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97 Cards in this Set

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Pharmacology
the study of drugs
Pharmacotherapeutics
the treatment of pathological conditions thru the use of drugs
Pharmacodynamics
the study of biochemical and physiologic interactions of drugs
Pharmacokinetics
the study of drug distribution rates on various body compartments
Absorption
the rate @ which a drug leaves its sit of admistration.
BIOAVAILABILITY
Factors of Absorption
Route
food/fluids
status of absorptive surface
rate of blood flow to small intestine
stomach acidity
gastrointestinal mobility
First Pass Routes
Oral
Rectal
Hepatic Artery
Portal Vein
Non First Pass Routes
IV
IM
Sub Q
Transderman
Sublingual
Buccal
Intraoccular
Distribution
The transport of a drug by the bloodstream to the site of action
Distribution of a drug occurs to what areas first
Vascular Areas:
Liver
Kidneys
Heart
Brain
Which organ is most responsible for metabolism / biotransformation of drugs?
LIVER

also: kidneys, lungs, plasma, intestinal mucosa
Diseases that can alter biotransfermation of drugs
Renal Failure
Conjestive heart failure
Liver Failure
Conditions that can alter the biotransformation of drugs
Starvation
Obstructive Jaundice
Genetic Disorders
Excretion
The elimination of drugs from the body
Idiosyncrascy
An unusual individual reaction to a food or drug
Side effect
an effect (whether therapeutic or adverse) that is secondary to the one intended
Iatrogenic effect
The unintentional harmful effect of medical intervention or advice
Extrapyramidal Effect
Physical symptoms that are associated with impoper dosing or unusual reactions to anti-psychotic drugs:
tremor, slurred speech, dystonia, anxiety, paranoia
Therapeutic Effect
A consequence of medical treatment of any kind that is deemed to be disirable and beneficial
Peak & Trough
Serun samples collected to determine the level of a drug in the blood.
Peak - collected 1/2 hr after the dose is give IV or 1 hr after it is given IM.
Trough - collected 1/2 hr before next dose
Loading Dose/Maintenance Dose
Loading dose is an initial higher dose that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose.
Teratogenicity
The capability of producing fetal malformaiton
Tolerance
Decreased response following a long term administration of drugs
Tachyphylaxis
quickly developing toleranc brought on by rapid and repeated administration of drugs
Duration
The amount of time the drug concentration is sufficient to work
Peak
increased drug concentration at site of action
Onset
The time it takes for a drug to elicit a therapeutic response
Half-Life
The time it takes for one half of the original amount of a drug to be removed. After about 5 half lives, most drugs are considered 97% removed.
Enterohepatic Circulation
Fat soluble drugs that are in bile and are reabsobed, returned to liver and again excreted into bile. Long half-lives.
Biliary excretion
When drugs are excreted by the intestine (feces)
Primary organ responsible for excretion
Kidneys
FDA Drug Categories
A- studies indicate no risk to fetus
B- studies indicate no risk to animal fetus
C- adverse effects reported in animal fetus
D- possible fetal risk in humans
X-fetal abnormalities reported. Should not be used in pregnant women.
Categories of Controlled Substances
C1- No medical use (heroine)
C2- Accepted use, high abuse (demerol)
C3 - less abuse than C2 (Codeine, nonOpioids)
C4-less abuse than C3 (benzos)
C5 - Cough suppressants, etc
Passive Transport
Diffusion
Hydrostatic Pressure
Osmosis
Characteristics that inhibit the passage through blood/brain barrier
- large molecular size
- highly charged molecules
- low lipid solubility
Mediated Transport (Active)
ATP - against the concentration gradient

Sodium Potassium Pump
Mediated Transport (Passive)
Facilitated Diffusion- down the concentration gradient
Could cause alteration in Blood-Brain Barrier
Hypertension, Inflammation
Radiation, Pressure
Infection, Ischemia
Trauma
Types of Tissue
Epithelial- Simple, Stratisfied
Connective - Cartilage/bone, loose/dense, elastin/regular, adipose/vascular
Muscle - smooth, cardiac, skeletal
Neural- neurons, synapses, neurotransmitters
Toxicity
The degree to which a substance can damage an organism
Malnourished patients, burn patients and others with low albumin are at risk for...
drug toxicity.
Acid/Base regulation plays a major roll in what three bodily processes?
- delivery of oxygen to the cells.
-cellular use of oxygen w/the subsequent production of ATP.
-hormonal regulation of metabolism.
Labs reflecting fluid status:
Hemoglobin & Hematocrit

BUN

Creatinine
3 primary proteins that bind and carry drugs:
Albumin

Alpha 1 Acid glycoprotein

Corticosteiroid-binding globulin
Drug classes that can alter the biotransformation of drugs
Certain antibiotics
(-azoles, -myocins)

Some sedatives
(barbituates)
Edema
a problem of fluid distribution that results in fluid accumulation.
Causes of Edema
-Loss of plasma proteins which causes loss of oncotic pressure or
-Increased capilary hydrostatic pressure or
-Lymph obstruction
Dehydration
indications both sodium and water loss
Symptoms of dehydration
thirst, dry skin, dry mucous membranes, high temp, weight loss, concentrated urine, tachycardia, weak pulse, postural hypotension
OsmolALity
the concentration of molecules per WEIGHT of WATER.
OsmolARity
the concentration of molecules per VOLUME of SOLUTION.
Electrolyte Ranges
Sodium 135-145 mEq/L
Potassium 3.5-5 mEq/L
Calcium 8.5-12 mg/dl
Phosphate 2.0-4.5 mg/dl
Magnesium 1.5-2.4 mEq/L
Isotonic Fluid Imbalances
Extracellular Fluid (ECF) loss or gain is accompanined by proportional changes in electrolytes.
Cells stay the same size
Hypertonic Fluid Imbalances
Water loss or Solute gain.

Due to hypertonic saline IV
diarrhea
insufficient water intake
diabetes

Cells shrink
Hypotonic Fluid Imbalances
Water gain or Solute loss

Due to: Vomiting, excessive sweating, diarrhea, diuretics, burns, renal failure

Cells swell
Common IV Fluids
Normal Saline (NS)
5% Dextrose in Water (D5W)
0.45 NS
D5W NS
D5W 0.45NS
Lactated Ringers
High Concentration Saline
Hypotonic Fluids
(ex: half NS)
Total electrolyte content less than 250 mEq/L.

Used to replace cellular fluid bc it is hypotonic as compared to plasma.

Can lead to intravascular fluid depletion, low bp, cellular edema
Hypertonic Fluids
(ex: Lactated Ringers w/ D5W, high concentration saline)
Total electrolyte content more than 375 mEq/L

Contain D5W

Draw water out of ICF to ECF, cause cells to shrink.

Could lead to dehydration
Isotonic Fluids
(ex: NS, D5W)
Total electrolyte content around 310 mEq/L.

Total osmolality close to that of ECF.

1L expands ECF by 1L, plasma by 0.25L

3L needed to replace 1L of blood loss
Goals for administering IV fluids
-to provide water, electrolytes and nutrients to meet daily requirements
-to replace water and correct electrolyte deficits
-to administer meds
pH
the concentration of hydrogen ions in arterial blood.
-increase H ions, decrease pH.
-decrease H ions, increase pH.
Base
can accept hydrogen ion.

-negative charge
Acids
donate a hydrogen ion.

-Positively charged
Normal pH
7.35-7.45
The body's ability to regulate acid/base balance is dependent upon
-lungs
-kidneys
-chemical buffer system
The most powerful buffer
Protein - hemoglobin

(intracellular)
Most important renal buffering systems
Phosphate Buffer System
and
Ammonia/Ammonium Ion Buffer System

(bothe extra and intracellular)
Most active buffer system,

Facilitates the conversion of hydrogen (strong acid) to carbonic acid (weak acid) and then eliminates via the lungs
Bicarbonate/Carbonic Acid Buffering System

(extracellular)
Acidosis
pH decreases
Respiratory: Hypoventilation causes retention of CO2 which leads to carbonic acid excess.
Metabolic: excess of fixed acids: Lactic acid from anaerobic metabolism, shock, cardiac arrest, excessive ingestion of acids
Alkalosis
pH Increases
Respiratory: Hyperventiliation causes excessive CO2 exhalation which leads to too little carbonic acid. (Panic attacks, fever in infants)

Metabolic: excess of bases or deficit of acid. Vomiting, diarrhea, antacid overdose
With regard to acid/base regulation, the unconscious, sedated or head injured are at risk for
CO2 accumulation
-nol
anti gout
nitrate
anti anginal
vaso dialator
-olol
betblockers
-kinase
anti thrombolitic
thromolitic
lactone
potassium sparing diuretics
-mide
lupe diuretics
-tidine
anti ulcerant
H2 receptor antagonist
preventative treatment
-mol
bronchodilators
beta 2 adrenergic for DOB
-pium
beta 2 adrenergic for DOB
relaxes bronchi
-ide
oral hypoglycemics
-rin
anticoagulant
anti HPN
affects the blood vessels of the heart
pine
Ca channel blocker
anti HPN
affects the blood vessels of the heart
-cillin
-micin
antibiotics
-vastatin
antihyperlipidemia
antihypercholesterolimia
-nium
neuromuscular blocking agent
-caine
local analgesics
-aluminum
-magnesium
-hydroxide
antacids
-prazole
proton pump inhibitors

w/evidence of ulcer scars
-vir
antiviral
-zepam
-lam
anti anxiety
major tranquilizer
-pril
ACE I inhibitor

affects the kidney
-sartan
ACE II antagonist

affects the kidney
-dol
non opioid analgesic
-done
opioid analgesic
-sone
corticosteiroid anti-inflammatory
-mine
antihistamine