chamberlain college of nursing nr565 week 1 study guide nr 565 week 1 study guide ch 278 latest
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NR 565 (NR565)
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NR565 Week 1 Study Guide
Chapter 2: Review of Basic Principles of Pharmacology
Chapter 7: Cultural and Ethnic Influences in Pharmacotherapeutics
Chapter 8: An Introduction to Pharmacogenomics
Chapter 2: Review of Basic Principles of Pharmacology
How Drugs are Developed
Drugs are developed by pharmaceutical companies to help patients and to make money
The early part of the drug development process is called the preclinical stage
Pharmaceutical companies will identify a drug target, starting sometimes with ingredients
isolated from a plant (or organism in the case of antibiotics) with desirable medicinal
properties, sometimes with a molecular target identified in the body to produce the desired
response, and sometimes with a disease in need of treatment.
Many drugs are examined as pharmaceutical companies seek the elusive perfect drug
with just the right combination of properties. Preclinical studies are performed on cells,
isolated tissues and organs, and in laboratory animals to identify promising compounds
Drugs approved by the Food and Drug Administration (FDA) must be both safe and
effective and are screened by pharmacologists specializing in various aspects of drug
activity.
Ideally, drugs will produce their desired effects at dosages well below those needed to
produce toxicity.
During the clinical stage of new drug development, pharmaceutical companies must
establish the safety and effectiveness of new products in humans.
Phase I clinical trials typically establish biological effects as well as safe dosages
and pharmacokinetics in a small number of healthy patients.
o During phase II clinical trials, new drugs are used to treat disease in a small number
of patients and to establish the n potential of the drug to improve patient outcomes.
If the drug still looks promising, phase III clinical trials will compare the new medication
to standard therapy in a larger number of patients studied by at sites across the country.
New drugs must be at least as good as, and it is hoped better than, other available
therapies. Throughout the process, pharmaceutical companies work with the FDA.
After being approved by the FDA, drugs are continuously monitored through post-marketing
surveillance, in which health professionals are encouraged to report adverse events, which
are studied by both pharmaceutical companies and the FDA.
Drug Responses
Homeostasis is the tendency of a cell, tissue, or the body not to respond to drugs but instead
to maintain the internal environment by adjusting physiological processes.
Before a medication can produce a response, it often must overcome
homeostatic mechanisms.
Drug effects depend on the amount of drug that is administered.
o If the dose is below that needed to produce a measurable biological effect, then
no response is observed; any effects of the drug are not sufficient to overcome
homeostatic capabilities.
, o If an adequate dose is administered, there will be a measurable biological response.
With an even higher dose, we may see a greater response.
At some point, however, we will be unwilling to increase the dosage further, either because
we have already achieved a desired or maximum response or because we are concerned
about producing additional responses that might harm the patient.
Because pharmacology is the study of substances that produce biological
responses, measurement of what happens when we administer medications is
important.
Two types - these responses differ in how they are measured and dictate dosing decisions
to achieve the desired effect.
, o Quantal
Responses that may or may not occur
Ie: convulsions, pregnancy, rash, sleep, death
A quantal response to a drug is observed in a population, and is either present or
absent in any single individual.
Quantal dose-response graphs plot the rate of an outcome occurrence in
a population against the drug dose.
o Graded
Biological effects that can be measured continually up to the
maximum responding capacity of the biological system
Most drug responses are graded
ie: changes in BP are measured in millimeters of mercury (mm Hg);
HR, diuresis; bronchodilation; FEV1; pain; coma scale
Graded responses are easier to manage clinically because we can see how
each patient responds to a particular dose of medication and, if appropriate, alter
the dosage to achieve a greater or less response
Expression Drug Responses
o Pharmacologists show the relationship between dose or concentration and drug
effect using graphs that show the dose–response relationship, or dose–response
curve.
Vertical axis - drug responses
Horizontal axis - concentration
o Dose-response curves provide information on the relationship between dosage
or concentration and responses for one more more drugs
o To “read” a concentration–effect or dose– response curve, move from left to right along
th e horizontal axis; this represents an increasing dosage or concentration.
At each dosage, the level of effect is shown by the vertical height of the curve.
When concentration–response data are shown for two drugs or two responses
on the same graph, we can compare the effects at each dose level.
o Pharmacologists compare drugs and their actions in several ways, including
potency, efficacy, intrinsic activity, and selectivity.
Potency is the expression of how much drug is needed to produce a
biological response.
Potency describes the difference in concentration or dosage of different
drugs required to produce a similar effect. Drugs that are more potent
require a lower dosage or concentration to produce the same response
o Efficacy expresses the ability of a drug to produce a maximum effect at any dosage.
Efficacy is the expression of the maximum effect a drug can produce.
Drugs with high efficacy can produce greater effects than lower-efficacy drugs
can.
o Intrinsic activity is very similar to efficacy in that it represents the ability of a drug to
produce a large response. Intrinsic activity, however, is used to describe the ability of
a drug to produce a response once it has occupied specific receptors.
Some drugs produce the maximum receptor stimulation once they occupy
receptors; their response is limited by how many drug molecules occupy receptor
sites.
Drug Selectivity
o An inability to tolerate the adverse effects of a medication, generally at therapeutic
or subtherapeutic doses
o The most reasonable way to express selectivity is as a ratio of the dose or
concentration producing the undesired effect to the dose or concentration producing
the desired effect.
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