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74 Cards in this Set
- Front
- Back
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Drug-drug interactions |
-can occur when taking 2 or more drugs -can be desired and intended -can be undesired and unintended |
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3 consequences of drug-drug interactions |
1. Intensification of effects 2. Reduction of effects 3. Creation of unique response |
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4 basic mechanisms of drug-drug response |
1. Direct chemical or physical interaction 2. Pharmacokinetic interaction 3. Pharmacodynamic interaction 4. Combined toxicity |
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Drug absorption effects in drug-drug interaction |
-drug enhanced or reduced -ex: laxities, elevating gastric pH |
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2 ways drug distribution can be altered |
1. Competition of protein binding 2. Alteration of extracellular pH |
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Metabolism alteration or drug interaction |
Inducing synthesis of hepatic drug-metabolizing enzymes |
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Inducer |
When a drug metabolism is stimulated by increasing the synthesis of a hepatic drug metabolizing CYP enzymes |
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Substrate |
A drug that is metabolized by an enzyme |
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Inhibitor |
Drug that decreases the metabolism of other drugs by inhibiting the activity of the enzymes |
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4 effects that drugs that induce p-glycoprotein have on other drugs |
PGP exports drugs from cellls 1. Reduced absorption 2. Reduced fetal drug exposure 3. Reduced brain drug exposure 4. Increased drug elimination |
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Desirable drug-drug interactions |
- drugs that increase therapeutic effects -drugs that reduce toxicity
-drugs tha |
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Serious drug interactions is proportional to? |
-drugs that reduce therapeutic effects -increases toxicity |
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Ways nurses minimize adverse drug-drug interactions |
1. Decrease # of medications 2. Take through drug history 3. Adjust dosage when inducer of metabolism is added or deleted 4.adjust administer timing |
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Co-administration with food can cause |
1. Decreased/increased absorption 2. Grapefruit juice affecting metabolism 3.increase toxicity 4.drug action impact 5. Timing of administration |
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When should you administer dose when it states to take ok an empty stomach? |
2 hours after a meal or 1 hour before |
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Pharmacodynamics |
The study of what drugs do to the body and how they do it |
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Difference between pharmacokinetics and pharmacodynamics |
Pharmacokinetics is how drugs move through the body and pharmacodynamics is about the effect drugs have on the body |
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Dose-response relationship |
As the dose increases, the response will increase |
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Maximal efficacy and where on the dose-response curve is it |
The largest effect a drug can produce Efficacy is noticed on the curve as the height of the dose-response curve |
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Receptors and examples of receptors |
-Chemicals in body that most drugs interact with -examples are hormones, neurotransmitters, and regulatory molecules |
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4 Types of receptor families |
1. G-coupled receptor system 2. Ligand-gated ion channel 3. Cell membrane embedded enzyme 4. Transcription factor |
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Selective drug and selective receptor |
-selectivity is the drug elicits response for which it is given -selective drug compared to a selective receptor, the receptors are selective for specific drugs due to it being the only drug to fit in that receptor |
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Simple occupancy theory |
The intensity of a response of a drug is proportional to the number of receptors occupied |
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Modified occupancy theory |
The relationship between affinity and intrinsic activity High affinity = high potency Increase intrinsic activity = increased max efficacy |
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Affinity |
Strength of the attraction between a drug and its receptor |
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Agonist |
Activate receptor Mimics endogenous chemicals Have affinity and increased intrinsic activity |
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Partial agonist |
Agonist with moderate intrinsic activity, only activity on a certain level The max effect = less then full agonist |
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Antagonist |
Prevent or decrease receptor activation Have affinity but no intrinsic activity |
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Non competitive antagonist |
Bind irreversibly |
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Competitive antagonist |
Able to bind reversibly |
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Drug responses that do not need a receptor |
-antacids -antiseptics -laxative -chelating agents |
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What makes it impossible to know how exactly a patient will respond to a medication |
Interpatient variability |
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ED50 |
Dose require to produce an effective or therapeutic response to 50% of the population |
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Therapeutic index |
Measure of the safety of the drug |
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Larger therapeutic index |
Safer |
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Smaller or narrow therapeutic index |
Less safe |
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Adverse drug reaction |
Any unintended effect that occurs at Norma drug doses |
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Mild adverse drug reactions |
Drowsiness Nausea Itching Rash |
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Severe adverse drug reaction |
Respiratory distress Neutropenia Heaptocellular injury Anaphylaxis Hemorrhage |
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Side effect |
Nearly unavoidable secondary drug effect produced at therapeutic doses whereas adverse effects can be avoided |
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Toxicity |
Adverse drug reaction caused by excessive dosing but may also occur at normal dosing |
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Allergic reaction |
Immune response Determined by the degree of sensitivity rather then dosage |
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Are allergies common to drugs? |
No |
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Idiosyncratic effect |
Drug response from genetic predisposition |
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Paradoxical effect |
The opposite of intended drug response |
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Iatrogenic disease |
Disease produced by drugs (or physician) |
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Physical dependence |
Develops after long term use or certain drugs |
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Abstinence syndrome |
Can result after discontinuation of drug depended treatment after the body has adapted to drug exposure |
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Carcinogenic effect |
Only a few drugs are carcinogenic
Cancer drugs have the most carcinogenic potential |
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Teratogenic effect |
Drug-induced birth defects |
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2 types of organ specific toxicity |
1. Hepatotoxic drugs- leading to liver failure 3. QT interval drugs- changes cardiac rhythm |
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Medication guides |
Documents FDA approved to educate patient on minimizing harm from potentially harmful drugs |
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Black boxed warning |
Strongest safety warning a drug can carry and still remain on the market |
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2 purposes of blacked box warning |
1. Potentially severe side effects- fetal harm 2. Ways to prevent or reduce harm |
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REMS |
Risk evaluation and mitigation strategy Plan to minimize drug induced harm |
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Medication error |
Major cause of morbidity and mortality |
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3 causes of fatal medication errors |
1. Human factors 2. Communication mistakes 3. Drug name confusion |
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3 common human errors in drug therapy |
1. Performance deficits- most common 2. Knowledge deficits 3. Miscalculation of dosage |
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Types of medication errors |
Prescribing Transcription Dispensing Administration |
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Factors that contribute to age related variations in drug response |
1. Increase severity of illness 2.multiple pathologies 3. Treatment with multiple drugs |
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Affects of kidney disease on drug excretion |
- reduced excretion and increased toxicity -decrease dosage must happen |
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Liver disease and drug metabolism |
-liver function decline, decreasing metabolism, and increasing drug levels |
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Electrolyte abnormalities and drug toxicity |
When drugs are given thar decrease an electrolyte like potassium, while potassium levels are already low, this can cause fatal responses |
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Tolerance |
Decrease responsiveness to drug after increased use Requires higher doses |
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3 categories of drug tolerance |
1. Pharmacodynamic tolerance-associated with long term administration of drugs 2. Metabolic tolerance-accelerated drug metabolism 3. Tachyphylaxis- reduced drug response due to repeated dosing |
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Placebo effect |
Any response based on psychological reaction to drug |
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Are placebo effects beneficial |
Not always and they can detract from the patients progress with them thinking the drug is harmful |
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Bioavailability |
Ability of drug to reach the systemic circulation from its site of administration |
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What preparation would bioavailability likely occur in |
Oral- due to tablet disintegration time, enteric coating, and sustained release formulas |
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Affect of diarrhea on drug absorption |
Decreased drug absorption due to the diarrhea accelerating the drug through the intestine |
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Gender related drug differences |
1. Women metabolize alcohol slower 2. Certain opioid analgesics are more effective in women 3. Quinidine cause greater QT interval in women |
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What effect can starvation have on drugs |
Starvation can reduce the bonding of drugs |
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What interaction can drugs have on comorbities |
Drugs taken to treat one condition may complicate management of another |
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Factors that influence patient to take medication |
Manual dexterity Visual acuity Intellectual capacity Physiologic state Attitude toward drugs Ability to pay |
