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76 Cards in this Set
- Front
- Back
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Absorption
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gtting the drug into the blood stream
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Drug absorption enhanced by
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rapid drug dissolution, high lipid solubility, large surface area and high blood flow
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Distribution
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getting the drug to the site of action
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Distribution influenced by:
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good blood flow and serum albumin levels (protein binding ability influences intensity)
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Distribution inhibited by:
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blood brain barrier (must be highly lipid soluble to pass)
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Metabolism
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- changes the drug into water soluble form for excretion
- P450 is needed for adequate blood flow/enzyme activity makes albumin and uses P450 enzymes |
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Metabolism is influenced by:
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age and adequacy of blood flow
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Pathophysiologic conditions
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liver disease --> decreased blood flow --> decrease metabolism of drug --> potential for drug toxicity;
- poor nutrition can impair liver metabolism --> drug toxicity |
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Excretion: 3
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1. glomerular filtration
2. passive reabsorption 3. active transport |
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glomerular filtration
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filtration moves drugs from blood to urine; protein bound drugs are not filtered
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passive reabsorption
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lipid soluble drugs move back into the blood, polar and ionized drugs remain in the urine
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active transport
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tubular pumps for organic acids and bases move drugs from blood to urine
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Breastfeeding
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take drugs immediately after feeding and postpone feeding for 4 hrs after nearly all drugs pass into breast milk especially if highly lipid soluble
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Under One
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absorption is variable; immature blood barrier increases free drug and decreases metabolism/excretion
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Over one
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metabolize drugs quicker
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Protein - binding (albumin)
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reversible bonds - albumin - an drug bound to albumin cannot leave the bloodstream
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Drug interactions: 2
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1. additive
2. antagonist |
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additive
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intensifies drug response
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antagonist
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one drug reduces effects of another
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Drugs/Food combo
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food decreases rate of absorption therefore drugs should be taken on an empty stomach one hr. before or 2 hrs. after- unless any drug irritating the gut is to be taken with food
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Allergic Rxns (require previous exposure)
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arise from immune response and are variable in rxn - ranging from mild to life threatening - can occur anytime, w/in minutes to weeks
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lipid-solubility
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more lipid soluble, the easier it is to pass the blood brain barrier and to move in/out of blood vessels
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Receptors
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drug attaches to a receptor --> interacts --> pharmacological response
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receptors regulation
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receptor function is regulated by molescules made in the body - drugs cannot give cells new functions - can only alter rate of preexisting processes - drugs produce their effects by helping the body hel itself
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affinity
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degree to which the drug attaches to a receptor drug with best fit and strongest affinity elicits the greatest response
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Adverse drug effects
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any undesirable response to a drug
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Predisposing factors
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extremes in age/body weight, underlying pathophysiological conditions
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Assessment
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Does the underlying illness acct for the symptoms? Drug interactions?
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FDA approval for drugs: Phase I
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normal healthy volunteersy (testing metabolism and biological effects)
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FDA approval for drugs: Phase II
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small # of volunteers w/the disease/illness (effectiveness and dosage rante)
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FDA approval for drugs: Phase III
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larger # of volunteers w/disease/illness (clinical effectiveness, dosage range, safety)
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FDA approval for drugs: Phase IV
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continued surveillance
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Expedited Approval
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shortens drug approval process for serious/life-threatening health problems
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Therapeutic Index
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ratio b/t a drug's therapeutic benefits and its toxic effects (low TI=small margin of safety)
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Antagonist
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blocks response - prevents receptor activation - no intrinsic activity
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Agonist
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mimics response - activates receptors has affinity and intrinsic activity - does not necessarily speed up process
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Iatrogenic
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caused by drug; target organs impact more significant than just nausea
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Peak and trough
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Peak - highest 30 min. after medication administered - monitor for possible toxic effects - has to do with route of administration.
Trough - right before next administration - monitor whether blood levels stay with in range - has to do with 1/2 life of drug |
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Plateau
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regular dose in 4 - half lives; to quickly get to plateau give big initial dose (loading dose)
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Bioavailability
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extent to which a drug's active ingredient is absorbed and transported to the site of action. Different drugs have different bioavailability.
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Potency
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amount of drug that must be given to produce an effect - produces its effects at low doses; does NOT mean the maximal effects a drug can produce
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Efficacy
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largest effect that a drug can produce
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Half life
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time required for the amount of drug in the body to decrease by 50% no matter the amount of drug (dependent on liver and kidney health)
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Pharmacokinetics
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what happens to a drug from when it enters the point where it leaves the body: absorption, distribution, metabolism, excretion
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Pharmacodynamics
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how drugs do what they do
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Stomatitis
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mucous membrane inflammation
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Super infections
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wipes out normal flora
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Blood dyscrasias
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drug target and have adverse effects on bone marrow
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First Pass through liver
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rapid inactivation of some oral drugs on their first pass thru the liver --> no therapeutic effect
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Ceiling effect
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when drug reaches the point when it create a greater response..
- some drugs have no ceiling effect (morphine) |
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Vitamin K + Coumodin
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Stops comodin from working
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MAOs + tyramine foods
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hypertone crisis inhibitors
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Drug Allergic Reactions: Type I
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Anaphylactic
- acute, potentially life threatening; treat with epinephrine |
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Drug Allergic Reactions - Type II:
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Cytotoxic or autoimmune
- damage to tissues - discontinue drug |
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Drug Allergic Reactions - Type III:
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Serum Sickness
-destructive inflammatory response -syptoms; stop drug |
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Drug Allergic Reactions - Type IV:
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Cell-Mediated
-Interaction btwn specific white blood cells - local inflammatory response - stop drug |
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Determatologic
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skin effects
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Stomatitis
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mucous membrane inflammation
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Superinfections
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dealing w/antibiotics - trying to deal with the bad and suppresses normal microorganisms (normal microflora)
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Blood dycrasia
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bone marrow suppression
- ability to interfere with red, white, platelt counts |
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Neurotoxicity
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mental status
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Hepatoxicity
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Liver enzymes (AST, ALT)
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Nephrotoxicity
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kidney
- monitor urine output, renal function tests, BUN, creatinine, urinary creatinine clearance, UA |
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Immunotoxicity
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WBCs, symptoms of infection
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Bone marrow toxicity
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WBCs, RBCs, platelets
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Ototoxicity
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Hearing and balance
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Teratogenicity
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Sexual organs--> impotence
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Placebo effect
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caused by psychological factors
- "all in your head" |
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Tolerance
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- Decreased responsiveness to a drug
- Results from repeated exposure to the drug |
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Abrupt cessation
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rebound effects
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changes in prego's:
absorption - Distribution - Metabolism - Excretion |
- Decreased tone & motility
- Increased blood volume - Increased - Increased renal blood flow |
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Prego's Risk Category: A
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Remote risk; no evidence of fetal harm
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Prego's Risk Category: B
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Animal studies no risk or risk that has failed to bedemonstrated in women
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Prego's Risk Category: C
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Animal studies show risk or no animal studies; no studies on women
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Prego's Risk Category: D
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Proven risk of fetal harm; drug given if benefits > risks
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Prego's Risk Category: X
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Proven risk; contraindicated; risks > benefits
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