Chapter 4

Front 1

use of many medications

Back 1

Polypharmacy

Front 2

Polypharmacy is most common among the

Back 2

elderly

Front 3

purpose of regulation and classification of drugs

Back 3

set standards, guidelines to protect public from drug misuse

Front 4

In 1912 _____________ prohibited sale of drugs labeled with false therapeutic claims that were intended to cheat consumer

Back 4

Sherley Amendment

Front 5

Today, before new drug is introduced into general population, must be approved by

Back 5

FDA (national regulatory body)

Front 6

In 1938, _____________ was first law requiring evidence of safety of drug before it is marketed to general public

Back 6

Food, Drug and Cosmetic Act

Front 7

In 1952, The Food, Drug and Cosmetic Act has had many amendments; one of them is the

Back 7

Durham Humphrey Ammendement

Front 8

The Durham Humphrey Ammendement clarified

Back 8

Restricts the number of prescriptions that can be refilled

Front 9

In 1962, the ______________ required demonstration of safety, effectiveness in animal and human studies before drug is put on market

Back 9

Kefauver-Harris Amendment

Front 10

True or False:
The FDA can withdraw a drug from the market if it is considered unsafe.

Back 10

True

Front 11

True or False:
Drug Facts are required on all OTC drug package labels.

Back 11

True

Front 12

Drug labels help the consumer to

Back 12

understand how to use product

Front 13

Chemical name of a drug is the

Back 13

chemical makeup of drug and defines the unique molecular structure

Front 14

Trade or brand name is

Back 14

the registered trademark belonging to particular drug manufacturer

Front 15

Patent on a drug last for

Back 15

17 years

Front 16

produces 50% of maximum response or specifica response in 50% of subjects

Back 16

Effective Dose

Front 17

The generic name that comes from the USAN is used because

Back 17

these names are far less complicated and easier to pronounce than the chemical name

Front 18

process of substance entering body

Back 18

absorption

Front 19

dispersion or dissemination of substances throughout fluids and tissues of body

Back 19

Distribution

Front 20

Irreversible transformation of substance and its daughter metabolites

Back 20

Metabolism

Front 21

Elimination of substances from body

Back 21

Excretion

Front 22

lower susceptibility to effects of drug due to repeated use

Back 22

tolerance

Front 23

Indications and therapeutic uses are strictly regulated by

Back 23

FDA

Front 24

the desired and beneficial pharmaceutical effect that a drug exerts at the target site of action

Back 24

Therapeutic effect

Front 25

injury that results from the use of a drug or dietary supplement

Back 25

Adverse drug effect

Front 26

desired effects are

Back 26

Therapeutic effects

Front 27

side effects or unintended consequences specially arising from drug thereapy are

Back 27

Adverse effects

Front 28

Adverse drug reactions are classified as

Back 28

- adverse effects
- toxic reactions
- allergic reactions
- idiosyncratic reactions

Front 29

__________ effects are dose related, and predictable

Back 29

Therapeutic

Front 30

________ act on target organs to achieve therapeutic response

Back 30

Pharmacologic Effects

Front 31

_________ effects are unpredictable and dose related

Back 31

Side effects

Front 32

________ effects act on nontarget organs

Back 32

Adverse

Front 33

________ is an unexplained, uncharacteristic response to a drug caused by hereditary factors or genetic differences

Back 33

idiosyncrasy

Front 34

_________ can range from a mild rash to an anaphylaxis which is life threatening

Back 34

Allergic Response

Front 35

________ are not dose dependent and are unpredictable

Back 35

allergic response

Front 36

__________ requires a foreign substance called an antigen to enter the body tha causes the body to produce antibodies in response to the antigen

Back 36

Allergic response

Front 37

_________ refers to the drug induced damage that develops in the fetus

Back 37

Teratogenic Reaction

Front 38

_________ depends on when drug exposure occured during DNA replication cycle

Back 38

Teratogenic Reaction

Front 39

Most teratogenic drug effects become evident when the fetus is in the ______ trimester of organogenesis

Back 39

first

Front 40

______ is a combinatation action of 2 drugs that gives a great total effect than sum of individual drug's effects

Back 40

Synergism

Front 41

Drug that causes effect by interacting with receptor

Back 41

Agonist

Front 42

takes place when one drug interferes with the action of another drug.

Back 42

Antagonist - Narcan fills receptors, kicks out opoid and takes over

Front 43

Extrarenal excretion routes include

Back 43

lungs, GI, saliva, lactation, sweat, etc

Front 44

Routes of Drug Administration include

Back 44

- Enternal Drug Administration
- Parenteral Drug Administration
- Topical

Front 45

Enternal Drug administration is absorbed from

Back 45

gut

Front 46

True or False:
It is sometimes okay to use sedation during pregnancy.

Back 46

False

Front 47

There are five parenteral routes of drug administration: _______, _________, _______, ________ & __________.

Back 47

- intravenous
- intramuscular
- subcutaneous
- intradermal
- intrathecal

Front 48

The enteral route of administration involves the drug being absorbed in the GI tract and includes

Back 48

oral, sublingual, buccal, and rectal

Front 49

Drugs taken by the _________ or _________ routes are absorbed directly through the oral mucosa

Back 49

- sublingual
- buccal

Front 50

buccal route of administration means

Back 50

between the cheek and tongue

Front 51

sublingual route of administration means

Back 51

Under the tongue

Front 52

The most common, acceptable, and convenient enteral route of administration

Back 52

oral (PO)

Front 53

________ route delivers drugs via a needle into the skin layers, subcutaneous tissue, muscle, CSF (cerebral spinal fluid), or veins, with needle angled at different degrees, depending on type of injection

Back 53

parenteral

Front 54

___________ injection of a drug is administered directly into teh circulation via a vein

Back 54

Intravenous (IV)

Front 55

________ is used in emergency situations when it is critical to get the drug inot the blood as quickly as possible

Back 55

Intravenous (IV) route

Front 56

________ is the most common route to administer antibiotics and fluid replacement solutions to critically ill patients

Back 56

Intravenous (IV)

Front 57

__________ are administered into the layers of skeletal musclel beneath the skin, including the deltoid muscle of the arm or gluteus muscle of the buttocks

Back 57

Intramuscular (IM)

Front 58

True or False:
Intramuscular (IM) absorbtion is rapid and uniform.

Back 58

True

Front 59

Hepatitis B vaccine is administered by

Back 59

Intramuscular (IM) route

Front 60

Irritating drugs are administered by

Back 60

Intramuscular (IM) route

Front 61

_________ administration of a drug involves the injection of liquid into the connective tissue under the skin.

Back 61

Subcutaneous (SC)

Front 62

True or False:
Subcutaneous (SC) administration can be used for irritating drugs or if a large volume of drug solution must be administered.

Back 62

False

Front 63

_________ refers to the application of drugs to the surface of the body directly where action is desired

Back 63

Topical administration

Front 64

When dental drugs are applied topically into the gingival crevice, it is referred to as _______________

Back 64

subgingival application

Front 65

This route is used in dentistry to administer topical anesthetics sucah as Oraqix and antimicrobials such as Arestin, Atridos and Perio Chip

Back 65

Subgingival application

Front 66

True or False:
The intention of topically applied drugs is to produce a local effect at the site of administration.

Back 66

True

Front 67

True or False:
Topical applications may be absorbed and produce systemic effects.

Back 67

True

Front 68

________ administration is used for drugs that are inhaled through the mouth or nose

Back 68

Inhalation

Front 69

_________ administration is used to treat asthma or rhinitis, diabetes, and for general anesthesia and moderate sedation.

Back 69

Inhalation

Front 70

Nitrous oxide and oxygen is most commonly delivered by this route

Back 70

Inhalation

Front 71

_________ administration of drugs is used to treat local conditions of the eye surrounding area including infections, dryness, glaucoma, and dilation of the pupil during an eye exam

Back 71

Ophthalmic

Front 72

Opthalmic drugs are available in the form of

Back 72

drops, irrigations, ointments, and medicated disks

Front 73

_______ administration of drugs is used to treat local conditions of the ear

Back 73

Otic

Front 74

Otic drugs include

Back 74

drops and irrigations

Front 75

__________ administration is the application of a medicated adhesive patch to the skin that delivers a time released dose of medication through the skin into the bloodstream.

Back 75

Transdermal

Front 76

The nicotine patch used for smoking cessation, scopolamine for motion sickness, contraceptive patches, nitroglycerin for angina, antidepressant patches (Emsam), and DentilPatch, are all examples of

Back 76

Transdermal Administration

Front 77

What the body does to the drug

Back 77

pharmacokinetics

Front 78

what the drug does to the body

Back 78

pharmacodynamics

Front 79

use of drugs in the treatment of disease

Back 79

pharmacotherapeutics

Front 80

most common drug name used. It is the same name in all countries.

Back 80

is the generic name

Front 81

the drug name used in written or TV advertisements and other marketing, and it is often descriptive, easy to spell, or catchy sounding so that prescribers will remember it easily and be more likely to use it

Back 81

trade name, or brand name

Front 82

meperidine

Back 82

Demerol

Front 83

the most difficult to remember, because they include the chemicals that make up the drug is what name?

Back 83

Chemical name - meperidine hydrochloride is chemical name for Demerol.

Front 84

What is the name given by the FDA?

Back 84

Official name. Ethacrynic acid is an official name

Front 85

when the medication forms a chemical bond at a specific site in the body it is called?

Back 85

a receptor site

Front 86

How long will a drug have a patent before it can be offered generically?

Back 86

usually 17 years

Front 87

Drug attaches at receptor site and activates the receptor; the drug has an action similar to the body's own chemicals.

Back 87

Agonist

Front 88

Drug attaches at drug receptor site, but no chemical drug response is produced and the drug prevents activation of the receptor.

Back 88

Antagonist

Front 89

Drug attaches at drug receptor site, but only a slight chemical action is produced.

Back 89

Partial agonist

Front 90

the tendency of the molecules of a substance (gas, liquid, or solid) to move from a region of high concentration to one of lower concentration.

Back 90

Diffusion - example is oxygen from alveoli to capillaries - from higher to lower oxygen concentration.

Front 91

the diffusion of fluid through a semipermeable membrane; the flow is primarily from the less thick or more concentrated solution to the thinner or less concentrated solution.

Back 91

Osmosis -

Front 92

the passage of a substance through a filter or through a material that prevents passage of certain molecules

Back 92

Filtration - example is using the kidneys as a filter or dialysis. It keeps some things in and some things out. Filtration is ACTIVE and has to have a pump.

Front 93

The ability of the medication to dissolve

Back 93

Soluability

Front 94

The most common delivery route of medication are what?

Back 94

enteral (directly into the gastrointestinal [GI] tract through oral, nasogastric tube, or rectal administration); parenteral (directly into dermal, subcutaneous, or intramuscular tissue, epidurally into the cerebrospinal fluid, or into the bloodstream through intravenous [IV] injections); and percutaneous (through topical [skin], sublingual [under the tongue], buccal [against the cheek], or inhalation [breathing] administration).

Front 95

The route of administration also influences absorption. Where is the medication must readily absorbed?

Back 95

Areas where the blood flow through tissues is very high and medication is rapidly absorbed. Examples: placing nitro pill under the tongue right next to blood vessels or spraying steroids into the nose and lungs through a nebulizer. IV meds injected into the bloodstream have the fastest action.

Front 96

Key Words used in Pharmacology and Drug Administration

Back 96

1) drug comes from the Dutch word droog, which means “dry.” For centuries, most drugs used for treating health problems came from dried plants
2)Medicines are those drugs used in the prevention or treatment of diseases. Pharmacology deals with the study of drugs and the action of drugs on living organisms. It comes from the Greek words pharmakon, which means “drugs,” and logos, which means “science.”
3) Therapeutic regimen refers to all the methods to be used for treatment of disease. In addition to drug therapy, this may include plans for special diets; use of hot packs, whirlpools, or ultraviolet lights; and counseling, biofeedback, or psychotherapy.

Front 97

Does both activate the receptor and prevents activation

Back 97

agonist-antagonist

Front 98

Refers to the ways that drugs move by means of circulating body fluids to their sites of action in the body.

Back 98

Distribution

Front 99

How does the medication get distributed throughout the body?

Back 99

Through the bloodstream and lymphatic systems.

Front 100

Some drugs do not pass well through cell membranes with very small passages. Which passageways are there?

Back 100

The placental (blood doesn't mix unless a break in the placenta) and blood-brain barriers. Only the smallest molecules can get through the blood-brain barrier. Small things oxygen & glucose can get through placental barrier. Alcohol can get through all tissues.

Front 101

What is the only nutrient able to get to the brain?

Back 101

glucose

Front 102

How do chemical properties of a drug also affect how the drug is distributed?

Back 102

Some chemicals bind together with proteins such as albumin. They serve as carriers giving a ride to drugs that are not easily dissolved.

Front 103

How do medications that dissolve early in lips (fats) distribute?

Back 103

These meds prefer adipose, or fat tissue, and stores of the med may build up in these areas. As the medication moving throughout the body binds at the receptor sites, more of the medication stored in adipose tissue will gradually be given up by those cells. A drug stored in fat cells may stay in the body for a longer time before released.

Front 104

Once the medication is absorbed and distributed in the body, the body's enzymes use it in chemical reactions through the process of what?

Back 104

metabolism

Front 105

many medications have to be stimulated or have activation of pro-drugs before they become usable, while drugs are broken down into smaller usable parts, primarily in the liver, through a series of complex chemical reactions until they become chemically inactive. This process is called what?

Back 105

Biotransformation

Front 106

When most of a medicine goes very quickly to the liver, a lot of the medication is inactivated through the liver before it can be distributed to other parts of the body. This is called what?

Back 106

"first-pass"

Front 107

Why are some medications given sublingually or IV?

Back 107

Because the first-pass, otherwise the patients wouldn't get the amount of medication they need.

Front 108

What role does cytochrome P-450 system play in metabolism?

Back 108

There are genetic differences in these pathways in the liver and people respond differently to a drug. Whether they grow tolerant of the drug and seem to need larger doses or whether they are sensitive to the drug and only need a small dose.

Front 109

Drugs are brokendown where in the body?

Back 109

We breakdown anything/everything that goes through the GI system through the liver. A little metabolism is also done in the lungs.

Front 110

All inactive chemicals, chemical by-products, and waste (often referred to as metabolites) finally break down through metabolism and are removed from the body through the process called what?

Back 110

excretion - Fibrous or insoluble waste is usually passed through the GI tract as feces. Chemicals that may be made water soluble are dissolved and filtered out through kidneys and lost in urine.

Front 111

What has been an issue of debate with all the drugs people consume now a days and these drugs being lost in the kidneys?

Back 111

That the drugs are contaminating our water supply and ground water.

Front 112

the standard method of describing how long it takes to metabolize and excrete a drug is called what?

Back 112

half-life

Front 113

how much medicine should be taken

Back 113

dose

Front 114

how often it should be taken

Back 114

Frequency

Front 115

how long it will last

Back 115

duration - diazepam has a very long half-life. Don't give to elderly

Front 116

Will a drug that has a long half-life to taken the same way has a drug that does not have a long half-life?

Back 116

No, the drug with the long half-life may only be taken once a day and the other medications may be taken twice daily.

Front 117

expected response of the medication is called what?

Back 117

desired action - example, meperidine (Demoral) relieves pain.

Front 118

Because a medication may influence many body systems at the same time, the effect of the medication is often not restricted to the desired action. Other actions are called what?

Back 118

side effects (mild, annoying problems) or adverse effects (more serious symptoms or problems). Experts there has to be 1 million symptoms before classified as a side effect.

Front 119

Because of side effects and adverse effects it is important that the nurse _______________ the patient following medicating.

Back 119

evaluate

Front 120

Are all side effects bad?

Back 120

No, morphine has side effect of drowsiness, but it may be beneficial when the pt has been in pain to be able to rest.

Front 121

Can some adverse/side affects be life-threatening?

Back 121

Occasionally, the allergic reaction is so severe the patient has trouble breathing, and rarely the heart may stop. This life-threatening response is called anaphylactic reaction. Certainly, if severe adverse effects such as damage to the kidney (nephrotoxic drug) or liver (hepatotoxic drug) or bleeding develop, the med must often be stopped.

Front 122

anaphylactic reaction

Back 122

Occasionally, the allergic reaction is so severe the patient has trouble breathing, and rarely the heart may stop. This life-threatening response is called anaphylactic reaction.

Front 123

Occasionally a patient may have a drug reaction that is a surprise. Strange, unique, or unpredicted responses are called what?

Back 123

idiosyncratic responses. These reactions may be the result of missing or defective-metabolic enzymes caused by a genetic or hormonal variation. These are usually rare.

Front 124

What is a paradoxical response?

Back 124

A reaction that is just the opposite of what you would expect to get. This is often seen in children in cold meds. Pain may be made worse if a paradoxical response is received. An example is that benedryl may make more hyper than drowsy. Amphetamines also an example for ADD.

Front 125

A second type of unexpected reaction is an increased reaction to a drug or a sensitivity caused by antibody response to a drug. What are these called?

Back 125

The first is hypersensitivity. The antibody response is an allergy. A hypersensitivity reaction is an analphylactic reaction and is a true medical emergency because the pt may suffer paralysis of the diaphragm and swelling of the oropharynx that interfere with breathing.

Front 126

What should a pt do that is aware he has an analphylactic reaction to something?

Back 126

Wear a medic alert bracelet.

Front 127

When one drug changes the action of another drug?

Back 127

drug interaction

Front 128

Drug products seen as identical with respect to their active ingredients are known as?

Back 128

generic equivalents - However, slight differences in processing or formulation may mean that the action of the generic drug in the body is slightly different from that of the brand-name product. These differences most commonly cause variations in absorption, distribution, or metabolism.

Front 129

Some products are chemically the same or identical and thus called?

Back 129

bioequivalent

Front 130

When two drugs are given together, the combined effect of the drugs is equal to either that of the single more active component of the mixture or the sum of the effects of the individual drugs.

Back 130

addictive effect - Goody's powders is an example of this.

Front 131

takes place when one drug replaces another at the drug receptor site, increasing the effect of the first drug.

Back 131

Displacement - Mrs. Lohman replacing Ashley on quiz. Mrs. Lohman increases the effect because she knows the answers.

Front 132

occurs when two drugs mixed together in a syringe produce a chemical reaction, so they cannot be given.

Back 132

Incompatibility - Phenergran crystallizes when meeting another drug in IV and may plug IV site. Also IV's with glucose can give a problem.

Front 133

occurs when one drug promotes the rapid excretion of another, thus reducing its activity.

Back 133

Interference

Front 134

Finally, if the effect of two drugs taken at the same time is greater than the sum of the effects of each drug given alone, the drugs have what effect?

Back 134

synergistic effect

Front 135

one type of synergistic effect in which a drug that might produce only a small effect by itself produces a larger effect when given with another specific drug is called?

Back 135

potentiation - an example is Probenicid & penicillin = binds to pcn and has greater effect than initially. Also Grisioforman absorves more with fat (bacon sandwich) 1+1=3

Front 136

Alcohol with drugs increases the drug interaction and alters the body's ability to use a particular food or drug. True or False?

Back 136

True

Front 137

What should every patient know about possible drug interactions?

Back 137

•Cigarette smoking can decrease the effect of medication or create other problems with some drugs by increasing metabolism.
•Caffeine, which is found in coffee, tea, some soft drinks, chocolate, and some medications, can also affect the action of some drugs.
•Medication should never be taken during pregnancy or by a patient trying to get pregnant without the advice of the health care provider.
•If the patient has any problem related to medication, the health care provider or a pharmacist should be contacted immediately.

Front 138

What is important for patients to know about alcohol-medication interactions?

Back 138

1) Many patients may not be aware that alcohol is one of the products that reacts most commonly with drugs.
2) Alcohol can influence whether a drug is effective by changing its availability.

Front 139

Can drugs effect laboratory tests blood substances?

Back 139

Yes, they may alter the results of some lab tests.

Front 140

Are some drugs more effective at different times of the day?

Back 140

yes, and drug treatment may work best when it is linked to the normal human circadian rhythm (a repetitive cycle based on a 24-hour clock