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3 Cardiopulmonary > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Why should PTs understand pharmacology?

A

medications may alter clinical presentation or course of therapy

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2
Q

Role of PTs in pharmacology

A

monitor for medication adherence
educate on preventative health care
monitor for exercise-induced changes w/medication
identify rehab effects vs drug effects

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3
Q

Drug definition

A

Substance (other than food) intended to affect the structure or function of the body, includes drugs of abuse

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4
Q

Drug names can be…

A

chemical
generic
brand name

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5
Q

Polypharmacy

A

multiple definitions
1. more drugs prescribed than warranted
2. Too many pills to take, pill burden
3. more than 5 drugs a day

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6
Q

Why is polypharmacy a problem?

A

Increased risk of ADRs
Low adherence to drug therapy
Unnecessary healthcare costs (hospitals, $)

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7
Q

Pharmacodynamics

A

why you took the drug in the 1st place

effect of the drug on the body

includes cellular effects by which drugs produce systemic effects

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8
Q

Pharmacokinetics

A

effects of body on the drug
involves absorption, distribution, metabolism, excretion

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9
Q

Absorption

A

HOW do we take it?

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10
Q

Distribution

A

WHERE does it go in the body

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11
Q

Elimination

A

HOW LONG does it stay in the body?
made up of metabolism and excretion

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12
Q

Steps of how new drugs are developed and approved

A
  1. Science and testing on animals
  2. Application to FDA to test on humans
  3. Clinical Trials
    *Phase 1 = max dose & ADRs
    *Phase 2 = effect of drug on disease
    *Phase 3 = placebo vs drug
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13
Q

Dietary Supplements

A

Has to meet these criteria:
1. supplement diets with vitamin, mineral, herb
2. ingestion
3. not food or meal
4. labeled at supplement

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14
Q

Prescription

A

Drug that is authorized by PCP

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15
Q

Over the counter drugs

A

available to any consumer

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16
Q

Risks of over the counter drugs

A

decreased awareness of dosages
increased drug-drug interactions
delay use of more effective meds

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17
Q

Enteral Absorption

A

via the GI tract
oral, sublingual, rectal

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18
Q

Parenteral Absorption

A

bypassing the GI system
Inhalation, Injection, Topical, Transdermal

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19
Q

Advantages of oral

A

Easy
safe–> don’t have to be sterile, and don’t reach peak plasma levels for awhile

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20
Q

Disadvantages of oral

A

must not be destroyed by acidic gastric environment
can cause GI upset
less predictable timeframe to reach effective plasma level

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21
Q

First Pass Effect

A
  1. Drugs are taken up from capillaries in stomach & small intestine and are transported by the hepatic portal vein to liver cells.
  2. Dosage has to be high enough to allow drug to survive enzymes of liver
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22
Q

Factors that affect the rate of GI absorption

A

Blood flow and intestinal motility
Gastric emptying time
Food

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23
Q

Buccal

A

between cheek and gums

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24
Q

Sublingual

A

under tongue

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25
Q

Sublingual and Buccal path of drugs

A

Oral mucosa –> veins –> superior vena cava –> heart
bypasses first-pass effect, so onset is much more rapid

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26
Q

Nitroglycerin

A

used to relieve acute anginal attacks

sublingual and buccal path of drugs

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27
Q

Rectal route

A

typically only used for treating local conditions

unconscious pts, vomiting (positive)
poor absorption, rectal irritation (negative)

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28
Q

Advantages of Parenteral

A

quantity of drug that reaches target site is more predictable than enteral routes

time frame is more predictable

no food, enzyme breakdown, GI issues

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29
Q

Routes of Parenteral

A

Inhalation
Injection
Topical
Transdermal

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30
Q

Inhalation

A

gases or aerosols
rapid entry into bloodstream
excellent for pulmonary conditions

can use nebulizer, spacer, diskus to avoid irritation

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31
Q

Spacer

A

one-way valved holding chamber for aerosolized drugs contained in MDIs
PTs should help to teach pts how to use inhalers

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32
Q

Injection

A

Can get peak drug level to target tissue quickly

easier to overdose, easy to cause infection

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33
Q

Methods of Injection

A

Intravenous
Intra-arterial
Intramuscular
Subcutaneous
Intrathecal
Intra-articular

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34
Q

Intravenous

A

can be a bolus or indwelling catheter

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35
Q

Intra-arterial

A

targets drug to certain tissues

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36
Q

Intramuscular

A

rapid, but stable drug use

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37
Q

Subcutaneous

A

injection directly in deepest skin layer, can be bolus or implanted device

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38
Q

Intrathecal

A

targets drug next to spinal cord, to enable easier bypass of blood-brain barrier

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39
Q

Intra-articular

A

injection into intra-articular space usually drugs to treat joint pain and/or inflammation

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40
Q

TOpical Administration

A

Can be applied to the skin or mucous membranes

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41
Q

Skin Topical Administration

A

drugs applied to skin, with intention of treating skin itself
generally POOR systemic absorption from skin

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42
Q

Mucous Membrane Topical Administration

A

drugs applied to mucous membranes with significant systemic absorption possible

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43
Q

Transdermal vs Topical

A

Goal is different
Drug design or modality used with it

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44
Q

Patches

A

only for transdermal use
only on intact skin
heat-dependent, avoid excessive heat

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45
Q

Indication

A

uses of the drug for a particular condition

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46
Q

ADRs

A

harmful unintended reactions to medicines that occur at doses normally used for treatment

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47
Q

Serious ADRs

A

require intervention by HCP
only had to occur once

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48
Q

Respiratory depression is a characteristic of all

A

opioids

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49
Q

Most common drug classes associated with ADRs

A

opioids
diuretics
anticoagulants

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50
Q

Patients that experience ADRs are more likely to be

A

older
female
have longer LOS
be taking larger number of medications

51
Q

Incidences of ADRs increases with

A

more than 4 meds

52
Q

Types of ADRs

A

Intrinsic ADR
Idiosyncratic ADR
Hypersensitivity ADR

53
Q

Intrinsic ADRs

A

predictable based on properties of the drug
typically dose-dependent
70-80% of ADRs

54
Q

Idiosyncratic ADR

A

unpredictable
can be due to genetic differences in metabolism

55
Q

Hypersensitivity ADR

A

reactions usually occur after prior exposure
dose dependent

56
Q

Dermatologic Toxicity

A

-development of cutaneous disease due to combined effects of drug and light
-NSAIDs, oral contraceptives are common offenders
Pts should decrease sun exposure between 10 AM to 4 PM and wear sun protective clothing

57
Q

Ototoxicity

A

-damage to organs or nerves in the ear, leads to hearing and balance problems
-Lasix/diuretics are common offenders
pts risk increases with renal impairment. Tinnitus should be reported to PCP

58
Q

GI Toxicity

A

-damage to mucosal lining of GI tract
-nausea, vomiting
-nsaids and chemotherapy are offenders
-pts with history of ulcers or older than 60 should be careful with multiple uses of NSAIDs, antiplatelet/coagulants
-report s/s of ulcers
-use lowest effective dose for shortest time

59
Q

Nephrotoxicity

A

Damage to kidney cells or causing renal impairment

-NSAIDs, asprin, acetaminophen
pts should recognize that kidney disease is asymptomatic. identify risk factors, and encourage high-risk pts to decrease NSAID consumption

60
Q

RF for kidney disease

A

DM
HTN
greater than 60 years old
family hx of kidney disease

61
Q

Hepatotoxicity

A

-damage to liver cells or causing liver impairment
-acetaminophen is common offender
pt with liver disease or consume more than 3 drinks a day should avoid acetaminophen

62
Q

CNS Toxicity

A

-observable disruption of normal brain function
-antihistamines, antidepressants are common offenders
pts are vulnerable if they are elderly; should reduce dosage and time frame. recent changes in cognition should be reported

63
Q

CV toxicity

A

many heart medications cause problems
-antihypertensives
-antiarrhythmics

64
Q

Antihypertensives

A

cause orthostatic hypotension
-you should perform transfers slowly
-incorporate cool-down period in exercise
-caution when exiting warm aquatherapy

65
Q

Antiarrhythmics

A

often cause rate and rhythm disturbances
monitor vital signs and pts subjective symptoms

66
Q

Common problems in older adults

A

polypharmacy
altered pharmacokinetics
altered pharmacodynamics

67
Q

Prescribing Cascade

A

prescription to combat ADR of other drug

68
Q

Altered pharmacodynamics causes

A

increased sensitivity to warfarin, benzodiazepines, opiates, NSAIDs

69
Q

PIMS

A

potentially inappropriate medications in older adults
risks tend to outweigh the potential benefits

70
Q

PTs role in managing meds

A
  1. Take complete drug hx or review inpatient charts
  2. be aware of changes in condition
  3. recognize ADRs
  4. Aware of drugs that impact mobility
  5. communicate with PCP
71
Q

Considerations with reviewing pts medication list

A

What has changed?
Total number of medications?
How many meds in same class of drugs?
Timing of medication?
Pt characteristics impacting drug?

72
Q

black box warning

A

strongest warning FDA requires for drugs that may cause serious or life-threatening ADRs

73
Q

bioavailability

A

percentage of drug that actually reaches the systemic circulation
(system/administered)x100

74
Q

Distribution of Drug

A

-movement of drug out of the systemic circulation and into interstitial/intracellular fluids
-volume distribution of a drug is not homogenous within the body

75
Q

Variables that affect volume of distribution

A

blood flow to the tissue
drug binding to plasma proteins (albumin)
tissue permeability
drug binding within cells

76
Q

Meds that easily cross all membranes…

A

take the longest to be eliminated
goes from blood–(brain)–viscera–muscle–fat

77
Q

Why is drug storage a problem?

A

-decreases amount of drug that reaches target tissue
-redistribution of drug as it moves out storage may cause prolonged effects
-potential damage to tissues that are storing drug

78
Q

Tissues that hold drugs for longer

A

adipose tissue
bone & teeth
organs, like liver and kidneys

79
Q

Metabolism

A

chemical alteration of drug to make it inactive and more suitable for excretion from body
liver is primary organ, relies on enzymes

80
Q

Liver enzyme

A

cytochrome P450
CYP = drug metabolizing enzyme

metabolize thousands of compounds
can be induced or inhibited by drugs, supplements, foods

81
Q

Substrate

A

molecule upon which an enzyme acts
birth control is an example of a substrate

82
Q

Inhibitor

A

turns a regular dose into an overdose
decreases the metabolism of a drug, which then increases the blood plasma level of drug

83
Q

Inducer

A

Increases metabolism of drug
decrease effectiveness of drug

84
Q

CYP450 Inducers

A

St Johns Wort
Chronic cigarette smoking

85
Q

Common drug with grapefruit warning

A

Statins

86
Q

Factors affecting drug metabolism

A

Age
Disease
Genetics
Drug/Supplement Interactions
Drug/Food interactions

87
Q

Age and drug metabolism

A

-Older adults have decreased liver mass, blood flow, and CYP450 enzyme activity
-reduced clearance of drugs
-some increased intensity of drugs

88
Q

Disease and Drug Metabolism

A

dysfunction or decreased blood flow to liver or kidney decrease metabolism

89
Q

Genetics and Drug Metabolism

A

slight change in proteins in drug-metabolizing enzymes

90
Q

Excretion

A

physical elimination of the drug from the body

kidney is the primary organ through glomerular filtration

GI and lungs have some roles

91
Q

What affects excretion?

A

health of kidney
blood flow to kidney
pH of urine
degree of protein binding

92
Q

Drug Elimination Rate

A

rate at which drug is eliminated helps determine the dose and frequency drug is prescribed

93
Q

Steady State

A

amount of drug administered during dosing exactly replaces the amount of excreted

94
Q

Half Life

A

amount of time required for 50% of the drug remaining n the body to be eliminated

(Volume of distribution/clearance of the drug)x.7 = half life

95
Q

Why is the knowledge of the half-life of a drug helpful for a PT?

A
  1. to determine whether S/S could be the result of drug’s effect
  2. In pts with decreased clearance an/or increased Vd, usually increase in half life
  3. to monitor and emphasize adherence with dose and frequency of drug administration
96
Q

Nifedipine

A

procardia
calcium channel blocker

97
Q

Dose

A

just the amount

98
Q

dosage

A

amount and frequency

99
Q

What influences dosing schedule?

A

Half Life
Therapeutic index

100
Q

Therapeutic Index

A

therapeutic window
rough indicator of a drug’s safety profile

101
Q

TD

A

Toxic dose, for 50% of people

102
Q

ED

A

effective dose for 50% of people

103
Q

Distribution and Exercise

A

-highly variable
-changes blood flow and perfusion
-can increase serum albumin
-all causes decreased free drug that is available to bind to target cells

104
Q

Metabolism and Exercise

A

-blood flow to liver decreases as ex increases
-may decrease metabolism and increase drug effect
-change in drug protein binding may off-set reduced metabolism

105
Q

Excretion and Exercise

A

-decreases renal blood flow and glomerular filtration rate
-prolonged drug effect because of decreased drug elimination rate

106
Q

Oral absorption and exercise

A

-decreased GI motility and blood flow
-decreased absorption rate, leads to delayed drug effect

107
Q

Transdermal absorption and Exercise

A

ex increases skin temp, blood flow, tissue hydration
-may cause increase in absorption of drug

108
Q

Subcutaneous and intramuscular injections and absorption

A

ex increases blood flow to muscles and subcutaneous tissues
-may cause increase in absorption rate

109
Q

Drug receptor theory

A

-to produce a response, drug must combine with receptor (cell membrane or inside cell)
-physiological response happens after interaction
-receptors respond to neurotransmitters, hormones, drugs, etc

drugs are designed to interact with specific receptors

110
Q

Agonist

A

drug binds to specific receptor and activates it, produces change in cell function. Affinity/efficacy

can either act on ion channel to change permeability, act enzymatically to influence functions, affect gene function

111
Q

Antagonist

A

drug binds to a specific receptor and prevents an endogenous agonist from binding to the receptor. produces no change in cell function. only affinity.

112
Q

Affinity

A

amount of attraction between drug and receptor

113
Q

Selective

A

drug is considered selective if it binds to only 1 receptor subtype and produces a single physiologic response

no drug is perfectly selective

114
Q

Example of agonist

A

albuterol is selective beta-2 adrenergic receptor agonist, binds to and activates beta-2 receptors and smooth muscle of bronchioles

115
Q

Example of antagonist

A

metoprolol is a selective beta-1 adrenergic receptor antagonist, binds to beta-1 receptors on cardiac muscle cells. prevents activation by norepinephrine and epineprhine resulting in decreased HR and BP

116
Q

Dose response curve

A

relationship between drug concentration (dose) and teh magnitude of the drug effect (response)

117
Q

THerapeutic Index

A

estimate of drug safety, assessment of clinical efficacy compared to toxicity. the closer to 1, the more toxic the drug.
TD/ED = TI

118
Q

Low therapeutic index

A

Patients are more likely to have ADRs at therapeutic drug concentrations

Plasma levels of drug are more likely to be monitored (you should measure INR with warfarin)

119
Q

Warfarin

A

Plasma INR should be checked regularly.
begin daily, and then transition to 1-4 weeks depending on kidney function

remember that warfarin has lots of interactions with food, drug, supplements. it works by inhibiting the synthesis of several clotting factors

120
Q

High INR

A

supratherapeutic
higher risk of bleeding

121
Q

Low INR

A

subtherapeutic
higher risk of clots

122
Q

Warfarin Interactions

A

sudden increase in vitamin K increases risk of clotting
sudden decrease in vitamin k increases risk of bleeding

123
Q

Transdermal administration

A

drugs applied to skin when teh intended site of action is beyond the skin
drug must penetrate skin and resist breakdown by enzymes
patches, iontophoresis, phonophoresis assist in release

124
Q

CYP450 Inhibitors

A

Grapefruit
Fluoxetine
Ciprofloxacin

3 Cardiopulmonary (9 decks)

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