Final review from kelli's notes

Question 1

What are factors that affect absorption?

Answer 1

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

Question 2

What is a quatronary amonium? What are the implications of this?

Answer 2

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

Question 3

Factors that affect distribution

Answer 3

cardiac output
type of capillary/tissue perfusion
protein binding
polarity of drug

Question 4

What can metabolism do to a drug

Answer 4

activate or deactivate it
increased/decreased potency
alteration of toxicity
INCREASED RENAL EXCRETION

Question 5

potency

Answer 5

drug amont required to induce clinical effects

Question 6

efficacy

Answer 6

ability of drug at a specific dose to induce a clinical effect

Question 7

Theraputic window

Answer 7

toxic effect - minimum theraputic concentation

Question 8

toxicity

Answer 8

drug concentration that induces untoward adverse effects

Question 9

Which requires a higher dose, a drug that is more potent or a drug that is less potent?

Answer 9

less potent

Question 10

Which can induce a STRONGER clinical effect, a drug that is more potent or a drug that is less potent?

Answer 10

Neither, potency does not impact efficacity

Question 11

dose response curve

Answer 11

as dose increases, response increases, but only to a point, this plateau is the efficacity of the drug

Question 12

Mechanisms of drug-drug interactions

Answer 12

any PK or PD principle or direct interactions
ex CYP450, absorption, PB competition, MAO inhibition, competition/synergy at receptor site, etc.

Question 13

What to do if teratogenic medication?

Answer 13

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

Question 14

Considerations for an elderly population

Answer 14

polypharmacy (many specialists)
DECREASED RENAL PERFUSION
for SOME elderly pts issues with reading/remembering to take meds can occur

Question 15

Considerations with neonates

Answer 15

decreased renal and liver function
immature BBB
higher body water – increased Vd for water-soluble and decreased for fat-soluble

Question 16

What does MAO A do?

Answer 16

breaks down NE and serotonin

Question 17

What does MAO B do?

Answer 17

breaks down dopamine

Question 18

AE of MAOI

Answer 18

HTN, possibly serotonin syndrome

Question 19

Where are MAO and COMT located? And what does COMT break down?

Answer 19

COMT breaks down dopamine, E and NE
MAO: Mostly presynaptic terminal
COMT: Mostly liver, some free

Question 20

Explain baroreceptor reflex. Where is it and what does it do? List some drug classes that
may elicit a baroreceptor response

Answer 20

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

Question 21

A1 agonism causes

Answer 21

vasoconstriction, prostate contraction (BPH symptoms increase)

Question 22

A2 agonism causes

Answer 22

platelet aggregation, decreased SNS outflow, presynaptic inhibition of NE release

Question 23

B1 agonism causes

Answer 23

increased HR, contractility, AV node conduction velocity. Renin release

Question 24

B2 agonism causes

Answer 24

bronchodilation, skeletal m/heart/lung vasodilation, decreased GI/GU motility increased K+ uptake, tremor, glycogenolysis (release of stored glucose)