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Drug
Chemical used to diagnose, treat or prevent disease
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Pharmacology
The study of drugs and their interactions with the body
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Drug Names
- Chemical Name: States its chemical structure, not used in practice
- Generic Name: Suggested by the manufacturer and confirmed by the government
- Official Name: Name posted in the United States Pharmacopeia (USP)
- Brand Name (Trade Name): Name given to the drug by the brand
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Sources of Drug Information
- United States Pharmacopeia (USP)
- Physicians Desk Reference
- Drug Information
- Monthly Prescribing Reference Guide
- AMA Drug Evaluation
- Internet or other outside sources
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Drug Profile
- Name: Generic, trade, etc.
- Classification: Broad group to which the drug belongs
- Mechanism of Action: The way the drug causes its effects (Pharmacodynamics)
- Indications: Conditions that make use of the drug appropriate, FDA set
- Pharmacokinetics: How the drug is absorbed, distributed, and eliminated. Onset and duration
- Side effects/Adverse reactions: The drug's untoward or undesired effects
- Routes of Administration: How the drug is given
- Contraindications: Conditions that make it inappropriate to give the drug
- Dosage: The amount of the drug that should be given
- How Supplied: Common concentrations and preparations
- Special Considerations: How the drug may effect people of different ages or conditions
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Drug Laws and Regulations
- Federal Law
- State Laws and Regulations
- Individual Agency Regulations
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The Pure Food and Drug Act, 1906
Made to improve drug labeling. Named the USP
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Harrison Narcotic Act, 1914
Limited the indiscriminate use of addictive drugs by regulating importation, manufacture, sale and use of opium, cocaine and their compounds or derivatives
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Federal Food, Drug and Cosmetic Act, 1938
Empowered the FDA to enforce and set premarket safety standards for drugs
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Durham Humphrey Amendments to the 1938 act
AKA Prescription Drug Amendments. Required pharmacists to have either a written or verbal prescription from a physician to dispense certain drugs. Also created the over-the-counter category
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Controlled Substances Act, 1970
Created the five schedules of drugs.
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Schedules of Drugs
- Schedule I: High abuse potential. No medical use. Research only.
- Schedule II: High abuse potential. Some medical indications.
- Schedule III: Less abuse potential. Some medical indications
- Schedule IV: Low abuse potential. Accepted medical indications
- Schedule V: Lower abuse potential. Accepted medical indications
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Assay
Test that determines the amount and purity of a given chemical in a preperation in a laboratory
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Bioequivalence
Relative therapeutic effictiveness of chemically equivalent drugs
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Bioassay
Test to ascertain a drug's availability in a biological model
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Phases of human studies of drugs
- Phase 1: Determine drug's pharmacokinetics, toxicity and safe dose
- Phase 2: Tested in a small population of people who have the target disease. Find therapeutic level and watch for side-effects
- Phase 3: Refine therapeutic dose and collect relevant data on side-effects
- Phase 4: Postmarketing analysis during conditional approval. Monitoring of performance in actual cases
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Six Rights of medication administration
- Medication
- Dose
- Time
- Route
- Patient
- Documentation
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FDA Pregancy Categories
- A: Adequate studies. No risk to fetus
- B: Animal studies have not demonstrated risk to fetus OR Adequate studies have showed no risk to humans but animals have had adverse effects
- C: Animal studies have demonstrated adverse effects but there are no adequate studies done on humans. However risk may be worth the gain OR No adequate studies in humans or animals
- D: Fetal risk demonstrated. Some situations may be worth the risks
- X: Fetal risk demonstrated. Risks outweigh any benefits
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Teratogenic Drug
Medication that may deform or kill the fetus
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Free Drug Availability
Proportion of a drug available in the body to cause either desired or undesired effects
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Pharmacokinetics
How a drug is absorbed, distributed, metabolized (biotransformed), and excreted. How drugs are transported in and out of the body.
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Pharmacodynamics
How a drug interacts with the body to cause its effects
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Active Transport
Requires the use of energy to move a substance
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Carrier-Mediated Diffusion (Facilitated diffusion)
Process in which carrier proteins transport large molecules across the cell membrane
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Passive Transport
Movement of a substance without the use of energy
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Diffusion
Movement of solute in a solution from an area of higher concentration to an area of lower concentration
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Osmosis
Movement of solvent in a solution from an area of lower solute concentration to an area of higher solute concentration
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Filtration
Movement of molecules across a membrane from an area of higher pressure to an area of lower pressure
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Pharmacokinetic Processes
- Absorption
- Distribution
- Biotransformation
- Elimination
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Ionize
To become electrically charged or polar
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Bioavailability
Amount of a drug that is still active after it reaches the target tissue
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Blood-Brain Barrier
Tight junctions of the capillary endothelial cells in the central nervous system vasculature through which only non-protein-bound, highly lipid soluble drugs can pass
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Placental Barrier
Biochemical barrier at the maternal/fetal interface that restricts certain molecules
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Metabolism
The body's breaking down chemicals into different chemicals
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Biotransformation
Special name for the metabolism of drugs
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Prodrug
Medication that is not active when administered but whose biotransformation converts it into active metabolites
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First-Pass Effect
The liver's partial or complete inactivation of a drug before it reaches the systemic circulation
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Oxidation
The loss of hydrogen atoms or the acceptance of an oxygen atom. This increases the positive charge (or lessens the negative) on the molecule
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Hydrolysis
The breakage of a chemical bond by adding water or by incorporating a hydroxyl (OH-) group into one fragment and a hydrogen ion (H+) into the other.
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Drug Routes
- Enteral- Through the gastrointestinal tract
- Parenteral- Outside of the GI tract
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Enteral Routes
- Through the GI tract
- -Oral (PO)- Swallowed
- -Orogastric/Nasogastric tube (OG/NG)
- -Sublingual (SL)- Under the toungue
- -Buccal- Between the cheek and gum
- -Rectal
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Parenteral
- -Intravenous (IV)
- -Endotracheal Tube (ET)
- -Intraosseous (IO)
- -Umbilical- Through the umbilical cord vein or artery
- -Intramuscular (IM)
- -Subcutaneous (SC)
- -Inhalation/Nebulized
- -Topical
- -Transdermal
- -Nasal
- -Instillation-Directly into a wound or the eye
- -Intradermal- Drug directly between skin layer
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Solid Drug Forms
- -Pills- Spherically shaped for swallowing
- -Powders
- -Tablets- Powders compressed into a disklike form
- -Suppositories- Drugs mixed with waxlike substance that melts at body temp for rectal or vaginal use
- -Capsules- Gelatin containers filled with powders or tiny pills. Gelatin dissolves in GI tract
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Liquid Drug Forms
- -Solutions- Most common liquid form. Generally water based, some oil
- -Tinctures- Prepared using an alcohol extraction process. Some alcohol usually remains
- -Suspensions- Preparation in which solid does not dissolve in solvent. If lefts alone they will separate
- -Emulsions- Suspensions with an oily solvent. Oil will seperate from solution
- -Spirits- Solution of a volatile drug in alcohol
- -Elixirs- Alcohol and water solvent. Often with flavorings added to improve taste
- -Syrups- Sugar, water and drug solutions
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Types of Drug Actions
- -Binding to a receptor
- -Changing the physical properties of cells
- -Chemically binding with other chemicals
- -Altering a normal metabolic pathway
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Receptor
Specialized protein that combines with a drug resulting in a biochemical effect
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Affinity
Force of attraction between a drug and a receptor
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Efficacy
A drug's ability to cause the expected response
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Second Messenger
Chemical that participates in complex cascading reactions that eventually cause a drug's desired effect
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Down-Regulation
Binding of a drug or hormone to a target cell that causes the number of receptors to decrease
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Up-Regulation
A drug that causes the formation of more receptors than usual
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Agonist
A drug that binds to a receptor and causes it to initiate the expected reaction
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Antagonist
Drug that binds to a receptor but does not cause it to initiate the expected response
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Agonist-Antagonist (Partial agonist)
Drug that binds to a receptor and stimulates some of its effects but blocks others
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Competitive Antagonism
One drug binds to a receptor and causes the expected effect which also blocking another drug from triggering the same receptor
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Noncompetitive Antagonism
The binding of an antagonist causes a deformity of the binding site that prevents an agonist from fitting and binding
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Irreversible Antagonism
A competitive antagonist permanately binds with a receptor site
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Side Effect
Unintended response to a drug
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Reponses to Drug Administration
- Allergic Reaction-Hypersensitivity
- Idiosyncrasy-A drug effect that is unique to the individual and not seen in general population
- Tolerance-Decreased response to the same amount of drug after repeated administrations
- Cross Tolerance- Tolerance for a drug that develops after administration of a different drug
- Tachyphylaxis-Rapidly occuring tolerance to a drug. May occur after one dose
- Cumulative Effect- Increased effectiveness when a drug is given in several doses
- Drug Dependence- Patient becomes accustomed to the drug and will suffer withdrawal if discontinued
- Drug Interaction- The effects of one drug ALTER response to another
- Drug Antagonism-The effects of one drug BLOCK the response to another
- Summation- Two drugs with same effects given together
- Synergism-Two drugs with same effect given together and produce a response greater than the expected sum
- Potentiation-One drug enhances the effects of another
- Interference-The direct biochemical interaction between two drugs. One drug effects another
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Drug-Response Relationship
Correlation of different amounts of a drug to clinical response
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Plasma-Level Profile
Describes the lengths of onset, duration, and termination of action as well as the drug's minimum effective concentration and toxic levels
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Onset of Action
The time from administration until the time the drug reaces its minimum effective concentration
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Minimum Effective Concentration
Minimum level of drug needed to cause a given effect
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Duration of Action
Length of time the amount of drug remains abouve its minimum effective concentration
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Termination of Action
Time from when the drug's level reaches its minimum concentration til it is eliminated from the body
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Therapeutic Index
Ratio of ta drug's lethal dose for 50 percent of the population to its effective dose for 50 percent of the population
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Biological Half-Life
Time the body takes to clear one half of a drug
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Factors Affecting Drug-Response Relationship
- -Age
- -Body Mass
- -Sex
- -Environment
- -Time of Administration
- -Pathology
- -Genetics
- -Psychology
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Drug Interactions
- -One drug alters the rate of intestinal absorption
- -Two drugs compete for plasma protein building resulting in one accumulating
- -One drug alters the other's metabolism
- -One drugs receptor site action could be antagonistic or synergistic to the other drug
- -One drug could alter the others excretion rate
- -One drug could alter the balance of electrolytesw neccessary for the other to work
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