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DEN 7203 Pharmacological Concepts > Exam 1 Pharmacotherapeutics > Flashcards

Exam 1 Pharmacotherapeutics Flashcards

Lecture 4

1
Q

Pharmacotherapy relates to the use of drugs in the _____ and ____ of disease

A

Prevention and treatment

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2
Q

Pharmacotherapeutics is the art and science of:

A

Applying drug-related didactic knowledge (pharmacodynamics and pharmacokinetics) and making therapeutic decision that are the most likely to benefit a specific patient

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3
Q

True or false: drug response varies between individuals

A

True

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4
Q

Even the most selective agents evoke a spectrum of reactions rather than a single pharmacologic outcome. Why?

A
  • target receptor is located in other organs and tissues
  • Drug may be selective but not specific so may have effects at other receptors (high doses)
  • Nonselective effects may cause GI upset
  • A therapeutic dose for one person may ineffective or toxic to another
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5
Q

What factors influence drug effects?

A
  • Patient factors
  • Drug factors
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6
Q

Examples of patient factors

A
  • Body weight and composition
  • Age
  • Genetic influences
  • Sex
  • Pregnancy
  • Environmental factors
  • Diet
  • Physiologic variables
  • Pathologic factors
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7
Q

Examples of pathologic factors

A
  • Hepatic dysfunction
  • Renal disease
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8
Q

Examples of drug factors

A
  • Variables in drug administration
  • Drug tolerance
  • Drug interactions
  • Extension effects
  • Side effects
  • Idiosyncratic reactions
  • Drug allergy
  • Drug poisoning
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9
Q

Vd is a function of body mass. Extremes in patient size may result in:

A

Significant differences in plasma concentration when given a standard adult dose

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10
Q

Two heavy patients, one obese and one muscular, may react ____ if given the standard dose

A

Differently

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11
Q

Adipose tissue contributes ____ to body water. So an obese person may be _____ but may also show resistance to ____

A

Little; More susceptible to a dose based on weight (mg drug per kg of body weight); Lipophilic agents

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12
Q

For children, adjustments based on ____ are helpful

A

Age and weight

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13
Q

Children often require ____ mg/kg weight doses

A

Larger (attributable to increased rate of elimination)

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14
Q

Geriatric patients are frequently ____ to drugs and have ____ metabolism and excretion

A

Hyperreactive; decreased

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15
Q

Neonates can experience drug accumulation due to:

A

Immature livers and kidneys

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16
Q

____ experience greater effects from drugs entering the CNS due to immature BBB

A

Neonates

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17
Q

Children may experience abnormal growth effects due to:

A

Staining of teeth

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18
Q

Children may experience abnormal growth effects due to:

A

Hormonal effects

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19
Q

Children may have greater sensitivity to some drugs due to:

A

Higher metabolic rate

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20
Q

Geriatric patients may be hyperreactive to drugs because of:

A
  • reduced elimination
  • existing pathology
  • drug-drug interactions
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21
Q

For some drugs, information may be lacking due to:

A

Exclusion of female subjects from drug studies

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22
Q

Dosage adjustments may be necessary for women because:

A

They tend to be smaller and have a higher % body fat

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23
Q

For women, ____ may have possible drug interactions

A

Systemic contraceptives

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24
Q

There are decreased levels of ____ in pregnancy

A

Albumin

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25
Q

Why is renal excretion increased in pregnant women?

A

Elevated cardiac output and glomerular filtration

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26
Q

During pregnancy, what is the Pregnane X receptor?

A

Nuclear receptor activated by elevated estrogen and progesterone levels that increases expression of CYP3A4 (more drugs metabolized during pregnancy)

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27
Q

True or false: many drugs are proven to be safe for fetus

A

False - few if any (best to avoid medications when possible)

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28
Q

There is a ____ of embryonic and fetal development. Defects vary with ____

A

Sequential pattern; Action of drug and timing

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29
Q

Between fertilization to 20 days, fetus either ______ to drug insult

A

Survives or succumbs

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30
Q

Teratogenic malformations are possible from ____ to ____

A

21 days (somites appear) to end of first trimester (differentiation/organogenesis)

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31
Q

Which drugs have toxic effects during pregnancy?

A
  • ACE inhibitors
  • Cortisone
  • Diazepam
  • Local anesthetics
  • Opioid analgesics
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32
Q

What toxic effect do ACE inhibitors have on fetus?

A

Renal toxicity

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33
Q

What toxic effect does cortisone have on fetus?

A

Cleft palate

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34
Q

What toxic effect does diazepam have on fetus?

A
  • Cleft palate
  • Respiratory depression
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35
Q

What toxic effect does local anesthetic have on fetus?

A
  • Bradycardia
  • Respiratory depression
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36
Q

What toxic effect does opioid analgesics have on fetus?

A
  • Respiratory depression
  • Death
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37
Q

True or false: there is clear data regarding the use of local anesthetics during pregnancy

A

False; however, even with a small risk, only urgent or emergency treatment should be provided during the 1st trimester. Regular dental care should not be postposed once patient is in 2nd trimester

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38
Q

What environmental factors may influence response to drugs?

A

Temperature, sunlight, altitude

39
Q

What can happen to children taking atropine on a warm day?

A

Antimuscarinic, decreases saliva and sweating that can cause hyperthermia

40
Q

Why would sunlight influence response to drugs?

A

Causes photosensitivity - skin reactions to sulfonamides/ sulfa drugs (act as photosensitizers that absorb and transfer energy)

41
Q

Nitrous oxide is more or less effective in high altitudes?

A

Less (reduction in partial pressure of nitrous oxide)

42
Q

Diet: use of insulin must be ____ to dietary intake to avoid hypoglycemia/hyperglycemia

A

Carefully matched

43
Q

Diet: grapefruit juice contains substances that inhibit ____

A

CYP3A enzymes

44
Q

Examples of physiologic variables

A
  • Salt and water balance
  • Exercise
  • Sleep
  • Body temperature
  • Blood pressure
  • Gastric, urinary, plasma pH
45
Q

Infected tissues tend to be more ____

A

Acidic

46
Q

Pathologic factors: altered patient reactivity most commonly involve?

A

Organs of absorption, distribution, metabolism, and excretion

47
Q

Hepatic dysfunction can ____ the metabolism and biliary excretion of drugs

A

Dramatically reduce

48
Q

Characteristics of hepatic dysfunction

A
  • Reduced blood flow slows delivery of drugs to the liver
  • Reduced transport can inhibit the uptake of drugs and export of metabolites
  • Altered CYP450 expression
49
Q

In renal disease, plasma half-times of drugs eliminated in the urine are ____ by renal failure

A

Greatly prolonged

50
Q

True or false: even if a drug is inactivated by the liver, inadequate excretion of metabolites may increase incidence of side effects

A

True

51
Q

Renal status is measured by:

A

Endogenous creatinine clearance (indicator of GFR)

52
Q

A 50% decrease in creatinine clearance indicates:

A

2x increase in half-time of a drug that is removed solely by glomerular filtration

53
Q

What should you do to avoid excessive drug accumulation in patients with renal disease?

A
  • Lengthen the dosage interval in accordance with degree of impaired elimination
  • Or, reduce dose
54
Q

Memorize table for dosage adjustments in renal failure

A
55
Q

You can minimize significance of side effects if an agent is given before:

A

Sleep (ex. nausea associated with opioids, sedative properties of antihistamines)

56
Q

Agent producing CNS stimulation is best given when?

A

During the day

57
Q

Drugs dosed with meals is to limit:

A

GI upset

58
Q

Duration of therapy should be limited when capable of producing:

A

Dependence or have potential for cumulative effects (chemotherapy)

59
Q

____ is a state of decreased responsiveness that develops on repeated or continuous exposure to the drug

A

Drug tolerance

60
Q

Two major categories of drug tolerance

A
  • Pharmacokinetic (effective drug conc is diminished)
  • Pharmacodynamic (reaction to a dose of a drug is reduced, receptor downregulation = cellular tolerance)
61
Q

Pharmacokinetic tolerance involves:

A

Induction of enzymes

62
Q

Pharmacodynamic tolerance involves:

A

Cell tolerance due to receptor changes and/or other cell changes

63
Q

Immune tolerance involves:

A

Antibodies bind to drug and inactivate

64
Q

Cellular tolerance involves:

A

Therapy results in changes in cells of a tissue

65
Q

Learned tolerance involves:

A

Individual uses coping skills to compensate for drug effects

66
Q

Drug interactions occur when:

A

The effect of one drug may be increased or decreased when administered with another drug

67
Q

Minimum number of medicines taken daily by 30% of patients aged 75 and older

A

10

68
Q

Adverse drug reactions: serious outcomes include?

A

Hospitalization, disability, congenital anomaly, life-threatening and/or other serious outcome

69
Q

Extension effects: prescribed dosages generally provide an intensity of effect that is ____

A

Submaximal (often the maximum effect is dangerous)

70
Q

Any adverse effect arising from an “extension” of the therapeutic effect is ____

A

Dose related and predictable (adjust the dose to avoid the effect without loss of therapeutic benefit)

71
Q

Furosemide is used for ____. The therapeutic effect is ____, but the toxic extension is _____

A

Edema and hypertension; diuresis; hypovolemia and hypotension

72
Q

Heparin is used for ____. The therapeutic effect is ____, but the toxic extension is _____

A

Thromboembolic disorders; inhibition of coagulation; spontaneous bleeding

73
Q

Insulin is used for ____. The therapeutic effect is ____, but the toxic extension is _____

A

Diabetes mellitus; reduction of blood glucose concentration; hypoglycemia

74
Q

____ are predictable, dose-dependent reactions unrelated to therapy but occur at therapeutic doses

A

Side effects

75
Q

Side effect of diphenhydramine

A

Xerostomia

76
Q

Side effect of phenytoin

A

Gingival enlargement

77
Q

Side effect of amoxicillin

A

Dermatitis

78
Q

Side effect of lidocaine

A

Convulsions

79
Q

Side effect of erythromycin

A

Nausea, vomiting

80
Q

Side effect of morphine

A

Constipation

81
Q

Some side effects are due to the ____ tissue-receptor interaction, but in ____

A

Same; different tissue or organ

(example is atropine which results in xerostomia as a side effect - but can also be used to control excessive salivation during dental procedures)

82
Q

Amphetamine original use and subsequent use

A

CNS stimulant; ADHD

83
Q

Diphenhydramine original use and subsequent use

A

Antihistamine; sedative

84
Q

Lidocaine original use and subsequent use

A

Local anesthetic; antiarrhythmic

85
Q

Methadone original use and subsequent use

A

Analgesic; heroin substitute

86
Q

Metronidazole original use and subsequent use

A

Antiparasitic; antibacterial

87
Q

What is an idiosyncratic reaction?

A

A genetically determined abnormal response to a drug, unique or specific to the individual

88
Q

Genetic trait for idiosyncratic reaction is often ____ in the absence of the drug. Often appears as ____

A

silent; abnormal drug sensitivity

89
Q

Extension effects, side effects, and allergies are often falsely described as:

A

Idiosyncratic

90
Q

Example of idiosyncratic reaction

A

Genetic abnormality of low plasma cholinesterase + procaine or other ester local anesthetics –> local anesthetic toxicity

91
Q

Drug allergy is of ____ origin

A

Immunologic

92
Q

Distinguishing characteristics of drug allergy

A
  • Prior exposure to drug or related compound
  • Severity of response is dose independent
  • Nature of the effect is not a function of the drug but is of the immune mechanism involved
  • Unpredictable, may follow multiple doses without consequence
93
Q

Patients complaining or local anesthetic “allergy” are most often experiencing:

A

Pain, anxiety, or tachycardia - not a true allergic reaction

94
Q

American Association of Poison Control Centers
- In 2019, more than ____ human poison exposures in US
- Most poisonings were ____
- 13% of all poison exposures were believed to be ____

A
  • 2,000,000
  • children under 5 yers (43%)
  • suicide attempts

DEN 7203 Pharmacological Concepts (7 decks)

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