5

Question 1

Tyramine

Answer 1

increases HR and BP by promoting norepinephrine release

Question 2

Trachyphylaxis develops because

Answer 2

norepenephrine stores are depleted.

Question 3

Sensitization

Answer 3

documented for a few CNS drugs

Question 4

Adverse drug effects

Answer 4

extension effect - dosage effect.Isn’t that drug is doings omething that it isn’t supposed to do, just that it is doing too much. Ex. Blood thinners (warfarin)

Question 5

Drugs often given at suboptimal dose because

Answer 5

too much of an effect can cause a problem.

Question 6

Idiosyncratic reactions

Answer 6

Rare and unpredictable reactions in a population

Unusual metabolism, distribution, binding affinity for receptor, other mechanism

Question 7

Drug allergies

Answer 7

10% of all adverse effects. Prior exposure required, dose less important, effect unrelated to a drug

Question 8

Antigenic potential of drugs can vary

Answer 8

enormously. Some so antigenic that they’re not therapeutic anymore.

Question 9

It is common for drugs that are proteins to be

Answer 9

allergenic

Question 10

It is common for small drugs to become allergenic after

Answer 10

conjugation to a protein.

Question 11

Sometimes cchemical changes can render a drug

Answer 11

allergenic

Question 12

Type I drug allergy

Answer 12

anaphylactic response

-mast cells. IGG on cells react with drug, causing degranulation spurring immune response.

Question 13

Type II drug allergy

Answer 13

cytotoxic response

IgG, IgM binds to antigen on plasma membrane, target cells get attacked.

Question 14

Type III druga llergy

Answer 14

Immune complex reactions. IgG neutrophil degranulation, complement fixation.

Question 15

Type IV drug allergy

Answer 15

T-celll mediated immunity.

Takes days to develop. T-cells produce immuen response. Usually comes from local.

Question 16

Pseudo allergies

Answer 16

Mimic effect of allergen downstream. Certain drugs can cause mast cells to degranulate. Not allergic, as it has nothing to do with activation by allergens.

Question 17

Pharmacogenetics

Answer 17

how drugs affect individual people

Question 18

Pharmacokinetic variations usually result from differences in

Answer 18

drug metabolism and are better understood with many examples.

Question 19

Pharmacodynamic variations usually result from differences in

Answer 19

drug targets or downstream elements and are not as well understood with fewer examples

Question 20

Phase 2 conjugation

Answer 20

by Nat 1 and 2

Question 21

Slow acetylation can lead to

Answer 21

drugs sticking around too long. Can cause problems.

Question 22

CYP2D6 removes ——— from oxygen

Answer 22

methyl groups

O-demethylation

Question 23

CYP2D6 poor metabolizers have a higher incidence of

Answer 23

CYP2D6 poor metabolizers have a higher incidence of adverse effects

Question 24

CYP2D6 poor metabolizers: codeine is

Answer 24

ineffective as an analgesic (10% of the population)

Question 25

CYP2D6 ultra metabolizers: can experience ——— in response to codeine

Answer 25

severe abdominal pain

Question 26

CYP2C9 poor metabolizers may have serious

Answer 26

bleeding complications

Question 27

Succinylcholine can induce

Answer 27

prolonged apnea in poor metabolizers

Question 28

Ryanodine receptor

Answer 28

The receptor mediates calciummediated calcium release from the sarcoplasmic reticulum in muscle

Question 29

Therapeutic index

Answer 29

TD/ED (Toxic over therapeutic)

Question 30

Antagonism

Answer 30

Biologic or clinical response to a drug is reduced by administration of a second drug

Question 31

Tetracycline chelates ———. Chelation interferes with ————–.

Answer 31

divalent metal ions

absorption and antimicrobial activity

Question 32

——— will diminish tetracycline effects

Answer 32

antacid

Question 33

Potentiation

Answer 33

A second drug with a different activity enhances the activity of the first drug

Drug B enhances absorption, alters distribution or inhibits elimination of Drug A

Question 34

Unexpected Drug Effect

Answer 34

hangover - exactly what it sounds like.

Question 35

Summation

Answer 35

The combined activity of two drugs acting at the same or similar sites

Question 36

Summation - Additive:

Answer 36

drug action is interchangablewhen dosed at fractions of their EC50’s

Question 37

Summation Infra-additive:

Answer 37

(yield less than additive response when dosed as above)

Question 38

Supra-additive:

Answer 38

(yield more than additive response when dosed as above)

Question 39

Synergism

Answer 39

The combined activity of two drugs produces an effect greater than the maximal effect produced by either drug alone

Question 40

Pharmaceutical Interactions

Answer 40

Drug incompatibility of a physical or chemical nature Example: mix organic acid and an organic base and one or both precipitates (chemical reactions more rare)

Question 41

Pharmacokinetic interactions

Absorption

Answer 41

An interaction can affect the rate or extent of effective absorption of the drug into the circulation, causing an increase or decrease in the drug’s effect.

Question 42

Pharmacokinetic interactions 2. Distribution

Answer 42

After a drug is absorbed, an interaction may alter it’s distribution or it’s rate of transfer from one site to another

Question 43

Pharmacokinetic interactions 3. Metabolism

Answer 43

Most drugs metabolized in the liver by microsomal (P450) enzymes

Question 44

Inhibition of CYP enzymes responsible for many

Answer 44

drug interactions

Question 45

Drugs that affect hepatic blood flow may also affect

Answer 45

metabolism of other drugs

Question 46

Pharmacokinetic interactions 4. Excretion

Answer 46

Urinary pH Weak acids (e.g. aspirin) more rapidly excreted in alkaline urine. Therefore, aspirin clearance increased by administration of Na+HCO3Weak bases (e.g. amphetamine) more rapidly excreted in acidic urine. Therefore, amphetamine clearance increased by administration of NH4+Cl