Exam Two - Key Foundational Concepts

Question 1

Pharmacology

Answer 1

study of drugs, actions, and reaction

Question 2

PD

Answer 2

pharmacodynamics

Question 3

Pharmacodynamics

Answer 3

“What the drug does to the body” this can be the desired therapeutic response, physiologic changes as well as adverse reactions/toxicities

Question 4

PK

Answer 4

Pharmacokinetics

Question 5

Pharmacokinetcs

Answer 5

“What the body does to the drug” full range of absorption, distribution, metabolism and excretion (ADME). May also include accumulation/toxicity

Question 6

Pharmacy

Answer 6

involves therapeutic use of drugs as well as medication safety, inventory control and distribution systems

Question 7

does-response relationships

Answer 7

as drug concentration increases, some maximal effect is reached (Emax)

Question 8

At half maximal effect

Answer 8

EC50
a description of potency

Question 9

Graded dose-response curve

Answer 9

degree of response varies with dose

Question 10

Quantal dose-response curve

Answer 10

average effect of a drug as a function of concentration in a given population

Question 11

effective (efficacious)

Answer 11

the ability of a drug to produce the desired effect

Question 12

Therapeutic Index (TI)

Answer 12

a range (index) of drug concentrations/doses needed to produce DESIRED THERAPEUTIC EFFECTS BELOW the level required to produce significant TOXICITY

Question 13

Therapeutic Window

Answer 13

want wide therapeutic windows. This means we have a lots of dosing room for desired effects before we hit toxicity. “safer” than those with narrow windows

Question 14

Narrow TI

Answer 14

drugs that have a small “dosing range”. The therapeutic dose is often only slightly above the non-effective dose and only slightly below a toxic dose.

careful dosing calculations/monitoring required for safe use

small dose changes may produce BIG concentration changes

Question 15

Examples of narrow TI drugs

Answer 15

some seizure meds, gidoxin, aminoglycoside ABX, some chemo agents, lithium, warfarin, etc

Question 16

Formula for TI

Answer 16

TI = TD50/ED50

Question 17

What is an example for an Alpha 1 agonist?

Answer 17

vasopressor support

Question 18

What is an example for Beta agonists?

Answer 18

inhalers for asthma and copd

Question 19

other examples of drugs working via receptors

Answer 19

histamine H1 & H2 receptors
muscarinic receptors

Question 20

Physiological effects and opioid receptors

Answer 20

mu, kappa, and delta receptors

Question 21

Mu receptors are responsible for

Answer 21

• analgesia
• respiratory depression
  -Euphoria
• sedation
• physical dependence
• slowed GI transit
• miosis
  -modulation of hormone and NT release

Question 22

Kappa receptors are responsible for

Answer 22

-analgesia
-minimal respiratory depression
- dysphoria
-mild sedation
-slowed GI transit
-miosis
-psychomimetic effects

Question 23

delta receptors are responsible for

Answer 23

-analgesia
-modulation of hormone and NT release

Question 24

Explain why we need dose tapering

Answer 24

receptor density on a cell can become upregulated or downregulated. If a drug chronically blocks a receptor, the cell will make more of that receptor. If you suddenly take away the drug, the cell will have way too many receptors which could have disastrous consequences (ex. beta blockers)

Question 25

Agonist

Answer 25

binds to a receptor and mimics the natural/typical action of a NT or other endogenous agent.

Question 26

Antagonist

Answer 26

binds to the receptor and blocks or attenuates the natural response to NT or endogenous chemical

Question 27

Partial agonist

Answer 27

binds the receptor, elicits some/sub-maximal response BUT, inherent binding may also block natural action of endogenous NTs/chemicals which can in the grand scheme… actually attenuates an agonistic response! this may be useful for over-active endogenous conditions of reducing side effects

Question 28

Why should we care about drugs?

Answer 28

-impacts to tests to therapy!
-can alter exercise tolerance, diagnostic testing, falls, hypotension, diabetics

Question 29

Adverse drug side effects

Answer 29

common, range from annoying to dangerous
-dizziness, drowsiness, weakness, low blood pressure, reduced/blunted HR, hypoglycemia, nausea, vomiting, diarrhea, constipation, etc

Question 30

Patient management of adverse drug effects

Answer 30

dose timing, consideration of meal times, separating drugs from testing or therapy, use snacks, monitory HR/BP

Question 31

Adverse drug-food interactions

Answer 31

common, impact absorption after PO dose - may be related to di/trivalent cations, pH, vitamins/cofactors or other chemical interactions

Question 32

patient management of adverse drug-food interactions

Answer 32

separate drug dose from offending food/drink, some meds require reducing/eliminating or at least being consistent with certain foods/drinks

Question 33

Metronidazole

Answer 33

an antibiotic that has a strong drug-food interaction with alcohol of any kind. alcohol including mouthwash, perfume, aftershave, etc.

Question 34

Drug drug interactions

Answer 34

common, to mild, to life threatening

Question 35

PD interactions

Answer 35

antagonistic effects, additive or synergistic effects (EX - BP/HR drops too low or stimulant with a sedative)

Question 36

Chemical incompatibility interactions

Answer 36

predominately with parenteral agents, precipitates, Di/Tri-valent cations with some common oral meds, consult pharmacy!

Question 37

PK interactions

Answer 37

ADME - especially drug metabolism in liver (cyp P450/clearance)

Question 38

Old drug classification for pregnancy/lactating

Answer 38

A - human studies OK
B - Animal studies OK
C - animal studies MAY show harm, no human studies but benefit may outweigh risk
D - “Don’t”… evidence of human risk, may have benefit
X - evidence of human risk, benefits DON’T outweigh

Question 39

updated drug classification for preg/lac

Answer 39

narrative