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Drug
Chemical used to diagnose, treat or prevent disease
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Pharmacology
Study of drugs & their interaction w/ the body
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Classification
Broad group to which a drug belongs
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Indication
Conditions that make the admission of a drug appropriate
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Pharmacodynamics
How a drug interacts with the body to cause its effect
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Side effect
The drugs untoward or undesired effects
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Contraindication
Conditions that make it inappropriate to give the drug
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Teratogenic Drug
Drugs that may deform or kill a fetus
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Pharmacokinetics
How a drug is absorbed, distributed, metabolized or excreted
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Affinity
Force of attraction between drug & receptor
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Efficacy
Drugs ability to cause the expected response
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Agonist
Drug which binds to receptor site causing a desired effect
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Antagonist
Drug which binds w/ a receptor site blocking it but not causing the desired effect
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Allergic Reaction
Aka hypersensativity, the effect occurs as a drug is antigenic & activates immune sys
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What is the difference between anaphylaxis & an allergic reaction?
An allergic reaction isnt necessarily life threatening where as anaphylaxis is
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Tolerance
Decreased response to the same amt of drug after repeated administrations
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Cross tolerance
Tolerance for a drug that develops after administration of a different drug. ie opiod b/c tolerance for 1 = tolerance for all
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Tachyphylaxis
Rapidly occurring tolerance to a drug. May occur aft a single dose
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Cumulative Effect
^ effectiveness when a drug is given in several doses
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Drug Dependance
Pt becomes accustomed to the drugs presence in his body & will suffer physical or psychological withdrawal symptoms upon its absence
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Drug Interaction
The effects of 1 drug alters the response to another drug
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Drug Antagonism
The effects of 1 drug block the response to another drug
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Summation (aka ____ ____)
- Additive effect
- 2 drugs w/ same effect given together. 1+1=2
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Synergism
2 drugs given together having the same effect & producing a response > the sum of their individual responses. 1+1=3
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Potentiation
- 1 drug enhances the effect of another
- ie Promethazine enhances morphine
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Interference
Direct biochemical interaction between 2 drugs; 1 drug effects the pharm of another
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Analgesic
Absence of the sensation of pain
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Anesthetic
Induces loss of sensation to touch or pain
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Sedation
State of decreased anxiety & inhibition
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Hypnosis
Instigation of sleep
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Parasympathomimetic
Causes effects like the parasympathetic NS (cholinergics)
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Parasympatholytic
Blocks the parasympathetic nervous sys
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Sympathomimetic
Causes effects like those of the sympathetic NS
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Sympatholytic
Blocks the action of the sympathetic sys
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Antidysrhythmic
Drug used to treat or prevent abnormal cardiac rhythms
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What is a schedule I drug?
- High abuse potential
- No med indication
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Describe a schedule II drug.
- High abuse potential
- May lead to dependance
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Describe a schedule III drug.
- Less abuse
- Moderate dependance
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Describe a schedule IV drug.
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Describe a schedule V drug.
- Low abuse
- Limited dependance
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What are class 1 recs as per the AHA?
Conditions for which there is evidence &/or general agreement that a given procedure or treatment is useful & effective
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What are class 2 AHA recs mean?
Conditions for which there is conflicting evidence &/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment
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What are class 2a rec as per the AHA?
Weight of evidence/opinion is in favor of usefulness/efficacy
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What are class 2b recs as per the AHA?
Usefulness/efficacy is less well established by evidence/opinion
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What are class 3 recs as per the AHA?
Conditions for which there is evidence &/or general agreement the the procedure/treatment is nor useful/effective & in some cases may harmful
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With regards to Levels of Evidence, describe level A.
Data derived fr randomized clinical trials
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W/regards to Levels of Evidence, describe level B.
Data derived fr a single randomized trial or non-randomized studies
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W/regards to Levels of evidence, describe level C.
Consensus of opinion of experts
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What are the 6 rights of med administration?
- Med
- Dose
- Time
- Route
- Patient
- Administration
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Some drugs act my changing physical props of a part of the body. Give an example.
Mannitol ^ urine output by ^ bloods osmolarity or osmotic pull
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Some drugs chemically combine w/ other substances. Give example.
Isopropyl alcohol, used to disinfect skin b/f needle insertion, denatures proteins on the surface of bacteria cells destroying the bacteria
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What is an example of a class or drugs that alter a metabolic pathway?
Cancer Drugs
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Tachyphalaxis is described as a ______.
Rapidly decreasing effectiveness of a drug w/repeated use
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Digixon is prescribed for CHF primarily too what?
Improve myocardial contractility & cardiac output
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Stimulation of histamine (H1) receptors often results in what?
Vasodilation & increased vascular permeability
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An "orphan drug" is defined as a drug used to . . . .
Treat a specific rare disease
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SLUDGE helps to ID the effects of _____ drugs on the autonomic nervous sys.
Parasympathomimetic
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When a drug causes a change in the cell membrane, preventing addl stimulation of the cell no matter how much stimulation is offered that drug is called a competitive/noncompetitive agonist/antagonist?
Noncompetitive Antagonist
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Meds used to treat extrapyramidal side effects fr antipsychotics & to treat Parkinsons Disease achieve therapeutic effects by increasing/decreasing the amt of _____ at receptor sites in basal ganglia.
Increasing the amt of dopamine
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Nitroprusside is used for _____ emergencies b/c it is a potent ____.
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Propranolol (aka ____) causes a ____ ____ effect.
- Inderal
- Negative Chronotropic
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A larger than expected dose of adenosine may be necessary in pts regularly taking ____ _____.
Certain Bronchodilators
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The principal action by which digoxen achieves its therapeutic effect in heart failure is by what?
Creating an environment where by Ca ions remain intracellular for a prolonged period
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Benzos are safer than barbituates in seizure pts b/c why?
The effects of benzos is limited by the amt of endogenous GABA in the CNS
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According to Frank-Starlings Law, the administration of NTG will result in ____ preload, ____ stroke vol and ____ myocardial O2 demand.
Decreased, Decreased, Decreased
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Reversable cholinesterase inhibitors enable/block parasympathetic/sympathetic stimulation for a finite period?
Enables Parasympathetic
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If a drug blocks nicotinic receptors @ the neuromuscular junction, what symptomatic effect might this have on the patient?
Inability to move voluntary and involuntary muscles
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At the cellular level, treatment of seizures is generally accomplished by ____ the influx of ____ ions into the neural cells.
Inhibiting, Na and CA
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Administration of a nonselective beta antagonist will most likely result in ____ and ____ ____.
Bronchoconstriction and inhibited glycogenolysis
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A drug that blocks muscarinic receptors in the peripheral nervous system would be classified as a _____.
Parasympatholytic
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Th chief physiologic effect of nerve gases such as VX and sarin are too . . . .
Irreversibly block the enzyme chlolinesterase
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Which classification of drug affecting the autonomic nervous system would be best suited to treat a pt w/spinal shock?
Alpha agonist
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Beta adrenergic antagonists reduce hypertension by what 3 ways?
- Neg inotropic effect
- Suppressing renin release fr the kidneys
- Diminishing reflex tach as a compensatory response
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Teratogenesis refers to the . . . . .
Effects of a drug on a developing fetus
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An important difference between analgesics and anesthetics is what?
Anesthetics block all sensations
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What is the term used to describe the effects a drug has on its target organ?
Pharmacodynamics
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An important physiologic distinction between the sympathetic and parasympathetic divisions of the autonomic nervous system is what?
Sympathetic ganglia are close to the spinal cord
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The absorption of ASA fr the stomach is ____ b/c the acidity of gastric contents ____ ionization of the drug.
Rapid, Impedes
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What disease is characterized by hypersecreation of adrenocorticotropic hormone leading to hyperglycemia, obesity, hypertension and electrolyte imbalances?
Cushings Disease
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TCAs achieve their therapeutic effect by doing what?
Prolonging the duration of Norepi & serotonin @ receptor sites
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In a pt experiencing an MI, a med that reduces afterload is beneficial b/c it
Reduces the workload of the heart, reducing myocardial O2 consumption
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The FDAs pregnancy safety designation of Category A for a drug means:
Adequate studies in pregnant women have not demonstrated a risk to the fetus in the 1st trimester or later trimesters
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_____ is the relative therapeutic effectiveness of chemically comparable drugs.
Bioequivalence
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In the renin-angiotensin-aldosterone system (RAAS), which element is most responsible for widespread vasoconstriction?
Angiotensin II
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The pharmacological effects of administering insulin to a hyperglycemic pt is an example of increased:
Carrier -mediated Diffusion
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NTG achieves its therapeutic effects by:
Blocking the entry of Ca into the cells of smooth muscle
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A prolonged deficiency in Vitamin C may result in ____.
Scurvy
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Hypoparathyroidism leads to decreased ____ ____.
Ca Levels
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Name 3 common side effects of loop diuretics.
- Reflex Tach
- Hypokalemia
- Orthostatic Hypotension
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The FDAs classification of a drugs treatment or therapeutic potential as "A" means the drug offers what?
Important therapeutic gains
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In the treatment of Parkinson's Disease, dopamine is not administered directly b/c it cannot:
Cross the blood brain barrier
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A significant issue with digitalis preparations is that they:
Have a very narrow therapeutic index
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A lesion in the posterior pituitary gland resulting in hypersecreation of ADH could cause:
Hypertension
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A suppository is defined as what?
A drug w/a wax like base that melts @ body temp, allowing absorption into body tissue.
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A large concern during the administration of an Alpha agonist is infiltration b/c it may cause:
Tissue necrosis
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What are the 5 intrinsic benzo effects?
- Anxiolytic
- Amnesic
- Sedative/Hypnotic
- Anticonvulsant
- Muscle Relaxant
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What is assay?
Test that determines the amt & purity of a given chemical in a preparation in a laboratory
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Define Bioequivalence.
Relative therapeutic effectiveness of chemically equivalent drugs
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Define Bioassay.
Test to ascertain a drugs availability in a biological model
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Medication packages containing a single dose for a single pt. is called?
Dose Packaging
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What is a med that may kill of deform a fetus called?
Teratogenic Drug
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Describe free drug availability.
The proportion of a drug available in the body to cause either desired or undesired effects
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Define pharmacokinetics.
How a drug is absorbed, distributed, metabolized (biotransformed) & excreted; how drugs are transported into & out of the body
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What are the 4 pharmacokinetic processes?
- Absorption
- Distribution
- Biotransformation
- Elimination
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Bioavailability is the amt of a drug _____?
That is still active after it reaches its target tissue
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What is the special name given to the metabolism of drugs?
Biotransformation
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What is a prodrug?
A med that isnt active when administered, but whos biotransformation converts it into active metabolites
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What is the first pass effect?
The livers partial or complete inactivation of a drug b/f it reaches the systemic circulation
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Enteral delivery of a med means the med is delivered . . . .
Through the intestinal tract
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Parentarel delivery of a med is any route that . . . .
Outside the gastrointestinal tract, typically using needles to inject directly into the circulatory sys or tissue
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Give 5 examples of enteral med routes.
- PO
- Orogastric/Nasogastric Tube (OG/NG)
- SL
- Buccal
- PR
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Parenteral Routes include (12):
- IV
- ET
- IO
- Umbilical
- IM
- SC
- Inhalation/Neb
- Topical
- Transdermal
- Nasal
- Instillation
- Intradermal
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An agonist-antogonist (partial agonist) is a drug that binds to a receptor & . . .
stimulates some of its effects but blocks others
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Competitive antagonism is when 1 drug . . . .
binds to a receptor & causes the expected effect while also blocking another drug fr triggering the same receptor
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What is non-competative antagonism?
The binding of an antagonist causes a deformity of the binding site that prevents an agonist fr fitting & binding
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Irreversible antagonism is a . . . .
Competitive antagonist permanently binds w/a receptor site
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What are side effects?
Unintended response to a drug
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List some side effects (13).
- Allergic reaction
- Idiosyncrasy
- Tolerance
- Cross-tolerance
- Tachyphylaxis
- Cumulative Effect
- Drug dependance
- Drug interaction
- Drug antagonism
- Summation
- Synergism
- Potentiation
- Interference
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Interference is. . . .
The direct biochemical interaction between 2 drugs; 1 drug affects the pharm of another
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What is a drug response relationship?
Correlation of different amts of a drug to clinical response
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What is the plasma level profile?
Describes lengths of onset, duration & termination of action as well as the drugs min effective concentration & toxic levels
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What is the onset of action?
Time from administration until a med reaches its minimum effective concentration
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The autonomic nervous sys ctrls what & is further divided into ____ & ____?
- Involuntary or automatic functions
- Sympathetic & parasympathetic nervous sys
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What are the effects of opiod agonists?
- Analgesia
- Euphoria
- Sedation
- Miosis
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What effect does morphine have on the heart?
Decreases preload & afterload
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What are the effects of a prototype benzo?
- Antianxiety
- Hypnotic
- Anesthetic
- Anticonvulsant
- Sedative
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What is EPS (aka ___) & what causes it?
- Extrapyramidal Symptoms
- Dystonic Reaction
- Caused by brain damage & antipsychotic drugs
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How to TCA's work?
By blocking the reuptake or nor-epi & serotonin thus extending the duration of their action
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How do SSRIs work?
By selectively blocking the reuptake of serotonin but they do not affect dopamine or nor-epi
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Whats used to treat ODs of TCAs?
Sodium Bicarbonate
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What is parkinsons disease?
A nervous disorder caused by the destruction of dopamine releasing neurons in the substantia nigra, part of the basal ganglia, which is a specialized area of the brain that crtl fine motor movement
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What is dyskinesia?
Disfunctional movements such as involuntary tremors, unsteady gait & postural instability
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What is the drug of choice for treating Parkinsons & why?
Levodopa b/c it can readily cross the blood brain barrier where it is absorbed by dopamine releasing neuron terminals
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Describe the blood brain barrier.
Tight junctions of the endothelial cells in the CNS vasculature thru which only non protein bound highly lipid soluble drugs can pass
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Define the Placental Barrier.
Biochemical barrier at the maternal/fetal interface that restricts certain molecules
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What is a prodrug?
A med that isnt active when administered, but whos biotransformation converts it into active metabolites
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What is the first pass effect?
The livers partial or complete inactivation of a drug b/f it reaches the systemic circulation
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What is oxidation?
The loss of hydrogen atoms or the acceptance of an O2 atom ^ pos charge on the molecule
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What are the 4 types of drug actions?
- Binding to a receptor site
- Changing physical props of cells
- Chemically combining w/other chemicals
- Altering normal metabolic pathway
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A receptor is a. . .
Specialized protein that combines w/ a drug resulting in a biochemical effect
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What are the three universal special considerations when dealing w/Meds?
- Pregnant
- Pediatric
- Geriatric
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Describe the chemical name of a drug:
States chemical composition & molecular structure
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The generic name for a drug is:
A drug name suggested by the manufacturer
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The official name for a drug:
Name given to a drug when the FDA lists the drug in the USP
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The brand name for a drug is:
The proper name for a drug given by the manufacturer
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