Pharm Lecture 2

Front 1

What is the primary site for metabolism?

Back 1

Liver and P450 (CYP) enzymatic system

Front 2

Considerations of Metabolism

Back 2

- Age
- Drugs (currently taking)
- Nutritional/Protein status
- 1st pass effect

Front 3

What is First Pass Effect?

Back 3

The inactivation of certain drugs in the liver

Front 4

What is the primary site for excretion?

Back 4

Kidney is the major route of excretion

Front 5

Routes of Excretion

Back 5

- Urine
- Sweat
- Stool / bile
- Breast Milk
- Saliva
- Expired Air (ex. anethesia - therefore lung function can effect excretion)

Front 6

What is Half Life?

Back 6

Time required to decrease amount of drug in the body by 50%

Front 7

What is Efficacy?

Back 7

Maximum effect that a drug can produce

Front 8

What is Potency?

Back 8

Amount of drug administered to produce an effect.
- High potency= low dose to achieve large effect
- Low potency= high dose to achieve small effect

Front 9

Agonist

Back 9

*Enhancer*
Drug binds to receptor, and there is a response

Front 10

Antagonist

Back 10

*Blocker*
Drug binds to receptor, but there is no response. Drug prevents binding of agonist

Front 11

Therapeutic Index

Back 11

Based on safety and drug dosage
- Lethal dose 50 divided by effective dose 50
- Large (high) index = relatively safe
- Small (low) index = relatively unsafe

Front 12

ED50

Back 12

Effective dose is established by ED50.
- based on drug only works as expected on 50% of the population, and does not on the other 50%

Front 13

Consequences of drug-drug interactions

Back 13

- Intensification of effects of one or both drugs (produces side effects from both)
- Reduction of effects of one or both drugs (one will work/one will not)
- Production of a new response that neither will elicit by itself (can be positive: pain+anti-anxiety)

Front 14

Adverse reactions

Back 14

Uninteded response to a medications

Front 15

Allergic reaction

Back 15

immune response (histamine response)
can be serious: anaphylactic

Front 16

Side Effect

Back 16

A known secondary response, ex. nausea, headache

Front 17

Toxicity

Back 17

Exaggerated response of a medication as exhibited throught plasma levels

Front 18

Idiosyncratic Effect

Back 18

Drug response resulting from a genetic predisposition

Front 19

Mutagenic Effect

Back 19

Genetic changes of chromosomes

Front 20

Carcinogenic Effect

Back 20

Drug has the ability to cause Cancer

Front 21

Teratogenic Effect

Back 21

Drug can cause birth defects

Front 22

Major sites of toxicity

Back 22

Liver (primary site of metabolism)
Cardiac (specifically HR/BP)

Front 23

Definition of Pediatric Patient

Back 23

Children 16 and under
- Adolescent: 12-16 yr
- Children: 1-12 yr
- Infant: 5 wks - 52 wks
- Neonates: birth - 4 wiks
- Term: 36-40 wks gestation
- Preterm: less than 36 wks gestation

Front 24

Considerations for Pediatric Patients and Medication Administration

Back 24

- ALL meds are WEIGHT BASED
- Concentrations incr. faster due to immature liver and kidney function
- Liver and Kidney function reached adult maturity around 1 yr
- Blood brain barrier is immature and connot protect up to 1 yr
- Absorption is increases in GI tract due to decrease acidity
- Protein binding is reduced increasing blood concentration

Front 25

What is a vaccine?

Back 25

Suspensions of attenuated or inactivated microbes

Front 26

How does immunity work?

Back 26

Stimulates the immune system to product immunoglobulins to foreign substances

Front 27

What is antibody titer?

Back 27

Measures the amount of antibodies that a person has to protect them for a given disease.
- If results show LOW titer, a booster is needed to reactivate

Front 28

Otitis Externa

Back 28

External Ear Canal Infection
ex. Swimmer's Ear

Front 29

Common Causes of Otitis Externa

Back 29

Abrasion or Moisture

Pseudomonas aeruginosa
Staphylococcus aureus

Front 30

Treatments for Otitis Externa

Back 30

Mild:
Antibiotic + anti-inflammatory

Severe:
Keflex PO for peds (pseudomonas)
Amoxicillin or Augmentin PO (staph)
Cipro PO for adults (staph)

Front 31

Otitis Media

Back 31

Middle ear infection

Front 32

Treatment of Otitis Media

Back 32

Amoxicillin PO (start)
Zithromax, Ceftin, or Augmentin
- When fever over 100F, Rocephin IM or PO (start)

Front 33

Open Angle Glaucoma

Back 33

Too much aqueous humor production, produces increased pressure

Front 34

Closed Angle Glaucoma

Back 34

Aqueous humor is being blocked (closed) causing build up of pressure
**Medical Emergency**

Front 35

Timolol
(Timoptic)

Back 35

Beta-adrenergic blocking agent
- decreases production of aqueous humor
- treatment for open- and closed- angle glaucoma

Front 36

What is selectivity?

Back 36

Selectivity of a drug is how it can attack the cells it needs and not injure others (in this case, attacks bacterial cells and not harm host or human cells)

Front 37

Narrow Spectrum Drug

Back 37

Works against only a few organisms

Front 38

Broad Spectrum Drug

Back 38

Works against a number of organisms

Front 39

Bacteriostatic

Back 39

Drugs that slow bacterial growth but do not cause cellular death
(statis=slow down)

Front 40

Bactericidal

Back 40

Drugs that can kill the bacteria at clinically appropriate levels of concentration
(cidal='suicide', death)

Front 41

Host (patient) Factors

Back 41

- Site of Infection: antibiotic has to have ability to penetrate site
- Pregnancy: placental and breast milk crossing
- Age: vulnerability to toxicity

Front 42

Phophylactic Antibiotics

Back 42

Usu. given to PREVENT the development of infection
- surgery
- prevention of bacterial endocarditis with mech. implantation
- neutropenia patients
- dental work
- recurrent UTI
- foreign travel

Front 43

PENICILLINS

Back 43

Mech of Action: weaken bacterial cell wall
Inactivated by Beta-Lactamase
Uses: Respiratory, Skin, Sinus, and UTI Infections
Adverse Effects:

Front 44

CEPHALOSPORINS

Back 44

Mech of Action: weaken bacterial cell wall
Bactericidal
1st and 2nd gen. are destroyed or inactivated by Beta-Lactamase
3rd and 4th gen. are resistant to Beta-Lactamase
Uses:
Adverse Effects: Hypersensitivity, Thrombophlebitis, AAPC

Front 45

VANCOMYCIN

Back 45

Mech of Action:
Bactericidal
Resistance:
Uses: MRSA, AAPC, Strep
Adverse Effects: GI (C-diff, pseudomembranous colitis), Ototoxicity, Rapid Infusion (red-man syndrome)

Front 46

TETRACYCLINE

Back 46

Mech of Action: Inhibits protein synthesis
Bacteriostatic

Front 47

MACROLIDES

Back 47

Mech of Action:
Bacteri...
Adverse Effects: Mild GI, Liver toxicity, Drug interactions w/Coumadin and anti-seizure
Uses: Strep, Broncitis, Skin Infection

Front 48

AMINOGLYCOSIDES

Back 48

Mech of Action: disrupt protein synthesis
Bactericidal
Adverse Effects: Ototoxicity and Nephrotoxicity
Uses: E. coli (septic), Pseudomonas aeruginosa

Front 49

SULFONAMIDE AND TRIMETHOPRIM

Back 49

Mech of Actions: suppresses bacterial growth by inhibiting folic acid and inhibits synthesis of bacterial cell wall
Bactericidal/stasis
Adverse Effects: GI Upset and diarrhea
Uses: UTI's E.coli , Pneumocystis carinii (resp infection in HIV pts), and minor staph/strep infections

Front 50

FLUOROQUINOLONES

Back 50

Mech of Action: Inhibits bacterial DNA gyrase
Bactericidal
Adverse Effects: GI Upset, Achilles Tendon Rupture, Photosensitivity, and Yeast Infection
Uses: Anthrax, UTI's E.coli, Broncitis, and Sinusitis