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N232 > Module 1: pharmacology > Flashcards

Module 1: pharmacology Flashcards

1
Q

What is pharmakokinetics?

A

What the body does through absoprtion, distribution, metabolism and excretion

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2
Q

What does absoprtion do?

A
  • movement of a substance from site of administration, across membranes and into circulation
  • primary factor that determines the length of time for the drugs effect to occur
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3
Q

What factors affect absorption?

A
  • whether pt has eatin
  • how much intestine is intact
  • pH of stomach
  • drug interactions
  • osmolarity
  • time-released
  • coating (enteric)
  • tablet vs liquid
  • first pass effect
  • muscle mass
  • bioavailability: How much drug is available to effect body by the time it reaches the bloodstream.
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4
Q

What does first pass effect mean?

A

reduces bioavailability (extent of absoprtion) of drugs to less than 100%.

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5
Q

How is rate of absorption affected?

A

how it is administered or its route

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6
Q

Enteral route:

A
  • muscoa of the stomach or small or large intestine
  • rate of absorption can be altered by many factors
  • metabolized by the liver
  • least bioavailable because of first pass effect
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7
Q

Sublingual and buccal route:

A
  • sublingual route are absorbed rapidly because of large blood supply in oral mucosa
  • bypasses the liver and are systemically bioavailable (same for buccal)
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8
Q

Parenteral route:

A
  • fastast route which can be absorbed, followed by enteral and topical
  • Intramuscular and subcutaneos injection are absorbed more slowly than intravenously
  • Absorption from any of these sites may be increased by applying heat to the injection site or by massaging the site.
  • The presence of cold, hypotension, or poor peripheral blood flow compromises the circulation, reducing drug activity by reducing drug delivery to the tissue.
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9
Q

Where are subcuntaneous injection administered into?

A
  • fatty subcuntaneous tissues under the dermal layer of the skin
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10
Q

Where are intradermal injections administered into?

A
  • superficial layer of skin immediately underneath the epidermal layer of the skin
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11
Q

Intramuscular:

A

Muscles have a greater blood supply than the skin does; therefore, drugs injected intramuscularly are typically absorbed faster than drugs injected subcutaneously.

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12
Q

Topical Route:

A
  • uniform amount of drug over a longer period
  • effects of the drug are usually slower in their onset and more prolonged in their duration of action
  • All topical routes avoid first-pass-effects of the liver, with the exception of rectal drug administration
  • used for local effects vs systemic
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13
Q

Transdermal route:

A
  • Through adhesive patches commonly used for systemic drug effects.
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14
Q

what is distribution:

A
  • How substances are distributed throughout the body to its site of action
  • drugs are first delivered to areas extensive blood supply
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15
Q

What are some factors that affect the distribution?

A

dehydration, blood pH, rate of deterioration, circulation, blood pressure, heart rate, albumin (blood protein) that binds to medications preventing them from reaching their target, when 2 protein bound medications are competing to attach to albumin

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16
Q

What are the areas of rapid distrubtion?

A
  • heart, liver, kidneys, and brain.
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17
Q

What are the areas of slow distrubtion?

A
  • muscle, skin and fat
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18
Q

Describe how drug interaction works:

A
  • Albumin is the most common blood protein are carries the majority of protein-bound molecules.
  • When an individual is taking two medications that are highly protein bound, these medications may compete for binding sites on the albumin, Because of this competition, there is more free, unbound drug. This can lead to an unpredictable drug response called a drug interaction.
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19
Q

what is metabolism?

A
  • also called biotransformation
  • the process of chemically converting a drug to a form that is usually more easily removed from the body
  • mostly occurs in the liver
  • First pass over effect: Renders some oral drugs inactive due to hepatic metabolism.
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20
Q

What factors may effect metabolism?

A

basic metabolic rate (BMR), water or lipid soluble, enzymes, genetics, age

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21
Q

What is excretion?

A

How drugs are removed from the body.

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22
Q

Where does most excretion occur?

A

in the kidneys

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23
Q

What factors affect excretin?

A

GFR, blood flow to kidney, water or lipid soluble

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24
Q

What are the first-pass routes?

A

o Hepatic arterial
o Oral
o Portal venous
o Rectal – leads to both first pass and non-first pass

25
Q

What are the non-first pas routes?

A 
Aural (instilled into the ear)
o   Buccal
o   Inhaled
o   Intra-arterial
o   Intramuscular
o   Intranasal
o   Intraocular
o   Intravaginal
o   Intravenous
o   Subcutaneous
o   Sublingual
o   Transdermal
26
Q

loading dose?

A

Loading dose: A higher amount of the drug given normally once or twice to “prime” the blood stream with a level sufficient to induce a therapeutic response.

27
Q

maintenance dose?

A

Before plasma levels can drop back towards zero intermittent maintenance doses are given to keep the plasma drug levels in therapeutic range.

28
Q

What is pharmacodynamics?

A

What the body does to the drug through its mechanism of action

29
Q

What are the 3 basic ways a drug can exert their actions?

A

Through receptors, enzymes, and nonselective interactions.

Not all mechanisms of action have been identified for all drugs.

30
Q

Mechanism of action: receptor interaction

A

The joining of the drug molecule with a reactive site (receptor) on the surface of a cell or tissue, most commonly a protein structure.
-The degree to which a drug attaches and binds with a receptor is called its affinity. The drug with the best fit and strongest affinity for the receptor will elicit the greatest response from the cell or tissue.

31
Q

What is meat by affinity?

A

the degree to which a drug binds with a receptor

32
Q

Mechanism of action: enzyme interactions

A

Enzymes are substances that catalyze nearly every chemical reaction in a cell. Drugs can produce effects that interact with these enzyme systems

33
Q

Mechanism of action: non-selective interactions

A

Drugs with nonspecific mechanisms of action do not interact with receptors or enzymes. Instead, their main targets are cell membranes and various cellular processes such as metabolic activities. These drugs can either physically interfere with or chemically alter cellular structures of processes.

34
Q

Drug-receptor interaction: agonist

A

Drug binds to the receptor; there is a response.
Molecules that activate receptors (neurotransmitters, hormones)
o When drugs act as agonists they bind to the receptor and mimic the action of the body’s own regulatory molecules.

35
Q

Drug-receptor interaction: partial agonist (agonist-antagonist)

A

Drug binds to the receptor; the response is diminished compared with the response elicited by an agonist.

36
Q

Drug-receptor interaction: antagonist

A

Drug binds to the receptor; there is no response. Drug prevents binding of antagonists
Produce their effects by preventing activation of receptors by agonists.
o Can produce beneficial pharmacological effects by blocking:
§ Actions of endogenous molecules at receptor site
§ Actions of drugs at receptor sites

37
Q

Drug-receptor interaction: competitive antagonist

A

Drug competed with the agonist for binding to the receptor. If it binds, there is no response

38
Q

Drug-receptor interaction: non-competitive antagonist

A

Drug combines with different parts of the receptor and inactivates it; agonist then has no effect

39
Q

potency

A

Amount of drug required to produce a desired effect

40
Q

efficacy

A

Producing a desired effect.

41
Q

resistance

A

Reduction in effectiveness of a drug
o Antimicrobial resistance (bacteria, virus, fungi, parasites)
o thNarcotic resistance – What about pharmacogenetics?
§ Neuropathic pain may be resistant.

42
Q

What is therapeutic drug monitoring?

A

A process of measuring peak and trough levels of a drug in a person’s blood with the goal of adjusting the dosage to maximize the therapeutic effect (and minimize toxicity).

43
Q

What is graded dose response?

A
  • A response to a drug such that as the dose of the drug increases the intensity of the response increases. Start small and give more until it gives therapeutic effect.

median effective dose, median lethal dose, median toxic dose

44
Q

what is median effective dose (ED50)?

A

The dose producing a response in 50% of the population.

45
Q

what is median lethal dose (LD50)?

A

The dose that is lethal to 50% of the population.

46
Q

what is median toxic dose (TD50)?

A

The dose that is toxic to 50% of the population.

47
Q

what are the lifespan differences to consider?

A

· Baby
· Elderly
· Sex
· Pregnancy

48
Q

what are the ethnocultural differences to consider?

A

· Ethnocultural implications

· Ethnopharmacology

49
Q

What can the nurse consider to give drugs safely?

A

· Ask why are you giving this med?
· Have I done the proper assessments?
· Does this patient need this med?
· Think about pharmacodynamics, pharmacogenetics, lifespan and ethnocultural considerations.
· Do not rush – take your time and be present and careful.

50
Q

What does steady state refer to?

A

drug removed via elimination = drug absorbed = max/ therapeutic affect

51
Q

Therapeutic Index:

A

the ratio of a drug’s toxic level to the level that provides therapeutic benefits.

52
Q

What does a low therapeutic index mean?

A

a greater likelihood to cause adverse reactions

53
Q

Additive effects?

A

The combined effects of the drugs combine such that if two drugs of similar action are administered at the same time, the action of one plus the action of the other results in the total effect of both drugs being given. 1+1=2.

54
Q

Synergistic effects:

A

the action of one drug enhances the action of another.

The two drugs administered together interact in such a way that their combined effects are greater than the sum of the effects for each drug given alone. 1+1 = greater than 2.

55
Q

Antagonist effect?

A

When the combination of two drugs results in drug effects that are less than the sum of the effects for each drug given separately. 1+1= less than 2.

56
Q

Drug considerations for pediatric patients

A

· Skin is thinner and more permeable.
· Stomach lacks acid to kill bacteria.
· The lungs have weaker mucus barriers.
· Body temp is less well regulated, and dehydration occurs easily.
· Liver and kidneys are immature and so drug metabolism and excretion are impaired.
· The most common method to calculate drug dosages is body weight, given in kg, not pounds.

57
Q

What is polymorphism?

A

the effect of a patient’s age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs.

58
Q

What factors contribute to drug polymorphism?

A
  • Environmental factors (diet, nutiritional status)
  • Cultural factors
  • Genetic (inherited) factors

N232 (15 decks)

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