Pharmacology

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PHARMOKINETICS

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a particular drug's onset of action, peak effect, and duration of action

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ABSORPTION

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movement of a drug from its site of administration into the bloodstream for distribution to the tissues.

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BIOAVAILABILITY

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a measure of the extent of drug absorption for a given drug and route (0-100%)

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FIRST PASS EFFECT

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the intial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the blood stream

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BIOEQUIVALENT

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2 meds have same bioavailability and same concentration of active ingredient

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ROUTE OF ADMINISTRATION

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how drug is administered effects rate of extent of absorption of that drug (enteral/gi, parenteral, and topical)

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enteral

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drug absorbed into the systemic circulation though the mucosa of stomach or small intestine

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sublingual and buccal

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absorbed into the vascularized tissue under the tongue/oral mucosa

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parenteral

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a general term meaning any route of administration other than the gi tract. ex)subcutaneous(fatty subcutaneous), intradermal(under more superficial), and intramuscular layer(muscular layer)

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topical

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applied to skin, eyes, ears, nose, lungs, rectum or vagina

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DISTRIBUTION

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transport of drug in the body by the bloodstream to its site of action. areas of rapid distribution include the heart, liver, kidneys, and brain. slow-muscle, skin, fat

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DRUG-DRUG INTERACTION

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unpredictable drug response and occurs when the presence of one drug decreases or increases the actions of another drug administered given at same time

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METABOLISM

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aka biotransformation, because it involves the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, or more potent active metabolite (as in the conversion of an inactive prodrug to its active form)
the liver is the most important organism involved in metabolism of drugs. other tissues are skeletal muscle, kidneys, lungs, plasma, intestinal mucosa

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CYTOCHROME P-450

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general name for large class of enzymes (found especially in the liver) that play a significant rule in drug metabolism

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SUBSTRATE

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a (drug or natural biochemical in teh body) on which enzyme acts

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EXCRETION

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elimination of drugs from the body. primary organ responsible is the kidney. also liver and bowel

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glomerular filtration

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active tubular reabsorption and active tubular secretion

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HALF-LIFE

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the time required for half of an administered dose of drug to be eliminated by the body

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steady state

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the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed w/each dose

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ONSET, PEAK, DURATION

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used to describe drug effects

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DRUG EFFECTS

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physiologic reactions of the body to a drug. hey can be theraputic or toxic and constitute how the function of the body is affected as a whole by the drug

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ONSET OF ACTION

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the time required for a drug to elicit a theraputic response after doing

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PEAK EFFECT

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the time required for a drug to reach its maximum therapeutic response in the body

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DURATION OF ACTION

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the length of time the concentration of a drug in the blood or tissues is sufficient to elicit a therapeutic response

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PEAK LEVEL

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the maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring

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TROUGH LEVEL

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the lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug monitoring

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TOXICITY

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the condition of producing adverse bodily effects of drugs and other chemicals in living systems, their detection, and treatment to counter act their poisonous effect

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THERAPEUTIC DRUG MONITORING

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the process of measuring drug peak and trough levels to gauge the level of patient's drug exposure and allow adjustment of dosages w/the joint goals of maximizing therapeutic effects and minimizing toxicity

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PHARMACODYNAMICS

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the study of the biochemical and physiologic interactions of drugs at their sites of activity. it examines the physiochemical properties of drugs and their pharmacologic interactions w/body receptors

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therapeutic effect

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the desired or intended effect of a particular medication

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mechanism of action

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drugs can produce actions, but cannot cause a cell or tissue to perform a function that is not part of its natural physiology

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receptor interactions

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entails the selective joining of the drug molecule w/a reactive site on the surface of a cell or tissue. once a drug binds to and interacts w/receptor, a pharmacologic response is produced. the degree to which a drug attaches to and binds w/a receptor is call its affinity

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enzyme

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protein molecules that catalyze one or more of a variety of biochemical reactions, including those related to the body's own physiologic processes as well as those related to drug metabolism

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nonselective interactions

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drugs with this do not interact with receptors or enzymes to alter physiologic or biologic function of he body, instead, cell membrane and various cellular processes such as metabolic activities are their main targets

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PHARMACOTHERAPEUTICS

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the treatment of pathologic conditions through the use of drugs

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contraindiction

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any condition, especially one related to a disease state or other paient characteristic, including current or recent drug therapy, that renders a particular form of treatment improper or undersirable

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acute therapy

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involves more intensive drug treatment and is implemented in the acutely ill (those w/rapid onset of illness) or even critically ill

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maintenance therapy

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does prevent progression of a disease or condition

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supplemental therapy

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supplies body with substance needed to maintain normal function

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palliative therapy

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make patient as comfortable as possible

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palliative therapy

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make patient as comfortable as possible

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supportive therapy

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maintains the integrity of body functions while the patient is recovering from illness or trauma

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PROPHYLACTIC THERAPY

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prevent illness, based on science

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EMPIRIC THERAPY

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prevent illness based on experience

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monitoring

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evaluation after therapy is implemented

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adverse effects

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any undesirable bodily effects that are a direct response to one or more drugs. includes side effects and adverse effects

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theraputic index

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the ratio between the toxic and therapeutic concentrations of a drug. if index is low, the difference between therapeutic and toxic drug concentrations is small, and use of the drug is more hazardous

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drug concentration

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toxic or therapeutic

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tolerance

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a decreasing response to repeated drug doses

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dependence

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a physiologic or psychcologic need for a drug

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controlled substances

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any drugs listed on of the the "schedules" of the controlled substance act (aka schedule drugs)

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informed consent

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permission obtained from a patient consenting to the performance of a specific test or procedure. required for most invasive procedures. it is voluntary

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investigational drug study

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a drug not approved for marketing by fda but available for use in experiments to determine its safety and efficiency has 4 phases of study

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phase I

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small number of healthy subjects

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phase II

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small number of volunteers who have the disease the drug is targeting

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phase III

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large number of patients who are followed by medical research centers. uses different studies and placebos

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phase IV

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studies are postmarketing studies voluntarily conducted by pharmaceutical companies to obtain further proof of the therapeutic effects of the new drug. class I and class II

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Class I

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most serious recall. use of drug product carries a reasonable probability of serious adverse health effects or death

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Class II

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less severe. use of the drug product may result in any significant health problems

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cultural considerations

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"one size fits all" but may need alterations in drug therapies. (must be sensitive to different cultures): culture, cultural competence, ethnicity, enthnopharmacology, race

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OPIOIDS

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are synthetic pain-relieving substances that were originally derived from the opium poppy plant. also referred to as narcotics.
high potential for abuse=schedule II

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opioid mechanism of action

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work by blocking receptors in the central nervous system. when these receptors are blocked, the perception of pain is blocked

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opioid indications

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intended drug effects are to relieve pain, reduce cough, relieve diarrhea, and induce anesthesia. certain opioids are used to treat opioid addiction

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opioid contraindictions

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known drug allergy, pregnancy (high dosage or prolonged use is contraindicated), respiratory depression or severe asthma without available resuscitative equipment, and paralytic ileus (bowel paralysis)

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opioid adverse effects

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CNS: diresis, miosis, convulsions, nausea, vomiting, and respiratory depression. non-CNS: histamine release can cause vasodilation leading to hypotension, spasms of colol leading to constipation, increased contractions of the ureter resulting in decreased uring flow, and dilation of cutaneous blood veselse leading to flushing of the skin of the face, neck, and upper thorax

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STIMULANTS

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An agent, action, or condition that elicits or accelerates a physiological or psychological activity or response. highly addictive

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stimulant mechanism of action

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work by releasing biogenic amines from their storage sites in the nerve terminals. the primary biogenic amine released is norepinephrine, and stimulates the CNS

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stimulant indications

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treatment of ADD ADHD, used to prevent or reverse fatigue and sleep, such as when they are used to treat narcolepsy, also have a slight analgesic effect.

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stimulant contraindictions

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drug allergy, diabetes, cardiovascular disorders, states of agitation, hypertension, known istory of drug abuse, and tourette's syndrome

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stimulant adverse effects

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reslessness, syncope (fainting), dizziness, tremor, hyperactive reflexes, talkativeness, tenseness, irritability, weakness, insomnia, fever, and sometimes euphoria, confusion, aggression, increased libido, anxitey, delirium, paranoid hallucinations, panic states, and suicidal or homicidal tendencies

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DEPRESSANTS

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Drugs that relieve anxiety, irritability and tension when used as intended. also used to treat seizure disorders and induce anesthesia. two classifications: benzodiapines, barbituates

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depressant mechanism of actions

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both work by increasing the action of GABA. GABA is an amino acid in he brain that inhibits nerve transmission in the CNS. the alteration of GABA action in the CNS results in relief of anxiety, sedation, and muscle relaxation

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depressant indications

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Benzodiapines: more widely used and abused, more commonly prescribed because they are felt by many to be safer. used to relieve anxiety, induce sleep, sedate, and prevent seizures. Barbiturates: used as hypnotics, sedatives, and anticonvulsants and to induce anethesia

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depressant contraindictions

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drug allergy, dyspnea or airway obstruction, narrow-angle glaucoma, and prophyria (metabolic disorder)

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depressant adverse effects

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overexpression of their therapeutic effects. drowsiness, sedation, loss of coordination, dizziness, blurred vision, headaches and paradoxical reactions, nausea, vomiting, constipation, dry mouth, abdominal cramping.

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ALCOHOL

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"elixir of life" depressant

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alcohol mechanism of actions

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causes CNS depression by dissolving in lipid membranes in the CNS

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alcohol indications

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is an excellent solvent for many drugs and is commonly employed as a vehicle for medicinal mixtures.

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alcohol contraindictions

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drug allergy, dyspnea or airway obstruction, narrow-angle glaucoma, and prophyria (metabolic disorder)

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alcohol adverse effects

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serious neurologic and mental disorders that may develop into seizures. nutritional and vitaman deficiencies especially of the B vitamins, can occur and can lead to wernicke's encephalopathy, korsakoff's psychosis, polyneuritis and nicotinic acid deficiency encephalopthy

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NICOTINE

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leaves of tobacco by posselt and reimann.

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nicotine mechanism of action

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works by directly stimulating the autonomic ganglia of the nicotinic receptors

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nicotine indications

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the nicotine found in nature has no known therapeutic uses, medically significant because of its addictive and toxic properies

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nicotine adverse effects

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CNS: produce tremors and convulsions, repiratory stimulation

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NURSING PROCESS

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an organizational framework for the practice of nursing. it encompasses all steps taken by the nurse in caring for a patient: assesment diagnoses, planning implementation, evaluation

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assesment

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data is collected and reviewed. subjective and objective

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diagnosis

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developed by nurses and are used as a means of communicating and sharing information about the patient and the patient experience. nanda.. sntence

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planning

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identification of goals and outcome criteria.

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goals

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objective, measurable, and relistic, with an established time period for achievement of the outcomes

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implementation

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initiation and completion of specific actions by the nurse

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evaluation

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evaluate nursing processes and reassess

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rights of drug administration

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right drug, right dose, right time, right route, right patient

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three checks of medication administration

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first check when you're taking out the medication from the cabinet.
second check after you've taken out all the medication from the cabinet and put the drawer back.
third check at the bedside right before you give the patient the medication

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understanding medication orders

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verbal: repeat order to confirm it with the prescriber spelling the drug name aloud and speaking slowly and clearly. list reason for use, no abbreviations, never assume

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error prevention medications

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check parameters, assess for effects of drug, all institutional pharmacy departments

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understanding a medication label

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never assume etc.

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medication errors

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any preventable ade involving inappropriate medication use by a patient or health care professional; they may or maynot cause the patient harm

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adverse drug event

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any undesirable occurence related to administration of or failure to administer a prescribed medication

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adverse drug reactions

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unexpected, unintended, undesired, or excessive responses to medications given at therapeutic dosages (as opposed to overdose)

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medication reconciliation

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a procedure implemented by health care providers to continually maintain an accurate and up-t-date list of medications for all patients at every phase of health care that is communicated in a timely manner to al applicable members of the health care team, with the overall goal of dramatically reducing the rate of medication errors; a key strategy of the 100,000 lives campaign