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161 Cards in this Set
- Front
- Back
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define pharmacology
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science that draws on info from multiple disciplines like a and p, physiology, psychology, chemistry, micro
study of drugs and interactions with living systems |
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definition of drug
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any chemical that can affect living processes
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ADME
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absorption, distribution, metabolism, excretion
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clinical pharmacology
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study of drugs in humans; used with clients and healthy volunteers usually during drug development
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therapeutics
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medical use of drugs to diagnose, prevent, or treat disease or prevent pregnancy
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what are desirable properties of ideal drug
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reversible, predictable, easy to administer, no drug interaction, low cost, chemically stable, simple generic name
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6 rights of drug admin
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drug,time, dose, patient, route, documentation
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NKDA
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no known drug allergies
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Describe types of names assigned to drugs
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generic - only one, most widely used
brand - for marketing chemical - scientific describing structure |
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pharmocokinetics
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what the body does to drugs as they move through it
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first pass effect
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liver will degrade the drug, some are so susceptible they cannot be given PO
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absorption
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movement of a drug from its site of admin into the blood
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routes of admin
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enteral - through the gut (mouth, tube, rectally)
parenteral - iv, im, subq |
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distribution
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movement of drugs throughout the body
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three major things that affect distribution
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blood flow
ability of drug to exit vasculature blood ability of drug to enter cells or system |
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metabolism and its consequences
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aka biotransformation; is the enzymatic alteration of drug structure; accelerated renal extretion, drug activation, increased therapeutic action, increased/decreased toxicity
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polypharmacy
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multiple drugs at once (usually 10 or more)
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excretion
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removal of drugs from the body via urine, bile, sweat, saliva, breast milk, expired air, kidney
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pharmocodynamics
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study of the biochemical and physiologic effects of drugs and the molecular mechanisms by which those effects are produced
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receptor
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any functional macromolecule in a cell to which a drug binds to produce its effects
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agonist
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drugs that act like natural pain relievers
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antagonist
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opposes or competes with natural body processes
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partial agonist
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does both, can block bc it can compete for the site of the agonist
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affinity
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strength of attraction bw drug and its receptor
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intended interactions
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augments helps or intensifies
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unintended interactions
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adverse (unwanted) interaction
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intensification
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potentiative - makes more potent
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3 basic mechanisms of drug drug interactions
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direct chemical/physical
pharmacokinetic pharmacodynamic |
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pharmacodynamic interactions include?
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potentiative or inhibitory
interactions at same receptor interactions at seperate receptor sites combined toxicity |
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What patients are at risk for pharmacodynamic interactions?
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polypharmacy patients
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drug food interactions include?
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absorption, metabolism, toxicity, impaired action, association with meals
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drug herb interactions include?
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toxicity
reduced therapeutic effects |
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ADR
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adverse drug reactions
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Most vulnerable to ADR?
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profoundly ill, polypharmacy
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side effect
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nearly unavoidable
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toxicity
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adverse drug reaction; unwanted response; makes you sick; over therapeutic index
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allergic reaction
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immune response, itching to anaphylaxis
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idiosyncratic effect
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uncommon peculiar effect
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iatrogenic
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medicine hurt the patient
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physical dependence
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body will have a physical adverse effect if we withdraw the medicine suddenly
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carcinogenic effect
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cancer causing (chemotherapeutic effects)
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teratogenic effect
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produced on a baby; birth defects
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contraindications
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do not give the drug except under the most desperate circumstances
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precaution
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increased risk of adverse reaction but not to the point where it will kill them
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medication error
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any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient or consumer
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Most common causes of medication errors
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human factors, name confusion, communication, distractions while putting meds together
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what are we practicing when reporting med errors?
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responsibility and accountability
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what do you do after recognizing a med error has been made?
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assess client for potential ADRs; report to charge nurse or TPCN and physician; fill out form (event notification form)
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list 5 factors that impact variations in drug response
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body weight and composition; age, gender, race and genetics, diet
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responses with activation of mu receptors
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analgesia, respiratory depression, sedation, euphoria, physical dependence, decreased GI motility
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responses with activation of kappa receptors
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analgesia, sedation, decreased GI motility
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functional class of opiods and effect
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narcotic analgesic, relieves pain
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morphine classification
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opioid agonist
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codiene classification
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opioid agonist
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MOA morphine
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mimics action of endogenous opioid receptors (mu) to produce analgesia and thereby relieve pain
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side effects of morphine
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drowsiness, mental clouding, anxiety reduction, sense of well being
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adverse effects of morphine
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resp depression, constipation, orthostatic hypotension, urinary retention/urgency, cough suppression, biliary colic, emesis, elevated intracranial pressure, dysphoria, sedation, miosis, neurotoxicity, immune and hormone suppression with prolonged use
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classic triad
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coma, resp depression, pinpoint pupils (morphine)
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What drug is contraindicated in p with gallbladder issues?
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morphine/codeine
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precautions/contraindications for morphine
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decreased resp reserve, pregnancy, head injury, infants/elderly, hypotension, liver disease
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What does morphine interact with?
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cns depressants, antihistamines, antihypertensives, MAOI, antiemetics, amphetamines, agonist-antagonist, antagonists
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how can morphine be administered?
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po, im, iv, sq, topical
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what other strong opiod is highly more effective than morphine?
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fentanyl
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what is the primary use of fentanyl?
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anesthesia
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what is the most common form of fentanyl
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transdermal
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what form of fentanyl is often used for breakthrough cancer pain?
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transmucosal (huge amounts of drug)
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list 4 other strong opioids
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meperidine, hydromorphone, methadone, heroin
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what is methadone used for
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to wean drug addicts
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what is an alternative to morphine
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hydromorphone (dilaudid)
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what is the drug of choice for heart attack (MI)
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morphine
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drug of choice for OB (births, etc)
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meperidine
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what injury should avoid opioids?
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head injury
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what is the limit on opiods to prevent addiction
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20 days
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over how many days should a patient be weaned from opiods
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7 days
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what class is pentazocine
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opioid agonist-antagonist
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list other opiod agonist antagonists
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nalbuphine, butorphanol
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MOA of opioid agonist antagonist
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act mostly at kappa receptor to produce analgesia and pain relief
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if you use an opioid agonist antagonist alone what effect will you actually get?
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agonistic
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if you use agonist antagonist with an agonist what effect will you actually get?
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antagonize - blocks mu receptor
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adverse effects of opiod agonist antagonist
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similar to opioids
resp depression, etc |
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what are some benefits and drawbacks to opioid agonist antagonist as opposed to opioid agonist
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less resp depression, low potential for abuse, less effective pain relief, can cause withdrawal symptoms with opioid addicts
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what class is naloxone
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opioid antagonists
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what is the MOA of opioid antagonists
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competes for opiate site and blocks effects of opioid agonist/agonist-antagonists
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what is the effect of opioid antagonists when given alone
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no significant effect
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what is the effect when given with other opioids
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results in reversal of other med; used in overdose situations
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adverse effects of opioid antagonists
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acute withdrawal
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what is the rebound effect
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when admin a reversal is often metabolized quicker than overdose is so symptoms of overdose will return
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class of tramadol
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non opioid centrally acting analgesics
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moa of centrally acting analgesics
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analog of codeine; binds with mu receptor producing analgesia for pain relief
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adverse effects of centrally acting analgesics
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sedation, dizziness, dry mouth, headache (these are rare)
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precautions with centrally acting analgesics
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can intensify other CNS depressants - absolutely avoid MAOIs
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list some therapeutic uses of sedative-hypnotics
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relieve anxiety; facilitate sleep; manage muscle spasms, seizure and panic disorders, augment anesthesia, manage alcohole withdrawal
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class of diazepam
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benzodiazepines
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what drug class are benzodizaepines
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class 4
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what are other benzodiazepenes
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clonazepam, lorazepam, clorazepate
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MOA of benzodiazepenes
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depress neuronal function at multiple CNS sites by potentiating endogenoug GABA
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why is effect of benzodiazepenes limited
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GABA production is limited so effects are limited too due to potentiation of GABA
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what are the cardiac effects of benzodiazepenes with po and iv admin
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po - minimal effect on heart and blood vessels
iv - potential profound hypotension and cardiac arrest |
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what are the resp effects of benzodiazepenes
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minimal effect unless in combo with other CNS depressants or given IV (give slowly IV!)
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adverse effects of benzodiazepenes
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cns effects (daytime vs nighttime effects), amnesia, paradoxical, abuse, malnutrition, liver disease, blood levels (diabetes effects?)
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drug interactions of benzodiazepenes
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with other CNS depressants
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what class 4 drug is like a benzodiazepene
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zolpidem (ambien)
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moa of zolpidem
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agonists at benzodiazepenes receptor site on GABA channel prolonging sleep duration and helps relieve insomnia
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adverse effects of zolpidem
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similar to benzodiazepenes (daytime drowsiness, dizziness); can intensify CNS depressants
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what class is ramelteon (rozerem)
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melatonin agonist
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moa of melatonin agonist
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activates melatonin receptors and rapidly induces sleep to treat insomnia
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adverse effects of melatonin agonist
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somnolence, dizziness, fatigue, reduced libido
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precautions with melatonin agonist
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ETOH, liver impairment, dangerous activities
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secobarbitol (secanol): what class?
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barbituates
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MOA of barbituates
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mimics GABA and depresses cns directly
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uses of barbituates
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main: relaxation and anxiety reduction;
seizure management, anesthesia, sleep disorders, mania, |
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adverse effects of barbituates
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resp depression, hypotention in toxic doses, can readily cause death
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precautions with barbituates
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highly addictive; elderly, combo with other CNS agents, caution with IM injection
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what has no limit with barbituates?
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no limit to CNS depression, no ceiling; danger of overdose death
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drug abuse
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using a drug in a fashion inconsistent with medical or social norms
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withdrawal syndrome
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manifests initially as anxiety and drug craving followed by increased respiratory rate, diaphoresis, yawning, lacrimation, rhinorrhea, mydriasis and stomach cramps
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cyclooxygenase (COX)
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enzyme that converts arachidonic acid into prostaglandins and related compounds
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prostaglandin functions
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sensitize pain receptors, promote uterine contraction, promote normal renal function, stimulate secretion of gastric mucous, lower set point for temp in hypothalamus
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what organs are detrimentally affected by inhibiting prostaglandins (and therefore pain)
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kidneys and stomach
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classifications of cox inhibitors
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anti inflammatory (NSAIDS)
non anti inflammatory (acetaminophen) |
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NSAID stands for?
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non steroidal anti inflammatory drugs
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examples of 1st gen cox inhibitors
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advil, ibuprofen, non selective
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examples of 2nd gen cox inhibitors
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"coxibs", celebrex, celecoxib, selective to cox 2
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example of non inflammatory cox inhibitor
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tylenol (doesn't effectively manage pain from prostaglandins)
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class of acetylsalicylic acid
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1st gen non selective cox inhibitor
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other names for acetylsalicylic acid
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aspirin, asa
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moa for aspirin
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non selective cox inhibitor, analgesic, antipyretic, anti inflammatory, suppression of platelet aggregation
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how long does suppression of platelet aggregation in aspirin last
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8 days
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what is asprin used to treat
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treat/prevent ischemic stroke, tia, MIs (acute and old), anginas, adjunt to angioplasty and revascularization, dysmenorrhea, cancer prevention, prevention of alzheimers, DOC for RA and juvenile arthritis
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aspirin can impair the function of what organs?
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renal (kidney)
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adverse effects of aspirin
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gastrointestinal, bleeding, renal impairment, salicylism (tinnitus), reye's syndrome, hypersensitivity
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contraindications for aspirin
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PUD and bleeding disorders
hypersensitivity extreme caution in pregnancy |
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drug drug interactions for aspirin
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anticoagulants and other NSAIDS
glucocorticoids (gastric ulceration) ibuprofen - impairs cardioprotective properties |
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side effects of aspirin use
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gastric distress, heartburn, nausea
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symptoms of acute aspirin poisoning
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resp excitation leading to resp depression to hyperthermia, stupor, coma, death
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treatment for aspirin poisoning
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supportive, charcoal, alkalinization of urine, dialysis
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moa for acetaminophen
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inhibits prostaglandin synthesis in CNS; lowers the brains perception/threshold of pain
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brand name for acetaminophen
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tylenol
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uses of acetaminophen
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pain and fever
NOT anti inflammatory |
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benefits of acetaminophen
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no gi, bleeding or renal impairment
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adverse effects of acetaminophen
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hepatotoxicity, ETOH (alcohol) connection
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symptoms of acute acetaminophen toxicity
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NVD, sweating, abdominal pain, liver failure, coma
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treatment for acute toxicity of acetaminophen
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mucomyst within 24 hours of overdose
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when do acetaminophen overdose symptoms generally appear
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within 24-72 hours post OD
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which cox inhibitors are indicated in RA and OA
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non asa (aspirin) 1st generation such as advil
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how are non asa cox inhibitors different from asa?
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non asa are NOT cardioprotective
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class of celecoxib (celebrex)
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2nd gen selective cox inhibitors
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benefits of 2nd gen selective cox inhibitors
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lower GI bleeding risk
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uses for 2nd gen cox inhibitors
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oa, ra, acute pain, dysmenorrhea, familial adenomal polyposis
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adverse effects of 2nd gen cox inhibitors
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dyspepsia, abdominal pain, renal toxicity, gi ulceration/bleeding, sulfonamide allergy
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what is the strongest anti inflammatory you can give someone
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steroids
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where are steroids produced in the body
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adrenal glands
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what happens to adrenal glands when we give steroids
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they atrophy from disuse
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what are the metabolic effects of glucocorticoids
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breakdown of fats, proteins, carbs (increases glucose), rob proteins for glucose production, fats redistributed long term (moon face)
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cardiovascular effects of glucocorticoids
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low levels, permeable vessels, dilated vessels, increased RBCs and PMN leukocytes, decreased lymphs, eosins, basophils and monocytes
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list two immune system effects of glucocorticoids
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inhibit synthesis of prostaglandins, leukotrienes and histamines; impede phagocytes and lymphocytes in inflammatory response
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uses of glucocorticoids
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anti inflammatory and immunosuppressants effects (high doses); RA; systemic lupus erythematosus; inflammatory bowel disease; miscellaneous inflammatory disorders, allergic disorders, asthma, dermatologic disorders, neoplasms, suppression of allograft rejection, prevention of respiratory distress syndrome
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adverse effects of glucocorticoids
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adrenal insufficiency; osteoporosis; infection; glucose intolerance; myopathy; fluid and electrolyte disturbance; growth retardation; psychologic disturbances; cataracts and glaucoma; peptic ulcer disease; iatrogenic cushings syndrome
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drug drug interactions with glucocorticoids
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interactions related to potassium loss; NSAIDS; insulin and oral hypoglycemics; vaccines
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how do we remove patients from glucocorticoid therapy
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taper over 7 days; switch from multiple to single doses; taper dosage to 50% of physiologic values; monitor for signs of insufficiency
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what are some of the signs of adrenal insufficiency
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hypotension; hypoglycemia, myalgia, arthralgia, fatigue
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