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111 Cards in this Set

  • Front
  • Back
four sources of drugs
plants, animals, minerals, and synthetic/semi-sythetic
Pure Food and Drug Act- 1906
*Passed to protect the public from adulterated or mislabeled drugs
*Drug company required to list if 1 of 11 dangerous and perhaps addicting drugs
*false and misleading claims are not allowed on the package
*only drugs sold in interstate commerce were covered
Food and Drug Act of 1909
*designated the United States Pharmacopedia and the National Formulary as official standards
Food Drug Cosmetic Act of 1938
*drug manufactures must test for harmful effects and drug labels must be accurate and complete
*durham-humphrey ammendment- specified how drugs can b ordered and dispended
*Kefauver-Harris Ammendment- require proof of safety and efficacy prior to approval
and permitted generic versions of drugs initially marketed 1938-1962
Generic Drug Criteria
*Pharmaceutical Equivelence
Pharmaceutical Equivalence
same active ingredients, dosage form, strength, and route
rate and extent of absorption are not significantly different than pioneer
*AUC, Cmax, Tmax
controlled substances:
Schedule 1
high abuse potential
no accepted medical use
research protocol only
may lead to severe dependence
Ex: herion, LSD
Controlled Substances:
Schedule 2
high abuse potential
accepted medical uses
may lead to severe dependence
written prescription, no refills
Ex: opium, morphine, cocaine
Controlled Substances;
Schedule 3
less abuse potential than 1 &2
accepted medical uses
low/moderate physical dependence, high psychological dependence
written or oral prescription, up to 6 months of refills
Ex: acetaminophen with codeine
anabolic steroids
Controlled Substances:
Schedule 4
lower abuse potential than 3
accepted medical uses
limited dependence
writen or oral prescription, 6 months of refills
chloral hydrate
Controlled Substances:
Schedule 5
lower abuse potential than 4
accepted medical uses
limited dependence
may or may not require a prescription
terpin hydrate with codeine
codeine in limited quantities
FDA Approval process
1.Investigational new drug
2.New Drug application
3.Abbreviated New Drug Application
Molecular Targets of Drugs
receptors, enzymes, carrier molecules, ion channels
Receptor Binding- Agonism
production of a molecular/cellular response to an interaction between a drug and a receptor that activates the receptor
Receptor Binding- Competitive Antagonism
agonsit and antagonist both trying to bind to the same receptor
Receptor Binding- Non competitive Antagonism
binding of antagonist to one receptor prevents agonist from binding to/activating another receptor
Pharmocologic antagonism vs. Effect antagonism
Effect Antagonism
If you have 2 different drugs:
one reacts with blood vessels to cause BP to drop and the 2nd reacts with receptors on the heart to cause BP to go up
Pharmaceutical phase
disnintegration and dissolution: in order for something to enter your body, it has to cross a biological membrane
Phamacokinetic phase
absorption- movement of drug molecules in the body
rate of absorption can determine the onset of action, duration of action, intensity of response
inject into space under skin with small needle
deep into muscle
DEPO injection- slow absorption
directly into the vein- most common
into the spine- spinal chord
Close to spinal chord
Hepatic biotransformation
inactivation or removal from body
drug is changed into something else and peed out
Object Drug
the drug whose action or kinetics is altered by a druf interaction
Precipitant Drug
the druf which causes the change to occur
Pharmacokinetic drug interaction
those in which one drug alters the rate or extent of absorption, distribution, metabolism or excretion of another drug
Pharmacodynamic drug interaction
those in which onee drug induces a change in a patient's response to a drug without altering the object drug's kinetics
-pharmacological interactions
Pharmaceutical drug interactions
includes physical and chemical incompatibilities
-falling out of solution
Characteristics of important object drugs
-narrow therapeutic range
-are metabolized by hepatic mixed function oxidases
-are used chronically
Variables that affect absorption
-nature of absorbing surface
-blood flow to site of administration
-solubility of the drug
-dosage form
Absorption of Dosage Forms
-liquids, elixirs, syrups
-coated tablets
-enteric coated tablets
-substained release
pharmacokinetic drug interaction
those which one drug alters the rate or extent of absorption, distribution, metabolism or excretion of another drug
-one drug causes a change in the plasma concentrations of another drug
ex: draw blood and see how much drug is in it
Pharmacodynamic drug interactions
those in which one drug induces a change in a patient's response to a drug without altering the object drug's kinetics
-pharmocological interactions
-no change in concentration effecting intensity of effect
Pharmaceutical drug interactions
physical and chemical incompatabilities like falling out of a solution
Mechanism of Altered Absorption
-drug binding (two drugs binding together because of taking them too close together)
-altered gut motility (speed at which speed moves through the gut)
-altered Gut pH
-altered gut flora
Altered Absorption Interactions of Highest Clinical Significance
-cholestyramine/ many drugs (lower cholesterol, can bind to other drugs, absorption based interaction)
-ketoconazole/drugs or food which decrease gastric acid
-tetracycline/ divalent or trivalent cations (loves to bind to Ca and not get absorbed)
-flouroquinlones/ antacids, sucralfate, divalent or trivalent cations
-oral contraceptives/ antibiotics
Enzyme Induction
certain drugs are capable of increasing metabolic enzymes in the liver- enzymes can change drugs and make them inactive
-dose related
-increase in levels of inducing drugs, increase in enzyme induction
-body can only process so much drug at a time
Important enzyme inducing precipitant drugs
anti-seizure drugs:
*rifampin- treat TB most popular enzyme induction
Time Course of Induction Effects
onset 5 days, maximal effect 2 weeks
offset 3 or more weeks
slow onset, slow offset
rifampin- onset 2-4 days, offset 2-3 weeks
Enzyme Inhibition
-The most reported mechanism for interaction between two drugs
-A number of drugs are capable of decreasing the activity of Cytochrome P450 enzymes
-drug concentrations goes up, toxity
Important Enzyme Inhibitors
Time Course of Inhibition
fast onset, fast offset
more dangerous
usually within 24 hours
Tubular Secretion
from the blood to tubular system
Tubular Reabsorption
from tubular system into blood
How nephron handles sodium and water
proximal tube- 60-70% is reabsorbed
Ascending loop of henle- 20-25% absorbed
water is reabsorbed in the collecting duct if ADH is present
MOA and primary use of acetazolamide
-prevents reabsorption of bicarbonate
-increases osmotic pressure
-causes osmotic diuresis
-produces alkaline urine
-eliminates more drugs for overdose
Generic Thiazides
Adverse effects of thiazides
Conditions to use cation with thiazides
-severe renal impairment
-diabetes mellitus
-electrolyte imbalance
-pregnant women
Consequences of hypokalemia in using thiazides
-orthostatic hypotension
-muscle weakness/cramps
Generic names of loop diuretics
-ethancrynic acid
-furosemide *
Adverse drug reactions for loop diuretics
-hypovolemia (decreased blood volume)
-ototoxicity (hearing loss)
Potassium- Sparing diuretics

Risk groups for potassium sparing hyperkalemia
-renal impairment
signs and symptoms of hyperkalemia
muscle weakness
flaccid paralysis
ecg abnormalities
MOA for spironolactone
aldosterone receptor antagonist
MOA for osmotic diuretics
increase intravascular osmotic pressure
-keeps water and sodium in the tubule
Calculation of creatinine clearance
IBW(male)= 50kg + (2.3 x in over 5ft tall)
IBW(female)= 45 kg + (2.3 in over 5 ft tall)

CLcr= [140-age] BW
------------ (x 0.85 for females)
Grading of renal impairment
normal >80 ml/min
mild 50-80 ml/min
moderate 10-50 ml/min
severe <10 ml/min
Depressive Symptoms
Must meet 5 with one being depressed mood or anhedonia
-weight loss/gain
-insomnia/ hypersomnia
-psychomotor agitation
-fatigue or decreased energy
-feelings of worthlessness
-decreased concentration
-recurrent thoughts of death

-symptoms persist for at least 2 weeks
Neurotransmitters involved in depression
Targets of medications
-metabolic enzymes (MAO)
-reuptake transporter
Targets for treatment
-serotonin transporter
-norepinephrine transporter
-dopamine transporter
-NE and 5-HT receptors
-monoamine oxidase
Selective Serotonin Reuptake inhibitors
-most commonly used
-safe, can't OD
-prozac, zoloft
SSRI side effects
-activation or sedation
-sleep distrurbances
-sexual side effects
-weight gain
SNRI side effects
-GI complaints
-sexual side effects
-increased BP
Tricyclic antidepressants
lethal in overdose as little as 3x daily dose
Goal of treatment
achieve remission
Best antidepressant treatment
all are equally effective
MOA of antacids
to neutralize stomach acidity
Indications for antacid
-peptic ulcer
-gastric hyperacitity
Drug interactions associated with antacids
-tetracycline (binds to Ca
-methenamine -requires acidic urine
-ketoconazole -increased gastric pH, decreases absorption
ADR of Aluminum hydroxide
-phosphate depletion
ADR of Magnesium
ADR Calcium carbonate
-calcium stone formation
-acid rebound (body starts secreting more acid)
ADR of sodium bicarbonate
-systemic alkalosis
-acid rebound
-sodium overload
Patient tips for using antacids
-take 1 and 3 hours after meals and at bedtime
-take 1 hour before and 2 hours after other meds
-shake liquid preps
-refrigerate liquids to taste better
-no calcium antacids with milk or vitamins
-chew tablets completely
MOA and indications for alginic acid
forms a form that floats on the liquid present in stomach
-used for control of reflux symptoms
MOA and indications for simethicone
defoaming agent used to relieve intestinal gas
-prevents the formation of large gas bubbles
Primary antiemetic use for scopolamine
motion sickness
primary antiemetic use for promethazine
common in hospital drugs
primary antiemetic use for ondansetron
largest advances in treating cancer to prevent nausea in cancer drugs
purpose of ipecac syrup
home emergency treatment
-contraindicated for:
caustic substances
depressed gag reflex
chronic use
Gastric Mucosal protection
epithelial cells secrete mucus and bicarbonate to neutralize layer of cells in stomach
-blood flow to repair cells
Heliobacter pylori in peptic ulcers
bacteria that lives in the lumen of the stomach and can cause ulcers if other factors are present
MOA of H2 Receptor antagonists
partially block secretion of acid
Indications for H2 blockers
-treat and prevent duodenal ulcers
-treat gastric ulcers
-hypersecretory states
Drug interactions with H2 blockers
Common H2 blockers
MOA of Sucralfate
forms a protective barrier at the ulcer site only in the intestine
-treatment, not prevention
Side effects of Sucralfate
constipation, diarrhea, nausea

*caution in renal failure
MOA of Misoprostil
prostoglandin analog
-prevents gastric ulcers while taking NSAIDS
Side effects of Misoprostil
diarrhea, abdominal pain, gas, headache
Cautions with Misoprostil
contraindicated in pregnancy
MOA of proton pump inhibitors
completely blocks gastric acid pump
Indications for proton pump inhibitors
-severe erosive esophagitis
-hypersecretory gastric conditions
-gastric and duodenal ulcers
MOA for bulk forming laxatives
absorbs water to increase bulk and distension of bowls to initiate reflex action
Indications for bulk forming laxatives
-psyllium (Metamucil)
MOA for stool softners
wetting agent used to soften stool mass
Indications for stool softners
used in hospital preventativly
MOA for stimulant laxatives
increase peristalsis by iritating nerves in the colon
indications for stimulant laxatives
used for active constipation
MOA for osmotic/saline laxatives
increase water content of bowel stimulating peristalsis
MOA for mineral oil
coat feces easing passage of stool

-absorbs fat soluble vitamins, tends to leak from rectum, lipid pneumonia
MOA of glycerin
used as a suppository in children
-osmotic action
MOA and side effects of diphenoxylate and atropine
inhibits intestinal smooth muscle
-derivative of opium

-dry mouth, dizziness, tachcardia, flushing
MOA and side effects of loperamide
inhibits intestinal smooth muscle and firms up stool mass
Purpose of atropine in diphenoxylate
to reduce abuse associated with diphenoxylate's opium effects