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Patho & Pharm > Foundations in Pharm > Flashcards

Foundations in Pharm Flashcards

1
Q

4 key components of assessment of drug therapy

A
  • indication
  • effectiveness
  • safety
  • adherence
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2
Q

4 phases of pharmacokinetics (ADME)

A
  • absorption
  • distribution
  • metabolism
  • excretion
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3
Q

factors influencing PK and PD

A
  • physiologic
  • pathophysiologic
  • genetic variability
  • drug interactions
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4
Q

pharmacokinetics (definition)

A

the study of drug movement through the body
what the. body does to the drug

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5
Q

3 ways for a drug to cross a cell

A
  • direct penetration of cell membrane
  • channels and pores
  • transport systems
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6
Q

what’s absorption in PK?

A

mvnt of a drug from site of administration into the blood

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7
Q

Factors affecting drug absorption (5)

A

rate of dissolution
surface area
blood flow
lipid solubility
pH

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8
Q

two routes of absorption

A

enteral vs parenteral

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9
Q

bioavailibility (F)

A

F= amount of drug absorbed/drug dosage

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10
Q

bioavailability is affected by (3)

A
  1. gastric empty tiem
  2. pH of the stomach
  3. speed the drugs moves through the GI tract
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11
Q

bioavailability of IV therapy is __

A

100%

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12
Q

bioavailability

A

bioavailability: ability of drug reaching the systematic circulation from the site of administration.

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13
Q

Bioequivalence

A

bioequivalence: two different drugs or different dosage forms of the same drug produce the same concentration vs drug time (generic products)

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14
Q

What’s the first pass effect?

A

drugs given orally are absorbed through GI tract and carried to liver
liver metabolizes the drug BEFORE reaching the systemic circulation, large drug inactivated, leading to decrease in therapeutic effect

administer drugs via parenteral, sublingual, transdermal, etc. e.g. nitroglycerine

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15
Q

distribution

A

mvnt of drugs form the blood to various tissues

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16
Q

volume of distribution

A

amount of drugs in the body/ plasma concentration

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17
Q

4 factors affecting distribution

A
  • blood flow
  • lipophilicity
  • molecular size and weight
  • drug protein binding
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18
Q

High protein-bound drugs

A

gradual release (blood is reservoir)

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19
Q

Low protein-bound drugs

A

immediate release

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20
Q

consequences of drug metabolism

A
  • accelerated renal excretion
  • drug inactivation
  • increased therapeutic action
  • activation of prodrugs
  • increased toxicity
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21
Q

Enzyme inducer__ level of drug in the body
Enzyme inhibitor___ level of drug in the body

A

Enzyme inducer decrease
Enzyme inhibitor increase

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22
Q

metabolism

A

enzymatic alteration of drugs

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23
Q

3 processes of renal drug excretion

A
  • glomerular filtration
  • passive tubular reabsorption
  • active tubular secretion
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24
Q

factors modifying renal drug excretion

A
  • pH dependent ionization
  • competition for active tubular transport
  • age. (newborns have limited capacity to excrete drugs)
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25
Q

pharmacodynamics (definition)

A

what drugs do to the body and how they do it

26
Q

dose-response relationships

A

relationship dosage size and intensity of response

27
Q

affinity

A

the strength of attraction b/t a drug adn its receptor

28
Q

intrinsic activity

A

the ability of a drug to activate a receptor following binding

29
Q

drugs acting through simple chemical or physical interactions with other small molecules

A

antacids, antiseptics, osmotic laxatives

30
Q

drugs acting on protein targets such as enzymes, membrane carriers, ion channels

A

ACE inhibiotrs, SSRIs, CCB

31
Q

DI definition and types

A

an interaction where the efficacy or toxicity of one or more drugs is altered
drug-drug
drug-food
drug-herb

32
Q

common CYP450 inducers

A

barbiturates
rifampin
carbamazepine
phenytoin
glucocorticoids

33
Q

common CYP450 inhibitors

A

erythromycin
clarithromycin
paroxetine
fluoxetine
cimetidine
fluoroquinolones
ketoconazole
omeprazole
grapefruit

34
Q

Top 5 CYP450 enzymes

A

CYP1A2,3A4, 3A5
2C9,2C19,
2D6

35
Q

Drugs with high interaction potential

A

digoxin (lanoxin)
phenytoin (dilantin)
theophylline (TheoDur)
Warfarin (Coumadin)
cimetidine (Tagamet)
cyclosporine (Neoral)
tacrolimus (Prograf)
lithium (Carbolith)
carbamazepine (Tegretol)
rifampin

36
Q

drugs requiring empiric dose adjustment

A

> 50% renally eliminated
active or toxic metabolites
may require incrase dosing interval or decrease dose

37
Q

Enterohepatic Recirculation

A

Repeating cycle in which a drug is transported from the liver into the duodenum and then back to the liver

38
Q

Steps in urinary excretion

A
  1. Glomerular filtration
    2. Passive tubular reabsorption
    3. Active tubular secretion
39
Q

Nonrenal Routes of Drug excretion

A

Breast milk
Bile
Lungs
Sweat and saliva

40
Q

What determines the dosing interval?

A

Drug half life

41
Q

time to reach plateau

A

~ 4 half lives

42
Q

3 Techniques for reducing fluctuations in drug levels

A
  1. Continuous infusion
  2. Administer a depot preparation: releases the drug slowly and steadily
  3. Reduce both the size of each dose and the dosing interval
43
Q

Maximal efficacy

A

largest effect that a drug can produce

44
Q

potency

A

amount of drug we must give to elicit an effect

45
Q

-Simple Occupancy theory

A

○ The intensity of the response is proportional to number of receptors occupied by the drug
○ Max response occur when all receptors occupied
○ Cannot explain potency difference

46
Q

-Modified occupancy theory

A

○ Affinity: explains potency
○ Intrinsic activity: explains maximal efficacy

47
Q

two types of antagonist and there differences

A

Noncompetitive: irreversible bind
Competitive: reversible bind

48
Q

ED50

A

average effective dose
standard dose

49
Q

therapeutic index calculation

A

LD50/ED50

50
Q

Drugs that induce PGP

A

reduced absorption, increased elimination

51
Q

Idiosyncratic effects

A

an uncommon drug response resulting from a genetic predisposition

52
Q

Paradoxical effect

A

opposite of the intended drug response

53
Q

Iatrogenic disease

A

disease that occurs as the result of medical care or treatment

54
Q

Tachyphylaxis

A

Reduction in drug responsiveness brought on by repeated dosing over a short time
E.g. transdermal nitroglycerin

55
Q

Biomarkers

A

gene characteristics related to drug responses

56
Q

factors influencing drug response

A

patient factors
genetics
disease factors
environmental factors

57
Q

Risk factors for nephrotoxicity

A

preexisting renal insufficiency
age
dehydration
more than one nephrotoxic drugs
dosage administered
extended treatment duration
recent exposure to vanco or aminoglycoside
other comorbidities

58
Q

Factors predicting drug removal by dialysis

A

low molecular weight
water-soluble
low protein binding
small volume of distribution

59
Q

fundamentals of deprescribing

A

medication d/c plan: tapering schedule
management plan: potential symptoms of withdrawal, monitor and follow-up
use of decision-support tools and algorithms

60
Q

therapeutic drug monitoring (2 ways)

A
  1. clinical response
  2. follow serum drug level
61
Q

what kind of drugs require therapeutic drug monitoring

A

durgs with a defined therapeutic range adn low therapeutic index

Patho & Pharm (13 decks)

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