Pharm Unit 1 Flashcards
(192 cards)
0
Q
what criteria would the perfect drug have?
A
highly potent 100% selective for the part of the body being treated no side effects no drug interation universally affordable
1
Q
What is MOA
A
Mechanism of Action (how the drug works)
2
Q
what is another name for the class of a drug
A
MOA (mechanism of action)
3
Q
basic pharmaceutical profile for drugs in a particular class?
A
absorption degradation & elimination potential drug-drug interactions monitoring requirements use in subpopulations (like pediatrics or pregnancy)
4
Q
special patient populations to consider with drug selections
A
age sex reproductive status culture polypharmacy
5
Q
patient education with certain drugs may include:
A
name of drug (brand name & generic) dose & dose interval length of treatment (acute or chronic)(refills?) need for monitoring and followup care signs & symptoms of toxicity goals of treatment help patient understand condition
6
Q
change biologic functioning via chemical action on cells
A
drugs
7
Q
study of how chemicals interact with living systems
A
pharmacology
8
Q
drugs that are chemicals that our own bodies produce
A
endogenous substances
9
Q
drugs administered to a person
A
exogenous substances
10
Q
drug use in humans in order to treat and prevent disease, recreation, or religion/culture
A
pharmacotherapy
aka applied pharmacology, medical pharmacology, &pharmacotherapeutics
11
Q
undesirable effects of chemicals on living systems
A
toxicology
12
Q
harmful drugs and/or inorganic toxins
A
poisons
13
Q
poisons of biological origin
A
toxins
14
Q
what is the smallest part of matter?
A
atom
15
Q
what is made up of only one type of atom?
A
element
16
Q
what is made up of more than one type of atom?
A
molecule (compound)
17
Q
total atomic weight of all atoms in a molecule
A
molecular weight (MW)
18
Q
three states of matter that are determined by ambient temperature and pressure
A
solid
liquid
gas
19
Q
what are the five elements that all ORGANIC COMPOUNDS are comprised of?
A
Carbon Hydrogen Oxygen Nitrogen Sulfur (some)
20
Q
a solid substance that is dissolved in a liquid
A
solute
21
Q
liquid (water) in which substances are dissolved
A
solvent
22
Q
electrically charged particles in solution
A
ions
23
Q
positively charged ion
A
cation
24
negatively charged ion
anion
25
ions in living systems are called . . .
electrolytes
26
what is something without an electrical charge?
neutral
27
scale that measures the acid in a solution
pH scale
28
chemicals that can accept a hydronium ion (H+) in solution
bases
29
chemical made up of a conjugate base and a hydronium ion (H+)
acid
30
what does the route of drug administration depend upon
physical state of the drug (chemical)
| inhaled, oral, injected
31
type of drug that has a right or left orientation
racemic (aka chiral, isomers, dimers)
32
what is it called when one chemical attaches or associates with another?
bonding
33
kind of bond that is strong and usually not reversible
| less common in drugs
covalent bonds
34
type of bond that is weaker in nature and is more reversible as drugs can dissociate away after initial bonding
weak bonds
35
two types of weak bonds
electrostatic bonds
| hydrophobic bonds
36
type of substance that does not form bonds
inert substance
37
name of the concept that causes solute to passively diffuse from areas of high concentration to areas of low concentration with out any energy being required
Concentration Gradient
38
name for a water soluble substance
hydrophilic
39
name for a lipid soluble substance
lipophilic
40
substance that is both water and lipid soluble
amphiphilic
41
in the body, what is the "water compartment" that water soluble drugs travel through?
plasma in the bloodstream
42
what do lipid soluble drugs have to get through to get out of the bloodstream and into the tissues?
phospholipid cell membrane
43
type of protein that helps carry a drug across the cell membrane
transporter protein
44
what type of drug (by solubility) can cross the Blood Brain Barrier
lipophilic
45
two things that help to create the blood brain barrier
neuroglia
| tight juctions
46
astrocyte cells that are supporting cells of the brain that help make up BBB
neuroglia
47
what areas of the brain do not have the BBB and why?
pituitary
hypthalamus
pineal
-because the brain needs to sample the body's internal environment for regulation of body function
48
name some substances that can easily pass through the BBB
lipophilic substances (alchohol, and anesthetics)
water
gases (such as carbon dioxide)
49
name three things that have difficulty passing through the BBB
proteins
electrolytes
many therapeutic drugs
50
expected benefits of a drug
target outcome
51
the drug that should work the best, be the first-line therapy, have the least toxicity to the patient, and be effective when used alone
Drug of Choice (DOC)
52
a drug that is effective when it is used alone is called
monotherapy
53
the reason or medical condition that the drug is being used
indication
54
this is what the FDA has legally determined to be the clinical condition for which a drug should be used
label indications (label approved)
55
when a clinician prescribes drugs that are not label approved for a specific condition due to clinical evidence that it will work based on the science of the drug
Off label use
56
possible reasons such as age, sex, reproductive status, allergies or comorbidities to NOT use a drug on a particular patient
contraindications
57
when a patient is to NOT be given a certain drug under any circumstances
absolute contraindications
58
when the need for a drug is greater than the possibility of an adverse drug reaction, and a risk-benefit decision has to be made by the provider and the patient
relative contraindication
59
two classes of legal drugs
prescription
| over the counter (OTC) and behind the counter (BTC)
60
book that is published by the FDA listing all approved drugs in the USA
The "Orange Book"
61
drugs that are further regulated by the Drug Enforcement Administration (DEA) due to their abuse potential are called . . .
controlled substances
62
another name for controlled substances that refers to the time constraints put on to how often a certain drug may be prescribed to or purchased by a single person
"Schedule drugs"
63
class of licit drugs that can be safely administered by a lay person who can also understand the directions, indications, and contraindications. they do not represent potential for loss of life, limb, or eyesight.
Over the Counter (OTC)
64
drugs that do not require a prescription, but are not kept out in the open because they still have to be regulated and have purchase limits.
Behind the Counter (BTC)
65
a drug that requires a prescription from a licensed provider in order to be obtained from a pharmacist
legend drug
66
a drug name that follows nomeclature rules
generic names
67
an FDA approved drug name that is owned by a drug company and used for marketing
brand name
68
who determines schedules for schedule drugs?
Drug Enforcement Agency (DEA)
69
this particular schedule of drug is considered illicit and is illegal in the USA
Schedule I
70
Schedules of drugs that are considered licit (legal) and require additional prescriptive authority from the federal government
Schedules II-V
71
a drug law that was passed in 1970
Controlled Substance Act
72
What does the term illicit mean?
use is subject to legal penalties (illegal)
73
schedule number of the drug that has a high potential for abuse, lack of safety for use in treatment, and no accepted medical use in treatment in the USA.
C-1
74
schedule of drugs with high potential for abuse that may lead to severe psychic or physical dependence
C-2 (vicodin, lortab, oxycodone, methadone...)
75
what schedule of drug to different depressants and stimulates fall under?
C-4
76
what class of drug has the lowest risk for abuse
C-5
77
what is a DEA code number?
4-digit number assigned to each CS (controlled substance)
78
two types of safe drug disposal
trash-mixed with non-drug substances
| flushed down the toilet
79
kind of nutrition that maintains a healthy body and helps prevent illness
preventive nutrition
80
type of nutrition that is designed to help cure illness and alleviate symptoms
prescribed nutrition
81
what is it called when nutrition is prescribed and therefore charted?
Medical Nutrition Therapy (MNT)
82
food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease.
medical foods
83
actions of drugs on the body
pharmacodynamics
84
actions of the body on drugs (referring to the detoxification, inactivation, and excretion of drugs)
pharmacokinetics
85
strength of a drug to bind to a specific receptor
affinity
86
a chemical that binds to a receptor is called a _______
ligand
87
drugs that bind and activate the receptor to produce the desired biologic effect
agonists
88
when body's endogenous substances inhibit or block the effect of an agonist, and they are competing for the same cell receptor binding site
antagonist
89
this means to speed up a reaction
catalyze
90
the name of an enzyme always ends in ___.
-ase
91
a sequential series of chemical reactions catalyzed by enzymes
metabolic pathway
92
prevent normal physiologic activity of cell pumps
pump poisoners
93
affects the water balance of the body's compartments
osmotic effects
94
when a drug has affects on the body beyond what is expected from its MOA
pleiotropic effects
95
these naturally restore the balance of bacterial flora in the body
probiotics
96
drugs that are designed in a lab and are engineered to act at the micro-molecular biochemical level
designer drugs
97
results of placebo-controlled, double-blind, cohort matched randomized control trials tell us if drug claims are really true
evidence based medicine (EBM)
98
steps of the EBP process
```
Assess the patient
Ask the question
Acquire evidence
Appraise the evidence
Apply by talking with the patient
Self evalutaion
```
99
substance given to a patient with no known drug effect
placebo
100
when a patient reports improvement or even objectively measured data improves even though they have not actually taken a drug
placebo effect
101
when both the investigator and the patient are unaware regarding who is receiving active drugs or placebos
double blind
102
when an investigator and their patients are aware of the therapy and know that they have received a placebo
open-label drug trial
103
trial of two drugs in the same class to see which one is better
head-to-head trial
104
comparison of generic drugs to brand name
bioequivalence
105
type of drug that requires a very consistent blood level and is therefore not allowed to be substituted with its generic brand
critical dose drug
106
medical conditions that the drug is FDA approved to treat
label indications
107
when a drug is label approved for one condition and then prescribed to treat another, with the support of a scientific basis
off-label prescribing
108
drugs that have limited uses for very rare diseases
orphan drugs
109
organization that aims to provide drug information to consumers with websites for drugs
Center for Drug Evaluation and Research (CDER)
110
summary of chemical and biological information on a drug, inlcluding data from RCT's, warnings, prescribing guidance, how it's supplied, dosing, ect.
Prescribing Information
111
where are vaccine-related injuries and/or adverse effects reported to?
Vaccine Adverse Effects Reporting System (VAERS)
112
put at the very top of the Prescribing Information for the drug to highlight a serious adverse effect risk
Black Box Warning (BBW)
113
what is it called when a patient just takes a medication as it is prescribed?
compliance
114
what is it called when a patient takes a medication as it is prescribed and follows through on other elements of the management plan (like diet and exercise)
adherence
115
when the continued administration of a drug results in decreased response to the same dose, thus a higher dose will be needed to achieve the same drug effect
tolerance
116
what is it called when tolerance develops rapidly?
tachyphylaxis
117
when a drug stops and a withdrawal syndrome developes
physical dependence
118
drugs in the same class that are used to prevent or relieve symptoms of withdrawal from another drug in the same class
cross-dependence (cross tolerance)
119
feeling of satisfaction and desire to repeat drug experience despite knowing that the drug us causing harm
psychologic dependence (addiction)
120
episodic drug use without dependence, often practiced within rituals & in company of others
recreational drug use
121
when drugs are marketed by a pharmaceutical company in a combined form (tablet, capsule) and a prescriber can use the combination of these two drugs with one prescription
fixed-drug (fixed-dose) combination
122
when all cell receptors are occupied by a drug
maximal response
123
dose at which 50% of the population studied will show the toxic effect
median toxic dose (TD50)
124
dose at which 50% of the population studied will die
median lethal dose (LD50)
125
drugs that are added to the primary drug to allow use of primary drug at lower dose to decrease toxicity
adjunctive drugs
126
dose at which 50% of the population exhibits the desired effect
effectiveness (ED50)
127
compares the TD50 (or LD50) with the ED50 to determine the margin of safety for a drug
therapeutic index (TI) (aka selective toxicity)
128
dose range that gives a benefit without toxicity
therapeutic window
129
a reaction that occurs that is not part of the expected therapeutic response to a drug
adverse drug reaction (ADR)
| aka adverse event, adverse effect, adverse drug event
130
any mistake made in diagnosis or treatment
medical error
131
any mistake made in prescribing, transcribing, dispensing, or administering medication
medication error
132
a medical (or medication) error that has not caused harm
near miss
133
when a medical mistake causes harm
preventable adverse effect
134
three types of ADR's
dose related (toxic)
predictable (side effects)
immunologic or idiosyncratic
135
ADR where as the dose increases, so does the ADR potential
dose related (toxic)
136
ADR that is really just a side effect of the drug
predictable ADR
137
and ADR that is unrelated to pharmacologic actions
idiosyncratic
138
an ADR that is an allergic reaction where an immune response has occured
immunologic
139
when serious and potentially life threatening symptoms occur, usually minutes after contact with an allergen
anaphylaxis
140
type I hypersensitivity
anaphylaxis
141
type III hypersensitivity
aka serum sickness
142
type IV hypersensitivity
contact dermatitis
143
rash eruptions that are independent of IgE effects
cutaneous drug reaction
144
"what the body does to the drug
pharmacokinetics
145
pharmacokinetics 4 steps (ADME)
absorption
distribution to tissues
metabolization (biotransformation & elimination)
excretion
146
when the response of combined drugs is additive (1+1=2)
addition
147
effect achieved by using combined drugs is greater than would be predicted than by simple additive effects often due to complementary effects of the drug MOA (1+1>2)
synergism
148
a drug with no effect will enhance the effect of another drug
potentiation
149
one drug inhibits the effect of another drug
antagonism
150
drug toxicity effect that causes loss of consciousness (LOC) and death.
named for the QT interval prolongation and tachycardia on the EKG
Long QT Interval Syndrome (LQTS)
151
amount of time needed for the plasma concentration to drop by 50% after the drug is discontinued. determines how long the drug remains in the system
half-life (elimination)
152
strategy to get a higher serum level immediately by using a larger dose for the first dose
loading dose
153
3 checks of medicine administration
1st: when you receive the med
2nd: when you prepare the med
3rd: when you bring the med to the patient
154
5 rights of medication administration
```
right patient
right drug
right dose
right route
right time
```
155
2 newly added rights of med administration
right reason
| right documentation
156
examples of medication calculation
conversion between systems
| pediatric dosing based on age, weight and ,surface area
157
dosage calculation formula for IV drips
drops/min= (mL of solution prescribed per hour x drops delivered per minute) / (60 min/hr)
158
four pediatric rules of dising
Fried's rule (toddlers)
Young's rule (children 1-12)
Clark's rule (newborns & young infants)
body surface area calculations
159
Fried's rule
| child's dose = ?
(age in months x adult dose) / 150
160
Young's rule (children aged 1-12)
| child's dose = ?
(child's age in years x adult dose) / (child's age + 12)
161
Clark's rule (newborns and young infants)
| child's dose = ?
(child's weight in lbs x adult dose) / 150
162
Body surface area calculation (most common way)
| child's dose = ?
(child's BSA / 1.73) x adult dose
163
reproductive and nursing status for drug administration includes:
last menstrual period
birth control
lactation history
164
pregnancy drug categories from least to greatest on risk of fetal harm
A, B, C, D, X
165
category that drugs are absolutely contraindicated in pregnancy or women who may become pregnant
Category X
166
at what point in her daily lactation cycle should a breastfeeding mother take he medications, just to be sure that it is cleared from her blood before her next feeding
30-60 minutes after nursing and 3-4 hours before her next feeding
167
list of medicines that are drug intolerances in children
```
Benzyl alcohol
BP meds
Arthritis meds
Iron
Aluminum
tetracyclines & quinolone antibiotics
```
168
geriatric drug concerns may include:
```
aging physiology
higher fall risk (sedatives)
respiratory depression risk (opiods)
renal toxicity
polypharmacy
```
169
when multiple drugs are used daily, and there is an increased risk of drug interactions and toxicities
polypharmacy
170
what problems to these help reduce?:
medication disclosure
ID drugs by generic name & class
right drug for right reason
know side effects for each
ID risk of adverse effects
eliminate drugs with no benefit or indication
substitute for less toxic drugs if possible
try to avoid prescribing drugs to treat other drug side effects
try to have each drug to one dose per day
polypharmacy issues
171
someone with the ability to assess, test, diagnose, generate and implement a plan of care
provider
172
examples of medical prroviders
```
MD (medical doctor)
MO (doctor of osteopthy)
NP (nurse practitioner)
PA (physician's assistant)
DDS (dentist)
DPM (podiatry)
```
173
healthcare member who dispenses drugs with an order from a licensed provider
pharmacist
174
healthcare member who administers drugs with an order from a provider
nurse
175
routes of drug administration
oral (withstand stomach acid)
oral disintegrating tablets ( straight to bloodstream)
sublingual
rectal (used in unconscious or vomiting people)
inhalational (lung or nasal sprays)
topical (usually dermatologic or ophthamlmologic)
transdermal (patches)
parenteral (intravenous, intramuscular, subcutaneous)
intrathecal (directly to CSF into brain ventricles)
epidural & spinal (injection to spaces surrounding spinal chord)
176
drug formulation with more rapid onset of action that also lasts a shorter period of time
immediate release
177
drug formulation with slower onset of action but more predictable release to body that last for a longer period of time
extended release
178
nursing medicinal responsibilities to prevent medication errors
```
assessment
administration of ordered meds and therapy
assessment of reaction to meds
teaching
assessment of teaching effectivness
```
179
patient education of the drugs they are prescribed includes:
```
name
dose
action
administration timing
storage and prep
alternative therapies and drugs to avoid
safety measures
points about drug toxicity
warnings about drug discontiuation
```
180
special warnings to give about drugs to patients:
```
drowsy warning
alcohol
diet
drug interactions
pregnancy
refills
```
181
effect of medication and medical errors on a nurses life
"Second Victim Syndrome"
182
5 steps of the nursing process
```
clinical history assessment
physical exam assessment
nursing diagnosis
intervention (plan of care)
evaluation (was plan of care effective?)
```
183
Medication Administration Record includes:
```
patient name
drug name, dosage, frequency & time & route of administration
name of prescriber
time given
date of most recent order
food & drug allergies
```
184
botanicals, recognized for medicinal effect, that are ingested, inhaled, or massaged into skin
herbal medicine (phytomedicine)
185
warnings about herbal medicine
may have interactions with OTC drugs
may have issues with purity and dosing variability
may have long term and short term issues
may affect an existing clinical condition
may have organ toxicity
may have an allergic reaction
186
type of juice that inhibits CYP3A4 enzyme path, causing drug to stay in the system for longer than they are supposed to and can cause drug levels to rise dangerously
grapefruit juice
187
4 types of food sensitivity reactions
```
food hypersensitivity & anaphylaxis (common reactions)
food intolerance (gluten, lactose)
food toxicity (poisoning -- additive, microbe toxins)
food idiosyncrasy (MSG reactions)
```
188
when patients exhibit food reactions to herbal products within the same botanical families
(nuts, citrus, shellfish, melons & ragweed pollen, birch pollen & apples, latex & certain foods)
cross reactivity
189
if allergic to latex, one may have cross reactivity to foods such as:
```
bananas
kiwis
peanuts
avocados
chestnuts
soybeans
```
190
common food additives that cause reactions
sulfites
MSG
dyes
191
5 injection sites
```
deltoid (upper arm)
rectus femoris (anterior thigh)
ventrogluteal (side hip)
dorsogluteal (back of hip)
vastus lateralis (side thigh)
```
