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Pharmacology Unit 1

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Pharmacology
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The study of drugs
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Pharmacotherapy
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Therapy using drugs
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Local Effects
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The drug only affects one area of the body
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Systemic Effect
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The drug affects the whole body
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Chronic
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develops and worsens over an extended period of time; 6 months or greater
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Acute
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Sx appear and change or worsen rapidly, ie. heart attack, 6 months or less
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derived from plants, animals and minerals, now mostly synthetic compounds or semisynthetic drugs(in a lab; more stable, less allergic Reaction)
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drug sources
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effect on the body, therapeutic use, chemical characteristics
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3 ways drugs are classified
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usually the first drug of a particular group to be developed, the standard that newer, similar drugs are compared to
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prototype
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chemical name
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2-(4-isobutylphenyl)propanoic acid
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generic name
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ibuprofen-always lower case
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trade/brand name
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Advil, Motrin-always capitalized, more expensive
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prescription/legend drug
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must be ordered from a licensed health care provider and dispensed by a pharmacist
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non-prescription
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over the counter, does not require a prescription
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Greater autonomy, fast and convenient access, potential for earlier resumption of activities, fewer visits to a health care provider, increased effort to learn about Sx/conditions
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advantages of OTC medication
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inaccurate self-diagnosis, potential risk for choosing a wrong drug/product, delayed treatment from a health care professional, potential for adverse reactions and interations
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Disadvantages to OTC medication
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Food, drug, and cosmetic act
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1938- gave FDA control over drug safety
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Durham-Humphrey Admendment
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1951-Designated drugs that must be prescribed by a physician and dispensed by a pharmacist (controlled substances)(legend vs OTC drugs)
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Controlled Substance Act
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1970-Regulated distribution of narcotics and other abused drugs. Categorized these drugs according to therapeutic usefulness and potential for abuse.
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schedule I-V
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How many categories of controlled substances?
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Schedule I
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Substances have high abuse potential and no accepted medical use. heroin, marijuana LSD
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schedule II
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Substances that have high abuse potential and severe psychological and or physical dependence liability. Ex. narcotics/opioid analegesics, CNS stimulates/amphetamines, barbiturate sedative-hypnotics, lauratab. can never be ordered with refills and must be filled within 7 days of the date originally written. No faxing, has to be mailed or hand delivered by PT
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Schedule III
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Substances that have less abuse potential than schedule II substances and moderate dependence liability. Ex. nonbarbiturae sedatives, nonamphetamine stimulants, medications that contain a limited quantity of certain narcotics. Prescriptions must be filled within 30 days of the date written and may be refilled up to 5 times within 6 months
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Schedudle IV
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Substances that have less abuse potential than schedule III substances and limited dependence liability. Ex. benzodiazepines, sedative-hypnotics, some prescription appetite suppressants. Prescriptions must be filled within 30 days of the date written and may be refiled up to 5 times within a 6-months period
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Schedule V
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Substances that have limited abuse potential. Primarily are antitussives or antidiarrheals that contain small amounts of narcotics (codeine, Lomotil). May be dispensed by the pharmacist w/out a physicians prescription but with some restrictions.
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registered with DEA/provide number on all prescriptions, keep accurate records of all transactions, provide for secure storage: locked containers, recording on narcotic sheets/MAR, maintain accurate inventory, report discrepancies to proper authorities
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Controlled substances must be:
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Drug enforcement administration, food and drug administration
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DEA stands for? FDA stands for?
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FDA
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___ is responsible for ensuring that new drugs are safe and effective before approving a drug to be marketed. (it is long and expensive process that can be later withdrawn)
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Phase I: healthy, phase II: subjects with disease that the drug is being studied for, phaseIII: larger groups, placebos, phase IV: FDA reviews the study and decides if it can be put on the market.
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Four Phases:
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Right drug, dose, patient, route, time, reason, documentation, education, evaluation, refuse.
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10 rights
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quality and safety education for nurses, promoting the improvement of quality and safety of health care systems
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what does QSEN stand for and what do they do?
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The Joint Commission, if not safe, they will shut you down, enhance safety
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National Patient safety goals
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Institue for safe medication practices, identifies high alert medications
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what does ISMP stand for? and what do they do?
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labeling medication syringes, bottles. Anticoagulants, medication reconciliation
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3 targeted high risk activities involving medications
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A=safest, C=unknown, X=known danger
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Pregnancy categories for safety are?
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Beers Criterion
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____ ____ is a list of inapproperate meds that should not be given to the elderly
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american hospital formulary service, physicians desk reference (PDR/look up a drug by the picture), drug handbooks
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3 drug reference books
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False
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T or F, the trade or brand name is related tot he chemical or official name and is independent of the manufacturer
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False-restricted the importation, manufacture, sale and use of opium, cocaine, marijuana and other drugs that the Act defined as narcotics.
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the harrison narcotic act prohibits fraudulent claims of drug effectiveness
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True
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prescriptions for schedule II drugs cannot be refilled
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True
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controlled drugs are categorized according to therapeutic usefulness and potential for abuse
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True
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the food and drug administration (FDA) is responsible for assuring the new drugs are safe and effective before approving the drugs and allowing them to be marketed
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Phototype
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indivddual drugs that represent groups of drugs are called___
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chemical
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drugs are classified according to their effects on particular body systems, their therapeutic uses, and their___characteristics
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systemic
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drugs may be given for local or___effects
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drug
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the goals of most pharmacoeconomic research is to identify ___ therapy regiments that provide the desired benefits at the least cost
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III
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Phase___ studies help to determine whether the potential benefits for the drug outweigh the risks
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cellular
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drug action occurs at the ____ level
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drugs
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—- can stimulate or inhibit cellular function
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exchange materials with environment, obtain energy from nutrients, synthesis hormones, neurotransmitters, enzymes, structural proteins, duplicate/reproduce, communicate
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5 common characteristics of cells
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pharmacokinetics
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—involves drug movement through the body
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absorption, distribution, metabolism, excretion
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4 processes of pharmacokinetics
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absorption
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the process whereby a drug moves from the site of entry into the body toward the circulatory system
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route, presence of food/other drugs, gastrointestinal function, dosage form, bioavailability, blood flow
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6 factors affecting absorption
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bioavialability
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the portion of a dose that reaches the circulatory system and is available to act on body cells
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distribution
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transport of drug molecules within the body.
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distribution
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depends largely on the adequacy of blood circulation
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plasma protein binding, blood-brain barrier, pregnancy/lactation precautions
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3 factors affecting distribution
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metabolism
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the process by which the body breaks down and concerts medication into active chemical substances
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liver
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the primary site of drug metabolism is the _____
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first pass effect
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some drugs are extensively metabolized in the liver, with only part of a drug dose reaching the circulatory system. also called presystemic metabolism
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excretion
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elimination of a drug from the body
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circulatory system, kidneys, bowel, lungs, skin
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excretion requires adequate functioning of the ____,___,___,___,___
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kidneys
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the primary sit of drug excretions is the
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serum drug levels
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measurement of the amount of the drug in the blood
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minimum effective concentration
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— must be present before a drug exerts its pharmacological action on a body cells
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toxic concentration
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is the level that toxicity occurs
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therapeutic range
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___is between high and low concentrations of a drug
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peak
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is the highest concentration and peak drug action occurs
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trough
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lowest level that medication is present in the body
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onset of action (MEC), peak, duration of action, trough
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serum levels of drugs indicate
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serum half life
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the time it takes the concentration of a drug to decrease by 50%, different for each drug, determined by the rate of metabolism and excretion
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pharmacodynamics
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what the drug does to the body
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receptors
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pharmacodynamics chemically binds with ____ at the cellular level
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T
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T or F pharmacodynamics create agonist or antagonist effects
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T
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T or F pharmacodynamics can change the permeability of cell membranes
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T
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T or F pharmacodynamics can modify the synthesis, release, or inactivation of neurohormones
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receptor theory of drug action
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the concept that certain drugs produce their effects by acting specifically at a receptor site on a cell or within the cell or its membrane
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non receptor drug actions
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drugs that do not act on receptor sites
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dosage, route of administration, drug-diet interactions, drug-drug- interactions
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4 drug related variable that affect drug actions
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age, body weight, genetic and ethnic characteristics, gender, pathological conditions, psychological considerations
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6 patient related variable that affect drug actions
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loading dose
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——–dose is administered at the beginning of drug therapy. it is larger than the regular dose, usded to attain a more rapid therapeutic blood level of the dug
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maintenance dose
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—— dose is needed to keep blood levels at a steady state or constant level
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additive effect
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occurs when two drugs with similar pharmacologic action are taken
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synergistic effect
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occurs when tow drugs with different sits or mechanisms of action are taken
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adverse effect
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unexpected or dangerous reaction of a drug
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antidote
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drug that is given to antagonize the toxic effects of another drug
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placebo effect
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when a patient experiences a response to a placebo, positive or negative, or they may appear to have side effects
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tolerance
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when the body becomes accustomed to a particular drug over time so that larger doses must be given
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cross-tolerance
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tolerance to pharmacologically related drugs
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adverse effects of drugs
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is an undesired response to a drug, all drugs can produce them
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adverse effects of drugs
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can be common or rare, mild, severe, local or widespread, van be very serious
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black box warnings
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on the label of a prescription drug or in the literature describing it. it is usually added after a large number of serious adverse effects have occurred.
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pregnancy categories
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are used to identify risk of fetal injury from drugs used by the mother during pregnancy
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a(safest)-x(known danger)
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pregnancy categories rang from — to —
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category A
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Safe. risk to the fetus has not been demonstrated in well controlled studies in pregnant women
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category B
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animal reproduction studies have not demonstrated risk to the fetus, and there are no well controlled studies in pregnant women
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category C
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animal reproduction studies have not demonstrated risk to the fetus, and there are no well controlled studies in pregnant women, however, potential benefits may outweigh potential risk in use of drug in pregnant women
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category D
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evidence of risk to the fetus has been demonstrated. however, the benefits may outweigh the risk in pregnant women if the drug is needed in a life threatening situation and other safe drugs cannot be used or are ineffective
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category X
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not safe
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drug toxicity
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results from excessive amounts of a drug and may damage body tissues
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drug overdose
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can result in a single large dose or prolonged ingestion of smaller doses
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start treatment as soon as possible, support and stabilize vital functions, prevent further damage, administer antidotes
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4 main goals in drug overdose treatment
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Acetylcysteine, PO
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antidote and route of OD of Acetaminophen
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Flumazenil, IV
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antidote and route of OD of Benzodiazepines
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Succimer (Chemet), PO
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antidote and route of OD of Lead
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Naloxone (Narcan), IV
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antidote and route of OD of Opoid analgesics
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Sodium bicarbonate, IV
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antidote and route of OD of Aspirin
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activated charcoal
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the “universal antidote”, it absorbs the toxins and rarely causes problems
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Naloxone
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___ is used to relieve respiratory depression associated with morphine
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dose
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Body weight affects drug action mainly in relation to___
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placenta
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during pregnancy, drugs cross the —– and may harm the fetus