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93 Cards in this Set

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Pharmacology Definition
the study of drugs that alter functions of living organisms
pharmacotherapy
the use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes
medications
drugs given for therapeutic purposes
basis of drug classifications (3)
effect on body systems
therapeutic uses
chemical characteristics
prototype
first drug in a group, sets the standard by which all other drugs in the group are measured (penicillin for antibs, morphine for analgesics, etc.)
generic name
related to the chemical or official name of the drug (amoxicillin)
trade name
designated and patented by the manufacturer - amoxil, trimox, zoloft, etc.
patents
required for drugs, have a time limit, generic versions of the drug can be made after the patent expires
high costs of drug therapy driven by:
research, availability of ingredients, high consumer demand (think viagra)
prescription drug requirement
prescription signed by someone with a DEA#
drug approval process
4 phases of testing and clinical trials, then FDA approval
phase 1 clinical trials
15-20 healthy volunteers - watching absorption, metabolism, excretion, toxicity
phase 2 clinical trials
50-100 people with disease
phase 3 clinical trials
10-15,000 people with disease - do benefits outweigh the risks? Leads up to the FDA approval.
Phase 4 clinical trials
following FDA approval, goes on for 15 years, drug is marketed for use with continued data collection for safety - this is the phase nurses are constantly directly involved in.
Requirements for OTC drugs
fda approves based on:
6th grade level comprehension of instructions
can consumer accurately self-diagnose?
is drug effective when used as recommended?
is drug safe when used as instructed?
strategies to study pharmacology
concentrate on therapeutic classifications
keep a reference handy
use own words in notes/cards
understand how drug works in body - applies to rest of class
local effects of drugs
effects only locally, such as sunscreen, ben-gay, lidocaine - exactly where placed
systemic effects of drugs
travels through multiple body systems
can a client experience systemic effects of local drugs and local effects of systemic drugs?
yes, for instance, if lidocaine is placed near an open wound, it could enter the bloodstream and have a systemic effect.
where can you look up info on medications?
pdr, online (epocrates, medlineplus.gov), textbook
Modern medicines are mostly
synthetic products made in labs
controlled drugs are
scheduled according to medical use and potential for abuse
OTC Drugs vs. their prescription versions
often differ in indications for use and recommended dosage
with a new drug, the FDA is responsible for
evaluating the drug for safety and effectiveness
pharmacokinetics
absorption, distribution, metabolism, excretion
absorption
process occurs from the time the drug enters the body to the time it enters the bloodstream

rate determines onset of action
first-pass effect
when a drug is given orally, it is absorbed from the GI tract and carried to the liver for metabolism via portal circulation - some of the drug is metabolized in the liver
distribution
drugs carried by blood and tissues to sites of action, metabolism and excretion

to heart, liver and kidneys - fast, to muscle, fat, organs, skin - slower
protein binding
drugs that bind to protein can be longer lasting or slow release. they are only released from their protein binding when the serum level is low. only free or unbound portion of drug can act because of size.
metabolism
breaking down a drug into its useable form
drugs mainly metabolized by
liver, kidneys

most by cytochrome P450 enzymes in liver - liver toxicity a risk (grapefruit juice)
other metabolism sites
blood, lungs, and GI mucosa
prodrugs
these are metabolized and THEN they become active -

most drugs are metabolized to inactive metabolytes
what happens if 2 drugs compete for protein-binding sites?
one drug will be displaced due to lack of adequate binding spots and therefore have a higher serum level - could be a big problem
some drugs that are highly protein bound:
warfarin
diazepam
sulfonamides
effect of long term malnutrition on protein binding meds
more drug circulates in blood due to lack of binding sites, increases serum level, has a stronger effect on the patient
excretion requirements
good circulation system
properly functioning kidneys, bowels, lungs and skin
MEC
minimum effective concentration - minimum serum level required for drug to have pharmacologic effect on cells
duration of action
time taht the serum blood levels are above the MEC
toxic concentration
excessive levels of a drug - either from one overdose, repeated doses, or slow metabolism of properly administered doses
serum half-life
amount of time required for blood serum level of a drug to decrease by 50%
pharmacodynamics
the action of a drug on a cell
receptor theory
primarily agonists and antagonists (agonists stimulate a cell to do its function, antagonists block a cell from doing its function) this is how antidotes work
nonreceptor actions
environmental changes like acid environment, osmolality

third agents such as vit. D

metal chelating agents (combine with drug and bind it)
drug related variables
dosage, routes of administration, drug-diet interactions (grapefruit juice), drug-drug interactions
enteral
oral administration
parenteral
injected administration
client related variables
age, pregnancy, body weight, genetic and ethnic characteristics, gender, pathologic conditions, psychological conditions (placebo)
neonate
immature organ development - liver and kidneys.
infant
liver function and blood-brain barrier still immature
children
increased metabolism of some drugs
older adults
GI, cardiac, liver and kidney status alter pharmacokinetics - impaired kidney and liver function greatly increase risk of adverse drug events
drug tolerance/cross-tolerance
body gets used to a drug eventually. cross-tolerance is getting used to related drugs
adverse effects
*any* undesired response to a drug
therapeutic effects
any desired response to a drug
drug toxicity
caused by excessive amounts of a drug and may cause permanent damage
drug overdose treatments
antagonists (antidotes), altering of environments, supportive measures
pregnancy drug category A
studies indicate no risk to human fetus
pregnancy drug category B
studies indicate no risk to animal fetus; info in humans not available
pregnancy drug category C
adverse effects reported in animal fetus; information in humans is not available
pregnancy drug category D
possible fetal risk in humans reported' however, considering potential benefits v. risk may, in selected cases, warrant the use in pregnant women.
pregnancy drug category X
fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs should NOT be used in pregnant women.
5 Rights of Medication Administration
right drug
right dose (including decimal)
right client
right route of administration
right time (when was last meal?)
RN Legal responsibilites for medication admin
expected to have sufficient drug knowledge to recognize and question erroneous orders

responsible to CMAs and LPNs whom they are supervising
LPN legal responsibilities for medication admin
can give medications
medication errors caused by:
illegible writing
similar-sounding drugs
pharmacist filling script
nurses w/ inadequate knowledge or not following 5 rights
client's OTC or polypharmacy
distraction or interruptions
medication orders require
clients full name
generic and/or trade name
dose
route
frequency
date, time, sig of prescriber
refills -- scheduled medications (schedule II not refillable)
drug preparations and dosage forms
liquids
tablets and capsules
suppositories
transdermal (patch)
pump delivery systems (insulin)
routes of administration
oral (enteral)
topical
parenteral - intradermal, subcutaneous, intramuscular, or intravenous
critical pathway
measurable path to healing
herbal and dietary supplements are a major concern because
no regulation
goals
must have an intended outcome in order to use a drug
drug selection and dosage
best drug, least side effects, individualized dosage
drug therapy in children
dosage based on weight
oral route preferred
for IM administration, use thigh
childproof containers
never refer to it as candy!
drug therapy in older adults
physiological funtionality is more important than the age of the client
assess drug hx and OTC use
give smallest effective dose for shortest effective duration
smallest number eff. dose (long-acting drugs)
start low, go slow
inc. nonpharmacological treatments
assess for limitations in home use
assess drug effectiveness and any reactions to meds
drug therapy in kidney impairment
high risk for drug accumulation - impaired metabolism
monitor renal status:
- increased BUN (blood, urea, nitrogen
-increased serum creatinine
-decreased urine output
drug therapy in liver impairment
high risk for drug accumulation
monitor liver status:
-bilirubin
-albumin
-alt and ast (liver enzymes)
drug therapy in critical illness
aggressive treatment
multidrug regimens
r/o multiorgan failure
most meds IV
dosage requirements vary hugely
timing essential - around clock
weigh clients'
evaluate lab values frequently
drug therapy in home care
short or long term drug therapy
many drugs admin by pt or family member
review drugs and OTC w/ client
assess home environ. for pot. safety hazards
eval. for expected response and side effects
basic unit of the central nervous system
the neuron (glia support and nourish the neurons)

Composed of cell body, dendrite and axon.
nerve fiber
an axon together with a myelin sheath
neurotransmittors
chemicals that carry messages from one neuron to another or from a neuron to body tissue like heart or skeletal muscle
afferent neuron
conducts sensory impulses towards the brain or spinal cord
efferent neuron
neuron that conducts motor impulses away from the brain or spinal cord
synapses
microscopic gap between neurons in a chain. can be electrical or chemical. neurotransmitter release and removal occurs here
receptors
proteins embedded in the cell membranes of neurons. a neurotransmitter must bind to receptors to exert an effect on the next neuron in the chain
cholinergic neurotransmitter system
uses acetylcholine, found in CNS and ANS.

In CNS, associated with level of arousla, memory, motor conditioning, and speech.
dopaminergic neurotransmitter system
uses dopamine, found in substantia nigra, the midbrain and the hypothalamus.
GABA-ergic
uses GABA
Noradrenergic
uses norepinephrine
serotonergic
uses serotonin
amino acid neurotransmitters
aspartate, glycine, glutamate