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Pathophysiology & Pharmacology Exam 1 Test Hints: Key Concepts and Drug Classifications, Lecture notes of Nursing

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Maryam Jaber 1.24.23
Pathophysiology & Pharmacology
Exam 1 Test Hints
Trade vs. Generic Name
Trade name (brand name): designated and patented by the manufacturer
Generic name: related to the chemical or official name and is independent of the
manufacturer
Rule of thumb: Generic name usually lowercase; Trade name usually capitalized
Examples
o Generic: ibuprofen; Trade: Motrin
o Generic: amoxicillin; Trade: Amoxil
Black Box Warning
Primary alerts for identifying extreme adverse reactions
The strongest warning that the FDA can give consumers
Prototype
Prototype drug is a well-understood drug model with which other drugs in its class
are compared
An individual drug that represents groups of drugs
Usually the standard for newer drugs in the class are compared
Examples:
o morphine is the prototype of the opioid analgesics
o penicillin is the prototype of the beta-lactam antibacterial drugs
Therapeutic vs. Pharmacologic classifications
Pharmacological classification is based on how the drug works, therapeutic
classification is based on their actual usefulness
Pharmacological effect is the prevention of replication of the bacteria, the
therapeutic effect is to cure the infection
Examples:
o Lowers blood pressure Antihypertensive (THERAPEUTIC)
o Treats Angina Antianginal (THERAPEUTIC)
o Blocks Beta 1 receptors on cardiac muscles Beta-adrenergic Antagonist
(PHARMACOLOGICAL)
o Influences clotting Anticoagulant (THERAPEUTIC)
o Lowers blood cholesterol Antihyperlipidemic (THERAPEUTIC)
o Inhibits HMG-COA which reduces cholesterol-HMG-COA Reductase
Inhibitor (PHARMACOLOGICAL)
Pharmacokinetics
Determining the movement of drugs throughout the body
There are 4 phases of pharmacokinetics: absorption, distribution, metabolism,
excretion
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Pathophysiology & Pharmacology Exam 1 Test Hints Trade vs. Generic Name

  • Trade name (brand name): designated and patented by the manufacturer
  • Generic name: related to the chemical or official name and is independent of the manufacturer
  • Rule of thumb: Generic name – usually lowercase; Trade name – usually capitalized
  • Examples o Generic: ibuprofen; Trade: Motrin o Generic: amoxicillin; Trade: Amoxil Black Box Warning
  • Primary alerts for identifying extreme adverse reactions
  • The strongest warning that the FDA can give consumers Prototype
  • Prototype drug is a well-understood drug model with which other drugs in its class are compared
  • An individual drug that represents groups of drugs
  • Usually the standard for newer drugs in the class are compared
  • Examples: o morphine is the prototype of the opioid analgesics o penicillin is the prototype of the beta-lactam antibacterial drugs Therapeutic vs. Pharmacologic classifications
  • Pharmacological classification is based on how the drug works, therapeutic classification is based on their actual usefulness
  • Pharmacological effect is the prevention of replication of the bacteria, the therapeutic effect is to cure the infection
  • Examples: o Lowers blood pressure – Antihypertensive (THERAPEUTIC) o Treats Angina – Antianginal (THERAPEUTIC) o Blocks Beta 1 receptors on cardiac muscles – Beta-adrenergic Antagonist (PHARMACOLOGICAL) o Influences clotting – Anticoagulant (THERAPEUTIC) o Lowers blood cholesterol – Antihyperlipidemic (THERAPEUTIC) o Inhibits HMG-COA which reduces cholesterol-HMG-COA Reductase Inhibitor (PHARMACOLOGICAL) Pharmacokinetics
  • Determining the movement of drugs throughout the body
  • There are 4 phases of pharmacokinetics: absorption, distribution, metabolism, excretion

How absorption, distribution, metabolism, and excretion work and be able to apply it to a patient

  • Absorption: Process that occurs from the time a drug enters the body to the time it enters the bloodstream to be circulated o Movement of a drug from its site of administration into the bloodstream and distribution to the tissues o Onset of drug action determined largely by rate of absorption o Bioavailability: the portion of a dose that reaches the systemic circulation and is available to act on body cells o A drug that is absorbed from the intestine must first pass through the liver before it reaches the systemic circulation
  • Distribution: Transport of a drug by the bloodstream to its site of action o Drugs are distributed fast to areas with extensive blood supply: heart, liver, kidneys, and brain o Slower distribution: muscle, skin, and fait o Protein binding: plasma proteins (albumin) act as carriers for drug molecules § Only the free or unbound portion of a drug act on body cells § Allows for part of a drug to be stored and released as needed o If a person is malnourished and has low albumin or protein blood levels and he is taking protein-bound medications, what is the patient at risk for developing? § Nephrotic syndrome o Blood-brain barrier § Composed of capillaries with tight walls, limits movement of drug molecules into brain tissue § Acts as a selectively permeable membrane to protect the CNS § Only drugs that are lipid soluble or have a transport system can cross the blood-brain barrier and reach therapeutic concentration
  • Metabolism (aka biotransformation): method by which drugs are inactivated or biotransformed by the body
  • Sublingual and buccal
  • Topical (and transdermal patches) o Drugs applied to skin are for local effects
  • Ophthalmic
  • Otic
  • Nasal
  • Vaginal and Rectal First Pass effect
  • Initial metabolism of some oral drugs as they are carried from the intestine to the liver by the portal circulatory system prior to reaching the systemic circulation for distribution to site of action
  • Parenteral/SL, and vaginal routes are not affected by first pass effect
  • Rectum is part of the GI tract, some drug will be absorbed into capillaries that feed the portal vein to the liver. However, some drugs will be absorbed locally into the perirectal tissues o Thus, they have a mixed first pass an non-first pass absorption and metabolism
  • Order of effect: o Drug is absorbed o Drug enters hepatic circulation, goes to liver o Drug is metabolized to inactive form o Drug conjugates and leaves liver o Drug is distributed to general circulation o Many drugs are rendered inactive by first-pass effect

Half-life

  • Definition: time required for the serum concentration of a drug to decrease by 50%
  • The greater the half-life, the longer it takes to excrete
  • Determines frequency and dosages
  • A drug with a short half-life requires more frequent administration than one with a long half-life Drug plasma concentration
  • Measurement of the amount of a drug in the blood at a particular time
  • The nurse’s goal is to keep the plasma concentration in the therapeutic range Pharmacodynamics
  • Pharmacodynamics: reactions between living systems and drugs; drug actions on target cells and the resulting alterations in cellular biochemical reactions and functions
  • “what the drug does to the body” – Mechanism of Action Agonist & Antagonist
  • Agonist: drug that produces effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances o Fits the lock and enhances its functioning (opens the door) o May accelerate or slow normal cellular processes, depending on the type of receptor activated o Examples: § Epinephrine-like drugs act on the heart to increase the heart rate § Acetylcholine-like drugs act on the heart to slow heart rate
  • Antagonist: drug that inhibits cell function by occupying receptor cells o (fits the keyhole but does not fit the lock) prevents the agonist from acting, does not open the door) may serve as an antidote Therapeutic index
  • Therapeutic Index: the margin between effectiveness and toxicity in the blood level of a drug
  • Median lethal dose LD 50/Median effective dose ED 50
  • Ratio compares blood concentration at which a drug becomes toxic and concentration at which a drug is effective Types of allergic reactions
  • Allergic reactions – acquired hyper response of body defenses to a foreign substance (allergen) o Signs and symptoms: rash (with or without itching) edema, runny nose, reddened eyes with tearing
  • Anaphylaxis – severe type of allergic reaction; can lead to life-threatening shock
  • Idiosyncratic reaction – adverse effects that cannot my explained by the known mechanisms of action of the offending agent What is a medical error and what to do if it occurs
  • Medical error: preventable adverse effect of care, whether or not it is evident or harmful to the patient
  • What to do if medication error occurs? o Ethical responsibility to report all occurrences o Follow hospital policies for reporting and documenting an error

Controlled Substances and nursing administration

  • Controlled substances: drugs that are categorized by federal law according to therapeutic usefulness and potential for abuse; also known as scheduled drugs
  • Dependence: the physiological or psychological need for a substance
  • Controlled substance: drug is restricted by the Controlled Substance Act 1970 o Nurses are required to store controlled substances in locked containers, administering them only to people for whom they are prescribed, recording each dose given on agency narcotic sheets and on the patient’s medication administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities Scheduled-V
  • Products containing moderate amounts of controlled substances. They may be dispensed by the pharmacist without a physician’s prescription, but with some restrictions regarding amount, record keeping, and other safeguards.