Advanced Principles Of Science

Question 1

What are the different stages of life

Answer 1

Neonate 37-42 weeks
Infant 4 weeks - 12 months
Child 1-12 years
Adolescent 12-17 years
Young adults 18- mid 20’s
Middle Ages 40-60
Older people >65

Question 2

Differentiate between IV bolus and IV infusion

Answer 2

Bolus - drug administrated into vein over a short period of time 1-2 minutes
IV - infusion fluid administered over a long period of time >30 mins

Question 3

Why might you need to change the formulation of a drug

Answer 3

Oral route causes too many side effects
Dysphagia
Nil by mouth

Question 4

What are serious ADRs classified by the MHRA

Answer 4

Death
Life threatening
Hospitalisation
In capability or disability

Question 5

What are the 5 types of ADR

Answer 5

A- augmented, exaggerations at normal dose (dose dependent)
B - bizarre reactions, not expected (e.g., anaphylaxis with penicillin)
C - continuing reactions - persistent for a long time ( oesreonecrosis of the jay with bisphosphonates)
D - delayed reactions
E- end of use, associated with withdrawal

Question 6

What is NTRO

Answer 6

N - nature of symptoms
T - timing of symptoms and period from when treatment was started
R- relationship of dose
O - other medication, could manifest due to underlying medication

Question 7

Drug absorption in neonates

Answer 7

Erratic absorption in newborns and unavailable in I’ll babies as they’re stomach doesn’t empty fully. IV or rectal are the best routes

Question 8

Drug distribution in neonates

Answer 8

Hydrophilic distribute in water and lipophilic distribute into fat
Increases percentage body water and ratio of intra to extracellular fluid

Question 9

Amount of albumin compared to free drug conc

Answer 9

Less albumin so more free drug in the plasma

Question 10

Drug metabolism is neonates

Answer 10

Not too different from children
Hyperbilirubinaemia in newborns affect metabolism
Immature metabolic pathway

Question 11

Drug elimination in neonates

Answer 11

Immature hepatic and renal function
Low elimination

Question 12

Drug absorption in children

Answer 12

Same as healthy adults
IM is faster because they have increased muscle flow

Question 13

Drug distribution in children

Answer 13

Larger doses are required as % body weight, body water and extracellular fluid decrease with age

Question 14

Drug metabolism in children

Answer 14

Between 1 and 9 drug metabolism is higher than adults
Higher doses are given

Question 15

Drug excretion in children

Answer 15

Maturity of glomerulus is 12-18 months
After 18 months renal excretion is that of an adults

Question 16

Drug absorption in elderly

Answer 16

Delay of gastric emptying
Reduction in splanchnic output and gastric acid output
Slower digoxin absorption but rest is the same as an adult

Question 17

Drug distribution in elderly

Answer 17

Reduced lean muscle mass
Total body water
Total body fat
Serum albumin level
Increased Vd for fat soluble compounds but reduced Vd for water soluble compounds

Question 18

Drug metabolism in elderly

Answer 18

Impaired first pass metabolism
Hypotension effects of nifedipine is increased

Question 19

Drug excretion in elderly

Answer 19

Glomerular filtration declines as does renal plasma flow
Lower doses of drugs with lower therapeutic index

Question 20

What is a pharmacokinetic interaction

Answer 20

Patient taking one drug alters the pharmacokinetic of another
Increases / reduces amount of drug available

Question 21

What are pharmacodynamic interactions

Answer 21

Different drugs having similar or antagonistic pharmacology
Could be competition at receptor sites

Question 22

What are the 3 mechanisms for absorption interactions

Answer 22

Changes in GI pH
Absorption and chelation (TCAs chelating with metallic ions - poor absorption)
Changes in GI motility

Question 23

What are the 2 main mechanisms for metabolism reactions

Answer 23

Phase 1 reactions - oxidation, reduction or hydrolysis
Phase 2 reactions - drugs / phase 1 metabolite are conjugated with another substance to make metabolites

Question 24

What are the 2 most important isoenzymes of CYP

Answer 24

CYP3A4
CYP2D6

Question 25

What happens in enzyme induction interactions

Answer 25

One drug increases the metabolism of another drug, lowering the plasma conc, when induced is removed the conc of the other drug is increased

Question 26

What happens in enzyme inhibition reactions

Answer 26

One drug inhibits the metabolism of another drug, increasing the concentrations and increasing risk of toxicity.

Question 27

Define absolute contraindication

Answer 27

Drug that causes life - threatening situations and should be avoided

Question 28

Define relative contraindication

Answer 28

Should be used in caution with another drug or in patients with co-morbidities