-
orphan drugs =
- drugs that show promise but no one wants to work on drug
- there are incentives given to provide finacial incentives
-
orphan drug act of 1983 =
provided financial incentives for drug companies to adopt and develop these drugs
-
Legend drugs are
prescription drugs
-
OTC
- deemed safe when used as directed
- some OTC were grandfathered in prior to current testing
-
big thing about alternative therapy drugs is
- they are not tested by FDA
- interactions may occur
-
problems with OTC
- may mask S&S of underlying issues
- drug interactions
- can be taken in greater than recommended dose
-
generic name is always
lower case
-
Brand names are always
Upper case
-
who is last person in link of medication admin
NURSE
-
-
-
sublingual med admin route
under tongue
-
parenteral med route =
- IV
- IM
- Intrdermal
- subcutaneous
-
slowest to fastest enteral med admin
- XR, XL = extended release
- enteric coated tablet
- tablet
- capsule
- liquid
-
enteric coated tablet given when
when passes up through stomach to be absorbed in small intestine
-
ODT tablet =
orally disintegrating tablets
-
In regards to drug absorption rate which is most important
blood flow
-
asthma inhaler is example of what type of drug route admin
topical
-
pharmacokinetics =
how the body acts on the drug
what the body does to drug
-
pharmacodynamics
how the drug effects the body
-
pharmacokinetics involves the processes of
- absorption
- distribution
- metabolism (biotransformation)
- excretion
-
what do you need to absorb a drug
absorption of drug
-
major organ of drug metabolism =
liver
-
major organ of drug excretion =
kidneys
-
absorption =
moving drug from site of admin to blood
-
what types of drugs are more likely to enter cell
- small particles
- non ionized
- lipophilic
-
enteral meds affected by
- food and drugs in stomach - especially fatty foods
- acidity of stomach
- blood flow to GI tract
-
antiacids shouldnt be taken within
2 hours of other meds
-
ileus =
intestinal blockage
-
First Pass Effect =
liver metabolizes part of the drug before it reaches the target tissue
-
high first pass effect
- drug doesn't reach tissue in large quantities
- may need higher dose
- cannot be given by oral admin if first pass effect is too large
-
IM works faster in who compared to
men VS women due to more vascular muscles in men than women
-
what will increase absorption of drug
- anything that increases blood flow
- temp increase
-
-
food and smoking does what to sublingual and buccal meds
slows absorption
-
Distribution =
- drug transport throughout body
- movement of the drug to the body's tissue
-
intratheccal =
into spinal column
-
benzodiazepines are stored where
in adipose tissue
-
bound drug =
drug in the blood stream bound to a protein
-
low protein levels can cause
increase for drug toxicity due to less bound drug
-
protein binding increases what
the length of drug action because as level of drug in blood stream goes down more drug is unbound from protein
-
increased risk of toxicity related to protein binding is
elderly and low albumin levels
-
cytochrome P450 =
enzyme system in the liver that is responsible for most of the metabolism of drugs
-
liver disfunction can lead to
- accumulation of drugs
- increased risk for drug toxicity
-
what do you test for liver function
- AST
- ALT
- if it is elevated = increased risk for toxicity and liver is not function as it should
-
if pt has elevated AST and ALT tests what process of drug interaction
- metabolism
- increases risk for drug toxicity
-
autoinduction =
drug speeds up liver metabolism
-
prodrug =
drug has to be metabolised before you get to the active ingredient in drug
-
BUN and Creatinine =
kidney function
-
what is test that is most important to determine kidney function
creatinine
-
elevated BUN and creatinine can show
decreased kidney function
-
therapeutic drug monitoring =
monitoring plasma levle sof drugs with low safety margin
-
minimum effective concentration =
amount of drug required to produce a therapeutic effect
-
therapeutic range =
range of plasma concentration of drug that produces a therapeutic effect
-
INR shows what
the level of anticoagulation in blood
-
high INR =
blood is more anticoagulated
-
toxic concentration =
plasma concentration of drug that leads to toxic effects
-
pharmokinetic processes give you what
- onset
- peak action
- excretion
-
half-life is
time it takes for 1/2 of drug to be eliminated from body
-
higher half life =
longer it takes to eliminate and longer onset of action
-
half life is affected by what
absorption, distribution, metabolism, and excretion
-
half life assists in
- determination of dosing schedules
- longer half life = give drug less often
-
maintenance dose =
dose required to keep the drug in the therapeutic range
-
loading dose =
a higher dose that usually is used for treatment. used for drugs that take longer to reach min effective concentration
once loading dose given then you start maintenance dose
-
dynamic equilibrum =
- steady state
- when the amount of drug absorbed equals the amount excreted the steady state is acheived
- this is when drug stays in the therapeutic range
-
pharmacodynamics
what drug does to body
-
medican effective dose =
the dose required to produce a therapeutic effect in 50% of a group of patients
-
potency =
- strength of a drug at a certain concentration or dose
- more potent drug = lower dose needed to achieve the effect
-
efficacy =
- greatest maximal response that can be produced from a particular drug
- drug has higher efficacy if it causes a more significant therapeutic response
-
agonist =
causes the same activity that natural chemicals would cause at the site
ie beta recpetor causes increased heart rate so a beta one agonist causes increased heart rate
-
antagonist =
- has opposite effect of agonist
- causes the opposite response of natural chemicals or competes with other drugs for the same receptors
- NARCAN is a narcotic antiagonist
-
partial agonist =
casues an agonist response but weaker
ie partial agonist narcotic = decreases pain but not as much as agonist narcotic
-
-
lock and key theory of drug interaction =
drug locks onto receptor site and has agonist or antiagonist effect
-
drug enzyme interaction =
drugs can interfere with enzyme systems in the body to change function
-
selective toxicity =
when a drug attacks only foreign cells and not healthy cells
-
factors influencing drug effects
- weight
- age
- gender
- physiological factors (dehydration)
- pathological factors (kidney and liver dysfunction)
- genetic
- immunological
- psychological (placebo effect)
- environmental
- drug tolerance
- cumulative effect
-
Pharmacogenomics =
study of genetic factor influencing drugs effects on the body
-
side effect vs adverse effect =
adverse effect is worse/more serious than side effect
-
idiosyncratic reactions =
- adverse drug effect that produces an unusual and unexpected response
- "can't be explained"
-
black box warning
warning on some drugs about serious adverse effect
-
phototoxicity =
skin absorbs excess ultraviolet radiation from sun or heat lamps
-
hypersensitivity =
increased immune response
-
angioedema =
swelling of dermis, periorbital area, can close airway
-
steven johnsons syndrome =
sever blistering of the skin with membrane involvement and fever
-
stomatitis=
inflammation of the mucous membranes
-
superinfections
when normal flora is killed and bad microbes are no longer suppressed
-
blood dyscrasia
decreased blood cell counts
-
assessment of liver toxicity =
elevated AST ALT, RUQ pain, jaundice
-
kidney toxicity assessment
- change in urine pattern
- elevated BUN creatinine
-
rhabdomyolysis=
extensive muscle necrosis with release of enzymes from the muscles
-
pathophysiology =
the study of altered health
-
etiology
the cause of something
-
risk factors
things that increase your chances to acquire disease
-
sign vs symptom
- sign = objective
- symptom = subjective
-
syndrome =
cluster of signs and symptoms
-
complication
adverse effect
-
sequelae =
impairment that follows or is caused by a disease
-
pharmacology =
study of drugs
-
pharmacotherapeutics =
the application of drug for the purpose of disease prevention and treatment of suffering
-
therapeutic effect =
positive effects of drugs
-
Adverse effects
negative effects of drugs
-
Indication =
why a drug is given
-
protype =
agent to which all other drugs in the classification are compared
-
combination drugs
- drugs with more that one active ingredient
- ie aspirin, acetaminophen
-
-
a brand name drug is
a drug produced by a specific company
-
a generic drug is a drug that
is produced by many different companies
-
bioavailability of a drug =
rate and extent of drug available to patient to effect the tissue
-
when should a generic drug be given
when it is available
-
"dispense as written"means
the pharmacy must fill brand name drug that DR write for
-
theraputic index -
difference between toxic level and minimum effective concentration level
tested by peak and trough
-
Pure food and drug act of 1906 =
- required proper labeling
- drug label reflected the contents
-
Federal Food, Drug and Cosmetic Act of 1938 = `
prevented the sale of drugs that had not been thoroughly tested for safety prior to marketing
-
Durham-Humphrey Amendment 1951=
designated prescription and OTC drugs
-
Kefauver-HArris Act 1962
MAnufacturers had to prove drugs were effective and safe
-
Pregnancy categories
- A-D and X
- no demonstrate risk- adverse reactions/abnormalities in fetus
-
teratogenic effects of drug
how a drug effects a fetus
-
Preg category A =
no demonstrated risk
-
Preg. Category B =
animal studies = no risk no sifficient evidence in human studies
-
preg cateegory C
animal studies show risk but no human, use may be acceptable despite potential risk
-
Preg. Catergory D =
evidence of potential risk but benefit may outweigh risk
-
Controlled Substances Act of 1970 =
define drug abuse and classified drugs according to abuse potential defined control of distribution, storage, dispensing and use imposes restriction and penalties for failure to comply
-
-
lower schedule number =
the more likely abuse potential
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