Pharmacology Ch. 1, 2, 5, 6, 7 Lilley 7th edition complete
compliance
implementation/fulfillment of prescriber's/caregiver's prescribed course of tx or
therapeutic plan by a patient.
Why would a physician ever order an antagonist type drug? Let's say an
individual has been overly stressed (trying to learn about pharmacology!) and his
heart rate is elevated above the normal range.
But the physician wants to lower the heart rate. So he prescribes a drug to stop the
stimulation of the beta - adrenergic receptor sites. Beta Blockers are a group of drugs
that can be used for this purpose. These drugs attach to beta receptors and prevent the
adrenaline from attaching. This causes a decrease in heart rate.
Remember from your physiology that adrenaline attaches to receptors on cells
innervated by the sympathetic nervous system to increase the heart rate.
Why would you give an agonist?
1. The advantage of giving an agonist is that it produces a longer or increased desired
effect of the body's own hormone or neurotransmitter.
2. An agonist may also be given if the individual's body is lacking or has a decrease
amount of the hormone or neurotransmitter. ex: estrogen. If a woman is no longer
producing estrogen, the drug fits into the receptor site and produces the same response
as if estrogen had been produced by the body.
an agonist has both affinity (attaches to the receptor site) and intrinsic activity (the drug
molecule activates the receptor site and produces an effect).
phytochemicals
pharmacologically active ing. from herbal remedies
legend drugs
meds that aren't legally available w/out Rx
iatrogenic effects
unintentional adverse effects that are caused by actions of a prescriber, or other health
care pro, or by specific tx
More than ____ classes of OTC drugs are marketed to treat a variety of illnesses
ranging from acne to cough and cold, pain relief, and weight control.
80
OTC Drug Review
In 1972, the Food and Drug Administration (FDA) initiated an OTC Drug Review to
ensure the safety and effectiveness of the OTC products available, as well as to
establish appropriate labeling standards.
first pass routes
heptatic arterial
oral
portal venous
rectal* (leads to both first pass and non-first pass effects)
physical dependence
physiological need for a drug to avoid physical withdrawal symptoms
,psychological dependence
"addiction" obsessive desire for the euphoric effects of a drug
noncompetitive antagonist
drug combines w/different parts of the receptor and inactivates it. agonist then has no
effect
competitive antagonist
drug competes w/agonist for binding to the receptor. if it binds there's no response
antagonist
drug binds to the receptor; there's no response, drug prevents binding of agonists
partial agonist
drug bins to the receptor; the response is diminished compared with that elicited by an
agonist
(agonist-antagonist)
agonist
drug binds to the receptor; there's a response
receptor
reactive site on a cell/cell surface
enzymes
substances that catalyze nearly every biochemical reaction in a cell
transdermal route
drug delivery through patches adhesed to skin.
ex. fentanyl
sublingual and buccal routes
drugs administered here are absorbed into highly vascularized tissue under the
tongue/oral mucosa
ex. sublingual nitroglycerine
enteral route
drug is absorbed into systemic circulation through mucosa and stomach and/or
small/large intestine
What is the ratio between a drug's therapeutic effects and toxic effects called?
therapeutic index
ratio of a drug's therapeutic benefits to its toxic effects is referred to as the drug's
therapeutic index.
When a patient asks the nurse why a lower dose of intravenous pain medication
is being given than the previous oral dose, what knowledge will the nurse draw
on to respond to the patient?
Medications given intravenously are not affected by the first-pass effect.
drugs administered orally = high first pass effect, lots metabolized before systemic
circulation
intravenous administration = bypass liver, prevents first pass effect, more drug reaches
circulation
,parenteral doses w/high first pass effect = smaller than oral doses, but produce same
pharmacologic response.
The nurse needs to be aware that which factors will affect the absorption of orally
administered medications? (Select all that apply.)
Presence of food in the stomach
pH of the stomach
Patient position upon intake of medication
Form of drug preparation
Time of day
Presence of food in the stomach
pH of the stomach
Form of drug preparation
The nurse understands that drugs exert their actions on the body by (Select all
that apply.)
interacting with receptors
making the cell perform a new function
inhibiting the action of a specific enzyme
altering metabolic chemical processes
interacting with receptors
inhibiting the action of a specific enzyme
altering metabolic chemical processes
Patients with renal failure would most likely have problems with drug
excretion
kidneys are responsible for the majority of drug excretion.
To achieve the most rapid onset of action, the health care provider will prescribe
the medication to be administered by which route?
Intravenously
When a drug is administered intravenously, it does not need to be absorbed because it
is placed directly into general circulation.
Highly protein-bound drugs
increase the risk of drug to drug interactions
When administering two medications that are highly protein bound, the medications can
compete for binding sites on plasma proteins. This competition results in either less of
both or less of one of the drugs binding to the proteins, thus increasing the risk of
toxicity.
Which action, when performed by the nurse, will increase the absorption of a
medication administered intramuscularly?
Massaging the site increases circulation to the area and thus increases absorption, but
this should not be performed after all IM injections; it is drug specific. See the
recommendations on specific drugs.
, Drug half-life is defined as the amount of time required for 50% of a drug to
be eliminated by the body
In pharmacokinetics, the time required for half of an administered dose of drug to be
eliminated by the body, or the time it takes for the blood level of a drug to be reduced by
50%, is the drug's half-life (also called elimination half-life).
What is an alternate name for biotransformation of a drug?
metabolism
A drug given by which route is altered by the first-pass effect?
oral
Medications absorbed in the stomach and small intestine travel through the portal
system and are metabolized by the liver before they reach the general circulation.
Pharmacokinetics involves the study of
distribution rates among various body compartments
Pharmacokinetics involves the study of how the drug moves through the body, including
absorption, distribution, metabolism, and excretion.
Parenteral
means any route of administration other than the gastrointestinal (GI) tract, usually
injection.
What is the study of the physiochemical properties of drugs and how they
influence the body called?
Pharmacodynamics
teratogens
compounds that result in structural defects in the fetus
Teratogenic effects of drugs or other chemicals
result in structural defects in the fetus. Compounds that produce such effects are called
teratogens.
idiosyncratic reaction
occurs unexpectedly in a particular patient from a genetically determined abnormal
response to normal dosages of a drug. The study of such traits, which are solely
revealed by drug administration, is called pharmacogenomics.
allergic reaction (also known as a hypersensitivity reaction)
is an immunologic hypersensitivity reaction resulting from the unusual sensitivity of a
patient to a particular medication.
adverse drug reaction (ADR)
any reaction to a drug that is unexpected and undesirable and occurs at therapeutic
drug dosages; an ADR may or may not be caused by medication errors.
medication error
preventable situation involving compromise of the "Six Rights"; they occur during
prescribing, dispensing, administering, or monitoring of drug therapy.
Adverse drug event (ADE)
broad term for any undesirable occurrence involving medications; a similarly broad term
also seen in the literature is drug misadventure.
Drug incompatibility
compliance
implementation/fulfillment of prescriber's/caregiver's prescribed course of tx or
therapeutic plan by a patient.
Why would a physician ever order an antagonist type drug? Let's say an
individual has been overly stressed (trying to learn about pharmacology!) and his
heart rate is elevated above the normal range.
But the physician wants to lower the heart rate. So he prescribes a drug to stop the
stimulation of the beta - adrenergic receptor sites. Beta Blockers are a group of drugs
that can be used for this purpose. These drugs attach to beta receptors and prevent the
adrenaline from attaching. This causes a decrease in heart rate.
Remember from your physiology that adrenaline attaches to receptors on cells
innervated by the sympathetic nervous system to increase the heart rate.
Why would you give an agonist?
1. The advantage of giving an agonist is that it produces a longer or increased desired
effect of the body's own hormone or neurotransmitter.
2. An agonist may also be given if the individual's body is lacking or has a decrease
amount of the hormone or neurotransmitter. ex: estrogen. If a woman is no longer
producing estrogen, the drug fits into the receptor site and produces the same response
as if estrogen had been produced by the body.
an agonist has both affinity (attaches to the receptor site) and intrinsic activity (the drug
molecule activates the receptor site and produces an effect).
phytochemicals
pharmacologically active ing. from herbal remedies
legend drugs
meds that aren't legally available w/out Rx
iatrogenic effects
unintentional adverse effects that are caused by actions of a prescriber, or other health
care pro, or by specific tx
More than ____ classes of OTC drugs are marketed to treat a variety of illnesses
ranging from acne to cough and cold, pain relief, and weight control.
80
OTC Drug Review
In 1972, the Food and Drug Administration (FDA) initiated an OTC Drug Review to
ensure the safety and effectiveness of the OTC products available, as well as to
establish appropriate labeling standards.
first pass routes
heptatic arterial
oral
portal venous
rectal* (leads to both first pass and non-first pass effects)
physical dependence
physiological need for a drug to avoid physical withdrawal symptoms
,psychological dependence
"addiction" obsessive desire for the euphoric effects of a drug
noncompetitive antagonist
drug combines w/different parts of the receptor and inactivates it. agonist then has no
effect
competitive antagonist
drug competes w/agonist for binding to the receptor. if it binds there's no response
antagonist
drug binds to the receptor; there's no response, drug prevents binding of agonists
partial agonist
drug bins to the receptor; the response is diminished compared with that elicited by an
agonist
(agonist-antagonist)
agonist
drug binds to the receptor; there's a response
receptor
reactive site on a cell/cell surface
enzymes
substances that catalyze nearly every biochemical reaction in a cell
transdermal route
drug delivery through patches adhesed to skin.
ex. fentanyl
sublingual and buccal routes
drugs administered here are absorbed into highly vascularized tissue under the
tongue/oral mucosa
ex. sublingual nitroglycerine
enteral route
drug is absorbed into systemic circulation through mucosa and stomach and/or
small/large intestine
What is the ratio between a drug's therapeutic effects and toxic effects called?
therapeutic index
ratio of a drug's therapeutic benefits to its toxic effects is referred to as the drug's
therapeutic index.
When a patient asks the nurse why a lower dose of intravenous pain medication
is being given than the previous oral dose, what knowledge will the nurse draw
on to respond to the patient?
Medications given intravenously are not affected by the first-pass effect.
drugs administered orally = high first pass effect, lots metabolized before systemic
circulation
intravenous administration = bypass liver, prevents first pass effect, more drug reaches
circulation
,parenteral doses w/high first pass effect = smaller than oral doses, but produce same
pharmacologic response.
The nurse needs to be aware that which factors will affect the absorption of orally
administered medications? (Select all that apply.)
Presence of food in the stomach
pH of the stomach
Patient position upon intake of medication
Form of drug preparation
Time of day
Presence of food in the stomach
pH of the stomach
Form of drug preparation
The nurse understands that drugs exert their actions on the body by (Select all
that apply.)
interacting with receptors
making the cell perform a new function
inhibiting the action of a specific enzyme
altering metabolic chemical processes
interacting with receptors
inhibiting the action of a specific enzyme
altering metabolic chemical processes
Patients with renal failure would most likely have problems with drug
excretion
kidneys are responsible for the majority of drug excretion.
To achieve the most rapid onset of action, the health care provider will prescribe
the medication to be administered by which route?
Intravenously
When a drug is administered intravenously, it does not need to be absorbed because it
is placed directly into general circulation.
Highly protein-bound drugs
increase the risk of drug to drug interactions
When administering two medications that are highly protein bound, the medications can
compete for binding sites on plasma proteins. This competition results in either less of
both or less of one of the drugs binding to the proteins, thus increasing the risk of
toxicity.
Which action, when performed by the nurse, will increase the absorption of a
medication administered intramuscularly?
Massaging the site increases circulation to the area and thus increases absorption, but
this should not be performed after all IM injections; it is drug specific. See the
recommendations on specific drugs.
, Drug half-life is defined as the amount of time required for 50% of a drug to
be eliminated by the body
In pharmacokinetics, the time required for half of an administered dose of drug to be
eliminated by the body, or the time it takes for the blood level of a drug to be reduced by
50%, is the drug's half-life (also called elimination half-life).
What is an alternate name for biotransformation of a drug?
metabolism
A drug given by which route is altered by the first-pass effect?
oral
Medications absorbed in the stomach and small intestine travel through the portal
system and are metabolized by the liver before they reach the general circulation.
Pharmacokinetics involves the study of
distribution rates among various body compartments
Pharmacokinetics involves the study of how the drug moves through the body, including
absorption, distribution, metabolism, and excretion.
Parenteral
means any route of administration other than the gastrointestinal (GI) tract, usually
injection.
What is the study of the physiochemical properties of drugs and how they
influence the body called?
Pharmacodynamics
teratogens
compounds that result in structural defects in the fetus
Teratogenic effects of drugs or other chemicals
result in structural defects in the fetus. Compounds that produce such effects are called
teratogens.
idiosyncratic reaction
occurs unexpectedly in a particular patient from a genetically determined abnormal
response to normal dosages of a drug. The study of such traits, which are solely
revealed by drug administration, is called pharmacogenomics.
allergic reaction (also known as a hypersensitivity reaction)
is an immunologic hypersensitivity reaction resulting from the unusual sensitivity of a
patient to a particular medication.
adverse drug reaction (ADR)
any reaction to a drug that is unexpected and undesirable and occurs at therapeutic
drug dosages; an ADR may or may not be caused by medication errors.
medication error
preventable situation involving compromise of the "Six Rights"; they occur during
prescribing, dispensing, administering, or monitoring of drug therapy.
Adverse drug event (ADE)
broad term for any undesirable occurrence involving medications; a similarly broad term
also seen in the literature is drug misadventure.
Drug incompatibility
