Dissolution
Dissolving of smaller particles in GI fluid before absorption
Pharmaceutical Phase
Drug becomes a solution through disintegration & dissolution in order to cross biologic membrane
Disintegration
Breakdown of tablet into smaller particles
Pharmacokinetics
Process of drug movement to achieve drug action
Absorption
Movement of drug particles from GI tract to body fluids
Absorption
Movement of drug particles from GI tract to body fluids…the primary factor affecting drug bioavailability…
Active Absorption
Type of absorption that requires a carrier such as an enzyme or protein to move drug against concentration gradient Requires energy
Pinocytosis
Type of absorption by which cells carry a drug across their membrane by engulfing the drug particles
First Pass Effect
Process by which the drug passes to the liver first AKA Hepatic First Pass
Bioavailability
Subcategory of absorption Percentage of the drug dose that reaches systemic circulation
Protein Binding Effect
A portion of a drug is bound to protein making it inactive & not available to receptors
Distribution
Process by which a drug becomes available to body fluids & tissues…influenced by blood flow, drug’s affinity to tissue & the protein binding effect…many drugs travel in blood stream via proteins (albumin, globulins)
Free Drug
A portion of a drug that remains unbound to protein making it active & able to cause a pharmacological response
Half life
Time is takes for half of the drug concentration to be eliminated
Metabolism
Process by which the body inactivates drugs or biotransforms drugs…liver is primary site for this
Excretion
Process by which the body eliminates drugs Main route is the kidneys (urine)
Pharmacodynamics
The study of the way drugs affect the body
Dose Response
Relationship between minimal versus the maximal amount of drug dose needed to produce result
Maximal Efficacy
Maximum drug effect
Peak of Action
Occurs when drug reaches it’s highest blood or plasma concentration
Onset of Action
Time it takes to reach minimum effective concentration (MEC) after drug is administered…the period of time between drug administration and the first indication the drug was effective
Duration of Action
Length of time the drug has a pharmacological effect
Time Response Curve
Chart that evaluates the 3 parameters of drug action: onset, peak & duration
Receptor Theory
The activity of many drugs is determined by the ability of the drug to bind to a specific receptor The better it fits at the receptor site, the more biologically active the drug is
Kinase-Linked Receptors
Ligand-binding domain for drug binding is on cell surface Drug activates enzyme inside cell
Ligand-Gated Ion Channels
Channel spans the cell membrane & opens allowing for flow of ions (primarily sodium & calcium)
G Protein-Coupled Receptor Systems
Three components: the receptor, G protein that binds with guanosine triphosphate (GTP) & the effector (enzyme or ion channel)
Ligand-Binding Domain
Site on the receptor at which the drug binds
Nuclear Receptors
Receptors found in cell nucleus Activation through transcription factors is prolonged
Agonists
Drugs that produce response
Antagonists
Drugs that block a response
Nonspecific Drugs
Affect various sites
Nonselective Drugs
Affect various receptors
Therapeutic Index
Estimates margin of safety of a drug through the use of a ratio that measures the effective (therapeutic) dose (ED) in 50% of people and the lethal dose (LD) in 50% of people The closer the ratio is to 1, the greater the danger for toxicity
Drug Actions
Stimulation/Depression Replacement Inhibition/Killing of Organisms Irritation
Therapeutic Range
Therapeutic Window Level of drug between the minimum effective concentration (MEC) in the plasma for obtaining desired drug action & the maximum toxic concentration (toxic effect)
Peak Drug Levels
Highest concentration of a drug in the plasma at a specific time Indicates rate of absorption
Trough Drug Levels
Lowest concentration of drug in the plasma at a specific time Indicates rate of elimination
Loading Dose
Large initial dose given to achieve a rapid MEC when immediate response is desired
Side Effects
Physiological effects not related to desired drug effects
Adverse Reactions
Range of untoward effects of drugs that cause mild to severe side effects More severe than side effects & always undesirable
Toxicity
Toxic effects When drug levels exceed therapeutic range
Pharmacogenetics
Scientific discipline of studying how the effect of drugs actions varies from a predicted drug response due to genetic or hereditary factors
Tachyphylaxis
Rapid decrease in response to the drug “Acute tolerance”
Tolerance
Decreased responsiveness to a drug over the course of therapy
Placebo Effect
Psychological benefit from a compound that may not have the chemical structure of drug effect
U.S. Food & Drug Administration (FDA)
Approves new drugs Develops bio markers & other scientific tools Streamlines clinical trials Ensures product safety
United States Pharmacopeia National Formulary (USPS-NF)
Current 3 volume authoritative source for drug standards Annual publication with 2 supplements
Controlled Substances
Drugs with potential for abuse Described in 5 schedules
Chemical Name
Drug name that describes it’s chemical structure
Generic Name
Drug’s official, nonproprietary name
Brand Name
Drug name chosen by the drug company that is usually trademarked & owned by that company
Drug Enforcement Agency (DEA)
U.S. sole legal drug enforcement agency that is part of the U.S. Department of Justice
Drug Interactions
Altered or modified action/effect of a drug as a result of interaction with one or multiple other drugs
Over-The-Counter (OTC) Drugs
Obtained without a prescription
Drug Incompatibility
Chemical or physical reaction that occurs among 2 or more drugs in vitro (outside the body)
Pharmacokinetic Interactions
Changes that occur in absorption, distribution, metabolism or excretion of a drug
Therapeutic Drug Monitoring (TDM)
Practice of checking serum drug levels Especially important for drugs with narrow therapeutic range & highly protein bound drugs
Pharmacodynamic Interactions
Interactions that result in additive, synergistic or antagonistic drug effects
Additive Effect
Occurs when 2 drugs with similar actions are administered result in a sum of effects
Synergistic Effect
Occurs when 1 drug has a potentiate effect on another Clinical effect is substantially greater than the combined effect of the 2 drugs
Antagonistic Effect
Occurs when 2 drugs given have opposite effects & cancel each other out
Common symptoms of drug-drug interaction
Nausea, GI upset, headache & dizziness
Drug-Food Interactions
Food can increase, decrease or delay drug absorption Food can bind with drugs causing decreased or slower absorption Food may have impact on absorption of different dosage forms
Drug-Laboratory Interactions
Abnormal plasma/serum electrolyte concentrations can affect certain drug therapies
Drug Induced Photosensitivity
Skin reaction caused by exposure to sunlight EX: sulfa drugs
Elimination
“Excretion”…Process by which the body eliminates drugs…main route is the kidneys (urine)
High Therapeutic Index
A wide margin of safety for drug use
Low Therapeutic Index
A narrow margin of safety for drug use
Pharmacology
The study of the effects of chemical substances on living tissue. They study of drugs, their sources, nature & properties. The study of the body’s reaction to drugs
Drug
Any chemical substance that, when administered, produces a change in function of the body.
Contraindication
A symptom or circumstance that makes treatment with a drug or device unsafe or inappropriate.
Cumulative Effect
A drug effect that is apparent only after several doses have been given. It is caused by excretion or metabolic degradation of only a fraction of each dose given.
Informed Consent
A policy in place for the patient’s protection. It allows the patient to be informed, without coercion, about healthcare procedures.
Physician’s Desk Reference (PDR)
An annual compendium of information concerning drugs, primarily prescription and diagnostic products.
United States Pharmacopeia National Formulary (USP-NF)
A collection of officially recognized drug names. Includes drugs of established usefulness.
Teratogenic
Causing abnormal development of the embryo
Off-Label Uses
Used for something other than what it has been approved for…EX: glucophage for weight loss
Four Sources of Drugs
Plants, Animals, Minerals & Synthetic
1938 Food, Drug & Cosmetic Act
Act that empowered the FDA to monitor & regulate the marketing & manufacturing of drugs
1970 Controlled Substances Act
Act that identified a schedule that showed the potential for abuse of drugs
Nurse Practice Acts
State laws regarding nursing practice
Clinical Pharmacist
A specialist who guides the physician in prescribing drugs (may be stationed on a patient care unit to assist physicians, nurses, and patients.)
Pharmacotherapeutics
The study of of the effects of drugs on the body.
Chronopharmacology
The study of the actions of drugs in relationship to time
Chemotherapy
The study of drugs used to prohibit the growth & production of abnormal cells.
Misfeasance
Giving the wrong drug or drug dose that results in the client’s death
Nonfeasance
Omitting a drug dose that results in the client’s death.
Malfeasance
Giving the correct drug but by the wrong route that results in the client’s death.
Schedule I Drug
A drug with no medical use with very high abuse potential that may lead to severe dependence (EX: heroine, marijuana, LSD, STP, peyote, hashish)
Schedule II Drug
A drug with medical use but with high abuse potential that leads to severe physical or psychological dependence (EX: morphine, opium, methadone, secobarbital, codeine, amphetamines, cocaine, oxycodone)
Schedule III Drug
A drug with medical use with moderate to low physical abuse potential but high psychological abuse potential (EX: Empirin with codiene, Lortab, Fiorinal, Tylenol with codeine)
Schedule IV Drug
A drug with medical use with limited physical or psychological dependence potential (EX: phenobarbital, Librium, Valium, Dalmane)
Schedule V Drug
A drug with medical use with very limited phsycial or psychological dependence potential…may not require prescription (EX: Robitussin AC, Lomotil)
Ampule
a sealed glass container used to store single doses of liquid injectible drugs
Vial
a glass container with rubber stoppers used to store liquid or powdered medication
Cartridge
single unit doses of parenteral medications to be used with specific injecting devices
Liniments
liquid suspensions for lubrication that are applied by rubbing
Ointments
semisolid medications used for local protection or for transdermal systemic effect
Troche
an oral preparation that dissolves in the mouth
Affinity
The inclination a drug has for binding or attaching itself to a specific receptor site
Antimetabolites
drugs which work by combining with cell enzymes because they resemble the usual substances acted on by the enzyme
Elimination
the period in which a drug is being excreted from the body
Termination
time when the effects of the drug are no longer evident in the body
Idiosyncratic Response
an abnormal or peculiar response to a drug (EX: elderly patient stimulated rather than sedated by sleeping medications)
Iatrogenic Response
relatively predictable adverse drug responses caused unintentionally by medical treatment (EX: GI ulceration from long term aspirin therapy)
Tachyphylaxis Response
a quickly developing tolerance to a drug given in rapid, repeated administrations (EX: using a topical nasal decongestant over just a few days can develop a blunted response)
Cumulative Response
results when the body cannot metabolize a dose of the drug before the next dose is given…this means the drug is being excreted more slowly than it is being absorbed
Antagonism
occurs when the combined effect of two drugs is less than the sum of the two drugs acting separately
Summation
occurs when the combined effect of two drugs is equal to the sum of the individual effects of the two drugs
Synergism
occurs when the combined effect of two drugs is greater than the sum of the two drugs acting independently
Potentiation
occurs when two drugs are given concurrently and one increases the effect of the other…the one doing the potentation doesn’t have the intended therapeutic effect
Competitive Antagonism
occurs when two different drug molecules compete for protein binding sites in the blood
Kefauver-Harris Amendment to the 1938 Act
legislation reference to drug labels & increased control on drug safety
FDA Modernization Act of 1997
legislation act that accelerated review of new drugs, required drug companies to provide info on off-label drugs & offer advanced notices of plans to discontinue drugs
Reversed
Drug becomes a solution through disintegration & dissolution in order to cross biologic membrane
Pharmaceutical Phase
Reversed
Dissolving of smaller particles in GI fluid before absorption
Dissolution
Reversed
Breakdown of tablet into smaller particles
Disintegration
Reversed
Process of drug movement to achieve drug action
Pharmacokinetics
Reversed
Movement of drug particles from GI tract to body fluids
Absorption
Reversed
Movement of drug particles from GI tract to body fluids…the primary factor affecting drug bioavailability…
Absorption
Reversed
Type of absorption that requires a carrier such as an enzyme or protein to move drug against concentration gradient Requires energy
Active Absorption
Reversed
Type of absorption by which cells carry a drug across their membrane by engulfing the drug particles
Pinocytosis
Reversed
Process by which the drug passes to the liver first AKA Hepatic First Pass
First Pass Effect
Reversed
Subcategory of absorption Percentage of the drug dose that reaches systemic circulation
Bioavailability
Reversed
A portion of a drug is bound to protein making it inactive & not available to receptors
Protein Binding Effect
Reversed
Process by which a drug becomes available to body fluids & tissues…influenced by blood flow, drug’s affinity to tissue & the protein binding effect…many drugs travel in blood stream via proteins (albumin, globulins)
Distribution
Reversed
A portion of a drug that remains unbound to protein making it active & able to cause a pharmacological response
Free Drug
Reversed
Time is takes for half of the drug concentration to be eliminated
Half life
Reversed
Process by which the body inactivates drugs or biotransforms drugs…liver is primary site for this
Metabolism
Reversed
Process by which the body eliminates drugs Main route is the kidneys (urine)
Excretion
Reversed
The study of the way drugs affect the body
Pharmacodynamics
Reversed
Relationship between minimal versus the maximal amount of drug dose needed to produce result
Dose Response
Reversed
Maximum drug effect
Maximal Efficacy
Reversed
Occurs when drug reaches it’s highest blood or plasma concentration
Peak of Action
Reversed
Time it takes to reach minimum effective concentration (MEC) after drug is administered…the period of time between drug administration and the first indication the drug was effective
Onset of Action
Reversed
Length of time the drug has a pharmacological effect
Duration of Action
Reversed
Chart that evaluates the 3 parameters of drug action: onset, peak & duration
Time Response Curve
Reversed
The activity of many drugs is determined by the ability of the drug to bind to a specific receptor The better it fits at the receptor site, the more biologically active the drug is
Receptor Theory
Reversed
Ligand-binding domain for drug binding is on cell surface Drug activates enzyme inside cell
Kinase-Linked Receptors
Reversed
Channel spans the cell membrane & opens allowing for flow of ions (primarily sodium & calcium)
Ligand-Gated Ion Channels
Reversed
Three components: the receptor, G protein that binds with guanosine triphosphate (GTP) & the effector (enzyme or ion channel)
G Protein-Coupled Receptor Systems
Reversed
Site on the receptor at which the drug binds
Ligand-Binding Domain
Reversed
Receptors found in cell nucleus Activation through transcription factors is prolonged
Nuclear Receptors
Reversed
Drugs that produce response
Agonists
Reversed
Drugs that block a response
Antagonists
Reversed
Affect various sites
Nonspecific Drugs
Reversed
Affect various receptors
Nonselective Drugs
Reversed
Estimates margin of safety of a drug through the use of a ratio that measures the effective (therapeutic) dose (ED) in 50% of people and the lethal dose (LD) in 50% of people The closer the ratio is to 1, the greater the danger for toxicity
Therapeutic Index
Reversed
Stimulation/Depression Replacement Inhibition/Killing of Organisms Irritation
Drug Actions
Reversed
Therapeutic Window Level of drug between the minimum effective concentration (MEC) in the plasma for obtaining desired drug action & the maximum toxic concentration (toxic effect)
Therapeutic Range
Reversed
Highest concentration of a drug in the plasma at a specific time Indicates rate of absorption
Peak Drug Levels
Reversed
Lowest concentration of drug in the plasma at a specific time Indicates rate of elimination
Trough Drug Levels
Reversed
Large initial dose given to achieve a rapid MEC when immediate response is desired
Loading Dose
Reversed
Physiological effects not related to desired drug effects
Side Effects
Reversed
Range of untoward effects of drugs that cause mild to severe side effects More severe than side effects & always undesirable
Adverse Reactions
Reversed
Toxic effects When drug levels exceed therapeutic range
Toxicity
Reversed
Scientific discipline of studying how the effect of drugs actions varies from a predicted drug response due to genetic or hereditary factors
Pharmacogenetics
Reversed
Rapid decrease in response to the drug “Acute tolerance”
Tachyphylaxis
Reversed
Decreased responsiveness to a drug over the course of therapy
Tolerance
Reversed
Psychological benefit from a compound that may not have the chemical structure of drug effect
Placebo Effect
Reversed
Approves new drugs Develops bio markers & other scientific tools Streamlines clinical trials Ensures product safety
U.S. Food & Drug Administration (FDA)
Reversed
Current 3 volume authoritative source for drug standards Annual publication with 2 supplements
United States Pharmacopeia National Formulary (USPS-NF)
Reversed
Drugs with potential for abuse Described in 5 schedules
Controlled Substances
Reversed
Drug name that describes it’s chemical structure
Chemical Name
Reversed
Drug’s official, nonproprietary name
Generic Name
Reversed
Drug name chosen by the drug company that is usually trademarked & owned by that company
Brand Name
Reversed
U.S. sole legal drug enforcement agency that is part of the U.S. Department of Justice
Drug Enforcement Agency (DEA)
Reversed
Altered or modified action/effect of a drug as a result of interaction with one or multiple other drugs
Drug Interactions
Reversed
Obtained without a prescription
Over-The-Counter (OTC) Drugs
Reversed
Chemical or physical reaction that occurs among 2 or more drugs in vitro (outside the body)
Drug Incompatibility
Reversed
Changes that occur in absorption, distribution, metabolism or excretion of a drug
Pharmacokinetic Interactions
Reversed
Practice of checking serum drug levels Especially important for drugs with narrow therapeutic range & highly protein bound drugs
Therapeutic Drug Monitoring (TDM)
Reversed
Interactions that result in additive, synergistic or antagonistic drug effects
Pharmacodynamic Interactions
Reversed
Occurs when 2 drugs with similar actions are administered result in a sum of effects
Additive Effect
Reversed
Occurs when 1 drug has a potentiate effect on another Clinical effect is substantially greater than the combined effect of the 2 drugs
Synergistic Effect
Reversed
Occurs when 2 drugs given have opposite effects & cancel each other out
Antagonistic Effect
Reversed
Nausea, GI upset, headache & dizziness
Common symptoms of drug-drug interaction
Reversed
Food can increase, decrease or delay drug absorption Food can bind with drugs causing decreased or slower absorption Food may have impact on absorption of different dosage forms
Drug-Food Interactions
Reversed
Abnormal plasma/serum electrolyte concentrations can affect certain drug therapies
Drug-Laboratory Interactions
Reversed
Skin reaction caused by exposure to sunlight EX: sulfa drugs
Drug Induced Photosensitivity
Reversed
“Excretion”…Process by which the body eliminates drugs…main route is the kidneys (urine)
Elimination
Reversed
A wide margin of safety for drug use
High Therapeutic Index
Reversed
A narrow margin of safety for drug use
Low Therapeutic Index
Reversed
The study of the effects of chemical substances on living tissue. They study of drugs, their sources, nature & properties. The study of the body’s reaction to drugs
Pharmacology
Reversed
Any chemical substance that, when administered, produces a change in function of the body.
Drug
Reversed
A symptom or circumstance that makes treatment with a drug or device unsafe or inappropriate.
Contraindication
Reversed
A drug effect that is apparent only after several doses have been given. It is caused by excretion or metabolic degradation of only a fraction of each dose given.
Cumulative Effect
Reversed
A policy in place for the patient’s protection. It allows the patient to be informed, without coercion, about healthcare procedures.
Informed Consent
Reversed
An annual compendium of information concerning drugs, primarily prescription and diagnostic products.
Physician’s Desk Reference (PDR)
Reversed
A collection of officially recognized drug names. Includes drugs of established usefulness.
United States Pharmacopeia National Formulary (USP-NF)
Reversed
Causing abnormal development of the embryo
Teratogenic
Reversed
Used for something other than what it has been approved for…EX: glucophage for weight loss
Off-Label Uses
Reversed
Plants, Animals, Minerals & Synthetic
Four Sources of Drugs
Reversed
Act that empowered the FDA to monitor & regulate the marketing & manufacturing of drugs
1938 Food, Drug & Cosmetic Act
Reversed
Act that identified a schedule that showed the potential for abuse of drugs
1970 Controlled Substances Act
Reversed
State laws regarding nursing practice
Nurse Practice Acts
Reversed
A specialist who guides the physician in prescribing drugs (may be stationed on a patient care unit to assist physicians, nurses, and patients.)
Clinical Pharmacist
Reversed
The study of of the effects of drugs on the body.
Pharmacotherapeutics
Reversed
The study of the actions of drugs in relationship to time
Chronopharmacology
Reversed
The study of drugs used to prohibit the growth & production of abnormal cells.
Chemotherapy
Reversed
Giving the wrong drug or drug dose that results in the client’s death
Misfeasance
Reversed
Omitting a drug dose that results in the client’s death.
Nonfeasance
Reversed
Giving the correct drug but by the wrong route that results in the client’s death.
Malfeasance
Reversed
A drug with no medical use with very high abuse potential that may lead to severe dependence (EX: heroine, marijuana, LSD, STP, peyote, hashish)
Schedule I Drug
Reversed
A drug with medical use but with high abuse potential that leads to severe physical or psychological dependence (EX: morphine, opium, methadone, secobarbital, codeine, amphetamines, cocaine, oxycodone)
Schedule II Drug
Reversed
A drug with medical use with moderate to low physical abuse potential but high psychological abuse potential (EX: Empirin with codiene, Lortab, Fiorinal, Tylenol with codeine)
Schedule III Drug
Reversed
A drug with medical use with limited physical or psychological dependence potential (EX: phenobarbital, Librium, Valium, Dalmane)
Schedule IV Drug
Reversed
A drug with medical use with very limited phsycial or psychological dependence potential…may not require prescription (EX: Robitussin AC, Lomotil)
Schedule V Drug
Reversed
a sealed glass container used to store single doses of liquid injectible drugs
Ampule
Reversed
a glass container with rubber stoppers used to store liquid or powdered medication
Vial
Reversed
single unit doses of parenteral medications to be used with specific injecting devices
Cartridge
Reversed
liquid suspensions for lubrication that are applied by rubbing
Liniments
Reversed
semisolid medications used for local protection or for transdermal systemic effect
Ointments
Reversed
an oral preparation that dissolves in the mouth
Troche
Reversed
The inclination a drug has for binding or attaching itself to a specific receptor site
Affinity
Reversed
drugs which work by combining with cell enzymes because they resemble the usual substances acted on by the enzyme
Antimetabolites
Reversed
the period in which a drug is being excreted from the body
Elimination
Reversed
time when the effects of the drug are no longer evident in the body
Termination
Reversed
an abnormal or peculiar response to a drug (EX: elderly patient stimulated rather than sedated by sleeping medications)
Idiosyncratic Response
Reversed
relatively predictable adverse drug responses caused unintentionally by medical treatment (EX: GI ulceration from long term aspirin therapy)
Iatrogenic Response
Reversed
a quickly developing tolerance to a drug given in rapid, repeated administrations (EX: using a topical nasal decongestant over just a few days can develop a blunted response)
Tachyphylaxis Response
Reversed
results when the body cannot metabolize a dose of the drug before the next dose is given…this means the drug is being excreted more slowly than it is being absorbed
Cumulative Response
Reversed
occurs when the combined effect of two drugs is less than the sum of the two drugs acting separately
Antagonism
Reversed
occurs when the combined effect of two drugs is equal to the sum of the individual effects of the two drugs
Summation
Reversed
occurs when the combined effect of two drugs is greater than the sum of the two drugs acting independently
Synergism
Reversed
occurs when two drugs are given concurrently and one increases the effect of the other…the one doing the potentation doesn’t have the intended therapeutic effect
Potentiation
Reversed
occurs when two different drug molecules compete for protein binding sites in the blood
Competitive Antagonism
Reversed
legislation reference to drug labels & increased control on drug safety
Kefauver-Harris Amendment to the 1938 Act
Reversed
legislation act that accelerated review of new drugs, required drug companies to provide info on off-label drugs & offer advanced notices of plans to discontinue drugs
FDA Modernization Act of 1997