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148 Cards in this Set

  • Front
  • Back
Any chemical that is capable of interacting with living organisms to produce a biologic effect
The study of weights and measures
Pharmacist (druggist)
One who is licensed to prepare and dispense drugs and compounds and to make up prescriptions
The study of how a drug acts on the body, including the response observed relative to the concentration of the drug at the active site in the person.
The study of the effect that genetic factors have on an individuals response to a drug
The study of the movement of drugs within the body, including the absorption, distribution, metabolism, and excretion.
A specialist in pharmacology
The study of drugs and their origin, nature, properties and effects upon living organisms
The use of drugs to diagnose, prevent or treat disease or to prevent pregnancy
The science of preparing, compounding and dispensing of drugs
Any substance which, when taken into the body, usually in small quantities, will endanger life or causes death.
Science of dosage of drugs
alkaline compound combined with an acid in the lab to yield a water soluble salt i.e. morphine sulfate
plant substance that on hydrolysis yields a sugar and one or more active substances i.e. digoxin
plant exudate; when water added some swell and become gelatinous masses and some in GI tract absorb water and become bulky i.e. metamucil
volatile oils give plants aroma i.e. peppermint; fixed oils are greasy i.e. castor oil
liquid preparation that contains at least one solvent and one or more dissolved solutes
aqueous solution
water plus a drug
water, plus sugar, and a drug
Alcoholic solution: Spirit
volatile substance dissolved in alcohol
Alcoholic solution: Elixir
sweetened alcholic solution
Alcoholic solution: Fluid extract
concentrated fluid preparation of vegetable drug with alcohol or water
Alcoholic solution: Tincture
alcoholic solution from drugs derived from plants
combination of two or more substances which can be separated by physical means. There is no chemical reaction
Mixture: Emulsion
fine droplets of fat or oil suspended in a liquid
Mixture: Suspension
thick milky solution
Mixture: Liniment
mixture of drug with oil used on the skin as a lubricant or counter irritant
Mixture: Lotion
an emollient liquid that may b a clear solution, a suspension, or an emulsion
powdered drug plus other compounds molded into various shapes and sizes--most common solid dosage form
elongated tablet coated for easy swallowing
Enteric coated tablet
outer covering resistant to dissolution in gastric juices. passes into duodenum before it breaks down. prevents ulcers.
designed to be placed under the tongue
has indentations on it so it may be broken into halves or quarters
Sustained release
made up of different layers that are released at different times in the GI tract
dissolve in water just before taking
often contain large amounts of drug for absorption or local effect in the GI tract
Troche (lozenge)
designed to dissolve slowly in the mouth
liquid, dry or beaded drug particles contained in a hard or soft gelatin case--also as time release, sustained release capsules
Semi-solid Preparations: Suppository
one or several drugs mixed with a firm base, such as gelatin and shaped for insertion into the body--the base gradually dissolves at body temperature releasing the drug
Semi-solid Preparations: Gel
clear or translucent semi-solid that liquefies when applied to the skin
Semi-solid Preparations: Ointment
oily or fatty suspensions with low solubility in water and aren't easily washed off by water or perspiration
Semi-solid Preparations: Paste
preparations like an ointment but thicker and stiffer and don't soften much with body heat so are absorbed less
methods for meeting drug strength and purity standards
Chemical Assay
the ingredients of the drug are chemically analyzed and the amount of drug must meet set U.S. standards and is measured in percent.
Biologic Assay
This method is used when the ingredients of a drug can't be analyzed and standardized. The amount of drug that produces a definite effect on a lab animal under standard conditions is tested. These drugs are measured in terms of action not weight and the notation is in units. Ex. insulin and heparin
United States Pharmacopoeia (USP)
The source for the official standard for drugs. It sets standards related to efficacy, safety, purity, packaging, labeling and dosage forms.
5 schedules of drugs
schedule #1 having the most abuse potential and schedule #5 the least
5 schedules of drugs: Schedule 1
drugs have no accepted medical use
5 schedules of drugs: Schedule 2
drugs have accepted therapeutic use, high abuse potential, both physically and psychologically
5 schedules of drugs: Schedule 3
drugs have lower abuse potential, may see low physical dependence and high psychological dependence
5 schedules of drugs: Schedule 4
drugs have less abuse potential, limited physical or psychological dependence
5 schedules of drugs: Schedule 5
drugs have limited abuse potential, federal law allows these to be sold OTC, although states may require a prescription
Development of new drugs:
It takes 6-12 years and millions of dollars to develop and test a new drug. The FDA requires a certain testing sequence.
Development of new drugs: Preclinical testing
done on at least 2 species of animals--primarily to assess for toxicity's. Also run tests on pregnant animals. Takes 1-3 years. If the drug looks promising the company applies for an investigational New Drug Permit from the FDA.
Development of new drugs: Clinical testing
done on humans--Nurse's role is to comply with investigative drug protocols--participants are protected by the Nuremburg Code
Clinical testing: Phase I
about 100 healthy volunteers are used to determine a safe dose range on people and to see how well the animal studies correlate with results in people
Clinical testing: Phase II
about 1,000 volunteers with the problem (disease) take part to see if the drug is an effective treatment--may use double blind studies
Clinical testing: Phase III
about 5,000 people-assessing for less common complications - if developer thinks everything is fine they apply for New Drug Application Status-this is given by the FDA
Clinical testing: Phase IV
post marketing surveilance - released for interstate sale and closely monitored - report serious adverse effects within 15 days and lesser effects every 3 months for 3 years and then every year
Drug names: Generic name (non-proprietary name)
Each drug has only one generic name. This name is not capatalized EXAMPLE: acetaminophen
Drug names: Trade or brand name (proprietary name)
symbol (R) appears at upper right of name which means the name is registered and restricted to the manufacturer of the drug who is the legal owner of the drug.
Drug names: Trade or brand name (proprietary name)
Easier to spell or pronounce
Drug names: Trade or brand name (proprietary name)
First letter is capitalized
Drug names: Trade or brand name (proprietary name)
More expensive than the generic due to extensive advertising. EXAMPLES: Tylenol, Datril, Tempra, plus 32 others
Chemical name
Primarily used by chemists
Chemical name
Represents the chemical formulation of the drug. Example: N-acetyl para-aminophenol
Information about drug strength:
Usually a measure of weight in either the metric or apothecary systems. Some drug dosages, usually liquids, may be measured in percentage, unit, ratio, or mEq.
Information about drug strength: unit
measures a drug in term of its action
Information about drug strength: percentage
measures drug in terms of g per 100 mL of solution
Information about drug strength: ratio
parts of drug per parts of solution example: 1:100
Information about drug strength: mEq
measures number of g of drug in a mL of a normal solution
Pharmacokinetics: Absorption
the movement of a drug from its site of administration into the blood
Pharmacokinetics: Absorption
The rate of absorption determines how soon the drug effects begin. The amount of drug absorbed helps determine how intense the effects will be.
Pharmacokinetics: factors affecting absorption
Drug form: drug must be in solution. Liquid form - very easy to dissolve/absorb
Pharmacokinetics: factors affecting absorption
Drug concentration: drugs in high concentration absorbed faster
Pharmacokinetics: factors affecting absorption
Surface area: the larger the surface area the faster the absorption
Pharmacokinetics: factors affecting absorption
Blood flow: > the blood flow, faster the absorption
Pharmacokinetics: factors affecting absorption
Lipid solubility: Highly soluble lipid absorbed faster than those with low lipid solubility
Pharmacokinetics: factors affecting absorption
pH: many drugs are weak acids or bases. In an acid solution bases will ionize and in an alkaline solution acids will ionize. Drugs in their nonionized form can be absorbed, where those in their ionized form are trapped - called ion trapping or partitioning.
Common routes of administration:
into the GI tract (PO, PR)
Advantages: convenient, economical and safe. Preferred route. Full glass of water and sit for a full 30 minutes.
Disadvantages: Heparin - Insulin broken down in the GI tract
Common routes of administration:
Intramuscular (IM)
injection into muscle tissue
Advantage: no significant barrier to absorption
3mL most you can give by this route
Disadvantages: discomfort, potential for injury - artery, nerves i.e. sciatic nerve, cost
Common routes of administration:
Intraveneous (IV):inj
drug absorbed immediately and completely. very rapid onset, controls levels in blood
Disadvantages: Costly, difficult, inconvenient, dangerous if given too rapidly. Embolism - obstruction of a blood vessel., once you give it there's no getting it back
Common routes of administration:
Subcutaneous Injections
Slower, smaller volume 1 mL, non-irritating
Disadvantages: same as for (IM)
The movement of a drug throughout the body.
Distribution: rate at which a drug is taken to tissues and organs depends on
Blood flow to tissues - fastest to heart, liver, brain and kidneys
Distribution: rate at which a drug is taken to tissues and organs depends on
Ability of drug to leave the blood: this occurs at the capillary beds - it is necessary as most drugs do not exert any effect in the blood stream. It is easy as there are spaces between the cells lining the capillaries.
Drug distribution: barriers
placental barrier
Drug distribution: Protein binding
Albumin, a large protein found in the blood stream has places on its surface where drug molecules can attach briefly. When bound to the protein the drug is inactive. When the drug molecules are "free" (not attached) they can leave the blood stream and reach sites of action, metabolism or excretion. Some drug molecules have a stronger attachment to the protein than others. This affects the amount of free drug at any given time. Drugs may compete with each other for binding sites and so can be a cause of drug interactions.
Metabolism (biotransformation):
the enzymatic alteration of drug structure-almost all metabolism takes place in the liver.
Metabolism: 5 consequences from most important to least important
1. promotion of renal excretion
2. inactivate the drug active drugs -- inactive drugs
3. increase the drug's effectiveness
4. activate the Pro Drug
5. changes the toxicity of the drug some less, some more toxic
Factors affecting metabolism: Age
ability of liver to metabolize drugs not fully developed until one year old. Enzyme function decreases in the elderly so drugs are not metabolized as well.
Factors affecting metabolism: First pass effect
drugs absorbed from the intestine are carried in the blood through the portal hepatic circulation before entering the general circulation - some drugs are metabolized so extensively that they have no therapeutic effect.
Factors affecting metabolism: Disease
liver disease and malnourishment will decrease metabolism.
Factors affecting metabolism: Competition between drugs
two drugs that are metabolized by the same pathway may compete with each other slowing the rate of metabolism of one or both drugs. This can lead to drug accumulation.
Pharmacokinetics: Excretion
is the removal of drugs from the body, mainly through the kidneys, although some drugs and their metabolites are excreted in bile, breast milk, saliva, sweat, and by the lungs. Polar and ionized compounds are filtered and removed in urine and other drugs are removed from the kidneys by active transport systems.
Factors affecting excretion
pH affects rate of excretion
Renal failure
Time course of drug responses: bioavailable
How long drug will have its effect
Subtherapeutic level - below therapeutic level not doing anything
Time course of drug responses: Plasma (serum) levels:
plasma levels are often monitored to help doctors regulate drug responses. Usually there is a direct correlation between therapeutic and toxic responses and the amount of drug present in the plasma (Peak & Troughs on Drugs)
Plasma (serum) levels: Minimum effective concentration
Drug level needed in the plasma to have a therapeutic effect
Plasma (serum) levels: Therapeutic range
Range of plasma drug level. Keep therapeutic level constant. Example: Acetaminophen vs Lithium. Acetaminophen has a large therapeutic range whereas lithium had a very small therapeutic range.
Plasma (serum) levels: Toxic level
Toxic effects begin to appear
Plasma (serum) levels: Peak and trough levels
level of drug in plasma Max and Min Levels
Time course of drug responses: Drug half-life
the time it takes for the amount of drug in the body to decrease by 50%. The rate of a drug's metabolism and excretion determine its half life. Each drug is different and a drug's dose doesn't affect its half-life. The longer the half-life the less frequently the drug needs to be administered so this determines the dosing interval.
Time course of drug responses: Repeated dosing
causes the drug to accumulate in the plasma until a plateau (steady state) is reached, when the amount of drug eliminated from the body between doses is the same as the amount administered. This plateau is reached after about 4 half lives.
Time course of drug responses: Loading dose
a large initial dose may be given when plateau must be reached more quickly. This leads to high plasma levels and plateau can be maintained by giving smaller or maintenance doses.
Time course of drug responses: Decline of drug levels
When the drug is discontinued it takes about 4 half lives for it to be removed from the body (94%). The longer the half life the longer it takes to eliminate the drug from the body. This can be very important in cases of toxicity.
Time course of drug responses: Therpeutic index
is a measure of a drugs safety. It's the ratio between a drugs therapeutic benefits 50% of the time and the lethal dose 50% of the time, when tested on lab animals. The closer the therpeutic index is to one the narrower the drug's margin of safety
Pharmacokinetics: Dose-response relationships
relationship between the size of the dose given and the response of the client. As the dose increases so does the effect, up to a point. It allows the dose to be adjusted to meet the clients need.
Dose-response relationships: Maximal efficacy
The largest effect that the drug can produce. Comfortable enough to sleep, this is considered a good pain level.
Dose-response relationships: Potency
Amount of drug that has to be given for the desired response
Maximal efficacy and Potency do not depend on each other.
The study of the mechanism of drug actions in living tissues. There are several ways by which drugs can produce therapeutic effects called mechanisms of action
3 basic ways drugs can exert their mechanisms of action
1. receptor interactions
2. enzyme interactions
3. nonspecific interaction
Receptor Interaction
Involves the selective joining of the drug molecule with a reactive site on the surface of a cell or tissue.
A receptor is a reactive site on the surface of a cell or tissue.
This joining elicits a biologic effect.
Once the drug binds to and interacts with the receptor, a pharmacologic response is produced.
Types of Drug-Receptor Interactions
Agonist - causes cell to do something. Drug bind to receptor and there is a response. The agonist has an affinity and efficacy with the binding site.
Antagonist - has affinity but no efficacy with the binding site. Drug binds to receptor, but there is no response. Drug prevents binding of agonists
2 types of antagonists
Enzyme Interaction
Enzymes are substances that catalyze nearly every biochemical reaction in a cell. Drugs can produce effects by interacting with these enzyme systems.
Must inhibit the action of a specific enzyme.
The drug "fools" the enzyme into binding to it instead of its normal target cell.
Protects the cell from the action of the enzyme
Nonspecific Interactions
These do not involve a receptor or an enzyme.
Cell membranes and various cellular processes, such as metabolic processes, are their main sites of action.
These drugs either physically interfere with or chemically alter these cellular processes.
Example: rolaids change pH of stomach
Factors affecting a client's response to pharmacological agents
weight - average doses based on average weight of 150 lbs.
nutritional status - example: High protein, low carb diet (Atkins) promotes rapid metabolism of drugs
psychological status - client's attitude
Response to Drugs
Side effect
Toxic effect
Idiosyncratic effect-unusual response to a drug
Physical dependence
Cumulative - excretion of drug is not complete before next dose is given.
Drug Interactions
Summation - additive effect
Potentiation - type of synergism
Antagonism - 2 drugs together one drug antagonizes another drug
Displacement - more drug than available sites on albumin
Incompatibility - example: calcium and iron given at same time, calcium will not be absorbed.
Drug-Food Interactions
Tyramine/MAO inhibitors
Vitamin K Foods - antagonize oral anticoagulants
Dairy products and Tetracycline
Grapefruit juice - increases antihypertensive B/P will bottom out.
Acidic Foods - increase iron absorption
Antibiotics/BCP (birth control pills)
Methods of Local Administration: For application to skin (Ointments)
Mixture of drug in fatty base. Sometimes referred to as "inunction"
Methods of Local Administration: For application to skin (Moist dressings)
Can be placed over an area or can be in form of irrigation
Must be kept moist
Cover with dry dressing
Methods of Local Administration: For application to skin (Wound packing)
Dressing inserted into cavity
Usually not cotton or cotton filled sponges because fibers stick to wound
Intradermal - parenteral route
Between skin and subcutaneous tissue
Used for diagnostic reasons, not therapeutic
Use forearm and 15 degree angle
Bleb must appear
Small amount of drug - less than 1cc
For application to mucous membranes
Sprays - nasal or throat
Suppositories - vaginal or rectal
Water based ointments
Irrigation - enemas
Application of ear drops: Adult
To administer: pull ear up and out
Lie down for 2-3 minutes after drops are administered
Application of ear drops: Child
To administer: Pull ear down and back
Lie down for 2-3 minutes after drops are administered
Methods to Give Drugs for Systemic Effects: Sublingual
tablet placed under tongue
absorbed by mucous membrane due to rich blood supply
Methods to Give Drugs for Systemic Effects: Buccal
substance placed between cheek and gum
absorbed by mucous membrane due to rich blood supply
Methods to Give Drugs for Systemic Effects: PO - oral
absorbed in the duodenum (small intestine)
tablet, capsule, suspension, elixirs, emulsions
To read meniscus, locate the lowest fluid mark
Methods to Give Drugs for Systemic Effects: PR - per rectum
useful when client unable to take PO drug because of being unable to swallow, drug has objectionable odor, client nauseous or vomiting, drug changed by digestive juices
Best absorption when rectum is empty
Methods to Give Drugs for Systemic Effects: Parenteral Routes Subcutaneous (SC)
into subcutaneous tissue
no more than 1cc should be administered
do not aspirate insulin or heparin
do not massage after insulin
Methods to Give Drugs for Systemic Effects: Intramuscular (IM)
into muscle
no more than 3cc should be administered
90 degree angle
never massage an IM medication
directly into vein
large volumes for diluted doses can be given over specific periods of time
bolus for concentrated doses
fastest way for bioavailability
directly into the heart
into the spinal column
into the peritoneal cavity
large volume of fluid
medication stored in a patch and slowly absorbed through skin example: nicotine patches
Roles of the Health Team Members in Medication Administration: Physician
legally authorized to prescribe medications
Roles of the Health Team Members in Medication Administration: Pharmacist
Prepares and distributes medications
Roles of the Health Team Members in Medication Administration: Nurse
administers, monitors efficacy and side effects, teaches, advocates
Medication Orders
Medication orders must be in writing, clear, complete and appropriate.
Need a written order to legally administer a medication in an institution.
telephone order read back
Components of a medication order
Clients name
Date order is written
Medication name
Prescribers signature
Types of medication orders
1. Routine order. regularly administered drug. Most common
2. PRN order. as needed
3. Single order. one dose at a specific time
4. Stat order. single dose to be given immediately
5. Protocol. standing order or criteria
Superscription: includes client name, address, age and date.
Inscription: drug name, strength and dose
Subscription: directions for pharmacist
Signature: directions for patient
Personal data: signature and if controlled substance, DEA#.
Six rights of medication administration
1. Right drug: Check doctors order. Check three times
2. Right dose: Using DA to calculate
3. Right route: Must be specified
4. Right time: As ordered by physician
5. Right client: Check ID bracelet and have client state name - against order sheet.
6. Right documentation