4. Pharmacology - Ana Oliviera Flashcards
Define:
- Pharmacokinetics
2. Pharmacodynamics
- What our body does to the drug (time course of drug from site of administration to elimination)
- What the drug does to our body
What are the 4 processes of pharmacokinetics?
Absorption
Distribution
Metabolism
Elimination/excretion
Pharmacokinetics
- Define absorption
- What factors need to be considered?
- Bioavailability: what is this and what is the range it is measured in?
- What are the 4 routes of administration?
- Process of transfer of drug from administration into general/systemic circulation
- Lipid solubility/disintegration/solubility/pH/molecular weight/surface area/contact time/interaction/gastric emptying rate/presence of food/alteration in intestinal motility
- Fraction of administered drug that reaches systemic circulation as a parent drug
0-1 - Enteral
Parenteral (IV, IM, subcutaneous)
Mucous membrane (inhalers, sublingual, suppositories)
Transdermal
Pharmacokinetics
- Define distribution
- Define volume of distribution
- What 2 types of drugs are mainly confined to blood and body water compartments?
- What 2 types of drugs are widely distributed to the tissues?
- What other factors effect distribution?
- What factors can increase the fraction of unbound drug?
- Process a compound is transferred from general circulation to other parts of body and tissues
- How widely a drug is distributed between various body fluids and tissues
- Water soluble/highly protein bound drugs
- Lipid soluble/extensive tissue binding drugs
- BBB/ plasma protein barrier
- Renal insufficiency/Low plasma albumin/late pregnancy
Pharmacokinetics
- Define metabolism
- What type of reactions are type 1 reactions?
- What type of reactions are type 2 reactions?
- What factors can affect metabolism?
- drug is chemically altered to facilitate its action or enhance its elimination
- Oxidation/reduction (cytochrome P450 enzymes)
- Conjugation/hydrolysis
- Race/ethnicity/age/gender/pathologies/genetics/stress/temperature/pollution/nutrition/interactions
Pharmacokinetics
- Define excretion
- Name 5 modes of excretion
- What factors effect excretion?
- Drugs/their metabolites are removed from the body
- Renal/biliary/respiratory/dermal/faecal
- Renal blood flow/renal function/glomerular filtration rate/urine flow rate and pH/concentration of drug in plasma/protein binding/size of drug complex/age
Pharmacokinetics
- What is half life?
- What is therapeutic drug monitoring?
- Time required to reduce plasma concentration to half its original value
- Individualised drug dosage by maintaining plasma or blood drug concentrations within a targeted therapeutic range.
Principles of medicine use in elderly
Discuss the following:
1. ADRs
2. Important aspects particular to old people
- Body changes/ Polypharmacy interactions/ compliance and concordance issues
- Altered physiology/ decreased homeostatic functions/ altered pharmacokinetics and pharmacodynamics/ side effects/ ADRs/ polymorbidity/ Polypharmacy/ less compliance
Principles of medicine use in elderly
Discuss the following:
1. Absorption
2. Distribution
- Bioavailability:
Rate/ interactions/ surface area/ intestinal motility/ blood flow
Swallowing difficulties - Regional blood flow:
More transport time/delayed peak concentration/ slower clearance
Plasma protein binding:
Less albumin levels/ less binding/ less total concentration
Lipid solubility
Principles of medicine use in elderly
Discuss the following:
1. Metabolism
2. Elimination
- Less blood flow to liver=less hepatic metabolism=less clearances
Gender/ co-morbidities/ race/ drug interactions/ frailty/ smoking/diet - Renal excretion:
Renal blood flow/ glomerular filtration rate/ urine flow rate/ pH
Principles of medicine use in elderly
Discuss the following:
1. Pharmacodynamics
2. Homeostatic functions
- Changes in receptor sensitivity/ receptor number/ hormone levels
- Less: postural control/ thermoregulation/ reserve of cognitive functions/ immune response/ response to environmental changes
Principles of medicine use in elderly Discuss the following: 1. Falls in elderly 2. Polypharmacy 3. Compliance and concordance
- More than 4 medicines/ sedation/ hypotension/ ototoxicity/ vision disturbances
- Multiple diseases
Drug interactions/ drug-disease interactions/ ADRs - Poor vision/ beliefs and understanding/ impaired cognitive function/ low manual dexterity/ Polypharmacy
Principles of medicine use in elderly
Discuss the following:
Medication review
NO TEARS Need and indication Open questions Tests and monitoring Evidence and guidelines Adverse effects Risk reduction/prevention Simplifications and switches
Antibiotics Interfere with bacterial cell wall 1. Name 3 and give 2 examples of each. 2. Name 4 subtypes of one of them and give 2 examples of each 3. What is their mechanism of action?
- Beta lactams
Glycopeptides (vancomycin and teicoplanin)
Anti-tuberculosis drugs (pyrazinamide and ethambutol) - Beta lactams:
Penicillins (benzylpenicillin, flucloxacillin and amoxicillin)
Carbapenems (imipenem and meropenem)
Cephalosporins (cefadroxil and cefataroline)
Monobactams - Beta lactams: bind to and inhibit penicillin binding proteins (PBPs) = peptidoglycan cross linking effected = weakens wall = cell lysis
Glycopeptides: binds to terminal D-alanine-D alanine at the end of pentapeptide chain in growing bacterial cell wall = blocks glycosidic bonds forming = blocks formation of peptide cross links
Anti-tuberculosis drugs: interferes with cell wall of mycobacteria
Antibiotics
Interfere with bacterial cell wall
1. Resistance and uses for beta lactams? Caution?
2. Resistance and uses for glycopeptides? Caution?
- Beta lactams
Beta-lactamases- hydrolyse beta lactam ring
Carried on gene/chromosome/plasmids
Resistance to resistor= clavulanic acid + tazobactam
Also, dehydropeptidase is an enzyme that can degrade imipenem (a carbapenem) so you have to give it with cilastatin
Carbapenems used in serious infection resistant to other antibiotics
Caution: allergy
- Van A gene = inducible high level resistance to vancomycin and teicoplanin
Van B gene = inducible high level resistance to vancomycin only
Caution: nephrotoxicity
Antibiotics Interfere with protein synthesis 1. Name the 4 and give 2 examples of each. 2. What is their mechanism of action? 3. Bacteriostatic/bactericidal? Each one
- Macrolides (erythromycin and clarithromycin)
Tetracyclines (doxycycline and tetracyclines)
Aminoglycosides (gentamicin and streotomycin)
Chloramphenicol - Macrolides: binds to 50s ribosome unit = blocks chain elongation
Tetracyclines: binds to 30s subunit = aminoacyl tRNA can’t enter acceptor site on ribosome = blocks chain elongation
Amino glycosides: inhibits protein synthesis in cytoplasm- binds to 30s subunit = blocks binding of formylmethionyl-tRNA to ribosome = prevents initiation complexes hence protein synthesis + misreading of mRNA codons
Chloramphenicol: binds to 50s subunit = blocks action on peptidyltransferase hence protein synthesis
Macrolides mainly bacteriostatic
Tetracyclines bacteriostatic
Aminoglycosides bactericidal
Chloramphenicol bacteriostatic
Antibiotics
Interfere with protein synthesis:
1. Resistance and caution for macrolides
2. Resistance and caution for tetracyclines
3. Resistance and caution for amino glycosides
4. Resistance and caution for chloramphenicol
- Macrolides
Resistance uncommon
Caution: interactions - Tetracyclines
Resistance: decrease in uptake or increase in extrusion/ enzymatic inactivation/ producing protein that interferes with tetracycline binding
Caution: phototoxicity/ chelation of metal ions leading to deposition in teeth and bone growth inhibition (don’t use in children)
3. Aminoglycosides Resistance: 1. Aminoglycoside modifying enzyme = inactivation 2. Membrane impermeability = poor access 3. Poor action site affinity Caution: nephrotoxicity and ototoxicity
- Chloramphenicol
Resistance: chloramphenicol acetylation/ can’t bind to ribosomal target
Caution: can effect human mitochondrial ribosomes = dose dependent toxicity to bone marrow
Antibiotics
Interfere with DNA replication
1. Name the 4 and give 2 examples of one of them
2. What is their mechanism of action?
- Quinolones (ciprofloxacin and ofloxacin)
Co-trimoxazole
Nitroimidazoles
Rifampicin - Quinolones: inhibits topoisomerase 2 and 4 = bacterial DNA can’t supercoil/ replicate/ seperate =rapid cell death
Co-trimoxazole: sulfonamides and trimethoprim (synergistic association)
Both act in following pathway: synthesis of tetrahydrofolate
Sulfonamides = structural analogues of PABA = enzyme inhibition
Trimethoprim = inhibits dihydrofolate reductase = enzyme inhibition
Nitroimidazoles: anaerobic organisms have the electron transport chain needed to reduce metronidazole to its active form = toxic to DNA = bactericidal
Rifampicin: binds to DNA dependent RNA polymerase = inhibits mRNA synthesis
Antibiotics
Interfere with DNA replication
1. Resistance and cautions: quinolones
2. Resistance and cautions: co-trimoxazole
3. Resistance and cautions: nitroimidazoles
4. Resistance and cautions: : rifampicin
- Quinolones
Resistance: mutations in gene encoding subunit of DNA gyrase/ ciprofloxacin effluent in some bacteria
Caution: interactions and caution in children - Co-trimoxazole
Resistance: DHF reductase without affinity to trimethoprim
DHT reductase with low affinity to sulfonamides
Caution: 1st trimester of pregnancy - Nitroimidazoles
Resistance: enzyme production = no formation of reactive metabolite
Caution: alcohol - Rifampicin
Resistance: changes in RNA polymerases
Caution: metabolic interactions and orange saliva, tears and sweat
Define agonist and state the 2 types
Binds and stimulates physiological regulatory effects of endogenous compounds
Full/partial
Define antagonist and name the 4 types
Bind but do not have regulatory effects and prevent binding of endogenous compounds
Competitive/non-competitive
Reversible/ irreversible
- Define drug affinity and state what it is numerically
2. Define drug efficacy and state what it is numerically
- How tightly a ligand binds to a receptor
K(small A) - Ability to produce a biological effect
R (small max) or B (small max)