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Pharmacology study of hisory, sources, and physical and chemical properties and how drugs effect living sytems Pharmacogenetics study of how ecch ind. will respond to specific drugs Pharmacodynamics study of the biochemical and physiological effects of drugs , drug mechanism of action Pharmacokinetics study of abvbasorption, distribution, biotransformation(metabolism) and excretion of drugs pharmacotheraputics study of how drugs may best be used in the treatment of illnesses, which drug would b e most or least appropriate for specific disease and what dose to use Pharmacognosy study of drugs derived from herbal and other natural sources, gaining better knowledge on how to develop synthetic drugs Toxicology study of poisons and poisonings Tablets most posular dosage form and easiet to administer Enteric coated tablet do not score they are to disolve in the small intestine Timed or Sustained Release release of the drug over several hours or slow and steady release Capsules drug is enclosed in a hard or soft soluble shell made of gelatin they consist of 2 parts that slide together, so they can be administered in food or tube feedings Troches lozenge Suppository inserted into one of the external body orifaces, rectum, vagina, or urethra Solutions clear liquid preperation (easy administration) Syrups are sweetend solutions that are often used to mask the unpleasnt taste of certain drugs. Elixirs are solutions but contain a solvent mixture of alcohol and water as well as other components( used as vehicles to disolve drugs) Tintures are solutions that contain alcohol as the primary solvent but shich may contain some water as well Douche solution is one intended to be sed in cleansing a body part or cavity usually vag Suspentions liquid dosage forms that contain drug particles and must be shaken thouroughly for proper administration Emulsions dipersion of fine droplets of and oil in watrer or water in oil, used orally for tatse . or topical to skin or veg oils in jection Topical semisolds apply drugs on the skin mostly for dermatological disorders, Topical patches drug passage through skin Implants implants under skindrugs may be administered for up to 5 years Parenteral Products topical patches Ampules steril sealed vials single dose Vials either single or multiple dose glass containers sealed with rubber daphragm Chemical Name drugs earliest stage often complex Code designation when the chemical name is too complex code is chosen Generic Nonproprietory name is assigned by the U.S Adopted Names Council (USAN) easier to pronounce and remember than chemical name Trade name (brand name) Drug after commercial distrubution, patent name and registered Bioequivelence Theriputic equivelence of generic compared to trade drug same drug but different formulation Food and Drug act of 1906 All drugs manufactured in the US meet minimal standards of Strengh, purity, and quality 1938 Federal food, drug and cosmetic act that a drug be shown safe before it could be distrubted in the interstate commerce Durham-humphrey act 1952 amendment to the food, drug and cosmetic act said that cetain drugs be labled with the legend "Caution - federal law prohibits dispensing w/out prescription 1962 Kefauver-Harris amendment required that both prescriptiona and non prescription drugs be shwn to b effective as well as safe 1970 Comprehensive drug abuse prevention and control act further classified drugs according to their potential for causing abuse. Also regulating manufacturing and distribution of drugs considered capable of causing dependence Federal statues of all drugs may be classified into one of four catagories Prescription or legend, Nonprescription or OTC, Investigational, Illicit (or street) NDA New Drug Application Before manjfactureer can market in the US they must file this, with detailed description of the drug, toxicity, and all ecperimental clinical trials of the drug in clients, then FDA will detrermine saftey and approve distribution DESI drug efficiency study implementation The Fda experts assembled the rating process thate designated drugs that were ineffective to be removed form the market, while drugs that were "possible effective" repuired reformulation or retedsting to remain Prescription drugs may be prescibed by authorixed health practitioners as part of their own specific practice, ie ; vets for animals, ect.. Controlled Substances agents that have been identified as having the ability to cause physical or psychological dependence or both. Classification of controlled substances Five catagories or schedules under the Controlled substances act of 1970 Must be refilled every 48 h to remain valid any controlled substance Nurse responsibility controlled substance to acess client receiving drugs for development of physical and or psychological dependency or abuse Nonperscription drugs drugs that may be acquired by the client with out prescription OTC Schedule I High potential for abuse and no accepted medical use in the US ie heroin, LSD Schedule II high protential for abuse, but do dave a currently accepted medical use in US. drug has been determined that abuse of this drug may lead to a severe psychological or physical dependence, ie. meperidene, morphine, cocaine, oxycodone, Ritalin Schedule III drugs have accepted medical uses in the US but hae a lower potential for abuse than Schedules I and II, eg. Tylenol with coeine, hydrocodone Schedule IV drugs that have low potential for abuse relative to schedule III abuse or thes drugs may lead to limited physical orpsychological dependence as compared with schedule III eg. Librium, Vailium Schedule V Drugs with lowest abuse potential of the controlled substances, consis of preparations containing limited quantitites of certain narcotic drugs generally use for antitussive and atidiarrheal properties, eg, lomotil, Robitussin A-C Schedule VI Some states have adopted this schedule for marijuana(north carolina) wihch is the only drug in this schedule. Reason is marijuana has limited medicinal use by prescription in selected situations. Catagory I drugs recognized by FDA as safe and effective for the therapeutic uses claimed for them Catagory II drugs not recognised by FDA as safe and effective Catagory III agents for which additional datas were required to establish safety or efficiency IND Notice of claimed investigagtional exemption for a new drug requirement that manufacuers must do after carrying out experimentation on animal to start experimentation on humans FDA medicalproducts reporting program an internet site for health professionals and consumers to voluntarily report adverse events nd product problems, drugs, medical devices, ect. The most widely used source of drug information in an institution Forumulary give the drug products that are useful and economical AHFS American society of hospital pharmacist reference that is sometimes available at a nursing station Physicians desk reference annual publication primarily for use by prescribers. contains several types of drug info identified by color coded pages, listed by generic and brand names as well as by manufacturer with colored pictures American Drug Index published annually lists basic drug info ie generic and brand, manufac, uses dosages and dosage forms, (little pharm info) Drug Facts and Comparisons Highly useful in annual bound version as well as in looseleaf and computer versions, : lists a variety of info including theactions indication interaction warning contraindictions, precautions, and client info for each drug. related drugs is presented in tabular form for easy comparisons of the content and relative cost of competing products Handbook of Nonprescription drugsq most available source for non prescription drugs Drug interactions guide hebal-drug interactions and the effects of drugs on clinical lab test. Info on the mechanism if known of each listed drug interaction , incl nurshing journals, textbooks and periodicals, as well as the product info that may accompanhy the drug package The Pharmacist best resource for drug info both in the institution and in the community most current and complete Product Insert detailed description of drug product that is reqaured to be included i the package of all legend drug products in the US with brand name and generic name, description, clinical pharacology, indications and usage, contraindictions, warnings, precautions , overdosage, dosage and administration, how supplied Drugs action they do not create new cellular functions but rather alter existing ones, altering chemical composition of body fluid, or forming a chemical vond with specific receptors Drugs that fit into the receptors are expected to elicit a comparable drug response Drugs that dont fit into the receptors will produce a weak response or not all all Antagonist a drug that have no specific pharm action of their own but interact with a receptor to inhibit or prevent the action of a an agonist Side effects those that result from the pharimcological effects of the drug Adverse effects negative side effects Drug Toxicity a predictable adverse drug effect related to dosage Theraputic index the safety of a drug expressed in the ratio: TI= LD50/ED50 LD 50 is the lethal dose of drug that will kill 50% of animals tested ED50 is the effective dose that produces a specific theraputic index in 50% of animals tested Allergic or hypersensitivity to drug not the result of the pharmacological action but that of one own immunological sysgtem to the presence of the drug allergic reaction occurs immediately after exposure of the sensitized individual or may be delayed for hours or days. Allergy appears as mild skin rash, hives, itching and difficulty breathing(dyspnea) Idiosyncratic drug reaction 1st exposure to a drug unlike allergy reaction , defined as abnormal reactivity : range from extreme to minute concentration on drug to complete resistance to drug even with higher doses Tetrogenic drug one that will cause a congenital defect in a n infant whose mother took drug while pregnant. Drug tolerance and dependence such as narcotics. barbituates. and antianxiety drugs : after repeated doses Drug tolerance a client develops a rsistance to the efectrs of a drug. characterized by the need for increased dose or frequemnc of drug administration. Its a PHYSICAL symptom Physical Drug tolerance When the body becomes so accustome to drug that the body cannot function normally unless the drug is present. withdrawal signa and symptome may occur. Psycological Dependence occurs when the drug is the center of a persons thought emotions, and activities. Physical effects are not present when the drug is withdrawn. Clients should be monitored closesly for dependence. Automatic stop order plicies help prevent unwanted drug dependency. Gradual decrease and differant drug will be prescibed Pharmacokinetic Factors the study of the liberation, absorption, distribution, biotransformation, and excretion of drugs. Inclused the sudy of the relationshiop of each of thes factor to the concentraion of a dur and or its chemical by product in various body sites oan over various periods. Lieration when a solid drug is admin. enterally (through the GI system) orrally, it must first disolve in gastric or intestinal fluid before it can be absorbed into the bloodstream. Administration of fluids with the dose will increase absorption rate and speed Bioavailability administration of two products containing the same drug results in the smae degree and are said to be bioequivelent Absorption processs by which a dug passes for its site of administration into fluids of the body that will carry it ot its site of action, 1st passage of a drug through the body unless it is introduce directly into the blood stram by iv Gastric influence of drug eg. food, may interfere, or dlay the transit time of drug, important because most drugs are absorbed in the small intestine. Stomach acidity may vayr at differnt time of the day. in differant ages, or because of injested material Sublingual administration sl under the tongue Translingual administration on the surface of the tongue Buccal inner cheek reason for sublingual translingual and buccal so the the drug gets into the bloodstream before being destroyed by the liver Parenterally (by injection) administration reason undergoing an absorption process that may route to site of action more efficiently Subcutaneosly injection is slower than IM because muscles have more blood vessels than subcutaneous tisssue. Im Intermuscular injection site speed increased by heat, massage or both Im or subcutaeous speed of absorption can be reduced by cold packs orcompress or vasoconstrictor(epinepherine) Depot injections sq or im injections may need to be slowed for sustained release by a formulated suspension, poorly soluable in water, or oily vehicle, Rectal absorption medicated enima,or supp, unpredictabe results, used alot for nausea and vomitting Distribution the process by which a drug is carried from site of absorption to site of action Drug entering bloodstream is carried most rapidly to the organs having most blood suppy, suchas heart kidneys brain, liver. less blood supply get much slower: muscle, skin , fat Physical and chemical characteristics of drug determine how the drug will be distributed. eg. drugs that are highly soluble in fatty tissue may accumulate rapidly in fat, acting as a reservoir and slowly releasing the drug back into the blood, prolonging the drug effect and delaying elimination(aome general anisthetics) Bound drugs drug is incapable of eliciting a pharmacological effect. in most cases equilibrium is established between bound and unbound drug, permittin boug=d drug to be release drom its binding sites when plasma concentration of unbound drug diminish. Two bound drugs administered both capable of being protein bound may compete for same binding site, displacemt of one dound drug by antother may increase the observed response to the displaced drug because mor may be circulating in blod, eg of drug interaction occurs when aspirin and wararin are use dtogehter. aspirin dis;lace s thje arfarin form its bs, resuts in increased anitcoagulant effec and hreater chance of hemorrjage. close monitoring is essential Biotransformation (metabolism) most reaction occur in the liver and are perfformed by the liver enzy,es with the drug. may be useful because it may allow body to inactivate a potent drug before accumulating and becoming toxic Microsomal enzymes drug-metabolizing enzymes, originate in smooth endoplastic reticulum of liver. reaction prduced when drugs are acted on by enzyes aka metabolites or active metabolite Microsomal enzyme inducers drugs eg(phenabarbitol) capable of inducing the release of microsomal enzymes for liver in a greater quantity than would be normal. Reason for microsomal enzyme inducers client may recieve drug that is normally metabolized and begins using a microsomal inducing drug in some cases a cicro somal enzyme drug may also be metabolized by me. this phenomenon has been used to wxplain why the dosage of cetain drugs must b continually increased to elicit sam response Elimination drugs and the metabolites may be eliminated form the body in severla differt ways. Most imp route of drug elimination kidneys, some thru feces, exhaltion of resp tract, breast milk, saliva, sweat. Measuring drug action drug half life or elimination half life if elimination half-life of drug was 4 h amount after 4h= 50% amt after 8h=25% after 12 h= 12.5% ect... Peak plasma point of drug is the highest plasma level achieved by administration of a single dose of drug Minimal level required to elicit a pharmacological response MEC MTC drugs that remain under the plasma level at which toxic effects of the drug are observed MTC Plasma level versus time plot of a drug administered orally at 4 h intervals in order to keep the plasma concentration of thedrug between the MEC and MTC Lowest level of drug concentration in body Trough level Information needed when gathering Plasma Concentration of a Drug 1. Prior history of drugs use in the client 2. Time of sampling 3. Age and weight 4. Other meds 5. statur of cleints renal, hepatic, heart Individual variation of pharacological response factors age, sex, weight, surface area, basal metabolic rate, disease states, genetic factors, Placebo effects, time of administration, tolerance, environmental factors, idiosyncratic responses, Drug interaction occurs when the pharm effect of one drug are poentiated or diminished by another drug, and effects are greater than that which would be expected by the individual effects of e drug together, drugs acting synergistically Synergistic drug when 2 drugs act at the same time and pharmacological response is greater than the which would be expectedby client Antagonistically action on drug diminishes another Drug interaction can be desirable or undesirable Herbs used world wide by up to 80% population Nursing Implications two important facts 1. herbs are not regulated by the FDA 2. hebals, like drugs are chemicals and have influence on the body