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pharmacology Flashcards

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1
Q

pharmacology

A

science of the properties of drugs and their effect on the body

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2
Q

therapeutics

A

branch of medicien that deals with different methods of treatment particularly drugs in disease

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3
Q

prescribing

A

give directions for the preparation and administration of a remedy to be used in the treatment of a disease

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4
Q

how many deaths per year in UK due to drug errors

A

700

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5
Q

key safety principles for prescribing

A

> Taking an accurate drug history
Checking for and acting on allergies and sensitivities, drug-drug and drug-disease interactions
Involving patients in prescribing decisions, where possible
Identifying and using reliable and validated sources of information when prescribing
Only prescribing within one’s own scope of practice, and seeking help where necessary
Taking responsibility for one’s own prescribing
Being receptive to feedback on prescribing errors
Employing timely and effective communication around prescribing, particularly on hospital discharge

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6
Q

4 examples of high risk drugs

A

insulin
opiates
warfarin
direct oral anticoagulants (DOACs)

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7
Q

what is magnapen?

A

a mixture of 2 penicillins

Ampicillin/flucloxacillin

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8
Q

diamorphine AKA

A

heroin

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9
Q

diamorphine vs morphine

A

diamorphine is 2-3 x more potent

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10
Q

antidote for diamorphine

A

naloxone hydrochloride

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11
Q

pharmacodynamics

A

the effect that a drug has on the body when it is administered

= why we might choose to prescribe it

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12
Q

pharmacokinetics

A

how the body absorbs, metabolises and excretes the drug

= the effect the body has on the drug

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13
Q

agonist

A

drugs that activate the receptor response

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14
Q

antagonist

A

drugs that block the receptor response

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15
Q

ways that drugs work

A

via receptors - activating or blocking

enzymes

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16
Q

pharmacodynamic interactions

A

when patient is treated with more than one drug for a single condition

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17
Q

PD interactions account for what percentage of adverse drug reactions?

A

30%

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18
Q

how to prevent harmful PD interactions

A

take care when patients are taking lots of drugs

think which other drugs they are taking which affect the same organ when prescribing

start low go slow

take care with older patients

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19
Q

ADME

A

the basic mechanism the body deals with medicines

Absorption
Distribution
Metabolism
Elimination

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20
Q

first pass metabolism

A

concentration of a drug, specifically when administered orally, is greatly reduced before it reaches the systemic circulation.

lost during absorption which is generally related to the liver and gut wall.

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21
Q

4 outcomes for first pass metabolism when drug reaches liver

A
  1. not metabolised before entering general circulation
  2. substantially metabolised, overcome by increasing dose
  3. completely metabolised = none enters circulation (has to be given via different route)
  4. uses first pass metabolism to convert to active form of drug
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22
Q

example of drug that is completely metabolised and hence is given bucally

A

GTN spray

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23
Q

effect of lipophilic vs hydrophilic drugs on distribution

A

lipophilic are widely distributed as a large proportion of our bodies are made of fat

hydrophilic are only distributed within the vascular circulation and muscle

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24
Q

example of a hydrophilic drug and what is difficult about this?

A

digoxin

tricky to get therapeutic window. e.g. if larger patient, not necessarily large dose since much of this may be fat.

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25
what to do if you are unsure about dosage
seek advice from pahrmacist
26
how are hydrophilic drugs excreted
unchanged via the renal system or biliary tract
27
how are lipophilic drugs excreted
converted to water soluble in the liver via different enzyme systems before leave body
28
most significant system that converts lipophilic drugs to water soluble?
cytochrome P450 system
29
why are drugs metabolised by the cytochrome P450 system clinically significant?
- narrow therapeutic window - if drug level too high or low can be catastrophic - undertreating or toxicity - old fashioned and arent designed to avoid significant interactions
30
``` warfarin theophylline carbamazepine phenytoin oral contraceptive pill ```
examples of clinically significant drugs metabolised by the P450 system
31
examples of clinically significant drugs metabolised by the P450 system
``` warfarin theophylline carbamazepine phenytoin oral contraceptive pill ```
32
if P450 system is induced what happens to clinically significant drugs metabolised by it?
metabolised more quickly removed from body more efficiently = lower drug level = undertreatment of the condition it is treated
33
if P450 system is inhibited what happens to clinically significant drugs metabolised by it?
metabolised more slowly removed from the body less efficiently =higher drug level = drug toxicity
34
why do you have to start carbamazepine and phenytoin at low dose?
induce their own metabolism = start at low dose and gradually increase it as the enzyme system is induced until it reaches a steady state
35
drugs which are enzyme inhibitors and therefore affect drugs metabolised by the P450 system
cipro (or levo) floxacin | erythro (or clarythro) mycin
36
what can ciprofloxacin and erythromycin cause when taken with drugs metabolised by P450 system?
drug toxicity
37
drug where the excreted hydrophilic form is not inactive
opioids
38
drug excreted but not processed first (already hydrophilic)
digoxin
39
what form does a drug need to be in to be excreted?
hydrophilic
40
2 places drugs are excreted
kidneys or biliary tract
41
important in kidney disease or biliary tract obstruction to check
patients medications since this can lead to accumulation to toxic levels
42
therapeutic window
range in which drug is clinically effective without causing toxic side effects
43
amoxicillin has a _____ therapeutic window
large
44
phenytoin has a ______ therapeutic window
narrow
45
drugs with narrow therapeutic window are more likely to be at risk of...
drug interactions
46
what does a drugs half life depend on?
- how quickly the drug is absorbed - whether the drug undergoes first pass metabolism - how the drug is distributed - metabolism of the drug - elimination of the drug - AMDE
47
how many half lives does it take for a drug given regularly to reach a steady state?
4
48
a way that you can figure out how often the patient takes te drug
look at the half life
49
adensonine
cardiac arrhythmia treatment
50
adensonine half life
10 seconds = have to be given IV or else will be no longer effect = good in emergency as frequency of administration would be impossible to maintain
51
some drugs with short half lives can be given as
continuous IV infusions
52
amiodarone half life
v long - 58 days | 232 days to therefore reach steady state.
53
what to do if drug has v long half life
give loading dose - higher level to speed up time to reach steady stead given IV or orally depending on both drug and clinical scenario
54
short half life - how often drug given?
more often
55
what is preferred freq of drugs?
once a day
56
MR
modified release
57
SR
sustained release
58
XL
extended release
59
CR
controlled release
60
when to prescribe with brand instead of generically?
when use specific slow release drugs due to short half life but wanting to give a singular dose a day
61
common reasons for checking drug levels include
drugs with narrow therapeutic window where symptoms may indicate drug toxicity where patient may not be taking the drug where you can't accurately predict the dose the patient needs
62
* Digoxin * Lithium * Carbamazepine * Phenytoin * Theophylline * Certain intravenous antimicrobials such as gentamicin * Warfarin
drugs commonly monitored
63
how is warfarin monitored?
monitor the effect on clotting levels by looking at the INR (international normalised ratio)
64
what is important when taking a sample for drug monitoring?
timing - discuss with pharmacist
65
what to take into account when choosing what to prescribe
allergies comorbidities potential pharmacodynamic drug interactions pregnancy and breast feeding
66
drugs most likely to interact
yellow box enzyme inducers and enzyme inhibitors
67
what is enteral administration?
administration via GI tract - including oral and rectal administration through a feeding tube
68
what is parenteral administration?
any non enteral route - intravenous, intramuscular or subcutaneous
69
why enteral administration?
easy for patients cheap
70
why parenteral administration?
gets into circulation most quickly
71
what is topical administration?
anything prescribed topically - inc eye and ear drops, nasal sprays and nebulisers and topical creams
72
why topical administration?
deliver high dose locally avoid systemic side effects or slow release into systemic - nicotine patches and analgesics
73
compliance
the extent to which the patients behaviour matches the prescribers recommendations
74
adherence
the extent to which the patients behaviour matches agreed recommendations from the prescriber
75
concordance
the consultation process in which doctor and patient agree therapeutic decisions that incorporate their respective views
76
% of patients non compliant with medication at some time
80%
77
% of compliance in patients with chronic health condition
40-50%
78
what does non compliance include?
receiving a prescription but not collecting the medicatin taking medication at the wrong time or in the wrong dose taking it more or less frequently than prescirbed stopping medication before the end of the course taking a drug holiday for a few weeks
79
patient centred factors affected non-compliance
improves with age psycho-social factors - health beliefs, religion etc ethnicity - language barrier, cultural differences the patient-prescriber relationship
80
therapy centred factors affecting non-compliance
route of administration duration of treatment - better with short courses complexity of regime side effects systemic factors
81
3 causes of medication related harm
side effects of medication interactions between different medications prescriber error - allergies and contraindications
82
type A side effects
predictable from known pharmacology but may be exaggerated in some people common and rarely fatal - managed by appropriate patient counselling or by reducing the dose
83
type A side effect in beta blockers
bradycardia
84
type B side effects
unpredictable (or bizarre) much less common, can be fatal cannot be predicted from the way the drug works should not take that medication again
85
type A side effect of warfarin
easy bruising
86
type A side effect in anticholinergic medications
hallucinations
87
type b side effect of penicillin
allergic reactions
88
type B side effect of chloramphenicol
aplastic anaemia
89
type C side effects?
medications that only cuaase side effects after a patient has been taking them for a long time whether should be stopped depends on what is being treated
90
type C side effect of steroids
cushings syndrome
91
type C side effect of L-Dopa medications
dystonias
92
type C side effect of bisphosphonates
osteonecrosis of the jaw
93
type D side effects
delayed uncommon and occur years after completing treatment
94
example of type D side effect
people who have received certain types of chemotherapeutic agents are more at risk of secondary cancers later in life
95
type E side effects
end of treatment effects some medications cause problems when stopped abruptly
96
drugs with withdrawal symptoms if stop abruptly
opiate alcohol benzodiazepine
97
SSRI type E side effect
serotonin syndrome
98
long term steroid type E side effect
addisonian crisis
99
prescribing cascade
when a medication is given to treat a side effect of another medication
100
example of intentional prescribing cascade
antiemetics in chemo
101
example of unintentional prescribing cascade
prescriber fails to recognise that the symptom is a side effect of another medication
102
amlodipine side effect
ankle oedema
103
why can soluble paracetamol cause hypertension
high salt content

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