DRUG ACTION: PHARMACEUTIC, PHARMACOKINETIC, AND PHARMACODYNAMIC PHASES

Differentiate the 3 phases of drug action Identify the 2 processes that occur before tablets are

absorbed into the body Describe the 4 processes of pharmacokinetics Explain the meaning of pharmacodynamics, dose response, maximal efficicy, the receptor, and, nonreceptor to drug action Define the terms protein-bound drugs, half-life, therapeutic index, therapeutic drug range, side effects, adverse rxns, and drug toxicity Describe the nursing implications of pharmacokinetics and pharmacodynamics

 Pharmaceutic
Disintegration and dissolution

The two pharmaceutic phases are disintegration and dissolution.

Rate limiting

 Absorption
Processes of drug absorption

The three major processes for drug absorption through the gastrointestinal membrane are passive absorption, active absorption, and pinocytosis.

 Absorption
Water-soluble vs. lipid-soluble drugs First-pass effect Bioavailability

Some factors affect rate of drug absorption

 Distribution
Protein-binding Free drugs Volume of drug distribution (Vd)

Drug distribution.

 Metabolism (biotransformation)
Half-life (t); see Table 1-2

Excretion (elimination)
Kidneys Creatinine clearance Liver Feces, others

What happens when there is slow rate of drug

excretion?

 Dose response and maximal efficacy Onset, peak, and duration of action

The time-response curve evaluates three parameters of drug action: (1) onset, (2) peak, and (3) duration. MEC, Minimum effective concentration; MTC, minimum toxic concentration.

 Receptor theory Agonists vs. antagonists

Two drug agonists attach to the receptor site. The drug agonist that has an exact fit is a strong agonist and is more biologically active than the weak agonist.

 Nonspecific drug effect

Cholinergic receptors are located in the bladder, heart, blood vessels, stomach, bronchi, and eyes.

 Nonselective drug effect

Epinephrine affects three different receptors: alpha, beta1, and beta2.

 Categories of drug action

Stimulation or depression Replacement Inhibition or killing of organisms Irritation

The therapeutic index measures the margin of safety of a drug. It is a ratio that measures the effective therapeutic dose and the lethal dose.

A, A low therapeutic index drug has a narrow margin of safety, and the drug effect should be closely monitored. B, A high therapeutic index drug has a wide margin of safety and carries less risk of drug toxicity.

Therapeutic range (therapeutic window) Peak and trough levels; see Table 1-4 Loading dose Side effects, adverse reactions, and toxic effect Pharmacogenetics Tachyphylaxis Placebo effect

The three phases of drug action.

Assessment Nursing interventions Cultural considerations Evaluation

Determinants that affect drug therapy.

TC has liver and kidney disease. He is given a medication with a half-life of 30 hours. You expect the duration of this medication to:
A. increase. B. decrease. C. remain unchanged. D. dissipate.

Answer: A

In older adults and those with renal dysfunction, the creatinine clearance is usually:
A. substantially increased. B. slightly increased. C. decreased. D. in the normal range.

Answer: C