Pharm Test 1 Graduate School

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Prescription writing

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Date
-Name and Address. Address for class 2 drugs. DOB helpful
-Drug name. Capitalize brand names but not generic.
-Dosaged with decimals. No (1.00)
-How many to be dispensed
-How often (over jacho bad things).
-what the drug is for, and special instruction (wash area first or empty stomach).
-Refill. Schedule II drugs-none. Class II to V five refills or 6 months.
-DEA number with Medicare provider number. Dea only for controlled.

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Down-regulation

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when a receptors are continualy stimulated by drugs, their responsiveness may be decreased or become desensitization.

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Refractoriness

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-lack of response to the drugs

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reversible agonist

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reversible agonist- when the drug activites the receptors.

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Competitive antagonist

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blocks the action of a receptor, and is reversible

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Efficacy

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is measured by the maximum effect that he drug can achieve.

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Potency

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relative measure that compares the doses of two different drugs that are required to achieve same effect

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Pharmacokinetics

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the study and analysis of the time course of the drug in the body.

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Therapeutic index

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the ratio of the doses required to produce death or serious toxicity in 50% of subjects vs doses requirements for effective treatment of 50% of subjects

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Oral Drug Absorption

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-Mostly passive diffusion (from high to low)
-only nonionized, lipid soluble drugs diffuse well.
-Active as in pinocytosis (fat soluble vitamins).

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PH effect on Oral drug absorption

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-drugs only pass through cell membrane if nonionized (no charge)
-if the drug is a base will be absorbed better in intestine (higher PH or more base like)

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Motility of the Cut

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-effects absorption by the time spent in the GI tract

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Blood flow

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-When eating, blood transferred from muscles to stomach
-in cardiac disease IM will absorb slower due to decrease blood flow

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First pass metabolism

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-the body removes so much of the drug on the first round into the body (through the liver)
-EX warfarin, NTG, Morphine,

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Bioavailability

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-the combination of inert ingredients determines the disintegration, dissolution, and drug availability in the body, and different combinations can result in different clinical effects amount products of the same labeled potency.

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Drug Distribution

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-first to heart, liver, kidneys and brain (high flow areas)
-second to fat, bone, and skin
-effected by body composition, CO, regional blood flow

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Plasma Protein Binding

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-drug that will bind to proteins. The amount that binds to protein will not be able go to receptor sites
-Hypoalbuminemia may incrase the effects of drugs-none
-Asa given along with Warfarin will double the effects of the warfarin due to the asa competition for protein.

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Volume of Distribution

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-mathematically determined measure of the size of a compartment that would be filled by the amount of a drug in the same concentration as that found in the blood of plasma.
-Highly water-soluble drug has a small volume of distribution and a high plasma concentration
-highly fat solubled the opposite.

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Drug Metabolism

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-proccess of a chemical change to a different compound called a metabolite which is easier
easier removed in urine (increases water solubility)
-some drugs are given in an inactive form and then actived through metabolism

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Phase 1reactions

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-oxidation, reduction, and hydrolysis. P-450 which hads a oxygen atom to a drug.

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Phase 2 reactions

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-synthetic or conjugation reaction which attacts another chemical group to a drug to make it water solubility...able to be piss out

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Drug Elimination

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-how the drug is removed from the body. Mostly Renal

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Glomerular Filtration

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-passive diffusion of fluids/solutes across member.
-protein bounded and big drugs can not be flitered out this way

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Tubular Secretion

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-active secreted. Mostly weak bases. PCN and Probenecid fight for this spot so PCN will work longer

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Tubular Re absorption

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-PH depent
-Weak acids will fliter out more if urine is a base
-weak bases will fliter out if urine is an acid
-IE amphetamine overdose given ammonium chloride IV to make urine acid

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Biliary Excretion

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-goes from the liver to the bile ducts to be pooped out
-Sometimes the drug can be free by gut bacteria. That's why antibiotics and oral

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Biological Half-Life

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-amount of time it takes for a drug to be reduced in half in the blood plasma levels.

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Type A Reaction

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-known side effects that are based on pharm of the drug. Bleeding with Warfarin
-Secondary effects
-drug interactions

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Type A reaction that are not normal

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-defects in drug quality
-abnormal pharmacokinetics
-altered sensitivity of the target receptors due to disease or genetics

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Type B reactions

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-Allergic Reaction
-Idiosyncratic

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Idiosyncratic

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-not expect results
-caused by decomposition of the active ingredients
-effects of the additives placed in the dosage form
-effects of the byproducts of the manufacturing of the drug
-Genetic cause (ASA and anemia due to gene)

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Pregnancy Risk

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-X=Fetal risk out way material benefits. IE Dead or Hunchback
-D=Shows risk to fetal. Be careful and measure Maternal benefits vs risk. IE losing a eye
-C=Unknown due to no trials in humans or risk in animals or no risk in animals.
-B= Risk in Animals but no humans. Or if no human studies have been done no risk in animals
-A=No risk. Have a healthy papy.

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Bioequivalence

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As pharmaceutical equivalent that display the same rate and extent of absorption.

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Schedule I

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-Registered research facilites only, and no legal/medical reason.
-IE Heroin, LSD, Mescaline, Weed

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Schedule II

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-no refills, written only, and expires after 72 hours
-IE. Narcotics (morphine, opium, methadone, oxycodone). Stimulants (cocaine, amphetamine, methyphenidates). Depressants (pentobarbital, and secobarbital)

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Schedule III

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-Prescription rewrite every 6 months or 5 refills. Telephone RX ok.
-IE (Codeine, Hyrocodone), Stimulants (Benzphetamine, chlorpheniramine, diethylpropion), and depressants (butabarbital)

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Schedule IV

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-Same as III
-Benzodiazepines (-pam, mepobamate

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Signs of Drug Seeking Behaviors

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overreporting of symptoms, multiple somatic complaints, vague symptom complexes, insistence on specific medications, refusal of gneric equivalent, self asserted high tolerance, first vist on pain meds, veiled threats, flattery followed by request, demands of polypharmacy, more then two pharmacies, more than two prescribers of controlled drugs.

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Phase I of clinical studies

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-testing on healthy people to find out absorption, distribution, metabolism, and excretion.

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Phase II

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-controlled studies on patients with target disease to determine short term risk and usefulness (less than 300)

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Phase III

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-Test phase before going free

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New drug application

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-apply through the NDA application. FDA has 180 days to review. May request more information, and may take 1 to 5 years to complete any well controlled trials if needed.

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African Differences

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-for HTN and they have salt sensitivity diuretics are first. Second is calicum channel blockers (isradipine). Beta blockers work different. ACE inhibitors don't work as well.

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Native American Differences

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-lower CAD but higher DM

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Asian

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-lower doses of Prilosec, Antidepressants, Valium, and antiarrhythmics.

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MAOI

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-foods with tyramine cause acute HTN
-Soy and agged Meat/cheese

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Three criteria for OTC meds

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-Safe
-Effective
-must be for a condition that the patient can manage without supervision

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Difference of Absorption and Bioavaibility in Woman

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-slower gastric emptying time due to estrogen.
-unable to metab. Alcohol as well

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Difference in Distribution in Woman

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-High Body Fat. Liophilic drugs work better
-Plasma Volume less and drugs with higher volumes of distribution will e more concentrated
-less organ blood flow in females
-estrogen attach to serum globuin. Increased levels of steroids and thryoxiene

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Difference in Metabolism in Women

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-Higher rates of metabolism for cyp450 3a4 but lwoer rates for 1a2 and 2d6.

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Different in Excretion in Women

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-just weight different. Nothing major

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Difference in Children for drug absorption

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-Gastric emptying prolong till 6 to 8 months
-PH doesn't increase to adult levels at 20 to 30 months
-more sysemic toxicity with topical area due to thin straum.

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Difference in Distribution in Children

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-require higher doses of hydrophilic drugs and less lipid-soluble
-less drug binding to plasma protein
-major change of body fat (esp males) in puberty watch for need to change dose

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Metabolism difference in children

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-CYP450 is low from newborn to 4 years. Higher than adults from 1 till puberty.
Metabolism difference in children (type II)
-Morphine last longer in newborn but normal after 3 months

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Drugs not to given for Lactation

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-Atenolol, Chloramphenicol (bone marrow), Cascara, Diazpem, Ergot (supress lactation, and HTN in baby), gold salts, Iodine, Lithium, Methadone, Propylthiouracil (kills thryoid),

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Excretion in children

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-drug excretion rates are lower for newborns, but normal after 6 to 12 months

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Absorption in old people

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-overall no. Less IM absorption due to less muscle. Delayed gastric emptying, acid production, and parietal cells

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Distribution in old people

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-Less water and more fat (watch Lipid due to high half lives) with Water-soluble have higher peak.
-More free drug vs protein binding.

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Metabolism in Old people

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-less first pass effect. If using a prodrug less changed over to active

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Excretion in Old people

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-decreased renal clearance of drugs

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Pharmacodynamic changes in Old people

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hypotension risk for antihypertensives, TCA, MAOI. Narcotics more of a effect.
-Beta drug don't work (both plus and blockers)a

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Tropical Antibiotics cream

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-has neomycin, bactracin, and polymyxin B.
-inhibits wall synthesis

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Mupirocin (Bactroban, Centany)

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-binds on RNA synthesis site
-most effective topical antibiotic
-about 50-60

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Tolnaftate (tinactin)

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-topical OTC antifungal drug for Superfical fungal infection
-distorts hyphae and stunts mycelial grwoth in fungi
-Class C given Nystatin instead
-Mild Skin irritation

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Terbinafine (lamisil solution)

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-treat tinea versicolor (trunk funical infection)
-inhibits a key enzyme in sterol biosynthesis
-burning at site

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Acycolvir (Zovirax)

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-used for HSV infection
-works by getting into DNA of virus and inhibits copying of DNA
-Class C
-don't give is senstive to Gancilovir
-Mild burning ate site
-cover every 3 hours

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Head Lice

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-Lindane, Malathion, Pyrethrins, and Permethrin.
-Most are flammability
-keep in hair for min 20 minutes.

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Acne Algorithm for Mild Acne

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-Benzoyl peroxide OTC for 4 to 6 weeks. If no improvement give antibiotic or retinoid.
-if no improvement go to moderate acne

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Acne algorithm for moderate acne

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-Add either topical antibiotic or retinoid. If no change add tetracyline
-If it doesn't work change to minocycline.
-if that doesn't work referr to dermatologist.

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Clonidine (catapres)
use and how it works

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-used for HTN, and withdrawn for boo's,smokes, or heroin. ADHD
-acts of alpha 2 receptors
-lowers BP, HR (when upright esp). Doesn't cause ortho effects or alter exercise ability
-absorbs easily from GI and goes to Brain easily.

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Clonidine (catapres)
side effects and interactions

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-class C
-ADR nightmares and insomnia. May cause pruritic rash. Rebound HTN if stop taking.
-ADR of sedatation
-Interactions ETHO, Beta blockers (HTN), TCA,

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methyldopa (adomet)

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-acts like neoephine and lowers BP to kidney, heart, and blow vessels. Reduce renal vascular resistance
-only half absorbed by GI tract.
-Class A
-ADR Positive Coombs test. Watch H & H. HTN. Hepaotoxicty
-interacts with tolbutamide (orinase) to produce hypoglycemic
-drowsiness goes away in 7 to 10 days.

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Tamsulosin (flomax)

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-best for BPH, but not HTN
-acts on Alpha one to block
-Preg C
-Cause Ortho Hypotension with first or new doses
-fluid retention sometimes happens
-impotence problems

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Prazosin

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-use in HTN
-Cause Ortho Hypotension with first or new doses
-fluid retention sometimes happens
-impotence problems
-may stop working pretty fast

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Doxazosin

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-HTN/BIG
-works on the alpha one to block
-Preg C
-Cause Ortho Hypotension with first or new doses
-fluid retention sometimes happens
-impotence problems

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atenolol (tenormin)/meteoprolol (lopressor)/propranolol

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-HTN, HR (prevents LV enlargement), Post MI (lower mortality by 30 to 40% due to prevent growth)
Migraine prevention, and anti arrhythmias
-blocks beta
-carefully in AV block, and Asthma. Watch with Diabetes cause it will block signs of hypoglycemia.
-ADR impotence and ejaculation, slow heart rate, dry mouth, depression, fatigue, and weakness

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Coreg (carvedilol)

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-non selective beta bockade and both alpha adrenergic effect
-reduced orthostatic hypotension and exercise induced tachy.
-use in HTN, CHF
-carefully in AV block, and Asthma. Watch with Diabetes cause it will block signs of hypoglycemia.
-ADR impotence and ejaculation, slow heart rate, dry mouth, depression, fatigue, and weakness

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Labetalol

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-doesn't effect HR, but needs beta blockage
-carefully in AV block, and Asthma. Watch with Diabetes cause it will block signs of hypoglycemia.
-ADR impotence and ejaculation, slow heart rate, dry mouth, depression, fatigue, and weakness

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Bethanechol

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-used mostly in neurogenic atony of the urinary bladder with retention. Can be used for Reflux Esophagitis
-class C
-Don't given in Pepic ulcer disease (increase acid), Urinary blockaged, asthma, and yperthyroidism (cardiac issues)
-ADR=orthostatic problems
-Atropine=antidote

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Atrophine

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-used for peptic ulcer disease and ABS
-signs of poisoning=burning, high fever, tachcardiac,
-antidote is physostigmine
-used to reduce secretions
-slows down peristalsis.

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Scopolamine

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-used for prevention of NV with motion sickness, and dry up spit.
-replace Q3 days, and clean hands with soap/water

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Oxybutynin

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-anti bladder spasm.
-take up to a week for full effects
-don't given with nitrofurantoin

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Benztropine

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-used to stop EPS symptoms related to anti psychotic durgs
-will be stopped two weeks after stopping of antipsychotic to see if they return.