-
What is Pharmacokinetic?
- drug movement in the body
- absorption, distribution, metabolism, excretion
-
What is pharmacodynamic?
drug action the body
-
Where does most of oral absorption occur?
small intestine
-
what are enteral route of medications?
-
What are parenteral routes of medication?
- intravenous IV - quick
- intramuscular IM - slower to work
- subcutaneous SQ - rapid absorption but limited to a smaller amount
- intradermal ID - takes 72 hours to see if there is a reaction
-
Peak & Onset for Morphine sulfate:
oral
sq
IV
IM
ID
- oral: onset variable, peak 60-120 min
- sq: onset 10-20 min, peak 30-60 min
- IM: onset 10-30 min, peak 30-60 min
- IV: onset immediate, peak 20 min
- ID: onset up to 18 hrs, peak 72 hrs
-
Where does most drug metabolism occur?
liver
-
Where does the first pass effect occur?
liver`
-
What's usually larger? oral or parenteral dose? why
ORAL because parentral medications don't go through the first pass effect so a lower dose is neccessary to not be toxic
-
Lipophillic vs. hydrophillic
- Lipophillic - fat loving - older adults
- Hydrophillic - water loving - babies
-
Where does most excretion occur?
urine
-
Who has more creatinine and why?
Men, comes from muscle.
-
what is the difference between serum creatinine level and creatinine clearance?
Creatinine levels should be high in urine and low in serum
-
Why is creatinine clearance important and how do we measure/estimate it?
It tells us how well your kidneys are working
-
How does creatinine clearance vary with age?
Older people don't have as much creatinine.
-
What are some special considerations with neonates/infants?
- decreased/erratic drug absorption
- decreased protein binding
- decreased protein binding
- decreased integrity of BBB
- decreased hepatic metabolism
- decreased renal excretion
- increased topical drug absorption
-
What is a special consideration for children >1 year old?
Most pharmokinetics similar to adult except increased hepatic metabolism until puberty. Weight plays a major factor (mL/kg/day)
-
What are some special considerations for older adults?
- few absorption differences
- decreased/no change in hepatic metabolism
- increased body fat relative to lean tissue
- longer half-lives for lipophillic drugs
- decreased total body water
- high serum concentration of hydrophillic drugs
- ***decreased renal excretion
-
What are the FDA Pregnancy Categories
- A- no risk to fetus in good studies
- B- Risk in animals but not human or no risk in animals but insufficient data in humans
- C- adverse effects in animals but insufficient data in humans. Weigh benefits/risks risk demonstrated. Weight benefits/risks.
- X- Risk > benefits. Do not use in pregnancy
- D- Human fetal
-
What is an agonist receptor?
-
What is an antagonist receptor?
-
What is the therapeutic level?
optimum level of the drug before toxicity.
-
What are peak/trough levels?
determines the therapeutic levels
-
What is a fast acting insulin? onset, peak & duration
- Novolog
- onset: 15-30 min
- peak: 30-90 min
- duration: 3-4 hours
-
What is a fast acting insuling?
-has a long peak than Novolog.
- Regular - HumulinR and NovolinR
- can be given SQ or IV
- onset: 30 min
- peak: 2-3 hours
- duration: 3-6 hours
-
What is an intermediate acting insulin?
-has a slower onset, but longer peak
- HumulinN - NovolinN
- onset: 1-4 hours
- peak: 4-12 hours
- duration: up to 24 hrs, usually given 2xdaily
-
What is a long acting insulin?
- Lantus - basal insulin (given mostly to type I)
- onset: 1-2 hrs
- NO PEAK
- duration: 20-24 hrs, given once a day.
-
Why don't we check blood levels on most drugs?
because we don't have a very narrow therapeutic level window.
-
Why do we check blood levels on some drugs?
Becuase it does have a very narrow therapeutic level window and we don't want to cause toxicity. We adjust the amount accordingly.
-
What are the following allergic reactions?
- Type I: anaphylactic (usually doesnt happpen on the first dose)
- Type II: cytotoxic/autoimmune
- Type III: immune complex reaction
- Type IV: cell mediated, delayed hypersensitivity
-
What is Iatrogenesis?
problem caused by medications/hospitals
-
What is idiosyncratic?
having reaction uncommon (genetic disposition)
-
What is Paradoxical?
Having the opposite effect as intended. Example: Benadryl. Making you energized rather than sleepy(intended)
-
Morphine Sulfate binds to Mu & Kappa receptors (affinity & efficacy)
- Mu: analygesia, decreased peristalsis, euphoria, physical dependence, respiratory depression, CNS depression
- Kappa: analgesia, decreased peristalsis, miosis(pupil constriction), CNS depression
-
Can you guess some possible side effects of morphine?
constipation, euphoria, drowsy
-
what is a opoid antagonist??
- Naloxone (Narcan)
- binds to mu and kappa receptors (affinity but no efficacy)
- reverses repiratory depression and analgesia
-
Sympatetic vs Parasympathetic?
- Sympathetic: pupils dilated, decreased salivation, increased heartrate, peripheral vasoconstriction, bronchioles dilated, slowed peristalsis, bladder detrusor relaxes, bladder sphincter contricts, glycogenolysis, gluconeogenesis
- Parasympathetic: Pupils constricted, increased salvation, decreased heart rate, peripheral vasodilation, bronchioles constricted, increased peristalsis, bladder detrusor contracts, bladder sphincter relaxes, glycogen synthesis
-
Sympathetic NS: Neurotransmitter & drug classes
- Norepinephrine
- Drug classes: sympathomimetics, adrenergic agonists, anticholintergics
-
Parasympathetic NS: Neurotransmitter & drug classes
- Acetylcholine
- Drug classes: parasympathomimetics, cholinergics, adrenergic antagonists or blockers
-
Adrenergic Subreceptors: Agonist Effects
ALPHA 1:
- peripheral vasoconstriction
- pupil dilation
- bladder sphincter contraction (adrenergic effects)
-
Adrenergic Subreceptors: Agonist Effects
ALPHA 2 in CNS:
lower BP (anti adrenergic effects)
-
Adrenergic subreceptors: Agonist Effects
BETA 1
increased heart rate and force of contraction
-
Adrenergic Subreceptors: Agonist Effects
BETA 2
bronchiole dilation, uterine relaxation, glucogenolysis, gluconeogenesis
-
Parasympathomimetics; acetylecholineresterase inhibitor main use is?
Alzheimer's and/or vacular dementia
-
Anticholinergic Side Effects (Sympathetic)
- constipation
- urinary retension
- dry, dilated eyes
- dry mouth (xerostomia)
- inhibition of sweating (hyperthermia)
- mental confusion, agitation (blocks acetylcholine in the CNS)
-
Cholinergic Side Effects (parasympathetic)
- S:alvation
- L:acrimation
- U:rination
- D:efacation
- G:I
- E:mesis
-
What kinds of cells do antibiotics kill?
kill off normal flora, thrush, growing cells
-
Where do we have bacteria in the body?
mouth, vagina, skin
-
What are some of the possible side effects of therapy with broad spectrum antibiotic?
CDIF, normal flora take over
-
Injuries can be prevented by...
- 1. intrinsic (internal to the person)
- 2. extrinsic (posted speed limit, other drivers)
-
What are risk factors related to infants?
- aspiration
- falls
- sids
- motor vehicle accidents
-
What are risk factors for toddlerS?
- falls
- burns
- poisoning
- aspiration
- electrical outlets
- traffic
- drowning
-
What are risk factors for preschoolers and school age kids?
|
|
