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Advanced Pharmacotherapeutics Exam 1 > Exam 1 Part 2 > Flashcards

Exam 1 Part 2 Flashcards

1
Q

any undesirable or unintended effect occuring after administration of medical product

A

adverse drug reaction

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2
Q

harmful or unintended response

A

adverse drug reaction

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3
Q

prevalence of adverse drug reactions?

A

common

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4
Q

three ADRs that can occur in anyone?

A

overdose, excessive effects, drug interactions

ODE yeah you know me

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5
Q

three ADRs that occur in susceptible pts?

A

intolerance, idiosyncracy, allergy

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6
Q

adverse effects that appear unpredictably?

A

idiosyncratic ADRs

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7
Q

what type of drugs are not direct immunogens?

A

small drugs

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8
Q

bind covalently with a protein to trigger an immune response?

A

haptens

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9
Q

what are haptens?

A

drugs that bind covalently with a protein to trigger an immune response

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10
Q

how many types of hypersensitivity responses?

A

4

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11
Q

results from a reaction mediated by IgE antibodies on mast cells after exposure to an antigen

A

type 1

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12
Q

urticaria, wheezing, rhinitis? Which hypersensitivity

A

type 1

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13
Q

anaphylaxis- which hypersensitivity?

A

type 1

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14
Q

immediate response in a previously sensitized person

A

type 1

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15
Q

occurs when drug binds to cells and is recognized by an antibody, usually IgG

A

type 2

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16
Q

hemolytic anemia- which hypersensitivity?

A

type 2

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17
Q

thrombocytopenia- which hypersensitivity?

A

type 2

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18
Q

drug-induced lupus- which hypersensitivity?

A

type 2
LUpus type TWO

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19
Q

IgG and IgM antiboties- which hypersensitivity?

A

type 3

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20
Q

IgG and IgM antibodies formed against soluble antigens- which hypersensitivity?

A

type 3

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21
Q

antigen-antibody complexes desposited in tissues like joints and lungs- which hypersensitivity?

A

type 3

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22
Q

serum sickness response- hypersensitivity?

A

type 3

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23
Q

what kind of response is a serum sickness response?

A

type 3- systemic

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24
Q

arthralgias, fever, swollen lymph glands, splenomegaly- which hypersensitivity?

A

type 3

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25
Q

ceclor reaction- which hypersensitivity?

A

type 3

see three

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26
Q

when does ceclor hypersensitivy reaction occur?

A

1-3 weeks after drug exposure

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27
Q

cell-mediated, delayed-type hypersensitivity?

A

type 4

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28
Q

what cells are activated in type 4 hypersensitivity?

A

cytotoxic T cells

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29
Q

two examples of type 4 hypersensitivity?

A

poison ivy and latex

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30
Q

contact dermatitis- which hypersensitivity?

A

type 4

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31
Q

with repeated exposure to drugs— this can be triggered 24-48 hours after drug contact?

A

cytokine storm

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32
Q

when does cytokine storm happen- which hypersensitivity?

A

type 4

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33
Q

how many hours after drug contact for cytokine storm?

A

24-48 hours

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34
Q

what percentage of ADRs are type A?

A

85-90%

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35
Q

dose dependent, predictable- which type ADR?

A

type A

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36
Q

idiosyncratic reaction- which type of ADR?

A

type B

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37
Q

what percentage of ADRs are type B?

A

10-15%

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38
Q

not dose-dependent, not predictable- which type?

A

type B

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39
Q

what type ADRs- result from chronic medication use?

A

type C
Think C for Chronic

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40
Q

what type of ADRs- delayed reactions?

A

type D

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41
Q

what type ADRs- result from drug drug interactions?

A

type E

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42
Q

what type ADRs- result from treatment failures?

A

type F

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43
Q

what is adult medication dosing based on? Weight

A

150 lbs

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44
Q

how are children dosed?

A

miligrams per kilogram

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45
Q

why do morbidly obese patients need adjustment of dosing of some meds?

A

changes in distribution

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46
Q

what characteristics of women affect possibility for ADRs?

A

different fat distribution, pregnancy changes, tend to be smaller

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47
Q

biorhythms may affect what two pharmacokinetic properties?

A

drug absorption and excretion

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48
Q

when is gastric ph at adult level?

A

3 years

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49
Q

gastric ph is higher or lower in small kids?

A

higher- less acidic

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50
Q

gastric emptying in kids?

A

slowed

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51
Q

when does gastric emptying reach adult levels?

A

6-8 months

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52
Q

why is metabolism different in kids?

A

liver immature- not enough microsomal enzymes

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53
Q

metabolism in older kids?

A

increased- may require higher dosing

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54
Q

changes in renal perfusion in kids?

A

decreased perfusion rate

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55
Q

when does renal clearance reach adult values?

A

2 years

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56
Q

percent of TBW in full term infants

A

70-80%

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57
Q

percent of TBW in premature babies?

A

0.85

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58
Q

percent of TBW in children 1-12 years?

A

0.64

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59
Q

greater TBW means what?

A

fat content is lower

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60
Q

protein binding in kids?

A

decreased

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61
Q

when does gastric ph reach adult levels?

A

20-30 months

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62
Q

what happens to oral bioavailability of acid-labile compounds in kids?

A

increased

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63
Q

example of increased oral bioavailability of acid-labile compounds

A

beta-lactams

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64
Q

oral bioavailability of weak organic acids is increased or decreased? Kids

A

decreased

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65
Q

example of decreased oral bioavailability of weak organic acids

A

phenobarbital and phenytoin

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66
Q

what two basic drugs have increased absorption in kids?

A

diazepam and theophylline

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67
Q

in very young kids, where are most orally administered drugs absorbed?

A

small intestine

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68
Q

infants have proportionally larger surface area of what?

A

small intestine

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69
Q

absorption in infants is WHAT compared with adults?

A

unpredictable

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70
Q

intestinal motility in infants is what?

A

increased

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71
Q

increased intestinal motility in infants alters absorption of drugs with what?

A

limited water solubility

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72
Q

what two drugs are an example of altered absorption of drugs with limited water solubility in infants?

A

phenytoin and carbamazepine

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73
Q

TBW in adults?

A

0.6

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74
Q

TBW in neonates and infants?

A

75-80%

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75
Q

is BBB permeable in neonate/infant?

A

yes

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76
Q

what age group have decreased plasma proteins available for drug binding?

A

younger than 6 months

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77
Q

what happens to total body fat in adolescence?

A

decreases in males; increases in females

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78
Q

what happens to total body fat in females in adolescence?

A

increases

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79
Q

what happens to total body fat in males in adolescence?

A

decreases

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80
Q

what happens to lean body mass in adolescent males?

A

increases more than in females

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81
Q

what phase metabolism? Enzymes break down drugs/toxins into smaller, less toxic components

A

phase 1

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82
Q

what phase metabolism? Responsible for synthesis of water-soluble compounds

A

phase II

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83
Q

less info available on which phase of metabolism in children?

A

phase II

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84
Q

adult levels of thiopurine methyltransferase not reached until what age in Koreans?

A

7-9 years

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85
Q

when do renal blood flow and glomerular filtration rate reach adult levels?

A

9 months

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86
Q

what age group should avoid ibuprofen?

A

before 6 months

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87
Q

the potential for adverse drug events within the pediatric inpatient population is how much higher than hospitalized adults?

A

three times

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88
Q

length of treatment, complexity of regimen, medication interval, palatability, cost, family issues

A

factors that influence outcomes in pediatric patients

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89
Q

medication concentration, written and oral instructions, calendars/sticker charts, telephone reminders, school admin, contracts

A

improving adherence in pediatric patients

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90
Q

two indications for drug therapy in pregnant women?

A

treat pre-existing condition, treat pregnancy complications

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91
Q

when should breastfeeding mothers take drugs?

A

immediately after breastfeeding

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92
Q

why should mothers take meds right after breastfeeding?

A

to lower the drug concentration at the next feeding

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93
Q

what types of drugs should be used in lactation?

A

highly protein bound, short half life

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94
Q

what does progesterone do to gastric tone?

A

decreases

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95
Q

what does progesterone do to gastric motility?

A

decreases

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96
Q

what effect does progesterone have on gastric emptying time?

A

prolonged

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97
Q

what effect does progesterone have on tidal volume?

A

increased

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98
Q

what effect does progesterone have on pulmonary vasodilation?

A

increased

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99
Q

what effect does progesterone have on inhaled drug absorption?

A

increased

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100
Q

what effect does progesterone have on bronchi?

A

bronchodilation

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101
Q

how much does maternal heart rate increase in pregnancy?

A

10-15 bpm

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102
Q

what happens to serum albumin concentrations in pregnancy?

A

decreased

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103
Q

what happens to protein binding availability in pregnancy?

A

decreased

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104
Q

what happens to volume of distribution for hydrophilic drugs in pregnancy?

A

increased volume of distribution

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105
Q

what does increased volume distribution in pregnancy do to plasma concentrations?

A

lower plasma concentrations

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106
Q

what happens to plasma lipid levels in pregnancy?

A

increase

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107
Q

what do increased plasma lipid levels in pregnancy affect? (two things)

A

altered drug transport and distribution

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108
Q

what is the result of drug competition for receptor sites occupied by hormones in pregnancy?

A

more free and unbound drug

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109
Q

is drug metabolism altered by pregnancy?

A

no

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110
Q

is drug metabolism altered by lactation?

A

no

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111
Q

lipophilic or lipophobic drugs pass easily into breast milk?

A

lipophilic

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112
Q

high or low protein binding pass easily into breast milk?

A

low protein binding

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113
Q

high or low molecular weight pass easily into breast milk?

A

low molecular weight

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114
Q

charged or uncharged pass easily into breast milk?

A

unionized/no charge

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115
Q

high or low ph pass easily into breast milk?

A

low ph

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116
Q

what happens to porosity of BBB in geriatrics?

A

increased

117
Q

what happens to baroreceptors in geriatrics?

A

less responsive

118
Q

what percent of older adults have visual impairment?

A

one third

119
Q

what percent of older adults have hearing impairment?

A

one third

120
Q

kidney size in older adults?

A

decreased

121
Q

renal blood flow in older adults?

A

decreased

122
Q

number of functioning nephrons in older adults?

A

decreased

123
Q

renal tubular secretion in older adults?

A

decreased

124
Q

is bioavailability changed in older adults?

A

no

125
Q

what happens to peak serum concentration in older adults?

A

lower and delayed

126
Q

what happens to TBW in older adults?

A

decreased

127
Q

what happens to lean body mass in older adults?

A

decreased

128
Q

what happens to fat stores in older adults?

A

increased

129
Q

what happens to plasma protein levels in older adults?

A

decreased (higher amount of unbound drug)

130
Q

what happens to gastric acid levels in older adults?

A

decreased

131
Q

what happens to GI emptying in older adults?

A

slowed

132
Q

drugs requiring an acidic environment to dissolve will take WHAT to be absorbed?

A

longer

133
Q

what effect does reduced gastric acid and slowed GI emptying have on systemic availability of a drug?

A

decreased

134
Q

reduced blood flow to organs leads to decreased WHAT in older adults?

A

decreased absorption

135
Q

what happens to drug absorption IM or SQ in older adults?

A

decreased

136
Q

drug absorption is WHAT in older adults?

A

slowed

137
Q

what happens to the efficiency of systemic circulation in older adults?

A

reduced

138
Q

what happens to cardiac output in older adults?

A

decreased

139
Q

what is the result of decreased cardiac output in older adults?

A

less drug clearance

140
Q

what type of meds have greater distribution and prolonged time to excretion in older adults?

A

lipophilic meds

141
Q

dehydration leads to increased concentration of what type of meds?

A

hydrophilic meds

142
Q

what happens to first pass effect in older adults?

A

can be reduced

143
Q

aging decreases the efficiency of what phase of metabolism?

A

phase 1

144
Q

slowed metabolism and reduced oxidation results in what two things?

A

increased blood levels, extended half lifes

145
Q

what effect does aging have on renal function?

A

decrease

146
Q

effect of aging on GFR?

A

decrease

147
Q

effect of aging on renal tubule excretion?

A

decrease

148
Q

decreased GFR results in what in elderly?

A

longer half lives; drug toxicity

149
Q

levels of WHAT may remain normal despite GFR changes?

A

creatinine

150
Q

muscle mass in elderly?

A

decreases

151
Q

overall creatinine in elderly?

A

decreased

152
Q

why is polypharmacy more likely in older adults?

A

more chronic disease

153
Q

HTN, CAD, DM, analgesics/antiinflamatories, sedatives, GI meds

A

majority of reasons older adults take meds

154
Q

what age of older adult at risk for ADR?

A

over age 85

155
Q

high/low BMI risk factor ADR older adults?

A

low

156
Q

what creatinine clearance is risk for ADR in OA?

A

<50

157
Q

how many comorbid disorders are risk in older adults?

A

more than 6

158
Q

how many meds at risk for ADR in OA?

A

more than 9 meds

159
Q

how many doses per day are risk for ADR in OA?

A

more than 12

160
Q

what kind of meds often produce accidental overdose in OA?

A

pain meds

161
Q

what four medications cause 2/3 of hospitalizations?

A

warfarin, insulin, oral antiplatelets, oral hypoglycemics

162
Q

helps identify potentially inappropriate meds for elders

A

Beers criteria

163
Q

these medications cause issues in ALL patients

A

Beers criteria

164
Q

medications that are potentially inappropriate in older adults

A

Beers criteria

165
Q

medications that should be avoided in older adults with certain conditions as they may exacerbate the condition

A

Beers criteria

166
Q

medications to use with caution in older adults

A

Beers criteria

167
Q

potentially clinically important drug-drug interactions that should be avoided in older adults

A

Beers criteria

168
Q

medications that should be avoided or have their drug dose reduced based on kidney function

A

Beers criteria

169
Q

example of CV beers criteria med?

A

digoxin

170
Q

example of endocrine beers criteria med?

A

sliding scale insulin

171
Q

how often should drug history be completed in older adults?

A

at least every 6 months

172
Q

ability to manage activities of daily living and cognitive status are strong indicators of patient’s ability to WHAT?

A

self-manage medications

173
Q

what type of systems should be assessed in OA?

A

social support systems

174
Q

narrow therapeutic ranges in older adults?

A

avoid

175
Q

slow elimination rates in older adults?

A

avoid

176
Q

totally depend on kidney excretion?

A

avoid

177
Q

the practice of using plants or plant parts to achieve therapeutic cure?

A

phytomedicine

178
Q

any plant part or plant used for its therapeutic value

A

herb

179
Q

branch of pharmacology that uses chemicals from plants, molds, fungi, insects, and marine animals

A

pharmacognosy

180
Q

oldest form of medicine

A

ayurvedic medicine

181
Q

three doshas of tridosha system?

A

vata, pitta, kapha

182
Q

system that corresponds to nervous system and movement?

A

vata

183
Q

representing transformation, circulation, warmth, digestion

A

pitta

184
Q

representing nourishment, solidity, and formative aspects of tissue, fluid, and bone

A

kapha

185
Q

what is the gold standard of care?

A

evidence-based model

186
Q

refers to using nonconventional with conventional methodologies to achieve health

A

complementary medicine

187
Q

refers to using nonconventional in place of conventional methodologies to achieve health

A

alternative medicine

188
Q

another name for parasympathomimetic drugs?

A

cholinergic drugs

189
Q

another name for parasympatholytic drugs?

A

cholinergic antagonist

190
Q

another name for sympathomimetic drugs?

A

adrenergic drugs

191
Q

another name for sympatholytic drugs?

A

adrenergic antagonist

192
Q

indications for what class? Nasal congestion, hypotension, dilation of pupils for eye exam

A

alpha 1 receptor antagonists

193
Q

indications for what class? Hypertension, ADHD, ODD

A

alpha 2 receptor agonists

194
Q

indications for what class? Cardiac arrest, heart failure, shock

A

beta 1 receptor agonists

195
Q

indications for what class? Asthma, premature labor contractions

A

beta 2 receptor agonists

196
Q

MOA what class? Slow heart rate and cause vasodilation by working centrally in the CNS to reduce sympathetic outflow

A

alpha 2 agonists

197
Q

alpha 2 agonist- example?

A

clonidine

198
Q

clonidine does what to BP?

A

lowers

199
Q

clonidine does what to HR?

A

lowers

200
Q

used for treatment of withdrawal symptoms?

A

clonidine

201
Q

used for hypertension in pregnancy?

A

clonidine

202
Q

used for oppositional defiant disordered? What drug

A

clonidine

203
Q

gynecomastic- side effect of what drug?

A

clonidine

204
Q

anticholinergic effects- side effect of what drug?

A

clonidine

205
Q

what class? Stimulates receptors in the lungs causing bronchodilation

A

beta 2 agonists

206
Q

can be used in preterm labor to cause smooth muscle relaxation of the uterus?

A

beta 2 agonists

207
Q

albuterol? What class

A

beta 2 agonists

208
Q

example of beta 2 agonist?

A

albuterol

209
Q

example of beta 2 agonist?

A

ritodrine

210
Q

ritodrine drug class?

A

beta 2 agonists

211
Q

what is ritodrine used for?

A

uterine smooth muscle relaxation

212
Q

may potentiate decrease in serum potassium

A

beta 2 agonists

213
Q

may affect glucose levels

A

beta 2 agonists

214
Q

indications for what class? Nasal congestion, hypotension, dilation of pupils for eye exam

A

alpha 1 receptor antagonists

215
Q

indications for what class? Angina, tachyarrhythmias, migraine prophylaxis, anxiety

A

nonselective beta 1 and 2 receptor antagonists

216
Q

indications for what class? Hypertension, angina, post MI as antidysrhythmic

A

selective beta 1 receptor antagonists

217
Q

block alpha 1 receptors leading to vasodilation?

A

alpha 1 antagonists

218
Q

class used for BPH?

A

alpha 1 antagonists

219
Q

class used for Raynauds?

A

alpha 1 antagonists

220
Q

class used for migraines?

A

alpha 1 ant

221
Q

prazosin/minipress- what class?

A

alpha 1 antagonists

222
Q

used for ureteral stones- what class?

A

alpha 1 antagonists

223
Q

used for BPH only?

A

tamsulosin/flomax

224
Q

tamsulosin, what class?

A

alpha 1 antagonists

225
Q

first dose effect- hypotension, what class?

A

alpha 1 antagonists

226
Q

reflex tachycardia- what class?

A

alpha 1 antagonists

227
Q

when should first does alpha 1 antagonist be taken?

A

at bedtime

228
Q

postural hypotension- what class?

A

alpha 1 antagonists

229
Q

what drug- anxiety and migraine prophylaxis?

A

beta antagonists

230
Q

beta antagonists are contraindicated in what condition?

A

av BLOCK

231
Q

caution in what two populations for beta antagonists?

A

asthma, diabetes

232
Q

what class- to decrease IOP in glaucoma?

A

cholinergic drugs

233
Q

what class- to treat atony of GI tract and urinary bladder?

A

cholinergic drugs

234
Q

what class- to diagnose and treat myasthenia gravis?

A

cholinergic drugs

235
Q

DRUG used to treat anticholinergic toxicity?

A

physostigmine

236
Q

what is physostigmine used to treat?

A

anticholinergic toxicity

237
Q

what class- work by encouraging ACH release from the PNS?

A

direct cholinergic agonists

238
Q

what class- increases gastric tone?

A

direct cholinergic agonists

239
Q

what class increases salivation?

A

direct cholinergic agonists

240
Q

bethanechol/urecholine- what class?

A

direct cholinergic agonists

241
Q

pilocarpine- what class?

A

direct cholinergic agonists

242
Q

indication of what class? Neurogenic bladder atony

A

direct cholinergic agonists

243
Q

indication of what class? Urinary retention

A

direct cholinergic agonists

244
Q

xerostomia- indication of what class?

A

direct cholinergic agonists

245
Q

contraindication of what class? Peptic ulcer disease

A

direct cholinergic agonists

246
Q

intestinal obstruction- contraindication of what class?

A

direct cholinergic agonists

247
Q

urinary tract obstruction- contraindication of what class?

A

direct cholinergic agonists

248
Q

latent or active bronchospastic disease- contraindication of what class?

A

direct cholinergic agonists

249
Q

hyperthyroidism- contraindication of what class?

A

direct cholinergic agonists

250
Q

flushing and pupil miosis- ADR of what class?

A

direct cholinergic agonists

251
Q

cholinergic toxicity- what class?

A

direct cholinergic agonists

252
Q

cholinergic toxicity caused by certain WHAT?

A

mushrooms

253
Q

what is the antidote for cholinergic toxicity?

A

atropine

254
Q

intake/output monitoring in what class?

A

direct cholinergic agonists

255
Q

abdominal assessment- what class?

A

direct cholinergic agonists

256
Q

when should direct cholinergic agonists be taken?

A

1 hour before or 2 hours after a meal

257
Q

what class- inhibits breakdown of ACH by acetylcholinesterase enzyme?

A

cholinesterase inhibitors

258
Q

neostigmine bromide- what class?

A

cholinesterase inhibitors

259
Q

pyridostigmine/mestinon- what class?

A

cholinesterase inhibitors

260
Q

donepezil/aricept- what class?

A

cholinesterase inhibitors

261
Q

indication for what class- myasthenia gravis?

A

cholinesterase inhibitors

262
Q

what drug acts as an antidote for anticholinergic intoxication and treats nonpolarizing neuromuscular blockage?

A

cholinesterase inhibitors

263
Q

alzheimer disease- indication for what class?

A

cholinesterase inhibitors

264
Q

seizures- ADR of what class?

A

cholinesterase inhibitors

265
Q

what labs should be monitored for donepezil?

A

CBC and CMP

266
Q

when should cholinesterase inhibitors be taken?

A

same time daily

267
Q

what should stigmine drugs for MG be taken with?

A

food or milk

268
Q

increased acid production- ADR of what class?

A

cholinesterase inhibitors

269
Q

excessive salivation- ADR of what class?

A

cholinesterase inhibitors

270
Q

hepatotoxicity- ADR of what class?

A

cholinesterase inhibitors

271
Q

contraindicated in GI or GU obstruction- what class?

A

cholinesterase inhibitors

272
Q

in MG- improves neuron signaling to the muscles- what class?

A

cholinesterase inhibitors

273
Q

allows for more connection of ACH with receptors, improving brain function, what class?

A

cholinesterase inhibitors

274
Q

decreases/suppresses respiratory secretion production preop? What drug

A

atropine

275
Q

blocks vagal stimulation to the heart at high doses- what drug

A

atropine

276
Q

used to relax the sphincter muscle of the iris causing mydriasis- what drug?

A

atropine

277
Q

what is used for asthma, common cold, hemorrhoids, parkinson?

A

belladonna tincture

278
Q

what class is belladonna tincture?

A

cholinergic antagonist

279
Q

oxybutynin- what class?

A

cholinergic antagonist

280
Q

scopolamine- what class?

A

cholinergic antagonist

281
Q

ipratropium bromide- what class?

A

cholinergic antagonist

282
Q

benztropine- what class?

A

cholinergic antagonist

283
Q

trihexyphenidyl/artane- what class?

A

cholinergic antagonist

284
Q

blocks most muscarinic receptors producing a myriad of responses- what class?

A

cholinergic antagonist

285
Q

reduces respiratory secretions and causes bronchial dilation? What class

A

cholinergic antagonist

286
Q

what class is contraindicated in glaucoma?

A

cholinergic antagonist

287
Q

when should scop patch be placed?

A

4 hours before needed

288
Q

how should benztropine be taken?

A

with food

Advanced Pharmacotherapeutics Exam 1 (4 decks)

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