Pharm Exam #1

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Pharmacology

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Pharmacology

the study of drugs and their interactions with living systems

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Medication

A chemical substance that is used to treat or prevent disease or relieve pain.

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Local effects of medications

act mainly at the site of application

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Systemic effects of medications

taken into the body, circulated via the bloodstream to sites of action, and eventually eliminated from the body

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Name drug sources

Plants, animals, minerals, synthetic compounds

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How are drugs classified?

According to their effects on particular body systems, their therapeutic uses, and their chemical characteristics.

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What are drug prototypes?

Individual drugs that present a group of drugs

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What is an example of a drug prototype?

Morphine represents analgesics

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How many names can a drug have?

3

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What are the names of a drug?

Generic name, trade name, and chemical name

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What is the risk of using different drug names for the same medication?

It increases confusion and the risk of misuse of a drug

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How can drugs be accessed?

By prescription or over the counter

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Prescription drugs

Medicines that cannot be used without the written approval of a licensed physician

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Over the counter drugs

Drugs available to consumers without a prescription. Also called nonprescription drugs

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Comprehensive Drug Abuse Prevention and Control Act

Gives a level of control over high abuse medications

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Controlled Substances Act

The federal law giving authority to the Drug Enforcement Administration to regulate the sale and use of drugs.

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Categories of Controlled Substances

Schedule I Schedule II Schedule III Schedule IV Schedule V

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Schedule I

This type of drug has no accepted medical use in the United States.

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Examples of schedule I drugs

heroie, marijuana, ecstasy

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Schedule II drugs

a type of drug with medicinal uses that is highly addictive and only available with a prescription

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Examples of schedule II drugs

oxycodone, fentanyl, morphine

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Schedule III drugs

a type of drug with medicinal uses that is moderately to highly addictive and only available with a prescription

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Examples of schedule III drugs

ketamine, testosterone, anabolic steroids

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Schedule IV drugs

a type of drug with medicinal uses that is moderately addictive and only available with a prescription

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Examples of schedule IV drugs

lorazepam, tramadol, diazepam

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Schedule V drugs

a type of drug with medicinal uses that is not very addictive and only available with a prescription

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Examples of schedule V drugs

Lomotil, Robitussin AC

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Who is responsible for approving new drugs in the US?

FDA

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Beers Criteria

A list of medications that are generally considered inappropriate when given to elderly people

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What are some sources for drug information?

Textbooks, internet sites, drug reference books, and journals

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Authoritative sources

sources that use factually verifiable observations and data to provide rigorous conclusions that will not collapse under scrutiny

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Pharmacokinetics

The process by which drugs are absorbed, distributed within the body, metabolized, and excreted.

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ADME

absorption, distribution, metabolism, excretion

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Rights of Medication Administration

Right drug Right dosage Right patient Right route Right time Right reason Right evaluation Right documentation Right to education Right to refuse

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Where are drug metabolizing enzymes located?

Kidneys, liver, RBCs, plasma, lungs, GI mucosa

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Enzyme induction causes

Increased action (higher dosage)

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Enzyme inhibition causes

Decreased action (lower dosage)

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Serum drug level

Lab measurement of the amount of a drug in the blood at a particular time

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minimum effective concentration

amount of drug required to produce a therapeutic effect

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Toxic concentration

level of drug that results in serious adverse effects

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Toxic concentration is caused by

A single large dose, many small doses given too frequently, and slow metabolism

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receptor theory of drug action

Most drugs exert their effects by chemically binding with receptor cells through -Activation, inactivation, or alteration of intracellular enzymes -Changes in the permeability of cell membranes to one or more ions -Modification of the synthesis, release, or inactivation of neurohormones

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Agonists

drugs that increase the action of a neurotransmitter

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Antagonists

drugs that block the function of a neurotransmitter

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Nonreceptor drug examples

antacids, osmotic diuretics, anticancer drugs, metal chelating agents

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Nonreceptor drugs

Drugs that do not act on receptor sites

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Receptor drugs

Have to bind to receptor sites to produce a reaction

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How does dosage effect drug reaction?

Frequency, number of doses, and size of dosage

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How does the route of administration effect drug reaction?

Influences absorption and distribution

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Drug to diet interactions

When elements of ingested nutrients interact with a drug and this affects the disposition of the drug

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Drug to drug interactions

when the effect of a medication is changed, enhanced, or diminished when taken with another drug, including herbal substances

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Additive effects

Drug interactions in which the effect of a combination of two or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone.

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Synergism

combination of two drugs causes an effect that is greater than the sum of the individual effects of each drug alone

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interference drug reaction

1 drug inhibits the metabolism or excretion of a 2nd drug, causes increased activity of the 2nd drug

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Displacement drug reaction

displacement of 1 drug by a 2nd, increasing activity of the 1st

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Pharmacogenomics

the study of how genetic inheritance affects the body's response to drugs

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Pharmacogenetics

the study of how genetic variation affects an individual's response to drugs

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Drug half life

the time required for the amount of drug in the body to decrease by 50%

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t = 1/2

Equation for drug half life

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What schedule of drugs is the least controlled?

Schedule V - least addictive

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Which schedule of drugs is the most controlled?

Schedule I - most addictive

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How do patients stretch their medications?

Patients will attempt to skip medications, cut a dosage in half, or use other family members' medications

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Polypharmacy

The use of many different drugs concurrently in treating a patient, who often has several health problems.

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Why might a patient try to stretch their drug supply?

They cannot afford the medication

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Black Box Warning

A type of warning that appears in a drug's prescribing information and is required by the U.S. Food and Drug Administration (FDA) to alert prescribers of serious adverse events that have occurred with the given drug.

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Examples of black box warning medications

Antidepressants

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Therapeutic Index

the ratio between the toxic and therapeutic concentrations of a drug

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Routes of administration of drugs

intramuscular, oral, subcutaneous, sublingual, intravenous, topical

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"Do Not Use" abbreviation list

QD/QOD (for daily/every other day) U for unit IU for international unit MS/MSO4/MgSO4 (for morphine/magnesium sulfate) Trailing zeros (e.g. 2.0 mg) following whole numbers Naked decimal points (e.g. .5 mg) preceding doses less than zero Available on ISMP or JACHO website

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Needle gauge

measurement of the diameter of a needle (lumen)

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A larger needle has a

smaller lumen

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A smaller needle has a

larger lumen

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Needle size depends on

patient size and weight, route of administration, and blood viscosity

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What can affect drug absorption?

Blood flow, pain, stress, hunger, fasting, food, pH, dosage form and route of administration

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Which oral dosage form of medication is faster in its absorption?

Solutions or liquid are absorbed faster than tablets.

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How are dosages determined for pediatric patients?

Peds doses are milligram per kilogram based upon the patient's weight

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What does it mean if a drug is protein bound?

Drugs that are protein bound cannot be distrusted through the body, only free drugs can cause action

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Absorption changes in older adults

Lower acidity in stomach, decreased blood flow in intestines; not clinically significant

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Distribution changes in older adults

Body water and lean body mass decreases, body fat % increases and causes high protein binding; lowers effectiveness of drug

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Metabolism changes in older adults

Decline in metabolic capacity, decreased liver mass and hepatic blood flow

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Excretion changes in older adults

Decreased renal blood flow, GFR is established

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Examples of authoritative sources

American hospital formulary service

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What patient age range is more susceptible to toxic concentration due to incorrect medication dosage?

Pediatric patients

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What needs to be included on an Rx?

Patient name, name of medication (brand or generic), dosage, route, and frequency of administration, date, time, and signature or prescriber

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