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Pharmacology Flashcards

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1
Q

What is the role of OT in medication management?

A

Understand the consequences and implications of common medications
Assist patients in ordering and refilling-patterns
Fine motor skills-handling pill, filling pill containers
Strength: opening containers
Cognition: taking at the right time, the correct amount, recognizing side effects

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2
Q

__ and __ can affect the pharmacokinetics of a drug.

A

exercise and application of PAMS and therapy

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3
Q

Therapy interventions seem to have the greatest potential to affect ___ of drugs that are administered by trans dermal techniques or by subcutaneous and intramuscular injection.

A

absorption and distribution

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4
Q

What is a drug?

A

any nonfood chemical that impacts the mind or body

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5
Q

What is pharmacology?

A

the study of medicines or drugs and their effect on the body

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6
Q

What is medicine?

A

something that is deliberately administered to prevent, diagnosis or have a therapeutic impact

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7
Q

Medical uses for drugs

A

Prevent Illness or Disease
- Prophylaxis
> Motion sickness
> Contraceptive
> Vaccinations

Diagnostic Use
- Contrast dyes
- Drugs that mimic exercise

Therapeutic Use
- Antibiotics
- Analgesics
- Management of diabetes, thryroid, cardiac

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8
Q

Who can prescribe medications?

A

Medical doctors
Osteopathic doctors
Dentists
Podiatrists
Chiropractors
Psychologists
Optometrists
Military PT
Physician assistants
Nurse practitioners

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9
Q

What is the FDA’s job regarding medications?

A

To make sure that it is
- pure
- effective
- balance between value and risk

Responsible for the review and approval of all new drugs before they can be made available to the public

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10
Q

When did laws start to pass to protect consumers from drugs?

A

1900s

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11
Q

What laws were created in the 1900s to protect consumers from drugs?

A

Food Drug and Cosmetic Act 1938: drug manufacture had to show it was safe
Durham-Humphrey Amendment (1951): prescription drugs could only be given with physician supervision
Kefauver-Harris Amendment (1962): drugs had to be safe and effective
1990s: tamper proof packaging

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12
Q

First and prior to applying for drug approval, the manufacturer must do…

A

preclinical testing
- may take 3-6 years
- involves lab and animal testing to determine biological activity of the drug

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13
Q

What are types of non-adherence?

A

Taking someone else’s meds
Taking more or less
Skipping doses
- Financial reasons
- Physical reasons
> Cant open
- Cognitive reasons
> Forgets
> Decides not to take due to evening out
Failure to follow directions
- Take with food
Stopping without consulting doc
Not filling meds

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14
Q

Health system related ways an OT can impact medication management?

A

Difficulty getting in with doc to renew prescription
Drug restrictions (dosage amounts, requirements)

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15
Q

Condition related ways an OT can impact medication management?

A

Asymptomatic chronic disease
- High Blood Pressure
Mental health related
- “I don’t need it”

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16
Q

Patient related factors an OT can impact medication management?

A

Pt impairments-physical or psychological
Behavioral
- Denial, anger

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17
Q

Therapy related ways an OT can impact medication management?

A

Complex medicine regimen
Incompatible with lifestyle
Side effects
Social stigma

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18
Q

Social and economic related ways an OT can impact medication management?

A

Cost
Lack of insurance
Language barrier
Cultural beliefs and attitudes
Poor social support
Health care literacy
- Cranberry juice is just as good as antibiotics

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19
Q

What is polypharmacy?

A

Typically 5 or more medications
30% of those over 65
In the US $1000.00 per person each year
Europe-$300.00

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20
Q

What are issues with polypharmacy?

A
  1. Increased risk of medication related issues-interactions
  2. Correct dosage, time of day, number of pills etc
  3. Economic burden
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21
Q

Why does OT care about polypharmacy?

A

Impact to therapy outcomes (LBP-intervention vs meds)
Impact to functional status
- Positive and negative
- 5 MMT, Full AROM, no energy-doesn’t do anything
- No pain, increased function (PT, OT or meds??)
- Change in status (new med on board??)
Adverse Reactions
- Side effects
- Fall risk
- Change in cognition, balance, motor function

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22
Q

What is pharmacodynamics?

A

The study of the action of the drug on the body
This includes the biomechanical and physiologic effects of the drug as well as the mechanism of action at the target cell or organ
- adverse side effects are a form of negative pharmacodynamics
- includes how the drug works

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23
Q

What is pharmacokinetics?

A

The study of how the body deals with the drug, including absorption, distribution, metabolism, and excretion
- how long required for the action, how long will it last, what factors speed up or slow down the effect

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24
Q

Is polypharmacy in our scope of practice?

A

advocacy, ADLs, in their homes

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25
How does aging impact absorption (drug getting into system)?
May be slowed but the absorbed share is most often not effected Change is due to decreased function of ventricles, intestines, and blood flow to intestines Of little importance
26
How does aging impact distribution?
Decreased hydrophilic drug distribution, increase lipophilic drug distribution Change is due do decline in fat-free mass and increase in body fat with aging Important for some drugs Drugs that may be affected: diazepam, digoxin, lithium
27
How does aging impact metabolism?
Hepatic metabolism may be reduced Change is due to decreased hepatic blood flow and liver mass Important for several drugs
28
How does aging impact renal elimination?
Renal elimination is reduced Change is due to decreased glomerular filtration rate Very important
29
What is medication reconciliation?
July 2004 – Joint Commission announces 2005 national patient safety goal #8 – medication reconciliation required for all accredited systems 8a) Implement a process for obtaining and documenting a complete list of the patient's current medications upon the patient's admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the list. 8b) A complete list of the patient's medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization.
30
Joint Commission recommendations on medications
Placing the medication list in a highly visible location in the patient's chart and including dosage, drug schedules, immunizations, and allergies or drug intolerances on the list. Creating a process for reconciling medications at all interfaces of care (admission, transfer, discharge) and determining reasonable time frames for reconciling medications. Patients, and responsible physicians, nurses and pharmacists should be involved in the medication reconciliation process. On discharge from the facility, in addition to communicating an updated list to the next provider of care, provide the patient with the complete list of medications* that he or she will be taking after discharge from the facility, as well as instructions on how and how long to continue taking any newly prescribed medications. Encourage the patient to carry the list with him or her and to share the list with any providers of care, including primary care and specialist physicians, nurses, pharmacists and other caregivers.
31
What is the chemical name of a drug?
Specific compound structure, long and cumbersome name, non-proprietary, chemical structure of the drug methylpropyl (phenyl), propanoic acid (Ibuprofen)
32
What is the generic name of a drug?
Official or nonproprietary and derived from the chemical name The more consistent name, single name for a drug: e.g. Ibuprofen—usually less expensive
33
What is the trade name of a drug?
Brand name assigned by and OWNED by the pharmaceutical company, proprietary Several companies may market the same generic drug under different names: Advil, Motrin, Mepipren
34
What is the difference between the generic and trade name?
Generic: - Less expensive - Safe and effective provided within the specific range criteria through testing on active ingredients (bioequivalent) - “Off label” - May still experience different affects than with the brand name drug Trade (brand): - More expensive - Very specific effect for given conditions - Preferred for those drugs that have a wider range of therapeutic and adverse effects when tested
35
Trade name of pseudophedrine
actifed, sudafed
36
Trade name of erythromycin
e-mycin, erythrocin
37
Trade name of cephalosporin
Keflex, Keflin, Suprax, Utrace
38
Trade name for penicillin
V-Cillin, Amoxil
39
Trade name for acetaminophen
TylenolT
40
Trade name for naproxen sodium
alieve
41
Trade name for ibuprofen
motrin, advil
42
Why are generic drugs cheaper than brand-name drugs?
A large portion of the cost of brand name drugs covers the high cost of research and development Generic manufacturers do not have to duplicate the cost of research and marketing conducted by the original manufacturer Therefore, the cost of the generic drug is usually less
43
Standard practice and most state laws require that a generic drug be generically equivalent to its brand-name counterpart.
Same active ingredients, strength, and dosage form—pill, liquid, or injection Must be therapeutically equivalent—it must be the same chemically and have the same medical effect
44
Advantages of generic vs. brand-name drugs
Generic drug usually marketed under generic name, which usually indicates the active ingredients Brand-name does not indicate active ingredients
45
FDA approves of nonprescription drugs if...
they are safe when the directions are followed
46
To become an OTC drug...
The use must be similar to the use when it was a prescriptions Pt can easily monitor and diagnosis self without medical knowledge There is a low rate of side effects No monitoring or additional test required
47
Schedule I drugs
Ex: marijuana, LSD, ecstasy (MDMA), heroin Highest potential for abuse and no accepted medical use and are not safe under medical supervision
48
Schedule II drugs
Ex: cocaine, opium, high grade morphine, oxycodone, methamphetamines (adderall) High potential for abuse, despite having an accepted medicinal use in the US
49
Schedule III drugs
Ex: low grade morphine, anabolic steroids, ketamine, certain codeine mixtures Can lead to moderate physical dependence or high psychological dependence
50
Schedule IV drugs
Ex: ambien, valium, xanax, rohypnol, zolpidem, soma, darvon, darvocet, ativan, talwin Has accepted medical use in the USE, but abuse of the drug may lead to limited physical or psychological dependence
51
Schedule V drugs
Ex: cough syrup, lomotil, motofen, lyrica, parepectolin Substances with limited quantities of certain narcotics that have less potential for abuse and have accepted medical use in the US with limited risk of physical/psychological dependency
52
Non prescription OTC drugs
Low frequency of toxic or adverse effects No need for periodic blood work or medical evaluation Effective with significant portion of patients Usually contains less drug per dose when compared to the corresponding prescription drug - Alieve (200 mg tablet) - OTC - Naproxen (250 or 500 mg tablet) prescription/OTC
53
Prescription drugs
Greater potential for adverse effects Monitoring needed for interactions Restricted for period of time for use Classified into schedules of drug - Schedule I: controlled substances, highest abuse potential - Schedule V: lowest abuse potential - Schedule III: includes anabolic steroids
54
What do you think of medical marijuana?
gonna be a discussion question
55
Symptoms for vitamin D toxicity
cramps, nausea, vomiting, calcium, crystal deposits that affect liver, kidney, lungs (calcium salts are irreversible)
56
Symptoms for vitamin A toxicity
water in the brain, vomiting, tiredness, constipation, bone pain, brittle nails, hair loss, birth defects
57
Symptoms for vitamin B6 toxicity
mobility issues such as tingling and numbness in hands and feet, trouble walking, trouble grasping small objects (difficult to reverse symptoms)
58
Symptoms of vitamin C toxicity
kidney and gallbladder stones in those prone, but normally it just makes really expensive urine
59
Symptoms for folate toxicity
pernicious anemia, kidney damage
60
Symptoms for vitamin B12 toxicity
diarrhea, swelling, blood clots in legs
61
Symptoms for vitamin K toxicity
anemia in adults, death in infants
62
Symptoms for niacin toxicity
flushed skin, nausea, diarrhea, liver damage
63
Symptoms of vitamin E toxicity
headache, tiredness, double vision, diarrhea, vitamin A, D, K deficiency
64
What is an agonist drug?
65
What is an antagonist drug?
a drug that binds to a protein but doesn't activate
66
What is a side effect?
Any effect other than the therapeutic effect desired Sometimes the side effect can become a therapeutic effect, like Botox
67
What are adverse effects (AE)?
Severe side effects-often don’t know till there a lots of people and several years May result in a drug being pulled Black box warning - life altering/threatening effects
68
What is a toxic effect?
Happens over time Dosage is above the therapeutic level Therapeutic Index (remember we want a large index!) Some drugs have a narrow margin - These pt’s have to be monitored more closely for toxicity - Lanoxin, Accutane, Lipitor(kidney and liver failure)
69
What is a paradoxical effect?
Opposite effect in certain patients Amphetamines (given to ADHD kids)
70
Symptoms of an allergic reaction
Mild to severe-itching to death Anaphylactic shock
71
What are idiosyncratic reactions?
Reaction to a drug that is different than expected due to a specific genetic make up, usually a specific ethnic group: Asian, Jewish, African etc.
72
What is malignant hyperthermia?
uncontrolled body temp after a a dose of succinylcholine-can be deadly
73
What is synergism?
Two drugs create a stronger effect - Tylenol and Codeine
74
What is antagonism?
Two drugs create a weaker effect than either would on it’s own - Antibiotics and Birth control
75
What is a drug food interaction?
happens when the food you ear affects the ingredients in a medicine you are taking so the medicine cannot work the way it should
76
Most common medications associated with adverse drug effects in the elderly
opioid analgesics NSAIDs anticholinergics benzodiazepines cardiovascular agents CNS agents musculoskeletal agents
77
Describe medication labeling
Overly technical Print too small Too much information No standardization Issues of literacy
78
How to simplify labels for pts
Highlighting of basic information One nugget of information per line Basic language easily understood
79
Losartan potassium
Generic name: Losartan Postassium Brand name: Cozaar Used to treat hypertension Can also be used to help protect the kidneys from damage due to diabetes.
80
Alendronate
Generic: Alendronate Brand name is Fosamax and Binosto Prevent osteoporosis Side effect: nausea, heart burn Never take alendronate at bedtime it will not fully absorb in the system.
81
Digoxin
Generic: Digoxin Brand name: Lanoxin Used to control the rate and rhythm of a pt heartbeat. Reduces swelling of hands and ankles in pts with heart problems Should avoid taking OTC antacids This is also used to treat angina (heart pain) and may be used after a heart attack
82
Tylenol
Generic name: Acetaminophen Brand name: Tylenol Mild-moderate pain reliever Should be avoided if you have liver disease Can be taken to reduce fever. Can cause instant renal failure after having consumed alcohol within 72 hours
83
Warfarin
Generic name: Warfarin Brand name: Coumadin, Jantoven Helps prevent blood clots from forming. Aspirin and warfarin are two commonly prescribed blood thinners they should not be taking together due to increase bleeding. Vitamin K is the antidote for warfarin. Can not take Warfarin before surgery due to risk of increased blood loss during surgery
84
Lasix
Generic: Furosemide Brand: Lasix Treats fluid retention Used for pts with congestive heart failure, liver disease, or a kidney disorder This medication can make your skin sensitive to sunlight; protective clothing, sunglasses, and sunscreen are highly recommended when taking this medication Can be injected instead of in a pill
85
Thyroxine
Generic name: Levothyroxine Brand names include: Synthroid, Unithyroid, and Levoxyl Can also treat thyroid cancer and enlarged thyroid Used to treat hypothyroidism, an under active thyroid
86
Nitroglycerin
Generic: Nitroglycerin Brand Name: Nitrostat Prevents and treats chest pain Lowers blood pressure as well. When used rectally, it can treat pain caused by tears in the skin around the opening for bowel movements (anal fissures). This medication allows more blood to flow to the heart
87
Metformin
Generic name: Metformin Brand Name: Glumetza Helps to restore the body's response to insulin, used for type 2 diabetes Can be used to treat PCOS
88
Esomeprazole
Generic name: Esomeprazole Brand name: Nexium Used to treat indigestion, heartburn, and acid reflux Patients taking PPIs have a higher risk of developing kidney disease
89
NSAID
Generic (brand) name: Aspirin (excedrine), Ibuprofen (advil, motrin), Naproxen (aleve, midol) Relieves pain, reduces inflammation, reduces fever Chronic use of NSAIDs may also present higher risks for people with heart disease, high BP, or diabetes Chronic use can lead to anemia Avoid taking NSAIDS if you have: kidney disease, liver disease, heart failure, history of stroke or heart attack, HBP if it's difficult to manage
90
Levodopa
Generic name: levodopa Brand name: Sinemet Used for Parkinson's

Geriatrics (20 decks)

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