Final Exam - Random Info Flashcards
digoxin absorption occurs where?
small intestine
how long after giving digoxin should we measure dose?
12-24 hours after previous dose
(over first 6-8 hours no correlation between plasma dig conc and inotropic response)
true or false: digoxin’s effect does not relate to plasma conc, it depends on conc at peripheral site, so we need to wait a significant amount of time to make sure drug has gotten to its site
true
conditions known to affect digoxin distribution (4)
electrolyte disturbances
thyroid disorders
exercise
renal disease (dec 4.5 L/kg)
digoxin half life
36 hours
digoxin drug interactions (3 to know)
itra/ketoconazole -> 50-100%
quinidine -> 70%
verapamil -> 70%
what is pharmacodynamics?
what the drug does to the body
what is pharmacokinetics?
what the body does to the drug
EPO vs hematocrit: is that a graded or quantal response?
graded
true or false: quantal effect has an all or none effect
true
doxorubicin (chemo agent, red devil) is a ____ response
a. graded
b. quantal
b. quantal
CKD urine albumin-creatinine ratio > ___ mg/g
30
in CKD, GFR < ___ mL/min for > ___ months
60; 3
true or false: the higher the Q (dosage adjustment factor), the greater the change in regimen
false (the lower the Q)
what is normal CrCl?
120 mL/min
vancomycin MOA
inhibits cell wall synthesis by binding to the D-alanyl-D-alanine portion of cell wall precursors -> prevents cross-linking
and further elongation of peptidoglycan structure -> weakens
the cell wall -> lysis (bactericidal)
higher vancomycin exposures are associated with a greater risk of ?
acute kidney injury (AKI)
MOA of aminoglycosides
multifactorial but ultimately involves inhibition of protein synthesis -> bactericidal
KS is a 80-year-old (5’4”, 55 Kg) woman who is admitted to hospital for heart failure. On admission her serum creatinine is 1.0 mg/dL. She is initiated on furosemide, carvedilol, lisinopril and spironolactone. Which of the following is the best assessment of this patient’s renal function and current condition?
A. Her serum creatinine is in the normal range and no dosage adjustments needed.
B. Because of her age-related decline in renal function, she may need to have drug regimens adjusted.
C. Because of her heart failure, she will have some degree of renal dysfunction and dosages may need to be adjusted.
D. Because of her age, the CG equation is the only accurate way to determine her ClCr
B. Because of her age-related decline in renal function, she may need to have drug regimens adjusted.
Which one of the following dialysis membranes is most likely to remove a drug with a molecular weight above 700 Da during hemodialysis?
A. Conventional hemodialysis (cellulose membrane)
B. High-flux hemodialysis (polysulfone synthetic membrane)
C. Low-flux hemodialysis (regenerated cellulose membrane)
D. Low-flux hemodialysis (cuprophan membrane)
B. High-flux hemodialysis (polysulfone synthetic membrane)
Each of the following are potential mechanisms by which the volume of distribution of drugs is increased in patients with chronic kidney disease EXCEPT?
A. Decreased plasma protein binding
B. Increased tissue binding
C. Increased fluid excretion
D. Increased fluid status
C. Increased fluid excretion
A man is seen in the geriatric medicine clinic this morning for a yearly follow-up. He currently takes digoxin 0.125 PO mg/day, torsemide 10 PO mg/day, and potassium chloride 20 mEq/day. All doses were last taken at 7 AM this morning. The patient has a vague complaint of stomach upset which began two days ago but is otherwise no apparent distress. A serum digoxin concentration was obtained at 8:30 AM today and was 3.1 ng/mL. Which one of the following statements best describes the appropriate course of action.
A. Increase the dose to 0.25 mg starting tomorrow.
B. The patient should skip tomorrow’s digoxin dose and begin 0.0625 PO mg/day the following day.
C. Do nothing today regarding the digoxin.
D. The patient should receive hemodialysis to remove the digoxin
C. Do nothing today regarding the digoxin.
The following figure depicts the effect-time relationship following the administration of an IV drug to a group of patients with normal renal function (hatched line) and impaired renal function (solid line). Which one of the following statements best describes the observation in the figure?
A. The half-life of the drug is prolonged in patients with impaired renal function
B. The responsiveness to the drug is reduced in patients with impaired renal function
C. The volume of distribution is lower in impaired renal function
D. The drug is 100% excreted unchanged in the urine
A. The half-life of the drug is prolonged in patients with impaired renal function
The following figure depicts the relationship between drug concentration and response(straight line). Which one of the following is the most appropriate pharmacodynamic model to use in this situation?
A. Log-linear model
B. Linear model
C. Sigmoid Emax model
D. Two-compartment model
B. Linear model
A patient with diabetes who has a CLcr of 15 mL/min is to receive a pain medication that has a fe of 0.75.The normal dose is 500 mg. Based on this information, which of the following is the most appropriate dose to administer for this patient.
A. 62.5 mg
B. 175 mg
C. 375 mg
D. 500 mg
B. 175 mg
(Q = 0.3475), dose ~174
true or false: phenytoin has a narrow therapeutic index
true
what do acidic drugs bind to?
albumin
what do basic drugs bind to?
aminoacid glycosides
