Sherpath: Overview of Key Concepts in Pharmacology

drug
any substance that positively or negatively alters physiologic function

medication
a drug specifically administered for its therapeutic effect on physiologic functions

chemical name
elements of molecular structure

official name
assigned by the U.S. Adopted Names Council, usually the generic name

generic name
not capitalized and often contains a prefix or suffix that helps to identify drug class

trade (brand) name
assigned by drug manufacturer
– a drug can have several different trade names but the same generic name

in the U.S., official lists have been reported in the
United States Pharmacopeia (USP) since 1820 and the National Formulary (NF) since 1988

USP and NF help
protect public safety by identifying medication properties that show an appropriate range of quality and purity

The Pure Food and Drug Act of 1906 designated the
USP and the NF as the only official authorities to establish drug standards, including the requirement the medications be free of impurities

subsequent legislation has continued to set standards related to medications including
-safety
-potency
-sales
-distribution
-efficacy

enforcement of medication legislation in the U.S. is the responsibility of the
U.S. Food and Drug Administration (FDA) which mandates that all medications undergo safety testing before being released to the public

in the U.S. the Comprehensive Drug Abuse Prevention and Control Act 1970
known as the controlled substances act (CSA), regulates controlled substances

one objective of the CSA is to
reduce opportunities for drugs to be diverted from legitimate sources to drug abusers

CSA mandates
regulations for handling and distributing of controlled substances by manufacturers, distributors, pharmacists, nurses, and care providers

compliance with CSA regulations is monitored by the
Drug Enforcement Administration (DEA), an office with in the Department of Justice

schedule I
-high potential for abuse
– no currently accepted medical use in treatment in the U.S.
– examples: heroin, LSD, and methaqualone

schedule II
– high potential for abuse; may lead to severe psychological or physical dependence
– has currently accepted medical use with severe restrictions
– examples: morphine, cocaine, methadone, and methamphetamine

schedule III
– lower potential for abuse compared to the drugs in schedules I and II, in regard to moderate dependence
– has currently acceptable medical use
– examples: anabolic steroids, narcotics, such as codeine or hydrocodone with asprin or acetaminophen, and some barbiturates

schedule IV
– lower potential for abuse relative to the drugs in schedule III; may lead to limited dependence
– has currently accepted medical use
– pentazocine, meprobamate, diazepam, and alprazolam

schedule V
– low potential for abuse relative to the drugs in schedule IV
– has currently accepted medical in treatment in the U.S.
-examples: over-the-counter cough medicine with codeine

tracking
every time a controlled substance is purchased or dispensed, a record must be documented
– an inventory must be kept of all controlled substances in stock and this inventory must be reported to the DEA every two years

floor stock
– although not required by the CSA, may hospitals and clinics require that floor stock of controlled substances be accounted for at the beginning and end of the nursing shift

disposal
if a controlled drug needs to be wasted, two licensed clinical staff members must witness the disposal of the substance and document the wasting of the drug in appropriate manner

pharmacokinetics
is the study of how a medication enters the body, moves through the body, and ultimately leaves the body

pharmacodynamics
is the process in which a medication interacts with the body’s cells to produce a biological response

pharmacokinetics includes
-absorption
-distribution
-metabolism
-excretion

absorption
the passage of a drug from the administration site into the blood stream

several factors affect absorption
– route of administration
– ability of the drug to dissolve or become soluble
– blood flow to the administration site
– body surface area
– patient age

the quickest rate of absorption fastest to slowest
– intravenously
– intramuscularly
– subcutaneously
– orally

distribution
process of delivering the medication to tissues and organs, and ultimately, to the specific site of action

distribution is affected by
-chemical properties of the drug
– effectiveness of the cardiac system
– ability to pass through tissue and organ membranes
– extent to which the drug binds to proteins or accumulates in fatty tissue

metabolism
process by which a drug is altered to a less active form to prepare for excretion
– products called metabolites
– takes place liver

excretion
process that removes the less active drug or its metabolites
– most exit body through the kidney in urine
– some exit by feces, breath, saliva, sweat, breastmilk

therapeutic effect influences by factors such as
– medication dose
– route of administration
– frequency of administration
– function of metabolizing organs
– age
– gender
-genetics

biological response can be either
systemic or local

systemic effect
some medications via some routes affect the whole body and the effects are seen in multiple body systems

local effect
some medications, via some routes, affect only limited body areas

half life
expected time it takes for the blood concentration to measure one half of the original drug dose due to drug elimination

onset of action
time it takes the body to respond to a drug administration
– onset id affected by the route of administration, the drug formulation, and pharmacokinetic factors

peak and trough levels
refer to the highest and lowest concentration of a drug in the bloodstream over time

peak plasma level
indicates the highest serum (blood) concentration of a drug

side effects
predictable, but unwanted, sometimes unavoidable, reactions to medications

adverse effects
severe, unintended, unwanted, and often unpredictable drug reactions

toxic effects
results from a medication overdose or the buildup of medication in the blood, due to impaired metabolism and excretion

organs that can be damaged from drug toxicity include
– kidneys
– liver
– organs of hearing
– heart

allergic reactions
unpredictable immune responses to medications

idosyncratic reactions
unpredictable immune responses to medications

idosyncratic responses can be
– over response
– under response
– abnormal reaction to the medication

medication interaction
occur when a drug’s action is modified by the presence of a certain food, herb, or another medication

synergistic effect
drugs effect is increased in the presence of another substance in the body

antagonistic effect
when drugs effect is decreased by taking it with another substance

incompatibility
combining drugs with another drug that causes an adverse chemical reaction

nonprescription medications
can be obtained with out a health care provider’s authorization

prescription medications
require a legal prescription from a health care provider

safe use of OTC medication includes understanding the
– desired effect of the medication
– potential side and adverse effects
– possible allergic reactions
– potential interactions with other medications and herbs
– warnings
– directions and dosage
– features, such as safety caps

water soluble vitamins (B and C)
are excreted by the body through the kidneys

fat- soluble vitamins ( A, D, E, and K)
are stored by the body for uses as needed

B3 (niacin) adverse effects
flushing, redness of skin, upset stomach

B6 (pyridoxine, pyridoxal, and pyridoxamine) adverse effects
never damage to the limbs, which may cause numbness, trouble walking, and pain

C (ascorbic acid) adverse effects
upset stomach, kidney stone, increased iron absorption

folic acid (folate) adverse effects
at high levels, especially in older adults, may hide signs of B12 deficiency

A (retinol, retinal, retinoic acid) adverse effects
nausea, vomitting, headache, dizziness, blurred vision, clumsiness, birth defects, liver problems, possible risk of osteoporosis

D (calciferol) adverse effects
nausea, vomitting, poor appetite, constipation, weakness, weight loss, confusion, heart rhythm problems, deposits of calcium and phosphate in soft tissues

echinacea
– stimulates the immune system, facilitates wound healing, fights flu and cold
– side effects: possible liver inflammation and damage if used with anabolic steroids or methotrexate

feverfew
alleviate and helps prevent migraines, relieves pain of arthritis
– side effects: increased bleeding, potentiates actions of anticoagulants

garlic
– lowers blood pressure and cholesterol and triglyceride levels
– side effects: increased bleeding, potentiates actions of anticoagulants

ginko biloba
– improves memory and mental alertness
– side effects: increased bleeding, potentiates actions of anticoagulants

ginseng
-increased physical stamina and mental concentration
– side effects: can increase heart rate and blood pressure; decreases effectiveness of anticoagulants

saw palmetto
– helps with enlarged prostate and urinary inflammation
– side effects: interacts with other hormones

St John’s Wart
– alleviates mild to moderate depression, anxiety, and sleep disorders
– side effects: interacts with antidepressants, birthcontrol pills, cyclosporine, digoxin, and human immunodeficiency virus (HIV) and cancer medications

to be considered a legally valid prescription, a medication order from any health care, setting must include:
– patient’s name
– date and time the order is written
– name of drug to be administered
– dosage of the drug
– route of drug administration
– frequency of drug administration
– signature of the person writing the order

routine
administered until the healthcare provider discontinues the order, or until a prescribed number of doses or days have occured

PRN
given only a when the patient requires it

one time/ on-call
given only once at a specified time, often before a diagnostic or surgical procedure

stat
given immediately and only once in a single does; frequently given for emergency situations

now
used when a medication is needed quickly but not as immediately as a stat medication given at a time

tablet
used for oral, sublingual, and buccal routes

powder
inhaled, mixed with food, or dissolved in liquids

troche
dissolve in mouth

solution
– syrups are mixed with sugar and water
– suspensions are finely crushed medications in liquids
– elixirs are medications dissolved in alcohol and water with glycerin or other sweetners
– drops are sterile solution or suspension administered directly into the eye, outer ear canal, nose, or sublingually
– injectable solutions are sterile suspensions supplied in ampules, vials, prefilled syringes, bags, or bottles

forms of medication
-tablets
-capsule
– powder
– troche
-solution
– inhalant
– skin preparations
– suppository

routes of medication administration
– oral (po)
– sublingual (under tongue)
-buccal (against cheek)
– via tube
– topical
– transdermal
– parenteral
– inhalation

sublingual and buccal medications are
more potent because the drug passes the liver and enters the blood stream directly
– may be inactivated by gastric juices if swallowed

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