Principles of Pharmocology Flashcards
(136 cards)
1
Q
What can medications do?
A
-Correct to decrease the severity of an illness or injury
-Manage life-threatening conditions
-Substantially reduce patient discomfort
2
Q
What is pharmocology
A
Scientific study of how various substances interact with or alter the function of living organisms
3
Q
What was the point of medicine in ancient times?
A
To treat the symptoms
4
Q
The Pure food and Drug Act
A
-1906
-Prohibited altering or mislabeling medications
5
Q
The Opium Exclusion Act
A
-1909
-Prohibited importing opium
6
Q
The Harrison Narcotic Act
A
-1909
-Restricted the use of various opiates and cocaine
7
Q
The Food, Drug, and Cosmetic Act
A
-1938
-Gave US FDA enforcement authority for approving new medication and removing unsafe medications from use
8
Q
What does off-label use mean?
A
-A purpose not approved by FDA
-Doses different from FDA
-Different route
9
Q
Who dictates off-label use?
A
A Services’ medical director or by agency/protocol
10
Q
What does off-label use increase?
A
-Increased liability for healthcare worker
11
Q
Schedule I
A
-High abuse potential
-No recognized medical purpose
12
Q
Schedule II
A
-High abuse potential
-Legitimate medical purpose
13
Q
Schedule III
A
-Lower potential for abuse
-Legitimate medical purpose
14
Q
Schedule IV
A
-Less potential abuse than schedule III
15
Q
Schedule V
A
Lower potential for abuse than IV
16
Q
Synthetic vs semisynthetic
A
-Synthetic is entirely made in a lab
-Semisynthetic is derived from plants and then modified in a lab
17
Q
What do pharmaceutical companies control?
A
-concentration
-Purity
-Preservatives
-Fillers
18
Q
Form of medications
A
-Capsules
-Tablets
-Powders
-Droplets
-Parenteral solution
-Skin Preparation
-Suppositroy
-Liquid
-Inhaler/Spray
19
Q
Chemical Name
A
-Used in development
20
Q
Generic Name
A
-Nonproprietary Name
-Include a stem
21
Q
Brand name
A
-Proprietary Name
-Chosen by manufacturer
-For marketing
22
Q
Tall Man lettering
A
-Capitalizing differences in medications that could be confused
23
Q
What does a manufacturer package insert include?
A
-Dosing
-Route
-Contraindication
-Adverse Effects
24
Q
AHA class I
A
Strong evidence supporting use
25
AHA class IIa
Moderate evidence
26
AHA class IIb
Weak evidence
27
AHA class III
Evidence does not support use
28
AHA class intermediate
Beginning or continuing research, no recommendation
29
Medication storage recommendations
-Must provide adequate protection
-Must be convenient
-Must prevent physical damage
-Should be placed in protective bins
-Should facilitate quick and accurate identification
30
What do controlled substances require in regard to medication security ?
-Additional security
-Additional record keeping
-Disposal precautions
31
What need to be documented about the use of controlled substances
Every last milliliter or milligram
32
Pharmacodynamics
-ACTION OF THE MEDICATION ON THE BODY
-Is the alteration of a function or process of the body as medication is administered
-Any medication can cause toxic effects
33
Pharmacokinetics
-ACTION OF THE BODY ON A MEDICATION
-Absorption, distribution, biotransformation, elimination
34
Where do receptor sites live?
In proteins connected to cells
35
Types of chemicals that activate receptors
Endogenous chemicals
Exogenous chemicals
36
What happens when a medication binds with a receptor site?
-Channels permitting the passage of ions in cell walls may be opened or closed.
--A biochemical messenger becomes activated.
-A normal cell function is prevented.
-A normal or abnormal cell function begins.
37
Agonist Medications
- Affinity: ability of a medication to bind with a particular receptor site
- Bind with receptor sites.
- Initiate or alter cell action
38
Agonise Threshold Level
-level at which initiation or alteration of cellular activity begins
-All receptor sites become occupied.
-The maximum capacity of the cell is reached
39
Agonist Potency
-concentration of medication required to initiate a cellular response
40
Agonist Efficacy
-Ability to initiate or alter cell activity in a therapeutic or desired manner
41
Antagonist Medications
-Bind with receptor sites to prevent cellular response to agonist chemicals
-Inhibit normal cellular activation
-Treat harmful agonist effects of exogenous medications
42
Types of Antagonist medications
Competitive and non-competitive
43
Competitive Antagonists
-Temporarily Bind with receptor sites
-Efficacy is related to concentration near receptor sites and affinity of medication versus agonist chemicals present
44
Noncompetitive Antagonists
-Permanently bind with receptor sites and prevent activation by agonist chemicals
-Continuation of effects until new receptor sites or cells are created
-Cannot be overcome by increased doses of agonist chemicals
45
Partial Agonist Chemicals
-Bind to the receptor site
-Do not initiate as much cellular activity as other agonists
-Lower the efficacy of other agonist chemicals
46
Alternative Mechanisms of Drug Activation
-Medications can alter cell function without interacting with receptors.
-Engineered to target
47
Antimicrobals
-Antibiotics and antifungals
-May target specific substances present in the cell walls of a bacteria or fungi
48
Chelating Agents
-Bind with heavy metals
-Create compound that can be eliminated
49
Diuretics
-Create osmotic changes
-Alter distribution of fluids and electrolytes
-Draw excess water away from certain body tissues while enhancing excretion of urine
50
Electrolyte-based medications
Change concentration and distribution of ions in cells and fluids throughout body
51
What factors affect medication response?
-Age
-Weight
-Genetics
-Enviroment
-Pregnancy
52
Tell me about body fat in infants
-Low and lowest in preterm infants
-Newborns have the highest percentage of body water
53
Weight based medication advantages
-Medication is proportional to body size
-Appropriate doses for all ages
54
Weight based medication limitations
-Need weight in kg
-Does not factor body composition
-based on ideal body weight
-People suck at estimating weight
55
Ideal weight women
45.5+(2.3 * inches over 5 ft
56
Ideal weight men
55+(2.3 * inches over 5 ft)
57
How does hyperthermia affect medication response?
-Increase hepatic blood flow and increaing medication metabolism
-Fever can slow the cytochrome P-450 system, decreasing metabolism of drugs
58
How does hypothermia affect medication response?
Impairs effectiveness of medication used in traditional cardiac life support
59
Genetic facts that can affect medication responses?
Primary pulmonary hypertension
Sickle Cell Disease
Glucose-6-phosphate dehydrogenase deficiency
60
How does pregnancy affect medication response
-Changes in body affect absorption, distribution, and elimination
-Numerous physiologic changes
-There is a fetus to protect
61
FDA pregnancy category classification A
Send it, harm is remote
62
FDA pregnancy category classification B
No controlled studies on pregnant people but send it
63
FDA pregnancy category classification C
An adverse effect is possible, only give if the benefit justifies the potential risk to fetus
64
FDA pregnancy category classification D
Fetus will be at risk but if mama needs to live she's gotta live
65
FDA pregnancy category classification X
Hell nah, fetus will be deformed, no possible benefit outweighs the risk
66
Therapeutic (desired) response
-Medication is selected based on the patient’s illness, injury, complaint, signs, and symptoms.
67
What patients are at higher risk for adverse effects?
Patients with chronic medical conditions
68
Medications that require repeated dosing demonstrate______
cumulative actions
69
Adverse effects vs side effects
Adverse is bad period no buts or ifs
Side effects are usually self-resolving and can be expected
70
Median lethal dose
LD50: death in 50% of animals tested
71
Median toxic dose
TD50: adverse effect in 50% of animals tested
72
Median effective dose
ED50: effective dose for 50% human and animals tested
73
Therapeutic index
Ratio between median effective dose and medial lethal dose or median toxic dose
74
Immune-mediated response
-Genetically predisposed patients have an initial exposure/sensitization to an allergen.
-Medication sensitivity may occur following the first exposure to a medication or substance.
-Subsequent exposure triggers exaggerated response of immune system
75
Medication tolerance
-Results from down-regulation
-Certain medication have a decreased efficacy when taken repeatedly
76
Cross-tolerance
Exposure to a medication within a particular class can cause tolerance to other medications in the same class
77
Tachyphylaxis
Repeated doses of medication within a short time rapidly causing tolerance, making the medication ineffective
78
What medications are most prone to abuse?
Uppers and downers
79
Habituation
Abnormal tolerance to adverse or therapeutic effects associated with a substance
80
Dependence
physical, emotional, or behavioral need for a substance to maintain a normal level of functioning
81
When does the body begin removing a medication?
As soon as it enters the body
82
What's a medication's duration and effectiveness determined by?
-Dose
-Route
-Clinical status of the patient
83
Onset
Related to absorption and distribution
84
Onset
Related to absorption and distribution
85
Peak
Related to absorption and distribution
86
Duration
Related to metabolism and elimination
87
What determines route of administration for medications?
-Physical and chemical properties
-routes available
-speed of effect needed
88
Bioavailability
Percentage of unchanged medication that reaches systemic circulation
89
Oral,orogastic, and nasogastric tube medication administration
Patient must be responsive, able to swallow/have a tube
90
First pass metabolism
GI tract -> portal vein -> liver
Metabolism occurs in liver which may alter/inactivate medication before systemic circulation
91
Endotracheal medication administration
-Not a reliable method
- 2-2.5 times the IV dose with 5-10 mL flush
92
OLEAN
Oxygen
Lidocaine
Epinephrine
Atropine
Narcan
93
Intranasal Medication Administration
-Liquid turns to mist
-Rapid absorption
-Near 100% bioavalability
-No needle stick
94
Intravenous Medication Administration
-Perfered method for prehospital setting
-100% bioavailability
-Quick onset
95
Intraosseous Medication Administration
-Any IV med can be done IO
96
IO locations
Proximal tibia
Femur
Distal tibia(medial malleolus)
Proximal humerus
Manubrium
97
Intramuscular medication administration
-In to large muscle
-75-100% bioavailability
-Need to know muscle and technique
98
Subcutaneous medication administration
-Into subcutaneous tissue
-some meds are SC only
-Slower absorption can prevent cardiovascular effects
99
Dermal and transdermal medication administration
-Medication in patches
-May alter a patient’s clinical presentation or interfere with other medications administered
-Deliver a relatively constant dose of mediation during a long period
-Often contain a large quantity of medication
100
Sublingual medication administration
-Bioavailability is low
-Large doses are required
-Patients must be conscious and alert
-Nitroglycerin is often given using this route
101
Inhaled or nebulized medication administration
-May assist patients with medications via metered-dose inhalers
- Liquid nebulization
102
Rectal medication administration
-Preferred over the oral route if patient is unresponsive, having seizures, vomiting, unable to swallow
-May have greater than 90% bioavailability
-Manufactured in suppository form, and gel form
-Unpredictable absorption
103
Ophthalmic Medication Administration
- Drops or ointment
- Typically administered for pain relief, allergies, and infections
104
Other methods of administration
Hemodialysis
105
What determines how a medication moves through the body?
Chemical properties
Physical properties
Patient factors
106
How is osmosis involved in the distribution of medications?
Allows IV fluids to leave the intravascular space and enter various tissues and cells
107
Filtration
-The process within the body that is used to redistribute water and other particles.
-Hydrostatic pressure forces various fluids against semipermeable membranes.
108
What passes easily through cell membranes
Small nonionic and lipophilic molecules
109
How do large hydrophilic and ionic molecules enter cells?
-Pinocytosis
-Facilitated diffusion
-active transport
110
3 barriers in the body against meds?
Blood-brain barrier
blood-placenta barrier
blood-testes barrier
111
How are plasma proteins involved in the distribution of medications
medications temporarily attach to them and med levels can change based on amount of plasma protein and medication interactions
112
How does fat tissue affect medication distribution
-Lipophilic medications can be sequestered in the fat tissues of an obese person
-medication is released slowly, causing prolonged effects
113
Medications with a high volume of distribution mean what?
Larger dose required to reach optimal plasma level
114
Medications with a lower volume of distribution mean what?
Lower doses is required
115
Biotransformation
Medications undergo some degree of chemical change by the body, becomes known as a metabolite.
116
Active metabolites
capable of pharmacologic activity
117
Inactive metabolites
no longer possess ability to alter a cell process of body function
118
Possible effects of biotransformation
-An inactive substance can become active
-An active medication can be changed into another active medication
-An active medication can be inactivated
-An active medication can be transformed into a substance that is easier to eliminate
119
Where does most biotransformation occurs?
In the liver
120
How does the cytochrome P-450 system change medications?
uses enzymes that alter the chemical structure of a medication
121
How are medication removed?
Eliminated primarily by the kidneys, either the med or the metabolite exits
122
Zero-order elimination
fixed amount of substance removed during a certain period, regardless of amount in the body (e.g. ethanol)
123
First-order elimination
-Majority of medications
-rate of elimination directly influenced by plasma level of substance, known as a medication’s half-life
124
Half-life
Time needed for metabolism or elimination of 50% of the substance in plasma
125
Is half life related to clinical effects or the amount of medication in the body?
Amount of medication in the body
126
10 Patient Rights
1. Patient
2. Medications
3. Dose
4. Route
5. Time
6. Documentation and reporting
7. Assessment
8. to refusal
9. Evaluation
10. Patient education
127
Sympathomimetic drugs
-Drugs with alpha or beta sympathetic properties
-Many drugs do both
128
Chronotropic drugs
HR go brrr
129
Inotropic drugs
Morning wood
130
What receptors are found on the heart?
Beta 1
131
Beta 1
Act on heart only
132
Beta 2
Act on lungs only
133
Alphas on the 3
Heart: nothing
Lungs: slight constriction
Vessels: constriction
134
10 Patient Rights
1. Patient
2. Medications
3. Dose
4. Route
5. Time
6. Documentation and reporting
7. Assessment
8. to refusal
9. Evaluation
10. Patient educationIn
135
10 Patient Rights
1. Patient
2. Medications
3. Dose
4. Route
5. Time
6. Documentation and reporting
7. Assessment
8. to refusal
9. Evaluation
10. Patient educationIn
136
Weight based medication limitations
-Need weight in kg
-Does not factor body composition
-based on ideal body weight
-People suck at estimating weight
