Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology - UT Housotn SON Gard School > Exam 1 - Lecture 3 & CNS Drugs > Flashcards

Exam 1 - Lecture 3 & CNS Drugs Flashcards

1
Q

Define FDA Pregnancy Category:

No fetal harm in studies in women

A

A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What drug characteristics make them easier to cross into breast milk?

A
  • Smaller molecular weight
  • Lipid soluble drugs
  • Breast milk more acidic - so accumulates more basic drugs (beta blockers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What drug metabolism phenotype describes pt who metabolizes prodrugs slowly?

A

Poor/Intermediate Metabolizing Phenotype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

FDA Pregnancy Categories for Teratogenic Risk

B

A

No fetal harm in animals; no studies in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Compared to males, is plasma volume levels higher or lower in females?

A

Plasma volumes are LOWER in females.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physiologic changes with geriatric pts. affecting drug processing:

A
  • Decreased 1st pass elimination (increased amount of drug entering systemic circulation)
  • Decreased serum albumin (increased concentraiton of unbound drug - more intense effect)
  • Creatinine clearance occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define FDA Pregnancy Category:

Fetal harm in studies in women; Weigh risk vs. benefit

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pharmacokinetic Differences by Race

American Indian / Alaska Native

A

•Little pharmacokinetic research has been done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What effects on prodrug to poor/intermediate metabolizer phenotypes have?

A
  • Prodrug: metabolized slowly into active drug
  • Prodrug: may lead to prodrug accumulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pharmacokinetics not affected by race:

A

•absorption*, (AAs may have difference)

glomerular filtration, &

passive tubular reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do pts. w/ ultrarapid metabolizing phenotype metabolize prodrugs?

A
  • Prodrug is rapidly metabolized to active drug
  • No dosage adjustment is needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define FDA Pregnancy Category:

Definite fetal harm in studies in women. Contraindicated

A

X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pharmacokinetic Differences by Race

African American

A
  • Hypertension: Not all AA are salt sensitive
  • Have less renin-dependent HTN- ACEI not 1st line
  • Afr Ams- more sensitive to bradykinin → at risk for ACEI- associated angioedema
  • Higher gastric bicarb secretion-, raises gastric pH → negatively affects absorption of some drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does estrogen affect distribution?

A
  • Estrogen is distributed attached to a serum-binding globulin.
  • Exogenous estrogens INCREASE levels of many serum-binding globulins
  • These serum binding agents will bind to drugs, resulting in less free drug
  • Examples - corticosteroid-binding / thyroxine-binding globulins = less free drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do pts. w/ ultrarapid metabolizing phenotype metabolize active drugs?

A
  • They rapidly metabolize active drug to the inactive form.
  • B/c of this - they may have therpetherapeuticre
  • They will require HIGHER doses of active drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define FDA Pregnancy Category:

No fetal harm in animals; no studies in women

A

B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pharmacokinetic Differences by Race

Asian Americans

A
  • East Asians- “Fast acetylators”: faster hepatic metabolism of certain drugs à may require more frequent and higher doses
  • May metabolize antidepressants slower (unless they are a ultra-rapid 2D6 metabolizers- 21%) à may require lower doses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Typcially, pts. who are have poor/intermediate drug metabolizing phenotype require higher or lower doses of medications?

A

LOWER DOSES for poor metabolizers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pharmacogenetic abnormalities can lead to:

A
  • Unexpected drug toxicity even when low doses of drugs are administered.
  • Unexpected drug-drug interactions.
  • Novel drug effects not seen in the “average” patient.
  • Failure to respond to “therapeutic” doses.

Example:

Individuals who do not produce enough CYP2D6 in the liver to metabolize codeine to morphine and thus may not experience normal pain relief with this drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Changes in older adult

A

Changes in older adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What effect on drug metabolism will ultrarapid metabolizers have?

A

FAST METABOLISM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Know this chart!

A

Know this chart!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Because plasma levels are lower in females, how will drug concentration be affected, especially in drugs with high volumes of distribution?

A

Drugs with high volume distributions will be MORE CONCENTRATED in plasma of females.

24
Q

What effects can having lower plasma volumes have on drug levels?

A

Drug levels will be more concentrated.

25
Q

If pregnant, what fetal exam is needed for the patient on paroxetine (paxil)?

A

Echocardiogram of fetus

26
Q

Know this:

Metabolism of drugs differences by sex may depend on the differences in the CYP450 enzymes

A

Know this:

Metabolism of drugs differences by sex may depend on the differences in the CYP450 enzymes

27
Q

When prescribing medications, consider all women of reproductive age pregnant unless:

A
  • You have tested them for pregnancy,
  • they give you a history of using a reliable contraceptive method,
  • t​hey are reliable enough to make use of their contraceptive method in a consistent manner.
28
Q

What effect on drug metabolism will poor/intermediate metabolizers have?

A

SLOW METABOLISM

29
Q

What should you be concerned with children and topical medications?

A
  • Children absorb topical medications more readily than adults due to larger body surface area (can lead to toxicity!)
  • There is great concern for the absorption of topical corticosteroids due to HPA axis suppression
  • Look up appropriate topical corticosteroids before prescribing to children
30
Q

FDA Pregnancy Categories for Teratogenic Risk

A

A

No fetal harm in studies in women

31
Q

What effect can having higher levels of free drug in the plasma have on the patient?

A

Higher risk for adverse effects.

32
Q

What effects on active drugs to poor/intermediate metabolizer phenotypes have?

A
  • Metabolizes slowly into active form
  • Potential for accumulation
  • Pts require lower dosages of medications
33
Q

If pregnant, what fetal exam is needed for the patient on SSRI?

A

Detailed fetal anatomy during 2nd trimester.

34
Q

Although drugs can affect fetal formation at all stages, when is the fetus most susceptible to damage?

A

1st trimester

35
Q

In patients with higher body fats proportions, like in female patients - how are absorption and distribution affected with lipophilic drugs?

A

Lipophilic drugs are more readily absorbed.

They have a greater volume of distribution.

36
Q

What are physiologic factors affecting drug prescription?

A

Pregnancy

Children

Infant

Geri

Our bodies change over time - affecting the pharmacokinetics of drugs.

37
Q

FDA Pregnancy Categories for Teratogenic Risk

C

A

Fetal harm in animals; no studies in women

38
Q

Review this chart

A

Review this chart

39
Q

For pts. with ultrarapid metabolizing phenotype, which drug type would need to be adjusted to higher doses: prodrug or active drug?

A

Active Drug (because they metabolize it quickly)

(No dosage change needed for pro-drug)

40
Q

How do pts. w/ poor/intermediate metabolizing phenotype metabolize active drugs?

A

Slowly, leading to potential accumulation

41
Q

FDA Pregnancy Categories for Teratogenic Risk

X

A

Definite fetal harm in studies in women. Contraindicated

42
Q

FDA Pregnancy Categories for Teratogenic Risk

D

A

Fetal harm in studies in women; Weigh risk vs. benefit

43
Q

Define FDA Pregnancy Category:

Fetal harm in animals; no studies in women

A

C

44
Q

What physiological changes during pregnancy directly affect pharmacokinetics?

A
  • Increased CYP450
  • Increased volume of distribution
45
Q

How does estrogen affect drug absorption?

A

Estrogen affects female gastric emptying by making it slower.

Drugs absorbed in the stomach will have longer exposure to absorption sites.

46
Q

Gender differences with pharmacokinetics

A

BMI - has an effect of distribution and excretion of drugs.

Females have higher body fat

47
Q

Which gender has a higher proportion of body fat - males or females?

A

Females have a higher proportion of body fat.

48
Q

Do children metabolize drugs faster or slower than adults?

A

FASTER

49
Q

Why is drug therapy for pregnant women especially difficult? because of the real likelihood of altered drug kinetics and dynamics, the possibility of drug-induced fetal toxicity, and the likelihood that for many drugs, precise estimates of fetal risk are not available.

A
  • Because of the real likelihood of altered drug kinetics and dynamics,
  • The possibility of drug-induced fetal toxicity, and
  • The likelihood that for many drugs, precise estimates of fetal risk are not available.
50
Q

Which gender has lower body weight and BMI - males or females?

A

Females have lower body weights and BMI.

51
Q

What is kernicterus and what drug causes it?

A

(permanent brain damage from severe jaundice) with sulfonamide medications.

52
Q

Are race related pharmacokinetics universal to all members of that race?

A

NO

53
Q

If drug concentration is high in maternal plasma, what is the concentration in breast milk?

A

Higher in breast milk with higher maternal plasma concentration.

54
Q

In women, what issues can happen with tricyclic antidepressants?

A
  • Take longer to achieve steady state
  • Women may experience side effects of drug because after drug saturates fat tissue
  • More free drug is available in the plasma
55
Q

chloramphenicol resulted in which neo-nate condition?

A

Gray baby syndrome (life-threatening characterized by body limpness and ashen gray color, cardiovascular collapse, cyanosis, hypotension, hypothermia, vomiting)

56
Q

What effects on prodrug accumulation will poor/intermediate metabolizer phenotypes have?

A

Accumulation of pro-drug

57
Q

At what age do most children metabolize drugs similar to adults?

A

1 year

Pharmacology - UT Housotn SON Gard School (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions