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115 Cards in this Set
- Front
- Back
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History of Pharmacology
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-records in every culture dating to antiquity
-records describe use of plants to relieve symptoms -dark ages show few records, herbs |
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Modern Pharm began in early 1800's
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-Chemists isolated pharm.
- pharm substances from natural substances -animal studies -early researchers used themselves as test subjects |
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John Jacob Abe
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Father of american pharmacology. founded first pharmacology department in united states at university of Michigan in 1890
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Characteristics of Drugs
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Therapeutic applications
interactions side effects mechanisms of action |
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Drugs elicit different responses depending on individual factors
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age
sex body mass health status genetics |
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Traditional Drugs as Chemical Agents
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Synthesized in a laboratory
produce biological responses in the body |
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desirable response =
undesirable response = |
therapuetic
adverse |
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What do you do if someone says they are allergic to a medication?
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ask them what happens when they take it.
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Dont forget to ask about alternative healthcare
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natural plant extracts, herbs, bitamins, minerals, dietary supplements, acupuncture, hypnosis, biofeedback, massage
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Advantages of Prescription drugs
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Health-care probider examines the client and orders proper drug.
-amount and frequency of drug is controlled -instructions on use and side effects of drug are discussed |
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Disadvantages of Prescription drugs
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Requires a prescription to obtain
need for health care provider apt. |
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Advantages of OTC drugs
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No health caare probider apt.
often less expensive |
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Disadvantages of OTC drugs
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client may choose wrong drug
client may not know reactions or interactions ineffective treatment may result in progression of disease |
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Prior to 19th century..
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Few standars and guidelines sto protect the public. Some drugs contained hazaardous levels of dangerous substances or addictive substances.
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United States Pharmacopoeia (USP) 1820
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1st drug reference book. summarized purity, strength, and directions for synthesis
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National Formulary (NF) 1852
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established by american pharmaceutical association.
focus was on pharmaceutical ingredients |
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USP and NF merged in 1975
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formed United States Pharmacopoeia-national formulary (usp-nf)
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Biologics Control Act 1902
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standardized serum and blood-related products
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Pure food and drug act 1906
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government controls labeling of medicines
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Sherley Amendment 1912
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prohibited drugs labeled with false therapeutic claims
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Food, Drug, and Cosmetic Act 1938
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thorough testing of drug, proof of safety and efficacy of drug
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Dietary Supplement Health and Education Act 1994
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controls misleading industry claims.
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Food and Drug Administration (FDA).
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officially established in 1988
controls and monitors drug distribution. department of U.S. health and human services. |
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Branch 1 of FDA.
CENTER FOR DRUG EVALUATION and RESEARCH |
Determines safety and efficacy of drugs
pharmaceutical labs must solicit approval from FDA before marketing a drug. |
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Branch 2 of FDA
Center for Biologics Evaluation and Research |
regulates use of biologics (serums,vaccines, and blood products)
1986 childhood vaccine act result of CBER work |
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Branch 3
Center for Applied Nutrition |
Oversees herbal and dietary products
enforces 1994 dietary and supplemental health and education act. regulation is not as close as Food, Drug, and Cosmetic Act |
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4 stages of Approval for Therapeutic and Biologic Drugs
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1.Preclinical Investigation
2.Clinical Investigation 3.Review of new drug application (NDA) 4.Postmarketing Surveillance |
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1. Preclinical Investigation
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involves lab research.
tests done on cells/animals determine drug/dose range examines adverse effects results are considered inconclusive |
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2. Clinical Investigation
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longest part of approval process. termed clinical trails phase. evaluates human benefits
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3. Review of New Drug Application. *NDA*
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average review time is 17-24 mos.
if drug is rejected...process is suspended |
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4. Postmarketing Surveillance
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new drug placed on market
surveyed for harmful effects in larger population FDA holds annual public meetings |
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Prescription Drug User Fee Act 1992
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established on 5 yr trail basis
drug and biologic manufacturers probide drug user fee FDA hired more employees FDA restructured its organization |
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the results of prescription act of 1992 was successfull...
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double the number of drugs approved
some review times cut by half |
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FDA Modernization Act 1997
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reauthorized Prescription drug user fee act.
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Drugs organized in two ways
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1. therapeutic classification of
drugs 2. Pharmacologic Classification |
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Therapeutic Classification
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is based on what the drug does. ex. antidepressants
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Pharmacologic Classification
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based on how the drugs achieve the effect. ex. chalcium channel blockers.
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Prototype Drug.
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serves as a model for a Drug class.it is a drug that is well understood, has known action and adverse effects, is used to compare other drugs in same class
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Most drugs have Three names...
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Chemical
Trade Generic |
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Drug has one CHEMICAL name
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assigned using standard nomenclature established by IUPAC. Describes phsyical and chemical properties of drug
complicated and difficult to pronounce |
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Drug has one GENERIC name
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assigned by the US adopted name council. Less complicated. Describes ACTIVE INGREDIENTS. Used by organizations...FDA,WHO, etc.
written in lower case. healthcare providers use these. |
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Drug has Several TRADE names.
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whose making it? Assigned by company marketing teh drug. Short. Easy to remember. called brand name. trade name is capitalized
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Negative Formulary List
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list of trade name drugs that pharmacisits may not dispense as generic drug substitutes. Claim there are differences in bioavailability between generic and trade name drugs. Pharmaceutical companies support list. claim differences could adversely affect patient outcomes
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Controlled substances are drugs that...
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are frequently abused. have a high potential for addiction or dependence (physical or psych) restricted use. are placed into one of five SCHEDULES.
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Controlled Substance Act 1970.
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placed drugs into 5 categories based on abuse potential and beneficial effects.
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Schedule I drugs
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Highest abuse potential and lowest clinical usefulness.
limited or no therapeutic use. ex. heroine, LSD, methaqualine |
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Schedule II drugs
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High abuse potential. very addictive. must have r/x. high physical and psych. dependence. no refills permitted without seeing healthcare provider
ex. morphine, methadone, cocaine. |
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Schedule III drugs
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Moderate abuse potential and physical dependence. HIGH psych. dependence. Therapeutic use with prescription.
ex. codeine. some barbituates |
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Schedule IV drugs
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lower abuse potential. low psycha nd physical dependence. commonly prescribed.
ex. vallium |
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Schedule V drugs
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lowest abuse potential and dependence, therapeutic use without prescription.
ex. OTC cough medicines with codeine. |
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Drug Administration
(5) |
Assess client
plan drug administration implement drug administration document evaluate effects |
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Nurse Responsibilities
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know actions and side effects
prepare drug safely administer drug safely evaluate client's response |
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6 RIGHTS of administration
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right client
right time right drug right dose right route right documentation |
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Educate client on...
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name and reason for drug
expected drug actions side effects potential interactions with other substances |
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Drug Orders...5 kinds
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1.scheduled medication or routine orders
2.single order 3.PRN order.(as needed) 4.STAT order (NOW!) 5.Standing order. (if this happens..do this.) |
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Protocols for all routes of administration...
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review medication order
wash hands and apply gloves identify client inform client position client document |
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Enteral route includes
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(has to go through digestive system) by mouth: by nasogastric tube or gastrostomy
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Guidelines by mouth
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asses clients level of consciousness
remain with client until all medication is taken offer a glass of water |
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guidelines by nasogastric tube
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administer liquid forms when possible. crush others *(never enteric coated/time released) assess and verify tube placement. Keep head of bed elevated for 1 hour. flush tubing after med is given.
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Guidelines for topical administration
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(non hairy non bony)
transdermal: rotate sites to prevent skin irritation. eye: client supine with head tilted back. ear: avoid placing drops directly on tympanic membrane |
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Guidelines for topical administration
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nasal: instruct client to open and breathe through nose
vaginal: client in supine position with knees bent and seperated rectal: client on left side |
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Parenteral drugs are administered via...
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PARENTERAL=NEEDLE
intradermal, subcutaneous,intramuscular,intravenous. most dangerous because you cannot get it back. and it is the fastest route straight into the bloodstream. |
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Intradermal: dermal layer of skin
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0.1- 0.2 ml
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Subcutaneous: deepest layers of the skin
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0.5- 1 ml
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Intramuscular: specific muscle
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2 -3 ml. only 1 ml in triceps and deltoid
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Intravenous: directly into the bloodstream.
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no limit to volume. note the rate of injection.
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Advantages to Enteral meds
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absorbed quickly
safe convenient and cheap sublingual: rapid onset |
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Disadvantages to Enteral meds
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difficulty swallowing pills
may be inactivated if tablets crushed or opened can be inactivated by enzymes depends on client gi motility and mobility contraindicated if pt. unconscious. |
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Advantages to Topical meds
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fewer side effects. limited to localized area. absorbed slowly
rectal safe for comatose clients can be used for local or systemic. |
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Disadvantages to Topical meds
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unless ordered. dont apply to compromised skin
rectal may be difficult to retain (gravity) not inactivated by enzymes or metabolized by liver |
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Advantages to Parenteral meds
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rapidly absorbed
rapid onset of action not inactivated by enzymes or metabolized in liver |
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Disadvantages to Parenteral meds
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possibility of introduction of pathogenic microbes
once injected, cannot be retrieved. (NEEDS TO BE STERILE) |
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4 components of pharmacokinetics.
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absorption
distribution metabolism excretion |
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To have an effect..drugs must..
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penetrate the plasma membrane to reach the tissues by either passive or active diffusion.
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Passive Transport
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molecule move from higher to lowever concentration. easy movement
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ABSORPTION
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where you administered meds to the when they reach the circulating fluids.
primary factor for determining length of time for effect of drug to occur |
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Factors affecting Absorption
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route of adminstration
drug formulation drug dosage digestive motility digestive tract enzymes blood flow at adminstration site degree of ionization of drugs pH of surrounding environment drug-drug interactions drug-food interactions |
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acid/base metabolism
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acids in acids
bases in bases helpful in overdose or poision control. Can increase excretion by increasing pH |
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Metabolism
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Biotransformation.
LIVER changes drug so it can be excreted. two main options. Activate or inactivate |
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Hepatic Portal Circulation
FIRST PASS EFFECT |
Drug is absorbed
drug enters hepatic circulation and goes to the liver prematurely drug conjugates and leaves the liver drug is distributed to general circulation. When this occurs you must give drugs in higher doses because the liver is deactivating drug. |
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Medications are administered by the blood
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greater blood flow to an area, higher concentration of drug is delivered.
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lipid soluble drugs
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completely distributed to body tissues
not limited by water soluble barriers. so it can cross the blood brain barrier |
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Drugs bind with plasma proteins
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Drug molecules bind with proteins in the plasma keeping them from leaving circulation and getting to the tissues. They randomly release and get to tissues to produce therapeutic effect.
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Drugs compete for protein binding
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Some have greater affinity
Displaced drug can reach high levels and can produce adverse effects. |
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How do you know which drug isn't getting to bind with the protein?
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look for an overreaction to the drug.
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ABSORPTION
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where you administered meds to the when they reach the circulating fluids.
primary factor for determining length of time for effect of drug to occur |
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Factors affecting Absorption
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route of adminstration
drug formulation drug dosage digestive motility digestive tract enzymes blood flow at adminstration site degree of ionization of drugs pH of surrounding environment drug-drug interactions drug-food interactions |
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acid/base metabolism
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acids in acids
bases in bases helpful in overdose or poision control. Can increase excretion by increasing pH |
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Metabolism
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Biotransformation.
LIVER changes drug so it can be excreted. two main options. Activate or inactivate |
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Hepatic Portal Circulation
FIRST PASS EFFECT |
Drug is absorbed
drug enters hepatic circulation and goes to the liver prematurely drug conjugates and leaves the liver drug is distributed to general circulation. When this occurs you must give drugs in higher doses because the liver is deactivating drug. |
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Medications are administered by the blood
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greater blood flow to an area, higher concentration of drug is delivered.
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lipid soluble drugs
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completely distributed to body tissues
not limited by water soluble barriers. so it can cross the blood brain barrier |
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Drugs bind with plasma proteins
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Drug molecules bind with proteins in the plasma keeping them from leaving circulation and getting to the tissues. They randomly release and get to tissues to produce therapeutic effect.
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Drugs compete for protein binding
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Some have greater affinity
Displaced drug can reach high levels and can produce adverse effects. |
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How do you know which drug isn't getting to bind with the protein?
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look for an overreaction to the drug.
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Pharmacodynamics? what is it?
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how and if drug will produce change on the body. understand how dosages are adjusted. prepares nurse to make decisions about patient reactions to prescribed dose.
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Median Effective Dose (ED^50)
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middle of the frequency distribution curve. dose that produces therapeutic respone in 50% of a group. average or standard dose..many clients require more or less and it is the nurse's job to determine if the median dose is effective. which means you must know what the drug is supposed to do so you can eval. if it is working.
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Median Lethal Dose (LD^50)
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used to assess safety of a drug. determined in preclinical trials. is LETHAL dose in 50% of a group of animals.
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Median Toxicicity Dose (TD^50)
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dose that will produce given toxicity in 50% of a group.
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Therapeutic Index
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measure of a drug's safety margin. the higher the value the safer the drug
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therapeutic index equation
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lethal dose / effective dose = ti
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Drug actions
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desired effects
side effects or adverse effects toxic effects |
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Drug interactions
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additive: 1+1=2 predictable reaction
synergistic: 1+1=3 ex. taking a sleeping pill with beer. not only sleep but depressed resp. also |
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Allergic Reactions
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acquired hdyper response.
anaphylactic shock: severe. massive release of histamine means bp decreases and depressed resp. |
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Graded Response Curve
phase 1 |
occurs at lowest dose. few target cells affected by drug
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Graded Response Curve
Phase 2 |
linear relationship. most desirable range linear relationship between amount of drug administered and degree of client response
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Graded Response Curve
Phase 3 |
plateau reached. dont continue to load. just maintain. increasing the dose has no therapeutic effect and may actually produce adverse effects
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Two ways to compare meds
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Potency vs. Efficacy
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Potency
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lower dosage with therapeutic response. ex. 1 mg of dilaudid compared to 1 mg of morphine.
2 mg dilaudid is lethal. 10 mg morphine is normal. |
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Efficacy
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magnitude of maximal response. potential action of the drug. compare advil to morphine
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Drugs that act as AGONISTS
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bind to receptor. produce same response as endogenous chemical. sometimes produce greater maximal response. ex. epinephrine
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Drugs that act as ANTAGONISTS
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occupy receptor. prevent endogenous chemical from acting. compete with agonist for receptor. inhibit effects of agonist by changing pharmacokinetic factors.
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Drug attaches to receptor.
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like lock and key. triggers second messenger events
initiates drug action can STIMULATE or INHIBIT normal activity. |
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Example of Agonist
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insulin. allows sugar into the blood stream. (receptor)
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Example of Antagonist
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benedryl. Histamine blocker. after exposure limited effect because receptors are already filled with histamine.
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