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83 Cards in this Set

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Animal: glands (thyroid hormone, insulin, sex hormones); shells/exoskeletons; beeswax; venoms.
Vegetable: all parts of plants, roots (digitalis); alkaloids or nitrogenous compounds (morphine, atropine); leaves (belladonna, peppermint); seeds (castor oil); and oils, gums, resins, and tannins.
Minerals: copper sulfate, aluminum, magnesium sulfate, iodine, iron, gold, etc.
Synthetic Drugs: corticosteroids, antianxiety agents, antidepressants, chemotherapeutic agents; recombinant DNA technology
Four types of drug studies:
Dose-response relationships (how much needed to produce effect)

2. Structure-activity relationships (how drug’s actions resemble/differ from closely related chemical compounds)

3. Metabolic fate (how body deals with drug)

4. Site/mechanism of action (where & how drug acts in the body)
study of the interaction of chemicals with living organisms to produce biologic effects
study of how drugs enter the body, reach site of action, and are removed from body (what the body does to the drug): absorptionàdistributionàmetabolismàexcretion.
study of drug action at biochemical & physiologic levels (effects & interactions of drugs with body tissues: what the drug does to the body).
the use of drugs to treat disease.
study of poisons/noxious effects of drugs.
(attraction) ability of drug to bind to receptor; LOCK & KEY theory, critical region of drug
capability of drug to cause effect; therapeutic ability.
Drug receptors
natural body components intended to respond to a chemical normally present in blood/tissues
compound that binds to specific receptor & stimulates biologic response; has affinity & efficacy
prevents stimulation of receptors; has affinity for specific receptors, but lacks efficacy (Narcan given for OD due to increased affinity for narcotic receptors.)
Desired action
expected, predictable response
Side effects/Adverse effects (ADEs):
unwanted drug reactions, can be expected.
Toxic effects
reaction to excessive amounts of drug.
Drugs do
not create new functions in the body, but modify existing functions.
Drugs act by:
Chemically altering body fluids
Chemically altering cell membranes
Binding to specific receptors: lock & key receptor; drug-enzyme interaction; physiochemical activity.
Idiosyncratic Reactions
unusual, unexpected : usu. genetic factor.
Type I
soon after exposure, IgE antibodies trigger histamine release: hives (urticaria), ANAPHYLACTIC SHOCK—EMERGENCY!!!
Type II
delayed reaction, IgM or IgG a-bodies trigger specific cell lysis (autoimmune response) e.g. methlydopa à hemolytic anemia.
Type III
serum sickness: urticaria, arthralgia, lymphadenopathy, fever; caused by formation of antigen-antibody complexes.
Type IV
cell-mediated response: contact dermatitis; usu. topical
FDA Pregnancy Risk Categories
A-- remote risk to fetus

B-- slightly higher risk to fetus than “A”

C-- greater risk than “B”

D-- proven risk for fetal harm

X—greatest risk for fetal harm; contraindicated.
Drugs may
inhibit or activate a process, or replace a missing element.
Dose-Response Curve
relationship between drug and effect it produces; response increases as drug concentration increases.
dose required to produce measurable response
increased dose will not increase response
Therapeutic Index (TI)
margin of safety; high TI = wide safety margin
refers to dose required to produce an effect; “strength” of the drug
important to consider when deciding between 2 drugs with similar actions: which drug “works better” (e.g. requires fewer doses?)
Drugs generally act in 1 of 2 ways:
May alter physics of cell environment

o May alter chemical environment of cells
time required to produce response, drug begins to act
highest effective drug concentration, maximum effect.
length of time drug able to produce effect
time required for elimination processes to reduce blood concentration by 50%.
Plateau Principle
maintain steady, therapeutic blood level
rate of excretion = rate of absorption
involves transport of drug across biologic membranes (skin, mucous membranes, stomach/intestinal lining, sub q or muscle tissue, etc.) to reach target tissue.
PO meds absorbed through GI tract via diffusion; rate affected by
Presence/absence of food

o Drug solubility

o Stability of drug in gastric pH

o Drug form (liquid, capsule, tablet, XR, SR)

o Presence of other drugs

o Gut circulation & gastric emptying
Parenteral meds
more rapidly absorbed & more predictable; IV immediate and has 100 % absorption
Topical meds (skin & mucous membranes)
has slowest absorption rate
proportion of drug available to produce systemic effects
process by which drugs transported by blood or body fluids to site of action; depends on protein binding, lipid solubility, & circulation.
breakdown/metabolism of drug; usu. done per microsomal enzyme system in liver
Drug broken down into
metabolites—may be therapeutic or toxic
Two phases:
(1) chemical change in drug molecule. (2) conjugation: altered molecule binds to another chemical group in blood & becomes more water soluble, easier to excrete.
PO meds undergo first-pass effect
as the portal system brings the drug from the gut to the liver; the liver breaks down the “lion’s share” of the drug before it reaches systemic circulation—may affect dosage determinations (PO doses higher than IV doses)
Other possible sites of biotransformation
kidneys, lungs, and intestines.
Factors influencing biotransformation
age; hepatic, renal, & CV disease
removal of drug & its metabolite from body
Most drugs eliminated by
kidneys, other sites include lungs, intestines, & sweat, salivary, & mammary glands
Drug Clearance
rate at which drug is eliminated; influenced by renal function. Some drugs excreted unchanged
implies that a drug may cause harm (e.g. allergy).

- May be absolute or relative.

- Cautious use means that med is given with extreme caution, & client must be closely monitored
one drug enhances the effects of another drug

§ (similar to 0 + 1 = 2)
combined effect of two drugs is greater than either drug alone.

§ (similar to 1 + 1 = 3)
two drugs together have combined effect (not greater than would be expected).

§ (similar to 1 + 1 = 2)
one drug interferes with, or blocks action of another drug; competitive.

§ (similar to 1 + 1 = 0)
May occur with foods, not just other drugs.

o Some drugs may alter/interfere with certain lab studies.

o Caution with herbal supplements!!!
Side Effects
Expected, may or may not cause harm.

- May be desired (e.g. ASA for inflammation also acts as anticoagulant,

TCA for depression also promotes sleep).
Adverse Effects:
Harmful & unexpected.

- Dependent on specific drug.
Can occur in any organ/system.

- Assess risk/benefit ratio carefully.

- Nephrotoxicity

- Ototoxicity

- Hepatotoxicity

- Neurotoxicity

- Blood dyscrasias

- Cutaneous reactions
Alteration in DNA
Idiosyncratic Reactions
Genetic predisposition

- Unpredictable

- Small population

- Mandates careful assessment of all clients
Peak levels drawn
drug’s highest activity level
Trough levels drawn
drug’s lowest level of activity; usu. obtained ½ hr. before next dose given
6 Rights of Medication Administration:
Right medication

Right client

Right dose

Right route

Right time

Right documentation

Also: Competent client’s right to refuse medication
Medication orders

§ Client’s name & address, ID #, age

§ Superscription: Rx (“take thou”)

§ Inscription: drug name, dosage form, amount of dose

§ Subscription: directions to pharmacist for preparation of drug & total amount to be dispensed (e.g. how many tablets)

§ Signature (Sig): directions for client including time, frequency, storage info, etc.

§ Generic equivalent acceptable?

§ Refill info: # & frequency regulated by federal law

§ Prescriber’s signature with title; may need DEA # if controlled substance
most common & convenient

§ Tablets, capsules, powders, liquids (syrups, elixirs, emulsions, tinctures)
Intradermal (ID)

§ Subcutaneous (SQ, SC, sub Q, sub q)

§ Hypodermoclysis

§ Intramuscularly (IM)

§ Intravenous (IV)

§ Intrathecal/intraspinal

§ Intra-articular

§ Intralesional

§ Intra-arterial
Mucous Membranes

· Inhalation

· Mouth/throat sprays, swabs, SL tablets, buccal tablets

· Nasal sprays, drops

· Vaginal suppositories, douches, foams, creams
Skin: lotions, ointments, compresses, patches, creams

- Ophthalmic: drops, ointments, and irrigations

- Otic: drops, irrigations
i. Bacteriostatic
do not directly kill bacteria; inhibit cell’s growth/reproduction; must work with host’s immune defenses to destroy organisms.
ii. Bactericidal
directly kill bacteria cell; adds to host’s defenses
- Antimicrobial Spectrum
range of microorgs. against which drug is effective
- Minimum Inhibitory Concentration (MIC
smallest amt. of drug required to halt growth of microorg.
- Minimum Bactericidal Concentration (MBC
smallest amt. of drug required to kill microorg.
- Therapeutic Index
ratio of drug that kills 50% of test animals to dose that is effective in 50% of test animals (TI=LD50/ED50); high TI safest.
Actions of ATB's
- Inhibit bacterial cell wall formation (bacterial cell explodes)
- Block protein synthesis in bacterial cell; form defective protein molecules
- Interfere with nucleic acid synthesis
- Inhibit metabolic pathways (antimetabolites)
- Disrupt bacterial cell membrane (cytoplasm leaks out)
i. Important Antibiotic-Resistant Microbes
1. Methicillin-resistant Staphylococcus aureus (MRSA)
2. Penicillin-resistant Streptococcus pneumoniae
3. Vancomycin-resistant Enterococci (VRE)
4. Multiple drug-resistant Mycobacterium tuberculosis
occurs during ABX therapy and involves resistant organisms; difficult to treat; more common with broad spectrum ABX that upset ecologic balance of normal flora (causes overgrowth of flora – e.g. yeast infection)
Misuse of ABX
Cannot cure viruses
- Must take full prescribed course!
1. Bacteria proliferate
2. The most resistant microorgs. survive
3. May result in drug resistance
- Using “leftovers” is dangerous
1. Negates reliable cultures
2. May become toxic on shelf
3. Hazardous to children
- Do not use someone else’s med!
: ibuprofen
- Salicylates
aspirin (ASA