INTRO TO PHARM TEXTBOOK
(p5) (🚨) Therapeutic and Pharmacologic Classification of Drugs: One useful method of "organizing" drugs is based on their "therapeutic" usefulness in treating particular diseases or disorders. This is referred to as a _________.
(p5) Therapeutic and Pharmacologic Classification of Drugs: One useful method of organizing drugs is based on their therapeutic usefulness in treating particular diseases or disorders. This is referred to as a THERAPEUTIC CLASSIFICATION.
(p51) In simplest terms, PHARMACODYNAMICS refers to how a medicine changes the body or acts in the patient. A more complete definition explains PHARMACODYNAMICS as the branch of pharmacology concerned with the mechanisms of drug action and the relationships between drug concentration at the site of action and the resulting effects in the body.
(p51) Pharmacodynamics and Interpatient Variability: The term pharmacodynamics comes from the root words pharmaco, which means "medicine," and dynamics, which means "change." In simplest terms, PHARMACODYNAMICS refers to how a medicine changes the body or acts in the patient. A more complete definition explains PHARMACODYNAMICS as the branch of pharmacology concerned with the mechanisms of drug action and the relationships between drug concentration at the site of action and the resulting effects in the body.
(p5) A __________ drug contains more than one active generic ingredient. This poses a problem in trying to match one generic name with one product name. As an example, Table 1.3 lists the drug diphenhydramine (generic name), also called Benadryl (one of the many trade names). Diphenhydramine (Benadryl) is an _________. Low doses of diphenhydramine may be purchased over the counter (OTC); higher doses require a prescription.
A COMBINATION drug contains more than one active generic ingredient. This poses a problem in trying to match one generic name with one product name. As an example, Table 1.3 lists the drug diphenhydramine (generic name), also called Benadryl (one of the many trade names). Diphenhydramine (Benadryl) is an ANTIHISTAMINE. Low doses of diphenhydramine may be purchased over the counter (OTC); higher doses require a prescription.
(p5) A major challenge in studying pharmacology is mastering the thousands of drug names. Adding to this difficulty is the fact that most drugs have multiple names. The three basic types of drug names are _______, _______, and _______ names.
A major challenge in studying pharmacology is mastering the thousands of drug names. Adding to this difficulty is the fact that most drugs have multiple names. The three basic types of drug names are CHEMICAL, GENERIC, and TRADE names.
_______ is a process involving the movement of a substance from its site of administration, across body membranes, to circulating fluids.
Absorption of Medications: (p39) ABSORPTION is a process involving the movement of a substance from its site of administration, across body membranes, to circulating fluids. (Mouth/skin to bloodstream) Drugs may be absorbed across the skin and associated mucous membranes, or they may move across membranes that line the GI or respiratory tract. Most drugs, with the exception of a few topical medications, intestinal anti-infectives, and some radiologic contrast agents, must be absorbed to produce an effect. In general, the more rapid the dissolution, the faster the drug absorption and the faster the onset of drug action.
(p4) (🚨 Learning objective) _______ is slightly different from pharmacology, although the areas are closely connected. _________ is concerned with the PREVENTION of disease and TREATMENT of suffering.
Another important area of focus for the nurse, sometimes challenging to distinguish from pharmacology, is therapeutics. THERAPEUTICS is slightly different from pharmacology, although the areas are closely connected. THERAPEUTICS is concerned with the prevention of disease and treatment of suffering.
As an example, _________ are a class of ANTIBIOTICS that are useful in the treatment of many infectious diseases. The mainstay of treatment for infective ENDOCARDITIS is antibiotic therapy, and this is instituted as soon as possible to minimize valvular damage.
As an example, AMINOGLYCOSIDES are a class of ANTIBIOTICS that are useful in the treatment of many infectious diseases.
_______ investigation, the second phase of drug testing, takes place in three different stages termed ________. _______ are the longest part of the drug approval process.
CLINICAL investigation, the second phase of drug testing, takes place in three different stages termed CLINICAL PHASE TRIALS. Clinical phase trials are the longest part of the drug approval process.
Caution must be used, however, because some AMINOGLYCOSIDES can cause ________ toxicity and _______ impairment, especially if _______ (a loop diuretic) is administered at the same time. (May skip the rest) You can see how, in this case, concepts from multiple science disciplines are integrated. Knowledge of chemistry would be inferred by the terms amino and glyco. Further study about "infectives" would draw information from the subject of microbiology including the use of antibiotics and sensitivities of gram-positive and gram-negative bacteria. The fields of anatomy and physiology would correlate much information with emphasis on ear anatomy and organs of the muscular, nervous, renal, and cardiovascular systems.
Caution must be used, however, because some AMINOGLYCOSIDES can cause INNER EAR toxicity and NEUROMUSCULAR impairment, especially if FUROSEMIDE (a loop diuretic) is administered at the same time.
🚨 Classification of Therapeutic Agents as Drugs, Biologics, and Complementary and Alternative Medicine Therapies: Substances applied for THERAPEUTIC purposes fall into one of the following three general categories: • ________ • ________ • _________
Classification of Therapeutic Agents as Drugs, Biologics, and Complementary and Alternative Medicine Therapies: Substances applied for THERAPEUTIC purposes fall into one of the following three general categories: • Drugs or medications • Biologics • Complementary and alternative medicine therapies.
Controlled Substances, Drug Schedules, and Teratogenic Risks: (Mostly on p17*) Some drugs are frequently abused or have a high potential for addiction. Technically, ADDICTION refers to the overwhelming feeling that drives someone to use a drug repeatedly. _______ is a related term, often defined as a physiological or psychological need for a substance.
Controlled Substances, Drug Schedules, and Teratogenic Risks: (Mostly on p17*) Some drugs are frequently abused or have a high potential for addiction. Technically, ADDICTION refers to the overwhelming feeling that drives someone to use a drug repeatedly. DEPENDENCE is a related term, often defined as a physiological or psychological need for a substance.
(p41) Distribution of Medications: _________ involves the transport of drugs throughout the body. The simplest factor determining distribution is the amount of blood flow to body tissues. The heart, liver, kidneys, and brain receive the most blood supply. Skin, bone, and adipose tissue receive a lower blood supply; therefore, it is more difficult to deliver high concentrations of drugs to these areas. The physical properties of the drug greatly influence how it moves throughout the body after administration. Lipid solubility is an important characteristic, because it determines how quickly a drug is absorbed, mixes within the bloodstream, crosses membranes, and becomes localized in body tissues. Lipid-soluble agents are not limited by the barriers that normally stop water-soluble drugs; thus, they are more completely distrib-uted to body tissues. (Phospholipid bilayer)
DISTRIBUTION involves the transport of drugs throughout the body. The simplest factor determining distribution is the amount of blood flow to body tissues. The heart, liver, kidneys, and brain receive the most blood supply. Skin, bone, and adipose tissue receive a lower blood supply; therefore, it is more difficult to deliver high concentrations of drugs to these areas. The physical properties of the drug greatly influence how it moves throughout the body after administration. Lipid solubility is an important characteristic, because it determines how quickly a drug is absorbed, mixes within the bloodstream, crosses membranes, and becomes localized in body tissues. Lipid-soluble agents are not limited by the barriers that normally stop water-soluble drugs; thus, they are more completely distrib-uted to body tissues. (Phospholipid bilayer)
Decisions Relative to Proper Drug Choices: Lawmakers, manufacturers, nurses, and patients along with family members are often placed in the position of making difficult decisions about proper drug choices. __________, a subdiscipline of health economics has helped in situations involving broader application of a particular type of drug therapy.
Decisions Relative to Proper Drug Choices: Lawmakers, manufacturers, nurses, and patients along with family members are often placed in the position of making difficult decisions about proper drug choices. PHARMAECONOMICS, a subdiscipline of health economics has helped in situations involving broader application of a particular type of drug therapy.
Drug-protein complexes are too large to cross capillary membranes; thus, the drug is not available for distribution to body tissues. Drugs bound to proteins circulate in the plasma until they are released or displaced from the drug-protein complex. Only _________ or ________ drugs can reach their target cells or be excreted by the kidneys. This concept is illustrated in Figure 4.3. Some drugs, such as the anticoagulant warfarin (Coumadin), are highly bound; 99% of the drug in the plasma is bound in drug-protein complexes and is unavailable to reach target cells. Drugs and other chemicals compete with one another for plasma protein-binding sites, and some agents have a greater affinity for these binding sites than other agents.
Drug-protein complexes are too large to cross capillary membranes; thus, the drug is not available for distribution to body tissues. Drugs bound to proteins circulate in the plasma until they are released or displaced from the drug-protein complex. *Only UNBOUND or FREE drugs can reach their target cells or be excreted by the kidneys. This concept is illustrated in Figure 4.3. Some drugs, such as the anticoagulant warfarin (Coumadin), are highly bound; 99% of the drug in the plasma is bound in drug-protein complexes and is unavailable to reach target cells. Drugs and other chemicals compete with one another for plasma protein-binding sites, and some agents have a greater affinity for these binding sites than other agents.
Drugs may also be organized by _________ classification. A _________ classification refers to the way a drug works at the molecular, tissue, or body system level.
Drugs may also be organized by PHARMACOLOGIC classification. A PHARMACOLOGIC classification refers to the way a drug works at the molecular, tissue, or body system level.
Pharmacodynamics has important nursing applications. Health care providers must be able to predict whether a drug will produce a significant change in patients. Although clinicians often begin therapy with average doses taken from a drug guide, intuitive experience often becomes the practical method for determining which doses of medications will be effective in a given patient. In addition, knowledge of therapeutic indexes, dose-response relationships, and drug-receptor interactions will help nurses provide safe and effective treatment. Inter-patient variability in responses to drugs can best be understood by examining a _________. A __________, shown in Figure 5.1, is a graphical representation of the number of patients responding to a drug action at different doses. Notice the wide range in doses that produced the patient responses shown on the curve. A few patients responded to the drug at very low doses. As the dose was increased, more and more patients responded.
FREQUENCY DISTRIBUTION CURVE
(p42) _______, also called _______, is the process of chemically converting a drug to a form that is usually more easily removed from the body.
Metabolism of Medications: METABOLISM, also called BIOTRANSFORMATION, is the process of chemically converting a drug to a form that is usually more easily removed from the body.
Not all drug molecules in the plasma will reach their target cells, because many drugs bind reversibly to plasma proteins, particularly _______, to form drug-protein complexes. C
Not all drug molecules in the plasma will reach their target cells, because many drugs bind reversibly to plasma proteins, particularly ALBUMIN, to form drug-protein complexes
Other drugs block intermediates of the renin-angiotensin pathway. Notice that each example describes how hypertension is con-trolled. A drug's ____________ classification is more specific than a __________ classification and requires a more in depth understanding of biochemistry and physiology. In addition, _________ classifications may be described with varying degrees of complexity, sometimes taking into account the drugs' chemical names.
Other drugs block intermediates of the renin-angiotensin pathway. Notice that each example describes how hypertension is con-trolled. A drug's PHARMACOLOGICAL classification is more specific than a THERAPEUTIC classification and requires a more in depth understanding of biochemistry and physiology. In addition, PHARMACOLOGIC classifications may be described with varying degrees of complexity, sometimes taking into account the drugs' chemical names.
Some tissues have the ability to accumulate and store drugs after absorption. The bone marrow, teeth, eyes, and adipose tissue have an especially HIGH AFFINITY, or _______, for certain meds. __________ binds to calcium salts and accumulates in the bones and teeth. It may take over a decade after BIPHOSPHONATE therapy for these drugs to decline by half in the skeletal system. Once stored, drugs may remain in the body for months to years and then slowly release back into the bloodstream.
Some tissues have the ability to accumulate and store drugs after absorption. The bone marrow, teeth, eyes, and adipose tissue have an especially HIGH AFFINITY, or ATTRACTION, for certain meds. TETRACYCLINE binds to calcium salts and accumulates in the bones and teeth. It may take over a decade after BIPHOSPHONATE therapy for these drugs to decline by half in the skeletal system. Once stored, drugs may remain in the body for months to years and then slowly release back into the bloodstream.
Table 1.2 shows a variety of pharmacologic classifications using HYPERTENSION as the therapeutic focus. A _______ treats hypertension by lowering plasma volume (pulling liquid out of the cell). CALCIUM CHANNEL BLOCKERS treat this disorder by decreasing CARDIAC _________. (Goodnick patient who you gave amlodopine)
Table 1.2 shows a variety of pharmacologic classifications using hypertension as the therapeutic focus. A DIURETIC treats hypertension by lowering plasma volume (pulling liquid out of the cell). CALCIUM CHANNEL BLOCKERS treat this disorder by decreasing CARDIAC CONTRACTILITY. (Goodnick patient who you gave amlodopine)
The _________ is the third phase of the drug approval process. During this phase, the drug's TRADE name is finalized. Clinical Phase III trials and animal testing may continue depending on the results obtained from preclinical testing.
The New Drug Application (NDA) review is the third phase of the drug approval process. During this phase, the drug's TRADE name is finalized. Clinical Phase III trials and animal testing may continue depending on the results obtained from preclinical testing.
The second method used to compare drugs is called _______, which is the magnitude of maximal response that can be produced from a particular drug. In the example in Figure 5.4b, drug A is more efficacious because it produces a higher maximal response.
The second method used to compare drugs is called EFFICACY, which is the magnitude of maximal response that can be produced from a particular drug. In the example in Figure 5.4b, drug A is more efficacious because it produces a higher maximal response.
(Reread once or twice) The larger the difference between the two doses, the greater the THERAPEUTIC INDEX. In Figure 5.2a, the therapeutic index is 4 (40 mg ÷ 10 mg). Essentially, this means that it would take an error in magnitude of approximately 4 times the average dose to be lethal. 🚨Thus, the therapeutic index is a measure of a drug's ________: The higher the value, the safer the drug.
🚨Thus, the therapeutic index is a measure of a drug's SAFETY MARGIN: The higher the value, the safer the drug.
(p46-47) 🚨🚨Loading Doses and Maintenance Doses: Few drugs are administered as a single dose. Repeated doses result in an accumulation of drug in the bloodstream, as shown in Figure 4.6. Eventually, a plateau will be reached where the level of drug in the plasma is maintained distribution of a continuous therapeutic level of drug to body tissues. Theoretically, it takes approximately four half-lives to reach this equilibrium. If the medication is given as a continuous infusion, the plateau can be reached quickly and be maintained with little or no fluctuation in drug plasma levels. **The plateau may be reached faster by administration of _______ doses followed by regular ________ doses. A ________ dose is a higher amount of drug, often given only once or twice to "prime" the bloodstream with a sufficient level of drug.
**The plateau may be reached faster by administration of LOADING doses followed by regular MAINTENANCE doses. A LOADING dose is a higher amount of drug, often given only once or twice to "prime" the bloodstream with a sufficient level of drug.
A ________ is a chemical agent capable of producing biologic responses within the body. These responses may be desirable (________) or undesirable (________).
A DRUG is a chemical agent capable of producing biologic responses within the body. These responses may be desirable (THERAPEUTIC) or undesirable (ADVERSE).
When classifying drugs, it is common practice to select a single drug from a class and compare all other medications within this representative group. A _________ drug is the well-understood drug model with which other drugs in its representative class are compared. By learning the characteristics of the prototype drug, students may predict the actions and adverse effects of other drugs in the same class.
A PROTOTYPE drug is the well-understood drug model with which other drugs in its representative class are compared. By learning the characteristics of the prototype drug, students may predict the actions and adverse effects of other drugs in the same class.
(Only read the "🚨" after studying once) Cellular Receptors and Drug Action: Drugs act by modulating or changing existing physiological and biochemical processes. To exert such changes requires that drugs interact with specific molecules and chemicals normally found in the body. 🚨A cellular macro-molecule to which a medication binds in order to initiate (p54) its effects is called a RECEPTOR. The concept that a drug binds to a receptor to cause a change in body chemistry or physiology is a fundamental theory in pharmacology. Receptor theory explains the mechanisms by which most drugs produce their effects. It is important to understand, however, that these receptors do not exist in the body solely to bind drugs. The receptor's normal or original function is to bind endogenous (substances that already live in the body) molecules such as hormones, neurotransmitters, and growth factors.
A cellular macro-molecule to which a medication binds in order to initiate (p54) its effects is called a RECEPTOR.
(p39) The Passage of Drugs Through Plasma Membranes: Pharmacokinetic variables (the variables of a how a drug moves through the body to its designated site) depend on the ability of a drug to cross plasma membranes. With few exceptions, drugs must penetrate these membranes to produce their effects. Like other chemicals, drugs primarily use two processes to cross body membranes:
Active transport and Diffusion/passive transport
After a drug is ADMINISTERED, it is called a ________. Drugs and _______ may be considered a part of the body's normal activities, from the essential gases that we breathe to the foods that we eat. (May skip) Because drugs are defined so broadly, it is necessary to clearly distinguish them from other substances such as foods, household products, and cosmetics. Many agents such as antiperspirants, sunscreens, toothpaste, and shampoos may alter the body's normal activities, but they are not necessarily considered medically therapeutic, as are drugs.
After a drug is ADMINISTERED, it is called a MEDICATION. Drugs and medications may be considered a part of the body's normal activities, from the essential gases that we breathe to the foods that we eat.
Although most modern drugs are synthesized in a laboratory, _______ are agents naturally produced in animal cells, by microorganisms, or by the body itself.
Although most modern drugs are synthesized in a laboratory, BIOLOGICS are agents naturally produced in animal cells, by microorganisms, or by the body itself.
Examples of BIOLOGICS include ______, monoclonal antibodies, natural blood products and components, interferons, and ________. Biologics are used to treat a wide variety of illnesses and conditions.
Examples of BIOLOGICS include HORMONES, monoclonal antibodies, natural blood products and components, interferons, and VACCINES. Biologics are used to treat a wide variety of illnesses and conditions.
Onset, Peak Levels, and Duration of Drug Action: ___________ represents the amount of time it takes to produce a therapeutic effect after drug administration. Factors that affect drug onset may be many, depending on numerous pharmacokinetic variables. As the drug is absorbed and then begins to circulate throughout the body, the level of medication reaches its peak. Thus, the ___________ occurs when the medication has reached its highest concentration in the bloodstream. It should be mentioned that depending on accessibility of medications to their targets, peak drug levels are not necessarily associated with optimal therapeutic effect. (Just because the drug got to its highest amount in the bloodstream, doesn't mean it is being effective in helping the patients condition)
Onset, Peak Levels, and Duration of Drug Action: ONSET of DRUG ACTION represents the amount of time it takes to produce a therapeutic effect after drug administration. Factors that affect drug onset may be many, depending on numerous pharmacokinetic variables. As the drug is absorbed and then begins to circulate throughout the body, the level of medication reaches its peak. Thus, the PEAK PLASMA LEVEL occurs when the medication has reached its highest concentration in the bloodstream. It should be mentioned that depending on accessibility of medications to their targets, peak drug levels are not necessarily associated with optimal therapeutic effect. (Just because the drug got to its highest amount in the bloodstream, doesn't mean it is being effective in helping the patients condition)
Other therapeutic approaches include __________ therapies. These involve natural plant extracts, herbs, vitamins, minerals, dietary supplements, and additional techniques outside of the realm of conventional therapeutics. Such therapies include BODY-BASED practices such as physical therapy, manipulations, ________, acupuncture, HYPNOSIS, and biofeedback. Because of their great popularity, herbal and alternative therapies are featured throughout this text wherever they show promise in treating a disease or condition. _______ therapies are presented in chapter 10.
Other therapeutic approaches include COMPLEMENTARY and ALTERNATIVE medicine (CAM) therapies. These involve natural plant extracts, herbs, vitamins, minerals, dietary supplements, and additional techniques outside of the realm of conventional therapeutics. Such therapies include BODY-BASED practices such as physical therapy, manipulations, MASSAGE, acupuncture, HYPNOSIS, and biofeedback. Because of their great popularity, herbal and alternative therapies are featured throughout this text wherever they show promise in treating a disease or condition. CAM therapies are presented in chapter 10.
(p39) ________ is thus the study of drug movement throughout the body. In prac-tical terms, it describes how the body deals with medications. __________ is a core subject in pharmacology, and a firm grasp of this topic allows the nurse to better understand and predict the ______ and _______ of medications in patients.
PHARMACOKINETICS is thus the study of drug movement throughout the body. In prac-tical terms, it describes how the body deals with medications. PHARMACOKINETICS is a core subject in pharmacology, and a firm grasp of this topic allows the nurse to better understand and predict the ACTIONS and SIDE EFFECTS of medications in patients. (Was before, but isn't as useful, may skip) Pharmacokinetics: How the Body Handles Medications: The term pharmacokinetics is derived from the root words pharmaco, which means "medicine," and kinetics, which means "movement or motion." PHARMACOKINETICS is thus the study of drug movement throughout the body. In prac-tical terms, it describes how the body deals with medications. Pharmacokinetics is a core subject in pharmacology, and a firm grasp of this topic allows the nurse to better understand and predict the actions and side effects of medi-cations in patients.
_________, or _________, is the application of drugs for the purpose of treating diseases and alleviating human suffering. Drugs are just one of many tools available to the nurse for these purposes
PHARMACOTHERAPY, or PHARMACO-THERAPEUTICS, is the application of drugs for the purpose of treating diseases and alleviating human suffering. Drugs are just one of many tools available to the nurse for these purposes
POSTMARKETING SURVEILLANCE, the final phase of the drug approval process, begins after ________ and the _______ have been completed. The purpose of this phase is to survey for harmful drug effects in a __________. Some adverse effects take longer to appear and are not identified until a drug is circulated to large numbers of people.
POSTMARKETING SURVEILLANCE, the final phase of the drug approval process, begins after CLINICAL TRIALS and the NDA review have been completed. The purpose of this phase is to survey for harmful drug effects in a LARGER POPULATION. Some adverse effects take longer to appear and are not identified until a drug is circulated to large numbers of people.
(p52) (Reread the part before "🚨" the first or second, then simply the part after "🚨") Therapeutic Index and Drug Safety: Administering a dose that produces an optimal therapeutic response for each individual patient is only one component of effective pharmacotherapy. Nurses must also be able to predict whether the dose is safe for the patient. Frequency distribution curves can be used to represent the safety of a drug. For example, the MEDIAN LETHAL DOSE (LD50) is often determined in preclinical trials, as part of the drug development process discussed in chapter 2. The LD50 is the dose of drug that will be lethal in 50% of a group of animals. As with ED50, a group of animals will exhibit considerable variability in lethal dose; what may be a nontoxic dose for one animal may be lethal for another. To examine the safety of a particular drug, the LD50 can be compared with the ED50, as shown in Figure 5.2a. In this example, 10 mg of drug X is the average effective dose, and 40 mg is the average lethal dose. 🚨🚨 The ED50 and LD50 are used to calculate an important value in pharmacology, a drug's ________, the ratio of a drug's LD50 to its ED50. _________= median lethal dose/median effective dose
The ED50 and LD50 are used to calculate an important value in pharmacology, a drug's THERAPEUTIC INDEX, the ratio of a drug's LD50 to its ED50. THERAPEUTIC INDEX= median lethal dose/median effective dose
The GENERIC name of a drug is assigned by the _________. With few exceptions, generic names are less complicated and easier to remember than chemical names. Many organizations, including the __________, the U.S. ________, and the ________, routinely describe a medication by its generic name.
The GENERIC name of a drug is assigned by the U.S. Adopted Name Council. With few exceptions, generic names are less complicated and easier to remember than chemical names. Many organizations, including the U.S. Food and Drug Administration (FDA), the U.S. Pharmacopoeia, and the World Health Organization (WHO), routinely describe a medication by its generic name.
(Read carefully with intent to remember) The Graded Dose-Response Relationship and Therapeutic Response: In the previous examples, frequency distribution curves were used to graphically visualize patient differences in responses to medications in a POPULATION. It is also useful to visualize the variability in responses observed within a ________ The GRADED DOSE-RESPONSE relationship is a fundamental concept in pharmacology. The graphical representation of this relationship is called a _________ CURVE, as illustrated in Figure 5.3. By observing and measuring the patient's response obtained at different doses of the drug, one can explain several important clinical relationships.
The Graded Dose-Response Relationship and Therapeutic Response: In the previous examples, frequency distribution curves were used to graphically visualize patient differences in responses to medications in a POPULATION. It is also useful to visualize the variability in responses observed within a SINGLE PATIENT. The GRADED DOSE-RESPONSE relationship is a fundamental concept in pharmacology. The graphical representation of this relationship is called a DOSE-RESPONSE curve, as illustrated in Figure 5.3. By observing and measuring the patient's response obtained at different doses of the drug, one can explain several important clinical relationships.
The PHARMACOLOGIC classification addresses a drug's ________, or how a drug ________________ (branch of biology dealing with normal functions of living organisms and their parts.
The PHARMACOLOGIC classification addresses a drug's mechanism of action, or how a drug produces its physiological (branch of biology dealing with normal functions of living organisms and their parts) effect in the body.
As another example, the therapeutic index of a second drug is shown in Figure 5.2b. Drug Z has the same ED50 as drug X but shows a different LD50. The therapeutic index for drug Z is only 2 (20 mg ÷ 10 mg). The difference be-tween an effective dose and a toxic dose is very small for drug Z; thus, the drug has a ________ safety margin. The therapeutic index offers the nurse practical information on the safety of a drug and a means to compare one drug with another.
The difference between an effective dose and a toxic dose is very small for drug Z; thus, the drug has a NARROW safety margin
Some patients required very high doses to elicit the desired response. The peak of the curve indicates the largest number of patients responding to the drug. The curve does not show the magnitude of response, only whether a measurable response occurred among the patients. As an example, think of the given response to an antihypertensive drug as being a reduction of 20 mmHg in systolic blood pressure. A few patients experi-enced the desired 20-mm reduction at a dose of only 10 mg of drug. A 50-mg dose gave the largest number of patients a 20-mmHg reduction in blood pressure; however, a few patients needed as much as 90 mg of drug to produce the same amount of blood pressure reduction. The dose in the middle of the frequency distribution curve represents the drug's ________. The _______ is the dose required to produce a specific therapeutic response in 50% of a group of patients.
The dose in the middle of the frequency distribution curve represents the drug's MEDIAN EFFECTIVE DOSE (ED50). The ED50 is the dose required to produce a specific therapeutic response in 50% of a group of patients.
(p13) Phases of Approval for Therapeutic and Biologic Drugs: The amount of time spent by the FDA in the review and approval process for a particular drug depends on several checkpoints along with a well-developed and organized plan. Therapeutic drugs and biologics are reviewed in four phases. Figure 2.3 summarizes these four phases as follows: 1. _________ investigation. 2. _______ investigation. 3. Review of the ________ 4. _________.
Therapeutic drugs and biologics are reviewed in four phases. Figure 2.3 summarizes these four phases as follows: 1. Preclinical investigation. 2. Clinical investigation. 3. Review of the New Drug Application (NDA). 4. Postmarketing surveillance.
There are several types of drug-drug interactions. These include the following: • ________. The action of drugs taken together as a total • ________. The action of drugs resulting in a potentiated (more than total) effect (when the drugs have a better effect together) • ________. Drugs taken together with blocked or opposite effects (one drug affects another's function) • ________. When drugs are taken together, one drug may shift another drug at a nonspecific protein-binding site (e.g., plasma albumin), thereby altering the desired effect.
There are several types of drug-drug interactions. These include the following: • ADDITION. The action of drugs taken together as a total • SYNERGISM. The action of drugs resulting in a potentiated (more than total) effect (when the drugs have a better effect together) • ANTAGONISM. Drugs taken together with blocked or opposite effects (one drug affects another's function) • DISPLACEMENT. When drugs are taken together, one drug may shift another drug at a nonspecific protein-binding site (e.g., plasma albumin), thereby altering the desired effect.
Both types of classification are widely used in categorizing the thousands of available drugs. Table 1.1 shows the method of therapeutic classification, using CARDIAC care as an example. Many different types of drugs affect cardiovascular function. Some drugs influence blood clotting, whereas others lower blood cholesterol or prevent the onset of stroke. Drugs may be used to treat elevated blood pressure, heart failure, abnormal rhythm, chest pain, heart attack, or circulatory shock. Thus, drugs that treat cardiac disorders may be placed in several types of _______ classes, for example, anticoagulants, antihyperlipidemics, and antihypertensives.
Thus, drugs that treat cardiac disorders may be placed in several types of THERAPEUTIC classes, for example, anticoagulants, antihyperlipidemics, and antihypertensives.
