Basic Pharmacology ch. 9 and 10

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Drug: Chemicals used to diagnose, treat, or prevent disease.
Pharmacology: The study of drugs and their interactions with the body
Chemical Discription: The most detailedname for any drug.States its chemical composition and molecular structure. i.e. ethyl-1-methyl-4-phynylisonipecotate hydrochloride
Generic Name: usually suggested by the manufacturer and confirmed by the United States Adopted Name Council. Becomes the FDA official name when listed in the USP. Usually lower case.
USP: United States Pharmacopeia.The official standard for information about pharmaceuticals in the United States.
Brand Name: Also called trade name or proprietary name. a proper name and should be capitalized. Most mfg. register the name as a trademark.
What are the 4 main sources of drugs: Plants, animals, minerals and laboratory(synthetic)
What are the sources for drug information?: United States pharmacopeia (USP), Physicians Desk Reference (PDR), Drug Information, Monthly Prescribing Reference, AMA Drug Evaluation
What are the components of a drug profile: names, Classification, Mechanism of action, indications, pharmakinetics, side effects, contraindications, dosage, how supplied, special considerations
Components of a Drug name: Most frequently include the generic and trade names. Be aware of every name for each med.
Classification: The is the broad group to which the drug belongs.
mechanism of Action pharmacodynamics: The way in which a drug causes is effects; its pharmacodynamics. The most important part of what we (EMS) are going to see.
Pharmacokinetics: How a drug is absorbed, distributed, metabolized(biotransformed), and excreted; how drugs are transported into and out of the body
BEAD: Biotransformation
Elimination
Absorption
Distribution
Side Effects/Adverse Reaction: Untoward effect: causes serious side effects. Undesired effects: Mild side effects.
Routes of administration: How the drug is given
Contraindications: Conditions that make it inappropriate to give the drug when the drug is simply not indicated. a predictable harmful effect will occur is the drug is given in this situation. May coinside with side effects.
Dosage: The amount if the drug that should be given
Special Consideration: How the drug may affect pediatric, geriatric or pregnant patients.
pure Food and Drug Act of 1906: Enacted to improve the quality and labeling of drugs. Named the USP the official source for drug info.
Harrison Narcotic Act of 1914: Limited the indiscriminate use of addicting drugs by regulating the importation, manufacture, sale and use of opium, cocaine and their compounds or derivatives.
Federal Food Drug and Cosmetica Act of 1938: Empowered the FDA to enforce and set premarket safety standards for drugs.
Durham Humphry Admendments: AKA the prescription drug amendments. required pharmacists to have either a written or verbal prescription from a dr. to dispense certain drugs. Also created over the counter meds.
Comprehensive Drug Abuse Prevention and Control Act: AKA Controlled Substances Act. is the most recent majot federal legislation affecting drug sales and use. Repelled and replaced the Harrison Narcotic Act.
5 Schedules of Controlled Substances
Schedule 1: high Abuse potential, leads to severe dependence, no accepted medical indications. Heroine, LSD, mescaline
Schedule 2: High Abuse potential, may leads to severe dependence, accepted medical indications. ie.e. opium, cocaine, morphine, oxycodone, methadone, secorbarbital
Schedule 3: Less Abuse potential may lead to moderate or low physical dependence, accepted medical indications. i.e. vicodin, tylenol with codeine
Schedule 4: Low abuse potential limited dependence. Diazepam, lorazepam, phenobarbital
Schedule 5: lower abuse potential, limited dependence, accepted medical indications. opioids often for cough or diarrhea
drug laws and regulations: State, Local , and Federal.
assay: Test that determines tje amount and purity of a given chemical in a preparation in the laboratory
Bioequivalence: relative therapeutic effectiveness of shemically equivalent drugs
bioassay: test to ascertain a drugs availability in a biological model.
Drug Development Timeline: preclinical 1-3 years
Clinical Research 1-10 years (average 5)
NDA review 2 months to 7 years (average 24 months)
Post market Surveillance indefinite
6 Rights of medication Administration: Right Medication
Right Dose
Right Time
Right Route
Right Patient
Right Document
Dose Packaging: Medication packages contain a single dose for a single patient
Teratogenic Drug: medication that may deform or kill the fetus
FDA Pregnancy Categories: A-no risk
B-no studies in pregnant woman(no risk in animals)
C-Adverse effects in animals=Use with caution
D-Fetal Risk Benefits could outweigh risks
X- Fetal Risk-risk outweighs any benefit to mother
Drug Free Availability: Proportion of a drug available in the body to cause either desired or undesired effects.
Broselow Tape: Used to calculate drug doseges in pediatric patients
Active transport: requires the use of energy to move a substace.
Carrier mediated diffusion or facilitated diffusion: process in which carrier proteins transport large molecules across the cell membrane
passive transport: movement of a substance without the use of energy
diffusion: movement of a solute from an area of higher concentration to an area of lower concentration
osmosis: movement of solvent in a solution from an area of lower concentration to and area of higher concentration.
Metabolism: The bodys breaking down of chemicals into different chemicals
biotransformation: special name given to the metabolism of drugs. Occurs in the Liver.
prodrug (parent drug): medication that is not active when administered, but whose biotransformation converts it into active metabolites.
first- pass effect: the livers partial or complete inactivation of a drug before it reaches the systemic circulation
oxidation: the loss of hydrigen atoms or the acceptance of an oxygen atom, This increases the positive charge on the molecule
hydrolysis: the breakage of a chemical bond by adding water, or by incorporating a hydroxyl group into one fragment and a hydrogen ion into the other
enteral route: delivery of a medication through the gastrointestinal tract
parental route: delivery of a medication outside of the gi tract, typically using needles to inject medications onto the circulatory system
Types of enteral routes: Oral
orogastric/nasogastric (OG/NG)
sublingual(SL)
Buccal
Rectal
Types of Parental Routes: IV, ET, IO, Umbilical, IM, SQ, inhalation/Nebulized, Topical, Transdermal, Nasal, Instillation, Intradermal
Drug Forms (solid): Pills-easy to swallow
Powders: powder form of tablet
Tablet- powder compressed
Suppositories- rectal or vaginal (mixed with wax)
capsul- gelatin filled with powder or tiny pills
Solutions: Most common liquid preparation. Generally water based; some may be oil based
Tinctures: Prepared using an alcohol extraction process; some alcohol usually remains in the final drug preparation
Suspensions: Preparations in which the solid does not dissolve inthe solvent; if left alone the solid portion will precipitate out.
Emulsions: medications combined with a fat or oil emulsifier
Spirits: Solution of a volatile drug in alcohol
Elixirs: Alcohol and water solvent, often with flavoring added to improve the taste
Syrups: Sugar, Water and drug solution
Types of Drug Actions: -Binding to a receptor site
-Changing the physical properties of cells
-Chemically combining with other chemicals
-altering a normal metabollic pathway
Receptor: Specialized protein that combines with a drug resulting in a biochemical effect.
Affinity: Force of attraction between a drug and a receptor
Efficacy: A drugs ability to cause the expected response
second messenger: Chemical that participates in complex cascading reactions that eventually cause a drugs desired effect
Down Regulation: binding of a drug or hormone to a target cell receptor that causes the number of receptors to decrease
Up regulation: a drug causes the formation of more receptors than normal
Agonist: drug that binds to a receptor and causes it to initiate the expected response
Antagonist: drug that binds to a receptor but does not cause it to initiate the expected response
partial agonist: drug that binds to a receptor and stimulates some of its effects but blocks others
competitive antagonism: one drug binds to a receptor and causes the expected effect while also blocking another drug from triggering the same receptor
noncompetitive antagonism: the binding of a antagonist causes a deformity of the binding site that prevents an agonist from fitting and binding
Irreversible Antagonism: a competitive antagonist permanently binds with a receptor site
iatrogenic: a disease or response induced by the actions of a care provider. (physician produced)
Drug response relationship: correlation of different amounts of a drug to clinical response
plasma level profile: describes the lengths of onset, duration, and termination of action as well as the drugs minimum effective concentration and toxic levels
Allergic Reaction: AKA hypersensitivity. Effects occurs as the drug in antigenic and activates the immune system
idiosyncracy: drug effect that is unique to the individual, different than seen or expected in the population than general
Cross Tolerance: tolerance for a drug that develops after administration of a different drug.
Tolerance: decreased response to the same amount of drug after repeated administration
tachyphylaxis: rapidly occuring tolerance to a drug, may occur after a single dose. (usually occurs with decongestant and bronchodilation agents)
cumulative effect: increased effectiveness when a drug is given in several doses
Drug Dependence: the patient becomes accustomed to the drugs presence in his body and will suffer from withdrawal symptoms upon its absence
Drug interaction: the effect of one drug alter the response to another
drug antagonism: the effects of one drug blocks the response to another
Summation: AKA Addictive effect. two drugs that both have the same effect are given together to get the same effect. 1+1=2
Synergism: two drugs that both have the same effect that are given together to produce a resonse greater than the sum of their individual responses. 1+1=3
Potentiation: One drug enhances the effect of another. i.e. phenergan enhances morphine
interference: The direct biochemical interaction between two drugs, one drug affects the pharmacology of another
onset of action: the time from administration until a medication reaches it minimum effective concentration
Minimum effective concentration: minimum level of a drug needed to cause a given effect
duration of action: length of time the amount of drug remains above its minimum effective concentration
termination of action: time from when the drug levels drops below its minimum effective concentration until it is eliminated from the body
therapeutic index (TI): ratio of a drugs lethal dose (LD)for 50% of the population to its effective dose (ED) for 50% of the population.

LD50/ED50
biologic half-life: time the body takes to clear one half of a drug
Drug response factors: Age, body mass, sex, environment, time of admin, pathology, genetics, psychology
6 Rights of drug administration: right person
right drug
right dose
right time
right route
right documentation
percutaneous drug administration: drugs applied to and absorbed through the skin
transdermal: slow and steady rate
mucouse membrane admin: drugs absorbed through mucous membranes at moderate to rapid rate
Asepsis (Aseptic): a condition free of pathogens
Local: limited to one area of the body
systemic: throughout the body
sterile: free of all forms of life
medically clean: careful handling to prevent contamination
disinfectant: cleansing agent that is toxic to living tissue. Never use on living tissue
antiseptic: cleansing agent that is not toxic to living tissue. used to clean living tissue
Topical Medication: material applied to and absorbed through the skin or mucous membrane
Mucous Membrane Sites of administration: tongue, Cheek, Eye, Nose, Ear
Abbreviations for Eye drug administration: o.d.-right eye
o.s. - left eye
o.u. - both eyes
Aural Medication: Drugs administered through the mucous membrane of the ear and ear canal
Pulmonary Medication Mechanisms: Nebulizer
Metered dose inhaler
Endotracheal tube
Metered Dose Inhaler: Handheld device that produces a medication spray for inhalation
LEAN: Endotracheal Medications
Lidocaine
Epinephrine
Atropine
Naloxone
Lozenge: solid form of medication that slowly dissolve in the mouth, permitting gradual swallowing
Hepatic Alteration: change in a medications chemical compoisition that occurs in the liver
Rectacl Administration: a good method. Bypasses the liver and absorption in more predictable
enema: a liquid bolus of medication that is injected into the rectum
bolus: concentrated mass of medication
Common rectal drugs: Valium, Versed, Narcan
Luer Adapter: Nipple at the end of a syringe
Luer Lock: Ability to screw syringe into place
Hypodermic Needle: hollow metal tube used with the syringe to administer medication
gauge: the size of a needle's diameter. the lower the number the larger the diameter
Kinds of parental drug containers: -glass ampules
- Single and multidose vials
- non constitutional syringe
- prefilled syringe
Ampule (Amp): breakable glass vessel containing liquid medication
Vial: plastic or glass container with a self sealing top
non constituted drug vial/mix-o-vial: vial with two containers, one holding powdered medication and the other holding a liquid mixing solution
Prefilled/preloaded syringe: syringe packaged in a tamper proof container with the medication aready in the barrel
medicated solution: parental medication packaged in an IV bag and administered as an IV infusion
infusion: liquid medication delivered through a vein
Parenteral routes: ID, SQ, IM, IV, IO
intradermal (ID): I.e. PPD. Deposit medication into the dermal layer of the skin. 15 degree angle
Subcutaneous (SQ): the layer of loose connective tissue between the skin and the muscle. Pinch skin and go in at a 45 degree angle
IM sites: Deltoid, Dorsal Gluteal above pocket to avoid sciatic nerve, Vastus lateralis, Rectus Femoris
IV Access: AKA cannulation. surgical puncture of a vein to deliver medication or withdraw blood
Peripheral venous access: surgical puncture of a vein in the arm, leg or neck
Central Venous Access: Surgical puncture of the internal jugular, subclavian or femoral veins
Peripherally inserted central catheter: PICC line threaded into the central circulation via a peripheral site. Used for long term care.
Huber Needle: Angled needle that attaches to the ports of a PICC. Only needle that can be used with these ports
Colloid: intravenous solutions containing large proteins that cannot pass through capillary membranes
Crystalloid: IV solutions that contain electrolytes but lack the larger proteins associated with colloids
Crystalloid Classes: Isotonic
Hypertonic
hypotonic
Isotonic: state in which solutions on opposite sides of a semipermeable membrane are in equal concentration
Hypertonic: State in which a solution has a higher concentraton on one side of a semipermeable membrane than on the other side
Hypotonic: state in which a solution has a lower solute concentration on one side of a semipermeable membrane than on the other side.
Common Colloids: Plasma Protein Fraction (Plasmanate), Salt Poor Albumin, Dextran, Hespan
Microdrip: 60 gtts per 1mL
macrodrip: 10 gtts per 1mL
over the needle catheter/angiocatheter: semiflexible catheter enclosing a sharp metal stylet.
heparin lock: peripheral iv cannula with a distal medication port used for intermittent fluid or medication infusions.
saline lock: peripheral iv cannula with a distal medication port used for intermittent fluid or medication infusions. Saline is injected onto the device to maintaain its patency
Venous access device: surgicall y implanted port that permits repeated access to central venous circulation
infusion controller: gravity flow device that regulates fluids passage through an electromechanical pump
extravascular: outside the vein
infusion pump: device that delivers fluids and medications under positive pressure
blood tube: glass container with color coded, self sealing rubber top
vacutainer: device that holds blood tubes
luer sampling needle: long, exposed needle that screws into the vacutainer and is inserted directly into the vein
Brand Name Drugs: Should be Capatalized, do not contain the (cemical composition or the ",USP" at the end
Official Name for Drugs: Not capatilized and contain the ",USP" at the end
Reference Materials, Sources for Drug information: USP (United States Pharmacopeia, PDA, Dring Information, Monthly Prescribing Reference, AMA Drug Evaluation
Physician Drug Reference (PDA): A compilation of drug inserts, printed fact sheets that drug mfg. supply, includes 3 indices and a section containing photos of drugs
Drug Information: Published by the American Society of Health System Pharmacists. Contains an authoratative listing of monographs on every drug used in the USA
Monthly Prescribibg Reference: Designed to Assist physicians in prescribing medication and which are available to treat certain diseases
AMA Drug Evaluation: published by the American Medical Association
Plants (Source of Drugs): Oldest Source. Digitalis
Why is there federal drug regulation?: To protect the public from adulterated and mislabeled drugs
Durham Humphry Amendment: Required pharmacists to have either a written or verbal presciption from a physician to dispense drugs
Schedule I: High Abuse Potential; may lead to severe dependence; no accepted medical indications; used for research, analysis or instruction only
Schedule II: High Abuse Potential; may lead to severe dependence; accepted medical indications
Schedule III: Less abuse potential than Schedule I and II; may lead to moderate or low physical dependence or high psychological dependence; accepted medical indications
Schedule IV: Low abuse potential compared to Schedule III; limited psychological and/or physical dependence; accepted medical indications
Schedule V: Lower abuse potential compared to Schedule IV; may lead to limited physical or psychological dependence; accepted medical indications
New Drug Development Phase I: To determine the drug's pharmacokinetics, toxicity and safe dose in humans. Carried out on limited population of volunteers. High risk drugs not carried out on humans
New Drug Development Phase II: Drug is tested on limited population of patients who have the disease it is intended to treat. Primary purpose is to find therapeutic drug level
New Drug Development Phase III: Main purpose is to refine the usual therapeutic dose and to collect data on side effects. Usually in a double blind study
New Drug Development Phase IV: Involves postmarket analysis during conditional approval. MFg. monitors its performance
FDA Classification of newly approved drugs: Method utilizes a number and a letter for each new drug in the IND phase or upon NDA review of the FDA.
IND Phase: Investigational New Drug. This phase is designated by the FDA if the results of animal testing are satisfactory
Free Drug Availability: Proportion of a drug in the body to cause either desired or undesired effects
Extracellular Fluid in Neonates: 80% (adults 50%-55%)
Pharmacodynamics: How a drug interacts with the body to cause its effects
Nubain (Nalbuphine): Agonist-Antagonist. Stimulates some of the opioid agonists analgesic properties but partially blocks others such as respiratory depression.
What is the most common second messenger?: cAMP cyclic adenosine monophosphate
Naloxone (Narcan): Antagonist. Binds to the opiate receptor, but will not initiate pain relief but does block narcotics and its response
mannitol (osmotrol): increases urine output by increasing the bloods osmotic pull
Prototype: drug that best demonstrates the classes common properties and illustrates its particular characteristics
Central Nervous System: Brain and Spinal Cord
Peripheral nervous System: Broken down into Autonomic and Somatic
Somatic Nervous System: Controls Voluntary "Motor" functions
Autonomic Nervous System: Controls involuntary functions. Broken down into Sympathetic and Parasympathetic
Sympathestic Nervous System: Fight or Flight
Parasympathetic Nervous System: Feed or Breed
Morphine: Opioid Drug. Decreases cardiac preload and afterload. Analgesia, Euphoria, sedation. Useful in MI.
Non Opioid Analgesic: Aspirin, Buprofen, acetaminophen
opioid Antagonist: reverse effects of opioid drugs, such as narcan
Adjunct medication: enhances other drug effects. i.e. valium and versed.
Opioid Agonist Antagonist: displays both agonist and antagonist properties. i.e. Nubain and stadol
Antianxiety and hypnotic drugs: benzodiazepines and barbituates. Decreases response to stimuli by increasing effectiveness of GABA
GABA: Gamma-aminobutyric acid. Chief inhibitory neurotransmitter in the CNS.
Romazicon (flumazenil): benzodiazeprine Antagonist(antianxiety, sedative/hypnotic) Reverses sedation
Antagrade: After administration of medications
MAOI: Antidepressent Medication
Monoamine oxidase inhibitor. DO NOT EAT CHEESE AND RED WINE (both contain tyramine)
EPS: Extrapyramidal Symptoms. Common side effects of antipsychotic medications. including muscle tremors and parkinsonism like effects
mimetic: to mimic and increase response
Autonomic ganglia: groups of autonomic nerve cells located outside the CNS
preganglionic nerves: Nerve fibers that extend from the CNS to the autonomic ganglia
postganglionic nerves: nerve fibers that extend from the autonomic ganglia to the target tissues
synapse: space between nerve cells
neurotransmitter: chemical messenger that conducts a nervous impulse across a synapse
neuron: nerve cell
cholinergic: pertaining to the neurotransmitter acetylcholine
adrenergic: pertaining to the neurotransmitter norepinephrine
Location of ganglia in the sympathetic nervous system: close to the spinal cord
Acetylcholine: Utilized in the preganglionic nerves of the sympathetic nervous system and in both the pre and postganglionic nerves of the parasympathetic nervous system.
Norepinephrine: is the postganglionic neurotransmitter of the sympathetic nervous system.
2 main types of ACh receptors: nicotinic and muscarinic
nicotinic: muscle. receptors are found at the neuromuscular junction and initiate contraction (somatic)
Muscarinic: (organ) found in many organs throughout the body responsible for promoting the parasympathetic response.
Parasympathomimetics: Cholinergics. drug or other substance that causes effects like those of the PNS
Parasympatholytics: Anticholinergic. drug or tother substance that blocks or inhibits the actions of the PNS
SLUDGE: Salivation, Lacrimation, Urination, Defecation, GAstric Motility, Emesis. Adverse effect of cholinergics.
Atropine: Muscarinic Cholinergic Antagonist.
sympathomimetic: drug or other substance that causes effects like those of the SNS. Adrenergic
sympatholytic: drug or other substance that blocks the actions of the SNS. Antiadrenergic.
Types of Sympathetic receptors: Adrenergic
-alpha 1
-alpha 2
-beta 1
-beta 2
Dopaminergic
Alpha 1: Response to stimuli
-vasoconstriction
-ejaculation
Alpha 2: Response to stimuli
-inhibits the continued release of NE
Beta 1: Response to stimuli
-increase HR
-increased conductivity
-increased automaticity
-increased contractility
Renin release
Beta 2: Response to stimuli
-Bronchodilation
-Vasodilation
-inhibits uterine contraction
-tremors
dopaminergic: response to stimuli
-vasodilation (increased blood flow) to the kidneys
Beta Blockers: Adrenergic Antagonists. used to treat tachcardia, hypertension, and angina. Causes bronchoconstriction and inhibited glycogenolysis. all end with olol.
fast potential: found in myocardial contractile tissue
Slow potential: found in av and Sa nodes
Antidysrhythmic: used to treat and prevent abnormal cardiac rhythms
Vaughn-Williams Claasifications Sodium Channel Blockers: Class 1A-widening QRS, Prolonged QT
Class 1B-widening QRS, Prolonged QT (lidocaine)
Class 1C- Prolonged PR, Widening QRS
I- prolonged PR, widening QRS
Vaughn-Williams Classifications Beta Blockers: Prolonged PR, bradycardia
Vaughn-Williams Classifications Potassium Channel Blockers: prolonged QT

indication in VFIB causes initial release of NE. delayed repolarization.
VAugh-Williams Classifications Calcium Channel Blockers: Prolonged PR, bradycardia (verapimil)

decrease SA and AV node automaticity
Vaughn-Williams Classifications Misc.: Adenisine, prolonged PR, bradycardia

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