Chapter 1 Integrated Cardiopulmonary Pharmacology
Terms in this set (95)
Adverse drug reaction
Can range from a mild rash to a life- threatening loss of blood pressure: allergies, headaches, bronchospasm, tremors, and photosensitivity.
What is one of the most serious ADRs?
A hypersensitivity reaction which can present itself as acute pulmonary edema, bronchial asthma, pulmonary fibrosis, or respiratory muscle impairment
How many drugs have been shown to cause pulmonary ADRs?
More than 150 drugs
American Hospital Formulary Service
Central nervous system
Chronic obstructive pulmonary disease
Food and Drug Administration
Regulates testing and approves new drugs in the U.S. market
Human immunodeficiency virus
Nothing by mouth
Over the counter
Physicians' Desk Refence
Published yearly and has product information mandated by the FDA. Same information as on drug insert but also pictures, which are useful in identification of unknown drugs.
American Hospital Formulary Service (AHFS) and Drug Facts and Comparison.
Personal Digital Assistant (PDA) versions of above references
By mouth (Latin per os)
United States Adopted Name Council
United States Pharmacopeia
Volume of distribution
This is the rate-limiting step—In other words, how fast it takes the drug to dissolve determines the rate of effect. IV is fastest because it bypasses the absorption process by going right into the bloodstream.
A continuous infusion
(e.g., IV drip) gives a regulated, consistent dose over time, causing a steady state in drug concentration
An intermittent dose
(e.g., injected shot) has peaks and troughs in drug concentration
The sum of the effects of two drugs given together is equal to each of them given separately but at the same time, or 1 + 1 = 2.
Binds with receptor (affinity) and causes a response. In other words, it activates the receptor
Binds with receptor (affinity) but has little or no response (e.g., protamine to inactivate heparin).
An antagonistic drug's intrinsic activity is 0, meaning it would bind but have no response.
Measures the amount of drug absorbed into circulation. It is influenced by drug solubility, dosage form, route of administration, and pH, to name a few factors
Brand Name or Trade Name
Owned by the company that discovered and produced the drug. For example, Sudafed® is the trade name for generic pseudoephedrine. Trade names are traditionally capitalized and have the registered trademark symbol.
Describes the chemical structure and is long and very complicated. This has little clinical use but is needed to make the drug.
Common Sense Rule: 6 Rights
Right drug—Tell patient name and use and check order.
Right dose—Most are unit dosage.
Right patient—Check wrist tag.
Right time—Check order.
Right route—Check order.
Right documentation-According to institution policy.
Can be physiologic and/or psychological, and both have withdrawal symptoms
Long-term exposure of drug to cell or tissue makes it less responsive over time.
Collective management of all aspects of disease and not just the pharmacotherapy.
Major vehicle for distribution is the bloodstream. Several things can affect distribution, such as blood flow, fat or water solubility, or protein binding.
Drugs are derived from a variety of sources, including plants, animals, minerals, chemicals, and recombinant DNA. Most drugs are now chemically synthesized, but in the future, many may be bioengineered.
Indications and contraindications
Drug interactions and adverse drug reactions
Dosage and administration
Drugs are first tested on animals; if the results are positive, testing proceeds to human trials
Human phase of testing involves
People who have the disease
Large multicenter trials
The extent to which a drug acts at one specific receptor site.
Emetics (which induce vomiting) may or may not be indicated. For example, a caustic drain cleaner that burns on the way down will also burn on the way back up.
This is the last component of pharmacokinetics, where the drug is excreted from the body.
Drugs can be excreted via urine, feces, pulmonary system, skin, and hair.
Urine testing and even hair testing can tell the types of drugs in the body, and the breath test can tell the amount of alcohol being excreted by the lungs.
Impaired renal function can prolong effects of drugs
Administered via the gastrointestinal (GI) system, PO = oral, SL = sublingual, NG = nasogastric, and rectal.
After being absorbed, some drugs do not go directly into circulation but pass through the liver, where enzymes can begin to inactivate. This is one reason why equivalent oral doses are higher than IV doses
Figure 1-8: The first pass effect. Drugs administered orally are first absorbed through the small intestine and then enter the liver where they begin to be metabolized (broken down) before reaching the bloodstream.
A list of drugs available at a particular health care system (drug stock at hand).
Given by United States Adopted Names (USAN) Council. Not owned by a particular company, called the nonproprietary name, and usually written in lowercase.
Time it takes for concentration of drug to decrease by one-half after administration. Drugs with short half-lives don't stay in the body long
Liver Disease can increase half-life, causing drugs to stay around longer and have greater-than-expected effects
Drug Half Lives (Table I-6)
Used in complementary or integrative medicine.
Little control of dosage, purity, and contaminants.
Herbal medicine has valid use but must be studied and undergo controlled production.
Many interactions with prescribed drugs
Inhaled into the lungs and absorbed into the pulmonary capillaries
Measure of drugs effectiveness of causing a response (efficacy). Example:
An antagonistic drug's intrinsic activity is 0, meaning it would bind but have no response. An intrinsic activity of 1 would be a full agonist, and 0.5 would equal a partial agonist.
Movement, and this literally means what happens to a drug from the time it enters to the times it leaves the body. Four phases: 1) Absorption, 2) Distribution, 3) Metabolism, 4) Elimination
After the drug has been absorbed and distributed, the body works to break it down via metabolism into several components called metabolites (some metabolites are active)
Major organ for Metabolism?
The liver is the major organ for metabolism via drug oxidation by the Cytochrome P-450 enzyme system. These enzymes can induce (increase) or inhibit (decrease) metabolic activity. Enzyme induction explains why people who frequently drink alcohol become more tolerant to it.
Drugs that Affect Live Enzymes (Table I-5)
Rifampin Influenza vaccine
Contains one third of the drug metabolism capacity as the adult liver therefore metabolism is reduced at birth.
_____ alone accounts for a reduction of 20-30% of liver mass
Increased doses, to saturate receptors and quickly achieve blood levels.
Subsequent, smaller doses to maintain therapeutic levels and steady state
Injectable routes that get right into the bloodstream and avoid the first-pass effect (e.g., IV = intravenous, IM = intramuscular, SC = subcutaneous).
What a drug does to the body.
Once absorbed, drug must reach receptor site where the action is.
The study of drugs and their action on the body, is a discipline that hinges on basic and clinical science.
A combination term for pharmacology and therapeutics
One of the drugs has no direct effect yet increases the expected effect of the other drug, or 1 + 0 = 3.
Drug potency is the amount of drug required to produce a desired response. If you only need a little, it is a potent drug.
When the drug response is compared to the drug dosage or concentration, a dose relation curve can be constructed
All drugs require proper prescription orders
Some hospitals may have protocols or standing orders for some drug usage.
Protein binding (Involved in distribution)
Protein binding occurs when a portion of the drug is bound to the proteins in the blood and therefore is not able to be free to bind to an active site and produce an effect.
Many drugs are available in racemic mixtures, which contain two different isomers. An isomer has the exact elemental components but the molecular arrangement is different. Each isomer can have different pharmacologic activity
When a Drug Binds to a Receptor, Three Things May Happen:
1) An ion channel can be opened or closed (e.g., calcium-channel blockers).
2) Biochemical messengers activated (e.g., beta-adrenergics causing increased cyclic 3, 5, AMP).
3) Normal cellular function turned off or on(e.g., antibiotics destroy cell wall).
Red flag Red Flags (Table I-I)
Drugs are those that have been identified as having an increased risk for causing or being involved in drug-drug interactions:
Synergism [Synergistic interaction]
Giving two drugs together results in a greater effect than expected if given separately, or 1 + 1 = 3.
Drugs are classed or grouped according to the drug use. For example, therapeutic classification of bronchodilators can have several drug classes (xanthines, beta-adrenergics, parasympatholytics, etc.).
The effective level in the blood is termed the therapeutic range.
Below this level, the drug is not likely effective.
Above this range, the danger of toxicity is present.
Figure I-4 Names of Drugs with blood levels/ranges
The study of drugs used to cure, treat, or prevent disease
(TI) is the ratio between the minimum effective dose and the maximum tolerated dose.
Increased amount of a drug is needed to produce the same effect
Toxicology is the study of drugs related to poisonings and environmental toxins
Absorbents bind to toxic agent (e.g., activated charcoal).
Through the skin, as in a skin patch, which allows slow release of the drug over time.
Volume of distribution
The size of a compartment necessary to account for the total amount of drug in the body if it were present throughout the body at the same concentration found in plasma.
c with a line over it
Drug Routes: Oral, Sublingual, Rectal, Nasogastric tube, Intravenous, Intramuscular, Transdermal, Inhalational
Oral (PO): May be enteric-coated, sustained-release, tablet, capsule, some crushable, some lose their potency when crushed---most convenient and economical
Sublingual (SL): Provides quick onset with good salivary flow
Rectal (PR): Can be more convenient when patients cannot swallow (nausea/NPO)
Nasogastric (NG) tube: Be careful of drug stability and cloggin up the tube
Intravenous (IV): Use in quick onset, emergency situations, and long-term infusions
Intramuscular (IM) Once injected, is there to stay, even if side effects occur
Transdermal: Is easier to remember, because doing less frequent
Inhalational: Has fewer systemic side effects, requires coordination
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