Pharmacokinetics involves - ANS absorption, distribution, metabolism and elimination).
Absorption: - ANS absorption from the administration site either directly or indirectly into the
blood/plasma.
Distribution: - ANS reversibly or irreversibly move from the bloodstream into the interstitial and
intracellular
Metabolism: - ANS biotransformed via hepatic metabolism or by other tissues.
Elimination: - ANS tissues. lastly, the drug and its metabolites are eliminated from the body.
route of administration with the highest bioavailability - ANS intravenous; putting entire dose into
a patient's vein and bypassing absorption.
avoids first-pass metabolism - ANS Intravenous route
administration has variable and erratic absorption. n - ANS Rectal administration
4. Steady state (SS) - ANS absorption. n is usually reached within 4-5 half-lives of drug.
Half-life of a drug is - ANS how long it takes for half the drug to be excreted from the body.
Determines how frequently the drug must be administered. Predicts how long toxic effects can
last.is constant with first-order pharmacokinetics of a drug.
Zero-order (nonlinear) pharmacokinetics - ANS means a drug is metabolized at a constant rate
per unit time.
CYP3A4 substrate drugs - ANS may have enhanced activity if any CYP3A4 inducer drugs are
used along with it.
Drug development process involves these steps according to the FDA: - ANS Discovery:
laboratory research to develop the new drug. Preclinical research with animal testing for safety
(Phase I). Clinical research on human subjects for medication safety (Phase II). Clinical
research in humans comparing the new drug to accepted medications placebo depending on
the study (Phase III). FDA review of the results to determine approval. Post marketing study to
identify adverse effects not found in earlier clinical studies (Phase IV)
2. Medication safety organizations - ANS The Institute for Safe Medication Practices (ISMP) The
Institute of Medicine (IOM) The Joint Commission The National Coordinating Council for
, Medication Error Reporting and Prevention (NCC MERP) Food and Drug Administration (FDA)
Safe Use Initiative
Two basic type of ADRS: - ANS pharmacological and idiosyncratic.
85% to 90% of ADRS - ANS are pharmacological.
Adverse drug reactions are usually preventable, - ANS frequently occur in a hospital or nursing
home setting, and include medication errors, adverse drug effects, and allergic idiosyncratic
type reactions.
ADRS are not commonly reported; - ANS the FDA does not mandate that ADRS be reported.
Polypharmacy - ANS involves using multiple health care providers for care, using multiple
medications, and using several pharmacies prescription filling.
ACEIS reduce blood pressure enzyme. - ANS by suppressing the release of
angiotensin-converting enzyme.
Important side effects of ACE inhibitors - ANS Important include cough and angioedema;
discontinue the ACEI if angioedema occurs.
Angiotensin II receptor blocking agents (ARBS): - ANS Icandesartan (Atacand), eprosartan
(Teveten), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan).
ARBS reduce blood pressure - ANS by blocking angiotensin II receptors.
Essential (primary) hypertension - ANS Essential (primary) accounts for 90% of cases;
secondary hypertension may caused by chronic renal failure.
Nitroglycerin - ANS Nitroglycerin is a nitrate drug that can be administered IV, SL, a topical
ointment and as a transdermal patch.
Nitrates are contraindicated - ANS with PDE-5 inhibitors (e.g., sildenafil and vardenafil)
Amiodarone is the antiarrhythmic - ANS Of choice when there is coexisting heart failure; can
cause thyroid and pulmonary toxicity.
Alpha-1 adrenergic stimulation - ANS results in vasoconstriction and increased blood pressure.
Alpha-1 adrenergic blockade - ANS results in vasodilation and reduced blood pressure.
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