5070 Deck 2: Intro to pharmacology

Intro to pharmacology-drugs to genetics

disorder

an abnormality of structure or function that hasn’t yet been classified as a ‘disease’

more broad than ‘disease’

latrogenic

unintentionally caused by a health care provider/institution

pathogenesis

describes the sequence of cellular/tissue/organ events that take place as a disease process begins

clinical manifestations

evidence of the disease; related to the primary problem or body’s attempt at compensation for the problem

signs

objective, observable'

local vs systemic

symptoms

subjective; ‘complaints’/concerns

diagnosis

naming of the altered health issue

requires H&P and review of findings

nursing diagnosis doesn’t equate to medical diagnosis

clinical course

evolution of the disease or disorder over time

complication

a disease or injury that develops during the treatment of a preexisting disease or injury

sequela(e)

an abnormal condition directly resulting from a disease or injury

a negative consequence of a disease or injury

patient hospitalized for R hip fracture develops C. difficile infection, is this a complication or sequela?

complication

diabetic patient develops chronic kidney disease and neuropathy after 20 years, are these complications or sequelae of diabetes?

sequelae of diabetes

patient with diabetes has an episode of hypoglycemia, is this a complication or sequelae?

sequelae

are surgical complications causing health problems an example of sequelae or complications?

complications

hemiplegia after a stroke, is this complication or sequelae?

sequelae

PTSD after a traumatic event, is this a complication or sequelae?

sequelae

morbidity

a diseased state (altered body system or organ structure/function)

allostasis

dynamic process that maintains or re-establishes homeostasis or balance in response to stressors and changes in the environment

why might allostasis be an adaptive process?

original homeostatic points may not always be possible to achieve

compensatory mechanisms

part of the allostatic process

physiologic changes initiated when the body is under stress and attempts to maintain homeostasis

are compensatory mechanisms meant to be chronically ‘turned on’?

no

what is the compensatory process meant to be?

short-term responses to a disturbance in homeostasis

what might become a vulnerability if it isn’t turned off with regard to allostasis?

compensatory mechanisms

in heart failure, what is the role of compensatory mechanisms?

they work overtime in order to protect the heart

end up worsening heart failure by making it fail quicker than it would’ve otherwise

stress

real or perceived threat to the balance of homeostasis

is chronic stress harmful?

yes

is acute stress harmful?

acute stress not always harmful, but may motivate us

what is the fight or flight response also known as

Sympathetic Nervous System activation

what is the first step of the fight or flight response?

hypothalamus secretes corticotropin releasing hormone (CRH)

what cellular process needs to be initiated during hyperplasia

the cell cycle

in the case of lung epithelium being exposed to chronic smoking, what can happen to the cells ?

metaplasia (another cell type replaces columnar cells), then dysplasia (severe injury and cells become cancerous)

what are ROS?

radicals like the hydroxyl radical OH-

what is the most reactive ROS?

OH-

why does the hydroxyl OH- act so unstable?

if has an unpaired electron in its outermost shell

what are other types of ROS ?

hydrogen peroxide H2O2

hypochlorite ion OCl-

superoxide anion O2-

what is an endogenous source of ROS?

from neutrophils and other phagocytes

inside the body sources

what is an exogenous source of ROS?

pollutant, radiation, cigarettes, etc

what are some ways that ROS can cause damage?

oxidative damage to proteins and DNA

increased lipid peroxidation

what are some consequences of ROS damage on the body process level?

mucosal damage, inflammation, disease processes

what body process normally produces some ROS?

normal mitochondrial oxidative phosphorylation

can medications have more than one classification?

Yes

in order for a medication to be therapeutic, it must what ?

enter the body

be absorbed and distributed to cells, tissues, or organs

alter physiological function

what is the type of molecule that the blood brain barrier allows to pass through?

fat-soluble medications

where do acidic medications absorb rapidly?

in the gastric mucosa

what pH do acidic medication pass through more easily at?

pH less than 7.0

where do basic medications absorb more easily?

small intestinew

what is the pH that basic pH medications prefer to be absorbed at?

pH greater than 7.0

onset of medication action

time after a medication administration for it to produce clinical effect

peak

time it takes for med to reach highest effective [ ]

trough

time after administration at which the drug is having its minimal effect

lowest [ ]

duration

length of time drug has clinical effect

plateau

blood serum [ ] reached and maintained after repeated, fixed doses

what does ADR stand for?

adverse drug reaction

what is the concentration of a drug during a toxic drug reaction?

is this intentional or unintentional?

when dose or plasma [ ] has risen above therapeutic range

could be either

idiosyncratic reactions

unpredictable effect where a patient overreacts or underreacts to a medication or has a reaction different from normal

besides the active ingredient in drugs, what can people also have reactions to ?

additives

proprietary blend things, etc

what is post-market surveillance for?

monitoring safety after a drug is approved

what does the C with roman numerals stand for ?

controlled substance

what is the black box warning (BBW) for on a drug label?

required by the FDA

if drug is potentially lethal/dangerous

off-label prescribing definition

using the drug for something the FDA hasn’t approved it for

after what phase of drug process does the FDA approve the drug?

phase 3

drug definition

any chemical compound that can influence living processes

how many scripts-usually- are generics?

1 in 10

adverse drug event is what ?

undesireable effect caused by the use/misuse of a drug with a patient

is an ADR preventable?

possible to be both

medication error- is it preventable/not preventable?

preventable!

when can a medication error ocur?

any point in med management cycle

what is medication reconcilliation?

comparing meds patient are taking/should be taking

resolving discrepancies in medications

when is medication reconciliation most important?

during transitions of care

what does a patient’s medication list include?

Rx, OTC, herbal/supplemental meds, cannabis

how many mL is one teaspoon?

5 mL

enteric coated medication is done for what reason?

drug designed so it dissolves in the small intestine, not the stomach

what types of pills don’t we crush?

enteric coated, sustained release, extended release

enteric feeding tube

goes directly into the GI tract

enteral route of administration is through what routes

via the GI tract, oral and rectal

what should be emphasized when doing medication reconcilliation?

non-judgmental approach

what are 4 types of liquid medications?

solutions, suspensions, emulsions, syrups

what are 4 types of semisolid drug forms?

ointments, creams, gels, pastes

what are 3 types of solid drug dosage forms?

tablets, capsules, powders

what does parenteral mean? what does this often mean?

outside the GI tract, often via injection

what are types of parenteral administration routes?

intravenous, subcutaneous, intramuscular, transdermal

etc etc

what is topical administration?

applied to body surface- skin or mucus membrane, local action

what are topical locations for drug administration?

skin, eye, ear, nose, lungs, vagina

buccal administration means

between tongue and cheek

what do sublingual and buccal routes bypass?

how fast is the absorption?

the GI system

rapidly into the bloodstream

what form must drugs be in in order to be absorbed through enteral feeding tube ?

solution

what is the epidural space

space outside the dura

intrathecal injection

drug is injected into the intrathecal (subarachnoid) space

what is in the subarachnoid/intrathecal space?

cerebrospinal fluid

what are the 4 facets of pharmacokinetics?

absorption, distribution, metabolism, excretion

patient’s functional state

patient with a tolerance will respond less intensely to medication compared to someone without a tolerance

placebo effect

component of drug response caused by psychological factors, including a patient’s expectations

pharmacokinetics definition

study of drug movement throughout the body

what do metabolism and excretion make together?

elimination

what type of junctions do GI tract lining have?

tight junctions

what are 4 ways that drugs can move through cells, rather than between them?

diffusion

channels and pores

vesicular transport

transporter proteins

how many drugs move through channels and pores?

few

what might be a reason for limited channel/pore movement of drugs through cells?

small openings

specific for particular molecules like sodium and potassium

transporter molecules do what?

move molecules from one side of the cell membrane to the other

how many types of transporters are there?

a lot!!