Chapter 1-6 textbook

Question 1

Vd formula

Answer 1

Amount in body/plasma drug concentration

Question 2

Clearance formula

Answer 2

0.693(Vd)/half life

Question 3

Water weight at birth

Answer 3

75-80%

Question 4

Infant’s stomach pH

Answer 4

alkaline: >4

Decreased absorption of weakly acidic drugs and increased absorption of weakly basic drugs

Question 5

Gastric emptying in infants

Answer 5

Prolonged

Question 6

Percutaneous administration of meds in infants

Answer 6

Increased absorption due to decreased thickness of skin

Question 7

Pulmonary absorption in infants

Answer 7

Decreased due to lower tidal volumes and increased respiratory rates

Question 8

Volume of distribution in infants

Answer 8

Increased due to increased total body water

Question 9

Metabolism in infants

Answer 9

Delayed–can cause increase in toxicities

Question 10

Physiologic changes in pregnancy

Answer 10

Increased blood volume, increased CO, decreased systemic vascular resistance, increased pH of intestinal secretions, increased gastric emptying time, decreased gastric acid secretions, decreased intestinal motility, increased renal blood flow, increased GFR, increased uterine blood flow

Question 11

Progesterone effects on GI

Answer 11

Decreased GI motility–delays absorption or orally administered drugs

Question 12

Which drugs are more likely to cross placenta

Answer 12

Lipid soluble, nonionized, lower molecular weight, unbound and free drugs

Question 13

pharmacokinetic changes in elderly

Answer 13

Decreased blood flow to GI, increased gastric pH, delayed gastric emptying, decreased albumin and lean body mass, increased total body fat and decreased total body water, decreased liver blood flow and enzymes, decreased GFR and secretion

Question 14

Pharmacokinetics

Answer 14

how the drug moves through the body

Question 15

4 parts of pharmacokinetics

Answer 15

Absorption, distribution, biotransformation (metabolism), excretion/elimination

Question 16

Bioavailability

Answer 16

how much of the drug reaches the site of action

Question 17

F value

Answer 17

The fraction of the drug that reaches the systemic circulation
Depends on first pass metabolism

Question 18

What routes will bypass first pass metabolism

Answer 18

IV and sublingual

Question 19

Bioequivalent

Answer 19

Contains same active ingredient
Identical in strength, dosage, and route of administration
Same rate and extent of biovailability

Question 20

Factors influencing absorption

Answer 20

Formulation, concentration, lipophillic, acidic vs basic

Question 21

Distribution

Answer 21

Transport of drug in body fluid from site of absorption

Delivery of drug to various tissue

Question 22

Factors to consider in distribution

Answer 22

Plasma protein binding, obesity, edema, tissue binding

Drug’s affinity for certain tissues

Question 23

What portion of drug is available to exert effects

Answer 23

Free drug–not protein bound

Someone with liver disease and decreased albumin will have less protein binding and can have more toxic levels of drug

Question 24

Biotransformation

Answer 24

Chemical inactivation of a drug through conversion to a water soluble compound that can be excreted

Question 25

2 major organs of excretion

Answer 25

Liver and kidney (also fecal, respiration and breastmilk) | Kidney greater--depends on GFR which depends on cardiac and kidney function

Question 26

Pharmacodynamics

Answer 26

How the drug affects the body

Question 27

High affinity drug

Answer 27

Agonist

Question 28

Low affinity drug

Answer 28

Antagonist

Question 29

First order kinetics

Answer 29

If you give a drug, the same amount of drug will be eliminated over time depending on half life

Question 30

Zero order kinetics

Answer 30

You excrete a constant amount of drug no matter how much you give Causes accumulation and receptor saturation--toxicity

Question 31

Examples of drugs that undergo zero order kinetics

Answer 31

Phenytoin, alcohol, aspirin, dilantin, theophylline

Question 32

Elderly have a decreased sensitivity to

Answer 32

Beta blockers and warfarin/heparin

Question 33

Not recommended to give ____ to elderly due to fall risk

Answer 33

antihistamines

Question 34

When do kidneys reach maturation in children

Answer 34

2 years old | Can reach toxic levels quickly prior to this

Question 35

Metabolism in children

Answer 35

Slower--fewer liver enzymes

Question 36

Examples of drugs that cross placenta easily

Answer 36

Acetaminophen, caffeine, cocaine, labetalol, morphine, penicillins, theophylline

Question 37

Examples of drugs that do not cross placenta easily

Answer 37

Heparin and insulin

Question 38

Category A medications

Answer 38

Studies in women showed no risk to fetus demonstrated in first trimester and no evidence of risk at later trimesters Ex. folic acid and thyroid hormone

Question 39

Category B medications

Answer 39

Animal studies have not shown a fetal risk and no controlled studies have shown an adverse effect in first trimester and no evidence of risk in later trimesters Ex. Erythromycin and penicillin

Question 40

Category C medications

Answer 40

Studies in animals have shown adverse effect on fetus and no controlled studies in women Only give drugs if benefits justifies risk Ex. Labetalol, nifedipine, ACE Inhibitors

Question 41

Category D medications

Answer 41

There is positive evidence of human fetal risk but benefits may be acceptable despite risk Ex. Glyburide, diazepam, aspirin, ACEI

Question 42

Category X medications

Answer 42

Studies in animals or humans have demonstrated fetal abnormalities Drug is contraindicated Ex. oral contraceptives, lovastatin, isotretinoin

Question 43

MEC

Answer 43

Minimum effective concentration

Question 44

MTC

Answer 44

Minimum toxic concentration

Question 45

How to make urine more acidic

Answer 45

Cranberry juice, vitamin c, NH4Cl

Question 46

How to make urine more alkaline

Answer 46

Aspirin

Question 47

Phase 1 of drug metabolism

Answer 47

Modify drug by oxidation, reduction and hydrolytic reactions

Question 48

Phase 2 of drug metabolism

Answer 48

Conjugation of drug molecule with transferase

Question 49

Examples of general inducers of CYP450

Answer 49

``` Anti-seizure drugs (carbamazepine + phenytoin) Rifampin HIV drugs Chronic alcohol Glucocorticoids Barbiturates St Johns Wort ```

Question 50

Therapeutic index

Answer 50

TD/ED

Question 51

Examples of general inhibitors of CYP450

Answer 51

``` Proton pump inhibitors Azoles Macrolides Grapefruit juice SSRI's Acute alcohol Cimetidine Amiodarone Non-dihydropyridine calcium channel blockers Protease inhibitors ```

Question 52

Gs protein

Answer 52

Stimulated protein; activates aneylyl cyclase which increases cAMP

Question 53

Gi protein

Answer 53

Inhibitory; decreases cAMP

Question 54

Gq protein

Answer 54

Activates phospolipase C; Activates DAG + IP3 which increases Ca