What are the three most important properties of an ideal drug?
safe, effective, selective
produces the anticipated response
can't produce harmful effects even in high doses
only produces the desired effect
What are some important properties of an ideal drug other than safe, effective, and selective? (7)
reversible action, predictable, easy administration, free of interaction, affordable, chemically stable, simple generic name
What are the three names that every drug has?
chemical, generic, brand or trade
What is a chemical name?
precise description of the chemical composition and molecular structure of the drug
What is a generic name?
nonproprietary name assigned by the US Adopted Names Council
What is a trade name?
proprietary name selected and marketed by a pharmaceutical company
Are generic and brand name medications the same?
What drugs would we be concerned about switching for a generic to a brand name?
low therapeutic indexes (warfarin)
What are the six rights of medication administration?
medication, patient, dose, route, time, documentation
What information should you give the patient about their prescription?
drug name, therapeutic category, dosage size, dosing schedule, route of adminisration, technique of administration, non-pharmacologic measures, expected response, duration of treatment, method of storage, major adverse side effects, drug-drug interaction, drug-food interaction, contact person
What is a randomized controlled trial?
RCTs are the most reliable way to objectively assess drug therapies. Subjects in an RCT are either given a experimental drug or a control (standard or placebo) for comparison.
Why is randomization important?
to prevent allocation bias which results when subjects in the experimental group are different from those in the control group
What is a blinded study?
one in which the people involved do not know to which group - control or experiment - individual subjects have been randomized
What is a double blind study?
the researchers as well as the subjects do not know to which group - control or experiment - subjects have been placed
What is the order of new drug development? (5)
preclinical testing, clinical testing phase I, II, III, and IV
Which phase of new drug development is drug metabolism, pharmacokinetics, and biologic effects assessed?
Which phase(s) of new drug development assess(es) therapeutic effects, dosage range, safety, and effectiveness?
phase II and III
Which stage of new drug development involves animals?
Which phase of new drug development involves healthy subjects?
Which phase of new drug development is postmarketing surveillance?
Drug development has historically excluded which groups of people?
women, children, those with co-morbidities
What are the three phases of drug activity?
pharmaceutical, pharmacokinetic, pharmacodynamic
What are the two main components of the pharmaceutical phase of drug activity?
disintegration of dosage form, dissolution of drug
What are the four main components of the the pharmacokinetic phase of drug activity?
absorption, distribution, metabolism, excretion
What is the pharmacodynamic phase of drug activity?
Arrange the following oral dosage forms from slowest to fastest absorbing. (powders, tablets/capsules, liquids/elixirs/syrups, EC tablets, suspension solutions, coated tablets)
Promethazine (Phenergan) is contraindicated in which population?
children < 2 years old
Increased drug sensitivity in infants is due to what five immature pharmacokinetic processes?
absorption (prolonged gastric emptying), protein binding of drugs (albumin levels low), blood-brain barrier (not fully developed), hepatic metabolism (not fully developed), renal drug excretion (not fully developed)
Why is topical drug absorption increased in neonates and infants?
What age is maturation of hepatic metabolism complete?
1 year old
What age is adult renal excretion reached?
1 year old
Describe the variable course of drug metabolism with relation to age.
Drugs metabolism is markedly faster than adults until 2 years of age, then gradual declines until puberty
What adverse effect of glucocorticoids is seen in children?
What adverse effect of tetracyclines is seen in children?
discoloration of developing teeth
How is dosing of a drug determined in the pediatric patient?
most commonly based on body surface area; initial dosing is, at best, an approximation; subsequent doses need to be adjusted
Why are geriatric patients more sensitive to drugs than younger adults?
system degeneration; altered pharmacokinetics; multiple pathologies
The _____ of treatment is essential in geriatric patients.
How does absorption of drugs change with age?
delayed gastric emptying and reduce splanchnic blood flow slows absorption
How does distribution of drugs change with age? (3)
increased body fat allows for storage of lipid-soluble drugs; decreased total body water concentrates drugs and causes a more intense effect; reduced serum albumin causes increase in levels of free drugs
How does metabolism of drugs change with age?
hepatic metabolism declines thereby prolonging some drug effects
How is the half-life of drugs affected by age?
How does excretion of drugs change with age?
renal function undergoes progressive decline beginning in early adulthood (reduced blood flow, GFR, active tubular secretion, number of nephrons)
What is the most common cause of adverse drug reactions in the elderly?
drug accumulation secondary to reduced renal excretion
How should nurses assess renal function in elderly patients?
What CV drug class is less effective in the elderly? Why?
beta blockers; reduced number of beta receptors; reduced receptor affinity
Nonspecific symptoms in the elderly, such as dizziness and cognitive impairment, can be indicative of what?
adverse drug reactions
Nonadherence of drug regimens is highest in which population?
What percent of nonadherence cases are intentional? Why?
75%; expense, side effects, patient's conviction that the drug is unnecessary or the dosage is too high
What is an opioid?
a drug that has actions similar to morphine
What are the three classes of opioid receptors?
Mu, Kappa, Delta
What response is expected when Mu opioid receptors are activated? (5)
How long can your administer meperidine (Demerol)?
up to 48 hours
What chemicals cause pain with inflammation?
What is the action of NSAIDs?
blockade of the production of prostaglandins by inhibiting cyclooxygenase (COX) at the site of injury in the periphery, thus decreasing the formation of mediators of pain in the peripheral nervous system
Are NSAIDs opioids?
What are the three major uses of cyclooxygenase inhibitors?
suppress inflammation, relieve pain, reduce fever
What are the three major adverse effects of cyclooxygenase inhibitors?
gastric ulceration, bleeding, renal impairment
Ketoralac (Toradol) is given as an injection and is restricted to 5 days or less because of this risk.
Which cyclooxygenase inhibitor does not have anti-inflammatory properties?
Which NSAID(s) prevent(s) MI and stroke?
Which pain reliever causes liver damage with overdose?