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Pharmacology > Exam 1: Intro to Pharm > Flashcards

Exam 1: Intro to Pharm Flashcards

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1
Q

Pharmacotherapeutics

A

Therapeutic (medical) use of a drug
Diagnose, prevent, or treat disease

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2
Q

Six rights

A

Right drug
Right dose
Right patient
Right route
Right time
Right documentation

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3
Q

FDA Stages for Approval

A
  1. Preclinical investigation/testing (all in lab)
  2. Clinical investigation/testing (longest part)
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4
Q

Clinical investigation

A

Phase I: Normal (Healthy ) volunteers
Evaluation effects on humans & of drug metabolism

Phase II & III: tested on patients, determine therapeutic effects, dosage ranges, safety

Phase IV: Post marketing surveillance, used for gen. pop., new side effects reporting -> ADRs not found in stage 3

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5
Q

Properties of an Ideal Drug

A

“Maximum benefit with minimal harm!!”

Effectiveness - Elicits the response it is intended for
Safety - Causes no (or little) harm
Selectivity - Response limited for which it is given

also important:
Reversible action
Predictability
Easy to administer
Few drug interactions
Low cost
Chemically stable
Simple generic name

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6
Q

generic name vs trade/brand name

A

generic - official name given by manufacturer used in practice, sometimes ending of name can indicate drug classification (-cillin: antibiotic)

trade/brand - most common name, pt might know

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7
Q

generic drug

A

Tend to be lower cost
Lower cost than “Brand name” drugs …. bc generic is produced after the patent ends for original producer

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8
Q

brand drug vs. generic drug

A

Both: must have same Active Ingredient
contain same dose of same drug

Concern with generics:
Different binders and fillers
May change absorption-rate and extent
May not work the same

Generic drugs must have FDA approval

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9
Q

Sources of drugs

A

Plants

Animals or humans: such as Hormones

Minerals or mineral products

Synthetic
Made in the laboratory with same molecular function as natural molecule

Recombinant DNA: fragment of DNA is inserted into DNA of another organisms

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10
Q

Legend

A

Any drug that requires a prescription

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11
Q

Over-the-counter (nonprescription)

A

Many Legend drugs are now being approved for OTC sale

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12
Q

Scheduled/ Controlled drugs

A

Any drug with the potential of being abused
Class I –V
Class I extremely high abuse potential, no accepted medical use (Heroin and LSD)
Class II-V progressively less, have acceptable use but also potential for abuse

1970 Controlled Substance Act

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13
Q

Drug classification

A

drugs w/ similar characteristics

Treatment: symptoms/illness/disease
(Antiemetic, Analgesic, Antihypertensives)

Similar effect on a body system
(Diuretics, Antacid)

Similar pathophysiology effect
(ACE Inhibitor, Beta Blocker)

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14
Q

Pharmacoceutic Phase

A

only PO meds

Disintegration (for tablets, capsules are already in solution)
Dissolution - dissolve into the GI fluid before absorption (rate of dissolution dictates rate of absorption)

enteric coatings**

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15
Q

Pharmacokinetic phase

A

ADME

  1. absorption
  2. distribution
  3. metabolism
  4. excretion
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16
Q

Three primary ways to cross a cell membranes

A
  1. Pass through channels or pores (Only very small ions such as potassium)
    2.Pass with the aid of a transport system (Different transport mechanisms- P-Glycoprotein ex.)
  2. Direct penetration of the membrane (Most common)
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17
Q

P-Glycoprotein:

A

multidrug transporter protein

transports wide variety out of cell so it can be eliminated

present in liver, kidneys, placenta, intestine, and capillaries of the brain

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18
Q

“like dissolves like”

A

Lipid soluble drugs (lipophilic) can directly penetrate (mostly lipid) cell membranes

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19
Q

Ion transport

A

Ions (net electric charge) cannot cross membrane

depend on the pH of the environment as to whether the drug is non-ionized and able to cross cell membrane or not

“I(on) can’t get in!” example

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20
Q

Absorption

A

drug enters the body, gets into blood

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21
Q

Distribution

A

drug moves from blood to site of action

determined by factors of blood flow to tissues/organs abscesses/tumors ex. of low blood flow

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22
Q

Metabolism

A

biotransformation

enzymatic alteration of drug structure

most occurs in liver

Normal route is drug absorbed -> goes to liver via portal vein -> just passes through -> then into systemic circ -> after targeted effect -> returns to liver to be metabolized

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23
Q

Excretion

A

exits and is removed from body

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24
Q

Enteral vs parenteral

A

enteral - GI - PO & feeding tubes

parenteral - “by injection” IV, SQ, IM

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25
Oral route
multiple preparations - have fillers & binders that allow for better dissolution and absorption convenient & safe absorption is variable on GI motility/enzymes & blood flow to GI tract slower onset & peak times **must pass through the liver via the portal vein "First pass effect"
26
enteric-coated drugs
Resist disintegration until in the small intestine coated to resist pharmacoceutic phase
27
sustained release drugs
Formulation (actual structure of pill w/ different spheres or matrices) which allows drug to slowly release over time
28
IV route
parenteral route less convenient, but immediate absorption (faster absorption and peak times) Risks: no turning back, fluid overload, infection, etc.
29
IM/SQ route
large spaces b/t cells - drugs absorb by moving b/t cells, through channels and pores blood flow impacts absorption - Deltoid = high blood flow less convenient, complications
30
Bioavailability
The percentage of the administered drug dose that reaches the systemic circulation (bloodstream) unchanged Oral never 100%, IV is 100% oral doses require higher dose
31
Sublingual/buccal route
quick, self-administrable, economic bitter taste, irritation of mucosa, not large quantities
32
Protein binding
drugs bind to proteins in body albumin (plasma protein) - most drugs bind in some way in bloodstream and dependent on level of attraction can restrict distribution
33
"free drug"
the drug that doesn't bind and can create the action desired
34
Blood brain barrier
only lipid soluble drugs or drugs w/ a carrier can pass through capillaries have tight junctions
35
Fetal-Placental barrier
Not an absolute barrier, lipid soluble & non-ionized agents pass through
36
Cytochrome P450 Enzymes
most drug metabolism in the liver performed by them different drugs metabolized by different enzymes
37
Drug inactivation & accelerated excretion
drugs are inactivated by liver enzymes to become water soluble and be excreted leads to accelerated renal excretion of drugs bc kidneys can't excrete lipid solubles
38
Increased therapeutic action/activation
some transformed into active metabolites w/ increased response (pro drugs) codeine transforms into morphine after metabolism
39
pro drugs
no pharmacologic activity UNTIL they are metabolized in the liver
40
Increased or decreased toxicity
metabolism can change safe drugs (acetaminophen) may become toxic most drugs are converted to inactive forms to excrete
41
why is dosing different for infants and malnourished pts?
infants - decreased ability to metabolize drugs malnourished - deficient hepatic enzymes
42
First-Pass Effect
Certain drugs are partially or completely inactivated on the first pass through the liver (NOT NORMAL) Result: drug may have minimal or no therapeutic effect These are not given PO - think sublingual (nitro ex.)
43
Cirrhosis or hepatitis
risks for drug toxicity due to inability to metabolize prolonged half-life
44
AST & ALT
liver enzymes that we check if drug can be hard on liver
45
Renal drug excretion
Glomerular filtration (protein bound drugs will not filter) Passive reabsorption (lipid soluble drugs can't be excreted) Active transport- P-glycoprotein pumps certain agents into urine
46
Urine pH
affects drug excretion acidic urine -> weak base drugs and vice versa b/c they ionize the drug and make it no longer lipid soluble and won't reabsorb back into the body **important to help treat overdoses and improve excretion rate
47
Renal disease
drug elimination slowed or impaired can lead to drug accumulation half-life prolonged
48
Plasma half-life
1st: Time it takes for a medication to decrease concentration in the plasma by 50% after administration 2nd: time it takes for the second half of the drug concentration to be reduced by half again takes about 4 half lives for any drug to be “almost” out of the blood stream
49
Pharmacodynamic phase
drug's effects on the body Primary - therapeutic Secondary - adverse
50
Cellular receptors
Most drugs work because they bind to a particular “receptor” to create a response or to block a response "Lock and Key" theory selectivity (beta-blockers) and affinity (naloxone) are important
51
Occupancy Theory
The intensity of the response to the drug is proportional to the number of receptors occupied.
52
Agonist
Mimics the action of the endogenous molecule Activates or “turns on” the receptor
53
Antagonist
Blocks action of endogenous molecules Prevent or shut down activation of the receptor
54
Partial agonist
Mimics action like an agonist but with less intensity Low affinity
55
Maximal Efficacy
Largest effect that a drug can produce
56
Relative Potency
Amount of drug we must give to elicit a response Highly potent drugs require smaller doses Plasma drug levels
57
ED
Average effective dose in 50% of the population May be referred to as the Minimum effective concentration (MEC)
58
LD
Average lethal dose Lethal to 50% of animals during testing May be referred to as the Toxic concentration (MTC)
59
Onset of Action
Period of time it takes after the drug is given to create a response
60
Peak Action
Time it takes for a drug to reach it’s highest concentration
61
Duration of action
Length of time during which the drug is present in a concentration great enough to produce a response
62
Therapeutic Index
“therapeutic range” or “therapeutic window” Estimates the margin of safety of a drug
63
“low” or “narrow” therapeutic index
have a “narrow margin” of safety serum drug levels monitored ex - Digoxin, anticonvulsants, Gentamycin
64
“high” therapeutic index
have a wide margin of safety Less danger
65
Peak serum level
Highest plasma concentration Peak time will vary depending on drug and route Drug guide will tell you the proposed peak time Blood sample is drawn at the proposed peak time
66
Trough serum level
Lowest plasma concentration Blood is drawn before the next dose is due
67
Side Effect
Predictable “secondary effect” Sometimes harmless and beneficial Sometimes causes injury
68
Toxic Effect:
When a drug accumulates in the blood above a therapeutic level
69
Idiosyncratic Reaction
Unpredictable. Client overreacts or underreacts to a drug
70
Allergic Reaction
Unpredictable immune response May be mild or severe
71
Carcinogenic
Ability of medications, environment and chemicals to cause cancer
72
Teratogenic
Drug induced birth defect from a teratogen highly dependent on when given in pregnancy
73
Physical Dependence
Patient’s body has adapted to drug due to prolonged exposure – will experience withdrawal symptoms if drug is discontinued
74
Drug interactions
An altered effect of a drug as a result of an interaction with another drug, nutrient or plasma/electrolyte levels
75
Pharmacokinetic Drug Interactions
Changes that occur in the absorption, distribution, metabolism or elimination
76
Pharmacodynamic Drug Interactions
Changes that occur in the drug’s effect on the body Include Additive, Synergistic, or Antagonistic effects
77
Enzyme Inducers
will increase the metabolic rate of other drugs Increase in metabolism will likely cause rapid drug excretion and a decrease in drug concentration in the blood
78
“Enzyme Inhibitors”
Drugs that inhibit the CYP Enzymes are “inhibitors” Example : Cimetidine Enzyme Inhibitors will decrease the metabolic rate of other drugs If metabolism is decreased, the plasma concentrations of the other drugs will be increased Toxicity is likely
79
Additive Effect
When two drugs with similar action are administered Can be desirable or undesirable Example: Codeine and Acetaminophen
80
Synergistic Effect
One drug potentiates the other Clinical effect is substantially greater than the combined effect of the two The effect can be desirable or undesirable Example: Alcohol and a Narcotic
81
Drug- nutrient interactions
Foods/nutrients can bind with drugs, causing less or slower drug absorption ex. tetracycline w/ dairy theophylline w/ caffeine
82
Drug/lab considerations
Abnormal plasma or serum electrolyte concentrations can affect certain drug therapies Example: Patient with a decreased serum potassium level or an increase in serum calcium level will be more prone to Digoxin Toxicity

Pharmacology (12 decks)

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