Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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
*Bioequivalence |
|
Pharmaceutical Equivalence
|
same active ingredients, dosage form, strength, and route
|
|
Bioequivalence
|
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 paregoric anabolic steroids |
|
Controlled Substances:
Schedule 4 |
lower abuse potential than 3
accepted medical uses limited dependence writen or oral prescription, 6 months of refills Ex:phenobarbital diazepam 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 |
|
Subcutaneous
|
inject into space under skin with small needle
|
|
Intramuscular
|
deep into muscle
DEPO injection- slow absorption |
|
Intravenous
|
directly into the vein- most common
|
|
Intrathecal
|
into the spine- spinal chord
|
|
Epidural
|
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
-suspensions -powders -capsules -tablets -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:
barbiturates carbamazepine *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
|
Erythromycin
*Antibiotics *Antifungals |
|
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
|
chlorothiazide
hydrochlorothiazide metolazone indapamide |
|
Adverse effects of thiazides
|
-hypokalemia
-hyperuricemia -hyperglycemia -hypercholesteremia |
|
Conditions to use cation with thiazides
|
-severe renal impairment
-diabetes mellitus -electrolyte imbalance -pregnant women -elderly -gout |
|
Consequences of hypokalemia in using thiazides
|
-arrhythmias
-orthostatic hypotension -muscle weakness/cramps |
|
Generic names of loop diuretics
|
-bumetanide
-ethancrynic acid -furosemide * |
|
Adverse drug reactions for loop diuretics
|
-hypokalemia
-hypomagnesemia -hyperuricemia -hypercholesterolemia -hypovolemia (decreased blood volume) -ototoxicity (hearing loss) -dematologic -gastrointestinal |
|
Potassium- Sparing diuretics
|
amiloride*
triamterene* spironolactone *similar |
|
Risk groups for potassium sparing hyperkalemia
|
-renal impairment
-diabetics -elderly |
|
signs and symptoms of hyperkalemia
|
parasthesias
muscle weakness flaccid paralysis bradycardia schock 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) [Scr][72kg] |
|
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
|
serotonin
norepinephrine dopamine |
|
Targets of medications
|
-metabolic enzymes (MAO)
-reuptake transporter -receptors |
|
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 -nausea -sexual side effects -weight gain |
|
SNRI side effects
|
-nausea
-GI complaints -insomnia -sexual side effects -increased BP -sweating -agitation |
|
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
-gastritis -gastric hyperacitity -heartburn |
|
Drug interactions associated with antacids
|
-tetracycline (binds to Ca
-methenamine -requires acidic urine -ketoconazole -increased gastric pH, decreases absorption |
|
ADR of Aluminum hydroxide
|
-constipation
-phosphate depletion -osteoporosis |
|
ADR of Magnesium
|
-diarrhea
-hypokalemia -hypermagnesemia |
|
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: unconscious 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 -prostaglandins |
|
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 -GERD -hypersecretory states |
|
Drug interactions with H2 blockers
|
-anticoagulants
-antidepressants -antacids -ketoconazole |
|
Common H2 blockers
|
cimetidine
famotidine nizatidine ranitidine |
|
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 -GERD |
|
MOA for bulk forming laxatives
|
absorbs water to increase bulk and distension of bowls to initiate reflex action
|
|
Indications for bulk forming laxatives
|
regulatory
-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
|