Question Answer
What is a medication Error 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.
FDA estimates how many errors per year 1.2 million
Manufacturing erors include contamination, mislabeling, incorrect drug, incorrect concentration, incorrect doses
other factors for medication errors miscommunication, handwriting, look-alike and sound-alike drugs, misuse of zeroes and decimal points, confusion of dosing units, use of dangerous abbreviations and symbols, lack of complete information, omission errors
what is the significance of medication errors close to 100,000 citizens experience permanent harm or death each year because of preventable medical errors, approximately 7,000 deaths are actually caused each year in the us by medication errors
what 3 things can be done to reduce medication errors prescriptions with similar drug names should always be verified, unfamiliar abbreviations must be verified, trailing zeroes should be avoided and leading zeroes must always be used
how should you check drug accurately each drug name should be checked, its name strength and dosge form should then be checked against the medication order
prescribing errors involve what type of health-care practitioners All health-care practitioners
What are the most common prescribing errors miscommunication or misinformation
administration errors include: giving a drug to the wrong patient, giving the incorrect strength of a drug, giving medications too frequently or not frequently enough, using the incorrect dosage form
how should you document medication errors in a clear, factual manner, without blame or judgement
What is the FDA Doing to minimize errors bar codes for all drugs, stop using certain abbreviations, clearer drug product labeling
What does ISMP stand for Institute for safe medication practices
What is MEDMARX the US Pharmacopoeia’s anonymous medication errors reporting program
Written order by the physician to include: divice, drug (Trade or generic name), amount (mg ml cc, times per day
before administering a drug check: double check dosage, check for cloudiness color changes sediment
Ask yourself what questions can drug be given by route ordered, is it compatible with other drugs being given, is patient allergic to this drug, is it contraindicated for patient condition, identify patient by bracelet and ask birthdate.
most RC drugs are: Unit dose (1 dose ready to use)
for nebs, stop treatment if: heart rate goes up more than 20 points, bronchospasm worsens
pharmacodynamics the study of how drugs interact with their sites of action
excretion removal of a drug or metabolites from the body
most common route of excretion through urine
clearance rate: the rate in which drugs disappear from the circulation
pharmacodynamics: the study of how drugs interact with their sites of action
genetics play a role in: drug metabolism usually found when patients have problems
a drugs therapeutic effects and its adverse effects are influenced by: the processes of absorption, metabolism, reabsorption, and excretion
what determins the dose-effect relationship of a drug pharmacodynamics, pharmacokinetics
pharmacokinetics the effect of the body on a specific drug
what is pharmacokinetics made up of: absorption, distribution, metabolism, excretion
absorption: movement of a drug from the site of administration
distribution the movement of a drug through the bloodstream into the tissues, and eventually into the cells
metabolism the conversion of a drug into another substance, or substances
where does metabolism primarily occur the liver
biotransformation (Metabolites) the process of conversion of drugs from their original to a new form
method by which a drug gets into the body administration
onset-time time it takes for a drug to be active
onset and peak effect can be altered by the route given
drugs given orally need: bigger dose than IV or inhalation
aerosol targets lung
potency the amount of a drug that must be given in order to produce a particular response
efficacy how well a drug produces its desired effect
effective dose the dose required to produce the therapeutic response in 50% of the population
lethal dose point at which a drugs dose would be fatal in 50% of thepopulation
therapeutic index the effective dose is compared with the lethal dose
affinity cell recipient
agonist drug that binds to a specific receptor, producing a stimulatory response
Antagonist drug that prevents n agonist from binding to its specific receptor
What factors affect drug action Age, Gender, Body weight, drug half-life, diurnal body rhythms, diseases
what is the major determining factor of the length of a drugs action oin the body? half-life
define adverse effects harmful unexpected effects caused by a drug
define side effects effects that were not necessarily intended (and may be either beneficial or harmful)
Most drugs bind with what to cause physiologic changes Protein targets
what are common protein targets? receptors, enzymes, ion channels, or carrier molecules
What do some drugs bind with to alter genetic response DNA
For any drug response drug and receptors must be… chemically and structurally compatible.
to have efficacy the drug must… bond with receptor and cause response.
response is proportional to… drug concentration
What are the types of drug receptors lipid soluble (corticosteroids), transmembrane receptor (alburterol)
lipid soluble-corticosteroids have attachment to intracellular receptor, modified cell transcription
Transmembrane receptor-albuterol have G proteins start the effector system
Effector system produces… second messenger that causes cell response
Drug interactions occur when… A drugs effect are altered by another drug’s effects
Drug interactions may result in… either an increased or decreased effect
sometimes both drugs effects are… altered, and sometimes the drug interaction may acctually be beneficial
drug allergies are… abnormal responses to drugs that occur in a small number of individuals
the term hypersensitivity is often used synonymously with… allergy
define anaphylactic shock severe sudden allergic reaction that may be life-threatening
anaphylactic reactions commonly cause… sharp oss of blood pressure, diaphragm paralysis, and oropharynx swelling
anaphylactic reactions signify… a true medical emergency
Define drug tolerance the development of resistance to a drugs effects to the degree that doses must be raised continually to acheive the desired response
define cross-tolerance occurs when a resistance develops to chemically similar drugs
dependence is often confused with tolerance
Define potentiation an interaction between two drugs causing a greater effect than that which would occur from the additive properties of the drugs involved
Define cumulative effect occurs when the body cannot metabolize and excrete one dose of a drug completely before the next dose is given
define toxicity state of being noxious, and refers to a drug’s ability to poison the body
define antidote a drug that has the opposite effect and can reverse the toxic symptoms of a drug
define overdose toxic dose of a drug that harms the patient
the parasympathetic and sympathetic nervous system… work together to keep the body in balance.
the body either… stimulates or blocks the parasympathetic nervous system
the autonomic nervous system coltrols essential to life-day to day bodily function
parasympathetic chemical transmitters acetylcholine at synapse and neuroeffector site
parasympathetic receptor sites nicotinic and muscarinic
nicotinic stimulate acetylocholine(Cholinergic) at autonomic ganglia
Nicotinic is used to stimulate, Increases BP, and vasoconstriction
type of Muscarinic found in the lung M1, M2, M3
M1 and M2 cause bronchoconstriction
Parasympatholytic inhibit the parasympathetic system
cholinergic stimulate receptor for each acetylcholine (Could be nicotinic or muscarinic)
Anticholinergic blocks receptor or acetylcholine
anticholinergic blocks cause bronchodilation
Sympathetic general alarm HR and BP up, Blood flow to heart and muscles up, bronchodilation
sympathetic neuroeffector norepinephrine
Norepinephrine terminated by reuptake and the enzymes COMT and MOA
Alpha 1 vasoconstriction (Nasal decongestant)
Beta 1 increase force and rate of cardiac contractions (Found in heart)
Beta 2 Relax bronchial smooth muscle (Found in bronchi, vascular and skeletal muscle)
What does sympathomimetic do stimulates the sympathetic system
What does sympatholytic do inhibits the sympathetic system
What does adrenergic do stimulates receptor for norepinephrine or epinephrine
what is adrenergic use for bronchodilation, nasal decongestant, vasoconstriction
Anti-adrenergic does… blocks receptor for norepinephrine or epinephrine
anti-adrenergic use for vasodilation, anti-hypertension, anti-arrhythmic, glaucoma
Ipratropin and Tiotropium are… anticholenergic
block M1 and M3 and get bronchodilation
olitic means work against or inhibit
cholinergic: stimulate parasympathetic
anticholinergic: block parasympathetic
Albuterol: stimulates sympathetic
Adernergic (Beta 2)is: Sympathomimetic
Epinephrine causes vaso constriction
Question Answer
What do Alpha receptors do? Think Vasoconstrict in mucus membranes. Less swelling less edema
Beta Receptors do what? Generally excite with exception of heart where it stimulates.
Explain beta 1. Heart increases rate, velocity and force
Explain beta 2. Lungs broncodialates
Parasympathetic stimulation effects? At heart: Decreases rate, force, and velocity. At lungs: Vasoconstricts, increases mucus secretions
Nervous impulses are conducted by what? Electrical and chemical means
Where does chemical transmission of electrical impulse occur? At the synapses
What is the chemical transmitter in the parasympathetic branch? Acetylcholine
What inactivates (or inhibits) Acetylcholine? Cholinesterase
Other name for Parasympathomemetics? Cholinergic
Other name for Parasympatholytics? anti-cholinergic
Other name for sympathomemetics? Adrenergic
Other name for Sympatholytics? Anti-adrenergic
Most common used class of drugs used by RCP’s sympathomemetic
What drugs act where acetylcholine is the neurotransmitter? Cholinergic and anti-colinergic
What drugs act where norepinepherine is neurotransmitter? Adrenergic and anti-adrenergic
Another name for norepinepherine? Adrenaline
Explain Beta receptor pathway in the Sympathetic branch…. 1. Norepinepherine 2. adenylcyclase 3. ATP 4. cyclic AMP 5. Phosphodiesterase
How do we reverse bronchoconstriction with medications? With beta-sympathomemetics (adrenogerics)these meds increase amount of Cyclic AMP therefore allowing bronchodialation. OR parasympatholytics which BLOCK Cyclic GMP allowing AMP to increase allowing bronchodialation
Another name for Generic? Non-Proprietary
Another name for Trade name? Proprietary
Passive diffusion? No energy (ATP) required
Facilitated diffusion? No energy (ATP) required uses carriers and transport is more rapid
Simple Diffustio? Does not require energy and relies on concentration gradient from higher concentration to lower.
Filtration? Filters through pores
Active Transport? Does require energy (ATP) and moves against a concentration gradient; lower to higher.
Pinocytosis? cell eats extra cellular fluid
What is major site of drug metabolism? The Liver
Excretion of a drug from the system occurs primarily through what organ? The Kidneys
Drug affinity? Measure of attraction of a drug with a receptor site.
Drug efficacy? Stimulates
Agonist- attaches and stimulates; has affinity and efficacy
Antagonist- blocks
Antagonism 2 drugs with opposing effects
Cumulation- Drug is not excreted as fast as it is administered
Tolerance More drug is needed to produce the same effect.
Tachyphylaxis Rapidly developing a tolerance
Additive (1+1=2) 2 drugs together give effect equal to individual effect
Synergism- (1+0=2) 2 different drugs; one inactive on receptor site and one active produces greater effect than one active drug does 50
Potentiation- (1+1=3) 2 drugs together make effect greater than one drug alone
TI= LD50/ED50 Therapeutic index= lethal dose 50/effective dose
LD50? ED50? Lethal dose 50: Dose amount lethal to 50% of test population Effective dose 50: dose amount that is effective in 50% of test population
Low number for TI? High number for TI? More dangerous Safer
How do you figure TI? take LD50 and divide by ED50 that number is your TI; higer number is safer than lower number
3 basic phases of drug action? 1. Drug administration Phase 2. Pharmacokinetic 3. Pharmacodynamic
Explain drug administration phase. Depends on form and route of administration
Explain pharmacokinetic phase Absorbtion, distribution, metablolism and elimination
Explain pharmacodynamic phase Think lock and key answers the question of how a paticular drug works
What is the main funstion of Liver? Metabolism of medications
What is main function of Kidneys? Excretion of medications
Autonomic nervous system does what? Controls involuntary, unconscious control mechanisms of the body
Where is respiratory center located? Vasometer that controls blood pressure? Medulla oblongata
Is parasympathetic or sympathetic essential to life? Parasympathetic; it controls day to day functions.
What division is responsible for Fight-or-Flight? Sympathetic Division
Explain neurotransmitter control Electrical impulse, being converted into chemical
Sympathetic effects at heart? ” ” ” Lungs? Increases rate, force and velocity. Relax and dialate (bronchodialates) increases mucus production
Chemical neurotransmitter in Sympathetic branch? Norepinepherine
Drugs that are similar to norepinepherine in structure Catacholamines
What is primarily responsible for terminating the action of norepinepherine? Reuptake process 1
Explain reuptake process 1- -norepinepherine is reabsorbed into membranes of the neuron
Explain reuptake process 2- -uptake in non-neuronal tissues
Methods of action for termination the a ction of norepinepherine other than reuptake processes? Enzymatic- COMT and MAO
COMT? is responsible for ending action of catecholimine bronchodialators. it very rapidly inactivates drugs such as epinepherine** Therefore these drugs are not useful for long term therapy.
MAO? capeable of degrading catecholimines… bc it is found in the GI tract it makes oral use of catecholamines very ineffective
What determines bronchodialation? The level of Cyclic AMP
WHat is it called when beta receptors become unresponsive to stimulation? Beta blockade; this can also be induced pharmacologically with beta blocking agents
What does Cyclic AMP do? Relaxes smooth muscle to cause bronchodialation and stops mast cell breakdown
Explain beta receptor pathway in PARASYMPATHETIC division 1. Norepinepherine 2. Guanylcyclase 3. ATP 4. Cyclic GMP 5. Phosphodiesterase
What does Cyclic GMP do? 1. Contracts smooth muscle causing bronchoconstriction 2. excites mast cells releasing histamine and other bronchoconstricting mediators