administer drug, assess for adverse effects, intervene to make drug regimen more tolerable, teach about drug, monitor and prevent drug errors.
T/F drugs can be both natural and synthetic
T/F natural drugs are better for you
Plant derived drug
a synthetic version of the active chemical found in a plant. The main component of the growing alternative therapy movement. Pharmacists identify the drug in a plant and then synthesize the same drug.
Animal derived drug
used to replace human chemicals not produced due to disease or genetic problem. These drugs are made through genetic engineering. This could cause a possible immune response because the chemicals are not identical.
genetic engineering alter bacteria to produce chemicals that are therapeutic and effective. EX: thyroid hormone
Steps to putting a drug on the market
preclinical trials, phase I studies, phase II studies, phase III studies, phase IV studies
drug tested on lab animals
drug tested on human volunteers
drug tested on informed patients
drug used in vast clinical market. in order to get this stage safety and efficacy must be proven
continual evaluation and post marketing surveillance of drug
Controlled Substances Act 1970
control over coding of drugs and the enforcement to FDA and DEA. This includes prescription, distribution, storage, and use. Based on potential for abuse.
high abuse potential, no medical use. Ex: pot, heroin, LSD
high abuse potential with severe dependence liability. Ex: narcotics, barbiturates, amphetamines
less abuse potential and moderate dependence. Ex: non-barbiturate sedatives, non-amphetamine stimulants
even less abuse potential, limited dependence liability. Ex: some sedatives, anti-anxiety agents, non-narcotic analgesics
limited abuse potential. Ex: small narcotics like codeine. can be purchased without prescription
chemicals produced by companies involved soley in manufacturing drugs; bioavailability of drug, dispensed as written. active ingredient is the same. allowed 10% of non active where brand drugs can only have 5%. produced by companies solely involved in manufacturing drugs. fillers and dyes may be off. *bioequivalent for therapeutics*
drugs discovered but are not financially viable, have not been adopted by any drug company.
available without prescription. taking these could mask signs and symptoms of underlying disease, interact with prescription or other drugs, and cause serious overdoses. grandfathered in to have efficacy and safety.
identification of drug
made by manufacturer, chemical and study information that led to approval (hard to read)
How are drugs dangerous for babies regulated?
through lettered categories. these drugs are called teratogen.
fetal adverse reaction. risk outweighs benefits
definite fetal risks but benefits may outweigh the risks. Need informed consent and develop a plan to reduce risks.
Drugs can work to replace or act as a substitute for missing chemicals, increase or decrease cellular responses (agonist/antagonist respectively), or interfere with the functioning of foreign cells.
protein pocket with a space for a module to attach to. When connected it make stimulate a response, oppose a reaction, etc.
opposes cellular action, but if you increase the concentration of the agonist the agonist will bind in the spot.
cannot be bumped off with a higher concentration.
crux of adverse or lack of therapeutic effects come from patient variables. Onset of action is the absorption, distribution, metabolism, and excretion. the way the body deals with the drug
the time it takes for the concentration of the drug to decrease by 50%. 0.693*volume of distribution/clearance. these can change due to issues with excretion due to reduced renal function (anything that may cause non-ideal circumstances).
first order drugs
liver metabolizes these. they have enzymes cyp450 enzymatic capabilities. For these, the liver has more than enough enzymes to stick to half lives. (nonsaturated kinetics)
zero order drugs
drugs are way overloaded so it is easy to reach toxic concentrations. alcohol. (saturated kinetics)
timing of peak effect
know when patients are most susceptible to see adverse effects. When should we see therapeutic response? If we see adverse events before the ________ _____ ________ ________ this could indicate liver disfunction causing drug to accumulate too quickly
phase 1: oxide, reduce, or hydrolyze
phase 2: conjugation (substance reaches out and latches on to the drug to help excrete it)
free drug concentration
the amount of drug that determines therapeutic effect. this is non bound drug that can actually “do its thing”.
reducing the drug of warfarin until infection is gone then increase warfarin again. This must occur because antibiotics would have a higher affinity to albumins and cause more free-drug warfarin to be present in the bloodstream which could cause toxicity.
the original form is called the parent drug and is then broken down into a ________. these are the children or what it gets changed into through biotransformation. ______s (same term) that are similar to the parent drug have the same therapeutic effect.
will damage the liver if you take too much tylenol. COnjugates will take the _____ _______ out of the body to reduce or prevent toxicity (glutothyone).
Metabolites can become ______ _______s through biotransformation.
concentration needed to make a change in 50% of people (AKA minimum effect of concentration). the concentration a drug must reach in the tissues that respond to the particular drug to cause the desired therapeutic effect
first pass effect can decrease the amount of drug (liver may take 50% of drug only allowing 50% to get to circulation). using a loading dose makes sure that the concentration at the active site gets to the correct level. allows the dose to reach critical concentration sooner
administered after a loading dose to keep the concentration in therapeutic level but lower than toxic level.
drug is put directly into the blood stream (IV) but concentration will drop because a little does get absorbed during first pass (even when not PO). the metabolism and excretion must be matched to reach _________ ___________ to ensure active concentration reaching active site. If renal function goes down then so should the dosage.
drug in inactive form depends on metabolism (liver) to convert the drug to an active ingredient.
site of excretion
80% renal, 20% hepatic elimination. dosage adjustments will list based on renal disfunction or glomerular filtration rate and will provide levels to reduce the drug in order to eliminate toxicity (to prevent buildup).
after absorption a drug goes through _________ _________. The target site is usually met through the blood though it is not always. extra adipose tissue may absorb the drug but if the tissue is where the active site is it is a therapeutic response. If the adipose isn’t a target site, no action will take place.
when the drug is bound to plasma protein (albumin) which is not the active site. 99% protein bound means that 99% is stuck to the albumins and the therapeutic effects are caused by 1% remaining free drug
how much you want to fit or occupy a space. this is in albumins, active sites, and the drugs administered.
minimum effect of concentration
EC50 (meaning 50% of population responded to this dose)
drug effects that are not the desired therapeutic effects; may be unpleasant or even dangerous
name given to a drug by the pharmaceutical company that developed it; also called a trade name
name that reflects the chemical structure of a drug
federal agency responsible for the regulation and enforcement of drug evaluation and distribution policies
process of altering DNA, usually of bacteria, to produce a chemical to be used as a drug
having adverse effects on the fetus
what happens to a drug from the time it enters the body until it enters the circulating fluid; intravenous administration causes the drug to directly enter the circulating blood, bypassing the many complications of absorption from other routes
the movement of substances across a cell membrane against the concentration gradient; this process requires the use of energy
property of a chemotherapeutic agent that affects only systems found in foreign cells without affecting healthy human cells (e.g., specific antibiotics can affect certain proteins or enzyme systems used by bacteria but not by human cells)
movement of a drug to body tissues; the places where a drug may be distributed depend on the drug’s solubility, perfusion of the area, cardiac output, and binding of the drug to plasma proteins
documented effect of the mind on drug therapy; if a person perceives that a drug will be effective, the drug is much more likely to actually be effective
receptor sites: specific areas on cell membranes that react with certain chemicals to cause an effect within the cell
the study of genetically determined variations in the response to drugs
the study of the interactions between the chemical components of living systems and the foreign chemicals, including drugs, that enter living organisms; the way a drug affects a body
movement of substances across a semipermeable membrane with the concentration gradient; this process does not require energy
hepatic microsomal system
liver enzymes tightly packed together in the hepatic intracellular structure, responsible for the biotransformation of chemicals, including drugs
synthetic chemicals used to interfere with the functioning of foreign cell populations; this term is frequently used to refer to the drug therapy of neoplasms, but it also refers to drug therapy affecting any foreign cell
the passage of water and water-soluble components from the plasma into the renal tubule
process by which the presence of a chemical that is biotransformed by a particular enzyme system in the liver causes increased activity of that enzyme system
first pass effect
a phenomenon in which drugs given orally are carried directly to the liver after absorption, where they may be largely inactivated by liver enzymes before they can enter the general circulation; oral drugs frequently are given in higher doses than drugs given by other routes because of this early breakdown
removal of a drug from the body; primarily occurs in the kidneys, but can also occur through the skin, lungs, bile, or feces
bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower-than-normal levels of blood components can be seen
skin reactions commonly seen as adverse effects of drugs; can range from simple rash to potentially fatal exfoliative dermatitis
formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug
excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient’s individual response
overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions
inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems
infections caused by the destruction of normal flora bacteria by certain drugs, which allow other bacteria to enter the body and cause infection; may occur during the course of antibiotic therapy
information gathering regarding the current status of a particular patient, including evaluation of past history and physical examination; provides a baseline of information and clues to effectiveness of therapy
part of the nursing process; determining the effects of the interventions that were instituted for the patient and leading to further assessment and intervention
actions undertaken to meet a patient’s needs, such as administration of drugs, comfort measures, or patient teaching
the art of nurturing and administering to the sick, combined with the scientific application of chemistry, anatomy, physiology, biology, nutrition, psychology, and pharmacology to the particular clinical situation
statement of an actual or potential problem, based on the assessment of a particular clinical situation, which directs needed nursing interventions
the problem-solving process used to provide efficient nursing care; it involves gathering information, formulating a nursing diagnosis statement, carrying out interventions, and evaluating the process
a very old system of measure that was specifically developed for use by apothecaries or pharmacists; it uses the minim as the basic unit of liquid measure and the grain as the basic unit of solid measure.
a method of determining the correct drug dose for a child based on the known adult dose (assumes that the adult dose is based on a 150-lb person); it states
finding the equivalent values between two systems of measure
a method of determining a pediatric drug dose for a child younger than 1 year of age, based on the child’s age and the usual adult dose (assumes that an adult dose would be appropriate for a 12.5-year-old child); it states
the most widely used system of measure, based on the decimal system; all units in the system are determined as multiples of 10
ratio and proportion
an equation in which a ratio containing two known equivalent amounts is on one side and a ratio containing the amount desired to convert and its unknown equivalent is on the other side
a method for determining pediatric drug dose based on the child’s age and the usual adult dose; it states
so-called germ warfare; the use of bacteria, viruses, and parasites on a large scale to incapacitate or destroy a population
a comparison of the relative cost of the same drug provided by different manufacturers to determine the costs to the consumer
includes herbs and other “natural” products as often found in ancient records; these products are not controlled or tested by the U.S. Food and Drug Administration and are considered to be dietary supplements; however, they are often the basis for discovery of an active ingredient that is later developed into a regulated medication
the worldwide digital information system accessed through computer systems
uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the FDA; off-label uses may lead to new indications for a drug
tendency for patients to self-diagnose and determine their own treatment needs
nonprescription drugs with no known therapeutic use; used to enhance mood or increase pleasure