Pharmacokinetics, Medication Interactions

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Pharmacokinetics

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What the body does to/with the drug as a function of time.
Guides dosing

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Minimum effective concentration

Back 2

lowest plasma protein concentration required to cause measurable response. Time called onset of action

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Duration of action

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time period when plasma concentration is above MEC

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Therapeutic index/range

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ratio between toxic dose and effective dose

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Biological/elimination half-life

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time it takes, after absorption for 50% of drug to be eliminated
it takes 4 - 5 half lives to eliminate around 98%
Helps determine duration of action

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Multiple dosing

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dose approximately every half-life in order to maintain steady state-blood levels

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Loading doses

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giving higher than maintenance doses in order to rapidly reach steady-state blood levels

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Factors affecting pharmacokinetics (5)

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dose, frequency, condition of body systems, drug form, route

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Drug-receptor interaction theory

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drug chemicals interact with receptors in luck and key fashion. Only certain keys fit certain locks. Specificity

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Rate interaction theory

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rate of binding determines the type and intensity of response
greater affinity or concentration of drug will increase rate and thus response

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Agonist

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chemical that combines with a receptor to produce a response

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Antagonist

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combines with receptor and inhibits action of agonist, the antagonist alone has no action

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Competitive antagonist

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binds with receptor at same site as agonist, has higher affinity for receptor than agonist has
can be overcome by higher concentration of agonist

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Non-competitive antagonist

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binds with receptor at site other than active site for agonist, creates change in receptor that prevents agonist binding
Cannot be overcome by higher agonist concentration

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Potentiation

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effect of one drug increased by the second
1 + 1 = 2
increased absorption, concentration at site
slower metabolism, excretion

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Synergism

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combined effect greater than each drug given alone
1 + 1 = 3
Ex) antibiotics for UTIs

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Side effect (secondary effect)

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ANY effect other than primary therapeutic effect

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Adverse reaction

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noxious, unwanted, unintended
severe = toxicity
considered reportable to FDA or monitoring agencies

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Hypersensitivity

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ANY excessive reaction

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Idiosyncratic response

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uncommon response, may be due to genetic predisposition

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Allergy

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histamine-mediated response, requires sensitization, severity varies

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Anaphylaxis

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Massive histamine release, abrupt onset

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Integumentary reactions

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hives/uritcaria, drug eruptions/rash, contact dermatitis, eczema, photosensitivity
angioedema - histamine mediated reaction in skin, mucous membranes, and/or internal organs

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Serum sickness

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Type III hypersensitivity reaction, more delayed, rare
skin rashes, edema, joint pain (arthralgia), anaphylaxis may follow

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Erythema multiformae

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delayed hypersensitivity reaction, complement system, "bulls-eye" lesions that may necrose

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Stevens-Johnson syndrome

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more sever fore of EM, "bulls-eye" lesions but involve mucous membranes too, joint pain, lesions may erode/necrose, painful, fever, malaise

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Toxic epidermal necrolysis

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more sever form of EM, "bully-eye" lesions coalesce, skin sloughs off

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Most common GI disturbance

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Nausea/vomiting

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Pseudomembranous colitis

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overgrowth of Clostridium dificile
diarrhea is worsening, mucus containing, bloody, distinct smell

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May lead to GI bleeds:

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NSAIDs, corticosteroids

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Nursing actions for possible nephrotoxicity

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Monitor BUN, creatinine, urine output, good hydration, pre-hydrate, use diuretic to move drug through faster, monitor therapeutic blood levels
Ex) antibiotics, antineoplastics (chemo)

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Toxicity to eight cranial nerve is:

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ototoxicity

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Paradoxical reactions

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opposite of expected therapeutic result

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Extrapyramidal reactions (Parkinsonian symptoms)

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extrapyramidal tracts are motor tracks in nervous system
tremor, gait disturbances, rigidity

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Myocardial toxicity

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causes cardiomyopathy, direct damage to myocardial tissue

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Cardiac vasoconstrictive agents

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Cocaine, meth, illicit drugs

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Blood dyscrasias

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dysfunction of flood forming organs, big broad vague
"bone marrow suppression/depression"

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Aplastic anemia

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lack of production of all blood cells

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Hemolytic anemia

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direct RBC damage/destruction, can cause renal failure if heme clog glomerulus

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Neutropenic precautions

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neutropenic = low neutrophils/WBCs
isolation, prevent infection

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Toxic hepatitis

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NOT infectious hepatitis, looks like viral form though
Acetominophen, antilipemic drugs

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Teratogenicity

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ability to harm fetus/cause birth defects
drugs organized in categories A, B, C, D, X

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Factors affecting adverse drug reactions (6)

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age, gender, genetic predisposition, history (of allergies), current disease state, pharmacodynamic/kinetic factors