NR 565 Pharmacology Week 1
14 key elements of presciption composition - ANS-Prescriber contact information
Prescriber name
License # (NPI)
DEA# (controlled substances)
Patient name
Allergies
DOB
Medication name
Efficacy of the medication Quantity
Indication
Dosage and frequency instructions Refills
Signature
3 aims of drug monitoring - ANS-1. Therapeutic dosage determination
2. Evaluating adequacy of medication
3. Identifying adverse effects
There are three potential outcomes of phase 1 metabolism: ANS-Oxidized, the most common
one. Reduced
Hydrolyzed
4 components of pharmacokinetics - ANS-Absorption, distribution, metabolism, excretion
8 rights of medication administration - ANS-Patient
Medication
Dose
Route
Time
Reason
Response
Documentation
9 factors that impact the outcome of medication - ANS-Comorbitidies + drug interactions
Gender + race
Genetics + pharmacogenomics
Absorption variability Placebo effect
Tolerance
Pathophysiology
Age
BMI
Absorption - ANS-The movement into the bloodstream for distribution
Absorption: enteral - ANS-GI tract > bloodstream > liver = 1st pass effect
Addiction - ANS-Compulsive use of a drug despite negative/dangerous effects
, Children's adverse drug effects include glucocorticoids, anthrax, and growth suppression.
Adverse medication effects in children: sulfonamides - ANS-Kernicterus-brain damage from high
levels of bilirubin
Adverse medication effects in children: tetracycline - ANS-Tooth discoloration
Adverse reactions: Allergic/hypersensitivity - ANS-Exaggerated immune response (i.e. mild
itching to anaphylaxis)
Adverse reactions: drug reaction - ANS - The most complicated and challenging to identify
Adverse reactions: idiosyncratic - ANS-Peculiar to the patient
Adverse reactions: pharmacologic - ANS-Extension of a drug's normal effect
Agonist - ANS-A drug that binds to and activates a receptor
Agonist: full - ANS-High efficacy, full response
Agonist: inverse - ANS-Produces opposite effect yet binds to the same receptors as agonist
Agonist: partial - ANS-Lower efficacy, sub-maximal activation when occupying all receptors
Alteration in CYP450 metabolism causes ___ - ANS-Medication interactions
Antagonist - ANS-Attenuates/weakens effects of an agonist
Antagonist: competitive ANS-Binds to the same receptors without activating them, thereby
preventing the agonist from acting. Antagonist: irreversible - ANS-Binds covalently; cannot be
displaced by competing ligands or washing
Antagonist: non-competitive - ANS-Binds to allosteric (non-agonist) receptor site to prevent
activation
Antagonist: reversible - ANS-Binds non-covalently; can be washed out
B Max - ANS-Maximum amount of drug/radioligand that can bind specifically to receptors in a
membrane preparation
used to determine the receptor site's density Beer's Criteria: Adults over 65 with potentially
inappropriate medication (PIM) use Interactions between PIM and other substances may
aggravate diseases or syndromes. includes medications that should be used with caution
Includes clinically significant drug interactions that should be avoided
Includes medications to be avoided or decreased dose due to decreased kidney function
The degree to which a medication can be absorbed is known as bioavailability (ANS).
Black-box warnings - ANS-When a medication is found to have serious/life-threatening risks
Still eligible for prescription
Carbamazepine - ANS-Potent inducer; metabolized by the same CYP450 enzyme it induces
Start at low dose, increase weekly due to steady decrease in half-life over time
Carcinogen - ANS-Substances that can cause cancer
ANS-Bariatric surgery-causes of decreased enteral absorption (decreased surface area) Active
(blood is moved away from the GI tract) Age (decreased motility)
Changes in pregnancy: bowel - ANS-Decreased tone and mobility
Increased drug absorption
Pregnancy-related changes include an increase in drug excretion, kidneys, and an increase in
GFR. Changes during pregnancy: liver, ANS, and increased hepatic drug metabolism
Absorption in children younger than two is significantly - ANS-marked CYP450 system is
thought to be ___ - ANS-Major system of enzymes responsible for phase 1 metabolism
CYP450: 450 mm - ANS-Absorbs light at 450 mm wavelength when exposed to carbon
monoxide (CO)
14 key elements of presciption composition - ANS-Prescriber contact information
Prescriber name
License # (NPI)
DEA# (controlled substances)
Patient name
Allergies
DOB
Medication name
Efficacy of the medication Quantity
Indication
Dosage and frequency instructions Refills
Signature
3 aims of drug monitoring - ANS-1. Therapeutic dosage determination
2. Evaluating adequacy of medication
3. Identifying adverse effects
There are three potential outcomes of phase 1 metabolism: ANS-Oxidized, the most common
one. Reduced
Hydrolyzed
4 components of pharmacokinetics - ANS-Absorption, distribution, metabolism, excretion
8 rights of medication administration - ANS-Patient
Medication
Dose
Route
Time
Reason
Response
Documentation
9 factors that impact the outcome of medication - ANS-Comorbitidies + drug interactions
Gender + race
Genetics + pharmacogenomics
Absorption variability Placebo effect
Tolerance
Pathophysiology
Age
BMI
Absorption - ANS-The movement into the bloodstream for distribution
Absorption: enteral - ANS-GI tract > bloodstream > liver = 1st pass effect
Addiction - ANS-Compulsive use of a drug despite negative/dangerous effects
, Children's adverse drug effects include glucocorticoids, anthrax, and growth suppression.
Adverse medication effects in children: sulfonamides - ANS-Kernicterus-brain damage from high
levels of bilirubin
Adverse medication effects in children: tetracycline - ANS-Tooth discoloration
Adverse reactions: Allergic/hypersensitivity - ANS-Exaggerated immune response (i.e. mild
itching to anaphylaxis)
Adverse reactions: drug reaction - ANS - The most complicated and challenging to identify
Adverse reactions: idiosyncratic - ANS-Peculiar to the patient
Adverse reactions: pharmacologic - ANS-Extension of a drug's normal effect
Agonist - ANS-A drug that binds to and activates a receptor
Agonist: full - ANS-High efficacy, full response
Agonist: inverse - ANS-Produces opposite effect yet binds to the same receptors as agonist
Agonist: partial - ANS-Lower efficacy, sub-maximal activation when occupying all receptors
Alteration in CYP450 metabolism causes ___ - ANS-Medication interactions
Antagonist - ANS-Attenuates/weakens effects of an agonist
Antagonist: competitive ANS-Binds to the same receptors without activating them, thereby
preventing the agonist from acting. Antagonist: irreversible - ANS-Binds covalently; cannot be
displaced by competing ligands or washing
Antagonist: non-competitive - ANS-Binds to allosteric (non-agonist) receptor site to prevent
activation
Antagonist: reversible - ANS-Binds non-covalently; can be washed out
B Max - ANS-Maximum amount of drug/radioligand that can bind specifically to receptors in a
membrane preparation
used to determine the receptor site's density Beer's Criteria: Adults over 65 with potentially
inappropriate medication (PIM) use Interactions between PIM and other substances may
aggravate diseases or syndromes. includes medications that should be used with caution
Includes clinically significant drug interactions that should be avoided
Includes medications to be avoided or decreased dose due to decreased kidney function
The degree to which a medication can be absorbed is known as bioavailability (ANS).
Black-box warnings - ANS-When a medication is found to have serious/life-threatening risks
Still eligible for prescription
Carbamazepine - ANS-Potent inducer; metabolized by the same CYP450 enzyme it induces
Start at low dose, increase weekly due to steady decrease in half-life over time
Carcinogen - ANS-Substances that can cause cancer
ANS-Bariatric surgery-causes of decreased enteral absorption (decreased surface area) Active
(blood is moved away from the GI tract) Age (decreased motility)
Changes in pregnancy: bowel - ANS-Decreased tone and mobility
Increased drug absorption
Pregnancy-related changes include an increase in drug excretion, kidneys, and an increase in
GFR. Changes during pregnancy: liver, ANS, and increased hepatic drug metabolism
Absorption in children younger than two is significantly - ANS-marked CYP450 system is
thought to be ___ - ANS-Major system of enzymes responsible for phase 1 metabolism
CYP450: 450 mm - ANS-Absorbs light at 450 mm wavelength when exposed to carbon
monoxide (CO)
