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Define Pharm
Study of biochemical and physiologic aspects of drug effect, absorption, distribution, metabolism, elimination.
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Define Pharmacokinetics.
Way the drug moves.
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Receptors?
Specific drug binding sites on cell. Mediate action of drug.
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Control substance Schedule 1
- Approved protocol.
- High abuse potential
- No medical purpose.
- Heroin
- LSD
- Marijuana
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Controlled substance schedule 2
- High abuse potential
- Never refilled
- Narcotics
- Amphetamines
- Barbiturates
- Codeine
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Controlled Substance Schedule 3
- Written/Oral prescription expires in 6 months
- Warning label
- Refill within 6 months
- Codeine
- Oxycodone
- Morphine
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Disintegration
Breaking up into smaller parts. More effective in absorption.
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Use of drugs.
Treat. Diagnose. Prevent.
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Pharmacotherapeutics.
- Use of drugs to prevent and treat disease. Also alt. uses:
- Estrogen to stop bleeding.
- Viagra used to erect penis.
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Pharmacokinetics.
- Study of what body does to drug.
- Absorption
- Distribution
- Metabolism
- Excretion
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Pharmacognosy
- Study of natural sources of drugs.
- Plants.
- Animals.
- Minerals.
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Toxicology.
Study of poisons. Adverse effects.
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Pharmaceutical Phase
Drug enters body.
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Pharmacokinetic Phase
- Absorption
- Distribution
- Metabolism
- Excretion
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Pharmacodynamic Phase
Biochemical and physical action/effects of drug.
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Seven rights of Nurses
- Drug.
- Patient.
- Dose.
- Time
- Route
- Technique
- Documentation
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Bioavailability.
Rate at which drug reaches general circulation.
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Bioequivalent
Equivalent dose of one drug to another drug's dose.
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High First pass effect.
Broken down a lot in liver.
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Having heart attack. Do you swallow nitroglycerine?
No. High first pass effect. After it passes liver it won't have much effect. Take sublingual. Bypasses first pass effect.
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Most dangerous route?
Intraveneous. It's Direct.
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Will you put cream to treat gangrene?
No. That's a factor affecting bioavailability. The treatment will not be effectively absorbed.
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Why don't you crush a med that's used for 24-hour relief?
It's meant to be absorbed over a 24 hour period. If it's crushed before given, the whole dose will be absorbed at once.
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What does enteric coating a tablet do?
It coats the med in a basic coat so it will not be absorbed before the small intestine.
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Why is it important to know about protein binding?
If a med is 50% protein binding, then half of it's dose will stick to a protein in the body while the other half does it's job. If the patient isn't eating, then there isn't an protein for the med to attach. That means both parts are free to do it's job = double the dose.
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Patient has a kidney problem. Would you give a fat loving or a water loving med?
Fat loving meds excrete through many parts of the body. So it works well with those with a bad kidney.
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Factors that limit bioavailability?
- Administration route of drug.
- Food or fluids given with.
- Dosage.
- Status of absorptive surface.
- Rate of blood flow to intestine.
- Acidity of stomach.
- Status of GI motility.
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Whats the enteral route?
- Oral.
- Sublingual
- Small intestine.
- Rectum.
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Routes that bypass liver.
- Sublingual.
- Buccal.
- Rectal.
- Intravenous.
- Intranasal.
- Transdermal.
- Vaginal.
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Factors that decrease metabolism.
- Cardiovascular dysfunction.
- Renal insufficiency.
- Starvation.
- Obstructive jaundice.
- Slow acetylator.
- Enthromycin of ketoconazole therapy.
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Factors that increase metabolism.
- Fast acetylator.
- Barbiturates
- Rifampin therapy.
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Drug action.
Cellular process between drug and cell.
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Drug effect.
Physiologic reaction to drug.
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Onset of a drug.
Time for drug to "kick in".
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Duration of a drug.
How long the effects last.
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How does the drug affect the cells.
Modify rate at which cell or tissues function. Can't make a cell do what it wasn't designed for.
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Therapeutic index.
Ratio between benefits and toxic effects.
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Additive effect.
Take tylenol and codeine for example. Both can treat pain alone. But if you raise the dose for one, you raise the chances of side effects. So you give both at the same time in low doses to treat the intense pain without the increase chances of side effects.
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Synergistic effect.
Two meds working together. Med A is to break the cell wall and Med B is made to go inside and kill bacteria in it.
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What are adrenergic agents?
Stimulate SNS. Adrenaline. Fight or Flight.
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What agents associated with adrenaline?
Adrenergic agents.
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Agents with flight or fight response?
Adrenergic agents.
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ALpha adrenergic receptors respond to?
NE.
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Beta-adrenergic receptors respond to?
Epi.
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Alpha1 adrenergic receptors located?
Postsynaptic effector cells (the cell, muscle or organ that nerve stimulates).
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Alpha 2 adrenergic receptors located?
Pre-synaptic nerve terminals. Nerve that stimulates the effector cells.
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What adrenergic receptor controls the release of NE and Epi?
Alpha 2
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What does the adrenergic agonist do?
Vasoconstricts.
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What is the result of the adrenergic agonist vasoconstricting?
Blood pressure goes up. It has to fight it's way through the smaller hole.
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Beta adrenergic receptor cells located?
Postsynaptic effector cells.
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Beta 1 adrenergic receptors located?
Heart.
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Beta 2 adrenergic receptors located?
Lungs.
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Beta adrenergic responses?
Lung, GI, uterine smooth muscle relaxation. Increase blood level. Cardiac stimulation.
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What is glycogenolysis?
Increase blood sugar.
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Dopaminergic receptors do what?
- DILATION of blood vessel:
- Renal.
- Mesentric.
- Coronary.
- Cerebral.
- INCREASED blood flow.
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What stimulates dopaminergic receptors?
Epi.
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Where are the alpha 1 and beta 2 receptors?
Cardiovascular blood vessels.
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What does the alpha 1 receptor do to the cardiovascular blood vessels?
Constricts.
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What does the beta 2 receptors do to the cardiovascular blood vessels?
Dilates.
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Where are the beta 1 receptors and what do they do?
Increases HEART contractility.
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What receptors are on the AV and SA node?
Beta 1
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What does beta 2 do to gastrointestinal muscle?
Decrease motility.
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Alpha 1 does what to sphincters?
Constrict.
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What receptor constricts the bladder?
Alpha 1
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What receptor causes ejaculation?
Alpha 1
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Are there beta 2 in uterus?
Yes.
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Mixed acting simpathomimetic.
Directly stimulates receptor by binding to it AND indirectly by releasing neurotransmitters.
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Drug effects of adrenergic agents.
- Vasoconstriction of blood vess.
- Relax GI smooth.
- Contraction of uterus and bladder.
- Ejaculation.
- Decreased insulin release.
- Dilated pupils.
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What happens if you stimulate beta 2 adrenergic receptors in airways?
- Relax bronchi.
- Uterine relax.
- Glycogenolysis.
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What does the beta 1 adrenergic receptors stimualate?
Heart. Increase heart rate, constriction and conduction through AV node.
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Benzphetamine.
Short-term management of obesity.
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Phentermine.
Short-term management of obesity.
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Dextroamphetamine.
Short-term management of obesity.
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Dexedrine.
Short-term management of obesity.
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Albuterol.
Bronchodilator.
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Isoentharine.
Bronchodilator.
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Metaproterenol
Bronchodilator.
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Ephedrine.
Bronchodilator.
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Isoproterenol.
Bronchodilator.
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Levalbuterol.
Bronchodilator.
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Terbutaline.
Bronchodilator.
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What can you use to treat open-angle glaucoma?
Epi or dipivefrin.
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How does a nasal decongestant work?
Constricts blood flow to nose.
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Naphazoline.
Nasal Decongestant.
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Phenylephrine.
Nasal Decongestant.
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Tetrahydrozyline.
Nasal Decongestant.
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Adrenergic side effects.
- Dry mouth.
- Nausea.
- Vomiting.
- Palpitations.
- Tachycardia.
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What does antihistamines do to NE?
Raise.
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Sameltrol is used for?
PREVENTION of bronchospasms.
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What happens with overuse of nasal decongestants?
Rebound nasal congestion or ulcers.
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Adrenergic-blocking agents.
Block stimulation of SNS.
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Sympatholytics.
Adrenergic-blocking.
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What can block adrenergic-blocking agents.
Epi.
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Adrenergic-blocking agents are for.
- Contrict blood vessels GOING TO BRAIN.
- Everywhere else, dilation of blood vess.
- Blood pressure down.
- Treat migraines.
- Stimulate uterine.
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Phentolamine.
- Reverses pressors such as Epi and NE.
- Restore blood flow. Prevent tissue necrosis.
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Cardiovascular side effects from adrenergic-blocking agents.
- Palpitations.
- Orthostatic.
- Hypotention.
- Tachycardia.
- Edema.
- Dysrythmias.
- Chest Pain.
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CNS side effects adrenergic-blocking agents.
- Dizziness.
- Headache.
- Drowsiness.
- Anxiety.
- Depression.
- Vertigo.
- Weakness.
- Numbness.
- Fatigue.
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Gastrointestinal side effects adrenergic-blocking agents.
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Beta 2 receptors located where?
Lungs.
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Cardioselective beta 1 blockers.
- Decrease heart rate.
- Prolong SA node recovery.
- Slows conduction through AV node.
- Decrease heart contractility.
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Non-selective beta blockers.
- Decrease heart rate.
- Constriction of lungs.
- Constrict bld vess.
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Therapetic uses beta blockers.
- Anti-high blood pressure.
- Migraine.
- Glaucoma.
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Atropine antidote for?
Cholenergic drugs.
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Cholinergic blocking: Eye.
Dilates.
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Cholinergic blocking: Gastrointestinal.
Decrease salivation, motility, gastric secretions.
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Cholinergic blocking: Genitourinary.
Urine retention.
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Cholinergic blocking: Glandular.
Decreased sweating.
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Cholinergic blocking: Repiratory.
Decreased bronchial secretions.
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Cholinergic blocking: Additive effects with?
- Antihistamines.
- Phenothiazines.
- Tricyclic antodepressants.
- MAIOs.
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