Fundamental Principles of Pharmacology

10 rights of drug administration

Right dose, Right medication, Right patient, Right route of administration, Right time of medication administration, Right patient education, Right documentation of medication administration, Right of the patient to refuse the medication, Right assessment prior to drug administration, Right evaluation following drug administration.

New Drug Application (NDA)

a drug that continues to show promise through clinical trials, NDA submitted to FDA signaling drug is ready to go public. examination of preclinical and clinical data to assess whether the proposed new drug is safe and effective.

substrate

a drug that is metabolized by a CYP is a substrate for the enzyme.

controlled substance

a drug whose use is restricted by the Comprehensive Drug Abuse Prevention and Control Act of 1970 and later revisions.

loading dose

a higher amount of drug, often give only once or twice, is administered to "prime" the bloodstream with a level sufficient to quickly induce a therapeutic response.

pharmacopeia

a medical reference summarizing standards of drug purity, strength, and directions for synthesis.

exclusivity

a period during which competing companies are not allowed to market generic versions of the product (pharmaceutical brand name drug), in order to recoup funds loss during research and development. Gives companies incentive to develop new and unique drugs. typical 5-year exclusivity; with flexibility to extend depends on certain factors.

Invesitgational New Drug (IND)

a promising drug research gets forwarded to FDA containing the animal and cell testing data, to be convincing enough to start human trials.

medication administration record (MAR)

a record containing information about what medication was given or omitted for the patient.

club drug

a relatively new term that refers to substances taken by people at dance clubs, all-night parties and raves. It is a vague term that refers to a diverse group of abused substances that includes ecstacy, GHB, methamphetamine, Rohypnol, ketamine, and other agents, usually ingested with alcohol.

orphan disease

a serious, although rare, disease that affects fewer than 200,000 people in the United States.

fetal-placenta barrier

a special barrier that inhibit many chemicals and drugs from exiting the blood. serves to prevent potentially harmful substances from passing from the mother's bloodstream to the fetuses. it is ineffective because many harmful substances are still permeable.

delirium tremens

a syndrome of intense agitation, confusion, terrifying hallucinations, uncontrollable tremors, panic attacks and paranoia. 35% of untreated patients will die.

anterograde amnesia

a type of short term memory loss where the user cannot remember events that occur while under the influence of the drug.

attentions deficit/ hyperactivity disorder (ADHD)

children who are inattentive or hyperactive. they are usually prescribed methylphenidate (ritalin) a CNS stimulant to help calm them down and initiate focus.

drug allergies

common events caused by a hyperresponse of body defenses. basophils, mast cells, eosinophils, or lymphocytes secrete chemical mediators that trigger the allergic response. specific chem. mediators: histamine, serotonin, leukotrienes, prostaglandins, and complement.

transdermal patches

contain a specified a,out of medication, although the rate of delivery and actual dose can vary. absorbed through the skin.

risk management

department that examine risks and minimizes the number of medication errors. personnel investigate incidents, tract data, identify problems, and provide recommendations for improvement.

pharmacologic classification

describes how the drug acts on the body. diuretic, treats hypertension by lowering blood plasma. pharmacologic class is more specific than therapeutic. Pharmacologic classification of a medication is based on the drug's mechanism of action; for example, the mechanism of action of calcium channel blockers is to block the calcium channels of the heart, and the mechanism of action of a local anesthetic is to interfere with nerve transmission.

therapeutic classification

describes what is being treated by the drug. antidepressants, antipsychotics, anticoagulants... the prefix anti- often refers to therapeutic class. Therapeutic classifications are based on why a drug is given and how effective it is in treating a particular condition; for example, antihypertensive medications are prescribed to decrease blood pressure, diuretics are prescribed to increase urinary output, and anesthetics are given to decrease or prevent pain.

medication administration record (MAR)

documented record of the drugs given to the patient after administered. including drug name, dosage, time, assessments, nurse's signature. transition to electronic medical records (EMR).

Maintenence dosage

dosages given to keep the plasma drug concentration in the therapeutic range.

drug

drug is any substance that is taken to prevent, cure, or reduce symptoms of a medical condition.

chemical group name

drugs named and classified by a portion of their chemical structure. fluoroquinolones, benzodiazepine.

excretion

drugs removed from the body. primary site is the kidneys.

drug-protein complexes

drugs that bind reversibly to plasma proteins. only unbounded, free drugs can reach their target cells or be excreted by the kidneys. drugs bounded will remain trapped in bloodstream until unbounded. one agent may displace bounded drug-protein complexes and free medication and reach high levels in blood stream causing adverse effects.

teratogens

drugs that cause birth defects. teratogens affect pregnant women.

scheduled drugs

drugs that have a significant potential for abuse and are placed into 5 categories, schedules. regulated according to degree of potential of abuse.

controlled substances

drugs whose use is restricted by the Comprehensive Drug Abuse Prevention Act.

combination drugs

drugs with more than one active generic ingredient.

enzyme induction

drugs with the ability to increase metabolic activity in the liver.

enteral route

include drugs delivered to the gastrointestinal (GI) tract, either orally or through nasogastric or gastrotomy tubes. the most common, most effective, least costly and safest.

dependence

is a powerful physiological or psychological need for a substance.

medication reconciliation

is a process of keeping tract of a patient's medications as their care proceeds from one healthcare provider to another.

Adverse Event Reporting System (AERS)

is a voluntary program that encourages health care providers and consumers to report suspected adverse effects directly to the FDA or the product manufacturer.

expiration date

is an approximation as to when the medications will begin to lose their effectiveness.

adverse drug effect

is an undesirable and potentially harmful action caused by the administration of medicine.

medication error

is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.

adherence

is compliance, defined as taking medications in the manner prescribed by the health care provider. non-adherence can mean not taking the medicine at all to taking it at the wrong time or dosage.

bioavailability

is defined as the rate and extent to which the active ingredient is absorbed from a drug product and becomes available at the site of drug action to produce its effect.

Pharmacology

is the study of drugs. This broad area of study includes characteristics of various drugs, methods used to administer drugs, how drugs move through the body, and the body's responses to drugs. As a nurse, your understanding of pharmacologic principles is critical for the well-being of your clients.

vaginal route

is used to treat local conditions such as vaginal infections, pain and itching.

indications

it is the condition for which a drug has been approved. it is expected that all prescription drugs have some degree of effectiveness at treating or preventing a health condition.

opiods

known as opiates or narcotic analgesics, prescribed for severe pain, anesthesia, persistent cough, and life-threatening diarrhea.

hepatic microsomal enzyme system

liver enzymes that metabolize drugs as well as nutrients and other endogenous substances; sometimes called the P-450 (CYP) system.

troches

lozenges, are drugs formulated to slowly dissolve in the mouth.

rectal route

may be used for either local or system drug delivery through the anus.

first-pass effect

mechanisms whereby drugs are absorbed, enter into the hepatic portal circulation, and are inactivated by the liver before they reach the general circulation.

topical route

medications applied to the skin or membranous linings of the eye, ear, nose, respiratory tract, urinary tract, vagina and rectum. types: dermatological preparations, installations and irritations, inhalations.

patent medicines

medicines that rose in early America with no regulation of what it contained; they were patented with a brand name. It claim to cure about any symptom or disease, when were often harmless and ineffective (food coloring, flavoring and aromatics). Some were hazardous, (cocaine, heroin, morphine) were a large portion of their ingredients. Vick's vapor rub, Phillip's milk of magnesia.

plasma half-life (t1/2)

most common description of a drug's duration if action. it is the length of time required for the plasma concentration of a drug to decrease by one half after administration.

isozymes

multiple similar forms of an enzyme that perform slightly different metabolic functions.

household system of measurement

not used frequently, but familiar to the American household. teaspoon, tablespoon, cup.

cross-tolerance

occurs between closely related drugs, the more two drugs are similar chemically, the greater the possibility of cross-tolerance between them. Example, physically dependent on ethanol exhibit cross-tolerance to other CNS depressant drugs.

drug interactions

occurs when a substance increases or decreases a drug's actions. The substance may be another drug, a dietary supplement, an herbal product or food. substance must be external to the body to be considered a drug interaction and not substances that are naturally found in the body.

pharmacotherapy

or pharmacotherapeutics, is the application of drugs for the purpose of disease prevention and treatment of suffering.

polypharmacy

patients who receive multiple prescriptions, sometimes for the same condition, that have conflicting pharmacologic actions. most often seen in older groups.

additive effect

pharmacodynamic drug interaction that is easiest to visualize, in this interaction, two drugs from a similar therapeutic class produce a combined summation response.

synergistic effect

pharmacodynamic drug interaction that produces an enhanced response, in this interaction, the effect of the two drugs is greater than would be expected form simply adding the two individual drugs' reponses.

therapeutic range

range of dosage that produces the desired effects of a drug.

enteroheptatic circulation

recycling of drugs and other substances by the circulation of bile through the intestine and liver.

parenteral route

refers to the administration of drugs by routes other than enteral or topical.

side effects

side effects are types of drug effects that are predictable and which may occur even at therapeutic doses.

diffusion

simple or passive transport is the movement of a chemical from an area of higher concentration to an area of lower concentration.

blood-brain barrier

special barrier that inhibit many chemicals and drugs from crossing and exiting out of the blood. it's purposes to protect the brain from pathogens and toxic substances.

postmarketing surveillance

stage 4 of the drug approval process, after NDA is completed, survey for harmful drug effects in a larger population.

formulary

standards used by pharmacists to prepare drugs. a list of pharmaceutical products and drug recipes.

apothecary system of measurement

system developed in ancient Greece. the basic unit, the grain (gr) was defined as the weight of one grain of wheat. 5gr=325mL

enteric-coated

tablets with a hard waxy coating that enables them to resist acidity. they are designed to dissolve in the alkaline environment of the small intestine.

prototype drug

the agent (single drug) from a class to which all other drugs in the class are compared to.

Black Box Warning

the drug insert that warns prescribers that the drug carries a risk for a serious or even fatal adverse effect.

preclinical research

the first stage of drug development. involves extensive laboratory testing by the pharmaceutical company to determine drug action and to predict whether the drug will cause harm to humans.

absorption

the first step toward reaching target cells, the process by which drug molecules move from their site of administration to the blood.

toxic concentration

the level of drug that results in serious adverse effects.

minimum effect concentration

the minimal amount of drug required to produce a therapeutic effect.

therapeutic drug monitoring

the monitoring of plasma levels of drugs that have a low safety margin and use these data to predict drug action or toxicity. to keep drug dosage within a predetermined therapeutic range.

metric system of measurement

the most common system of drug measurement. Volume (liter, cubic centimeter=1mL of fluid), Weight (kg, g, mg, mcg)

generic name

the name of a drug assigned by the U.S. adopted name council, usually less complicated and easier to remember. one generic name for each drug. suffix -lol indicate beta-adrenergic blockers, suffix -statin denotes a lipid-lowering drug.

distribution

the phase of pharmacokinetics describing the movement of pharmacologic agents throughout the body after they are absorbed.

U.S. Food and Drug Administration (FDA)

the regulatory agency responsible for ensuring that drugs and medical devices are safe and effective.

clinical phase trials

the second stage of drug development. 3 different stages: (1) Safety- to determine proper dosages on healthy individuals. (2) Effectiveness- affects of drug on disease; treatment group and placebo (control) group. (3) Patient variability-diseased individuals given drug to determine the differences/interactions of the drug on different conditions.

pharmacokinetics

the study of drug movement throughout the body. it describes what the body does to the medication after it is administered. 4categories: absorption, distribution, metabolism, excretion.

pharmacology

the study of medicines.

antagonistic effect

type of pharmacodynamic drug interaction, occurs when adding a second drug results in a diminished pharmacologic response. result in drug action being cancelled.

risk-benefit ratio

when the benefits of taking a drug with carcinogenic potential may outweigh the long-term risks. a patient has a condition that is likely to cause premature death if left untreated, benefits of treating the patient now to extend life is worth the risk of developing cancer later.

characteristics that define a drug allergy

(1) typically occur with very small amounts of the drug. (2) symptoms are unrelated to the pharmacologic actions of the drug. (3) patients often exhibit cross-allergy, drugs with similar structure or from the same pharmacologic class. (4) require a previous exposure to the drug which sensitizes the patient to subsequent exposures.

four steps of the nursing process

1. Assessment 2. Planning 3. Implementation 4. Evaluation

storage factors that can influence drug effectiveness:

1. temperature- room temperature, sometimes refrigerated/frozen. Heat can degrade drug faster. 2. light-drugs are sensitive to light and degrade with exposure. 3. moisture and air-sometimes drugs interact with atmospheric gases or with water vapor.

extended release

XR, XL, LA, SR medications are designed to dissolve very slowly, resulting in a longer duration of action for the medication.

hallucinogens

a diverse class of chemicals that have in common the ability to produce an altered, dreamlike state of consciousness. `the prototype drug for this class is LSD. `psilocybin (shrooms), mescaline (peyote), DMT are similar drugs.

prodrugs

agents that require metabolism to produce their action.

trade name

also called the proprietary name, product or brand name is assigned by the pharmaceutical company marketing the drug. short and generally easy to remember.

idiosyncratic response

an adverse drug effect that produces an unusual and unexpected response that is not related to the pharmacologic action of the drug. not classified as allergies because they are not immune related.

affinity

an attraction for certain medications/drugs.

medication error index

an index that categorizes medication errors by evaluating the extent of harm an error can cause.

placebo

an inert substance that serves as a control "non-treatment" group.

addiction

an overwhelming compulsion that drives someone to repeat drug-taking behavior, despite serious health and social consequences. depends on agent/drug factors, user factors, and environmental factors.

chemical names

are assigned using standard nomenclature established by the IUPAC. a drug has only one chemical name. sodium chloride, lithium carbonate.

The Orphan Drug Act

became law in 1983, provides drug manufacturers for orphan diseases, development grants, tax credits, and 7 years exclusivity to market it.

metabolism

biotransformation, the process used by the body to chemically change a drug molecule.