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78 Cards in this Set
- Front
- Back
Pharmacotherapeutics
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clinical Pharmacology
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Pharmacodynamics
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action and observable effects, biochemical and physiological
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Pharmacokinetics
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absorption, distribution, metabolism, excretion
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Toxicology
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study of harmful effects
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Therapeutic effect
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effect for which drug is administered
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side effect
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any effect other than the therapeutic effect
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untoward effect
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harmfull/ unpleasent side effet
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3 cardinal rules of drug action
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1. all drugs are potential poison
2. all drugs have more than one effect 3.drugs do not cure disease, they relieve symptoms |
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1906 Pure Food and drug act
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drugs to be labeled and manufactured according to USP and NF
drugs did not have to be safe or effective |
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1938 Federal Food Drug and Cosmetic Act
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saftey ensured
quality/ purity of origin assured improved labeling |
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1952 Durham-Humphrey Amendment
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distinguishes rx drugs (legend drugs) vs over the counter (no rx needed)
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1962 Kefauver-Harris Drug Amendements
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drug must be effective as well as safe
Thalidomide incident (1958) |
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1970 Drug Abuse Prevention and Control Act
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Controlled Substances Act
reserach into and prevention of drug abuse treatment/ rehab of abuseres strengthen law inforcement authority improve regulation of manufacture and distribution |
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Schedule of controlled drugs I-V
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I - moste stringent regulations V- least strict
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Schedule I
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forbidden except for research
highest abuse potential researchers must apply to FDA for clearance - IND9investigational new drug exemption) |
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Schedule II
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high potential for abuse (psychological and physiological dependence)
30 day supply, no refill, must renew rx 90 day supply in some cases |
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Schedule III
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moderate to low physical dependence
maybe high psychological dependence 5 refills then new rx, may renew by phone/ fax |
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Schedule IV
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lower potential for abuse
rx like Schedule III |
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Schedule V
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DEA monitors distribution
Pharmacy keeps records RX needed in Ca |
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FDA
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must approve studies
quality control |
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Public Health Service
under HHS (health and human services) |
helps with biologics, if company makes serum, antitoxin etc. - Department of Public Health
-inspects and licenses establishment -examines and licenses products |
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D.E.A. under Department of Justice
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Drug Enforcemnet Administration, established in 1973
controles distribution and sale of all drugs seperation of drug enforcement and approval for new drugs |
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Department of Commerce,
Federal Trade Commission |
controles misleading advertisment for over the counter drugs
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efficacy
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largest effect that a drug can produce
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potency
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amount of drug needed to get an effect
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Therapeutic index
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lethal dose/ effective dose
high number desired indicate relative margin of safety |
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additive
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when the combined effect of two or more drugs administered at the same time is equal to the sum of their individual effects (2+2=4)
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antagonistic
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two or more drugs are given together and combined effects are less then the algebraic sum of the individual effects (2+2=1)
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synergistic
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when the combined effect of two or more drugs administered at the same time is greater than anticipated from the sum of their individual effects (2+2=6)
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potentiation
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the increase in effectiveness seen when a drug that has no effect by itself increases the effect of a different drug (0+2=3)
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official name
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name used in the official drug reference, the U.S.P
between 1906 and 1976 N.F. was also official, now combined with U.S.P. |
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chemical name
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name describing the exact chemical composition of a drug
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generic name
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code name given during testing
will become official name when included in U.S.P. |
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Trade name
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copyrighted name, copyright might be renewed so name stays with company
in contrast to patent on the drug itself (17 years) after that other companies can produce under generic name |
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U.S.P.
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Pharmacopeia of the United States of America
first in 1820, every 5 years single drugs older drugs deleted in favor of newer, more effective agents |
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N.F.
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National Formulary 1888-1975, now with U.S.P.
single drugs and formulas for drug mixtures often includes drugs deleted from U.S.P. |
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AMA Drug Evaluations
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prepared by appointed experts
drugs grouped according to use general discussion provided for each group |
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P.D.R.
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Physician's desk reference
manufactures buy space cross references information like drug inserts |
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Drug Facts and Comparisons
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grouped according to use
includes over the counter medications |
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A.H.F.S.
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American Hospital Formulary Service
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local drug activity
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drug action occurring only at site of application (usually skin or mucous membranes)
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Systemic drug activity
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action of drug that is absorbed then distributed through the body
1. whole body or target organ 2. toxic effects may occur when drug applied for local effects - becomes systemically absorbed |
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parenteral
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everywhere but GI tract
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Skin
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local action intended
caution broken skin uses: antiseptic, cleaning, emollient |
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Nasal mucosa
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local - too much may become systemically absorbed
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Inhalation
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local - antibiotics, detergents and enzymes for breaking up secretions
systemic- anesthetics |
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Genitourinary
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usually local action intended
caution: if traumatized tissue can get dangerous systemic effect |
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Gastrointestinal Tract (Enternal Routes)
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oral
sublingual or buccla rectal |
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Oral - usually systemic effect
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timing around meals:
before - quicker absorbtion with - drug irritations after - slower absorbtion contraindications patient vomitting or unconscious drug too irritating drug doesn't reach blood in high enough concentration (not absorbed through GI tract, destroyed by digestive enzymes, destroyed by liver) bypass using sublingual, buccal or rectal route |
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Sublingual and buccal
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systemic (for drugs destroyed by liver)
local anesthetic or entiseptic |
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Rectal
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local - stimulate defecation refelx
systemic - retention enemas or suppositories 1. bypass liver and digestive enzymes 2. irritating to stomach 3. uncooperative/ unconcious patient 4. antiemetic |
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Parenteral routes
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referes to injetions
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Parental routes
more hazardous |
rapidly absorbed
local tissue damage entrance of microorganisms |
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Types of injection
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intradermal
subcutaneous intramuscular intravenous antraarterial intraspinal intraarticular |
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subcutaneous
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must be highly soluble and potent in small volume
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intramuscular
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spreads over larger area
suspensions absorb slowly fewer sensory nerve endings irritation less likely caution - blood vessels and nerves in area |
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intravenous
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most rapid, most dangerous
injection - irritating subsatnce or emergency infusion - often just fluids and electrolytes |
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agonist
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increases/ intensifies activity of receptor
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partial agonist
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compound which increases the activity of a receptor but is less effective than other agonist and can decrease their effectiveness when in competition with the for the same receptor
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antagonist
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decreases activity of receptor or prevents agonist from acting on receptor
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competitive antagonist
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binds to same receptor site as agonist
effects are reversible competition with agonist can control exact degree of response |
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noncompetitive antagonist
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binds to different part of receptor than agonist but still prevents normal agonist action
cannot be displaced by competition can block effect no matter what concentration of agonist |
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structurally specific drug
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drug that requires a specific receptor
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structurally nonspecific drug
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simple chemical/ physical reaction
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Factors that influence the rate of passage through a membrane
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lipid solubility
non ionized move more readily ionized particles are trapped |
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passage through pores
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influenced by size and shape of molecule
degree of ionization acidic drugs - less ionized at low pH alkaline drugs - less ionized at high pH |
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absorption
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transfer of drug molecules from place deposited to circulating fluids
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factors that affect drug absorption
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route of administration
local conditions at site of administration chemical properties of drug form of medication given |
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factors that affect drug absorption
"chemical properties of drug" |
lipid solubility vs water solubility
lipid soluble will pass through membrane passively, water soluble will be repelled (charged) size and shape of molecule, the smaller the easier degree of ionization (ionization produces charged molecules that will not pass through the cell membrane, therefor degree of ionization influences absorption) |
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distribution
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blood brain barrier
placental barrier |
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blood brain barrier
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very tight junctions
capillaries are less permeable, glial cells are tightly packed together, small pores lipid soluble drugs will be able to dissolve in blood brain barrier and gain access to the CNS |
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placental barrier
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very large intracellular spaces
low perfusion area |
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effect of plasma protein binding on drug distribution
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slow release of drug
cn affect onset, intensity ad duration sometimes use prime dose, than smaller maintenance dose |
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drug metabolism
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usually liver
usually changed to less active chemical, if more active often metabolized again more ionized, so more readily eliminated cytochrome P450 |
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cytochrome P450
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enzymes induced by drug, than that drug will be metabolized more readily
enzymes inhibited by drug than drug will be metabolized more slowly smoking/ drinking induce P450 |
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individual patient differences
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age
a. infant - immature systems, incomplete blood brain barrier b. aged - deterioration of systems, cardiovascular disease weight sex environment (physical/ psychosocial issues) Physiological, pharmacological or pathological state genetic predrug status |
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drug idiosyncracy
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any abnormal or peculiar response to a drug generally thought to be a result of genetic deficiencies that lead to abnormal metabolism of drug
can not be predicted!!!! |
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drug allergy
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reaction to drug resulting from previous exposure
local or systemic can not be predicted without prior "allergic" experience |