1 / 64

Pharmacology Exam Review

Pharmacology Exam Review. Ch. 1. Chemical name : chemical structure Code name : experiential drug Generic name: Assigned by United States Adopted Name Council, drug shows therapeutic use and the manufacturer wishes to market the drug Trade name: brand name or proprietary name

milton
Télécharger la présentation

Pharmacology Exam Review

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pharmacology Exam Review

  2. Ch. 1 • Chemical name: chemical structure • Code name: experiential drug • Generic name: Assigned by United States Adopted Name Council, drug shows therapeutic use and the manufacturer wishes to market the drug • Trade name: brand name or proprietary name • Official name: experiential drug becomes approved, generic name becomes official name

  3. Ch. 1 • FDA: approval of drugs, lengthy, costly, research phases • Orphan drugs: rare disease drug, fewer than 200,000 people • Prescription: includes: • Name/address/date • Rx, superscription • Inscription • Subscription • Sig, signature • Name of prescriber

  4. Ch. 1 • OTC: without prescription • Know abbreviations: QID, BID, TID, Q4…

  5. Ch. 2 • Agonist: drug binds to a receptor creates an effect • Antagonist: blocks receptor effect • Bioavailibility: amount of drug available for action in systemic system • Drug administration routes: • Enteral (GI), Parenteral (IV), Transdermal, inhalation, topical

  6. Ch. 2 • First pass effect: initial metabolism in the liver of a drug taken orally before the drug reaches the systemic system • Hypersensitivity: allergic/immune mediated reaction to a drug, can be serious requiring mechanical ventilation • Idiosyncratic effect: unexpected reaction to drug, other than a allergic reaction

  7. Ch. 2 • Pharmacodynamics: mechanism of drug action by which drug molecule causes effect; after kinetic phase • Pharmacokinetics: time course and disposition based on absorption, distribution, metabolism, eliminitaion • Pharmacogentics: genetic factors, influence drug response

  8. Ch. 2 • Synergism: combined effect greater than individual • Tachyphylaxis: rapid decrease in response to a drug • Tolerance: decreased intensity of a drug • Pinocytosis: substance goes into a cell by process of membrane engulfment and transport of the substance into the cell

  9. Ch. 2 • Metabolism: liver primary site of metabolism and biotransformation • Excretion: Kidney primary site • Receptors: linked to G proteins, cause both constriction and dilation from epinphrine or Ach stimulation

  10. Ch. 3 • Aerodynamic diameter of a particle: determines deposition in airway • Dead volume: amount of solution that remains in a SVN after sputtering • HFA: hydrofluoroalkane, propellant for MDIs • Spacer, reservoir and holding chambers

  11. Ch. 3 • Aerosol delivery: • Advantages: • Smaller doses, rapid onset, targeted delivery, fewer side effects, painless, lung provides portal to body • Disadvantages: • Many variables, dose reproducibility, difficult coordination, lack of knowledge, lack of standardized info, varying devices

  12. Ch. 3 • Mass Median Aerodynamic Diameter (MMAD) • Indicates where the mass of drug is centered in a distribution of particle sizes • >10 nasopharngeal and oropharyngeal regions • 5-10 microns: central airways • 2-5 microns: lower airway (bronchodilator range) • 0.8-3 microns: small airways, alveoli

  13. Ch. 3 • Mechanisms of Deposition • Inertial impaction: function of particle size and velocity and increases with larger size and higher velocities • Gravitational settling: sedimentation, particle size and time • Diffusion (Brownian motion): affects particles less than 1 micron

  14. Ch. 3 • Devices: DPI, MDI, SVN, USN, SPAG • USN: electric powered, piezoelectric principle, • SPAG: Ribavirn • SVN: gas powered, uses a baffle to disperse particles to form aerosol from liquid • Time: 10-15 minutes, decreases with higher flows, flow set at 6-8 liters, volume 3-5 ml. • Advantages of SVN: can nebulize many drugs, mixtures, minimal coordination, useful in old/young, low inspiratory flows, modifiable doses • Disadvantages: expensive/cumbersome, Tx time lengthy, variability in performance, contamination

  15. Ch. 3 • BAN: Aeroclipse, undiluted meds, shorter tx times • MDI: drug, propellent, canister, valve, and mouth piece. HFA, portable/compact, short tx time, hard to coordinate, difficult to assess depletion, large oral impaction w/o holding chamber. Shake canister if not used frequently, may prime device, recommend spacer/holding chamber over open mouth • Breath actuated inhalers: Maxair

  16. Ch. 3 • Holding chamber: one way valve/spacer, holds the aerosol cloud until inspiration occurs, decreases waste and oral impaction, reduce electrostatic charge, do not wipe inside. • DPI: requires inspiratory flow of 30-90 L/min, old/young may not be able to use • IPPB, Endotracheal tube administration, mask, mouth piece.

  17. Ch. 5 • Ach: transmission stimulates bronchoconstriction, muscle contraction. Responds to cholingergic/nicotinic receptors. Destroyed by cholinesterase. Blocked by anti-cholinergics, parasympatholytics • Adrenergic: stimulates receptors for norepinephrine/epinephrine. Beta agonist, receptors alpha/betas, causes bronchodilation, increased HR, alpha constriction

  18. Ch. 5 • Peripheral nervous system: outside the CNS, includes sensory/sympathetic and parasympathetic nerves, Autonomic nervous system (parasympathetic and sympathetic branch) • Sympatholytic, sympathomimetic, cholinergic, anticholinergic, antiadrenergic, adrenergic, parasympatholytic

  19. Ch. 5 • Efferent: from brain to body • Afferent: from body to brain • Cholinergic: stimulated by Ach, contraction…cholinesterase destroys AcH • M1-3 in lungs, M3 when stimulated by Ach causes constriction. M2 cholinesterase decreases AcH. Anticholinergics block all M receptors; all are G linked

  20. Ch. 5 • Anticholingerics: • Atropine: blocks salivary glands, increases HR, bronchodlation, pupil construction • Atrovent • Tiotropium Adrenergics: Alpha and Beta receptor stimulators (know what each does)

  21. Ch 6 • Adrenergics: beta agonist, bronchodilators • Asthma paradox: increased asthma mortality despite knowledge and tachnology • cAMP: produced by Beta receptor stimulation, from conversion of ATP by adenlycyclase • cGMP: opposite effect of cAMP, causes bronchoconstriction • Downregulation: long term desensitization of Beta receptors to beta agonists

  22. Ch. 6 • Fast acting vs long acting • Ultra short: Racemic, stridor/airway swelling • Adrenergics are stereoisomers, Levalbuterol does not have the S-isomer • Albuterol/Proventil/ProAir/Ventoline • Beta receptors • SVN 0.5% soln, 0.5 ml, 2.5 mg, 0.63 mg, 1.25 mg, TID/QID. • MDI (proAIR) 90 ug/puff x 2 puffs • Onset 15 min, peak 30-60 min, duration 5-8 hours

  23. Ch. 6 • Beta 2 agonists cause: • Bronchial smooth muscle relaxation • Inhibition of histamine release • Stimulation of mucociliaryclearence • Are called sympathomimimic as they mimic epinephrine, also called adrenergics, or beta agonists • Adrenergic stimulation causes: Beta 1, Beta 2 and Alpha responses

  24. Ch. 6 • Racemic Epinephrine/microNefrin/Nephron • Alpha 1 and Beta receptors • Vasoconstriction for stridor • SVN 2.25% solution, 0.25-0.5 ml • Onset: 3-5 min, peak 5-20 min, duration: 0.5-2 hr • Increases HR, bronchodilates and vasoconstricts • Side effects: HR increases, tremors, shakiness

  25. Ch. 6 • Levalbuterol/Xopenex • SVN: 0.31, 0.63, 1.25 mg TID • MDI: 45 ug/puff x 2, q4-6 • Same onset/peak/duration as albuterol • One less isomer than albuterol (no S-isomer) • Pure R-isomer of racemicalbuterol • Side effects: tremor, less HR changes

  26. Ch 6 • Long acting (prophylactic) • Not for acute bronchospasm • Brovana/arfometerol, SVN only • Formoterol/Foradil • Mixed with Pulmicort to make symbicort • Dose 12 ugBID • Salmeterol/Serevent • Mixed with Flovent to make Advair • Dose DPI 50 ug/BID • Onset 20 min, peak 5-6, duration 12 hrs

  27. Ch. 6 • Saligenin agents: albuterol, beta 2 preferential drug • Short/long acting bronchodilators: Have antiinflammatory effects, however not enough to replace antiinflammatory drugs • Used in treatment of COPD, asthma • LABA prophylactic use, BID, stays attached to beta receptor longer

  28. Ch. 6 Mode of Action of Adrenergics: Once attached to a β2 receptor in bronchial smooth muscle the drug then attaches to the intracellular Gs protien which stimulates adenlycyclase to form cAMP from ATP which then decreases Ca2+↓ and Myosin resulting in SM relaxation . Also activate β receptors on mast cell mb. , thus used in prophylaxis of allergic asthma .

  29. Ch. 6 • Side effects: • Tremor, palpitations, headache, insomnia, nervousness, dizziness, nausea, tolerance, loss of bronchoprotection, hypokalemia; downregulation • Routes of administration with adrenergics: • Continuous SVN: severe asthma, 10-15 mg an hour of albuterol • SVN route the best route

  30. Ch. 6 • Respiratory assessment with adrenergics: • Assess effectiveness; peak flows • Breath sound change • Vital signs • A 20% change in HR from baseline may warrant a change in therapy • Check glucose, potassium levels • Device education

  31. Ch. 7 • Anticholinergics: only two used for the inhalation route: • Atrovent(Ipatropium Bromide), 0.5 mg SVN, MDI dose • Spiriva (Tiotropium Bromide), handihaler dry powder • Both have little systemic side effects • Use one or the other. Used for COPD and also during asthmatic attacks

  32. Ch. 7 • Combivent: Combo of Atrovent and Albuterol in a MDI • Duoneb: Combo of Albuterol and Atrovent in a SVN • Give combos for synergetic effect • Atropine: No longer aerosolized, used to increase HR, dry mouth. Tertiary compound, means it crosses BBB has systemic effects

  33. Ch. 7 • Spiriva • DPI, 18 ug/inhalation, given QD • Onset 30 min, peak 3hr, duration 24 hrs • Atrovent: • MDI (HFA)17 ug/puff x 2 puffs, QID • Onset 15 min, peak 1-2 hr, duration 4-6 hrs • SVN 0.02% solution, 0.5 mg TID

  34. Ch. 7 • Mode of action of anticholinergics • cGMP inhibits constriction and mucus production • cGMP acts as a secondary messenger much like cAMP but instead of converting ATP, cGMP prevents neurotransmitters from entering the bronchial smooth muscle cell • Unlike sympathometic bronchodilators, Atrovent/Spiriva do not cross the blood brain barrier and thus have essentially no systemic side effects (both are derivatives of Atropine, but are quaternary amines) • Slower bronchodilator effects and less intense than adrenergics

  35. Ch. 7 • Atrovent is non selective M blocker • Quaternary compund, does not cross the BBB • Spiriva: dissociates more slowly from M1 and M3 receptors. More selective than Atrovent • M2: inhibits further AcH release • Cholinergic effects: decrease HR, miosis, contraction of lens, salivation, urination, secretion of mucus, bronchoconstriction • AcH destroyed by cholinesterase

  36. Ch. 7 • Anticholinergic effects: increased HR, pupil dilation, flattened lens (USE CAUTION WITH ATROVENT WITH patients with Glaucoma), drying of upper airway, urinary retention, antidiarrheal, mucociliary slowing • Adverse effects: dry mouth, cough, avoid spraying in eye

  37. Ch. 8 • Methylxanthines: derived from Xanthines, consist of Caffeine, theophylline, and theobromine • Phosphodiesterase: enzyme that inhibits cAMP. Xanthine believed to inhibit this enzyme, thus increasing bronchodilation • Uses: Apnea/bradycardias; most common use of Xanthine, in form of Caffiene for neonates

  38. Ch. 8 • Uses: COPD as a weak bronchodilator, increasing respiratory muscle strength, increases contractility for patients on long term mechanical ventilation (helps with diaphragm wasting); respiratory muscle endurance, central ventilatory drive, cardiovascular effects by increasing CO, and antiinflammatory effects

  39. Ch. 8 • Theophylline: lots of side effects, must keep in narrow therapeutic range, headache, anxiety, restlessness, nausea, anorexia, vomiting, abdomial pain, hematemesis, tachypnea, palpitations, SVT, ventricular arrhythmias, hypotension, diruresis

  40. Ch. 9 • Abhesives: coating of film that preventsor reduces adhesion • Elasticity: rheologic property characteristic of solids it is represented by the storage of modulus G • Expectorant: medication meant to increase the volume or hydration of airway secretions • Gel: macromolecular description of pseudo-plastic material viscosity and elasticity

  41. Ch. 9 • Mucin: principle airway gel forming mucins • Mucoactive agent: effect on mucus secretion • Mucokinetic agent: increases ciliary clearance or respiratory mucus • Mucolytic agent: degrades polymers in secretions • Mucoregulatory agent: reduces volume of airway mucus secretion and appears to be especially effective in hypersecretory states

  42. Ch. 9 • Know layers of mucosa (gel, sol layer, epithelial cells, cilia, goblet cells, bronchial glands- produce most mucus) • Produce 100 ml of mucus daily • Acetylcysteine (NAC): Mucomyst, 10%/20%, SVN 3-5 ml • Causes bronchospasm, give with bronchodilator • Rotten egg smell, nausea • Directly instilled, or aerosolized • Breaks down sulfhydryl groups for disulfide bonds of mucus • Given to COPD, pneumonia, congestion, acetaminophen overdose • Incompatible with anti-biotics (do not mix mucomyst)

  43. Ch. 9 • Factors affecting mucus transport: • COPD/CF • Airway drying • Narcotics • Artificial airways/suctioning • Cigarette smoke • Pollution • Hyperoxia/hypoxia

  44. Ch. 9 • Food intake (milk) in particular does not increase mucus • Adrenergics: increase cilia beat and mucus production • Cholinergics: increase ciliary beat and mucus • Anticholinergics: decrease cilia beat and decrease mucus production • Xanthines: increase cilia beat and production • Steroids: no effects on cilia, decrease mucus production

  45. Ch. 9 • Sputum: mucus plus oral secretions • Bronchorrhea: watery sputum • Asthma: inflammation/increased mucus production • CF: impaired proteins, get frequent infections such as pseudomonas, require Dornase Alfa. Most congestion is not mucin, instead puss from neutrophil degradation

  46. Ch. 9 • Physical properties of mucus include viscosity, elasticity, cohesion, and adhesity. • Dornase Alfa: • Pulmozyme dose 2.5 mg • Given during infections with CF • Reduces extracellular DNA and F-actin polymers, reduces viscosity and adhesiveness of mucus • Does not cause bronchospasm, may cause pharyngitis, laryngitis, rash, chest pain, conjunctivitis

  47. Ch. 9 • Expectorants: • Sodium Bicarb: increases pH of mucus weakening bonds lowering viscosity and elasticity, used directly or aerosolized. Weak • Guaifesnsin: cilitoxic when applied directly • Hypertonic Saline: >0.9%, for induction of cough • Use adjunct therapy for mucus control • PEP, CPT, IPPB, Heated humidity, postural drainage, Bronchodilators, Vest • Bland aerosols (without medications)

  48. Ch. 10 • Surfactant agents regulate surface tension in films at gas-liquid interfaces, described by LaPlace’s Law • Surfactants are used are prophylactic or rescue treatment for RDS • Used exogenous surfactants include: • Beractant (Survanta), Calfactant (infasurf), Poractantalfa (Curosurf)

  49. Ch. 10 • Surfactant is directly instilled into the airway via endotracheal tube and adaptor, must closely monitor patient for compliance changes in order to prevent pneumothorax • Surfactants used are all natural based • Surfactant is composed of: • 85-90% lipids and 10% Proteins • Exogenous surfactant enter into the alveolar pool and replace deficient natural surfactant

  50. Ch. 11 • Adrenal cortical hormone: chemicals secreted by the adrenal cortex (steroids) • Endogenous: made within body • Exogenous: outside body • IgE: immune antibody, increased with allergen • Prostglandin: hormone type substances circulating in body • Steroids: Glucocorticoids or corticosteroids, antiinflammatory effect

More Related