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Pharm & Ototoxicity > Controlled Subs, Adverse Drug Events, & Pharmacogenomics > Flashcards

Controlled Subs, Adverse Drug Events, & Pharmacogenomics Flashcards

1
Q

Under the Title 21 United States Code (USC) Controlled Substances Act (CSA) , congress gave the United States Drug Enforcement Administration (DEA) authority to

A

Set the schedule of controlled substances
Control and enforcement of laws related to these substances

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2
Q

The Controlled Substances Act (CSA) places all drugs, substances, and certain chemicals used to make drugs into _____ distinct categories or schedules

A

five (5)

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3
Q

what are the drug categories dependent on

A

drug’s acceptable medical use
drugs potential for abuse
drug’s safety or dependence liability

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4
Q

what is a determinate factor in the scheduling of the drug

A

abuse rate

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5
Q

considered the most dangerous class of drugs with a highest potential for abuse

A

schedule I

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6
Q

represents the least potential for abuse

A

schedule 5

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7
Q

what are schedule I drugs

A

substances or chemicals defined as drugs with no currently accepted medical use and a high potential for abuse

most dangerous of all the schedules

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8
Q

what are ex of schedule I drugs

A

Heroin
Lysergic acid diethylamide (LSD)
3,4-methylenedioxymethamphetamine (ecstasy)
Peyote (some controversy regarding religious use by Native American People who have used it for centuries)
Small spineless cactus native to the desert of south TX and north

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9
Q

Small spineless cactus native to the desert of south TX and north Mexico (contains psychoactive alkaloids, particularly mescaline) used by Native Americans

A

peyote

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10
Q

what are schedule II drugs

A

substances or chemicals defined as drugs but with a high potential for abuse; less than Schedule I drugs

can potentially lead to severe psychological or physical dependence

dangerous

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11
Q

schedule II ex

A

Morphine & Fentanyl (100x more powerful than morphine)
Hydrocodone & combination acetaminophen with < 15 mgs of hydrocodone per dosage unit (e.g., Vicodin)
Oxycodone (OxyContin)
Cocaine (powerful local anesthetic and vasoconstrictor-not used much for medicinal purposes in the U. S.)
Methamphetamine
Methadone (used in drug addiction/detoxification programs)
Meperidine (Demerol)
Adderall and Ritalin (used for ADHD)

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12
Q

what are schedule III drugs

A

substances or chemicals defined as drugs with a moderate to low potential for physical and psychological dependence

abuse potential is less than that of Schedule I & II drugs but greater than Schedule IV drugs

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13
Q

ex of schedule III

A

Products containing < 90 milligrams of codeine per dosage unit (Tylenol with codeine)
Ketamine (used as a general anesthetic but abused as a recreational drug-hallucinogenic effects)
Anabolic steroids –Testosterone
Marijuana (cannabis) – Moved from Schedule 1 in May 2024
Many states now have legalized medicinal and recreational use

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14
Q

what are schedule IV drugs

A

substances or chemicals defined as drugs with a low potential for abuse and low risk of dependence

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15
Q

ex of schedule Iv

A

Xanax (alprazolam, a benzodiazepine used to treat anxiety and panic disorders)
Valium
Ativan (Benzodiazepine; treats anxiety, anxiety with depression, and insomnia
Ambien
Tramadol (non-narcotic pain medication)

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16
Q

what are schedule V drugs

A

substances or chemicals defined as drugs with lower potential for abuse than Schedule IV

usually used for antidarrheal, antitussive & analgesic purposes

consist of preparations containing limited quantities of certain narcotics

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17
Q

consist of preparations containing limited quantities of certain narcotics

A

schedule V

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18
Q

schedule V ex

A

Cough preparations with < 200 mgs of codeine or per 100 milliliters (e.g., Robitussin AC)
Lomotil (for diarrhea)
Lyrica (for nerve pain/neuropathy)

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19
Q

Drug effects on the body can be

A

therapeutic effects
adverse effects (ADRs)

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20
Q

what are ADRs

A

Any undesirable action - side effects
toxicity reactions

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21
Q

maybe b/w 4th & 6th leading cause of death in US

A

ADRs

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22
Q

what is included in ADRs

A

undesired effects, many which can be tolerated
these are generally reversible upon drug discontinuation
they are dose-related

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23
Q

toxicity reactions seen in ADRs

A

esults in cell & tissue damage
permanent and generally intolerable reactions

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24
Q

what is dose related

A

will get better or worse based on the dose you have taken

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25
Q

the more you take the more you get the side effect or the more you take the more the side effect diminishes

A

dose related

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26
Q

Opiate analgesics and drugs for general anesthesia (GA) accounted for more than _____ of all drugs implicated in ADRs

A

50%

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27
Q

In the Thiesen, et al (2013) study, other factors that increased the risk of ADR were

A

increasing age of child (1.06 each yr)

incrasing # of drugs (1.25 for each additional drug)

oncological treatment (1.90 compared to other Rx)

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28
Q

ADRs were common in hospitalized children

A

yes

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29
Q

Children who had undergone GA were at 2x greater risk of developing an ADR

A

false
6x

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30
Q

______ & _____ were a significant cause of ADRs in hospitalized children

A

GA agents and opiate analgesics

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31
Q

why older children are at risk? why is age a risk factor?

A

because they are more active and more exposed to exposure to other infections and things that younger ones might not have exposure to

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32
Q

what is a monograph

A

package inserts that must accompany prescription drugs in the pharmacy inventory

contain information about the drug, including a listing of adverse effects

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33
Q

FDA requires that all ADRS observed for the drug to be included in the

A

monograph

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34
Q

ADRs are reported by

A

Systems/organs affected
Percentage of population affected

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35
Q

ADRs can be categorized according to

A

body or organ system affected (skin, cardiovascular, respiratory, etc.)

general side effects that affect whole body (malaise, fatigue, boy pain, back pain)

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36
Q

Signs of an ADR in the Nervous System can include

A

Dizziness
Drowsiness
Confusion
Depression
Delusions (belief or altered realty despite evidence to the contrary)
Hallucinations (sensory experiences that appear real but are not)
Anxiety or hyper-excitability/hyperactivity
Decreased mental acuity
Altered judgment
Delayed reaction time
Headaches

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37
Q

Signs of an ADR in the Eyes, with eyelids and conjunctiva being the frequent targets for drug toxicity

A

Blurred/double vision
Increased ocular pressure
Damage to the retina and optic nerve
Erythema multiforme

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38
Q

Stevens-Johnson Syndrome

A

Painful skin rash that spreads and blisters
Increased risk if the patient has a gene called HLA-B 1502

skin & mucuous membranes on the inside are affected

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39
Q

what is Erythema multiforme and signs

A

skin disorder that’s considered an allergic reaction to an infection or medicine

Allergic reaction to some antibiotics, NSAIDs, and infections
Allergic reaction involves mucous membranes, skin and eyelids
Produces variety of skin lesions from bumps, plaques, to blisters
In its most severe form, it is called Stevens-Johnson Syndrome

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40
Q

Signs of an ADR in the Auditory-vestibular systems can include

A

Dizziness
Vertigo
Other balance disorders
Hearing loss
Tinnitus

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41
Q

the most common side effects of medications

A

tinnitus & dizziness

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42
Q

Signs of an ADR related to the Skin can include

A

Drug-induced itching and redness
Acne
Alopecia
Herpes simplex
A viral infection, caused by a group of herpes viruses that can produce cold sores, genital inflammation, or conjunctivitis
Sweating
Urticaria (hives)
Skin ulcers
Steven Johnson syndrome (affects skin & mucous membranes)

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43
Q

viral infection, caused by a group of herpes viruses that can produce cold sores, genital inflammation, or conjunctivitis

A

herpes simplex

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44
Q

Drug hypersensitivity and allergies are an adverse drug reaction

A

true

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45
Q

why do Drug hypersensitivity and allergies occur

A

due to the immune system

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46
Q

how does the immune system attack a drug

A

The immune system is a constellation of responses mounted by the body to attacks from outside the body

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47
Q

anything that is coming in from the body elicitating an allergic reaction or immune response

A

antigen

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48
Q

any substance, from a virus to a wood sliver, that elicits an immune response

A

antigen

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49
Q

antigen specific

A

iparts of the immune system recognize and act against particular antigens

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50
Q

parts of I.S. is systemic

A

not confined to the initial infection site but work throughout the body

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51
Q

parts of I.S. have memory

A

recognize and mount an even stronger attack to the same antigen the next time

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52
Q

how to vaccines work

A

you take covid vaccine and now when you get covid next time the body has a quick response and doesn’t make virus multiply and make you sick

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53
Q

The most important component of the immune system is

A

Self/Non-self Recognition

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54
Q

what is Self/Non-self Recognition

A

achieved by every cell displaying a marker based on the major histocompatibility complex (MHC)

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55
Q

what are mhc

A

group of genes that code for cell surface proteins essential for the immune system

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56
Q

Any cell not displaying marker MHC is treated as non-self and attacked

A

true

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57
Q

examples of autoimmune diseases

A

multiple sclerosis (MS), sudden sensorineural hearing loss, rheumatoid arthritis, and Type 1 diabetes

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58
Q

Sometimes the process breaks down and the immune system attacks the body’s own cells

A

autoimmune disease

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59
Q

instances when the immune response to innocuous substances is inappropriately overwhelming

A

allergies

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60
Q

two main fluid systems in the body that are partof the immune system and also transport agents of this system

A

Hematopoietic (blood) and Lymphatic systems

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61
Q

cells of hematopoietic system

A

Erythrocytes or red blood cells (RBCs) - Carry oxygen
Leukocytes or white blood cells (WBCs) - Fight infections
Thrombocytes or platelets - Help control bleeding

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62
Q

Carry oxygen

A

Erythrocytes or red blood cells (RBCs)

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63
Q

fight infections

A

Leukocytes or white blood cells (WBCs)

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64
Q

help control bleeding

A

Thrombocytes or platelets

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65
Q

simpe substances that elicit this response of allergies is called

A

allergens

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66
Q

clear, transparent, and colorless

A

lymph

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67
Q

what is lymph

A

clear, transparent, and colorless
flows in the lymphatic vessels alongside the blood vessels, bathing tissues and organs in its protective covering

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68
Q

examples of allergens

A

dust & pollen

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69
Q

what are lymph nodes

A

Along the lymph vessels
filters lymphatic fluid

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70
Q

area where antigens are usually presented to the immune system

A

lymph nodes

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71
Q

RBCs, WBCs, & thrombocytes and platelets all develop from a common cell in the bone marrow

A

true
develop at the pluripotent hematopoietic stem cell

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72
Q

how do the different cell types differentiate

A

They differentiate into these different cell types by interactions with dozens of glycoproteins called hematopoietic growth factors

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73
Q

glycoproteins

A

hematopoietic growth factors

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74
Q

what are pluripotent hematopoietic stem cell

A

whatever organ or system they go in, they will becomes cells or organs of that area

type of stem cell that can differentiate into cells from any of the three germ layers in the body, and are thought to be the source of most cell types.

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75
Q

what are glycoproteins

A

they have a carbohydrate (sugar) attached to proteins

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76
Q

hematopoietic growth factors

A

naturally occurring substances which regulate the production of circulating blood cells

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77
Q

what are the two divisions of leukocytes

A

Granulocytes (containing large granules in the cytoplasm)
Agranulocytes (without granules)

78
Q

what are leukocytes

A

WBCs

79
Q

difference between granulocytes and agranulocytes

A

Granulocytes (containing large granules in the cytoplasm)
Agranulocytes (without granules)

80
Q

what are agranulocytes

A

lymphocytes (single large nucleus, no granules)

81
Q

what are lymphocytes

A

single large nucleus, no granules)

82
Q

what do lymphocytes contain

A

Consisting of B cells, T cells, and monocytes
Lymphocytes circulate in the blood and lymph systems and make their home in the lymphoid organs

83
Q

primary organs of the immune system include

A

Bone marrow (B lymphocyte production)
Thymus gland (T lymphocyte production)
T and B cells are the main cells of the lymphatic system

84
Q

where does everything come from

A

Bone marrow

85
Q

B lymphocyte production

A

bone marrow

86
Q

T lymphocyte production

A

thymus gland

87
Q

They are produced in the bone marrow and mature in the thymus

A

t cells?

88
Q

main cells of the lymphatic system

A

t and b

89
Q

differentiate between t and b cells

A

T cells are involved in cell-mediated immunity
Cell-mediated immunity does not depend on antibodies for its adaptive immune functions and is primarily driven by mature T cells
B cells are involved in humoral immunity (related to antibodies)
Humoral immunity produces antigen-specific antibodies and is primarily driven by B cells

90
Q

what is the function of t and b cells

A

to recognize specific “non-self” antigens, during a process known as antigen presentation

91
Q

involved in humoral immunity (related to antibodies)

A

b cells

92
Q

are involved in cell-mediated immunity

A

t cells

93
Q

cell mediated immunity

A

Cell-mediated immunity does not depend on antibodies for its adaptive immune functions and is primarily driven by mature T cells

94
Q

humoral immunity

A

Humoral immunity produces antigen-specific antibodies and is primarily driven by B cells

95
Q

how does immune system recognize cells?

A

protein that sits on the membrane of all cells
- every cell displaying a marker based on the major histocompatibility complex (MHC)

96
Q

secondary organs for the immune system include (at/near portals of entry for pathogens)

A

Adenoids, tonsils, spleen, lymph nodes, Peyer’s patches (within the intestines), and appendix

97
Q

WBCs originate in the _______ and then migrate to the________organs

A

bone marrow
other primary and secondary lymph

98
Q

what is another term for antibodies

A

immunoglobulins (Igs)

99
Q

what are antibodies/Igs

A

play a very important role in the immune system
These are large, Y-shaped proteins secreted by the plasma and are offspring (clones) of primed B cells

100
Q

what are antibodies used for

A

used by the immune system to identify and neutralize foreign objects such as bacteria and viruses
antibody recognizes a unique molecule of the pathogen called an antigen

101
Q

antibody recognizes a unique molecule of the pathogen called

A

an antigen

102
Q

Antibodies constitute the _____ part of the blood proteins

A

gamma globulin

103
Q

The antibodies inactivate antigens through various mechanisms

A

true

104
Q

Development of Antibodies or Immunoglobulins (Igs)

A

immuno competent but immature b lymphocyte is stimulated to maturity

When an antigen binds to its surface receptors, the B cell is sensitized or primed and undergoes clonal selection reproducing by mitosis

Most of the family of these clones become plasma cells

These cells, after an initial lag (up to 14 days), produce highly specific antibodies at a rate of ~ 2000 molecules/second for 4 to 5 days

The other B cells become long-lived memory cells

105
Q

plasma cells, after an initial lag (up to 14 days), produce highly specific antibodies at a rate of ~ 2000 molecules/second for______ days

A

4 to 5 days

This action is needed to neutralize the antigen quickly

106
Q

what is the primary immune response

A

plasma cells, after an initial lag (up to 14 days), produce highly specific antibodies at a rate of ~ 2000 molecules/second for______ days

107
Q

what do the other b cells do in memory cells

A

They will participate in the secondary immune response which is quicker and more effective

108
Q

most abundant Igs

A

IgG - 76%

109
Q

IgG dominates in the secondary immune responses

A

true

110
Q

IgG is the only antibody that crosses the

A

placental barrier to the fetus

111
Q

dominates in primary immune responses

A

IgM

112
Q

responsible for the 3 to 6 month immune protection of newborns that is conferred by the mother

A

IgG

113
Q

why is IgG important for babies and fetuses

A

IgG is the only antibody that crosses the placental barrier to the fetus

responsible for the 3 to 6 month immune protection of newborns that is conferred by the mother

newborn immune system is immature and cannot protect the fetus or the newborn
takes around 3 mos to have any immune response

114
Q

waht is the IgG

A

most dominant immunoglobulin and only one to cross placental barrier to provide immunity to fetus

115
Q

Immunity can be either

A

Natural or artificial
Innate or acquired/adaptive
Active or passive

116
Q

Active natural

A

contact with infection
Develops slowly, is long term, and antigen specific

117
Q

Active artificial

A

immunization-vaccines)
Develops slowly, lasts for several years, and is specific to the antigen for which the immunization was given

118
Q

Passive natural

A

trans-placental mother-to-child)
Develops immediately, is temporary, and affects all antigens to which the mother has immunity

119
Q

Passive artificial

A

injection of gamma globulin
Develops immediately, is temporary, and affects all antigens to which the donor has immunity

120
Q

what do vaccines offer

A

Active Artificial Immunization

121
Q

how do vaccines teach the body’s immune system to recognize and block viruses

A

Vaccines activate T cells to detect viruses, with their activity peaking 10 to 18 days after vaccination. They also instruct B cells to produce antibodies that block the virus from replicating and direct T-killer cells to destroy infected cells

122
Q

what do all types of vaccines do

A

All vaccines leave the body with “memory” T-lymphocytes and B-lymphocytes that remember how to quickly fight the specific virus if it reappears in the future.

123
Q

explain how covid 19 vaccines work

A

COVID-19 mRNA vaccines introduce a “spike protein” from the virus into our muscle cells, which use it to produce the protein. Once spike protein is made, the cells break down and eliminate the original injected spike proteins. The immune system recognizes the spike protein as foreign, builds an immune response, and creates antibodies, similar to a natural infection. This process trains the body’s memory cells to recognize and quickly defend against future COVID-19 infections, providing protection without the risk of illness.

124
Q

The target cells in the immune system of immediate-type reaction are

A

mast cells and basophils (type of WBC)

125
Q

where are mast cells found

A

in connective tissue and basophils

126
Q

similarities between mast cells and basophils

A

They both contain histamine, an important chemical for fighting infections

127
Q

what is a negative of histamines

A

when released into the body inappropriately or in too high a quantity, histamine is a potentially devastating substance resulting in allergic reactions

128
Q

It takes between _____ days of sensitizing exposure for the mast cells and basophils to become primed with IgE antibodies

A

7 to 10

129
Q

what is the allergic cascade

A

explains how the body overreacts to harmless substances, leading to the symptoms we associate with allergic reactions

second exposure to the same allergen that causes a destructive dominoeffect in the system

130
Q

may act as specific antigens to mast cells and basophils

A

drugs or drug metabolites

131
Q

part of the immune system and contains granules rich in histamine and heparin(anticoagulant to prevent blood clots)

A

mast cell

132
Q

Antigens combines with adjacent molecules of the IgE antibodies that have become attached to the mast or basophil cell surface
The antigen-antibody combination causes release of histamine resulting in allergic manifestations

A

true

133
Q

type 1 reactioin

A

mediated by IgE

134
Q

what are the most severe reactions

A

anaphylaxis
asthma symptom
dermatitis

135
Q

type II reactions are mediated by

A

IgG & IgM

136
Q

what happens in type II reactions

A

hemolysis (break down) of red blood cells (blood disorder)
e.g., some forms of anemia, blood transfusion reactions and some types of tissue transplant rejection

137
Q

Type III reaction mediated by

A

IgG

138
Q

type III reactions caused by IgG

A

arthralgia (muscle/joint pain) and fever
lymphadenopathy (swollen lymph nodes)

139
Q

which immunoglobulin is most active in each type of reactions and an example of each

A

Type I reaction medicated by IgE
anaphylaxis

typeII reaction mediated by IgG, IgM
some forms of anemia

type iii reaction mediated by IgG
arthralgia (muscle/joint pain) and fever
lymphadenopathy (swollen lymph nodes)

140
Q

what is anaphylaxis

A

anaphylactic shock is a severe, progressive, whole-body allergic reaction to a chemical that has become an allergen

141
Q

what happens in anaphylaxis

A

After being exposed to a substance such as bee sting venom and suffering a mid allergic reaction, the person’s immune system becomes sensitized to it
When the person is exposed to that allergen again, anaphylaxis happens quickly after; it is severe, and potentially life threatening

142
Q

Some drugs may cause an anaphylactic-like (anaphylactoid) reaction when people are first exposed to them

A

yes
e.g., morphine, radiographic contrast material like iodine, aspirin, etc.

143
Q

anaphylactoid

A

These are systemic not immune system reactions that do NOT require prior sensitization to an antigen as required in true anaphylaxis
The symptoms, risk of complications, and treatment, however, are the same for both types of reactions
ex:Some drugs may cause an anaphylactic-like (anaphylactoid) reaction when people are first exposed to them like aspirin

144
Q

Anaphylaxis is life-threatening and can occur at any time within minutes to a couple of hours

A

true

145
Q

common causes of anaphylaxis

A

Drugs - penicillin & anesthesia meds

Food allergies - peanuts & shellfish

Insect bites - bee stings and fire ants

146
Q

risks of anaphylaxis

A

history of any type of allergic reaction

For some people it may appear to occur with no known cause
But that is usually because first exposure caused mild/no symptoms

147
Q

immune response =

A

anaphylaxis

148
Q

no immune response and why it can happen with the first exposure =

A

anaphylactoid

149
Q

During anaphylaxis, tissues in different parts of the body release histamine and other substances, which causes the airways to tighten and leads to other symptoms like

A

Abdominal pain
Anxiety
Chest discomfort or tightness, wheezing, pulmonary edema
Cough and difficulty breathing
Difficulty swallowing due to swelling of the throat
Dizziness, light-headedness, unconsciousness
Skin redness, hives, itchiness, pale and blue skin (from lack of O2)
Nausea/vomiting and diarrhea
Weak and rapid pulse and low blood pressure
Abnormal heart rhythm
Slurred speech
Swelling of the face, eyes, and/or tongue
Mental confusion

150
Q

signs and symptoms of anaphylaxis

A

lip swelling, rashes, difficulty breathing, skin redness, abdominal pain

151
Q

treatment for anaphylaxis

A

Epinephrine (adrenaline) to reduce body’s allergic response
Oxygen to help compensate for restricted breathing
Intravenous (IV) antihistamines and cortisone to reduce inflammation and swelling in order to open airways
A beta-agonist (such as albuterol) to relieve breathing symptoms

152
Q

reduce body’s allergic response

A

Epinephrine (adrenaline)

153
Q

help compensate for restricted breathing

A

O2

154
Q

reduce inflammation and swelling in order to open airways

A

Intravenous (IV) antihistamines and cortisone

155
Q

relieve breathing symptoms

A

beta-agonist (such as albuterol)

156
Q

An anaphylactoid or an anaphylaxis/anaphylactic shock is an EMERGENCY medical condition

A

true

157
Q

examples of teratogen drugs to fetal development

A

isotretioin (Accutane) for severe cystic acne (99% teratogenic)

Thalidomide, first marketed in the late 1950s as a sedative and was used in the treatment of nausea in pregnant women
Banned by 1961 in most countries due to limb reduction defects (phocomelia) in offspring of mothers who took the drug
Other effects later attributed to thalidomide included
Congenital heart disease, malformations of inner and outer ear, and ocular abnormalities

158
Q

thalidomide effects

A

limb reduction defects (phocomelia) in offspring
Congenital heart disease, malformations of inner and outer ear, and ocular abnormalities

159
Q

infectious teratogens

A

rubella (German measles)

160
Q

causes from rubella

A

Can cause significant hearing loss, heart, neurological, and eye defects

161
Q

environmental factors that are teratogen

A

radiation
Can cause miscarriage, birth defects, intellectual disability, intrauterine growth retardation, and childhood cancers like leukemia

162
Q

causes from radiation

A

Can cause miscarriage, birth defects, intellectual disability, intrauterine growth retardation, and childhood cancers like leukemia

163
Q

Drugs that are teratogenic may still be approved by the FDA, if

A

The therapeutic benefits outweigh the risk
Physician labeling clearly contraindicates use during pregnancy

164
Q

benefits of taking thalidomide

A

useful for treating leprosy, multiple myloma, and some AIDS symptoms

165
Q

why does fda still approve teratogenid drugs but not drugs that cuase cancers

A

only affects small segment of populatioin and labeling can control it

166
Q

improve risk vs. benefit assessment of drugs used for pregnant and nursing mothers

A

The FDA implemented new Pregnancy and Lactation Labeling Rule (PLLR-The Final Rule) (in effect June 2015

167
Q

PLLR recommendations categories

A

fetal risk summary

clincial considerations

data

168
Q

describe fetal risk summaries

A

Characterizes the likelihood, from both human and animal data, that a drug increases the risk of four types of developmental abnormalities
Structural anomalies, fetal and infant mortality, impaired physiologic function, and alterations to growth

169
Q

4 categories of fetal risk summary

A

Structural anomalies, fetal and infant mortality, impaired physiologic function, and alterations to growth

170
Q

clincal considerations

A

Discussing fetal risk from inadvertent exposure and prescribing decisions based on drug effects on labor, delivery, and fetus

171
Q

data

A

Detailed discussion of available data; human data appears before animal data

172
Q

The human genome contains ~ 3 billion nucleotides making up ~ 25,000 genes that may encode > 100,000 proteins

A

true

173
Q

what is pharmacogenomics

A

aka pharmacogenetics
study of the role of the genome in drug response – a combination of pharmacology & genetics

fast emerging field that studies how the genetic makeup of a patient affects their response to drugs

174
Q

combo of pharmacology and genetics

A

pharmacogenomics

175
Q

fast emerging field that studies how the genetic makeup of a patient affects their response to drugs

A

pharmacogenomics

176
Q

Drug target receptors are sufficiently common in the population such that most medications act as intended on most people

A

true

177
Q

examples of inter individual differences

A

in genes that encode these drug targets OR
in genes that encode proteins for drug metabolism

178
Q

Genomes of humans are ______ identical regardless of race, ethnicity, or geographic region

A

~ 99%

179
Q

this 1% leads to

A

possibility of ~3 million differences in individual base pairs throughout the genome

180
Q

If one nucleotide in a specific position is exchanged with another nucleotide, the alteration is referred to as a

A

Single nucleotide polymorphism or SNP (pronounced “SNIP”)

181
Q

Majority of nucleotide variations are

A

SNPs

182
Q

other mutation or variation examples

A

Insertions, deletions, duplications, and translocations of one or more nucleotides or even entire chromosomes

183
Q

SNPs or other genetic variations can affect protein amount or function by

A

altering coding sequence of transcription or mRNA translation, which could be pharmacologically important

184
Q

Genetic polymorphisms in pharmacokinetics are common in major enzymes that metabolize both

A

phase I and II

185
Q

example of polymorphisms

A

succinylcholine by the enzyme serum cholinesterase

186
Q

inherited variation of enzymatic hydrolysis of the short-acting muscle relaxant

A

succinylcholine by the enzyme serum cholinesterase

187
Q

1 in ~ every 2000 Caucasians has a genetic alteration of the plasma enzyme serum cholinesterase

A

true

188
Q

enzyme serum cholinesterase function

A

to metabolize the muscle relaxant succinylcholine (given IV with general anesthesia)

189
Q

why is it important to know the ethnicity with polymorphism

A
190
Q

The altered enzyme has a 1000 fold decreased affinity for succinylcholine, causing

A

Decreased metabolism, slow elimination, & prolonged circulation

191
Q

A sufficiently high plasma level of succinylcholine would lead to respiratory paralysis and death if not supported with artificial respiration till the drug clears from the body

A

true

192
Q

cytochrome P450 (CYP) liver enzymes metabolize >____ classes of drugs

A

30

Pharm & Ototoxicity (10 decks)

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