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What is pharmacology?
study of medications and their effect or action on the body
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Six Rights of Med Administration
patient, medication, dose, route, time, documentation/reporting
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What is a chemical name
- describes drug chemical makeup, the composition and molecular structure
- Ex. 2-butyl-3-benzofuranyl 4-[2-(diethylamino)-ethoxy]-3,5-diiodophenyl ketone hydrochloride
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What is a generic name?
- aka nonproprietary; a general name, not manufacturer specific, usually derived from chemical name but easier
- Ex. amiodarone
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What is a trade name
- aka brand name; unique name that the manufacturer registers the drug with the FDA, always capitalized
- Ex. Cordarone, Pacerone
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What is an official name
- name given after a generic name has been approved by US adopted names counsel, approved by FDA and listed in the USP
- Ex. amiodarone USP
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Four sorces of drugs
plants, animals, minerals, synthetic
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What is the Pure Food and Drug Act
aimed to protect the public from mislabled, poisonous or harmful medications
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What is the Food, Drug and Cosmetic Act
- - addition to the Pure Food Act that required information on label about habit forming substances, side effects.
- - Authorized creation of FDA.
- - Mandated that drugs could only be dispensed with a prescription from MD, dentist, or veterinarian
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What are schedule I drugs
- - highest abuse potential
- - severe dependence possible
- - no accepted medical use
- - ex. heroin, LSD, marijuana, MDMA
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What are schedule II drugs
- - very high abuse potential
- - may lead to severe addiction
- - ex. amphetamine, opiates, cocaine, demerol, barbiturates
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What are schedule III drugs
- - lower abuse potential than I and II
- - low to moderate physical dependence
- - high psychological dependence
- - combination narcotics (those containing APAP)
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What are Schedule IV drugs
- - low abuse potential
- - limited dependence
- - ex. phenobarbital, diazepam, lorazepam
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What are schedule V drugs
- - lowest abuse potential
- - limited dependence
- - ex. cough syrups with codiene
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What does the FDA do
determines safety and efficacy before a drug goes to market
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What does the DEA do
rugulates physicians permitted to dispense controlled substances
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What does the Federal Trade Commision monitor
- drug advertising
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What is the purpose of Phase I trials
test drug in healthy individuals to determine safe dose
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What is the purpose of Phase II trials
determine drug safety and efficiacy and establish most effective dose
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What is the purpose of Phase III trials
evaluate efficacy and side effects
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What is the purpose of PHase IV trials
postmarket to determine long term efficacy and cost effectiveness
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List some special populations in drug therapy
- - pregnant patients
- - breastfeeding patients
- - pediatrics
- - geriatrics
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Describe the CNS
- - brain and spinal cord
- - sends impulses to the body thru efferent nerves
- - recieves impulses from the body thru afferent nerves
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Describe the peripheral nervous system
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What is the autonomic nervous system
- - sends sensory impulses from internal structures thru afferent nerves to the brain
- - divided into sympathetic and parasympathetic
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What is a ganglia
- - grouping of nerves in the periphery
- - act as relay station to relay impulses
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Describe the sympathetic nervous system
- - fight or flight
- - active during stress and activity
- - regulates hypoglycemia, hypothermia, trauma
- - adrenergic nerves - release norepinephrine and epinephrine
- - sympathomimetic - effect resembling symphatetic nervous system - after admin epi
- - sympatholytic - inhibit sympathetic nervous system
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Describe the parasympathetic nervous system
- - dominates during rest and relaxation
- - aka rest and digest
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What is neurochemical transmission
- process of chemical signaling between cells
- - helps cells talk to each other
- - helps nerves keep a signal going
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what is affinity of a drug
- attraction of a drug to a receptor
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What is an agonist
drug that binds to a receptor and causes a response
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What is a solution
- liquid containing disolved chemical substances
- ex. NS
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What is a suspension
- - drug to be incorporated into solution
- - need to be shaken
- - will separate on standing
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What is a fluid extract
concentrated form of drug
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What is a tincture
- dilute alcoholic extract of a drug
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What are spirits
volatile substance dissolved in alcohol
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What is a syrup
drug suspended in sugar and water
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What is an elixer
syrup with alcohol and flavoring added
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What is a milk
- aqueous suspension of insoluble drug
- ex. milk of magnesia
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What is an emulsion
- liquid in liquid formulation
- ex. oil in water
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What is a liniment or lotion
for external use
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What is an extract in solid form
concentrated preparation of drug made by putting drug into solution and evaporating the excess solvent out
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What is a powder
drug that has been pulverized
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what is pill
drug shaped into a form to be swallowed, usually coated to hide taste
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What is a capsule
gelatin container enclosing a medication
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what is a pulvule
like a capsule but not made of gelatin, does not separate
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What is a suppository
drug mixed in a firm base that melts at body temp
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What is an ointment
semisolid prepartion for external aplication
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what is a patch
medication impregnated into membrane or adhesive that is applied to the skin
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What is a vapor
gaseous medication administration
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Describe local and systemic effects
- - local - the reaction from direct application to the tissue
- - systemic - the reaction after the drug is absorbed, involves more than one organ
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What is percutaneous route of administration
med absorbed through skin or mucous membrane
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What is transdermal route of administration
- deliver of drug through the patients skin
- - absorption can be affected by thickness of skin, hair, circulation
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What is sublingual med administration
- under the tongue
- rapidly absorbed
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What is the buccal route of adminsitration
- between the cheek and gum
- - ex. glucose gel
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What is the pulmonary route
inhalation or injection into the pulmonary system
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What is NAVEL
- Drugs that can be delivered by pulmonary route
- Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine
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What is enteral route
- drug is absorbed somewhere along GI tract
- - all po drugs are enterally administered
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What is a parenteral route
- medications are administered by any route other than the alimentary canal (digestive tract), skin or mucous membrane
- - administered with needle and syringe
- - IV - most rapid absorption
- - IO - can use for any med that can be given IV
- - IM - take longer to act because must be absorbed from muscle to blood
- - SQ - small amout of drug injected into fat, slow absorption
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What is pharmacokinetics
- study of metabolism and action of a medication within the body
- - time it takes for absorption, duration of action, distribution and excretion
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What is absorption
- - med transfer from site of administration to target organ
- - depends on blood flow, surface area, concentration, pH
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What is distribution
- process by which a medication moves throughout the body
- - drug disributes to the blood
- - only free drug in the blood (not bound to proteins like albumin) can have an effect on tissues
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What is biotransformation
- the manner in which the body metabolizes medications
- - can involve either transforming hte medication into a metabolite or making it more water soluble
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What is excretion
- elimination of the drug either as toxic or inactive metabolites
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What is glomerular filtration
passive process where blood flows through the kidney, glomeruli are bundles of capillaries
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What is tubular secretion
active transport process in which meds are bound to transporters to aid in elimination
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What is partial reabsorption
occurs when some of the drug is reabsorbed after being filtered
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What is pharmacodynamics
- way a medication produces a response
- aka mechanism of action
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Four ways medications can cause an action
- - change in cell properties
- - bind to receptor
- - bind with other chemicals in the body
- - alter normal metabolic pathways
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what is an anatagonist
blocks receptor site from being stimulated by other chemicals in the body
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what is biological half life
time it takes for body to eliminate half of the drug
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What are the factors affecting drug response
- - age
- - weight
- - sex
- - environment
- - time of administration
- - condition of the patient
- - genetic factors
- - psychologic factors
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What are side effects
reactions that can manifest as signs or symptoms that are not what wewanted to happen but are expected due to how the medicaion works
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what is an iatrogenic response
- an adverse condition inadverently induced in a patient due to a medication
- ex. developing a UTI due to folley catheter or developing a GI infection due to antibiotic
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What is idiosyncrasy
a unique response to a drug that is not seen in other patients
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What is tolerance
- - can result from taking a medication for an extended period of time
- - must take higher dose to get the same response
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what is cross tolerance
- patient develops tolerance to a class of drugs
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what is tachyphylaxis
patient becomes rapidly tolerant to a medication
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What is a cumulative effect
increased effect when a drug is given in several successive doses
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What is a stimulation effect
- - addictive effect
- - two drugs given have the same effect therefore causing an enhanced response in the patient
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What is synergism
a patient gets two drugs that result in a greater effect than the sum of either drug alone
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what is potentiation
the effect one drug has on another, in particular, one drug increases the effect of another
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What is interference
the direct biochemical interaction that takes place between two drugs
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What are the components of a drug profile
- - drug name - generic and trade name
- - classification - based on effect
- - mechanism of action - describes how medicine works
- - indications - reasons for using the drug
- - kinetics - ADME
- - side effects and ADRs
- - routes of administration
- - forms - tablets, capsules, liquid, injection
- - doses - what should be given based on condition
- - special considerations/special populations
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What is an analgesic
- medication to relieve pain (induce analgesia)
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Name some common analgesics
- - opioid agonist - bind to opiate receptors and block pain signal
- - nonopiod anagesics - can reduce fever also
- 1. salycilates - ASA
- 2. NSAIDs - ibu
- 3. para aminophenol derivatives - APAP
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What is an opiod antagonist
- reverse effects of an opioid drug
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What is an opioid agonist-antagonist
decrease pain but do not have the same side effects of opioid agonist
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What is an anesthetic
- causes loss of sensation to touch or pain
- - systemic - general anesthesia
- - local - focuses only on a portion of the body
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What is a sedative
drug that reduces anxiety by causing sedation
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What is a hypnotic
drug that ensure sleep
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Name some classes of sedative hypnotics
- - benzodiazepines - most commonly used for sedation, ex. ativan, valium, versed (end in pam)
- - barbiturates - similar to benzos, work on GABA, phenobarbital
- - nonbarbiturate hypnotics - less side effects with similar effect of barbiturates and benzos, ex. propofol, etomidate
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How does an anticonvulsant work
inhibit influx of sodium into cells to reduce depolarization
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What is a CNS stimulant and how does it work
- - increase release of dopamine and norepinephrine to increase wakefulness and awareness
- - ritalin
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What is a stimulant
- cause excitation of CNS
- ex. cocain, caffeine, amphetamines
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What are cholinergic medications
- - work on parasympathetic NS
- - block ACh effects
- Side effects
- Salivation/sweating
- Lacrimation
- Urination
- Defecation/drooling/diarrhea
- GI upset
- Emesis
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What are muscarinic cholinergic antagonist
- block ACh at athe muscarinic receptors
- ex. atropine
- increase secretions, HR, dilates pupils and decreases GI
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What are neuromuscular blocking agents
- affect somatic NS by inducing paralysis
- depolarizing - continuous stimulation of muscle cells, ex. succinylcholine
- nondepolarizing - long acting, do not stimulate, ex. vecuronium
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What are sympathomimetics
- stimulate sympathetic NS
- stimulation at the adrenal medulla to release norepi and epi
- lead to stimulation of dopaminergic receptors producting dialtion - no meds here
- lead to stimulation of adrenergic receptors
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Adrenergic receptors
- alpha 1 - produce vasoconstriction and bronchoconstriction
- alpha 2 - control release of norepi
- beta 1 - increase HR, cardiac contraction increased and strengthened, increase cardiac conduction
- beta 2 - stimulate vasodilation and bronchodilation
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What are chronotropic medications
affect the HR
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What are inotropic drugs
affect force of contraction
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What are dromotrophhic drugs
effect conduction and velocity of the heart
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what are cardiac glycosides
- block ionic pumps in the heart to increase Ca concentration
- ex. digoxin
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What are antiarrhythmics
- treat rhythm disorders
- sodium channel blockers - slow conduction in heart
- beta blockers
- potassium channel blockers - increase contraction
- calcium channel blockers - block inflow of Ca into cell decreasing force of contraction
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treatment goals of antihypertensives
- keep BP w/in normal limits
- improve blood flow
- reduce stress placed on heart
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What are diuretics
- help kidney remove excess salt and water leading to decreased volume and decreases stress on CV
- Thiazides - control sodium and water excreted by kidney
- loops - lower concentration of sodium and calcium ions
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What are vasodilators
- act on smooth mucles of arterioles and veins
- ex. nitro
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Sympathetic blocking agents
- beta blockers
- adrenergic inhibitors
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Agiotensin converting enzyme inhibitor (ACE)
- target RAAS
- decrease conversion of angiotensin I to angiotensin II
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Angiotensin II receptor antagonists
block angiotensin II from binding to receptor
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Antiplatelets
- interfere with aggregation or collection of platelents
- do NOT break down aggregated platelets, only prevent further build up
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Anticoagulant
prevent thrmobi from forming
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fibrinolytic agents
dissolve thrombus after clot has formed and prevent it from breaking off and entering the bloodstream
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xanthines
- second line treatment for respirtory emergency
- releive constriction by relaxing smooth muscles of bronchioles and stimulating cardiac muscles to work harder to increase blood flow
- stimulate CNS
- ex. caffeine
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Antacids
- neutralize stomach acid
- relieve indigestion
- mylanta, tums, MOM
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Antiemetics
- treat vomiting
- promethazine, compazine, reglan, zofran
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H2 receptor antagoinist
reduce acid produced in stomach by blocking cells that secrete acids
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antineoplastic medications
chemotherapy
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uricosuric medications
lower uric acid levels in the body by increasing excretion of uric acid by the kidney
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toxoid
modified bacterial toxin to stimulate antibody forming
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vaccine
suspension of nonpathogenic organism given to induce immune response
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immunosuppressants
inhibit body's ability to attack foreign objects/organs
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bioavailability
amount of drug still active once reaching target
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