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PHARMA-CONFI > 1General Concepts > Flashcards

1General Concepts Flashcards

1
Q

Pharmacokinetics

A

What body does to a drug

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2
Q

Pharmacokinetics -4processes

A

1.Absorption
2.Distribution
3. Metabolism (Biotransformation)
4. Excretion

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3
Q

Li
Nk between pk and pd

A

Concentration

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4
Q

Absorption

A

Drug uptake from site of ADMINISTRATION to BLOOD stream

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5
Q

Factors related to drug absorption

A
  1. DRUG characteristics
    2.Route of administration
    3.Blood flow
    4.CELL MEMBRANE characteristics
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6
Q

 Drug characteristicsg

A

Drug formulation
Concentration of the drug
Lipophilic, lipophobic
non-ionized drugs , ionized
Acidic drugs,alkali drug

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7
Q

Blood flow

A

Increase blood flow causes increased absorption

Decrease blood flow causes decreased absorption

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8
Q

Cell membrane characteristics

A

Drugs cross the membrane via passive diffusion or active transport

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9
Q

Routes of drug administration

5

A

Enteral
Parenteral
Inhalation
Topical
Transdermal

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10
Q

Enteral route

A
  1. buccal or sublingual.
  2. Oral -most common
    Most unpredictable
    Least effective
    30 minutes
    Absorption in the DUODENUM
  3. Rectal -anima or suppository 
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11
Q

Parenteral route

A

Intramuscular
Intravenous
Subcutaneous 

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12
Q
  1. Inhalation.
A

5 minutes
Can be titrated
IV. Can also be treated.

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13
Q
  1. Topical
A

Placed on skin for local effects

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14
Q
  1. Transdermal.
A

 Patch placed on the skin(fentanyl patch)
15 minutes

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15
Q

Intravenous

A

100% bioavailability
Immediate action, very rapid
Titration can be done
Disadvantage -can cause overdose due to rapid onset

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16
Q

Intramuscular

A

Acts in 5 minutes
Site buttocks, gluteal, muscle,upper lateral quadrant
Deltoid
Anterior thigh
Injected at 90°
Depth -adults 1 inch
Kids 1/4 inch
Never beyond 2/3 of the needle
length

Absorption : QUICKLY from AQUEOUS solutions and SLOW from OILYsolutions

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17
Q
  1. subcutaneous.
A

Action is in 15 minutes
The angle is 45°

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18
Q

Important points for onset of drug effects

A

Oral route 30 minutes
Subcutaneous injection and patch—- 15 minutes
INtramuscular and INhalation—- 5 minutes
IV-immediate

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19
Q

Bioavailability

A

How much a Drug reaches the circulator system is AVAILABLE AT THE SITE OF ACTION .

It is an INDEX

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20
Q

Factors affecting bioavailability
8

A

1 drug chemical formulation
2 Route of administration
3. Degradation of the drug prior to absorption
4. G.I. perfusion and the pH
5. Presence of other substances, like binders, or dispersing agents in G.I. tract
6. GI absorption mechanism that is active transport versus passive diffusion
7. Solubility to be well absorbed, the drug must be likely hydrophobic
8. Hepatic first pass mechanism

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21
Q

Normal drug metabolism

A

Normally, swallow drugs—— G.I. system—-blood—-site of action—-go to the liver—-gets metabolized——-excreted by the kidneys

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22
Q

Hepatic first pass metabolism

A

Swallowed drug——-a portion of the drug goes to the digestive system, and it gets metabolized——-another potion goes to the hepatic portal system—— then to the liver—— then to the rest of the body

So efficacy decreases, and by availability decreases, it’s only for some medications

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23
Q

The biological membran

A

It’s a bilayer of phospholipid, 100 Angstrom thick and adsorbed protein molecules

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24
Q

Transfer mechanisms across the biological membranes

A

1 passive transfer
2. Active transport

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25
Q

Passive transfer
1. Simple passive diffusion QQQ

A

does not require energy

Only lipid soluble drugh

  1. Simple passive diffusion.—-for LIPID SOLUBLEdrugs
    Penetrate the bi membrane through membrane phospholipids

2.requirements:
1. Drug should be lipid soluble

  1. Have a high concentration on the outside and low on the inside that is concentration gradient.
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26
Q

Passive transfer
2. Filtration.

A

Only water molecules pass.

Water soluble molecules,small enough to pass through the membrane channels are carried by the bulk flow of WATER

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27
Q

Passive transfer
3 . Facilitated diffusion.

A

CARRIER BASED transfer

the driving force of the CONCENTRATION DIFFERENCE of the drug across the membrane

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28
Q

Active transport

A

For lipids, insoluble substances like GLUCOSE
Require energy as the carrier transfers the molecules across the concentration gradient

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29
Q

Osmosis

A

A pure, solvent like water moves to a semi permeable membrane.
The membrane is IMPRRMEABLE to the SOLUTE , but PERMEABLE to the SOLVENT .

This is against a concentration gradient.

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30
Q

Properties of drug for osmosis

A
  1. Lipid solubility.
  2. Degree of ionization.
  3. Molecular size and shape.
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31
Q

Normal drug

A

Activates in the body

Gets metabolized

Becomes inactive

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32
Q

Prodrug

A

Inactive

Becomes metabolized

Becomes active

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33
Q

Some drugs have active metabolites, even in Secondary

A

Example -1diazepam to DESMETHYL DIAZEPAM

2 codeine it gets metabolized to morphine, which is way more potent than codeine

  1. Digitoxin to digoxin.
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34
Q

 Only lipid soluble compounds go through the blood brain barrier

A

Example : THIOPENTAl is highly LIPID SOLUBLE and NON IONIZED it easily penetrate the blood brain barrier and gain access to the cerebral spinal fluid (CSF)induces sleep within seconds after IV administration

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35
Q

Drug distribution definition

A

Transport of a drug from bloodstream to various tissues in the body

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36
Q

Factors affecting drug distribution
4

A

rate of blood flow
Protein binding
Permeability
Gastric emptying time

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37
Q

Rate of blood flow

A

Increase blood flow increase perfusion
Decrease blood flow decrease perfusion

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38
Q

Protein binding

A

Most of the drugs have some CARRIERS in blood. Most important is ALBUMIN

these carriers DELAY delivery to the site of action.

Inc lipophilic—- inc BBB

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39
Q

Permeability

A

Ability to cross the capillary barriers like the blood brain barrier
Drug should be very LIPOPHILIC, and NON- IONIZED

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40
Q

Gastric emptying time

A

Indirect effect,
If drug in the stomach is for a longer time it takes more time for the drug to get distributed to the tissues

So longer gastric entering time has a negative effect

Solid meals 20 to 30 minutes
Liquid nails shorter
Sit ups, have a shorter gastric and entering time

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41
Q

Bi transformation/metabolism, definition

A

What is the chemical alternation of a NON POLAR… LIPID SOLUBLE DRUG, or compounds TO a more POLAR.. LIPID INSOlUBLE or water soluble compounds, so that they do not get reabsorbed in the renal tubule, and that easily excreted out through the body

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42
Q

Difference between active drug and drug for excretion

A

Active drug —nonpolar and lipophilic
For excretion drug has to be -ionized and hydrophilic

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43
Q

Biotransformation leads to

A
  1. Normal drug.— active drug to inactive, drug or it’s metabolites example morphine
  2. Prodrug.— an inactive drug becomes active.
    Example levodopa, (inactive) to dopamine (active )

Prednisone, (inactive)to prednisolone (active)

  1. Active drug forms, active metabolites
    Example diazepam to desmethyl diazepam
    Digitoxin to digoxin
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44
Q

Phase 1 reaction

A

CYP 450 is responsible for drug metabolism IN BOTH PHASES

This phase occurs in liver microsomal enzyme systems

Liver has HEPATOCYTES which helping metabolism

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45
Q

Common drug reaction in phase 1

A

Oxidation

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46
Q

reactions in phase 1

A

Hydroxylation
Reduction
Hydrolysis
Oxidation

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47
Q

CYP 2D6

A

Related to codeine metabolism

Also causes genetic polymorphism

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48
Q

Patterns in phase 1 reaction

A
  1. Active drug to inactive metabolite
  2. Inactive, drug, active metabolite ( prodrug)
  3. Active drug do a second active compound, which converts to an inactive metabolite
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49
Q

The enzyme families involved in microsomal drug metabolism

A

Cytochromes

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50
Q

The cellular site of cytochrome P4 50 system

A

Hepatocytes

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51
Q

P4 50 inducers

A

They metabolize faster
so the therapeutic affect of other drugs is seen for a shorter time
Therefore efficacy is decreased

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52
Q

P4 50 inhibitors

A

The metabolize slower
so the therapeutic effect of other drugs can be seen for a longer time
Therefore efficacy is increased

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53
Q

Phase 1 reaction

A

Oxidation reduction, hydrolysis, and hydroxylation

All others like conjugation, glue colonization, etc. are in phase 2

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54
Q

Phase 1 to phase 2

A

Lipophilic drug gets converted to a hydrophilic drug

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55
Q

Phase 2 reactions

A

Occur mainly in the liver and kidneys

Most common reaction is conjugation, which comprises of
acetylation
methylation
Sulphation
Glucoronidation

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56
Q

Function of phase 2 reaction

A

Makes the drug HYDROPHILIC so that it can leave the body through KIDNEYS

Makes a non-ionized substance ionized

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57
Q

Conjugation mainly occurs in

A

Liver and kidneys
In Phase 2

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58
Q

Factors affecting hepatic drug metabolism

5

A

1.Microsomal enzyme, inhibitors
2.Microsomal enzyme, inducers
3.Plasma, protein binding
4.Genetic factors
5.Liver diseases

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59
Q

Microsomal enzyme, inhibitors examples

A

Grapefruit juice
Antifungals ketoconazole
Cimetidine

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60
Q

mechanism of action of microsomal enzyme, inhibitors

A

De inhibit or slow, the metabolism of other drugs.……so there are higher than expected blood levels of a drug.

so the therapeutic effects of a drug can be seen for a longer time
The efficacy of the drug is increased

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61
Q

for inhibitors, the enzymes are less functional

A

saw Drug levels are higher, because enzymes are less

therefore the efficacy is greater

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62
Q

Grapefruit juice / ketoconazole and warfarin

A

they will inhibit the metabolism of warfarin

so concentration and therapeutic effects of warfarin are increased

Efficacy is increased

So INR is increased

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63
Q

Microsomal enzyme, inducer example

A

Rifampicin

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64
Q

mechanism of action of microsomal enzyme induction

A

The inducer causes more rapid metabolism of other drugs,

so lower than expected blood levels of a drug,

the therapeutic affect of drug is seen for a short amount of time
So the efficacy of the drug is decreased

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65
Q

for inducer, there is more enzyme

A

So drug levels are low,
because the enzyme is more
so more drug is metabolized
the efficacy is less

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66
Q

rifampin and warfarin

A

rifampin is an inducer,
so the drug warfarin will metabolize faster,
so warfarin concentration decreases quickly,
and therefore INR decrease

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67
Q

Plasma, protein binding

A

So… the drug will not enter the liver to be metabolized
Results in longer plasma, half life of the drug

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68
Q

example of a plasma, protein binder

A

Albumin

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69
Q

genetic factors

A

CYP two D6

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70
Q

Liver diseases

A

because IMPAIRMENT of the microsomal drug metabolizing system,

so there are elevated levels of UNMETABOLIZED DRUG

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71
Q

stages of the liver disease

A

Fatty liver,

hepatitis,

cirrhosis

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72
Q

In liver disease

A

Most of the drug should be given in LOWER doses

73
Q

acute alcohol

A

Microsomal enzyme, inhibitor

74
Q

Chronic alcohol

A

Microsomal enzyme, inducer

75
Q

One shot of alcohol, and acetaminophen or amitriptyline

A

this is microsomal enzyme, inhibitor

this prevents the metabolism of acetaminophen or amitriptyline,

so there are toxic levels of acetaminophen or amitriptyline

76
Q

chronic alcoholic and acetaminophen or amitriptyline used

A

alcohol at as microsomal enzyme, inducer

so acetaminophen gets metabolized very quickly

so the analgesic effect of acetaminophen is decreased

77
Q

in liver cirrhosis due to alcohol if we give acetaminophen

A

same reaction as acute alcohol

liver does not work anymore
so the drug is not being metabolized

it acts as P4 50 inhibitor so the dosage can go up, and the patient has toxicity of acetaminophen 


78
Q

cimetidine and propanolol

A

Cimetidine is CYP 450 inhibitor therefore order the propanol bioavailability is doubled

79
Q

Genetic factors like CYP two D6, (genetic polymorphism)

A

They rapidly metabolize the Drug
Example codeine

So efficacy is decreased

Also, The morphine toxicity goes up so there is respiratory depression

80
Q

In In drugs with 450 inducer

A

The drug gets metabolized faster,

The therapeutic is seen for a shorter period of time

so efficacy is decreased

81
Q

in having P450 inhibitor

A

The drug gets metabolized slower.

The therapeutic effect can be seen for a longer period of time,

and the efficacy is increased.

82
Q

codeine is contraindicated in kids less than 12 years of age

A

this is because if a kid has CYP 2D6 GENETIC POLYMORPHISM it would result in

decreased efficacy of codeine and also morphine toxicity, and hence respiratory depression and death,

as we do not know who has, which child has this genetic polymorphism 
This genetic condition is very rare, but still

83
Q

Molecules which cannot cross the membrane

A

Glucose, which is a large molecule

Charged molecules example sodium chloride

These are all HYDROPHILIC

84
Q

After prodrugs get activated

A

They go to systemic circulation so that we can see the effect. They do not go to kidneys for excretion

85
Q

Codeine is not a prodrug. why?

A

As codeine is active, but when it gets active, it forms morphine, which is active to

86
Q

If a Drug does not get metabolized

A

It stays active for a longer period of time

87
Q

Amphetamine

A

It is an indirectly acting sympathomimetic(breaking bad)

Use in narcolepsy that is, if anybody sleeps a lot

88
Q

Drug for insomnia

A

Hypnotics like benzodiazepines

Or GABA Benz agonist like
zolpidem and
zopiclone.…they do not have any side effects

89
Q

Microsomal enzyme, inhibitors

A

They in higher level cause toxicity

90
Q

Liver, disease, example, severe hepatitis, or any liver problem

A

There is a decrease number of P4 50 cells or hepatocytes, so decrease the metabolism of the drug, and therefore toxicity

91
Q

Inhibitors

A

They cause increased efficacy of drug in the beginning, but eventually cause toxicity due to overdose

92
Q

Alcohol

A

Acute alcohol—-(alcohol plus drug simultaneously)—-it is an inhibitor

so the longer time the drug is available the drug does not get metabolized example acetaminophen itself is hepatotoxic. Alcohol is also hepatotoxic, therefore increased hepatotoxicity, and this can cause liver problem damage.

Chronic alcohol —-inducer

Severe alcohol —— drug does not get metabolized at all, as there is no P450 available so drug toxicity

93
Q

Less than 12 years of age codeine is contraindicated

A

CYP two D6 is rapid metabolizer

Codeine levels decrease and morphine levels increase

94
Q

elimination of the drug or excretion of the drug

A

It is a process by which the drug and their metabolites are removed from the body

drugs are excreted from the body either UNCHANGED or as METABOLITES

95
Q

most important sites for drug elimination

A

Kidneys

biliary,

lungs

96
Q

renal excretion

A

Occurs mainly by:
glomerular filtration,
tubular secretion, and
partial reabsorption,

mostly done for IONIZED WATER SOLUBLE compounds as compared to lipid soluble compounds

97
Q

Factors affecting renal excretion

7

A

glomerular filtration rate

kidney tubular reabsorption

active secretion

changes in
plasma protein concentration, and
plasma protein binding

blood flow

number of functional nephrons and renal disease

volume of distribution

98
Q

Metronidazole and warfarin

A

Metronidazole decreases the clearance of warfarin by 40%

99
Q

Biliary excretion

A

Numerous CATIONIC,
ANIONiC and
STEROID like molecules are
selectively removed from the blood for excretion into the bile, and eventually the
FAECES

100
Q

Lungs

A

excrete VOLATILE compounds that were originally inhaled into the system

101
Q

example of compounds excreted by the lungs

A

Nitrous oxide

volatile general anesthetics, example, halothane ether, chloroform

102
Q

Saliva

A

Most drugs can be detected in saliva after administration, but it is not considered a route of drug excretion

103
Q

Zero order elimination of drug

A

Occurs in a LINEAR constant fashion regardless of the concentration.

Concentration will decrease linearly.

104
Q

Examples of zero order elimination

A

alcohol,

phenytoin

aspirin, at high or toxic doses

105
Q

first order elimination

A

Elimination of the drug in a proportional fashion to drug concentration.

Concentration of the drug will decrease EXPONENTIALLY with time.

Based on half life, most of the drugs are first order

106
Q

drug half life

A

The time required for the PLASMA CONCENTRATION of a drug to DECREASE by 50%

107
Q

The elimination half-life

A

Time required to metabolize and excrete 50% of the drug from the system

108
Q

how many half days does it take to eliminate a Drug from the body?

A

About 4 1/2 -5

This is especially important for lactating mothers

109
Q

Pharmacodynamics

A

what the Drug does to the body

it is the relationship between the CONCENTRATION of the drug at the site of action and the BIOCHEMICAL and PHYSIOLOGICAL effect

110
Q

response of the receptors in pharmacodynamics is affected by

A

Presence of the drugs, competing for the same receptors

the functional state of the receptor

the pathophysiological factors, such as hypokalaemia

111
Q

agonists

full agonist

A

The drug elicits, a full response by binding to the physiological, receptors and mimicking the regulatory effects of endogenous, signalling compounds in

Drug, gives the same physiological response

112
Q

Example of a full agonist

A

beta two receptor agonist, Ventolin (salbutamol) , albuterol

113
Q

Partial agonist

A

A drug that acts on the physiological receptor, but illicit an effect, which is only partially as effective as the agonist drug

114
Q

Antagonist

A

A drug which binds to the physiological receptor, but does not trigger an effect

in the presence of an antagonist the agonist drug cannot reach the receptor site to produce an effect

115
Q

Competitive antagonism

A

Not very strong response can be achieved by increasing the dose of the agonist in presence of the antagonist

116
Q

Non-competitive antagonism

A

strong and very dangerous

when a response cannot be achieved with increasing the dose of the agonist in the presence of the antagonist

117
Q

Inverse agonist

A

They r ACTIVE drugs.

not used really

it gives an opposite response.

They are not the same as antagonists.

118
Q

Agonist antagonist

A

Yeah, the substances which act as an agonist at one site white acting as an antagonist on the other side

119
Q

examples of agonist antagonist 

A

opioids (naltrexone)

pentazocine

120
Q

Therapeutic index

A

It is a comparison off the Amount of an agent, or a drug that causes a therapeutic effect to the amount of the same agent that causes toxic effect

121
Q

therapeutic index is equal to

A

LD 50 /ED 50

LD50 is equal to the lethal dose of a drug for 50% of the population

ED 50 is effective dose of a drug for 50% of the population

122
Q

The drug with the higher therapeutic index

A

SAFE as you need increase lethal dose

123
Q

Therapeutic window

A

Describe the range between the LOWEST therapeutic concentration, and the beginning of toxicity

Lowest level of therapeutic index and lowest level of toxicity

124
Q

is wide therapeutic window, safe or narrow, therapeutic window safe

A

Wide therapeutic window is safe

125
Q

Narrow therapeutic window

A

Drug is DANGEROUS example lithium, so monitoring the patient is very important

126
Q

Efficacy

A

The number of RECEPTORS that must be ACTIVATED to yield a maximum RESPONSE

127
Q

A Drug with high efficacy

A

Needs to stimulate only a small percentage of receptors

128
Q

QQQ A drug that produces the greatest maximum affect

A

has highest efficacy

129
Q

Factor determining the effect of a drug on physiological processes

A

Affinity
intrinsic activity


130
Q

increased efficacy

A

Is equal to
increased affinity and
increase intrinsic activity

131
Q

Define affinity

A

A measure of TIGHTNESS that a DRUG binds to the RECEPTOR

132
Q

Intrinsic activity

A

A measure of the ability of a DRUG once bound to the RECEPTOR to generate an EFFECT

133
Q

Drug formulation

A

it determines the AFFINITY and INTRINSIC ACTIVITY of a drug

134
Q

The factors that determine the appropriate dosage of a drug

A

Patient’s medical history
age
bodyweight

NOT patient gender

135
Q

potency

A

It is a relative CONCENTRATION of two or more drugs that produce the same drug effect

136
Q

EC 50

A

It is an index .

It is the dose causing 50% of maximal effect

137
Q

smaller the EC 50

A

greater the potency of the drug

138
Q

determining factor for potency

A

AFFINITY of the receptor for the drug

139
Q

additive affect

A

RESPONSE for the drug is NO GREATER than that which would be expected had the drug been given one at a time

there is NO ENHANCEMENT OF POTENTIAL of the individual drugs

example when we REPEATING the PRESCRIPTION of a drug.

140
Q

Cumulative effect

A

When a drug is administered repeatedly, a HIGHER CONCENTRATION of the drug that is desired, will be achieved

this results in SIDE EFFECTS

A+A+A

141
Q

Synergistic response

A

When the COMBINATION ACTION of two drugs is GREATER than the sum of their individual actions in synergism

A drug acts beneficially, when it is prescribed with another drug

1+1=4

142
Q

Alcohol acts synergistic with

A

diazepam
narcotics
barbiturates,
phenothiazines

143
Q

Theraupeutic dose

A

Has side effects

144
Q

over the therapeutic dose

A

Toxicity

145
Q

toxicity

A

When the dose of the drug is excessive in the blood for the particular patient

toxicity is OVERDOSE

146
Q

Drug allergy

A

An adverse effect due to an immune reaction to a Drug

147
Q

Side effects

A

Adverse effect that occurs WITHIN the therapeutic dose range of the drug

example atropine side effect is xerostomia

148
Q

idiosyncratic reaction

A

Are reaction to a medication that is unusual and unpredictable specific to a particular person and like allergy it can occur on first exposure to the medication

it affects only a very few individual

example chloramphenicol causes aplastic anaemia

149
Q

Teratogenicity

A

The capacity of a drug to cause foetal abnormalities when administered to a pregnant mother, by crossing through placenta

example thalidomide

150
Q

hypersensitivity reaction type one immediate/anaphylactic

A

mediator: antibody

IGE antibody is induced by allergin and binds via the FC, receptors to mast cells and basophils

after encountering the antigen again the fixed IgE becomes cross-linked, introducing degranulation, and the release of the mediators example histamine

example anaphylaxis to penicillin

151
Q

hypersensitivity reaction type 4 delayed

A

mediator—cell
helper, T lymphocytes, sensitized by an antigen release lymphokines . on second contact with the same antigen the lymphokines induce, inflammation and activate macrophages that in turn release various mediators

example poison ivy, TB test

152
Q

drug abuse

A

Use of an illicit drug or a prescription or over-the-counter medication for purposes, other than that indicated for or

an amount is greater than prescribed

153
Q

Habituation

A

Acquired TOLERANCE from REPEATED EXPOSURE to a particular STIMULUS

154
Q

addiction

A

A compulsive,UNCONTROLLED DEPENDANCE on a substance or a habit for such a degree that cession results in SEVERE emotional, mental or psychological reaction

155
Q

Tolerance

A

The need to increase the dose in order to achieve the same effects, originally achieved from a lower dose.
It is the phenomenon of DECREASED RESPONSIVENESS to a Drug following CHRONIC administration.

156
Q

physical dependence

A

A condition in which CONTINUED ADMINISTRATION OF DRUG IS REQUIRED to prevent unpleasant withdrawal symptoms like nausea, severe headache, and body ache

157
Q

Psychological or emotional dependence

A

Repeated use of substance, but WITHOUT the addictive physiological, need to increase the dose

158
Q

Highest physical and psychological dependence

A

Narcotics(opioids)

amphetamines
cocaine
LSD

159
Q

The criteria for including a Drug into one of the five schedules in the controlled substance act

A
  1. Potential for abuse, (most important) 2.medical usefulness
    3.degree to which it produces physiological dependence
    4.degree to which it produces physical dependence
160
Q

schedule one drug examples

A

Highest abuse, potential

Ex: Heroin, LSD ,mescaline

161
Q

Schedule I important points

A
  1. these drugs are NOT considered LEGITIMATE for medical use.
  2. They CANNOT be prescribed and made available.
  3. They are available only for SPECIFIC approved research projects.
  4. SPECIAL LICENSING procedure may be followed to use this or other schedule once of stances
162
Q

Schedule II example

A

hi abuse, potential

example:

morphine, cocaine, pentobarbital, oxycodone,methadone, codeine and amphetamine, secobarbitol and straight codeine

163
Q

Important points for scheduled ii

A

1.They have a strong potential for abuse or addiction but which have legitimate medical use

  1. these drugs can be prescribed, but they cannot be refilled.

3.A new prescription must be written for refills.

  1. Prescription for schedule II drugs cannot be called into the pharmacy over the telephone
  2. No refills
164
Q

Schedule three examples

A

moderate abuse potential

example:
hydrocodone with acetaminophen( vicodin)
codeine with acetaminophen( Tylenol 3)

165
Q

Schedule three important points

A
  1. these drugs may be called into the pharmacy over the telephone.
  2. The prescriber can authorize refills without need of a new written prescription.
  3. No greater than five prescriptions in six months
166
Q

Schedule 4 examples

A

Less abuse potential

example
diazepam (Valium)
Lorazepam (Ativan )
triazolam (Halcyon)
Alprazolam (Xanax),
chloral hydrate
Dextroposition (Darvon)

167
Q

Important points for schedule 4

A
  1. A category of drugs that have less potential for abuse or addiction than those of schedule 1 to 3.

2.prescription can be telephoned.

  1. No more than five prescriptions for six months
168
Q

schedule five examples

A

Least abuse potential

example medication, containing a small amount of codeine

169
Q

Properties of schedule five

A

A category of drugs that have a small potential for abuse or addiction.

They can be bought OTC in some states.

170
Q

Prescription

A

The FDA determines which drugs are to be sold by prescription only
the prescription must have the address of the patient and dentist, as well as the DEA number of the dentist

171
Q

Monitored drugs

A

Or any CONTROLLED SUBSTANCES under the federal control, drug and substance act,
example narcotic analgesics
example Tylenol #3 and OxyContin

Non-narcotic control drugs like methylphenidate (ritalin)
Benzodiazepines (valium)
Barbiturates (phenobarbital)
As well as other opioid medication’s, not listed in the Control Drug, in substance act, such as tramadol

172
Q

which of the following factors does not affect the bioavailability of warfarin?

A
  1. Perfusion of G.I. system
  2. drug chemical, formulation
  3. route of administration
  4. Glomerular filtration rate
  5. hepatic first passed affect.

Answer GFR as it is related to excretion. All others are related to metabolism.

173
Q

The distribution and use of all of the following agents is are controlled by the Control Drug, and substance act, except

A
  1. Amobarbital
  2. amitriptyline
    3.amphetamine
  3. diazepam
  4. hydrocodone

answer to it is a TCA -2
rule: Opioid, sedatives and amphetamines… most of these belong to Control Drug
amphetamine schedule three
diazepam is schedule 4
Hydrocodone is scheduled 3

174
Q

concurrent intake of digoxin, with which of the following agents can result in digoxin toxicity

A

Ketoconazole
Rifampicin
codeine
propanolol

answer A
whenever you see the word toxicity look for the word inhibitor A is an inhibitor

B is an induser
C&D have no effect

175
Q

Anaphylactic shock has three criteria

A

bronchospasm,
laryngeal oedema
CNS collapse

176
Q

A drug with a greater efficacy

A

has greater affinity for the receptors .ie has more POTENCY

177
Q

Greatest, maximal effect

A

Causes increased efficacy

Greater efficacy……. causes increased affinity for receptor……

so increased potency.

178
Q

Tachyphylaxis

A

Tachyphylaxis is a medical term describing an acute, sudden decrease in response to a drug after its administration; i.e. a rapid and short-term onset of drug tolerance.

It can occur after an initial dose or after a series of small doses. Increasing the dose of the drug may be able to restore the original response

PHARMA-CONFI (7 decks)

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