Chapter 7

study of medications and their effect or action on the body

patient, medication, dose, route, time, documentation/reporting

• describes drug chemical makeup, the composition and molecular structure
• Ex. 2-butyl-3-benzofuranyl 4-[2-(diethylamino)-ethoxy]-3,5-diiodophenyl ketone hydrochloride

• aka nonproprietary; a general name, not manufacturer specific, usually derived from chemical name but easier
• Ex. amiodarone

• aka brand name; unique name that the manufacturer registers the drug with the FDA, always capitalized
• Ex. Cordarone, Pacerone

• 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

plants, animals, minerals, synthetic

aimed to protect the public from mislabled, poisonous or harmful medications

• - 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

• - highest abuse potential
• - severe dependence possible
• - no accepted medical use
• - ex. heroin, LSD, marijuana, MDMA

• - very high abuse potential
• - may lead to severe addiction
• - ex. amphetamine, opiates, cocaine, demerol, barbiturates

• - lower abuse potential than I and II
• - low to moderate physical dependence
• - high psychological dependence
• - combination narcotics (those containing APAP)

• - low abuse potential
• - limited dependence
• - ex. phenobarbital, diazepam, lorazepam

• - lowest abuse potential
• - limited dependence
• - ex. cough syrups with codiene

determines safety and efficacy before a drug goes to market

rugulates physicians permitted to dispense controlled substances

- drug advertising

test drug in healthy individuals to determine safe dose

determine drug safety and efficiacy and establish most effective dose

evaluate efficacy and side effects

postmarket to determine long term efficacy and cost effectiveness

• - pregnant patients
• - breastfeeding patients
• - pediatrics
• - geriatrics

• - brain and spinal cord
• - sends impulses to the body thru efferent nerves
• - recieves impulses from the body thru afferent nerves

• - somatic
• - autonomic

• - sends sensory impulses from internal structures thru afferent nerves to the brain
• - divided into sympathetic and parasympathetic

• - grouping of nerves in the periphery
• - act as relay station to relay impulses

• - 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

• - dominates during rest and relaxation
• - aka rest and digest

• process of chemical signaling between cells
• - helps cells talk to each other
• - helps nerves keep a signal going

- attraction of a drug to a receptor

drug that binds to a receptor and causes a response

• liquid containing disolved chemical substances
• ex. NS

• - drug to be incorporated into solution
• - need to be shaken
• - will separate on standing

concentrated form of drug

- dilute alcoholic extract of a drug

volatile substance dissolved in alcohol

drug suspended in sugar and water

syrup with alcohol and flavoring added

• aqueous suspension of insoluble drug
• ex. milk of magnesia

• liquid in liquid formulation
• ex. oil in water

for external use

concentrated preparation of drug made by putting drug into solution and evaporating the excess solvent out

drug that has been pulverized

drug shaped into a form to be swallowed, usually coated to hide taste

gelatin container enclosing a medication

like a capsule but not made of gelatin, does not separate

drug mixed in a firm base that melts at body temp

semisolid prepartion for external aplication

medication impregnated into membrane or adhesive that is applied to the skin

gaseous medication administration

• - local - the reaction from direct application to the tissue
• - systemic - the reaction after the drug is absorbed, involves more than one organ

med absorbed through skin or mucous membrane

• deliver of drug through the patients skin
• - absorption can be affected by thickness of skin, hair, circulation

• under the tongue
• rapidly absorbed

• between the cheek and gum
• - ex. glucose gel

inhalation or injection into the pulmonary system

• Drugs that can be delivered by pulmonary route
• Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine

• drug is absorbed somewhere along GI tract
• - all po drugs are enterally administered

• 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

• study of metabolism and action of a medication within the body
• - time it takes for absorption, duration of action, distribution and excretion

• - med transfer from site of administration to target organ
• - depends on blood flow, surface area, concentration, pH

• 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

• the manner in which the body metabolizes medications
• - can involve either transforming hte medication into a metabolite or making it more water soluble

- elimination of the drug either as toxic or inactive metabolites

passive process where blood flows through the kidney, glomeruli are bundles of capillaries

active transport process in which meds are bound to transporters to aid in elimination

occurs when some of the drug is reabsorbed after being filtered

• way a medication produces a response
• aka mechanism of action

• - change in cell properties
• - bind to receptor
• - bind with other chemicals in the body
• - alter normal metabolic pathways

blocks receptor site from being stimulated by other chemicals in the body

time it takes for body to eliminate half of the drug

• - age
• - weight
• - sex
• - environment
• - time of administration
• - condition of the patient
• - genetic factors
• - psychologic factors

reactions that can manifest as signs or symptoms that are not what wewanted to happen but are expected due to how the medicaion works

• 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

a unique response to a drug that is not seen in other patients

• - can result from taking a medication for an extended period of time
• - must take higher dose to get the same response

- patient develops tolerance to a class of drugs

patient becomes rapidly tolerant to a medication

increased effect when a drug is given in several successive doses

• - addictive effect
• - two drugs given have the same effect therefore causing an enhanced response in the patient

a patient gets two drugs that result in a greater effect than the sum of either drug alone

the effect one drug has on another, in particular, one drug increases the effect of another

the direct biochemical interaction that takes place between two drugs

• - 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

- medication to relieve pain (induce analgesia)

• - 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

- reverse effects of an opioid drug

decrease pain but do not have the same side effects of opioid agonist

• causes loss of sensation to touch or pain
• - systemic - general anesthesia
• - local - focuses only on a portion of the body

drug that reduces anxiety by causing sedation

drug that ensure sleep

• - 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

inhibit influx of sodium into cells to reduce depolarization

• - increase release of dopamine and norepinephrine to increase wakefulness and awareness
• - ritalin

• cause excitation of CNS
• ex. cocain, caffeine, amphetamines

• - work on parasympathetic NS
• - block ACh effects
• Side effects
• Salivation/sweating
• Lacrimation
• Urination
• Defecation/drooling/diarrhea
• GI upset
• Emesis

• block ACh at athe muscarinic receptors
• ex. atropine
• increase secretions, HR, dilates pupils and decreases GI

• affect somatic NS by inducing paralysis
• depolarizing - continuous stimulation of muscle cells, ex. succinylcholine
• nondepolarizing - long acting, do not stimulate, ex. vecuronium

• 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

• 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

affect the HR

affect force of contraction

effect conduction and velocity of the heart

• block ionic pumps in the heart to increase Ca concentration
• ex. digoxin

• 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

• keep BP w/in normal limits
• improve blood flow
• reduce stress placed on heart

• 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

• act on smooth mucles of arterioles and veins
• ex. nitro

• beta blockers
• adrenergic inhibitors

• target RAAS
• decrease conversion of angiotensin I to angiotensin II

block angiotensin II from binding to receptor

• interfere with aggregation or collection of platelents
• do NOT break down aggregated platelets, only prevent further build up

prevent thrmobi from forming

dissolve thrombus after clot has formed and prevent it from breaking off and entering the bloodstream

• 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

• neutralize stomach acid
• relieve indigestion
• mylanta, tums, MOM

gasX

• treat vomiting
• promethazine, compazine, reglan, zofran

syrup of ipecac

reduce acid produced in stomach by blocking cells that secrete acids

chemotherapy

lower uric acid levels in the body by increasing excretion of uric acid by the kidney

modified bacterial toxin to stimulate antibody forming

suspension of nonpathogenic organism given to induce immune response

inhibit body's ability to attack foreign objects/organs

amount of drug still active once reaching target