NUR 226 Focused Pathopharmacology Review

Comprehensive vocabulary flashcards covering ADME, pharmacokinetics, pharmacodynamics, NSAIDs, topiramate safety, pain physiology, and pain management pharmacology for NUR 226.

Absorption

The movement of a drug from its administration site into systemic circulation, influenced by gastric emptying and the route of administration.

Distribution

The movement of a drug from the bloodstream to tissues and target sites of action, influenced by blood flow, plasma protein binding, tissue differences, the blood-brain barrier, and the placenta.

Metabolism (biotransformation)

The chemical modification of a drug, occurring primarily in the liver and frequently involving Cytochrome P450 enzymes.

Excretion

The process by which a drug or its metabolites exit the body, primarily via the kidneys.

Increase

If someone has low albumin levels while they are on a medication that is highly protein binding, what is going to happen to the levels of the free drug/active drug in the system

First-pass effect

The hepatic and intestinal metabolism of an orally absorbed drug before it reaches systemic circulation, reducing bioavailability compared to intravenous delivery which has $100\%$ bioavailability.

Enzyme induction

A process that increases the metabolic activity of enzymes toward their substrates, leading to lower drug exposure.

Enzyme inhibition

A process that slows the metabolism of enzyme substrates, leading to increased drug exposure.

Pharmacokinetics

What the body does to the drug, comprising absorption, distribution, metabolism, and excretion (ADME).

Pharmacodynamics

What the drug does to the body, including its therapeutic and physiological effects at target receptor sites.

Mechanism of action

The specific biochemical or physiological process through which a drug produces its effects.

Agonist

A substance or drug molecule that binds to and activates a receptor.

Antagonist

A substance or drug molecule that binds to a receptor to block or reduce its activation.

Bioavailability

The fraction of an administered drug dose that reaches the systemic circulation unchanged.

Half-life

The time required for the total amount or concentration of a drug in the body to decrease by $50\%$.

Onset

The exact time point at which a therapeutic drug effect first begins.

Peak

The maximum drug concentration level in the blood or the maximum therapeutic effect achieved.

Trough

The lowest drug concentration level in the body, typically measured immediately before the next scheduled dose.

Duration

The total length of time that a therapeutic drug effect persists in the body.

Steady state / plateau

A stable average drug concentration achieved with repeated dosing when the rate of drug input balances the rate of drug elimination.

Loading dose

A larger initial dose of a medication administered to achieve therapeutic target levels more rapidly.

Maintenance dose

Repeated, ongoing doses given to maintain drug concentrations within the therapeutic range.

Therapeutic window

The plasma concentration range located between the minimum effective concentration and the toxic concentration.

Therapeutic index

The relative safety margin between toxic and effective doses, where a narrow index represents less safety margin for dosing errors.

Potency

The amount or dose of a drug required to produce a specific, predetermined biological effect.

Efficacy

The maximum therapeutic effect that a drug is capable of producing, regardless of dose.

Side effect

An additional, non-therapeutic, and often anticipated effect produced by a medication.

Adverse effect

A harmful, unintended, and undesirable effect caused by drug administration.

Additive interaction

A drug-drug interaction wherein the combined overall effect equals the mathematical sum of each drug's individual effects.

Synergism

A drug interaction wherein the combined effect is greater than the simple sum of the individual drug effects.

Antagonistic interaction

A drug interaction wherein the presence of one drug diminishes or cancels out the therapeutic effect of another.

Cyclooxygenase (COX)

Enzymes that synthesize prostaglandins, which are inhibited by NSAIDs to provide analgesic, antipyretic, and anti-inflammatory actions.

Nonselective NSAIDs

A class of drugs including ibuprofen, naproxen, aspirin, ketorolac, and indomethacin that inhibit both COX-1 and COX-2 enzymes to varying degrees.

COX-1

An enzyme form that helps protect the gastric mucosa, supports platelet activity, and maintains renal hemodynamics; its inhibition promotes GI irritation and bleeding.

COX-2

An inducible enzyme form that mediates inflammation and pain signaling pathways.

Celecoxib

A selective COX-2 inhibitor with lower GI ulceration risk that retains cardiovascular and renal toxicities, requiring caution in patients with sulfonamide allergies.

Aspirin

A nonselective NSAID that irreversibly inhibits platelet aggregation at low doses, can cause tinnitus in salicylate toxicity, and carries a risk of Reye syndrome in pediatrics.

Reye syndrome

A severe, life-threatening pediatric complication associated with aspirin administration during viral illnesses.

Topiramate

An antiepileptic drug prescribed for migraine prevention that can cause paresthesias, cognitive slowing, oligohidrosis, metabolic acidosis, kidney stones, and fetal harm.

Oligohidrosis

A drug-induced reduction in sweating that impairs thermoregulation, causing hyperthermia and heat intolerance.

Metabolic acidosis (Topiramate-induced)

A drop in serum bicarbonate caused by topiramate, presenting clinically with fatigue, anorexia, rapid/deep breathing (Kussmaul breathing), and confusion.

Acute angle-closure glaucoma

An urgent ophthalmologic complication of topiramate characterized by sudden blurred vision, severe ocular pain, and red eyes.

Pain

An entirely subjective sensory and emotional experience in which patient self-report serves as the primary assessment standard.

Nociception

The physiological neural process of detecting, encoding, and processing noxious, potentially tissue-damaging stimuli.

Transduction

The initial step of nociception where noxious thermal, mechanical, or chemical stimuli are converted into electrical action potentials by nociceptors.

Transmission

The conduction of pain impulses along peripheral nerve fibers to the spinal cord and up to higher brain centers.

Perception

The conscious, neurocognitive awareness and emotional interpretation of painful input within the brain.

Modulation

The endogenous neural process of dampening or amplifying pain signaling along spinal and supraspinal pathways.

Pain threshold

The lowest intensity of a painful stimulus that a person perceives as actually causing pain.

Pain tolerance

The maximum duration or intensity of pain that an individual is willing and able to endure.

Acute pain

A self-limiting, protective pain mechanism associated with recent tissue injury or inflammation.

Chronic pain

Non-protective, persistent or recurrent pain extending beyond normal tissue healing, commonly exceeding $3\text{ months}$ in duration.

Somatic pain

Pain arising from cutaneous tissues, skeletal muscles, or joints that is characteristically well-localized.

Visceral pain

Pain originating from internal organs that presents as poorly localized, deep, or cramping discomfort.

Referred pain

Pain perceived at an anatomical site distinctly distant from the actual source or injured organ.

Neuropathic pain

Pain initiated by a primary lesion or dysfunction within the somatosensory nervous system, often described as burning, shooting, or electric.

Nociplastic pain

Pain arising from altered nociceptive processing without evident ongoing tissue damage or somatosensory nerve lesion.

PQRST

A systematic clinical mnemonic for pain assessment: Provokes/Palliates, Quality, Region/Radiation, Severity, and Timing.

FLACC

A validated behavioral pain assessment tool measuring five categories: Face, Legs, Activity, Cry, and Consolability.

Acetaminophen (APAP)

An analgesic and antipyretic medication lacking anti-inflammatory action that can lead to severe hepatotoxicity in overdose.

Acetylcysteine (NAC)

The specific antidote administered to mitigate hepatic toxicity following acetaminophen overdose.

Naloxone

A pure competitive opioid receptor antagonist used to reverse life-threatening opioid-induced respiratory depression.

Fentanyl transdermal

A sustained-release transdermal opioid patch designed for chronic pain; it must never be cut or exposed to external heat sources.

Tramadol

A centrally acting dual-mechanism analgesic providing weak mu-opioid agonism and monoamine reuptake inhibition, carrying seizure and serotonin syndrome risks.

Gabapentin / pregabalin

Adjuvant medications used to manage neuropathic pain, commonly associated with sedation, dizziness, and heightened fall risk.

Muscle relaxants

Centrally acting skeletal muscle relaxants such as cyclobenzaprine and baclofen, which carry significant CNS depression and sedation risks.

Sumatriptan

A selective 5-HT1 serotonin receptor agonist used for acute migraine abortive therapy, contraindicated in uncontrolled hypertension and ischemic heart disease.