N5334 Final
Prescribing basics - ANS Prescribing is regulated by state BON
Proper RX - ANS Providers name and address, Telephone
DEA
Pt name/DOB/Address
Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity and
signature.
Drug Schedules: Most addictive to least - ANS 1: Heroin,LSD, MJ
2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine, fentanyl,
adderall, ritalin
3: codeine, ketamine, testosterone
4: xanax, valium, soma, ambient, tramadol
5: antidiarrheal, antitussives, lomotil, lyrica
Pharmacodynamics - ANS The effects of drugs on the body. Receptors are large molecules
usually proteins, that interact and mediate the action of drugs
agonist - ANS produce receptor stimulation and a conformational change every time they bind.
Do not need all available receptors to produce a maximum response
Partial agonist - ANS drugs that have properties in b/w those of full agonist and antagonist.
They bind to receptors but when they occupy the receptor sites, they stimulate only some of the
receptors.
antagonist - ANS drugs with affinity for a receptor but with no intrinsic activity. Affinity allows the
antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from
causing receptor activation. The block action of drugs (ex. Narcan)
Bioavailabity - ANS % of administered dosage of the drug that survives the first pass through
the liver and reaches the blood stream
half life - ANS Time required for the amount of a drug in the body to decline by 50%, drugs with
shorter half lives must be administer frequently. 4.5-5.5 times the half life to get steady state and
to be limited from the body
what the body does to the drug - ANS absorption, distribution, metabolism, excretion
,Distribution - ANS movement of absorbed drug in bodily fluids throughout the body to target
tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein binding,
size of molecule (smaller molecules are more able to diffuse)
Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugs
can pass)
Protein binding - ANS unbound drug is free which is active, crosses membrane. Low plasma
proteins result in more free drug. Competition: when 2 highly bound drugs are given it increases
the level of both drugs
Metabolism - ANS take place in the liver mostly. Chemical change of a drug structure to:
Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug (inactive
until metabolized in the body into the active compound, ex: levodopa), increase or decrease
toxicity
CYP450 - ANS enzymes constitutes the most important of the phase I metabolizing enzymes
(account for about 75% of drug metabolism in the liver)
Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the substrates
rendering them more readily excretable
Substrate - ANS an agent that is metabolized by an enzyme into a metabolite and product and
eventually excreted
Inhibitors - ANS compete with other drugs for a particular enzyme affecting the metabolism
(decreased) of the substrate and decreases the excretion of the substrate and increasing the
circulating drug
inducer - ANS competes with other drugs for a particular enzyme affecting metabolism of the
substrate (increases) decreasing the efficacy of the drug
excretion - ANS renal: passive glomerular filtration, active tubular secretion, tubular
reabsorption, gi tract, lung, sweat and salivary, mammary
genomics - ANS study of the complete set of genetic information present in a cell, an organism,
or species
pharmacogenetics - ANS the study of the influence of hereditary factors on the response of
individual organisms to drugs, and the study of variations of DNA and RNA characteristics as
related to drug response
Pharmacogenetics tests - ANS Mentioned on drug labels can be classified as "test required,"
"test recommended," and "information only." Currently, four drugs are required to have
, pharmacogenetics testing performed before they are prescribed: cetuximab, trastuzumab,
maraviroc and dasatinib
wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to initial
dosing
Carbamazepine and Asisans - ANS Initiating carbamazepine therapy in these patients (allele
HLA-B*1502) are at high risk for developing Steven Johnson syndrome or toxic epidermal
necrolysis (TEN)
The ability of the anesthetic to penetrate the axon membrane is determined by 3 properties.
What are they? - ANS Molecular size, Lipid solubility, degree of ionization at tissue pH
Why is epinephrine given with local anesthetics? - ANS Decreases local blood flow (decreased
risk of bleeding)
Delays systemic absorption of the anesthetic
prolongs anesthesia
reduces the risk of toxicity
What is the most widely used local anesthetic? - ANS Lidocaine
What is a possible fatal reaction to benzocaine - ANS Methemoglobinemia
What is included in application guidelines for topical anesthetics - ANS avoid wrapping the site
and heating the site, avoid application to open skin
Which medication will not cause rebound headaches from overuse? - ANS propranolol
(preventative)
What is the best option for menstural migraine? - ANS low dose estrogen about 3 days prior to
menses
What food can trigger migraines? - ANS Hot dog d/t nitrates
What medication is a Seratonin 1B1D receptor agonist? - ANS Sumatriptan
Butterbur can help as prevention for migraine therapy. What side effect can occur? - ANS Liver
damage
What are the 3 main classes of opiod receptors? - ANS Mu kappa delta
Which of the following will reserve he effects caused by opioid agonist? - ANS naloxone
Prescribing basics - ANS Prescribing is regulated by state BON
Proper RX - ANS Providers name and address, Telephone
DEA
Pt name/DOB/Address
Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity and
signature.
Drug Schedules: Most addictive to least - ANS 1: Heroin,LSD, MJ
2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine, fentanyl,
adderall, ritalin
3: codeine, ketamine, testosterone
4: xanax, valium, soma, ambient, tramadol
5: antidiarrheal, antitussives, lomotil, lyrica
Pharmacodynamics - ANS The effects of drugs on the body. Receptors are large molecules
usually proteins, that interact and mediate the action of drugs
agonist - ANS produce receptor stimulation and a conformational change every time they bind.
Do not need all available receptors to produce a maximum response
Partial agonist - ANS drugs that have properties in b/w those of full agonist and antagonist.
They bind to receptors but when they occupy the receptor sites, they stimulate only some of the
receptors.
antagonist - ANS drugs with affinity for a receptor but with no intrinsic activity. Affinity allows the
antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from
causing receptor activation. The block action of drugs (ex. Narcan)
Bioavailabity - ANS % of administered dosage of the drug that survives the first pass through
the liver and reaches the blood stream
half life - ANS Time required for the amount of a drug in the body to decline by 50%, drugs with
shorter half lives must be administer frequently. 4.5-5.5 times the half life to get steady state and
to be limited from the body
what the body does to the drug - ANS absorption, distribution, metabolism, excretion
,Distribution - ANS movement of absorbed drug in bodily fluids throughout the body to target
tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein binding,
size of molecule (smaller molecules are more able to diffuse)
Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugs
can pass)
Protein binding - ANS unbound drug is free which is active, crosses membrane. Low plasma
proteins result in more free drug. Competition: when 2 highly bound drugs are given it increases
the level of both drugs
Metabolism - ANS take place in the liver mostly. Chemical change of a drug structure to:
Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug (inactive
until metabolized in the body into the active compound, ex: levodopa), increase or decrease
toxicity
CYP450 - ANS enzymes constitutes the most important of the phase I metabolizing enzymes
(account for about 75% of drug metabolism in the liver)
Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the substrates
rendering them more readily excretable
Substrate - ANS an agent that is metabolized by an enzyme into a metabolite and product and
eventually excreted
Inhibitors - ANS compete with other drugs for a particular enzyme affecting the metabolism
(decreased) of the substrate and decreases the excretion of the substrate and increasing the
circulating drug
inducer - ANS competes with other drugs for a particular enzyme affecting metabolism of the
substrate (increases) decreasing the efficacy of the drug
excretion - ANS renal: passive glomerular filtration, active tubular secretion, tubular
reabsorption, gi tract, lung, sweat and salivary, mammary
genomics - ANS study of the complete set of genetic information present in a cell, an organism,
or species
pharmacogenetics - ANS the study of the influence of hereditary factors on the response of
individual organisms to drugs, and the study of variations of DNA and RNA characteristics as
related to drug response
Pharmacogenetics tests - ANS Mentioned on drug labels can be classified as "test required,"
"test recommended," and "information only." Currently, four drugs are required to have
, pharmacogenetics testing performed before they are prescribed: cetuximab, trastuzumab,
maraviroc and dasatinib
wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to initial
dosing
Carbamazepine and Asisans - ANS Initiating carbamazepine therapy in these patients (allele
HLA-B*1502) are at high risk for developing Steven Johnson syndrome or toxic epidermal
necrolysis (TEN)
The ability of the anesthetic to penetrate the axon membrane is determined by 3 properties.
What are they? - ANS Molecular size, Lipid solubility, degree of ionization at tissue pH
Why is epinephrine given with local anesthetics? - ANS Decreases local blood flow (decreased
risk of bleeding)
Delays systemic absorption of the anesthetic
prolongs anesthesia
reduces the risk of toxicity
What is the most widely used local anesthetic? - ANS Lidocaine
What is a possible fatal reaction to benzocaine - ANS Methemoglobinemia
What is included in application guidelines for topical anesthetics - ANS avoid wrapping the site
and heating the site, avoid application to open skin
Which medication will not cause rebound headaches from overuse? - ANS propranolol
(preventative)
What is the best option for menstural migraine? - ANS low dose estrogen about 3 days prior to
menses
What food can trigger migraines? - ANS Hot dog d/t nitrates
What medication is a Seratonin 1B1D receptor agonist? - ANS Sumatriptan
Butterbur can help as prevention for migraine therapy. What side effect can occur? - ANS Liver
damage
What are the 3 main classes of opiod receptors? - ANS Mu kappa delta
Which of the following will reserve he effects caused by opioid agonist? - ANS naloxone
