Final review from kelli's notes Flashcards
What are factors that affect absorption?
lipid solubility,
molecular weight,
ionization of drug (pKa),
route of administration,
stomach acid, first pass effect, food content in stomach,
whether the drug is a quaternary ammonium
What is a quatronary amonium? What are the implications of this?
A quatronary amonium is a drug that is polar, so it stays where it is given. For example, when inhaled, it stays in the lungs meaning it only causes local affects, but this also means that if they reach the bloodstream, they won’t get out
Factors that affect distribution
cardiac output
type of capillary/tissue perfusion
protein binding
polarity of drug
What can metabolism do to a drug
activate or deactivate it
increased/decreased potency
alteration of toxicity
INCREASED RENAL EXCRETION
potency
drug amont required to induce clinical effects
efficacy
ability of drug at a specific dose to induce a clinical effect
Theraputic window
toxic effect - minimum theraputic concentation
toxicity
drug concentration that induces untoward adverse effects
Which requires a higher dose, a drug that is more potent or a drug that is less potent?
less potent
Which can induce a STRONGER clinical effect, a drug that is more potent or a drug that is less potent?
Neither, potency does not impact efficacity
dose response curve
as dose increases, response increases, but only to a point, this plateau is the efficacity of the drug
Mechanisms of drug-drug interactions
any PK or PD principle or direct interactions
ex CYP450, absorption, PB competition, MAO inhibition, competition/synergy at receptor site, etc.
What to do if teratogenic medication?
We don’t want the pt to abruptly stop their medication, they should use birth control and avoid getting pregnant until an alternative can be discussed and implemented
Considerations for an elderly population
polypharmacy (many specialists)
DECREASED RENAL PERFUSION
for SOME elderly pts issues with reading/remembering to take meds can occur
Considerations with neonates
decreased renal and liver function
immature BBB
higher body water – increased Vd for water-soluble and decreased for fat-soluble
What does MAO A do?
breaks down NE and serotonin
What does MAO B do?
breaks down dopamine
AE of MAOI
HTN, possibly serotonin syndrome
Where are MAO and COMT located? And what does COMT break down?
COMT breaks down dopamine, E and NE
MAO: Mostly presynaptic terminal
COMT: Mostly liver, some free
Explain baroreceptor reflex. Where is it and what does it do? List some drug classes that
may elicit a baroreceptor response
The baroreceptor reflex is controlled by presure receptors in the carotid sinus and the aortic arch. When blood pressure gets too low, these receptors induce tachycardia, when it gets too high, bradycardia in order to control BP
hydralazine, dihydropyridines, a1 agonists, albuterol, phenylephrine - basically anything that alters arterial vascular pressure
A1 agonism causes
vasoconstriction, prostate contraction (BPH symptoms increase)
A2 agonism causes
platelet aggregation, decreased SNS outflow, presynaptic inhibition of NE release
B1 agonism causes
increased HR, contractility, AV node conduction velocity. Renin release
B2 agonism causes
bronchodilation, skeletal m/heart/lung vasodilation, decreased GI/GU motility increased K+ uptake, tremor, glycogenolysis (release of stored glucose)
