Exam 1 Part 2 Flashcards
any undesirable or unintended effect occuring after administration of medical product
adverse drug reaction
harmful or unintended response
adverse drug reaction
prevalence of adverse drug reactions?
common
three ADRs that can occur in anyone?
overdose, excessive effects, drug interactions
ODE yeah you know me
three ADRs that occur in susceptible pts?
intolerance, idiosyncracy, allergy
adverse effects that appear unpredictably?
idiosyncratic ADRs
what type of drugs are not direct immunogens?
small drugs
bind covalently with a protein to trigger an immune response?
haptens
what are haptens?
drugs that bind covalently with a protein to trigger an immune response
how many types of hypersensitivity responses?
4
results from a reaction mediated by IgE antibodies on mast cells after exposure to an antigen
type 1
urticaria, wheezing, rhinitis? Which hypersensitivity
type 1
anaphylaxis- which hypersensitivity?
type 1
immediate response in a previously sensitized person
type 1
occurs when drug binds to cells and is recognized by an antibody, usually IgG
type 2
hemolytic anemia- which hypersensitivity?
type 2
thrombocytopenia- which hypersensitivity?
type 2
drug-induced lupus- which hypersensitivity?
type 2
LUpus type TWO
IgG and IgM antiboties- which hypersensitivity?
type 3
IgG and IgM antibodies formed against soluble antigens- which hypersensitivity?
type 3
antigen-antibody complexes desposited in tissues like joints and lungs- which hypersensitivity?
type 3
serum sickness response- hypersensitivity?
type 3
what kind of response is a serum sickness response?
type 3- systemic
arthralgias, fever, swollen lymph glands, splenomegaly- which hypersensitivity?
type 3
ceclor reaction- which hypersensitivity?
type 3
see three
when does ceclor hypersensitivy reaction occur?
1-3 weeks after drug exposure
cell-mediated, delayed-type hypersensitivity?
type 4
what cells are activated in type 4 hypersensitivity?
cytotoxic T cells
two examples of type 4 hypersensitivity?
poison ivy and latex
contact dermatitis- which hypersensitivity?
type 4
with repeated exposure to drugs— this can be triggered 24-48 hours after drug contact?
cytokine storm
when does cytokine storm happen- which hypersensitivity?
type 4
how many hours after drug contact for cytokine storm?
24-48 hours
what percentage of ADRs are type A?
85-90%
dose dependent, predictable- which type ADR?
type A
idiosyncratic reaction- which type of ADR?
type B
what percentage of ADRs are type B?
10-15%
not dose-dependent, not predictable- which type?
type B
what type ADRs- result from chronic medication use?
type C
Think C for Chronic
what type of ADRs- delayed reactions?
type D
what type ADRs- result from drug drug interactions?
type E
what type ADRs- result from treatment failures?
type F
what is adult medication dosing based on? Weight
150 lbs
how are children dosed?
miligrams per kilogram
why do morbidly obese patients need adjustment of dosing of some meds?
changes in distribution
what characteristics of women affect possibility for ADRs?
different fat distribution, pregnancy changes, tend to be smaller
biorhythms may affect what two pharmacokinetic properties?
drug absorption and excretion
when is gastric ph at adult level?
3 years
gastric ph is higher or lower in small kids?
higher- less acidic
gastric emptying in kids?
slowed
when does gastric emptying reach adult levels?
6-8 months
why is metabolism different in kids?
liver immature- not enough microsomal enzymes
metabolism in older kids?
increased- may require higher dosing
changes in renal perfusion in kids?
decreased perfusion rate
when does renal clearance reach adult values?
2 years
percent of TBW in full term infants
70-80%
percent of TBW in premature babies?
0.85
percent of TBW in children 1-12 years?
0.64
greater TBW means what?
fat content is lower
protein binding in kids?
decreased
when does gastric ph reach adult levels?
20-30 months
what happens to oral bioavailability of acid-labile compounds in kids?
increased
example of increased oral bioavailability of acid-labile compounds
beta-lactams
oral bioavailability of weak organic acids is increased or decreased? Kids
decreased
example of decreased oral bioavailability of weak organic acids
phenobarbital and phenytoin
what two basic drugs have increased absorption in kids?
diazepam and theophylline
in very young kids, where are most orally administered drugs absorbed?
small intestine
infants have proportionally larger surface area of what?
small intestine
absorption in infants is WHAT compared with adults?
unpredictable
intestinal motility in infants is what?
increased
increased intestinal motility in infants alters absorption of drugs with what?
limited water solubility
what two drugs are an example of altered absorption of drugs with limited water solubility in infants?
phenytoin and carbamazepine
TBW in adults?
0.6
TBW in neonates and infants?
75-80%
is BBB permeable in neonate/infant?
yes
what age group have decreased plasma proteins available for drug binding?
younger than 6 months
what happens to total body fat in adolescence?
decreases in males; increases in females
what happens to total body fat in females in adolescence?
increases
what happens to total body fat in males in adolescence?
decreases
what happens to lean body mass in adolescent males?
increases more than in females
what phase metabolism? Enzymes break down drugs/toxins into smaller, less toxic components
phase 1
what phase metabolism? Responsible for synthesis of water-soluble compounds
phase II
less info available on which phase of metabolism in children?
phase II
adult levels of thiopurine methyltransferase not reached until what age in Koreans?
7-9 years
when do renal blood flow and glomerular filtration rate reach adult levels?
9 months
what age group should avoid ibuprofen?
before 6 months
the potential for adverse drug events within the pediatric inpatient population is how much higher than hospitalized adults?
three times
length of treatment, complexity of regimen, medication interval, palatability, cost, family issues
factors that influence outcomes in pediatric patients
medication concentration, written and oral instructions, calendars/sticker charts, telephone reminders, school admin, contracts
improving adherence in pediatric patients
two indications for drug therapy in pregnant women?
treat pre-existing condition, treat pregnancy complications
when should breastfeeding mothers take drugs?
immediately after breastfeeding
why should mothers take meds right after breastfeeding?
to lower the drug concentration at the next feeding
what types of drugs should be used in lactation?
highly protein bound, short half life
what does progesterone do to gastric tone?
decreases
what does progesterone do to gastric motility?
decreases
what effect does progesterone have on gastric emptying time?
prolonged
what effect does progesterone have on tidal volume?
increased
what effect does progesterone have on pulmonary vasodilation?
increased
what effect does progesterone have on inhaled drug absorption?
increased
what effect does progesterone have on bronchi?
bronchodilation
how much does maternal heart rate increase in pregnancy?
10-15 bpm
what happens to serum albumin concentrations in pregnancy?
decreased
what happens to protein binding availability in pregnancy?
decreased
what happens to volume of distribution for hydrophilic drugs in pregnancy?
increased volume of distribution
what does increased volume distribution in pregnancy do to plasma concentrations?
lower plasma concentrations
what happens to plasma lipid levels in pregnancy?
increase
what do increased plasma lipid levels in pregnancy affect? (two things)
altered drug transport and distribution
what is the result of drug competition for receptor sites occupied by hormones in pregnancy?
more free and unbound drug
is drug metabolism altered by pregnancy?
no
is drug metabolism altered by lactation?
no
lipophilic or lipophobic drugs pass easily into breast milk?
lipophilic
high or low protein binding pass easily into breast milk?
low protein binding
high or low molecular weight pass easily into breast milk?
low molecular weight
charged or uncharged pass easily into breast milk?
unionized/no charge
high or low ph pass easily into breast milk?
low ph
what happens to porosity of BBB in geriatrics?
increased
what happens to baroreceptors in geriatrics?
less responsive
what percent of older adults have visual impairment?
one third
what percent of older adults have hearing impairment?
one third
kidney size in older adults?
decreased
renal blood flow in older adults?
decreased
number of functioning nephrons in older adults?
decreased
renal tubular secretion in older adults?
decreased
is bioavailability changed in older adults?
no
what happens to peak serum concentration in older adults?
lower and delayed
what happens to TBW in older adults?
decreased
what happens to lean body mass in older adults?
decreased
what happens to fat stores in older adults?
increased
what happens to plasma protein levels in older adults?
decreased (higher amount of unbound drug)
what happens to gastric acid levels in older adults?
decreased
what happens to GI emptying in older adults?
slowed
drugs requiring an acidic environment to dissolve will take WHAT to be absorbed?
longer
what effect does reduced gastric acid and slowed GI emptying have on systemic availability of a drug?
decreased
reduced blood flow to organs leads to decreased WHAT in older adults?
decreased absorption
what happens to drug absorption IM or SQ in older adults?
decreased
drug absorption is WHAT in older adults?
slowed
what happens to the efficiency of systemic circulation in older adults?
reduced
what happens to cardiac output in older adults?
decreased
what is the result of decreased cardiac output in older adults?
less drug clearance
what type of meds have greater distribution and prolonged time to excretion in older adults?
lipophilic meds
dehydration leads to increased concentration of what type of meds?
hydrophilic meds
what happens to first pass effect in older adults?
can be reduced
aging decreases the efficiency of what phase of metabolism?
phase 1
slowed metabolism and reduced oxidation results in what two things?
increased blood levels, extended half lifes
what effect does aging have on renal function?
decrease
effect of aging on GFR?
decrease
effect of aging on renal tubule excretion?
decrease
decreased GFR results in what in elderly?
longer half lives; drug toxicity
levels of WHAT may remain normal despite GFR changes?
creatinine
muscle mass in elderly?
decreases
overall creatinine in elderly?
decreased
why is polypharmacy more likely in older adults?
more chronic disease
HTN, CAD, DM, analgesics/antiinflamatories, sedatives, GI meds
majority of reasons older adults take meds
what age of older adult at risk for ADR?
over age 85
high/low BMI risk factor ADR older adults?
low
what creatinine clearance is risk for ADR in OA?
<50
how many comorbid disorders are risk in older adults?
more than 6
how many meds at risk for ADR in OA?
more than 9 meds
how many doses per day are risk for ADR in OA?
more than 12
what kind of meds often produce accidental overdose in OA?
pain meds
what four medications cause 2/3 of hospitalizations?
warfarin, insulin, oral antiplatelets, oral hypoglycemics
helps identify potentially inappropriate meds for elders
Beers criteria
these medications cause issues in ALL patients
Beers criteria
medications that are potentially inappropriate in older adults
Beers criteria
medications that should be avoided in older adults with certain conditions as they may exacerbate the condition
Beers criteria
medications to use with caution in older adults
Beers criteria
potentially clinically important drug-drug interactions that should be avoided in older adults
Beers criteria
medications that should be avoided or have their drug dose reduced based on kidney function
Beers criteria
example of CV beers criteria med?
digoxin
example of endocrine beers criteria med?
sliding scale insulin
how often should drug history be completed in older adults?
at least every 6 months
ability to manage activities of daily living and cognitive status are strong indicators of patient’s ability to WHAT?
self-manage medications
what type of systems should be assessed in OA?
social support systems
narrow therapeutic ranges in older adults?
avoid
slow elimination rates in older adults?
avoid
totally depend on kidney excretion?
avoid
the practice of using plants or plant parts to achieve therapeutic cure?
phytomedicine
any plant part or plant used for its therapeutic value
herb
branch of pharmacology that uses chemicals from plants, molds, fungi, insects, and marine animals
pharmacognosy
oldest form of medicine
ayurvedic medicine
three doshas of tridosha system?
vata, pitta, kapha
system that corresponds to nervous system and movement?
vata
representing transformation, circulation, warmth, digestion
pitta
representing nourishment, solidity, and formative aspects of tissue, fluid, and bone
kapha
what is the gold standard of care?
evidence-based model
refers to using nonconventional with conventional methodologies to achieve health
complementary medicine
refers to using nonconventional in place of conventional methodologies to achieve health
alternative medicine
another name for parasympathomimetic drugs?
cholinergic drugs
another name for parasympatholytic drugs?
cholinergic antagonist
another name for sympathomimetic drugs?
adrenergic drugs
another name for sympatholytic drugs?
adrenergic antagonist
indications for what class? Nasal congestion, hypotension, dilation of pupils for eye exam
alpha 1 receptor antagonists
indications for what class? Hypertension, ADHD, ODD
alpha 2 receptor agonists
indications for what class? Cardiac arrest, heart failure, shock
beta 1 receptor agonists
indications for what class? Asthma, premature labor contractions
beta 2 receptor agonists
MOA what class? Slow heart rate and cause vasodilation by working centrally in the CNS to reduce sympathetic outflow
alpha 2 agonists
alpha 2 agonist- example?
clonidine
clonidine does what to BP?
lowers
clonidine does what to HR?
lowers
used for treatment of withdrawal symptoms?
clonidine
used for hypertension in pregnancy?
clonidine
used for oppositional defiant disordered? What drug
clonidine
gynecomastic- side effect of what drug?
clonidine
Remember G C
anticholinergic effects- side effect of what drug?
clonidine
what class? Stimulates receptors in the lungs causing bronchodilation
beta 2 agonists
can be used in preterm labor to cause smooth muscle relaxation of the uterus?
beta 2 agonists
albuterol? What class
beta 2 agonists
example of beta 2 agonist?
albuterol
example of beta 2 agonist?
ritodrine
ritodrine drug class?
beta 2 agonists
what is ritodrine used for?
uterine smooth muscle relaxation
may potentiate decrease in serum potassium
beta 2 agonists
may affect glucose levels
beta 2 agonists
indications for what class? Nasal congestion, hypotension, dilation of pupils for eye exam
alpha 1 receptor antagonists
indications for what class? Angina, tachyarrhythmias, migraine prophylaxis, anxiety
nonselective beta 1 and 2 receptor antagonists
indications for what class? Hypertension, angina, post MI as antidysrhythmic
selective beta 1 receptor antagonists
block alpha 1 receptors leading to vasodilation?
alpha 1 antagonists
class used for BPH?
alpha 1 antagonists
class used for Raynauds?
alpha 1 antagonists
class used for migraines?
alpha 1 ant
prazosin/minipress- what class?
alpha 1 antagonists
used for ureteral stones- what class?
alpha 1 antagonists
used for BPH only?
tamsulosin/flomax
tamsulosin, what class?
alpha 1 antagonists
first dose effect- hypotension, what class?
alpha 1 antagonists
reflex tachycardia- what class?
alpha 1 antagonists
when should first does alpha 1 antagonist be taken?
at bedtime
postural hypotension- what class?
alpha 1 antagonists
what drug- anxiety and migraine prophylaxis?
beta antagonists
beta antagonists are contraindicated in what condition?
av BLOCK
caution in what two populations for beta antagonists?
asthma, diabetes
what class- to decrease IOP in glaucoma?
cholinergic drugs
what class- to treat atony of GI tract and urinary bladder?
cholinergic drugs
what class- to diagnose and treat myasthenia gravis?
cholinergic drugs
DRUG used to treat anticholinergic toxicity?
physostigmine
what is physostigmine used to treat?
anticholinergic toxicity
what class- work by encouraging ACH release from the PNS?
direct cholinergic agonists
what class- increases gastric tone?
direct cholinergic agonists
what class increases salivation?
direct cholinergic agonists
bethanechol/urecholine- what class?
direct cholinergic agonists
pilocarpine- what class?
direct cholinergic agonists
indication of what class? Neurogenic bladder atony
direct cholinergic agonists
indication of what class? Urinary retention
direct cholinergic agonists
xerostomia- indication of what class?
direct cholinergic agonists
contraindication of what class? Peptic ulcer disease
direct cholinergic agonists
intestinal obstruction- contraindication of what class?
direct cholinergic agonists
urinary tract obstruction- contraindication of what class?
direct cholinergic agonists
latent or active bronchospastic disease- contraindication of what class?
direct cholinergic agonists
hyperthyroidism- contraindication of what class?
direct cholinergic agonists
flushing and pupil miosis- ADR of what class?
direct cholinergic agonists
cholinergic toxicity- what class?
direct cholinergic agonists
cholinergic toxicity caused by certain WHAT?
mushrooms
what is the antidote for cholinergic toxicity?
atropine
intake/output monitoring in what class?
direct cholinergic agonists
abdominal assessment- what class?
direct cholinergic agonists
when should direct cholinergic agonists be taken?
1 hour before or 2 hours after a meal
what class- inhibits breakdown of ACH by acetylcholinesterase enzyme?
cholinesterase inhibitors
neostigmine bromide- what class?
cholinesterase inhibitors
pyridostigmine/mestinon- what class?
cholinesterase inhibitors
donepezil/aricept- what class?
cholinesterase inhibitors
indication for what class- myasthenia gravis?
cholinesterase inhibitors
what drug acts as an antidote for anticholinergic intoxication and treats nonpolarizing neuromuscular blockage?
cholinesterase inhibitors
alzheimer disease- indication for what class?
cholinesterase inhibitors
seizures- ADR of what class?
cholinesterase inhibitors
what labs should be monitored for donepezil?
CBC and CMP
when should cholinesterase inhibitors be taken?
same time daily
what should stigmine drugs for MG be taken with?
food or milk
increased acid production- ADR of what class?
cholinesterase inhibitors
excessive salivation- ADR of what class?
cholinesterase inhibitors
hepatotoxicity- ADR of what class?
cholinesterase inhibitors
contraindicated in GI or GU obstruction- what class?
cholinesterase inhibitors
in MG- improves neuron signaling to the muscles- what class?
cholinesterase inhibitors
allows for more connection of ACH with receptors, improving brain function, what class?
cholinesterase inhibitors
decreases/suppresses respiratory secretion production preop? What drug
atropine
blocks vagal stimulation to the heart at high doses- what drug
atropine
used to relax the sphincter muscle of the iris causing mydriasis- what drug?
atropine
what is used for asthma, common cold, hemorrhoids, parkinson?
belladonna tincture
what class is belladonna tincture?
cholinergic antagonist
oxybutynin- what class?
cholinergic antagonist
scopolamine- what class?
cholinergic antagonist
ipratropium bromide- what class?
cholinergic antagonist
benztropine- what class?
cholinergic antagonist
trihexyphenidyl/artane- what class?
cholinergic antagonist
blocks most muscarinic receptors producing a myriad of responses- what class?
cholinergic antagonist
reduces respiratory secretions and causes bronchial dilation? What class
cholinergic antagonist
what class is contraindicated in glaucoma?
cholinergic antagonist
when should scop patch be placed?
4 hours before needed
how should benztropine be taken?
with food
