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pharmacology
study of drugs and their interactions with living organisms
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pharmacodynamics
study of the action of drugs on living tissue
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pharmacokenetics
study of the process of drug absorption, distribution, metabolism and excretion
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pharmacotheraputics
study of the use of drugs in treating disease
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pharmacy
preparing and dispensing medications
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posology
study of the amount of drug that is required to produce theraputic effects
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toxicology
study of the toxic or poisionous efeects of drugs
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FDA definition of drug
any substance used in the diagnosis, cure, mitigation, treatment or prevention of disease in humans or animals
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3 medical uses for drugs
- 1. theraputic
- 2. preventative
- 3. diagnostic
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theraputic uses
- antibiotics
- analgesics
- hormone replacement
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preventative uses
- vaccination
- "prevent motion sickness"
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diagnostic uses
- radiopaque dyes
- simulate cardiac excerise
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what should i know about the medications i will administer
- use
- dose
- methods of admin
- side/adverse effects
- drug interactions
- precautions
- symptoms of OD
- abuse
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responsibilities of administering meds
- written order
- should meds be held
- id allergies
- action and side effects
- dosage
- condition of patient
- id patient
- admin on time and proper method
- stay w/ pt. for oral drugs
- record info
- family/pt teaching
- 5 rights rule
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5 rights rule
- patient
- drug
- dose
- route
- time
- (result)
- (document)
- (refuse)
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11 precautions
- 1. no distractions
- 2. proper space and light
- 3. check label 3 times
- 4. unexpired meds
- 5. prepare just prior to admin
- 6. only admin meds you prepare
- 7. properly labeled
- 8. prep techniques
- 9. store as recomeneded
- 10. keep narcotics and controlled meds locked
- 11. acurate and complete records
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name the federally sanctioned unbiased compiliation of drug info in USA in 1906
united states pharmacopeia
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3 natural sources from which modern drugs are derived
- 1. plants
- 2. animals
- 3. minerals
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recombiant dna technology
- directs bacterium to produce mass amounts of a specific protien
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genetic engineering
- "gene splicing"
- -cell or virus may be administered to an individual who sufferes from the lack of that specific gene
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human genome project
significance for revealing the gene or genes responsible for 1000's of genetic diseases and for synthesizing protiens or enzymes absent or deficent in each disease.
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3 substances produced by recombiant dna technology
- 1. growth hormone
- 2. insulin
- 3. clotting facor
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3 diseases for human genome project
- 1. huntingtons
- 2. cystic fibrosis
- 3. colon cancer
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most pharmaceutical milstones occured____
in the 20th and 21st century
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drug legislation of 1906
"federal food and drug act"
- -first written source for medication formula
- - first attemts to protect consumers of food and drugs
- - dangerous drugs must be listed on label
- - no enforcement agency
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"durham-humphrey amendment" 1951
- - specified how prescription drugs could be ordered and dispensed
- -OTC drugs that didnt need script
- -warning labels for side effects
- -legend drugs
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comprehensive drug abuse prevention and control act of 1970
- - established the drug enforcement admin as a division of the department of justice
- - drugs with potential for being abused were recognized as controlled substances
- - isolated drugs w/ pot. to be abused were placed into 5 schedules
- - security of controlled substance
- - limitations of controlled subtance
- - DEA numbers
- -DEA enforcement
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major difference between schedule I and schedule II
Schedule I- not accepted for medical use
Schedule II- accepted for medical use
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drug categories in schedule I
- opioids
- canabis
- psycedelic
- methaqualone
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define prescription drug
not safe for use unless under the supervision of a medical professional
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name the drug approved for OTC sale in 1983
hydrocortisone
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define chemical name
describes its molecular structure and distinguishes it from all other drugs
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example of chemical name
6-chloro-3
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define generic name
- second name for the drug
- common name
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example of generic name
hydrochlorothiazidide
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define trade or brand name
third name given when the FDA gives final approval for marketting
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example of trade name
esidrix
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what is the offical name worldwide
generic
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which name is in CAPS and which is not
generic- no caps
TRADE- CAPS
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define informed consent
contain detailed info about study, potential benifits, side and adverse effects.
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define placebo
"sugar pill"
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define double blind clinical studies
- -using the drug and placebo
- - neither the pt nor the physician knows which pt is recieving which
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how many phases of human clinical trails
3
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Phase I
- - normal volunteers are treated w/ new drug
- - tests for metabolism of drug and effects in humans
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Phase II
- -subjects are patients
- - tests for therapeutic use, dosage range and safety
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Phase III
- -subjects are patients
- - tests for safety and effectiveness
- (usually 500-3000 subjects in II and III)
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where is a major site for phase III
austin, tx
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__ established pregnancy safe categories __ through ___ in __
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USA adopted a similar pregnacy safe categorie in __ but added category __
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describe category X
fetal abnormalities and positive evidence of fetal risk
should not be used in pregnant women
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what other category was added
- N
- -drugs in this category have not been classified
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are generic and brand name drugs the same?
everything is exactly the same in both except the fillers
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define pharmceutical phase
"How we get drug into body"
study of the ways in which various drug forms influence pharmacokinetic and pharmacodynamic activities
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define disinigration
breakdown of solid dosage forms
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define dissolution
process by which drug goes into solution and becomes available for absorption
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define pharmacokinetic phase
"what does the body do to the drug"
study of the concentraion of a drug during the process of absorption, distribution, metabolism or biotransformation and excretion
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define absorption
movment of drug molecules into circulating fluids
drug enters bloodstream from site of admin
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define distribution
transport of drugs from bloodstream to various tissues and eventually site of action
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define metabolism
chemical inactivation of a drug by converting into a water soluble compund to be excreted from body
LIVER
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define excretion
drugs active or inactive metabolites exit the body
KIDNEY
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define pharmcodynamic phase
"what does the drug do to the body"
study of the mechanism of drug action(MOA) on living tissue
response of tissue to specific chemical agents
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3 major MOA
- 1. drug receptor inter action
- 2. drug enzyme interaction
- 3. nonspecific interaction
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DRUG RECEPTOR INTERACTION
joining of drug molecule w/ a reactive site on the surface of cell tissue yeilding biological effect
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drug enzyme interaction
drug inhibits action of specific enzyme
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nonspecific interaction
drug interfers or alters cellular proccess
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3 general properties of drugs
- 1. drugs do not confer any new functions on a tissue or organ; they only modify
- 2. they exert multiple actions rather than a single effect
- 3. drug action results from a physiochemical interaction between drug and a functionally important molecule in the body
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name the 3 phases of drug activity that influence the concentration of a drug by the time it reaches site of action
- 1. pharmaceutical
- 2. pharmacokenetic
- 3. pharmacodynamics
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define pharmaceutics
study of the ways in which various drug forms influence pharmacokenetic and pharmacodynamic activities
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which form of drugs is most effective
oral drugs in liquid form
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4 factors for pharmacokenetic is the rate and extent to which a drug is
- absorbed
- distributed
- biotransformed or metabolized
- excreted
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physichemical properties of drugs
most drugs are water soluble and they are either weak acids or weak bases
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the more ionized or charged the drug for is, the more________
it attracts water molecules and therefore the more water soluble it is
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which structures are highly lipid
- cell membrane
- body compartments
- BBB
- placental barrier
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to cross a lipid structure the drug must be_________
less charged(less ionized) to become lipid soluble
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the enviornment in which the drugs will be absorbed must be ____ for acidic drugs and ____ for basic drugs so that the drugss will become __ ___ in order to be ___ soluble
- acidic
- alkaline
- less charged
- lipid
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phisiochemical properties of cell membrane
the extent to which a drug attains pharmacokenetic activity depends on the rate at which it crosses the cell membrane
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most drugs are comprised of __ molecules and can cross the cell membrane by __ transport
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drugs that have huge molecules rely on ___ transport
active
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name the variables that affect drug absorption
- 1. nature of absorbing surface
- 2. blood flow at site
- 3. soulubility of drug
- 4. pH
- 5. drug concentration
- 6. pharaceutical prep(dosage forms)
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weak acid in acid media=
weak basic in basic media=
weak acid in basic media=
weak basic in acid media=
- nonionized(fat souluble)
- nonionized(fat souluble)
- ionized(water soluble)
- ionized(water soluble)
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multiple drug forms/preperations
aeresol,capsules, lotion, losange, powders, pills, etc
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Route: Intravenous
1. bioavailability
2. charecturistics
- 1. 100%
- 2. most rapid onset
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Route: Intramuscular
1. bioavailability
2. charecturistics
- 1. 75%
- 2. large volumes often
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Route: subcutaneous
1. bioavailability
2. charecturistics
- 1. 75%
- 2. smaller volumes than IM; painful
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Route: Oral(PO)
1. bioavailability
2. charecturistics
- 1. 5%
- 2. most convenient; first pass effect may be significant
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Route: Rectal(PR)
1. bioavailability
2. charecturistics
- 1. 30%
- 2. less first pass effect
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Route: Inhalation
1. bioavailability
2. charecturistics
- 1. 5-100%
- 2. often very rapid onset
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Route: Transdermal
1. bioavailability
2. charecturistics
- 1. 80%
- 2. usually very slow; used for lack of first pass effect
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define enteral route
administration into GI tract
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list enteral routes
- oral
- nasogastric
- buccal
- sublingual
- rectal
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Route: Oral
1. site
2. Pass
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Route: nasogasatric
1. site
2. Pass
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Route: buccal
1. site
2. Pass
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Route: sublingual
1. site
2. Pass
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Route: rectal
1. site
2. Pass
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define hepatic first pass
orally administered drugs absorbed through the GI tract and absorbed by the liver before entering general circulation
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hepatic portal system
responsible for directing blood from GI to liver
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define parenteral route
into sites other than GI usually by needle
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which route of drug administration where NONE have a hepatic first pass
parenteral and percutaneous
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list the parenteral routes
- intravenous (vein)
- Intrapleural( pleura)
- intra-arterial(artery)
- intracisternal(synovial fluid, joint)
- intracardiac(heart)
- intraperitoneal(abdomen)
- intraspinal(spinal column)
- intraosseous(bone marrow)
- intrathecal(spinal fluid)
- intramuscular(muscle)
- subcutaneous(beneath skin)
- intradermal(dermis)
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define distribution
transport of a drug in body fluids from the bloodstream to various tissues of the body and then the site of action
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list the factors that affect the rate at which a drug enters diff. areas of the body
- 1. permeability of capillaries
- 2. cardiac output
- 3. regional blood flow
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define drug resivour
allow a drug to accumulate by binding to specific tissues in the body
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list the 2 types of drug resivors
- 1. plasma protien binding
- 2. tissue binding
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list 2 barriers to drug distribution
- 1. BBB
- 2. placental barrier
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define metabolism/biotransformation
process of chemical inactivation of a drug by conversion into more water soulble compound or metabolites which can then be excreted from the body
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name the major organ the accomplishes metabolism
liver
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define percutaneous
administration through the skin or mucous membranes
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list percutaneous
- transdermal(epidermis)
- topical(epidermis)
- intraocular(eye)
- intrarespiratory(lung)
- intravaginal(vagina)
- Intrauterine(uterus)
- Intraurethral(urethra)
- intranasal(nose)
- otic(ear)
- intravesicle(bladder)
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the ___ converts fat souluble components into_____ so they can be_____
- liver
- water soluble
- excreted
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what does DMMS stand for
drug microsomal metabolizing system
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describe the DMMS
vast majority of drugs are metabolized in the liver by this system
group of enzymes
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what is the key element of the DMMS system
cytochrome P-450
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some drugs may be taken up to the DMMS so that______
a significant drug dosage is metabolized before the drug ever reaches the systemic circulation
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define enzyme induction
increase in the amt of drug-metabolizing enzymes after repeated admin of certain drugs
decrease plasma concent.
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define enzyme inhibition
- -decrease in amt of drug metabolizing enzymes
- -adverse effects due to increased plasma
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define hepatic first pass effect
phenomenon of drug metabolism where the concentration of the drug is greatly reduced before it reaches systemic circulation
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define excretion
drugs and pharmacologically active and inactive metabolites are eliminated from the body
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name the major organ that accomplishes excretion
kidney
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other sites that excrete
- breast
- lungs
- sweat
- tears
- saliva
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describe drug-receptor interaction
- -drugs are selectively active
- -specific
- -drug w/ best fit to receptor will produce the greatest response from cell
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define receptor
reactive cellular site where drug interacts
specific location on cell membrane or w/in cell
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define affinity
propensity of a drug to bind to a receptor
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define efficacy
drugs ability to initiate biologic activity as a result of binding
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define agonist
drug that combines with receptors and produces a sequence of biochemical and physiologic changes
is both efficacy and affinity
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define antagonist
agent designed to inhibit or counteract effects produced by other drugs caused by cellular components during illness
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define drug-enzyme interaction
- -interaction of drugs and cellular enzymes
- -drugs can inhibit action of specific enzymes and alter physiologic response
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example of drug-enzyme interaction
antineoplastic(anticancer) drugs
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define non-specific drug interaction
drugs that demonstrate no structural specificity and act by general effects on cell membranes and cellular process
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example of nonspecific drug interaction
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define plasma level profile
used to analyze drugs characteristic pharmacokinetic effects
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define onset of action
interval b/t time drug is admin and first sign of effect
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define termination of action
point where drug effect is no longer seen
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define duration of action
period from onset of drug to when the response is no longer perceptible
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define minimal effect concentration
lowest plasma concentration that produces desired drug effect
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define peak plasma level
highest concentration attained
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define toxic level
plasma concentration produces serious adverse effects
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explain dose response curve
- -used to compare and evaluate drug response among different drugs that are similar
- -also for drug potency
- -strength needed to produce therapeutic effect
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explain time response curve
determine frequency of admin of meds in order to maintain an effective drug response
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explain therapeutic drug range
determine safety and effectiveness of a drug
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therapeutic effect=
desired effect
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define biological half life
time required to reduce by one half the amt of unchaged drug that is in the body at the time that equilibrium is reached
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the longer the half life,_______
the longer the drug stays in the body
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biologic half life is determined by
the rate of biotransformation and excretion of drug
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duration of a dose can be determined by
the biologic half life
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define therapeutic index
provides a quantitative measure of the relative safety of a drug
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therapeutic index represents a ration between___
lethal dose and effective dose
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the closer the dose to___, the greaterthe danger involved in admin of drug
1
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define drug bioavailability
percentage of active drug substances absorbed and available to reach the target tissues after drug admin
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drugs are considered to be biologically equivalent if______
they attain similar concentrations in blood and tissue at similar times
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define side effects
predictable and undesireable effects produced at therapeutic drug dosages
not harmful
effect other than therapeutic
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name some predictable side effects
- nausea
- vomiting
- diarehha
- dizzy
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define adverse effect
unintended, undesired, and unpredictable
some are immediate some take time
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name some predictable adverse
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name the four unpredictable adverse reactions
- type I- anaphylactic
- type II- cytoxic
- type III- Arthus, an immune complex
- type IV- cell-mediated or delayed hypersensitivity
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describe type I
- -anaphylactic
- -immedieate w/in minutes of exposure to chemical in previously sensitized person
- - may be fatal
- - mediated by IgE antibodies on mast cell
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define drug interactions
when effects of one drug are modified by the prior or concurrent admin of another drug
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define tolerance
decreased response
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define adiction
compulsive drug abuse/dependence
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define dependence
reliance on drug use
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define cumulation
the body can not excrete one dose of a drug before the next dose is given, resulting in high levels of drug in body; toxicity
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define iatrogenic
unintentional drug effect or disease induced by physicians prescribed therapy
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define idiosyncratic
drug effect unique to an individual that is unexpected
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describe incompatability
physical alterations that occur before admin when dif drugs are mixed in same syringe
cloudy
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describe additive
combined effect of 2 drugs, each produce same biological response and same MOA, = to sum of individual effects
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define summative
combined effect of 2 drugs, same biological, diff MOA, equal to sum
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define synergism
combined effect of 2 drugs is greater than sum of individual
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define antagonism
combined effect of 2 drugs is less than sum
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define polypharmacy
indiscriminate use of numerous meds concurrently
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define alternative medicine
- non scientific
- no support data
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define indication
an illness disorder for which a drug has a documented usefulness
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Drug (general)
chemical substance that produces change in body function
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define contraindications
situations where a certain drug should NOT be admin
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ED-50
- effective dose
- dose that will produce an effect that is half of the max response
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LD-50
- lethal dose
- dose that will kill 50% of animals tested
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site of action
location w/in body where drug exerts therapeutic effect
specific receptor
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therapeutic index
ration of LD50 to ED50
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doses
- 1. intitial
- 2. lethal
- 3. loading- first dose, higher, elevate blood, therapeutic range
- 4. maintenance
- 5. max
- 6. min
- 7. toxic
- 8. usual
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what is the result of enzyme induction
decreased pharmacologic effect in body
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name this example:
st. johns wort induces enzymes that metabolize warfarin. result is decreased effectiveness of warfarin
enzyme induction
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enzyme inhibition results
toxicity due to increased pharmacologic effect in body
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name the example
Prilosec inhibits 3 enzymes that metabolize warfarin
enzyme inhibition
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angle of a needle for IM
90 degree
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angle of a needle for intradermal
15 degree
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angle of a needle for subcutaneous
45 degree
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