612 Module 1, Pharmacology

Front 1

What are the 3 basic types of drug delivery?

Back 1

1. Enteral
2. Parenteral.
3. Topical

Front 2

What are the 3 types of enteral drug delivery?

Back 2

1. oral
2. sublingual
3. rectal

Front 3

What are the four types of parenteral drug delivery?

Back 3

1. IV
2. IM
3. SQ
4. Body Cavity (ex. into a joint)

Front 4

What are the 4 types of topical drug delivery?

Back 4

1. Skin-inflamed = increased absorption.
2. Mucous membranes-nose & lungs.
3. Eyes
4. ears

Front 5

A CYP 450 inducer has what effect on metabolism and drug?

Back 5

increases metabolism and decreases drug effect.

Front 6

A CYP 450 inhibitor has what effect on metabolism and drug?

Back 6

decreases metabolism and increases drug effect.

Front 7

What organ is where drugs are primarily excreted?

Back 7

kidneys

Front 8

Can drugs be excreted through breast milk?

Back 8

yes

Front 9

Define efficacy

Back 9

how big a response a drug elicits.

Front 10

Define potency

Back 10

what dose is needed to illicit a desired response.

Front 11

What does a dose-response curve represent?

Back 11

how much drug is required to get a desired response.

Front 12

If you increase the dose of a drug you also increase the chance of _____?

Back 12

side effects.

Front 13

What are 4 factors effecting drug distribution?

Back 13

1) protein binding vs. amount of free drug.
2. blood perfusion to target area
3. membrane permeability
4> lipophilic vs. calcium binding.

Front 14

A lipid soluble drug can pass what 3 barriers in the body?

Back 14

1. blood-brain barrier.
2. blood-placenta barrier
3. blood-testicular barrier

Front 15

What is the basic physiology of the hepatic first-pass effect.

Back 15

Enteral administration leads to GI absorption into venous blood stream which passes through the liver before entering the systemic blood stream.

Front 16

Which general drug classes are altered in the hepatic first pass effect?

Back 16

antibiotics and analgesics.

Front 17

Why is the first pass effect significant to pharmacology.

Back 17

Many drugs are altered in the liver before entering the systemic circulation.

Front 18

Who is WHO and how do they define an adverse reaction of a drug?

Back 18

WHO=World Health organization. They define an adverse drug reaction as any noxious, unintended, & undesired effect of a drug.

Front 19

What common side effect is caused by drugs acting on the CNS?

Back 19

somnelence

Front 20

Name two types of interactions that may occur with drugs?

Back 20

1. Drug-drug interaction.
2. Drug-food interaction.

Front 21

What are 6 common drugs with a narrow therapeutic index.

Back 21

1. Theophylline 2. coumadin 3. lithium. 4. digoxin 5. dilantin, tegretol 6. MGSO4

Front 22

Define drug tolerance

Back 22

The body has adapted so that there is a decreased drug response to the same dose.

Front 23

Define withdrawal

Back 23

symptoms displayed as a body reacts to coming off of a drug.

Front 24

Define drug dependence

Back 24

psychological need for the drug

Front 25

True or False: If a person displays both drug tolerance and dependence they are addicted?

Back 25

False

Front 26

Why should a provider use caution if a patient has liver problems such as hepatitis, liver cirrhosis, or increased AST/ALT enzymes?

Back 26

Liver problems can result in decreased drug metabolism in the liver, decreased drug excretion. This can lead to increased drug levels or toxicity.

Front 27

What serum labs are late indicators of decreased renal function?

Back 27

BUN & creatinine

Front 28

What is the relationship of plasma protein binding and free drug levels?

Back 28

More protein binding = less available free drug. Conversely, less protein binding = greater amounts of available free drug.

Front 29

What is an additive drug interaction? Give an example.

Back 29

When two drugs are combined to have a greater effect than expected. ex Plavix and aspirin.

Front 30

Define and give an example of a synergistic reaction between two drugs.

Back 30

A much greater response occurs than expected. ex. tylenol and codeine (Tylenol #3). combined effect is greater than the sum of their individual effects 1+1=3

Front 31

Define and give and example of a potentiation effect between two drugs.

Back 31

Potentiation occurs when one drug, which does not have a singular therapeutic effect, enhances the effect of another drug. ex PCN and probenacid in WWII

Front 32

Define antagonism interaction.

Back 32

1+1=0 Active resistance: substance
binds to the same site an agonist would bind to without causing activation of the receptor

Front 33

What test renal test should a provider order for a patient demonstrating increased serum BUN and Creatinine clearance?

Back 33

24h creatinine clearance.

Front 34

How does smoking influence CYP 450

Back 34

Smoking is a CYP 450 inducer, which increases metabolism and decrease drug effects.

Front 35

Pediatric patients have a greater percentage of body water compared to adults. How does this effect drug concentrations?

Back 35

Increases drug concentrations.

Front 36

Dehydration in children may _____ drug levels?

Back 36

increase

Front 37

What is the formula for dosing pediatrics by weight?

Back 37

mg/kg/day divided by # of doses.

Front 38

Name three problems with alcohol abuse and prescribing medications.

Back 38

1. alcohol potentiates CNS drugs.
2. alcohol abuse can lead to gastritis which affects drug absorption.
3.alcohol abuse can effect the liver, monitor enzymes.

Front 39

True or False

Renal clearance in pediatric patients is the same as adults.

Back 39

False, renal clearance may different in pediatric patients.

Front 40

Why is the nutritional status of an elderly client an important consideration for prescribing medications?

Back 40

Altered nutritional status may lead to lowered serum albumin concentrations, which decreases protein binding, which can lead to toxicity.

Front 41

True or False

Elderly patients have decreased renal function?

Back 41

True, decreased renal function should be monitored with creatinine clearance because it effects drug excretion.

Front 42

Sensory and cognitive changes in the elderly client can lead to problems with patient ______ with their medications?

Back 42

compliance.

Front 43

What two drugs are commonly discontinued in pregnant women because they are known to harm the fetus?

Back 43

Dilantin and ACE inhibitors.

Front 44

What considerations must be weighed when considering prescribing a Pregnancy Class C drug for a pregnant patient?

Back 44

risks vs. benefits.

Front 45

As a practitioner you determine that a particular drug needs to be prescribed for your client who is breast feeding, because there is a lack of research of the effect of the drug on babies you advise her to _____ & _____?

Back 45

Pump and dump.

Front 46

What 4 psychosocial factors affect drug compliance?

Back 46

1. does the patient believe the drug will help?
2. affordibility.
3. access
4. other drugs the patient may be taking.

Front 47

Name the four pharmockinetic processes.

Back 47

1. absorption
2. distribution
3.metabolism
4. excretion

Front 48

Define absorption

Back 48

movement of a drug from its site of administration into the blood.

Front 49

Define distribution

Back 49

movement of the drug throughout the body.

Front 50

Define drug metabolism

Back 50

biotransformation of a drug, the enzymatic alteration of a drug structure

Front 51

Define excretion

Back 51

removal of a drug from the body

Front 52

Define pharmacodynamics

Back 52

what drugs do to the body and how they do it.

Front 53

Define agonists

Back 53

Drugs that activate receptors. When drugs bind to receptors and mimic the actions of the bodies own regulatory molecules.

Front 54

Define antangonist

Back 54

drugs that produce an effect by preventing receptor activation by endogenous regulatory molecules and drugs.

Front 55

Explain the therapeutic index

Back 55

1. measure of a drugs safety.
2. ratio of LD50 to ED50
3. A large therapeutic index indicates safety.
4. Small therapeutic index is unsafe.

Front 56

Define bioavailability

Back 56

ability of a drug to reach the systemic circulation from its site of administration.

Front 57

Define half-life

Back 57

time required for the amount of drug to decrease in the body by 50%.

Front 58

Define half-life

Back 58

the time required for the amount of drug in the body to decrease by 50%.

Front 59

Why is the half-life of a drug is important to remember when prescribing medications?

Back 59

It determines the dosing interval.

Front 60

Define steady-state

Back 60

when the amount of drug coming into the body is equivalent to the amount of drug excretion. Shorter half-life + shorter time interval to reach steady state. Increased half-life = increased time interval to steady state.

Front 61

What 2 effects does increased body fat have on drugs in the body?

Back 61

lipid soluble drugs may be stored which decrease plasma levels and amount of available drug.

Front 62

What effect does a decline in lean body mass and total body water have on water soluble drugs.

Back 62

In this case water soluble drugs are distributed in smaller volumes, leading to increased drug concentrations and drug effects.

Front 63

What effect does decreased renal function in the elderly have on drug levels in the body?

Back 63

Decreased renal function leads to decreased excretion and accumulation of drug in the body. This can lead to adverse effects and toxicity.

Front 64

What must a provider consider when prescribing medications for a patient who is constantly vomiting?

Back 64

The patient's vomiting effects absorption. consider IV or IM administration. Vomiting can change gastric pH, which can alter drug distribution. Increases in bile can effect drug metabolism.

Front 65

How is pharmocokinetics effected by pediatric patients?

Back 65

Absorption is the same as adults after 2. Protein binding capacity is the same at 1. Peds metabolize drugs faster than adults. Renal excretion is the same at age 1.

Front 66

How does pregnancy effect pharmocokinetics.

Back 66

Absorption-decreased bowel tone and motility increase absorption. May need to decrease dose. Hepatic metabolism and GFR increases, may need more drug.

Front 67

List 4 adverse reactions in geriatric patients.

Back 67

1. increased drug accumulation.
2. poly pharmacy
3. multiple diagnosis.
4. poor compliance.

Front 68

List 4 adverse reactions in pediatric patients.

Back 68

1. overdose
2. SIDS
3. Teeth staining
4. Kernicterus

Front 69

List 4 common adverse drug reactions in healthy people.

Back 69

1. overdose
2. anaphylaxis
3. acute liver failure
4. acute renal failure

Front 70

What are 4 adverse reactions in pregnant patients?

Back 70

1. Congenital anomolies
2. decreased respiratory rates in children.
3. premature uterine contractions.
4. osteoporosis.

Front 71

What adverse drug reactions can occur in people with a pre-existing condition such as diabetes?

Back 71

1. Acute renal failure
2. elevated bld. sugar
3. increased accumulation of drug.

Front 72

Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester or later trimesters, the possibility of fetal harm appears remote. Pregnancy risk category____?

Back 72

A

Front 73

Animal studies revealed no harm to the fetus; however, there are no adequate and well-controlled studies in pregnant woman, or animal studies have been conducted and there are no studies in pregnant woman. Pregnancy Risk Category______?

Back 73

B

Front 74

Positive evidence of human fetal risks, but benefits may be acceptable despite risks. Pregnancy Risk Category____?

Back 74

D

Front 75

Animal Studies show adverse effects and there are not well-controlled studies in pregnant women. Benefit must outweigh risk. Pregnancy risk category _____?

Back 75

C

Front 76

Studies in animals or pregnant women demonstrated positive evidence of fetal abnormalities or fetal risk is based on human experience. Risk in pregnancy outweighs any benefit. Pregnancy risk category_____?

Back 76

X

Front 77

What type of drugs are more likely to be found in maternal breast milk?

Back 77

Lipid soluble. Drugs that are weak bases (increased pH) will be trapped in breast mil.

Front 78

At what age in development is a fetus at most risk for the teratogenic effects of some drugs?

Back 78

3-8 weeks.

Front 79

Governmental agency responsible for enforcing and monitoring provisions of the Food, Drug and Cosmetic Act.

Back 79

FDA

Front 80

Regulates biologic products like vaccines.

Back 80

United Stated Public Health Service

Front 81

Official source of drug standards for the United States

Back 81

United States Pharmacopeia (USP) source of drug information

Front 82

Pharmaceutical industry finances this reference. It includes the manufacturers drug package inserts. Does not have comparative information on safety or efficacy.

Back 82

Physicians Desk Reference

Front 83

Published annually, contains FDA equivalency classifications and drug costs in addition to drug information.

Back 83

Mosby’s GenRx

Front 84

American Hospital Formulary
Service Drug Information

Back 84

Comprehensive source of comparative information on all drugs available in the United States. Updated annually.

Front 85

What 8 factors guide a provider when making a drug choice.

Back 85

1. Patho 2. drugs do tx patho. 3. Mechanism of action. 4. distinguishing features of the specific drug. 5. absorption. 6. dirstribution. 7. excretion. 8. safety.