Flashcards in Pharmacology Deck (124):
What is the definition of a drug?
Foreign substances placed into the body.
What is the definition of a medication?
Drugs or other agents used to diagnose, treat or prevent disease.
What is pharmacology?
The study of drugs and their actions on the body.
What are the four types of drug names?
1. Chemical Name 2. Generic Name; Suggested by the manufacturer and confirmed by the United States Adopted Name Council. 3. Drug Brand Name; The proper name should be capitalized. Also known as the trade name. 4. Official Name: The name approved by the FDA and placed into the US Pharmacopeia.
What agency confirms a generic drug name for use in the US Pharmacopiea?
The US Adopted Name Council
What are the main sources of drugs?
Plants, Animals, Minerals and Synthetics made in vitro.
What is the oldest source of drugs?
What are rules when referencing drugs?
Use more than one source, confirm with medical control. Be careful using Internet sources for drug references.
What is a Drug Insert?
A printed fact sheet supplied with most medications.
The Physicians Desk Reference is a compilation of what?
What are the components of a drug profile?
Name, Classification, Mechanism of Action, Indications, Pharmacokinetics, Side effects/Adverse effects, Routes of Administration, Contraindications, Dosages, How Supplied, Special Considerations.
Describe the classification component of a drug profile.
The broad group to which a drug belongs.
Describe the Mechanism of Action component of a drug profile.
The pharmacoynamics; the how/way in which the drug works.
Describe the Indications component of a drug profile.
The conditions which make administration appropriate.
Describe the pharmacokinetic component of a drug profile.
How the drug is absorbed, distributed, metabolized and eliminated. This typically includes the onset and duration of action.
Describe the side effects component of a drug profile.
The untoward or undesired effects.
Describe the route of administration component of a drug profile.
How the drug can be given. IE. Orally, SubQ, IV, IO, ect.
Describe the contraindication component of a drug profile.
Conditions in which you should not administer a drug.
Describe the dosage component of a drug profile.
The amount that should be given.
Describe the How supplied component of a drug profile.
Typically includes the common concentrations of the available preparations for the drug.
Describe the special considerations component of a drug profile.
How the drug may affect pediatric, geriatric and pregnant patients.
Describe the Pure Food an Drug Act of 1906.
Federal Legislation that improved quality and labeling. It also named the US Pharmacopeia as the official source of drug information.
Describe the Harrison Narcotic Act of 1914.
Federal Legislation that limited the use of addicting drugs by regulating the importation, manufacture, and sale of some substances.
Describe the Federal Food, Drug and Cosmetic Act of 1938.
Empowered the FDA to enforce and set premarked safety standards for drugs.
Describe the Durham-Humprhy Amendments
The were amendments to the Federal Food, Drug and Cosmetic Act of 1938. Required pharmacists to have written or verbal prescription from a physician to dispense certain drugs. Created the category of "Over the Counter" medications.
Describe the Kefauer Harris Amendments
They were amendments to the Federal Food, Drug and Cosmetic Act of 1938. Required manufactures to provide proof of safety and effectiveness. Stopped the re-marketing of inexpensive generic drugs under new trade names.
Describe the Comprehensive Drug Abuse Prevention and Control Act of 1970
Federal Legislation. Also known as the Controlled Substances Act of 1970. Most recent major federal legislation relating to drugs. It repealed and replaced the Harrison Narcotic Act. Created 5 schedules of controlled substances.
Test that determines the amount of purity of a given chemical in a preparation in a lab.
How many phases of Human Studies are there?
What does Phase 1 of a Human Study do?
Determines the pharmacokinetics, toxicity and safe dosage in humans. Usually tested on healthy individuals.
What does Phase 2 of a Human Study do?
It is tested on a limited number of patients who have the disease it is intended to treat. The primary purpose is to find therapeutic drug levels, watch for toxicity and side effects.
What does Phase 3 of a Human Study do?
Refine the therapeutic dose and collect data on side effects. Usually a double blind study. Once phase 3 is over a New Drug Application is filed.
What does Phase 4 of a Human Study do?
This is the post marketing analysis during conditional approval. Many drugs are recalled and discontinued after being released to the public.
What are the rights of med administration?
Right Medication, Right Patient, Right Dose, Right Route, Right Time and Right Documentation
What are Teratogenic drugs?
Drugs that during the 1st trimester of pregnancy may deform, injure or kill a fetus.
What are special considerations when working with a pregnant patient?
Changes in the mothers Anatomy and Physiology and the potential to harm the fetus.
What are special considerations when working with pediatric patients?
The pharmacokinetics are different; differences in gastric pH, differences in gastric emptying time, low enzyme levels. Children up to a year old have diminished plasma protein concentrations and thus drugs that are protein bound have a higher Free Drug Availability. Metabolic rates vary from low at birth then rising rapidly during the first few years of life and then lowering to adult levels later.
Define Free Drug Availability
A proportion of a drug that will be available in the body to cause desired or undesired effects.
What are some special considerations when working with a Neonate?
They have a higher proportion of extracellular fluid than adults. Neonates have 80% and adults have 50-55%. They are also susceptible to drugs penetrating the blood brain barrier due to the immature connective tissues.
What are the two most common factors in calculating drug dosages in pediatric patients?
Body Surface Are and Weight
Describe a Broslow Tape
It approximates the height and weight ration and assumes the childs weight at the 50th percentile for the height. It primarily addresses drugs administered in the critical care setting.
What are some special considerations when working with the geriatric populations?
Once older than 60 pharmacokinetic changes occur. They may absorb oral medications slower due to decreased gastrointestinal motility. Body fat increases and muscle decreases cause lipid soluble drugs to have a greater deposition thus lowering the amount available. Liver function changes may affect/delay or prolong drug action.
How a medication is absorbed, distributed, metabolized and excreted. How a medication moves in and out of the body.
What are the processes of Pharmacokinetics?
Absorption, Distribution, Biotransformation and Elimination
What is Active Transport?
The process that moves molecules against a concentration gradient using ATP. The Na+/K+ pump is an example.
What is Carrier Mediated/Facilitated Diffusion?
The process by which a special carrier protein on the surface of a cell will move large molecules such as glucose across the plasma membrane. These typically do not use ATP.
What is Passive Transport?
The movement of a substance without the use of energy.
What are the three types of passive transport?
Diffusion, Osmosis and Filtration
Diffusion and Osmosis require what?
A concentration gradient.
It involves the movement of solutes in a solution down their concentration gradient.
It involves the movement of the solvent up its concentration gradient.
The movement of molecules across a membrane down a pressure gradient.
Describe Absorption as a Pharmacokinetic Process
It is the first step unless a drug is administered directly into the blood stream. Vasculature is important, areas such as muscles with more vasculature will absorb more faster than an area with less. Shock/Hypothermia that slows blood flow will affect absorption conversely Inflammation and hyperthermia will speed absorption. The water solubility of a drug affects absorption. Amount of available surface area is important. Drug concentration affects absorption, this is the thought behind a "loading dose".
What is Bioavailability?
The amount of a medication that is still active after it reaches its target tissue.
Describe Distribution as a Pharmacokinetic Process
Most drugs pass easily into interstitial spaces then on to target tissues. Some drugs bind to proteins found in the blood. Albumin is a common protein that drugs will bind to. When bound to a protein a drug may remain for a longer time. Therapeutic effects are due to the unbound portions of a drug. Changes in blood pH can affect protein conformation and thus binding.
Explain Hypoalbuminemia and it's effects on Pharmacokinetics
It is the low levels of albumin which is a protein found in the blood. It effects the available protein binding for drugs. With less proteins to bind drugs they are now available to increase the drug level in the blood and increasing effects including side effects.
Describe Biotransformation as a Pharmacokinetic Process
It is the metabolism of a drug and has one of two effects. 1. Can transform drugs into a more or less active metabolite. 2. Can make the drug more water (less lipid) soluble. Some drugs are totally metabolized while others are only partially. Protein bound drugs are not available for Bio-transformation.
Biotransformation can turn ProDrugs into active metabolites.
Most Biotransformation processes occur in the liver. (Specifically the Smooth Endoplasmic Reticulum of Hepatocytes).
Define a ProDrug
A medication that is not active when administered but who's biotransformation converts it to active metabolites.
Explain the First Pass Effect
The liver's partial or complete inactivation of a medication before it reaches the systemic circulation. This is why some drugs cannot be given orally, they must bypass the GI tract and be given IV.
What are the Phases of Liver and Hepatic Microsomal Enzymes.
Phase 1: or non synthetic reactions. These often OXIDIZE the parent drug. May reduce or hydrolize it. This makes the drug more water soluble and easier to excrete.
Phase 2: or Conjugation reactions. These combine the prodrug or its metabolites with a naturally occurring chemical making the drug more polar and easier to excrete.
Describe Elimination as a Pharmacokinetic Process
Most drugs (toxins or metabolites) are excreted in the urine. Some are excreted in the feces or expired in air.
What are the two major processes occuring with Renal Excretion?
Glomerular Filtration: This is a function of glomerular filtration pressure and thus blood pressure and flow through the kidneys. Conditions that effect BP can prolong drug actions but limiting Filtration.
Tubular Secretion: Active transport pumps move drugs from the proximal tubules into the urine. Some drugs compete for these pumps and this are given with other drugs to prolong their effects.
What is one important attribute that can change the re-absorption of the renal tubules?
What are the two broad categories of drug routes? What is the difference between the two groups?
Enternal and Paraentral.
Enternal routes have to pass through the GI tract and are thus subject to First Pass Metabolism while Paraentral routes do not go through the GI tract.
List the Enternal Routes of Med Admin
Oral: Good for Self Admin.
Orogastric/Nasogastric: Used for oral meds when the Orogastric or Nasogastric tube is already in place.
Sublingual: Under the Tongue, Good absorption without Gastric Acidity.
Buccal: Between the cheeks and gums, similar to Sublingual.
Rectal: Reserved for vomiting or unconscious patients and those who can't comply with IV Med admin.
List the Paraenternal Routes of Med Admin
IV: Rapid Onset, Preferred Route in Emergencies
Endotracheal: Alternate Route for select drugs. NAVEL and LEAN
IO: Delivers meds to the medullary space in bones.
Umbilical: Both the vein and arteries can be used.
IM: Allows for slower absorption than IV.
Subcutaneous: Slower than IM
Inhaled/Nebulized: Rapid Delivery, useful for lung problems.
Topical: Directly into the skin.
Transdermal: For drugs that can be absorbed through the skin. Allows for a slow continuous release.
Nasal: Directly into the nasal mucosa. Has an expanding role in EMS.
Instillation: Similar to topical but places into a wound or the eye.
Intradermal: For allergy testing, delivers a drug between dermal layers.
What is NAVEL?
The drugs that can be passed through an ET tube for an adult patient.
What is LEAN?
The drugs that can be passed through an ET tube for a pediatric patient.
What are the drug forms?
Solids: Powders, Tablets, Suppositories and Capsules
Liquids: Solutions, Tinctures, Suspensions, Emulsions, Spirits, Elixers and Syrups.
What drug storage factors should be taken into account?
Temp, Exposure to Light, Moisture, Shelf Life
The effects Drugs have on the body.
We are concerned with the mechanism of action and the relationship between concentration and it's effect.
What are the Four ways a drugs act on the body/cells?
1. Bind to receptor sites.
2. Change the physical properties of a cell.
3. Chemically combine with other chemicals.
4. Alter normal metabolic processes.
What is Affinity?
The force of attraction between a medication and a receptor. The higher the affinity the stronger the attraction and more difficult it is to displace the medication from the receptor.
What is Efficacy?
A medications ability to cause the expected response.
What is cAMP? What does it have to do with Medications?
Cyclic AMP is a common second messenger which is released to begin a cascade of events within a cell as a result of binding of a medication to a receptor site on the cell surface.
What is Down Regulation?
When a cell lowers the number of receptor sites for a drug or medication on it's cell surface.
What is Up Regulation?
When a cell increases the number of receptor sites on the cell surface.
What is an Agonist?
Medications that bind to a receptor site and produce an expected outcome.
What is an Antagonist?
A Medication that binds to a receptor site and blocks agonists from producing a response.
What is Competitive Antagonism?
It is surmountable in that if enough of an agonist is given it can displace an antagonist.
What is Non-Competitive Antagonism?
It is insurmountable in that no amount of agonist given will over come the antagonist. The binding of the antagonist causes a deformity in the binding site which won't allow a drug to fit/bind anymore.
What is Irreversible Anatagonism?
It may occur when a competitive antagonist PERMANENTLY binds with a receptor site. No amount of agonist will stimulate the receptor. For the effects to wear off the cell must create new binding sites.
What are the most common drugs associated with SPECIFIC Complaints resulting in hospitalization in the elderly?
What are the most common drugs associated with NonSpecific Complaints resulting in hospitalization in the elderly?
What does an Analgesic do?
Relieves the sensation of pain. Does not sedate.
What is Anagesia?
The absence of the sensation of pain.
What is Anesthesia?
The absence of ALL sensation.
What is Miosis? What is Madriasis?
Miosis: Constricted Pupils
Madriasis: Dilated Pupils
What are the Opiate receptor types?
mu1: Analgesia and Euphoria
mu2: Respiratory and physical depression, miosis, reduced GI motility.
delta: Analgesia, dysphoria, pshychotomimetic effects (hallucinations) and resp../vasomotor stimulation.
Kappa: analgesia, sedation, miosis, and resp. depression
sigma: pshychotomimetic, dysphoria and possibly madriasis.
Epsilon: Effects uncertain
What receptor sites do Opioids effect?
GABA and Dopamine Receptors
What are Adjunct Medications?
They enhance the effects of other analgesics.
What is the Opioid protype?
What is the Benzo antagonist?
What is the other name for Lorazepam?
What is the other name for Diazepam?
What is the other name for Midazolam?
Put the 3 common Benzos in order from fastest off to longest.
What are the 3 types of seizures?
Partial, Grand Mal, Absence
What are the 3 Anti-depressant/pshychotheraputic drug types?
TCA: Tricyclic Antidepressants
SSRI: Serotonin Reuptake Inhibitors
MAOI: Monoamine Oxidase Inhibitors
What would you want to do if someone overdosed on Lithium or Aspirin?
Alkalize the Urine: Administer BiCarb
What is Parkinson's Disease?
Neuron disorder caused by Dopamine Receptor Issues
Treatment: Levadopa is the inactive drug that when activated becomes Sinemet
What are the Autonomic nervous system receptor types? What are the neurotransmitters?
What are the four cranial nerves that carry parasympathetic fibers?
3: Oculomotor Nerve
7: Facial Nerve
9: Glossopharyngeal Nerve
10: Vagus Nerve
Stimulation of the parasympatheic system causes what?
Pupillary Constriction: Miosis
Secretion by the Digestive Glands
Reduction in HR and Cardiac Contractile Force
Increased Smooth Muscle activity along the digestive tract.
What are the types of ACh receptors in the Parasympathetic system?
Where are Nicotinic (N) receptors found?
All autonomic ganglia where ACh serves as the presynaptic neurotransmitter for both the sympathetic and parasympathetic systems.
Where are Nicotinic (M) receptors found?
At the neuromuscular junction. They initiate muscle contraction as a part of the Somatic Nervous system.
Where are Muscarinic receptors found?
Many organs throughout the body. They are primarily responsible for promoting parasympathetic responses.
What is a Parasympathomimetic?
A medication type that stimulates cholinergic receptors. Also called cholinergics.
What are Parasympatholytics?
Medications that block cholinergic receptors, also known as anticholinergics or cholinergic blockers.
What is SLUDGE?
The acronym for the CHOLINERGIC drugs that act on the Parasympathetic NS.
What is the anticholinergic drug protoype?
What are the two types of Neuromuscular Blocking Agents?
Depolarizing and Nondepolarizing
Succs is the only Depolarizing neuromuscular blocking agent used in EMS.
Stimulation of the sympathetic fibers results in the release of what?
Norepinephrine from postganglionic nerves.
What are the types of Sympathetic receptors?
Adrenergic and Dopaminergic
What are the different types of Adrenergic receptors?
What do Alpha 1 Adrenergic Receptors do?
Cause peripheral Vasoconstriction
What to Alpha 2 Adrenergic Receptors do?
They are found on the presynaptic surfaces of sympathetic neuroeffector junctions. Stimulation of Alpha2 receptors in inhibitory. They serve to prevent the over release of norepinephrine in the synapse.
What do Beta 1 Adrenergic receptors do?
Causes increases in Heart rate, cardiac contractile force and cardiac automaticity and conduction.
Renin Release: Kidneys
What do Beta 2 Adrenergic receptors do?
Causes vasodilation and bronchodialation.
Inhibitions of Contractions: Uterus
Tremors: Skeletal muscle
What do Beta 3 receptors do?
Promotes the breakdown of lipids for energy production.
What are medications that stimulate the sympathetic nervous system called?
What are medications that inhibit the sympathetic nervous system called?