSG
3. food dyes |
|
|
Term
| Why are sulfites used in food? |
|
Definition
Bacterial inhibitors
anti-fermentors
preservatives
anti-browning for vegetables |
|
|
Term
| Sulfites in food can cause an asthmatic symptom, what is the mechanism that causes this symptom? |
|
Definition
| sulfur dioxide may be released and cause bronchospasm (like an asthma attack) |
|
|
Term
| What is the diagnostic and treatment for sulfite allergens? |
|
Definition
Reactions confirmed with oral challenge in supervised setting only (ready to administer life-saving treatment for acute anaphylaxis)
Treatment: avoidance |
|
|
Term
| What are symptoms of Chinese Restaurant symdrome? |
|
Definition
within 15-20 minutes after ingestion headache, occipital burning;
note that asthmatics more susceptible & reaction may be more severe |
|
|
Term
| What can food dyes cause to people with a food dye allergy? |
|
Definition
Urticaria: azo dyes with an (-N=N-) group, e.g. tartrazine
non-Azo don't cause urticaria. |
|
|
Term
|
Definition
drugs with limited usage for really rare diseases
FDA gives incentive to companies research and produce them |
|
|
Term
| What is the Center for Drug evaluations and research sites? |
|
Definition
| In charge of current drug review policies, procedures and timelines |
|
|
Term
| What is the Drug Safety Initiative? |
|
Definition
| Aims to provide drug info to consumers with links for drugs |
|
|
Term
| What are drug registry programs? |
|
Definition
Pharmacist check for providers specific cerification.
Prescribing requires blood tests, and special monitoring
ex. accutane |
|
|
Term
|
Definition
assigned by the FDA
unique identifier number for all human drugs |
|
|
Term
|
Definition
| amount of time needed for the plasma concentration to drop by 50% after the drug is discontinued – determines how long the drug remains in the system |
|
|
Term
| How long will a therapeutic effect be continued for? |
|
Definition
until a STEADY STATE LEVEL is reached in the plasma
takes about 4-5 half-lives of ANY drug |
|
|
Term
|
Definition
A strategy to get a higher serum level immediately
A larger dose is used for the first dose |
|
|
Term
| What is the problem with using a loading dose? |
|
Definition
| possible increase in initial temporary toxicity |
|
|
Term
| What does it mean to maintain a dose? |
|
Definition
| to maintain the steady state of the drug |
|
|
Term
| What is continuous infusion regimen? |
|
Definition
| you want to make sure there are no peaks or troughs, but STILL TAKES 4-5 HALF-LIVES OF TIME TO REACH STEADY STATE |
|
|
Term
| What is the prescriber information aka package insert? |
|
Definition
| includes data about the RCTs, warnings, prescribing guidance, how supplied, dosing ect |
|
|
Term
| What is the VAERS Vaccine adverse events reporting system? |
|
Definition
Only for vaccine-related injuries or adverse effect reporting
financially compensate a child for a significant adverse event or disability |
|
|
Term
| What is the Black box warning? |
|
Definition
|
|
Term
| What is the Black box warning? (BBW) |
|
Definition
| Put at the top of a Prescribing Information for the drug highlight a serious adverse effect |
|
|
Term
|
Definition
| The pt takes the medication as prescribed, implies controlling the pt |
|
|
Term
|
Definition
| pt takes the medication as prescribed and follows through on other elements of the management plan, such as diet and exercise. This term implies partnership |
|
|
Term
|
Definition
| continued administration results in decreased response to the same dose, higher dose will be needed to obtain same effect |
|
|
Term
|
Definition
| when tolerance develops rapidly |
|
|
Term
| What does dependence mean? |
|
Definition
| It means that if the drug is stopped withdrawal syndrome will occur |
|
|
Term
| What is cross-dependence? |
|
Definition
drugs within the same class can be used to prevent or relieve the symptoms of withdrawal from another drug in the same class
ex. replace alcohol with Librium to prevent withdrawal delirium tremors reaction (both sedative hyponotics) |
|
|
Term
| What is psychological dependence? |
|
Definition
| sometimes also called addiction; feelings of saticfaction and desire to repeat drug experiences despite knowing the drug is causing harm |
|
|
Term
| What is Intermittent dose regimen ? |
|
Definition
has peaks and troughs, reaches steady state after 4 - 5
half-lives. |
|
|
Term
| What can occur with intermittent dose regimen? |
|
Definition
| With the intermittent dose regimen, toxicity can occur at peaks, and lack of drug effect (pain, HTN, arrhythmia) can occur at troughs. |
|
|
Term
| What is recreational drug use? |
|
Definition
implies episodic use without dependence, often practiced with rituals and in the company of others
ex.) marijuana |
|
|
Term
|
Definition
| limitations of what drug can be prescribed to the pt |
|
|
Term
| What does accuracy of medication depend on? |
|
Definition
1. dose calculations
2. medication process |
|
|
Term
| what are the 3 CHECKS OF MEDICATION ADMINISTRATION? |
|
Definition
– FIRST check is when you receive the medication (check lable)
– SECOND check is when you prepare the medication (tablets in med cup, pour
liquid)
– THIRD check is when you physically bring the medication to the patient |
|
|
Term
| What are the 5 Rights of Medication Administration? |
|
Definition
– RIGHT patient (two identifiers, e.g. arm ID band and self-verbalization)
– RIGHT drug (check the label & prescription/order)
– RIGHT dose
– RIGHT route
– RIGHT time
*RIGHT reason
*RIGHT documentation |
|
|
Term
| What are the different types of measuring systems? |
|
Definition
Metric system
Apothecary system
Household system
Avoirdupois system |
|
|
Term
| IV drip calculation formula |
|
Definition
drops/min =
[mL of solution prescribed per hr * drops delivered per mL]
60 min/hr |
|
|
Term
| The joint commission on the Accreditation of Healthcare Organizations mandated that medical reconciliation be done.. what is this? |
|
Definition
| When pts go to different medical facilities, make sure the pt is getting the correct drugs; critical area for medication error |
|
|
Term
What are fixed drug combinations?
What are the benefits and drawbacks? |
|
Definition
this is putting two drugs into one
Benefits: reduce pill burden
possibly less cost
Drawbacks: the prescriber cant change the dose of an individual compartment |
|
|
Term
| What is efficacy in drugs? |
|
Definition
| the degree to which a drug is able to induce maximal effects of the defined outcome |
|
|
Term
|
Definition
child’s dose =
(age in months x adult dose)
150
|
|
|
Term
|
Definition
child’s dose =
(child’s age in years x adult dose)
(child’s age + 12) |
|
|
Term
| What are dose response curves? |
|
Definition
| Plots the dose of the drug vs the response |
|
|
Term
| What is drug discontinuation and what is important about it? |
|
Definition
Some drugs CANNOT be abruptly stopped.
Suddenly stopping may cause:
1. many anti-hypersensitivities ( especially vasodilators can cause acute vasoconstriction hypersensitivity. BAD)
2. SSRI (selective serotonin reuptake inhibitors) antidepressants may cause withdrawal symptoms
3. epilepsy drugs may induce seizures |
|
|
Term
| Toxicity and Adverse Effects may be caused by one of 3 things |
|
Definition
1. Primary Pharmacologic effect
2.SEcondary pharmacologic effect
3. idiosyncratic (unrelated) |
|
|
Term
| What are adjunctive drugs? |
|
Definition
these are drugs added to the primary drug so that smaller dose of the primary drug may be given with lower toxicity
ex. often see in chemotherapy pts |
|
|
Term
|
Definition
| rate at with 50% of the population will show this toxic effect |
|
|
Term
|
Definition
dose at with 50% of the population will die
from animal studies or accidental overdoses in humans |
|
|
Term
| What does the therapeutic index (selective toxicity) mean? |
|
Definition
It is the margin of safety of a drug ( how far the therapeutic dose is from the toxic dose)
NArrow margin of safety may be tolerated when treating a fatal illness
ex. AIDs, anit-cancer drug |
|
|
Term
| What are the two drugs that can not enter the placenta? |
|
Definition
|
|
Term
| What can cross the placenta membrane? |
|
Definition
|
|
Term
| During which gestational age of the fetus will there be a teratogenic effect? |
|
Definition
|
|
Term
| after day 60, what can a teratogen cause? |
|
Definition
| day 60 onward causes abnormal cell growth & organ development |
|
|
Term
| What are factors to consider for fetal safety? |
|
Definition
1. gestational age
2. how much dose was received?
3. length of exposure; how long it was administered
4. individual fetal genetic susceptibility. you can never predict EXACT fetal effects |
|
|
Term
| What is the therapeutic window? |
|
Definition
efficacy (produce maximal effects) vs. safety
what dose range gives us benefit without toxicity
ex. Theophylline has a therapeutic window of a serum level from 5-15 mcg/mL |
|
|
Term
| What is an adverse drug reaction? |
|
Definition
| reaction that occurs that is not the expected therapeutic response to a drug (NOT predicted or expected) |
|
|
Term
| When talking about medication errors, what is a near miss and what is a preventable adverse event |
|
Definition
near miss: a mistake that has not caused harm
preventable adverse event: harm is caused by mistake |
|
|
Term
| What are the three types of ADR? |
|
Definition
1. dose-related (toxic)
2. predictable (side effects)
3. immunologic or idiosyncratic |
|
|
Term
| What are the three types of ADR? |
|
Definition
1. dose-related (toxic)
2. predictable (side effects)
3. immunologic or idiosyncratic |
|
|
Term
| What should you document during the nursing history of a patient? |
|
Definition
1. reproductive and nursing status
2. last menstrual period (LMP)
3. birth control (BC)
4. lactation history |
|
|
Term
| What are the 5 labeling categories for teratogenicity? |
|
Definition
Category A
Category B
Category C
Category D
Category X |
|
|
Term
|
Definition
possibility of fetal harm is remote.
Example: levothyroxine (Synthroid) |
|
|
Term
|
Definition
fairly safe, but not proven completely safe.
Example: cephalexin (Keflex) |
|
|
Term
|
Definition
animal studies have revealed an adverse effect OR studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus. Clinical judgment regarding this risk/benefit ratio is needed.
Example: Betaxolol eyedrops (Betopic) for glaucoma. |
|
|
Term
|
Definition
evidence of human fetal risk, but benefits from use in pregnant women may be acceptable despite the risk. This drug may be needed in life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective.
Example: fludarabine phosphate (Fludara), an anti-leukemia drug |
|
|
Term
|
Definition
studies in animals and humans have demonstrated fetal abnormalities, or there is evidence of fetal risk based on human experience, or both. The risk of using the
drug in pregnant women clearly outweighs any possible benefit. ABSOLUTELY CONTRAINDICATED in pregnancy, or in women who may become pregnant. If pregnancy category X, NEVER EVER USE IF POSSIBLY PREGNANT OR COULD BECOME PREGNANT !!!
Example: isotretinoin (Accutane) |
|
|
Term
| Drugs during pregnancy guidelines |
|
Definition
1. Try to avoid
2. Check on the drug before prescribing and use current resources |
|
|
Term
| What is a drug that was once considered safe in all trimesters, but now is not safe in any trimesters? |
|
Definition
|
|
Term
| What are the symptoms for an allergic drug rash? |
|
Definition
| sudden, itchy, small red papules; usually starts on the trunk and spread to the limbs |
|
|
Term
| What is the time frame for allergic drug rash? |
|
Definition
usually occur 1-3 weeks after initial exposure to the drug and happen 2-3 days after starting drug if there was prior exposure
drug examples: common with beta lactam & sulfonamide
interventions: stop drug immediately, may need antihistomine |
|
|
Term
| What are drugs that a pregnant woman should NOT take? |
|
Definition
1. antimicrobials
2. antivirals
3. HTN drugs
4. anticonvulsants
5. systemic corticosteroids
6. anticoagulants
7. analgesics
8. antiemetics
9. URI (nasal congetion & cough)
10. NSAIDs
11. Antidepressants
12. Pruritis
13. Acne
14. Statins |
|
|
Term
| What are the symptoms, time frame and examples of anaphylaxis? |
|
Definition
Symptoms: dyspnea, uticaria, angioedema, flushing, GI symptoms (nausea vomiting)
timeframe: within minutes after contact but may take several hours |
|
|
Term
| What are interventions for Anaphylaxis? |
|
Definition
assess ABCs
administer epinephrine
may need glucagon (if on beta blockers) to raise BP and blood glucose
place supine |
|
|
Term
| Which drug causes the famous "gray baby syndrome?" |
|
Definition
|
|
Term
| What is Type one hypersensitivity? |
|
Definition
anaphylaxis, true allergy IgE
bronchospasm, urticarial (rash), upper airway edema |
|
|
Term
| What is type 2 hypersensitivity? |
|
Definition
| example is hemolysis (destruction of RBC) from the beta-lactam antibiotic such as penicillin |
|
|
Term
| What is type 3 hypersensitivity? |
|
Definition
also called serum sickness
arthralgias, pupuric rash, fever
due to decomp of immune complexes
most commonly with antibiotics such as : penicillin, aspirin, sulfonamides |
|
|
Term
|
Definition
| delayed allergic reaction )type 3 hypersensitivity) |
|
|
Term
| What is hypersensitivity 4? |
|
Definition
contact dermatitis
ex. can occur with topical antihistimines |
|
|
Term
| What are T-cell activation |
|
Definition
cutaneous drug reaction independent of IgE, also called fixed drug reactions
typically a morbilliform drug rash of ampicillin and sulfa drugs |
|
|
Term
Fats/ligand-induced apoptosis
What does ERYTHEMA MULTIFORME progress into? |
|
Definition
| Stevens-Johnson syndrome (SJS) |
|
|
Term
| what is Stevens-Johnson syndrome (SJS)? |
|
Definition
| skin ulceration and blisters that is severe and can lead to blindness |
|
|
Term
| Which drugs can cause Fats/ligand-induced apoptosis? |
|
Definition
1. sulfa drugs
2. allopurinol
3. anticonvulsants |
|
|
Term
| Which drugs can cause lupus-like syndrome and anemia? |
|
Definition
1. procainamide
2. quinidine
3. phenytoin
4. hydralazine |
|
|
Term
| What are symptoms of an anticonvulsant hypersensitivity syndrome? |
|
Definition
1. fever
2. rash
3. hepatitis |
|
|
Term
| What is pharmacokinetics? |
|
Definition
what the body does to the drug
ADME: absorption/distribution/metabolization/excretion |
|
|
Term
| What affects the rate and amount of drug transfer to the blood? |
|
Definition
|
|
Term
| Why are there barriers to absorption? |
|
Definition
| Because the drug much pass through multiple barriers to reach target tissue receptors |
|
|
Term
| What determines the distribution barriers? |
|
Definition
|
|
Term
| Where could you find water soluble membranes? |
|
Definition
| wet layer lining gut cells and bloodstream |
|
|
Term
| Where would you find lipid soluble membranes? |
|
Definition
|
|
Term
| What is biotransformation? |
|
Definition
metabolization;
Chemical rxns in the body that either inactivate drugs or make them more water-soluble for easier renal excretion |
|
|
Term
| Where does the FIRST PASS EFFECT or FIRST PASS ELIMINATION take place in? |
|
Definition
|
|
Term
| All ORALLY ADMINISTERED DRUGS will be absorbed in with organ first? second? |
|
Definition
| Absorbed in the GI tract adn go to the liver via the hepatic portal vein |
|
|
Term
| After passing through the liver, will more or less drug be delivered through the body? |
|
Definition
|
|
Term
| What factors are important to consider when thinking about the metabolization of drugs? |
|
Definition
1. liver blood flow
2. type of drug
3. other drugs being taken
4. genetic and disease factors |
|
|
Term
| Which enzyme is responsible in performing biotransformation? |
|
Definition
hepatic enzymes
CYP450 series of enzymes |
|
|
Term
| How can there be an increased drug level in the body in infants/children and geriatric patients when administering drugs? |
|
Definition
Because they may not have full activity of the hepatic enzymes and CYP450 series of enzymes
drug-drug interactions |
|
|
Term
|
Definition
IF THE PARENT DRUG IS A PRO-DRUG, biotransformation actually converts it into active drug
example: amitriptyline (Elavil) is converted to nortriptyline (Pamelor) as the active metabolite |
|
|
Term
|
Definition
| the chemical that results from biotransformation |
|
|
Term
| Give an example of a toxic metabolite |
|
Definition
| aspartame: will form formaldehyde |
|
|
Term
| What is the first order kinetics? |
|
Definition
the rate of elimination depends on the concentration of the drug in the plasma
(more drug in the plasma takes longer to eliminate; and vice versa) |
|
|
Term
| What is ZERO ORDER KINETICS? |
|
Definition
| some special situation exists that causes the rate of elimination to be "constant" and not be related to the drug concentration in plasma |
|
|
Term
| How does the body excrete drugs/waster? |
|
Definition
| Renal but also perspiration and GI route |
|
|
Term
| What is addition when we talk about drugs? |
|
Definition
the response of combined drug is additive (1+1=2)
Example: adding 2 BP drugs, each drops the SBP by 5 points, using them together will drop the SBP by 10 points |
|
|
Term
| Describe what synergism is. |
|
Definition
effect achieved by using combined drugs is greater than would be predicted than by simple additive effects often due to COMPLEMENTARY EFFECTS of drug MOA.
Example: adding 2 BP drugs, each drops the SBP by 5 points, using them together will drop the SBP by 15 points |
|
|
Term
|
Definition
a drug with no effect will enhance the effect of another drug
Example: adjuvant drugs used in combination with the primary therapeutic drug |
|
|
Term
|
Definition
| one drug inhibits the effect of another drug |
|
|
Term
| What is the disease effect? |
|
Definition
disease condition may affect metabolism of drugs
Example: reduced biotransformation of drugs in liver disease (e.g. cirrhosis) as well as in
cardiac disease (reduced liver blood flow) resulting higher than normal drug level |
|
|
Term
|
Definition
amount of unchanged drug that reaches the systemic circulation
Affects onset of drug action AND duration of drug action
Often affected by protein binding to albumin and the amount of free, active drug |
|
|
Term
|
Definition
oliver and other enzyme systems convert drugs to water soluble chemicals that can
now be excreted renally into the urine
Clinical: renal impairment (e.g. geriatrics) toxic high levels of drug |
|
|
Term
|
Definition
Hepatic enzymes biotransform drugs, then metabolites are excreted via bile to gut
and excreted in feces
Clinical: reduced hepatic perfusion (e.g. heart failure, geriatrics) -->buildup of
drugs in body. |
|
|
Term
| What are common types of drug-drug interactions? |
|
Definition
o Competition for drug biotransformation pathways causing a drug to either be
increased in level (toxicity) or decreased in level (subtherapeutic)
o Competition for excretion pathways (increase levels & toxicity)
o Possible physiologic interactions
• special transporters in the GI tract pump oral drugs back into the intestine, reducing
bioavailability (called the P-glyoprotein transporters)
• drugs can affect the function of these transporters |
|
|
Term
| Drug-drug Interactions due to biotransformation interactions: |
|
Definition
• Enzyme inhibition: drugs that inhibit the biotransformation enzymes result in increased
levels of drugs in the body
• Enzyme induction: some drugs “induce” (make more of) the biotransformation enzymes,
resulting in decreased levels of drugs in the body
• Shared pathway interactions: if two drugs need to use the same biotransformation
pathway, they have to “wait to take their turn” and thus increases levels of both drugs |
|
|
Term
| How can the possibility of drug-drug interactions be minimized ? |
|
Definition
• continued awareness of potential for drug interactions --> increased monitoring
• possibly choose a different drug if interactions are a concern
• educate patients regarding dietary influences on drugs
• warn patients about potential drug-drug interactions, and educate regarding symptoms of
toxicity or symptoms of drug ineffectiveness |
|
|
Term
| Recognition of special drug toxic effects – LQTS (Long QT Interval Syndrome) |
|
Definition
• Causes sudden loss of consciousness (LOC) and death
• EKG findings are QT interval prolongation and tachycardia
• The fatal arrhythmia is “torsades de pointes”
o This syndrome can be inherited (more predisposed, even without drugs)
(congenital LQTS)
o This syndrome may occur in ANYONE with certain drugs or drug combinations
o May be more common in antibiotic drugs |
|
|
Term
| What is Pharmacogenomics? |
|
Definition
Understanding the human genome to BOTH explain and PREDICT drug reactions:
* adverse drug reactions
* differences in efficacy between individuals and groups
* tailoring drug therapies based on
* and more (use your imagination)
* human genome project |
|
|
Term
| Examples of pharmacogenomics in current practice? |
|
Definition
---Those with pseudocholinesterase deficiency should not receive the muscle relaxant succinylcholine (Anectine)
---Asians need reduced dose of rosuvastatin (Crestor)
---Bidil (isosorbide + hydralazine) for HF in African-Americans as a racial
subgroup |
|
|
