Chapter 8 - Individual Variation in Drug Responses Flashcards

1
Q

In the very young patient, heightened drug sensitivity is the result of

A

organ immaturity

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2
Q

in older adults, heightened sensitivity results largely from

A

decline in organ function

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3
Q

Recall that, because of pH partitioning, if there is a difference in pH on two sides of a membrane, a drug will accumulate on the side where

A

the pH most favors its ionization

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4
Q

if liver function declines, the rate of metabolism will

A

decline, causing drug levels to climb

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5
Q

Tachyphylaxis?

A

a reduction in drug responsiveness brought on by repeated dosing over a short time

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6
Q

The most serious toxicity of digoxin is production of

A

potentially fatal dysrhythmias

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7
Q

The tendency of digoxin to disturb cardiac rhythm is related to levels of

A

potassium

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8
Q

When potassium levels are low, the ability of digoxin to induce dysrhythmias

A

greatly increased

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9
Q

Pharmacodynamic tolerance is the result of

A

adaptive processes that occur in response to chronic receptor occupation.

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10
Q

How is metabolic tolerance brought about?

A

by the ability of certain drugs (eg, barbiturates) to induce synthesis of hepatic drug-metabolizing enzymes, thereby causing rates of drug metabolism to increase

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11
Q

Diarrhea can _____ absorption by accelerating transport of drugs through the intestine.

A

reduce

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12
Q

Pharmacogenomics

A

the study of how genetic variations can affect individual responses to drugs

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13
Q

What two drugs require genetic testing before use?

A

maraviroc [Selzentry] and trastuzumab [Herceptin

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14
Q

Variants in the gene that codes for cytochrome _____ can greatly reduce the benefits of tamoxifen [Soltamox, Nolvadex-Dimage], a drug used to prevent breast cancer recurrence

A

CYP2D6

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15
Q

Variants of the gene that codes for ______ can greatly reduce the benefits of clopidogrel [Plavix], a drug that prevents platelet aggregation

A

CYP2C19

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16
Q

About 1 in 14 people of European heritage have a form of ______ that is unable to convert codeine into morphine, the active form of codeine.

A

CYP2D6 — As a result, codeine cannot relieve pain in these people.

17
Q

Variants in the gene that codes for _______ can increase the risk of toxicity (bleeding) from warfarin [Coumadin], an anticoagulant with a narrow TI.

A

CYP2C9

18
Q

Variants in the genes that code for the beta1-adrenergic receptor (ADRB1) produce receptors that are

A

hyperresponsive to activation

19
Q

The most common mechanism by which genetic variants modify drug responses is by

A

altering drug metabolism

20
Q

The most serious adverse effect of MAO inhibitors is ______ , which can be triggered by foods that contain

A

malignant hypertension ; tyramine, a breakdown product of the amino acid tyrosine. Accordingly, patients taking MAO inhibitors must rigidly avoid all tyramine-rich foods (eg, beef liver, ripe cheeses, yeast products, Chianti wine).

21
Q

The most serious adverse effect of MAO inhibitors is ______ , which can be triggered by foods that contain_____

A

malignant hypertension ; tyramine, a breakdown product of the amino acid tyrosine. Accordingly, patients taking MAO inhibitors must rigidly avoid all tyramine-rich foods (eg, beef liver, ripe cheeses, yeast products, Chianti wine).

22
Q

Kidney disease can _________ drug excretion

A

Reduce

23
Q

If liver function declines, the rate o metabolism will _______

A

Decline, causing drug levels to climb

24
Q

Recall that because of PH partitioning, if there is a difference in pH on two sides of a membrane, a drug will accumulate in the side where_____

A

The pH most favors ionization

25
Q

The most serious toxicity of digoxin is production of______

A

Potentially fatal dysthymias

26
Q

The tendency of digoxin to disturb cardiac rhythm is related to levels of

A

Potassium.

27
Q

When potassium levels are low, the ability of digoxin to induce dysthymias ______

A

Greatly increases

28
Q

Pharmacodynamic tolerance is the result of ________

A

Adaptive process that occur in response to chronic receptor occupation

29
Q

Metabolic tolerance?

A

Tolerance resulting from accelerated drug metabolism.

30
Q

The most common mechanism by which genetic variants modify drug response is by _____

A

Altering drug metabolism