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91 Cards in this Set

  • Front
  • Back
dosage forms
routes of administration
storage (follow directions of how to handle)
What is pharmaceutic phase?
plants, minerals, animals, (marine life)
I. Sources of Drugs (pharmaceutic phase)
fillers; don’t include the active ingredient; nontherapeutic chemical
rate of absorption
stability of storage
(nurses should follow instructions – honor the rules of pharmaceutics)
What are the purposes of using excipients?
dissolution enhancers
wetting agents
pH stabilizers
What are the substances that are used as excipients?
1. oral
2. enteral
3. parenteral
4. topical
5. intradermal implants
II. What are drug routes?
1. intradermal
2. subq
3. intramuscular
4. intravenous
5. intraarterial
6. intrathecal (subarachnoid, subdural, cerebrospinal fluid)
7. intraspinal
8. intraarticular
What are parenteral drug routes?
anything absorbed across a membrane;
What are topical drug routes?
These are written as part of the prescriptive process.
IV. What are dosage forms and preparations?
TABLETS - most complex dosage forms
Buccal tablet - held between cheek & gum
Sublingual t. - under tongue
coated t. - outside layer for taste
enteric-coated t. - coating to prevent disintegration in gastric juices or protect stomach
effervescent t. - have Nabicarb and acidulant to generate CO2 when added to
sustained-release t. - time-release dose of coated particles
capsules - gelatin cases enclosing solid drugs, melt
caplets - tablets that resemble capsules in shape

pellets or needles - surgically implanted
troches - oral or vaginally
lozenges - oral
what the body does to the drug
what the drug does to the body
What are the 4 basic process of pharmacokinetics?
- determine # of drug molecules to reach site
- regulate plasma concentration of drug
intensity of drug action
- regulate the duration of drug action

*translates into the planning of the dose
The collective effect that is determined by the processes of pharmacokinetics.
physiological status
psychological state
environmental factors – *ex. outside temp and sun
What are the patient variables that modify the general principles of pharmacokinetics ?
The most common way drugs move across membranes.
diffusion is the most common method of drug movement across membranes

also, drugs that are more neutral are more fat soluble
Process of a drug passing from site of administration to venous or lymphatic circulation.
Proportion of administered drug available to produce effects.
Drug solubility
surface area
blood flow
lipid solubility
pH partitioning
Components of Absorption
1. the physical and chemical properties of the drug
2. the anatomical and physiological factors of the absorptive surface.
What affects the rate of drug absorption?
This drug type crosses membranes more easily.
1. lipid (vs. non lipid soluble)
2. polar (vs. nonpolar)
barriers to absorption: none
absorption pattern: instantaneous and complete
advantages: rapid onset, control, use of large fluid volumes, use of irritant drugs (rapidly diluted in blood)
disadvantages: high cost, inconvenient, difficult, irreversible, dangerous, fluid overload, infection, embolism
IV absorption characteristics
barriers to absorption: no significant barriers, just the capillary wall
absorption pattern: rapid or slow, determined by water solubility of the drug and blood flow to the site of administration
advantages: for parenteral administration of poorly soluble drug, administer depot preparations – effects can persist for days to months reducing # of injections
Ex. benzathine penicillin G – a month or more following injection
disadvantages: discomfort and inconvenience
IM absorption characteristics
barriers to absorption: no significant barriers, just the capillary wall
absorption pattern: rapid or slow, determined by water solubility of the drug and blood flow to the site of administration
advantages: for parenteral administration of poorly soluble drug, administer depot preparations – effects can persist for days to months reducing # of injections
disadvantages: discomfort and inconvenience
SC absorption characteristics
Barriers to absorption: layer of epithelial cells (must pass through cells) and the capillary wall (pass between cells)
absorption pattern: highly variable, factors contributing:
1. solubility and stability of drug
2. gastric and intestinal pH
3. gastric emptying time
4. food in the gut
5. coadministration of other drugs
6. special coatings on the drug
advantages: easy, convenient, inexpensive; no risk for fluid overload, infection, embolism; potentially reversible
disadvantages: variability – difficult to control onset, intensity, duration; inactivation (“first-pass effect”); pt requirements – conscious, cooperative; local irritation
*generally preferred to parenteral
Oral route characteristics
fastest to slowest
liquids --> suspensions --> powders -->capsules --> tablets --> coated --> enteric coated
oral preparations
fastest to slowest
IV --> IM --> SC --> Intrathecal --> epidural
parenteral preparations
-tightly controlled plasma drug levels
-for drugs destroyed by GI
-drugs that cannot cross membranes
-drugs that cause irritation to GI or mouth
-desire depot effect
-pt will not swallow drugs
When would parenteral administration be preferred?
when drugs contain the same amount of the identical chemical compound
chemical equivalence
if the drug is absorbed at the same rate and to the same extent
Movement of drugs throughout the body, as determined by blood flow to tissues, ability of the drug to exit the vasculature, ability of drug to enter cells.
transportation of drug molecules to active site by body fluids (also non active site!)
1. Cardiac output and regional bloodflow
2. Plasma-binding protein
3. Drug concentration
4. Physiologic barriers
5. Drug reservoirs (storage sites)
Factors than influence distribution
plasma-bind inactivates drug (can’t cause therapy)
reversible (then it causes therapy)
low to high affinity of drug for protein
nonspecific binding: protein + drug competitive binding
*too much free drug in blood can cause toxicity, because it’s actively therapeutic
How dose plasma-binding protein - Albumin affect distribution?
BBB – blood brain barrier
placental barrier
milk barrier
What are physiological barriers to distribution?
storage sites:
fat, bone, teeth, kidneys;
release drug long after administration
What are drug resevoirs?
-enzyme mediated modification of chemical structure of a drug. (* use biotransformation) metabolism is ALL chemical rxns, biotransformation is unique to substances that enter the body
-enzymatic alteration of drug structure (usually in the liver) – Hepatic microsomal enzyme system (P450) CYP1, CYP2, CYP3 metabolize drugs
chemicals resulting from drug modification
1.increase drug polarity for accelerated renal excretion (ionized)- convert lipid-soluble to polar; most important
2.drug inactivation - convert pharmacologically active compounds to inactive forms (nonreversible)
3.increased effectiveness
4.activation of prodrugs - pharmacologically inactive as administered, prodrugs get converted into their active forms via metabolism
5.increased or decreased toxicity
5 therapeutic consequences of biotransformation
Liver, placenta, kidneys, lungs, blood plasma, intestinal mucosa
sites of biotransformation
-microsomal enzymes (cytochrome P450 system)located in smooth endoplasmic reticulum
-12 closely related enzyme families
CYP1, CYP2, CYP3 - metabolize drugs
CYP4-CYP12 - metabolized endogenous compounds
- many drugs are metabolized by non-specific enzymes
hepatic metabolism
2.Induction of enzymes
3. first pass effect or phenomenon
4. Nutritional status
5. Competition between drugs
6. Genetic variability in enzymes (pharmacogenetics)
factors affecting biotransformation
movement of drugs and/or their metabolites
from tissues ‡circulation ‡excretory organs
skin - sebaceous, lungs, liver, kidneys, colon
rate of removal of drug from body (amt/time)
passive diffusion from blood vessels in kidney in the t-tubule (place where blood meets urine)
glomerular filtration rate
renal excretion
how most drugs are excreted
drug is removed via bile into feces
hepatic excretion
drug metabolites are exhaled
pulmonary excretion
water soluble
Forms of metabolites necessary for renal excretion - to get them out with the urine
NOT lipid soluble; have uneven distribution of charge (water – electrons stay by the O rather than the H); but NO net charge
polar molecules
Not lipid soluble; have a net electrical charge (+ or -). Except for very small molecules ions are unable to cross membranes.
1. passage through channels or pores (least common – too small)
2. passage with the aid of a transport system (most drugs lack a transport system that will help them cross)
3. direct penetration of the membrane itself (most common) – drug must be lipid soluble
3 ways drugs cross membranes
beyond therapeutic levels - side effects could be damaging.
toxic concentration
smallest amt to give effective therapeutic response.
Minimum effective concentration (MEC)
Between MEC and Toxic concentration
Therapeutic Range
This is a dynamic process that changes over time
Measure blood drug concentration (plasma drug level)
1. correlate with anticipated therapeutic response
2. assess absorption, distribution, metabolism, excretion
how pharmacokinetics affect drug plasma levels
1. Time course or time response
a. onset of action – time it takes to start to see therapy
b. peak serum level
c. time to peak action
d. duration of action

2. Plasma or biological half-life of drug
a. length of time required to reduce serum concentration by 50%
b. biotransformation and excretion
time-course of single-dose administration
how long and how many doses to reach plasma concentration plateau
plateau principle of repeated drug administration
usually double (take 2 pills right now, and every 12 hrs. take one; or give an injection and give the rest oral)
loading dose principle of repeated drug administration
once plateau is reached, how much to keep at plateau.
maintenance dose principle of repeated drug administration
Usual: 94% of drug will be eliminated in a time frame approximate to 4 half lives of the drug when drug administration is stopped.
repeated drug administration: decline from plateau
do not give a loading dose with these type of drugs
low therapeutic impact
-lipid soluble and cross cell plasma membranes
-reabsorbed in kidney - not excreted
-need to be biotransformed to ionized form so that kidney can excrete
-dissolution and absorption affected by pH
-water soluble
-do not readily cross plasma membranes
-positive charged: alkaloids, bases, and metallic radicals
-negative charged: acids and radicals
-ionized trapped by kidney and excreted
-drug inactive when bound
-drug can not cross plasma membranes when bound
-drug can not cross filter across kidney glomerulus when bound
What happens when a drug is bound to a protein (albumin)?
physiological response to a drug
mechanism of acton
the study of the biochemical and physiological effects of drugs and the molecular mechanisms by which those effects are produced.
-what drugs do to the body and how they do it.
1. Drug action – drug-->target organ (or molecule) interaction
2. Drug effect – drug action-->body response
3. Drugs affect natural processes of body
4. Drugs DO NOT elicit new functions
theories of drug action
1. Chemical alteration intra or extra cell space
2. Physical alteration cell environment
what nonspecific drugs do
Drug receptor interactions
a. membrane protein, nucleic acids, lipids, enzymes, CHO residues
b. lock and key
c. affinity
d. agonist
e. antagonist
what specific drugs do
1. drugs can mimic the actions of endogenous hormones or neurotransmitters, and elicit a response; or
2. drugs can block the action of endogenous hormones or neurontransmitters and prevent a response.
*drugs can’t make a body do anything it isn’t already capable of doing (except gene Tx)
What effects can happen when a drug binds to a receptor.
any functional molecule to which a drug can bind to produce its effects.
USUALLY refers to the body’s own receptors for hormones, neurotransmitters and other regulatory molecules.
drugs that minic the body’s own regulatory molecules;
they activate receptors. Has high affinity and high intrinsic activity.
– drugs that block the actions of endogenous regulators; they prevent receptor activation by endogenous regulatory molecules and drugs. Has affinity but no intrinsic activity. Ex: drugs used to treat overdose (naloxone for opiods), antihistamines
strength of attraction between drug and receptor. Drugs with high affinity can bind to receptors when present in low amounts and are effective at low doses – POTENT.
ability of the drug to activate the receptor once bound. Drugs with high intrinsic activity cause intense activity with low doses. It is reflected in its maximal efficacy.
intrinsic activity
A. Drug efficacy – ability to cause an effect
B. Drug RELATIVE potency – amount of drug for effect
C. Circadian rhythm - 24 hour body clock
D. Interethnic relationships - genetics

more potent drugs have a lower therapeutic index
factors affection pharmacodynamics
used to compare multiple drugs
dose-response relationship curve
Dose range that provides desired therapeutic effect with a minimum of adverse effects
therapeutic index
LD50 / ED50

lethal dose in 50% of subjects / effective dose in 50% of subjects

the larger the #, the safer
therapeutic index
A.Body size and weight
D.Genetic factors
E.Ethnic differences
F.Pathophysiologic factors
G.Psychosocial factors
H.Nutritional factors
I.Environmental factors
K.Variability in absorption
L.Drug interactions
M.Compliance (failure to take medicine as instructed)
factors that affect individual drug response
any noxious, unintended, and undesired effect that occurs at normal drug doses. (maybe 4th leading cause of death?)
more common in elderly, very young, severely ill, and people taking multiple drugs (polypharmacy)
Adverse Drug Reaction (ADR)
NOTE: terms used interchangeably - adverse drug reaction, iatrogenic, side-effect, toxic, idiosyncratic, drug-induced disease
nausea, vomiting, dizziness, drowsiness, dry mouth, abdominal gas or distress, constipation, diarrhea
most common adverse drug reactions
Side effects
allergic reaction
idiosyncratic effect
iatrogenic disease
physical dependence
Types of Adverse Drug Reactions
nearly unavoidable secondary drug effect that occurs at therapeutic dose
effect is dose-dependent
side effect
caused by excessive drug dose or dosage
e.g. morphine coma
immune mediated
prior sensitization
independent of drug dosage
allergic reaction
uncommon drug response due to genetic predisposition
e.g. CYP enzymes
idiosyncratic effect
disease produced by drugs
Dermatologic Hematoligic
Nephrotoxicity Hepatoxicity
Ocular toxicity Ototoxicity
iatrogenic disease
Modification of action of drug by another pharmacologically active CHEMICAL

response to drug combinations
drug-drug interaction
Complete summary of individual drug
drug monograph
Drug name- generic (Trade)
Drug Classification(s)
Pregnancy Category
Drug Schedule
Pharmacodynamics (Therapeutic actions, Actions, Mechanism of action)
Pharmacotherapeutics (Uses, Indications)
Contraindications (preexisting conditions that could lead to ADRs or affect therapeutic action; may chose not to use drug)
Precautions (life span, Pregnancy category, Proceed with caution observe carefully)
ADRs (side effects, undesired effects)
Interactions (drug, herb/supplement, environment, nutrition)
Patient Monitoring considerations (assessment, testing, evaluate)
Patient instruction issues (patient teaching points)
drug monograph headings