NURS 116 entire course

Its grind time

Pharmacology

study of medicines

Pharmacotherapeutics

utilization of medicines to heal or manage patient care

Naturally sourced drugs (5)

1. aspriin (willow tree bark)

2. Penicillin (molds)

3. Digoxin (digitalis plant)

4. Taxol -> yew tree bark

5. morphine -> poppy milk

Canadian Pharmaceutical Association

publishes the CPS (Compendium of pharmaceuticals and specialties) + collaborates with health canada

Drug approval process (5)

1. Laboratory (testing on non-humans; 3-5 years)

2. CTA (clinical trials application to health canada) -> 3 phases

3. NDS (new drug submission) to health canada; 10% approval)

4. NOC (Notice of compliance) + DIN (Drug ID) assigned

5. Drug monitoring via MHDP (marketed health product directorate; monitor adverse cases)

Clinical trial phases (3)

phase I -> small sample (100 volunteers)

phase II -> up to 300 volunteers (with disease/ailment)

phase III -> up to 3000 (10% of drugs make it here)

Placebo (3)

substance "said" to have an effect, which may lead to an actual effect

2. not used as standard

3. not used as comparative subsances

categories of drugs (3)

1. drug/medication

2. biologic

3. natural health product NHP

drug/medication

chemical agent, synthetically produced

Biologic

from endogenous substance of animal cells

i.e. antibodies, blood products, hormones, etc.

Natural health product (NHP), examples and differentation (3)

from nature

i.e. vitamins, minerals, herbs, etc.

2. less regulated

3. effects vary

therapy

anything that benefits the patient

Generic drug name (2)

1. Describes drug without proprietary affiliation

2. 1 generic name per drug and same throughout the world

Brand/trade drug name (3)

1. From manufacturing company

2. Often the 1st drug to the market and patent protected for 20 years prior to other manufacturers.

3. Many trade names per one generic drug

Chemical drug name

name is chemical composition. Assigned by IUPAC

i.e. potassium chloride

If a drug has a generic name will it have a different chemical name

no, they will be the same

What are the brand and generic names for reactine

reactine -> brand name

Cetrizine hydrochloric acid -> generic

Brand vs Generic drug (3)

1. Cost:

- generic -> cheaper; covered by insurance companies

- brand -> expensive; sometimes no covered by insurance

- i.e. Tylenol vs acetaminophen

2. Prescribing -> may sub generic name if trade not available

3. Bioequivelence (amount of drug in circulation)

prototype drug (2)

1. single drug from drug class to serve as a reference drug within a particular class

2. Usually the original drug of the kind, and not necessarily the most utilized drug

Therapeutic drug class nomenclature and example

the name specifies a treatment/therapy of a particular disease/disorder; more broad

i.e. antihypertensive

Pharmacological drug class nomenclature and example

describes molecular/receptor activity; more specific, defines exact mechanism of action

i.e. calcium channel blocker

Schedule I (3)

1. prescription and dispensed by pharmacist

2. all prescription drugs and controlled drugs (potential for abuse)

3. Prescription can be granted to specific health care professionals

Schedule II (2)

1. only from a pharmacist, must be retained in an area with no public access

2. need to talk to a pharmacist but no prescription

Schedule III

open access in a pharmacy or pharmacy area

Unscheduled

sold in any store without professional supervision

examples of unscheduled drugs

advil, ibuprofen, tylenol

Pharmacotherapy in implementation

assessment -> alterations to physiology?

implementation -> enhance or suppress normal physiology

evaluation -> assessment of drug action

Pros of prescribed meds (4)

1. continous therpatutic level maintained

2. prevent complications, safer

3. predictable

4. long term

Cons of prescribed meds (2)

1. strict adherence to timing

2. less flexibility

Pros of unscheduled meds (3)

1. symptom specific

2. flexible dosing

3. patient centered control

Cons of unscheduled meds

risk of under or over use

Pharmocotherapeutics in pediatrics

measured by weight (per kilogram) until exceeds adult weight

What weight measurment should be sued for dose

Kgs

Prophylaxis

giving something before it happens

Example of prophylaxis

if drug causes nausea -> give patient something to treat nausea before it happens

What is serum synonymous with

blood and plasma

diligence in drug administration (3)

1. understand therapeutic goal

2. specific monitoring requirements

3. monitoring for effect and adverse effects

drug formulation

ingredients are prepared to be administered in a specific form (solid, liquid, injectable)

Drug route of administration definition and specification (2)

1. way the drug is taken into the body

2. specified by drug formulation.

Drug route of administration is dependent on what (3)

Dependent on medical situation

2. drug kinetics

3. formulation availability

4. setting

Oral (PO) what and what kind of effects (2)

1. mouth -> liquid (syrup, elixir); tablets/pills (chewable, gel); powder (mixed with food, drink)

2. leads to systemic effects

What is another name for Oral (PO) drugs

Classified as enteral (passes through GI tract)

Oral drug kinetics challenges (3)

1. Acidic environment

2. peristalsis depended

3. enters portal circulation (liver first).

What does it mean when a drug has to enter portal circulation first

1st pass metabolism

Why is PO not advisable (6)

1. GI obstruction

2. need for rapid drug action

3. Gi surgery

4. inability to swalow

5. malabosprtion disorders

6. stomach acid

Why is PO the hardest route (7)

1. must survive stomach acid and enzymes

2. first pass metabolism

3. absorption affected by food, pH, motility

4. slow onset

5. variable

6. GI effects

7. unpredictability

Sublingual (SL) (location, MOA, systemic?) (3)

1. under the tongue

2. capillary absorption into blood stream, bypassing GI system and 1st pass metabolism, faster than PO

3. systemic effect

Intranasal (insufflation) (location and MOA 2)

1. nasal cavity

2. capillary absorption, transport along cranial nerve network, BBB

is intranasal systemic or local? examples (4)

localized or systemic effects (based on drug)

- local (nasal mucosa) -> Rhinocort spray

- systemic effect -> flu vaccine

- CNS effect -> cocaine

Inhalation (location and MOA 2)

1. inhaled into lungs

2. pulmonary capillary network (rapid effects)

is inhalation systemic or local and examples (3)

localized or systemic effect (drug dependent)

- local -> asthma drugs

- systemic -> general anesthesia

Endotracheal (ET) (3)

1. lungs

2. ER/ICU situations

3. Tube inserted into an airway through the nose

endotracheal systemic localied? what kind of durg

1. systemic

2. few drugs only (i.e. epinephrine)

Topical (2)

1. applied directly to surface (creams, ointments)

2. many molecules too large to penetrate skin layers

topical prescence (local, systemic)

local effect

minimal systemic presence

how is molecule size expressed

- expressed in daltons (molecular weight)

What is the size range for a molecule to penetrate the capillary networj

500 daltons

caution with topical

systemic presence % can be contraindicated

Example of topical systemic and local

retinoid creams local effect -> collagen fiber repair and synthesis

systemic -> low but contraindicated in pregnancy

Transdermal definition, absorption, attributes and effect (4)

1. patch

2. dermal capillary absorption -> small enough molecules to penetrate skin layers

3. systemic effect desired

5. long acting -> slow and steady release and absorption

Example of transdermal (3)

1. nitroglycerine patch

2. nicotine patch

3. morphine patch

Rectal

1. inserted into rectum

Rectal drug effect (3)

1. local and systemic effect

2. 50-75% bypasses 1st pass metabolism

- systemic effect unreliable, many factors affecting it

Where are rectal drugs absorbed

intestine

rectal drug examples for each effect (2)

- local (glycerine suppository)

- systemic (morphine suppository)

Parenteral administration

not enteral, requires an injection

Intravenous (IV) location and attributes (3)

1. needle-catheter into a vein

2. immediate absorption, fast onset of action

3. dose given = dose circulating to receptors

Intravenous effect (1) and cons (2)

1. systemic effect, common in hospital settings

2. expensive

3. nfection risk

intramuscular (IM)

1. needle injection into muscle tissue

2. capillary bed absorption into bloodstream

Aqueous IM

faster effect

depot preperation of IM

slower effect

Intramuscular effect

systemic

Intramuscular injection sites (3)

1. deltoid site

2. ventrogluteal site

3. Rectus femoris

Subcutaneous (SC) (2) location and how is it absorbed

1. Injection into adipose tissue of hypodermis

2. absorption via capillary bed

Subcutaneous effect and example (2)

1. systemic efect -> faster or slower onset

2. i.e. insulin

recommended sites of subcutaneous (4)

1. abdomen

2. outer thighs

3. outer arms

4. above buttoks

Implanted ports considerations (4)

1. what type of port

2. A&P

3. which drugs can be administered

4. how to maintain potency

Pharmacokinetics (2)

1. movement across cell membranes via lipid bilayer

2. 4 phases: ADME

Factors of molecular kinetics (2)

1. Molecular characteristics

2. Membrane transport

Molecular characteristics (3)

1. charge (ionization)

2. lipophillicity vs hydrophilicity

3. size

Size affecting molecular characteristics

1. large is hard

2. small is easier

Membrane transport (2)

1. passive (not ATP) -> diffusion, osmosis, facilitated diffusion

2. active (ATP) -> electrolyte pumps (sodium, potassium)

ADME general rule (2)

1. lipophilic, non-ionized, small = easy absorption and distribution

2. hydrophilic, ionized = easy excretion

Absorption is

time for drug to reach systemic circulation

Factors affecting absorption (2)

- administration route

- molecular characteristics

Which route has a higher plasma concentration

IV route

Bioavailability

systemic circulation concentration

How to measure bioavailability

measurable via blood (plasma) tests (rarely: urine)

First pass metabolism (orally) (2)

1. less then 100% bioavailability

2. drug through lumen of GI tract -> liver (hepatic portal) -> metabolizes -> less effect

Some drugs that pass through gastric mucosa (5)

1. ETOH

2. Caffeine

3. ASA

4. Warfarin

5. Dilantin

What bioavailability do intravenous routes have

100% bioavailability

Drug dosage based of oral or not (2)

orally -> large dosage because first pass

others -> not enough produced

IV drug examples (6)

1. Nitroglycerine

2. Lidocaine

3. Midazaolam

4. Diazepam

5. Meperidine

6. THC

Therapeutic range and loading dose (4)

1. achieve peak plasma level quickly

2. repeated doses or higher 1st dose of drug given

3. regular recommended doses given after, to keep the drug 4. within therapeutic range, commonly IV, PO

recommended therapeutic dose symbol (2)

ED 50 -> median therapeutic dose

range is recommended

In pediatrics what metric should be used

kg

Avoiding toxic range or dose use what symbol

TD 50 -> median toxicity dose

therapeutic index calculation

TD50/ED50 or TD50:ED50

TD 50 is derived from

LD 50 lab data

Is a larger or smaller TI safer

larger because TD:ED shows difference and how many more times a dose has to be to become toxic