Exam 1 Part 2 Flashcards
1
Q
any undesirable or unintended effect occuring after administration of medical product
A
adverse drug reaction
2
Q
harmful or unintended response
A
adverse drug reaction
3
Q
prevalence of adverse drug reactions?
A
common
4
Q
three ADRs that can occur in anyone?
A
overdose, excessive effects, drug interactions
ODE yeah you know me
5
Q
three ADRs that occur in susceptible pts?
A
intolerance, idiosyncracy, allergy
6
Q
adverse effects that appear unpredictably?
A
idiosyncratic ADRs
7
Q
what type of drugs are not direct immunogens?
A
small drugs
8
Q
bind covalently with a protein to trigger an immune response?
A
haptens
9
Q
what are haptens?
A
drugs that bind covalently with a protein to trigger an immune response
10
Q
how many types of hypersensitivity responses?
A
4
11
Q
results from a reaction mediated by IgE antibodies on mast cells after exposure to an antigen
A
type 1
12
Q
urticaria, wheezing, rhinitis? Which hypersensitivity
A
type 1
13
Q
anaphylaxis- which hypersensitivity?
A
type 1
14
Q
immediate response in a previously sensitized person
A
type 1
15
Q
occurs when drug binds to cells and is recognized by an antibody, usually IgG
A
type 2
16
Q
hemolytic anemia- which hypersensitivity?
A
type 2
17
Q
thrombocytopenia- which hypersensitivity?
A
type 2
18
Q
drug-induced lupus- which hypersensitivity?
A
type 2
LUpus type TWO
19
Q
IgG and IgM antiboties- which hypersensitivity?
A
type 3
20
Q
IgG and IgM antibodies formed against soluble antigens- which hypersensitivity?
A
type 3
21
Q
antigen-antibody complexes desposited in tissues like joints and lungs- which hypersensitivity?
A
type 3
22
Q
serum sickness response- hypersensitivity?
A
type 3
23
Q
what kind of response is a serum sickness response?
A
type 3- systemic
24
Q
arthralgias, fever, swollen lymph glands, splenomegaly- which hypersensitivity?
A
type 3
25
ceclor reaction- which hypersensitivity?
type 3
see three
26
when does ceclor hypersensitivy reaction occur?
1-3 weeks after drug exposure
27
cell-mediated, delayed-type hypersensitivity?
type 4
28
what cells are activated in type 4 hypersensitivity?
cytotoxic T cells
29
two examples of type 4 hypersensitivity?
poison ivy and latex
30
contact dermatitis- which hypersensitivity?
type 4
31
with repeated exposure to drugs--- this can be triggered 24-48 hours after drug contact?
cytokine storm
32
when does cytokine storm happen- which hypersensitivity?
type 4
33
how many hours after drug contact for cytokine storm?
24-48 hours
34
what percentage of ADRs are type A?
85-90%
35
dose dependent, predictable- which type ADR?
type A
36
idiosyncratic reaction- which type of ADR?
type B
37
what percentage of ADRs are type B?
10-15%
38
not dose-dependent, not predictable- which type?
type B
39
what type ADRs- result from chronic medication use?
type C
Think C for Chronic
40
what type of ADRs- delayed reactions?
type D
41
what type ADRs- result from drug drug interactions?
type E
42
what type ADRs- result from treatment failures?
type F
43
what is adult medication dosing based on? Weight
150 lbs
44
how are children dosed?
miligrams per kilogram
45
why do morbidly obese patients need adjustment of dosing of some meds?
changes in distribution
46
what characteristics of women affect possibility for ADRs?
different fat distribution, pregnancy changes, tend to be smaller
47
biorhythms may affect what two pharmacokinetic properties?
drug absorption and excretion
48
when is gastric ph at adult level?
3 years
49
gastric ph is higher or lower in small kids?
higher- less acidic
50
gastric emptying in kids?
slowed
51
when does gastric emptying reach adult levels?
6-8 months
52
why is metabolism different in kids?
liver immature- not enough microsomal enzymes
53
metabolism in older kids?
increased- may require higher dosing
54
changes in renal perfusion in kids?
decreased perfusion rate
55
when does renal clearance reach adult values?
2 years
56
percent of TBW in full term infants
70-80%
57
percent of TBW in premature babies?
0.85
58
percent of TBW in children 1-12 years?
0.64
59
greater TBW means what?
fat content is lower
60
protein binding in kids?
decreased
61
when does gastric ph reach adult levels?
20-30 months
62
what happens to oral bioavailability of acid-labile compounds in kids?
increased
63
example of increased oral bioavailability of acid-labile compounds
beta-lactams
64
oral bioavailability of weak organic acids is increased or decreased? Kids
decreased
65
example of decreased oral bioavailability of weak organic acids
phenobarbital and phenytoin
66
what two basic drugs have increased absorption in kids?
diazepam and theophylline
67
in very young kids, where are most orally administered drugs absorbed?
small intestine
68
infants have proportionally larger surface area of what?
small intestine
69
absorption in infants is WHAT compared with adults?
unpredictable
70
intestinal motility in infants is what?
increased
71
increased intestinal motility in infants alters absorption of drugs with what?
limited water solubility
72
what two drugs are an example of altered absorption of drugs with limited water solubility in infants?
phenytoin and carbamazepine
73
TBW in adults?
0.6
74
TBW in neonates and infants?
75-80%
75
is BBB permeable in neonate/infant?
yes
76
what age group have decreased plasma proteins available for drug binding?
younger than 6 months
77
what happens to total body fat in adolescence?
decreases in males; increases in females
78
what happens to total body fat in females in adolescence?
increases
79
what happens to total body fat in males in adolescence?
decreases
80
what happens to lean body mass in adolescent males?
increases more than in females
81
what phase metabolism? Enzymes break down drugs/toxins into smaller, less toxic components
phase 1
82
what phase metabolism? Responsible for synthesis of water-soluble compounds
phase II
83
less info available on which phase of metabolism in children?
phase II
84
adult levels of thiopurine methyltransferase not reached until what age in Koreans?
7-9 years
85
when do renal blood flow and glomerular filtration rate reach adult levels?
9 months
86
what age group should avoid ibuprofen?
before 6 months
87
the potential for adverse drug events within the pediatric inpatient population is how much higher than hospitalized adults?
three times
88
length of treatment, complexity of regimen, medication interval, palatability, cost, family issues
factors that influence outcomes in pediatric patients
89
medication concentration, written and oral instructions, calendars/sticker charts, telephone reminders, school admin, contracts
improving adherence in pediatric patients
90
two indications for drug therapy in pregnant women?
treat pre-existing condition, treat pregnancy complications
91
when should breastfeeding mothers take drugs?
immediately after breastfeeding
92
why should mothers take meds right after breastfeeding?
to lower the drug concentration at the next feeding
93
what types of drugs should be used in lactation?
highly protein bound, short half life
94
what does progesterone do to gastric tone?
decreases
95
what does progesterone do to gastric motility?
decreases
96
what effect does progesterone have on gastric emptying time?
prolonged
97
what effect does progesterone have on tidal volume?
increased
98
what effect does progesterone have on pulmonary vasodilation?
increased
99
what effect does progesterone have on inhaled drug absorption?
increased
100
what effect does progesterone have on bronchi?
bronchodilation
101
how much does maternal heart rate increase in pregnancy?
10-15 bpm
102
what happens to serum albumin concentrations in pregnancy?
decreased
103
what happens to protein binding availability in pregnancy?
decreased
104
what happens to volume of distribution for hydrophilic drugs in pregnancy?
increased volume of distribution
105
what does increased volume distribution in pregnancy do to plasma concentrations?
lower plasma concentrations
106
what happens to plasma lipid levels in pregnancy?
increase
107
what do increased plasma lipid levels in pregnancy affect? (two things)
altered drug transport and distribution
108
what is the result of drug competition for receptor sites occupied by hormones in pregnancy?
more free and unbound drug
109
is drug metabolism altered by pregnancy?
no
110
is drug metabolism altered by lactation?
no
111
lipophilic or lipophobic drugs pass easily into breast milk?
lipophilic
112
high or low protein binding pass easily into breast milk?
low protein binding
113
high or low molecular weight pass easily into breast milk?
low molecular weight
114
charged or uncharged pass easily into breast milk?
unionized/no charge
115
high or low ph pass easily into breast milk?
low ph
116
what happens to porosity of BBB in geriatrics?
increased
117
what happens to baroreceptors in geriatrics?
less responsive
118
what percent of older adults have visual impairment?
one third
119
what percent of older adults have hearing impairment?
one third
120
kidney size in older adults?
decreased
121
renal blood flow in older adults?
decreased
122
number of functioning nephrons in older adults?
decreased
123
renal tubular secretion in older adults?
decreased
124
is bioavailability changed in older adults?
no
125
what happens to peak serum concentration in older adults?
lower and delayed
126
what happens to TBW in older adults?
decreased
127
what happens to lean body mass in older adults?
decreased
128
what happens to fat stores in older adults?
increased
129
what happens to plasma protein levels in older adults?
decreased (higher amount of unbound drug)
130
what happens to gastric acid levels in older adults?
decreased
131
what happens to GI emptying in older adults?
slowed
132
drugs requiring an acidic environment to dissolve will take WHAT to be absorbed?
longer
133
what effect does reduced gastric acid and slowed GI emptying have on systemic availability of a drug?
decreased
134
reduced blood flow to organs leads to decreased WHAT in older adults?
decreased absorption
135
what happens to drug absorption IM or SQ in older adults?
decreased
136
drug absorption is WHAT in older adults?
slowed
137
what happens to the efficiency of systemic circulation in older adults?
reduced
138
what happens to cardiac output in older adults?
decreased
139
what is the result of decreased cardiac output in older adults?
less drug clearance
140
what type of meds have greater distribution and prolonged time to excretion in older adults?
lipophilic meds
141
dehydration leads to increased concentration of what type of meds?
hydrophilic meds
142
what happens to first pass effect in older adults?
can be reduced
143
aging decreases the efficiency of what phase of metabolism?
phase 1
144
slowed metabolism and reduced oxidation results in what two things?
increased blood levels, extended half lifes
145
what effect does aging have on renal function?
decrease
146
effect of aging on GFR?
decrease
147
effect of aging on renal tubule excretion?
decrease
148
decreased GFR results in what in elderly?
longer half lives; drug toxicity
149
levels of WHAT may remain normal despite GFR changes?
creatinine
150
muscle mass in elderly?
decreases
151
overall creatinine in elderly?
decreased
152
why is polypharmacy more likely in older adults?
more chronic disease
153
HTN, CAD, DM, analgesics/antiinflamatories, sedatives, GI meds
majority of reasons older adults take meds
154
what age of older adult at risk for ADR?
over age 85
155
high/low BMI risk factor ADR older adults?
low
156
what creatinine clearance is risk for ADR in OA?
<50
157
how many comorbid disorders are risk in older adults?
more than 6
158
how many meds at risk for ADR in OA?
more than 9 meds
159
how many doses per day are risk for ADR in OA?
more than 12
160
what kind of meds often produce accidental overdose in OA?
pain meds
161
what four medications cause 2/3 of hospitalizations?
warfarin, insulin, oral antiplatelets, oral hypoglycemics
162
helps identify potentially inappropriate meds for elders
Beers criteria
163
these medications cause issues in ALL patients
Beers criteria
164
medications that are potentially inappropriate in older adults
Beers criteria
165
medications that should be avoided in older adults with certain conditions as they may exacerbate the condition
Beers criteria
166
medications to use with caution in older adults
Beers criteria
167
potentially clinically important drug-drug interactions that should be avoided in older adults
Beers criteria
168
medications that should be avoided or have their drug dose reduced based on kidney function
Beers criteria
169
example of CV beers criteria med?
digoxin
170
example of endocrine beers criteria med?
sliding scale insulin
171
how often should drug history be completed in older adults?
at least every 6 months
172
ability to manage activities of daily living and cognitive status are strong indicators of patient's ability to WHAT?
self-manage medications
173
what type of systems should be assessed in OA?
social support systems
174
narrow therapeutic ranges in older adults?
avoid
175
slow elimination rates in older adults?
avoid
176
totally depend on kidney excretion?
avoid
177
the practice of using plants or plant parts to achieve therapeutic cure?
phytomedicine
178
any plant part or plant used for its therapeutic value
herb
179
branch of pharmacology that uses chemicals from plants, molds, fungi, insects, and marine animals
pharmacognosy
180
oldest form of medicine
ayurvedic medicine
181
three doshas of tridosha system?
vata, pitta, kapha
182
system that corresponds to nervous system and movement?
vata
183
representing transformation, circulation, warmth, digestion
pitta
184
representing nourishment, solidity, and formative aspects of tissue, fluid, and bone
kapha
185
what is the gold standard of care?
evidence-based model
186
refers to using nonconventional with conventional methodologies to achieve health
complementary medicine
187
refers to using nonconventional in place of conventional methodologies to achieve health
alternative medicine
188
another name for parasympathomimetic drugs?
cholinergic drugs
189
another name for parasympatholytic drugs?
cholinergic antagonist
190
another name for sympathomimetic drugs?
adrenergic drugs
191
another name for sympatholytic drugs?
adrenergic antagonist
192
indications for what class? Nasal congestion, hypotension, dilation of pupils for eye exam
alpha 1 receptor antagonists
193
indications for what class? Hypertension, ADHD, ODD
alpha 2 receptor agonists
194
indications for what class? Cardiac arrest, heart failure, shock
beta 1 receptor agonists
195
indications for what class? Asthma, premature labor contractions
beta 2 receptor agonists
196
MOA what class? Slow heart rate and cause vasodilation by working centrally in the CNS to reduce sympathetic outflow
alpha 2 agonists
197
alpha 2 agonist- example?
clonidine
198
clonidine does what to BP?
lowers
199
clonidine does what to HR?
lowers
200
used for treatment of withdrawal symptoms?
clonidine
201
used for hypertension in pregnancy?
clonidine
202
used for oppositional defiant disordered? What drug
clonidine
203
gynecomastic- side effect of what drug?
clonidine
Remember G C
204
anticholinergic effects- side effect of what drug?
clonidine
205
what class? Stimulates receptors in the lungs causing bronchodilation
beta 2 agonists
206
can be used in preterm labor to cause smooth muscle relaxation of the uterus?
beta 2 agonists
207
albuterol? What class
beta 2 agonists
208
example of beta 2 agonist?
albuterol
209
example of beta 2 agonist?
ritodrine
210
ritodrine drug class?
beta 2 agonists
211
what is ritodrine used for?
uterine smooth muscle relaxation
212
may potentiate decrease in serum potassium
beta 2 agonists
213
may affect glucose levels
beta 2 agonists
214
indications for what class? Nasal congestion, hypotension, dilation of pupils for eye exam
alpha 1 receptor antagonists
215
indications for what class? Angina, tachyarrhythmias, migraine prophylaxis, anxiety
nonselective beta 1 and 2 receptor antagonists
216
indications for what class? Hypertension, angina, post MI as antidysrhythmic
selective beta 1 receptor antagonists
217
block alpha 1 receptors leading to vasodilation?
alpha 1 antagonists
218
class used for BPH?
alpha 1 antagonists
219
class used for Raynauds?
alpha 1 antagonists
220
class used for migraines?
alpha 1 ant
221
prazosin/minipress- what class?
alpha 1 antagonists
222
used for ureteral stones- what class?
alpha 1 antagonists
223
used for BPH only?
tamsulosin/flomax
224
tamsulosin, what class?
alpha 1 antagonists
225
first dose effect- hypotension, what class?
alpha 1 antagonists
226
reflex tachycardia- what class?
alpha 1 antagonists
227
when should first does alpha 1 antagonist be taken?
at bedtime
228
postural hypotension- what class?
alpha 1 antagonists
229
what drug- anxiety and migraine prophylaxis?
beta antagonists
230
beta antagonists are contraindicated in what condition?
av BLOCK
231
caution in what two populations for beta antagonists?
asthma, diabetes
232
what class- to decrease IOP in glaucoma?
cholinergic drugs
233
what class- to treat atony of GI tract and urinary bladder?
cholinergic drugs
234
what class- to diagnose and treat myasthenia gravis?
cholinergic drugs
235
DRUG used to treat anticholinergic toxicity?
physostigmine
236
what is physostigmine used to treat?
anticholinergic toxicity
237
what class- work by encouraging ACH release from the PNS?
direct cholinergic agonists
238
what class- increases gastric tone?
direct cholinergic agonists
239
what class increases salivation?
direct cholinergic agonists
240
bethanechol/urecholine- what class?
direct cholinergic agonists
241
pilocarpine- what class?
direct cholinergic agonists
242
indication of what class? Neurogenic bladder atony
direct cholinergic agonists
243
indication of what class? Urinary retention
direct cholinergic agonists
244
xerostomia- indication of what class?
direct cholinergic agonists
245
contraindication of what class? Peptic ulcer disease
direct cholinergic agonists
246
intestinal obstruction- contraindication of what class?
direct cholinergic agonists
247
urinary tract obstruction- contraindication of what class?
direct cholinergic agonists
248
latent or active bronchospastic disease- contraindication of what class?
direct cholinergic agonists
249
hyperthyroidism- contraindication of what class?
direct cholinergic agonists
250
flushing and pupil miosis- ADR of what class?
direct cholinergic agonists
251
cholinergic toxicity- what class?
direct cholinergic agonists
252
cholinergic toxicity caused by certain WHAT?
mushrooms
253
what is the antidote for cholinergic toxicity?
atropine
254
intake/output monitoring in what class?
direct cholinergic agonists
255
abdominal assessment- what class?
direct cholinergic agonists
256
when should direct cholinergic agonists be taken?
1 hour before or 2 hours after a meal
257
what class- inhibits breakdown of ACH by acetylcholinesterase enzyme?
cholinesterase inhibitors
258
neostigmine bromide- what class?
cholinesterase inhibitors
259
pyridostigmine/mestinon- what class?
cholinesterase inhibitors
260
donepezil/aricept- what class?
cholinesterase inhibitors
261
indication for what class- myasthenia gravis?
cholinesterase inhibitors
262
what drug acts as an antidote for anticholinergic intoxication and treats nonpolarizing neuromuscular blockage?
cholinesterase inhibitors
263
alzheimer disease- indication for what class?
cholinesterase inhibitors
264
seizures- ADR of what class?
cholinesterase inhibitors
265
what labs should be monitored for donepezil?
CBC and CMP
266
when should cholinesterase inhibitors be taken?
same time daily
267
what should stigmine drugs for MG be taken with?
food or milk
268
increased acid production- ADR of what class?
cholinesterase inhibitors
269
excessive salivation- ADR of what class?
cholinesterase inhibitors
270
hepatotoxicity- ADR of what class?
cholinesterase inhibitors
271
contraindicated in GI or GU obstruction- what class?
cholinesterase inhibitors
272
in MG- improves neuron signaling to the muscles- what class?
cholinesterase inhibitors
273
allows for more connection of ACH with receptors, improving brain function, what class?
cholinesterase inhibitors
274
decreases/suppresses respiratory secretion production preop? What drug
atropine
275
blocks vagal stimulation to the heart at high doses- what drug
atropine
276
used to relax the sphincter muscle of the iris causing mydriasis- what drug?
atropine
277
what is used for asthma, common cold, hemorrhoids, parkinson?
belladonna tincture
278
what class is belladonna tincture?
cholinergic antagonist
279
oxybutynin- what class?
cholinergic antagonist
280
scopolamine- what class?
cholinergic antagonist
281
ipratropium bromide- what class?
cholinergic antagonist
282
benztropine- what class?
cholinergic antagonist
283
trihexyphenidyl/artane- what class?
cholinergic antagonist
284
blocks most muscarinic receptors producing a myriad of responses- what class?
cholinergic antagonist
285
reduces respiratory secretions and causes bronchial dilation? What class
cholinergic antagonist
286
what class is contraindicated in glaucoma?
cholinergic antagonist
287
when should scop patch be placed?
4 hours before needed
288
how should benztropine be taken?
with food
