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Pharmacy Practice 7 > ADT Final > Flashcards

ADT Final Flashcards

1
Q

define Pharmacobezoar

A

A mass of undissolved drug(s) in the gastrointestinal tract.

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2
Q

effects of Pharmacobezoar

A

Causes erratic absorption.
Prolongs absorption phase.

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3
Q

examples of Pharmacobezoars

A

theophylline, diltiazem, carbamazepine.

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4
Q

Sodium Bicarbonate and Cardiotoxicity mechanism

A

Inhibition of calcium sodium channels.

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5
Q

Sodium bicarbonate reduces free _____ concentrations

A

TCA

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6
Q

t/F Binding to plasma proteins or tissues makes drug inactive.

A

true

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7
Q

T/F Increasing plasma concentration of drug can saturate protein binding.

A

true

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8
Q

how does low blood pressure effect clearance?

A

impairs clearance

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9
Q

Antidote for Methanol Poisoning
MoA?

A

fomepizole
Alcohol dehydrogenase inhibitor.

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10
Q

Indications for Hemodialysis (HD)? (AEIOU)

A

A = Metabolic Acidosis.
E = Electrolyte disturbances.
I = Intoxications.
O = Fluid Overload.
U = Uremia.

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11
Q

As free drug concentration increases, glomerular filtration ________, leading to __________ renal drug clearance.

A

increases, increased

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12
Q

Activated charcoal can be used to reduce the _______ of a drug that remains in the stomach.

A

toxicity

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13
Q

Whole bowel irrigation can help clear ______.

A

toxins

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14
Q

Intrinsic Clearance: The maximum ability of the liver to irreversibly ________ a drug by all pathways.

A

remove

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15
Q

As the rate of metabolism ________, the plasma drug concentration increases.

A

increases

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16
Q

As the rate of metabolism increases, the plasma drug concentration _________.

A

increases

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17
Q

higher Vmax = ______ drug metabolized

A

more

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18
Q

_______ Vmax = more drug metabolized

A

higher

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19
Q

Km is the affinity where a lower value requires _____ drug concentration for half-maximal metabolism, where Higher Km requires ______ drug concentration for equivalent half-maximal metabolism.

A

less,more

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20
Q

High affinity = _______ intrinsic clearance, Low affinity = ______ intrinsic clearance.

A

faster, slower

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21
Q

_____ affinity = Faster intrinsic clearance, ____ affinity = Slower intrinsic clearance.

A

high, low

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22
Q

Clearance is affected by changes in ______ binding.

A

protein

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23
Q

Causes of Altered Hepatic Blood Flow:

A

CHF, cirrhosis, sepsis, shock, mechanical vent, positive end-expiratory pressure (decrease Q). Vasopressors (increase Q).

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24
Q

what does Q mean?
Q is equivalent to?

A

liver blood flow/drug delivery to liver.
clearance

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25
Q

ffp = 1 - E, where E= 0 means ____ drug escapes first-pass metabolism (_____ bioavailability). and E=1 means ___ drug escapes first-pass metabolism (_______ bioavailability).

A

all, good
no, poor

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26
Q

define Vd

A

Amount of drug binding in plasma vs. in tissue.

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27
Q

Increased Vd indicates the drug is _____ bound to proteins in tissue than plasma.

A

more

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28
Q

_______ Vd indicates the drug is more bound to proteins in tissue than plasma.

A

increased

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29
Q

If intrinsic clearance decreases, the amount of drug that escapes first-pass metabolism (ffp) ________.

A

increases

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30
Q

If intrinsic clearance _______, the amount of drug that escapes first-pass metabolism (ffp) increases.

A

decreases

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31
Q

Synonymous mutation type means it’s a ______ mutation

A

silent

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32
Q

Non-synonymous mutation type means ________ or _______ mutation

A

missense, nonsense

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33
Q

define Pharmacogenetics:
Drug response related to a single or a few ______.

A

genes

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34
Q

define Pharmacogenomics:
Study of variations of all ___________ related to drug response.

A

DNA and RNA

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35
Q

list the “Three Rights”

A

Right Person: Who benefits from the med.
Right Test: Don’t do the wrong one!
Right Interpretation: Give genetic info and inform physicians to make appropriate management decisions.

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36
Q

How many chromosomes are in the human body?

A

46

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37
Q

How many base-pairs are in the entire genome?

A

3.2 billion

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38
Q

What percentage of the genome makes proteins?

A

~1%

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39
Q

Avoid prescribing abacavir in patients with __________ mutation.

A

HLA-B*5701

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40
Q

Avoid prescribing phenytoin or carbamazepine in patients with _________ mutation.

A

HLA-B*1502

41
Q

Mutations in CYP2D6 are common in ________ and can cause _________ metabolism.

A

Africans, ultrarapid

42
Q

Mutations in CYP2C19 are most common in ________, causing _____ metabolism of drugs via the 2C19 pathway, such as _________(drug).

A

Oceanians, poor, clopidogrel

43
Q

CYP2C19 polymorphism requires a _______ in the initial warfarin dose.
VKORC1 polymorphism also requires a _______ in the initial warfarin dose.

A

reduction, reduction

44
Q

Main Resource for Pharmacogenetic Information?

A

The Clinical Pharmacogenetics Implementation Consortium (CPIC).

45
Q

what is a major SE of Azathioprine, mercaptopurine, thioguanine.?

A

Myelosuppression

46
Q

if low TPMT: Reduce daily dose by _____, frequency to _____ times weekly.
if intermediate TPMT: Reduce dose by ______
if high TPMT: ______ dosing

A

10X, three
30-80%.
normal

47
Q

Thioguanine with low NUDT15 activity: ______ dose by 25%.

A

reduce

48
Q

Thioguanine with low NUDT15 activity: Reduce dose by _____

A

25%

49
Q

Irinotecan Dose Reduction:
Patients Homozygous for UGT1A1*28 allele: Start with ____ of normal dose.

A

70%

50
Q

Irinotecan Dose Reduction:
Patients Homozygous for _______ allele: Start with 70% of normal dose.

A

UGT1A1*28

51
Q

CYP2D6 and Tamoxifen:
Poor metabolizer (0): ______ concentration.
Intermediate metabolizer (0.5): _____ concentration.
Normal/Intermediate (1): _____ concentration.
Normal (1.5-2): ______ concentration.
Ultrarapid (>2): ______ concentration.

A

lower
lower
lower
normal
normal

52
Q

Avoid CYP2D6 inhibitors with tamoxifen (bupropion, fluoxetine, paroxetine, quinidine, terbinafine).

A

.

53
Q

Tissue-Agnostic Agent: A drug that targets specific ________ across multiple cancer types.

A

biomarkers

54
Q

The two tissue-agnostic agents are Larotrectinib and Entrectinib, which treat _____ solid tumors

A

NTRK-fusion

55
Q

what does SMMART do?

A

allows tracking of cancer progression over time to adjust drug combinations before resistance develops.

56
Q

phenytoin is used to treat Tonic-clonic seizures, Partial seizures, Generalized status epilepticus and seizure prevention.
what is the MoA?

A

Increases efflux or decreases influx of sodium ions and Prolongs inactivation of voltage-gated sodium ion channels.

57
Q

what causes purple glove syndrome?

A

large- multiple doses of IV phentoin

58
Q

long-term use of phenytoin may lead to?

A

lupus erythematosus

59
Q

what Alters phenytoin plasma binding due to displacement?

A

hyperbilirubinemia, jaundice, liver disease, renal dysfunction

60
Q

what Alter phenytoin plasma binding due to hypoalbuminemia?

A

liver disease, nephrotic syndrome, burns, trauma, malnourishment, elderly.

61
Q

what drugs influence plasma protein binding of phenytoin?

A

Warfarin, valproic acid, aspirin (>2g/d), NSAIDs.

62
Q

Hypoalbuminemia ______ phenytoin Vd.

A

increases

63
Q

Coadministration of Valproic Acid ______ Vd and fu plasma of phenytoin.

A

increases

64
Q

Renal failure ________ the Vd of phenytoin.

A

increases

65
Q

Phenytoin is a ______(extraction) drug.
Protein binding changes that increase fu would cause an _______ in Vd and clearance, with ______ in t1/2.

A

low E
increase, no change

66
Q

phenytoin Hypoalbuminemia increases fu plasma, therefore Css,total _________.

A

decreases

67
Q

phenytoin Hypoalbuminemia ________ fu plasma, therefore Css,total decreases.

A

increases

68
Q

Phenytoin At steady-state, the rate of drug in ______ the rate of drug out.
aka
Rate of drug ________ = Rate of drug elimination.

A

equals
administration

69
Q

for phenytoin: Rate of drug administration = Rate of drug ________.

A

elimination

70
Q

For oral LD of phenytoin, only ______ can be absorbed at a time.

A

400mg

71
Q

what are Initial Immunosuppressants for Organ Rejection Prevention

A

Thymoglobulin, alemtuzumab, rituximab, basiliximab.

72
Q

what are Maintenance Immunosuppressants

A

Cyclosporine, tacrolimus, sirolimus, everolimus, mycophenolate, azathioprine, methylprednisolone, prednisone.

73
Q

what is the Treatment for Acute Rejection?

A

Thymoglobulin

74
Q

Adverse Effects of Cyclosporine

A

Hirsutism, nephrotoxicity, hypertension, gingival hyperplasia.

75
Q

Adverse Effect of Mycophenolate?

A

Gastrointestinal hemorrhage.

76
Q

Mycophenolic acid is _______.

A

teratogenic

77
Q

what drug is an IL-2 inhibitor?

A

Basiliximab

78
Q

what drugs Decrease transcription of IL-2?

A

Cyclosporine, tacrolimus.

79
Q

Azathioprine Combination with allopurinol causes?

A

severe myelosuppression

80
Q

avoid combining azathioprine with ACE-Is due to?

A

increased risk of myelosuppression.

81
Q

side effects of azathiioprine?

A

Pancytopenia (leukopenia, anemia, thrombocytopenia), alopecia, hepatotoxicity, pancreatitis.

82
Q

SE;s of sirolimus?

A

Hyperlipidemia, pancytopenia, mouth ulcers.

83
Q

SEs of tacrolimus?

A

Nephrotoxicity, hyperglycemia.

84
Q

Definitions:
Prematurity:
Neonates:
Infants:
Children:
Adolescents:

A

Prematurity: Born before 37 weeks.
Neonates: Younger than 28 days of life when born full term.
Infants: 28 days to 1 year old.
Children: 1-11 y/o.
Adolescents: 12-16 y/o.

85
Q

Children have ______ clearance.

A

increased

86
Q

Absorption: ______ in neonates and young infants, ________ Tmax.

A

slower, prolonged

87
Q

Neonates have _______ gastric pH, ________ bioavailability of drugs like penicillin and ampicillin.

A

elevated, increasing

88
Q

Children have ________ percutaneous absorption.

A

enhanced

89
Q

Neonates and young infants have _______ bioavailability of rectal metabolism.

A

enhanced

90
Q

intramuscular Absorption: ______ in infants due to ______ blood flow.

A

reduced, reduced

91
Q

Infants have less body fat, so highly lipid-soluble drugs are distributed _____.

A

less

92
Q

Drugs renally eliminated have _______ clearance in neonates and ______ clearance in young children (older than 1 year).

A

decreased, increased

93
Q

Promethazine is contraindicated under?

A

2 y/o

94
Q

what drug is contraindicated in children under 2?

A

promethazine

95
Q

Ceftriaxone contraindicated in _______ (under 28 days of age).

A

neonates

96
Q

what cephalosporin is contraindicated in neonates?

A

ceftriaxone

97
Q

FDA Warning: Not to use ______ in children under 12.

A

codeine

98
Q

Avoid drugs containing benzyl alcohol for kids.
Main ones to watch for are ________ saline and water.

A

bacteriostatic

99
Q

Avoid drugs containing __________ for kids.
Main ones to watch for are bacteriostatic saline and water.

A

benzyl alcohol

Pharmacy Practice 7 (8 decks)

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