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EO 004 Flashcards

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1
Q

[EO 004.01] What is pharmacology?

A

The study of how the body and drugs interact.

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2
Q

[EO 004.01] What are the 2 sub-categories of pharmacology?

A
  1. Pharmacokinetics
  2. Pharmacodynamics
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3
Q

[EO 004.01] What are the 4 processes of pharmacokinetics?

A
  1. Absorption
  2. Distribution
  3. Metabolism
  4. Elimination
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4
Q

[EO 004.01] What are the 2 properties that affect pharmacokinetics?

A
  1. Properties of drug
  2. Properties of patient
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5
Q

[EO 004.01] List 3 properties of drugs or patients that pharmacokinetics helps determine.

A
  1. Onset of drug
  2. Concentration of drug in the body
  3. Potency of drug
  4. Half-life/metabolism
  5. Bioavailability
  6. Drug-Drug influence (inhibit vs induce)
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6
Q

[EO 004.01] Define absorption.

A

How the drug gets into systemic circulation or other site of action.

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7
Q

[EO 004.01] List the 4 general methods of absorption.

A
  1. Passive diffusion
  2. Facilitated diffusion
  3. Active transport
  4. Endo/exocytsosis
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8
Q

[EO 004.01] List a 3 routes of administration.

A
  1. IV/IO
  2. IM
  3. SQ
  4. Oral
  5. Sublingual
  6. Transdermal/topical
  7. Inhalation
  8. Rectal
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9
Q

[EO 004.01] List a few factors that affect absorption.

A
  1. Formulation of med
  2. Route
  3. Surface Area
  4. pH of GI tract
  5. Perfusion at absorption site
  6. Contact time
  7. Solubility of med
  8. Molecular size of med
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10
Q

[EO 004.01] Define bioavailability.

A

The percentage of a dose that reaches systemic circulation.

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11
Q

[EO 004.01] Define distribution.

A

Movement of a drug throughout the body.

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12
Q

[EO 004.01] What is Volume of Distribution?

A

The amount of fluid a drug needs to be dissolved in to produce the same concentration in plasma.

This is important since the concentration of a drug in plasma shows the dose available to enter tissues from the blood stream.

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13
Q

[EO 004.01] What is the formula for Volume of Distribution?

A

Vd = amount/concentration

ex. Vd = 50mg/1mg per L = 0.05/0.001 = 50 L

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14
Q

[EO 004.01] List a few factors affecting distribution.

A
  1. Blood flow
  2. Capillary permeability
  3. Drug structure
  4. Binding to compounds in body
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15
Q

[EO 004.01] What’s the difference between bound and unbound drugs?

A

Bound drugs cannot leave systemic circulation, not active.

Unbound drugs are able to leave systemic circulation into tissues.

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16
Q

[EO 004.01] What is a drug reservoire?

A

A place where drugs are bound and dissolved for long periods of time.

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17
Q

[EO 004.01] What is the blood-brain barrier?

A

Tight capillaries that heavily restrict movement of substances from blood into the brain.

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18
Q

[EO 004.01] Define metabolism as it relates to pharmacokinetics.

A

The process of chemically modifying drugs within the body to create new compounds called metabolites.

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19
Q

[EO 004.01] What is a pro-drug?

A

A drug intended to be metabolized to reach its active form.

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20
Q

[EO 004.01] Where are most drugs metabolized?

A

The liver.

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21
Q

[EO 004.01] List a couple factors affecting metabolism

A
  1. Individual variations
  2. 1st pass metabolism
  3. Capacity limitations
  4. Drug interactions
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22
Q

[EO 004.01] What is 1st pass metabolism?

A

The amount of drug metabolized before reaching systemic circulation.

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23
Q

[EO 004.01] What are a few factors that stem from individual variation?

A
  1. Blood flow to liver
  2. Liver enzyme activity
  3. Disease/illness of liver
  4. Drug distribution
  5. Genetics (general metabolism)
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24
Q

[EO 004.01] What is capacity limitation?

A

The maximum rate of enzymes to metabolize a substance.

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25
[EO 004.05] The 10 required elements of an OTC prescription?
1. Date 2. Patient SN 3. Name and address of pt (unit acceptable) 4. Name of prescribed drug ( generic or brand name acceptable, but generic name is encouraged) 5. Strength and dosage 6. Quantity of drug 7. Dosage instructions 8. Name, address and signature of prescriber 9. Refill authorization 10. If a controlled substance where refills are allowed, the number of refills and the interval between them
26
[EO 004.05] Once daily abbreviation
Daily
27
[EO 004.05] Twice daily abbreviation
BID
28
[EO 004.05] Three times daily abbreviation
TID
29
[EO 004.05] Before meals abbreviation
AC
30
[EO 004.05] After meals abbreviation
PC
31
[EO 004.05] Every morning abbreviation
qAM
32
[EO 004.05] At bedtime abbreviation
qHS
33
[EO 004.05] Every x hours abbreviation
qxh
34
[EO 004.05] Whenever need abbreviation
PRN
35
[EO 004.05] Give immediately abbreviation
STAT
36
[EO 004.05] Orally abbreviation
PO
37
[EO 004.05] Drop/drops abbreviation
gtt / gtts
38
[EO 004.05] Transcribing verbal orders you must write?
1. "Verbal order" or "V/O" 2. Prescriber's name 3. Your name 4. Sign your name 5. Date / time * Prescriber must co-sign in 24hrs
39
[EO 004.05] What are the 3 types of medication orders?
1. Loading (primary) dose 2. Maintenance dose 3. STAT order
40
[EO 004.05] What is a loading (primary) dose?
A large initial dose intended to raise plasma levels to near steady state
41
[EO 004.05] What is a Maintenance dose?
The dose given to a patient at regular intervals to maintain a stead state
42
[EO 004.05] What is a STAT order?
An order for a drug to be given immediately
43
[EO 004.01] What is elimination?
Removing a substance from the body.
44
[EO 004.01] Where is plasma filtered?
The kidneys.
45
[EO 004.01] What sort of drugs are removed through urine?
Water-soluble and ionized forms of drugs.
46
[EO 004.01] What is a consideration for women in terms of elimination?
Breast milk is a route of elimination, drugs can be eliminated this way and affect nursing infants.
47
[EO 004.01] What is half-life?
The time required by the body, tissue, or organ to metabolize or inactivate half the plasma concentration of a drug.
48
[EO 004.01] What is zero-order elimination?
A proportion or flat amount removed over a give period of time.
49
[EO 004.01] How do you calculate half-life or zero-order elimination?
Measuring the concentration of drug at two separate points in time.
50
[EO 004.01] What is the therapeutic window?
The range of concentration of a drug that provides a strong, desired therapeutic effect without adverse effects.
51
[EO 004.01] What is the purpose of half-life and zero-order elimination?
To estimate how long it will take for the body to clear a drug, or how long before concentration drops below therapeutic window.
52
[EO 004.01] What are the types of doses?
1. Loading dose 2. Maintenance dose 3. Bolus dose 4. Maximum dose 5. Toxic dose 6. Therapeutic dose
53
[EO 004.01] What is a loading dose?
An initial large dose to provide high blood level concentration without delay.
54
[EO 004.01] What is a maintenance dose?
Dose required to maintain the therapeutic window/desired concentration.
55
[EO 004.01] What is a bolus dose?
One time dose of medicine given IV at a controlled but rapid pace.
56
[EO 004.01] What is a maximum dose?
The largest safe dose to administer, either at once or over time.
57
[EO 004.01] What is a toxic dose?
An unsafe dose, typically expressed as LD50 - a dose lethal to 50% of the population.
58
[EO 004.01] What is a therapeutic dose?
Dose required to produce the desired effect.
59
[EO 004.01] What is a receptor?
A macromolecule involved in chemical signalling.
60
[EO 004.01] What is a ligand?
A molecule that binds to and affects a receptor.
61
[EO 004.01] What is the lock-and-key hypothesis?
That a ligand has a section that fits a receptor-site as uniquely as a key. Any ligand featuring that unique structure can bind.
62
[EO 004.01] What are factors that affect ligand binding?
1. Affinity - probability that a drug will bind 2. Intrinsic efficacy - degree of strength a ligand can exert on the receptor 3. Concentration - higher concentration of ligand increase chance of binding. 4. Density - greater number of receptors increases chance of a ligand binding
63
[EO 004.01] What is an agonist?
A ligand that produces a response when bound to the receptor.
64
[EO 004.01] What is an antagonist?
A ligand that prevents a response when bound.
65
[EO 004.01] What are the two types of antagonists?
1. Reversible: able to dissociate from the receptor without permanent change. 2. Irreversible: forms a stable bond with the receptor.
66
[EO 004.01] What is a partial agonist?
An agonist that binds to a receptor, activating it, but preventing other, stronger agonists from binding.
67
[EO 004.01] What two methods do antagonists prevent activation?
1. Competitively, binding to the same site as an agonist would. 2. Non-competitively, binding to a secondary site and causing changes incompatible with an agonist binding.
68
[EO 004.01] What is a therapeutic effect?
The desired, expected physiological effect
69
[EO 004.01] What is an adverse event?
A severe, negative response.
70
[EO 004.01] What is a side effect?
Secondary effects that a medication will predictably cause. Can vary in nature and severity between drugs.
71
[EO 004.01] What is a toxic effect?
An effect developing after prolonged intake of a medication that accumulates due to impaired metabolism or elimination.
72
[EO 004.01] what is an idiosyncratic effect?
An unpredictable, typically unexplainable, negative consequence of a drug.
73
[EO 004.01] What is a drug allergy?
An adverse event involving an over-response of the immune system (histamines).
74
[EO 004.01] What is an anaphylactic reaction?
A severe, life-threatening immune reaction.
75
[EO 004.01] How are anaphylactic reactions treated?
Epinephrine, salbutamol, anti-histamines, steroids, and even intubation
76
[EO 004.01] What is a drug intolerance?
An adverse effect not immunologically mediated. Not an allergy.
77
[EO 004.01] What is a drug tolerance?
The need for progressively higher doses to achieve the same effect.
78
[EO 004.01] What is a drug-drug interaction?
When one medication modifies the action of another. Can be additive, deleterious, beneficial, or negative.
79
[EO 004.01] What is a drug-food interaction?
When food alters the action of a drug.
80
[EO 004.01] What is a pharmacodynamic drug-drug interaction?
When a drug interacts with receptors at the site of action.
81
[EO 004.01] What is a pharmacokinetic drug-drug interaction?
When one drug affects the body's ability to absorb, distribute, metabolize, or eliminate, thus affecting other drugs.
82
[EO 004.01] What is a teratogen?
Any agent or factor causing abnormalities of form or function in a fetus.
83
[EO 004.01] What is a birth defect?
An abnormality of form or function.
84
[EO 004.01] What are the functions of the placenta?
1. Provide nutrients 2. Barrier to unwanted chemicals 3. Secrete hormones
85
[EO 004.01] In what methods do drugs cross the placenta?
1. Simple/facilitated diffusion 2. Active transport 3. Pinocytosis 4. Leakage(?)
86
[EO 004.01] Does a drug have to cross the placenta to cause harm?
No, constricting blood vessels or interfering with nutrient exchange can cause harm, among others.
87
[EO 004.01] When is teratogenesis most likely?
20-56 days post-conception
88
[EO 004.01] What are the most likely effects to occur between 20 and 56 days?
1. Spontaneous abortion 2. Gross anatomic defects 3. Covert embryopathy 4. None of the above
89
[EO 004.01] What adverse effect happens before day 20?
All-or-nothing death.
90
[EO 004.01] What are the broad categories used by the FDA and *not* Canada to categorize a drug's risk to a fetus/mother?
A, B, C, D, X
91
[EO 004.01] What is the most common teratogen?
Alcohol!
92
[EO 004.01] What is the most common addiction involving a teratogen?
Smoking, involving nicotine.
93
[EO 004.01] What is fetal alcohol syndrome?
Exposure to alcohol in uteri causing various cognitive and physical abnormalities.
94
[EO 004.01] What are the drugs affecting the myometrium?
1. Oxytocin 2. Misoprostol 3. Prostaglandin gel
95
[EO 004.02] What are Surgeon General (SG) Restricted Products?
Drugs, biologics, or medical devices requiring an additional level of control. Typically unlicensed medical products.
96
[EO 004.02] Why is it important to be attentive to SG Products?
1. Some are narcotics 2. May lose authorization from Health Canada 3. CBRN counter-measures may have intelligence value.
97
[EO 004.02] What are the steps for a med tech to have SG products issued?
1. Pharm O / MO keeps SG product 2. Med tech has SG product issued via loan card 3. Med tech returns SG product if unused, or submits appropriate form if SG product was consumed
98
[EO 004.02] How are narcotics disposed of in a clinic?
By a Pharm O. Also SG products. If none avail, contact supporting Pharm O or med supply depot.
99
[EO 004.02] How are non-narcotics disposed of?
1. Used responsibly and reasonably. 2. Return to pharmacy if unused or partially used. 3. IV fluids without meds are sent in the sink. 4. If in field, bonfire, bury, amnesty bush, etc.
100
[EO 004.02] Why shouldn't we donate medications?
1. Can overwhelm a nation's ability to distribute 2. May not be able to properly dispose of unwanted meds 3. Looks bad if we donate day old tylenol.
101
[EO 004.02] What is a STAT order?
One-time dose given immediately. It is not repeated without subsequent order.
102
[EO 004.02] What should be included in annotation of medication?
1. Date 2. Time 3. Administering person's signature 4. Name and dose of drug
103
[EO 004.02] When should annotation of medical administration be done?
After administration of medication.
104
[EO 004.02] List the 12 required points of medication labelling.
1. Name of establishment 2. Phone # of establishment 3. Prescription # 4. Patient name and SN 5. Date of issue 6. Name of prescriber 7. Name of medication, generic & brand 8. Instructions for use 9. Strength / concentration 10. Quantity issued 11. Repeats if applicable 12. Initials of prescription filler
105
[EO 004.02] Which civilian federal laws are CAF policies based on?
1. Food and Drugs Act 2. Controlled Drugs and Substances Act (formerly Narcotics Act)
106
[EO 004.02] What are the five sub-categories for drugs between the CDS Act and FDA?
1. Narcotics (including verbal narcotics) 2. Controlled 3. Targeted Substances (mainly benzodiazepines) 4. Prescription 5. Non-prescription
107
[EO 004.02] What are the relevant RCMS policies for pharmaceuticals?
1. CFHS Instruction 4200-59 (Restricted Acts: Pharmaceuticals) 2. CFHS Instruction 4200-44 (Narcotic and Controlled Drugs)
108
[EO 004.02] List the levels of responsibility in garrison for control of pharmaceuticals.
Level 1: *Pharmacist*, mil or civ Level 2: *B Surg* directly responsible Level 3: *Senior NO (mil)* responsible to CO if no MO or Pharm O. Level 4: *The CO* is directly responsible.
109
[EO 004.02] What documentations dictate who can administer certain pharmaceuticals?
CFHS Instruction 4200-59 (Restricted Acts: Pharmaceuticals) and 4200-44 (Narcotic and Controlled Drugs)
110
[EO 004.02] If a unit has an MO, who can administer controlled drugs?
1. MO 2. Civilian practitioner 3. NO 4. Civilian RN
111
[EO 004.02] If a unit has no mil MO, how and when can a unit have and use controlled drugs?
Under a CO's authority with proper CAF protocols and CO's approval.
112
[EO 004.02] In the case of no MO, who can administer controlled drugs under the CO's authority?
1. NO 2. Civilian RN 3. Civilian practitioner 4. PA or med tech on independent duty 5. PA, med tech, or rescue specialist in extreme circumstances
113
[EO 004.02] What are Class B protocols?
Protocols allowing QL5 to administer certain controlled drugs if: - On a named operation - Written authority from Task Force Surgeon is obtained - Competency to do so exists.
114
[EO 004.02] List the steps of the 3.6 Pain Protocol for the Adult pathway including QL5 and Class B steps.
Look in your protocol books, I can't insert pictures for free. Also slide 27 of EO 004.02 if ya lazy or don't have a book.
115
[EO 004.02] List the security requirements for narcotics in garrison.
1. Approved safe 2. Inside a room with: no windows; or steel mesh on windows. 3. Deadbolt locks x 2 on doors 4. Door hinges on interior of room 5. Intrusion alarm system
116
[EO 004.02] Who is allowed to have keys/combo to narc safe?
1. Pharmacists 2. CO or B Surg
117
[EO 004.02] Who is allowed to have keys/combo if no pharmacist, MO, or NO are at unit?
CO and PA.
118
[EO 004.02] What requirements exist in garrison when controlled substances are stored in a ward?
1. Located in out-of-the-way areas to minimize illegal entry and sight 2. Secured to wall 3. Double locked (not necessary but typical) 4. Keys held by MO or NO
119
[EO 004.02] What security requirements exist in the field for controlled substances?
Varies, typically in direct control of whoever signed them out, or given to SMA/Officer in charge.

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