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Pharmacology OTD > QUIZ 1 > Flashcards

QUIZ 1 Flashcards

1
Q

Why should OT students study pharmacology – 4 main reasons

A
  1. Understand patient’s responses to different drugs
  2. Determine ideal therapy schedule
  3. Learn to recognize drug therapy interactions
  4. Recognize adverse drug reactions and report them
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2
Q

What is Pharmacology?

A

-Study of how chemical substances affect living tissues
-How chemical agents bind to receptors to enhance or inhibit normal function

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3
Q

What is Pharmacotherapeutics

A

use of agents to prevent, dx, and cure disease

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4
Q

2 areas of Pharmacotherapeutics:

A
  • Pharmacodynamics: What the DRUG does to the BODY (mechanism of action)
  • Pharmacokinetics: What the BODY does to the DRUG (ADME) (how fast)
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5
Q

What is Toxicology?

A

study of neg. effects of chemicals on living things

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6
Q

What does ADME stand for?

A

A: Absorption (phase 1)
D: Distribution (phase 2)
M: Metabolism (phase 3)
E: Excretion (phase 4)

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7
Q

List the Enteral routes of administration

A
  • Oral
  • Rectal
  • Sublingual (under tongue, ie nitroglycerin)
  • Buccal (in cheek)
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8
Q

List the 2 primary routes of administration

A
  1. Enteric
  2. Parenteral (injection)
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9
Q

List the parenteral routes of administration

A
  • IV
    directly into vein
  • Subcutaneous
    under skin to fat
    faster than oral but slower then IM
    rate is variable depending on the site
    ex: insulin
    heat, exercise, massage of the area will facilitate absorption
    limb mobility or vasoconstriction from cooling will slow absorption.
  • Intramuscular
    into skeletal muscle ie. flu shot
  • Epidural
    into spinal column outside of dura
  • Intrathecal
    delivered to cerebrospinal fluid (CSF) to get to CNS
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10
Q

Potential Problems with IV

A
  • IV has most potential for harm
  • Clot or infection of IV site
  • Goes directly into the blood
  • Potential for most harm if incorrect drug or dose administered
  • Must be performed slowly as IV push
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11
Q

Most convenient administration route

A

ORAL
- Tablet, capsule, or liquid
- Absorbed across cell membranes or carrier mediated transporters
- Tablets or capsules must disintegrate to release the drug before absorption can take place
o Immediate release
o Extended release
o Enteric–coated ( prevents drug from being absorbed in the stomach until it reaches the intestines)

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12
Q

Breakdown of drugs in GI tract may occur due to:

A
  • Enzymes
  • Bacteria present in GI tract
  • Acidic environment
  • Efflux pumps – pump medication back out into GI tract for elimination
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13
Q

Examples of Inhalation

A
  • Inhaled anesthetics – induce sleep quickly
  • Bronchodilators
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14
Q

Examples of Topical

A
  • Cream, lotion, ointment, eye and ear drops
  • Not as much systemic absorption unless skin is broken
  • Bypasses first pass metabolism by the liver
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15
Q

What is Bioavailability?

A
  • The fraction of a given drug that is actually absorbed into the body’s blood stream from the site of administration
  • Example: Fosamax (1-10% oral bioavailability) used for osteoporosis: given on empty stomach 30 min before meal
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16
Q

What is Absorption?

A

How the drug gets absorbed into the body.

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17
Q

What is Distribution?

A
  • VD = volume of distribution
  • Once a drug enters circulation it is then distributed throughout the body
  • Total of drug concentration in body / plasma concentration
  • If volume of drug is bound to plasma the VD will be small
  • If the volume of drug is bound to tissue VD is large
  • If a drug is highly bound to plasma proteins, not a lot of drug is available for response
  • Only free drug is able to produce an effect
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18
Q

Potential problems of Distribution:

A
  • Blood brain barrier
  • Fat loving drugs
  • Hard for water soluble drugs to cross blood brain barrier
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19
Q

What is Metabolism?

A
  • How a drug is inactivated and prepared for elimination
  • Primarily a function of the liver to decrease drugs lipid solubility and inactivate drug
  • 2 phases:
  • Phase 1 = metabolism
    Inhibitor = grapefruit juice
    Inducer = cig smoke
  • Phase 2 = inactivation of the compound to make it less lipid soluble
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20
Q

What is Excretion?

A
  • Through urine, saliva, breast milk, tears, sweat, lungs, GI, urine and feces are most common
  • Renal excretion- glomerular filtration in kidneys through which drugs can be excreted
  • Fecal – uptake of drug into liver
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21
Q

What is half life?

A

t ½
- The time it takes for ½ the drugs concentration to be eliminated from the body
- Most drugs are considered removed from the body in about 5 half lives
- If a drugs half life is 2 hours multiple that by 5 and then in approx. 10 hours it will be removed.

22
Q

Most common target for action

A
  • Protein molecule with drug binding site
23
Q

Targets for drug action

A
  • Transport molecules
  • Enzymes
  • Nucleic acids
24
Q

Miscellaneous targets for drug action

A
  1. Hormone binds to the receptor
  2. Hormone binding activates the receptor
  3. The activated receptor stimulates a response
25
Q

4 types of receptors:

A
  1. Ion channel linked receptor – action in milliseconds
  2. G protein coupled receptor – action in seconds
    - Crosses membrane 7 x
    - Target of many drugs
  3. Dna coupled receptor – action in hours
    - Hormones, steroids
    - Must be lipophilic to cross membrane
    - Stimulate gene transcription within the cell
  4. Kinase linked receptor – action in hours
    - Target for innovative tx for cancers
    - MISC. RECEPTOR SITES:
    - misc site: ,any diuretics, enzymes
    - non human target: antibiotics
26
Q

MISC. RECEPTOR SITES:

A
  • any diuretics
  • enzymes
  • non human target: antibiotics
27
Q

Drug receptor interactions

A
  • drugs can be receptor specific and selective or not
  • the more specific the drug is: the more targeted the approach can be and
    the fewer side effects
28
Q

Agonistic reaction

A
  • agonist: binds to a receptor and triggers a conformational change which brings a response.
  • when all receptors are bound max effect is seen.
  • partial or full agonists
    after chronic use – receptor # can decrease
29
Q

drug receptor interactions

A
  • Antagonistic or agonistic
30
Q

Non competitive Antagonist

A
  • binds to a receptor and blocks the conformational change preventing the flow of ions into or out of a cell-prevents the response
  • binds to allosteric site (different site than the agonist uses, but same receptor) on the receptor to prevent activation of the receptor
31
Q

Competitive Antagonist

A

Competitive antagonists produce a parallel shift to the right in the dose/response curve for agonists
- can be displaced
- bind permanently on the same site or different site, blocking the agonist but not activating the receptor- therefore, it blocks the agonist’s action.
- after chronic use, receptor # can increase

32
Q

Kefauver-Harris Amendment of 1962

A
  • Also known as the “Drug Efficacy Amendment”.
  • Required drug manufacturers to provide proof of the effectiveness and safety of their drugs before approval .
  • Required drug advertising to be more closely regulated and disclose accurate information about side effects
  • Ex: Thalidomide: was prescribed to help with nausea and insomnia in pregnant women- caused a rare birth defect.
33
Q

How long does drug development take?

A
  • based upon clinical studies and can take up to 12 years
34
Q

Phases of drug development

A
  • preclinical– tissue and animal testing ( 6 yrs)
  • Phase 1 – safety assessment with small population.
  • Phase 2- drug effectiveness study
  • Phase 3 – double blind randomized control trials with other therapies
  • Phase 4- post marketing surveillance - Monitors for drug safety
35
Q

What are orphan drugs

A

Drugs for rare diseases – companies are provided research grants and a streamlined approval process

  • Compassionate use
36
Q

Drug naming and classification

A
  • Chemical name – based on structure and compound
  • Brand name – has a patent
  • Generic name – the official name of the compound
  • Ex. Brand name = Tylenol
    Gen name = acetaminophen
    Chemical name = N -acetyl-p- aminophenol
  • Rx should be written using generic name unless a specific brand is necessary
37
Q

SCHEDULED DRUGS – CONTROLLED SUBSTANCES

A
  • Schedule 1 – most potential for abuse – only avail for research ( LSD, HEROIN)
  • Schedule 2 – high potential for abuse – no refills allowed (STIMULANTS, OPIOIDS)
  • Schedule 3 – lower abuse but can cause dependence – 5 refills in 6 months ( TYLENOL WITH CODEINE)
  • Schedule 4 – lower abuse than above ( TRAMADOL)
  • Schedule 5 – lowest abuse potential ( LIQUID CODEINE)
38
Q

ADVERSE DRUG REACTIONS

A
  • Every drug has a drug risk benefit ratio
  • Types of adverse drug reactions (ADR)
  • Drug/ drug reactions
  • Drug/ food interactions
  • Allergic reactions
  • Doesn’t include human error in admin or patient compliance
  • 1 in 10 admissions is due to ADR
39
Q

ADVERSE DRUG EVENT:

A
  • Anything that can go wrong when a person is administered a drug (including prescribing and administration compliance)
  • Much more inclusive
  • Major players: insulin, warfarin, digoxin
40
Q

SIDE EFFECT:

A
  • minor effect of drug
41
Q

ADVERSE DRUG EVENT AND REACTION: ( ADL)

A
  • serious effect of drug at therapeutic doses
  • neg outcome that occurs while taking but does not imply the drug is the cause
42
Q

WHY DO WE HAVE ADR’s

A
  • most are an extension of what the drug is supposed to do
  • drugs with narrow therapeutic window are responsible for most ADRs
  • pediatric and geriatric pop
  • polypharmacy (multiple meds among dif pharmacies)
  • genetic variations in metabolism
  • organ dysfunction (liver, kidney)
43
Q

CLINICAL ISSUES

A
  • drug admin wrong
  • wrong prescription
  • wrong dose
44
Q

PATIENT ISSUES

A
  • non-compliance (compliance rate of 50%)
  • lapse on warfarin – clotting
  • lapse in antibiotics – develop resistance
  • lapse in seizure meds – seizures
  • lapse in beta blockers – rebound htn
45
Q

OTHER SOURCES FOR ADRS

A
  • sound alike drugs ( hydroxyzine, hyrdraalazine)
  • use brand names vs generic names
  • SALAD ( sound alike look alike drugs)
46
Q

HOW TO IDENTIFY ADRs

A
  • Can be difficult
  • Disease progression
  • May be perceived as new condition or unrelated to drug use

Use the following questions:
- Have the symptoms been reported previously with the same drug?
- Is the timing of the reaction consistent with the dosing schedule
- Did symptoms go away when drug was withdrawn or reduces
- Did symptoms re-appear when drug was re- introduced
- was the correct dose given

47
Q

WHAT TO DO IF YOU SUSPECT AN ADR

A
  • report to pts physician
  • report to medwatch – tracks ADRs
  • FDA decides what to do with that information such as adding it to label or withdraw it from the market
48
Q

DRUG-DRUG INTERACTIONS

A
  • When a second drug is added to the first drug – results in diminished response or additive effect
  • May be beneficial or harmful
    FOOD – DRUG INTERACTIONS
  • Warfarin and leafy green vegetables can lead to increased clots
49
Q

DRUG ALLERGIES

A
  • Range from mild to sever
  • A true drug allergy is immune related and takes 1-2 weeks develop
  • Second re – introduction of the drug causes clinical response
  • Lots of allergies are actually side effects and not a true allergy
50
Q

MANIFESTATIONS OF DRUG ALLERGIES

A
  • Urticarial rash – whealy rash
  • Angioedema – swelling of lips and face
  • Stevens johnsons syndrome – lesions of mucosa and systemic symptoms
  • Blood disorders
  • Testing for allergies can be done but is not routine
51
Q

DRUG INFORMATION RESOURCES

A
  • Evaluate:
  • Author
  • Purpose
  • Objectivity
  • Accuracy
  • Reliability/credibility
  • Currency
  • Links
52
Q

ONLINE RESOURCES and APPS

A

US National library of medicine
Medline plus
Drugs.com (pill identifier)
FDA
Evidence based guidelines
Mayo clinic
Rx list

Pharmacology OTD (5 decks)

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