Pharmacology

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adverse effects

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drug effects that are not the desired therapeutic effects; may be unpleasant or even dangerous

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brand name

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name given to a drug by the pharmaceutical company that developed it; also called a trade name

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chemical name

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name that reflects the chemical structure of a drug

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drugs

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chemicals that are introduced into the body to bring about some sort of change

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Food and Drug Administraion (FDA)

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federal agency responsible for the regulation and enforcement of drug evaluation and distribution policies

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generic drugs

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drugs sold by their chemical name; not brand (or trade) name products

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generic name

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the original designation that a drug is given when the drug company that developed it applies for the approval process

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genetic engineering

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process of altering DNA usually of bacteria, to produce a chemical to be used as a drug

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orphan drugs

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drugs that have been discovered but would not be profitable for a drug company to develop; usually drugs that would treat only a small number of people; these orphans ca be adopted by drug companies to develop

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over-the counter (OTC) drugs

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drugs that are available without a prescription for self-treatment of a variety of complaints, deemed to be safe when used as directed

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pharmacology

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the study of the biological effects of chemicals

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pharmacotherapeutics

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clinical pharmacology-the branch of pharmacology that deals with drugs; chemicals that are used in medicine for the treatment, prevention, and diagnosis of disease in humans

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phase I study

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a pilot study of a potential drug done with a small number of selected, healthy human volunteers

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phase II study

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a clinical study of a proposed drug by selected physicians using actual patients who have the disorder the drug is designed to treat; patients must provide informed consent

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phase III study

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use of a proposed drug on a wide scale in the clinical setting with patients who have the disease the drug is thought to treat

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phase IV study

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continual evaluation of a drug after it has been released for marketing

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pre clinical trials

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initial trial of a chemical throught to have therapeutic potential; uses laboratory animals, not human subjects

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teratogenic

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having adverse effects on the fetus

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absorption

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what happens to a drug from the time it enters the body until it enters the circulating fluid; intravenous administration causes the drug to directly enter the circulating blood, bypassing the many complications of absorption from other routes

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active transport

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the movement of substances across a cell membrane against the concentration gradient; this process requires the use of energy biotransformation

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chemotherapeutic agents

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synthetic chemicals used to interfere with the functioning of foreign cell populations; this term is frequently used to refer to the drug therapy of neoplasms, but it also refers to drug therapy affecting any foreign cell

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critical concentration

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the concentration a drug must reach in the tissues that respond to the particular drug to cause the desired effect

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distribution

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movement of a drug to body tissues; the places where a drug may be distributed depend on the drug's solubility, perfusion of the area, cardiac output, and binding of the drug to plasma proteins

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enzyme induction

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process by which the presence of a chemical that is biotransformed by a particular enzyme system in the liever causes increased activity of that enzyme system

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excretion

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removal of a drug from the body; primarily occurs in the kidneys, but can also occur through the skin, lungs, bile, or feces

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first-pass effect

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a phenomenon in which drugs given orally are carried directly to the liver after absorption, where they may be largely inactivated by liver enzymes before they can enter the general circulation; oral durgs frequently are given in higher doses than drugs given by other routes because of this early breakdown

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glomerular filtration

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the passage of water and water-soluble components from the plasma into the renal tubule

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half-life

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the time it takes for the amount of drug in the body to decrease to one half of the peak level it previously achieved

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hepatic microsomal system

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liver enzymes tightly packed together in the hepatic intracellular structure, responsible for the biotransformation of chemicals, including drugs

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loading dose

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use of a higher dose than that which is usually used for treatment to allow the drug to reach the critical concentration sooner

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passive diffusion

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movement of substances across a semipermeable membrane with the concentration gradient; this process does not require energy

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pharmacodynamics

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the science that deals with the interactions beetween the chemical components of living systems and the foreign chemicals, including drugs, that enter living organisms; the way a drug affects a body

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pharmacogenomics

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the study of gentically determined variations in the response to drugs

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pharmacokinetics

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the way the body deals with a drug, including absorption, distribution, biotransformation and excretion

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placebo effect

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documented effect of the mind on drug therapy, if a person perceives that a drug will be effective, the drug is much more likely to actually be effective

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receptor sites

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specific areas on cell membranes that react with certain chemicals to cause an effect within the cell

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selective toxicity

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property of a checmotherapeutic agen that affects only systems found in foreign cells without affecting healthy human cells (e.g. specific antibiotics can affect certain proteins or enzyme systems used by bacteria but not by human cells)

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blood dyscrasia

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bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower-than-normal levels of blood components can be seen

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dermatological reactions

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skin reactions commonly seen as adverse effects of drugs; can range from simple rash to potentially fatal exfoliative dermatitis

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drug allergy

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formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug

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hypersensitivity

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excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient's individual response

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poisoning

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overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions

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stomatitis

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inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems

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superinfections

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infections caused by the destruction of bacteria of the normal flora by certain drugs, which allow other bacteria to enter the body and cause infection; may occur during the course of antibiotic therapy

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assessment

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information gathering regarding the current status of a particular patient, including evaluation of past history and physical examination; provides a baseline of information and clues to effectiveness of therapy

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evaluation

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part of the nursing process; determining the effects of the interventions that were instituted for the patient and leading to further assessment and intervention

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implementation

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actions undertaken to meet a patient's needs, such as administration of drugs, comfort measures, or patient teaching

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nursing

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the art of nurturing and administerting to the sick, combined with the scientific application of chemistry, anatomy, physiology, biology, nutrition, psychology, and pharmacology to the particular clinical situation

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nursing diagnosis

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statement of an actual or potential problem, based on the assessment of a particular clincial situation, which directs needed nursing interventions

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nursing process

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the problem-solving process used to provide efficient nursing care; it involves gathering information, formulating a nursing diagnosis statement, carrying out interventions, and evaluating the process.

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apothecary system

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a very old system of measure that was specifically developed for use by apothecaries or pharmacists; it uses the minim as the basic unit of liquid measure and the grain as the basic unit of solid measure

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Clark's rule

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a method of determining the correct drug dose for a child based on the known adult dose (assumes that the adult dose is based on a 150-lb person); it states child's dose = weight of child (lb) / 150 lb x average adult dose

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conversion

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finding the equivalent values between two systems of measure

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Fried's rule

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a method of determining a pediatric drug dose for a child younger than 1 year of age, based ont he child's age and the usual adult dose (assumes that an adult dose would be appropriate for a 12.5 year old child); it states child's dose (age <1 yr) = child's age (mo) / 150 mo x average adult dose

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metric system

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the most widely used system of measure, based on the decimal system; all units in the system are determined as multiples of 10

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ratio and proportion

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an equation in which a ratio containing two known equivalent amounts is on one side and a ratio containing the amount desired to convert and its unknown equivalent is on the other side

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Young's rule

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a method for determining pediatric drug dose based on the child's age and the usual adult dose; it states child's dose (age 1-12 yr) = child's age (yr) / child's age (yr) + 12 x average adult dose

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alternative therapy

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includes herbs and other "natural: products as often found in ancient records; these products are not controlled or tested by the US FDA; however, they are often the basis for discovery of an active ingredient that is later developed into a regulated medication

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biological weapons

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so-called germ warfare; the use of bacteria, viruses, and parasites on a large scale to incapacitate or destroy a population

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cost comparison

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a comparison of the relative cost of the same drug provided by different manufacturers to determine the costs to the consumer

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internet

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the worldwide digital information system accessed through computer systems

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off-label uses

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uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the FDA; off-label uses may lead to new indications for a drug

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self-care

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tendency for patients to self-diagnose and determine their own treatment needs

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street drugs

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nonprescription drugs with no known therapeutic use; used to enhance mood or increase pleasure

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action potential

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sudden change in electrical charge of a nerve cell membrane; the electrical signal by which neurons send information

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afferent

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neurons or groups of neurons that bring information to the CNS; sensory nerve

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axon

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long projection from a neuron that carries information from one nerve to another nerve or effector

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dendrite

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short projection on a neuron that transmits information

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depolarization

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opening of the sodium channels in a nerve membrane to allow the influx of positive sodium ions, reversing the membrane charge from negative to positive

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effector cell

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cell stimulated by a nerve; may be a muscle a gland or anohter nerve cell

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efferent

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neurons or groups of neurons that carry information from the CNS to an effector; motor neurons are efferent

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engram

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short-term memory made up of a reverberating electrical circuit of action potentials

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forebrain

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upper level of the brain; consists of the two cerebral hemispheres, where thinking and coordination of sensory and motor activity occur

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ganglia

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a group of nerve bodies

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hindbrain

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most primitive area of the brain, the brainstem; consists of the pons and medula, which control basic, vital functions and arousal, and the cerebellum, which controls motor functions that regulate balance

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limbic system

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area in the midbrain that is rich in epinephrine, norepinephrine, and serotonin and seems to control emotions

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midbrain

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the middle area of the brain, it consists of the hypothalamus and thalamus and includes the limbic system

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neuron

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structural unit of the nervous system

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neurotransmitter

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chemical produced by a nerve and released when the nerve is stimulated; reacts with a specific receptor site to cause a reaction

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repolarization

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return of a membrane to a resting state, with more sodium ions outside the membrane and a relatively negative charge inside the membrane

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Schwann cell

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insulating cell found on nerve axons; allows leaping electrical conduction to speed the transmission of information and prevent tiring of the neuron

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soma

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cell body of a neuron; contains the nucleus, cytoplasm, and various granules

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synapse

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junction between a nerve and an effector; consists of the presynaptic nerve ending, a space called the synaptic cleft and the postsynaptic cell

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anxiety

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unpleasant feeling of tension, fear, or nervousness in response to an environmental stimuls, whether real or imaginary

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anxiolytic

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durg used to depress the CNS prevents the signs and symptoms of anxiety

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barbiturate

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former mainstay drug used for the treatment of anxiety and for sedation and sleep induction; associated with potentially severe adverse effects and many drug-drug interactions, which makes it less desirable than some of the newer agents

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benzodiazepine

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drug that acts in the limbic system and the reticular activating system to make gamma-aminobtyric acid (GABA) an inhibitory neurotransmitter, more effective causing interference with neuron firing; depresses CNS to block the signs and symptoms of anxiety, and may cause sedation and hypnosis in higher doses.

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hypnosis

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extreme sedation resulting in CNS depression and sleep

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hypnotic

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drug used to depress the CNS; cause sleep

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sedation

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loss of awareness of and reaction to the environment stimuli

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sedative

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drug that depresses the CNS; produces a loss of awareness of and reaction to the environment

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affect

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feeling that a person experiences when he or she responds emotionally to the environment

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biogenic amine

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one of the neurotransmitters norephinephrine, serotonin, or dopamine; it is thought that a deficiency of these substances in key areas of the brain results in depression

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depression

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affective disorder in which a person experiences sadness that is much more severe and longer lasting thatn is warranted by the event that seems to have precipitated it, with a more intese mood; the condition may not even be traceable to a specific event or stressor

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monoamine oxidase inhibitor (MAOI)

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drug that prevents the enzyme monoamine oxidase from breaking down norepinephrine (NE), leading to increaded NE levels in the synaptic cleft; relieves depression and also causes sympathomimetic effects

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selective serotonin reuptake inhibitor (SSRI)

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drug that specifically blocks the reuptake of serotonin and increases its concentration in the synaptic cleft; relieves depression and is not associated with anticholinergic or sypmathomimetic adverse effects.

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tricyclic antidepressant (TCA)

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Drug that blocks the reuptake of nonrepinephrine and serotonin; relieves depression and has anticholinergic and sedative effects

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tryramine

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an amine found in food that causes vasoconstriction and raises blood pressure; ingesting foods high in tyramine while taking an MAIO poses the risk of a severe hypertensive crisis

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antipsychotic

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drug used to treat disorders involving thought processes; dopamine-receptor blocker that helps affected people to organize their thoughts amd respond appropriatly.

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attention-deficit disorder

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behavioral syndrome characterized by an inability to concentrate for longer than a few minutes on an excessive activity.

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bipolar disorder

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behavorial disorder that involves extremes of depression alternating with hyperactivity and excitment

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major tranquilizer

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former name of an antipsychotic drugs; the name is no longer used because it implied that the primary effect of these drugs is sedation, which is no longer thought to be the desired therapeutic action

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mania

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state of hyperexcitability; one phase of bipolar disorders, which alternate between periods of severe depression and mania

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narcolepsy

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mental disorder characterized by daytime sleepiness and periods of sudden loss of wakefulness.

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neuroleptic

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a drug with many associated neurological adverse effects that is used to treat disorders that involve thought processes (e.g., schizophrenia)

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schizophrenia

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the most common type of psychosis; characteristscs include hallucinations, paranoia, delusions, speech abnormalities, and affective problems.

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absence seizure

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type of generalized seizure that is characterized by sudden, temporary loss of consciousness, sometimes with staring or blinking for 3 to 5 seconds; formerly known as a petit mal seizure

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antiepileptic

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drug used to treat the abnormal and excessive energy bursts in the brain that are characteristic of epilepsy

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convulsion

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tonic-clonic muscular reaction to excessive electrical energy arising from nerve cells in the brain

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epilepsy

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collection of various syndromes, all of which are characterized by seizures

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generalized seizure

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seizure that begins in one area of the brain and rapidly spreads throughout both hemispheres

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partial seizures

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also called focal seizures; seizures involving one area of the brain that do not spread throughout the entire organ

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seizure

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sudden discharge of excessive electrical energy from nerve cells in the brain

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status epilepticus

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state in which seizures rapidly recur; most severe from of generalized seizure

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tonic-clonic seizure

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type of generalized seizure that is characterized by serious clonic-tonic muscular reactions and loss of consciousness with exhaustion and little memory of the event on awakening; formerly known as a grand mal seizure

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anticholinergic

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drug that opposes the effects of acetylcholine of acetycholine-receptor sites

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bradykinesia

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difficulty in performing intentional movements and extreme slowness and sluggishness; characteristic of Parkinson disease

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corpus striatum

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part of the brain that reacts with the substantia nigra to maintain a balance of suppression and stimulation

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dopaminergic

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drug that increases the effects of dopamine at receptor sites

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Parkinson disease

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debilitating disease, characterized by progressive loss of coordination and function, which results from the degeneration of dopamine-producting cells in the substantia nigra

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parkinsonism

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Parkinson disease-like extrapyramidal symptoms that are adverse effects associated with particular drugs or brain injuries

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substantia nigra

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a part of the brain rich in dopamine and dopamine receptors; site of degenerating neurons in Parkinson disease

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basil ganglia

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lower area of the brain, associated with coordination of unconscious muscle movements

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cerebellum

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lower portion of the brain, assocated with coordination of muscle movements, including voluntary motion, as well as extrapyramdal control of unconscious muscle movements

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extrapyramidal tract

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cells from the cortex and subcortical areas, including the basal ganglia and the cerebellum, which coordinate unconsciously controlled muscle activity; allows the body to make automatic adjustments in posture or position and balance

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hypertonia

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state of excessive muscle response and activity

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interneuron

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neuron in the CNS that communications with other neurons, not with muscles or glands

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pyramidal tract

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fibers within the CNS that control precise, intentional movement

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spasticity

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sustained muscle contractions

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spindle gamma loop system

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simple reflex arcs that involve sensory receptors in the periphery that respond to stretch and spinal motor nerves and cause muscle fiber contraction; responsible for maintaining muscle tone and keeping an upright position against the pull of gravity

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A fibers

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large-diameter nerve fibers that carry peripheral impulses associated with touch and temperature to the spinal cord

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A-delta fibers

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small diameter nerve fibers that carry peripheral impulses associated with pain to the spinal cord

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C fibers

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unmyelinated, slow-conducting fibers that carry peripheral impulses associated with pain to the spinal cord

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ergot derivative

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drug that causes a vascular constriction in the brain and the periphery; relieves or prevents migraine headaches but is associated with many adverse effects

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gate control theory

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theory states that the transmission of a nerve impulse can be modulated at various points along its path by descending fibers from the brain that close the "gate" and block transmission of pain information and by A fibers that are able to block transmission in the dorsal horn by closing the gate for transmission for the A-delta and C fibers

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amnesia

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loss of memory of an event or procedure

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analgesia

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loss of pain sensation

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anesthetic

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durg used to cause complete or partial loss of sensation

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balanced anesthesia

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use of several different types of drugs to achieve the quickest, most effective anesthesia with the fewest adverse effects

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general anesthesia

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use of drugs to induce a loss of consciousness, amnesia, analgesia, and loss of reflexes to allow performance of painful surgical procedures

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induction

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time from the beginning of anesthesia until achievement of surgical anesthesia

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local anesthesia

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use of powerful nerve blockers that prevents depolarization of nerve membranes, blocking the transmission of pain stimuli and, in some cases, motor activity

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plasma esterase

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enzyme found in plasma that immediately breaks down ester-type local anesthetics

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unconsciousness

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loss of awareness of one's surroundings

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volatile liquid

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liquid that is unstable at room temperature and releases vapors; used as an inhaled general anesthetic, usually in the form of a halogenated hydrocarbon

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acetylcholine receptor sites

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area on the muscle cell membrane where acetylcholine (ACh) reacts with a specific receptor site to cause stimulation of the muscle in response to nerve activity

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depolarizing neuromuscular junction (NMJ) blocker

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stimulation of a muscle cell, causing it to contract, with no allowance for repolarization and restimulation of the muscle; characterized by contraction and then paralysis

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malignant hyperthermia

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reaction to some NMJ drugs in susceptible individuals; characterized by extreme muscle rigidity, severe hyperpyrexia, acidosis, and in some cases death

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neuromuscular junction (NMJ)

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the synapse between a nerve and a muscle cell

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nondepolarizing neuromuscular junction (NMJ) blocker

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no stimulation or depolarization of the muscle cell; prevents depolarization and stimulation by blocking the effects of acetylcholine

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paralysis

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lack of muscle function

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sarcomere

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functional unit of a muscle cell, composed of actin and myosin molecules arranged in layers to give the unit a striped or striated appearance

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sliding filament theory

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theory explaining tmuscle contraction as a reaction of actin and myosin molecules when they are freed to react by the inactivation of troponin after calcium is allowed to enter the cell during depolarization

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acetylcholinesterase

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enzyme responsible for the immediate breakdown of acetylcholine when released from the nerve ending; prevents overstimulation of cholinergic receptor sites

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adrenergic receptors

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receptor sites on effectors that respond to norephinephrine

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alpha receptors

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adrenergic receptors that are found in smooth muscles

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autonomic nervous system

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portion of the central and perpheral nervous systems that, with the endocrine system, functions to maintain internal homeostatis

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beta-receptors

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adrenergic receptors that are found in the heart, lungs, and vascular smooth muscle

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cholinergic receptors

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receptor sites on effectors that respond to acetylcholine

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ganglia (ganglion(s))

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groups of closely packed nerve cell bodies

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monoamine oxidase (MAO)

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enzyme that breaks down norepinephrine to make it inactive

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muscarinic receptors

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cholinergic receptors that also respond to stimulation by muscarine

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nicotinic receptors

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cholinergic receptors that also respond to stimulation by nicotine

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parasympathetic nervous system

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rest and digest response mediator that contains central nervous system (CNS) cells from the cranium or sacral area of the spinal cord, long preganglionic axons, ganglia near or within the effector tissue, and short postganglionic axons that react with cholinergic receptors

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sympathetic nervous system

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fight or flight response mediator; composed of CNS cells from the thoracic or lumbar areas, short preganglionic axons, glanglia near the spinal cord, and long post ganglionic axons that react with adrenergic receptors

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adrenergic agonist

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a drug that stimulates the adrenergic receptors of the sympathetic nervous system, either directly (by reacting with receptor sites) or indirectly (by increasing norepinephrine levels)

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alpha-agonist

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specifically stimulating to the alphareceptors within the sympathetic nervous system, causing body responses seen when the alpha-receptors are stimulated

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beta-agonist

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specifically stimulating to the beta-receptors within the sympathetic nervous system, causing body responses seen when the beta-receptors are stimulated

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glycogenolysis

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breakdown of stored glucose to increase the blood glucose levels

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sympathomimetic

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drug that mimics the sympathetic nervous system (SNS) with the signs and symptoms seen when the SNS is stimulated

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adrenergic-receptor site specificity

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a drug's affinity for only adrenergic receptor sites; certain drugs may have specific affinity for only alpha- or only beta-adrenergic receptor sites

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alpha-selective adrenergic blocking agents

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drugs that block the postsynaptic alpha receptor sites, causing a decrease in vascular tone and a vasodilation that leads to a fall in blood pressure; these drugs do not block the presynaptic alpha-receptor sites and therefore the reflex tachycardia that accompanies a fall in blood pressure does not occur

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beta adrenergic blocking agents

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drugs that at therapeutic levels, selectively block the beta-receptors of the sympathetic nervous system

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beta selective adrenergic blocking agents

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drugs that at therapeutic levels specifically block the beta receptors in the sympatheetic nervous system while not blocking the beta receptors and resultant effects on the respiratory system

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bronchodilation

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relaxation of the muscles in the bronchi, resulting in a widening of the bronchi; an effect of sympathetic stimulation

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pheochromocytoma

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a tumor of the chromaffin cells of the adrenal medulla that periodically releases large amounts of norepinephrine and epinephrine into the system with resultant severe hypertenstion and tachycardia

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sympatholytic

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a drug that lyses, or blocks, the effects of the sympathetic nervous system

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alzheimers disease

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degenerative disease of the cortex with loss of acetylcholine producing cells and cholinergic receptors; characterized by progressive dementia

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cholinergic

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responding to acetylcholine; refers to receptor sites stimulated by acetylcholine, as well as neurons that release acetylcholine

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miosis

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constriction of the pupil; relieves intraocular pressure in some types of glaucoma

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myasthenia gravis

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automimmune disease characterized by antibodies to cholinergic receptor sites, leading to destruction of the receptor sites and decreased response at the neuromuscular junction; it is progressive and debilitating, leading to paralysis

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nerve gase

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irreversible acetylcholinesterase inhibitor used in warfare to cause paralysis and death by prolonged muscle contraction and parasympathetic crisis

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parasympathomimetic

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mimicking the effects of the parasympathetic nervous system, leading to bradycardia, hypotension, pupil constriction, increased GI secretions and activity, increased bladder tone, relaxation of sphincters, and bronchoconstriction

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anticholinergic

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drug that opposes the effects of acetylcholine at acetylcholine receptor sites

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belladonna

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a plant that contains atropine as an alkaloid; used to dilate the pupils as a fashion statement in the past; used in herbal medicine much as atropine is used today

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cycloplegia

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inability of the lens in the eye to accommodate to near vision, causing blurring and inability to see near objects

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mydriasis

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relaxation of the muscles around the pupil, leading to pupil dilation

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parasympatholytic

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lysing or preventing parasympathetic effects