FR Review 1 - Intro through Fluids and Electrolytes Flashcards
List the four categories of pharmacokinetics
A: Absorption
D: Distribution
M: Metabolism (liver and kidney)
E: Excretion
List 2 criteria for medications to be listed as OTC.
- Relief of symptoms where Dx may not be necessary.
2. Uncomplicated cases of some chronic or recurrent disease.
Define a behind the counter medication and give an example.
Px not needed but must get the medication from the pharmacist –> sudafed
When a company develops a new drug, for how long do they maintain the patent?
10 years
What must a generic drug maker prove to FDA in order to sell their version of the drug?
Must prove bioavailability is within 80% of original brand name drug.
When must a pharmacist dispense the generic version of a drug?
Always unless the prescriber specifies brand name medically necessary.
List and describe 6 phases of clinical drug trials.
Pre-clin: efficacy, toxicity, and pharmacokinetics
0: Single subtherapeutic doses to small groups (15-20) for kinetics and dynamics - no safety/efficacy
1: Given to mall group (20-100) of healthy volunteers to determine ADME
2. Given to large group (20-300) with disease to determine dose and overall efficacy
3. Large (300-3000) RCT against standard of care
4. Post marketing surveillance in general pop –> side effects may not show earlier b/c of low power
List and describe 2 ways KY tracks drugs of abuse.
KASPER: Tracks pharmacy, Pt, and prescriber any time a controlled substance is dispensed.
MethCheck: tracks purchasing of sudafed.
What are ergogenic drugs?
PEDs –> GHB, EPO, steroids (testosterone), etc
What is the sig?
Signa –> latin for directions
What component of prescription must match sig?
Quantity
How long is a prescription valid for?
Usually 1 year except for controlled substances
List the 8 levels of drug schedules and give examples of each.
C-1: heroin, MDMA, cocaine C-2: oxycontin, morphine, fentanyl, stimulants C-3: barbiturates C-4: benzodiazepines, THC C-5: cough syrups with codeine, Gabapentin (KY) Legend drugs: anything else requiring Px OTC: ASA, APAP (tylenol) BTC: pseudoephedrine
What is the only drug dispensed w/o safety cap?
Nitroglycerine
T/F: The prescriber or patient may request any drug be dispensed without a safety cap.
True
How many milliliters are in a tsp? Tbsp?
Tsp = 5ml, Tbsp = 15ml
How many ml are in an ounce? How many Tbsp in an ounce?
1 ounce = 30 ml or 2 Tbsp
Compare grams to milligrams to micrograms.
1g = 1,000mg = 1,000,000mcg
What is meant when a drug solution is listed as a 20% solution?
20% solution = 20g of drug per 100ml of solvent or 20g of drug per 100g of base (solid).
Differentiate herbal and nutritional supplements from drug products.
Herbal and nutritional products list a serving size
Describe homeopathy.
Using microdoses of like to treat like
What is an orphan drug?
Made only in special cases –> to expensive to make regularly
T/F: All legend drugs are controlled substances.
False: All prescription drugs are legend drugs, but not all legend drugs are controlled substances
Describe drugs that CAN be easily absorbed through the GI tract.
Small molecules
Non-ionized, or non-charged, drugs
Lipophilic drugs
Acid drug mixed with an acid or base with base
Describe drugs that CANNOT be easily absorbed through the GI tract.
Large molecules
Ionized, or charged, drugs
hydrophilic drugs
Acid drug mixed with a base
What kinds of drugs easily cross the blood-brain and the placenta barriers?
Lipophilic because both barriers are mostly fat
What is meant if a drug is in a “depot” form?
Injected drug formulated to be slow release
Differentiate high volume of distribution from low.
High: drug goes everywhere in the body (lipophilic drugs)
Low: drug stays where you put it (hydrophilic drugs)
What happens to a drug that binds to plasma protein?
The drug is inactive
How are lipophilic and hydrophilic drugs eliminated?
Lipophilic by liver, hydrophilic by kidneys
How many half-lives does it take for a drug to be completely eliminated?
5 - 6
Define steady state relative to pharmacokinetics.
When absorption = metabolism/elimination
What is the role of CP450 in pharmacokinetics?
Family of pac-man like enzymes that chew up drugs in the liver.
What is the result of a drug that induces CP450? Inhibits?
Induce: Need higher dose b/c more drug chewed up
Inhibit: Need lower dose b/c less drug chewed up
What are the postganglionic NTs of the ANS?
Symathetic: Epi and Norepi
Parasympathetic: Ach
Acetylcholine is deactivating in most parts of the body. The exceptions where Ach is activating are…
Gut, kidney, and CNS
List the effects of PNS stimulation.
Bradycardia, HypoTN, Miosis (constricted pupil), inc blood to skin and viscera, inc peristalsis, inc excretion and salivation
List the effects of SNS stimulation.
Tachycardia, HTN, mydriasis (pupil dilation), bronchodilation, inc glucose production in liver, inc blood to skeletal muscles, brain, and heart.
List the SNS receptors and their locations and effects.
A1: vasculature A2: n/a for this class B1: heart B2: lungs and vasculature Alpha constricts and beta dilates
Which receptors do epi and norepi bind to and what is the clinical result?
Epi: A1, A2, B1, B2
Norepi: A1, A2, B1
Clinical: Norepi is a more potent vasopressor and provides no bronchodilation
What causes hepatic encephalopathy in hepatitis.
Failing liver can’t make ammonia into urea. Ammonia crosses the blood-brain barrier.
What is the specific effect of nerve gasses and insecticides?
They are irreversible acetylcholinesterase inhibitors. Drugs we use are reversible inhibitors (stigmines, ex).
List 5 side effects of anticholinergic medications.
C-DUST: Constipation, Dry mouth, Urinary retention, Sedation, Tachycardia
What is the effect of PGs and angiotensin-2 (AG-2) in the kidneys?
PG: dilate afferent arteriole
AG-2: constricts the efferent arteriole
How much Na, Cl, K, Ca, HCO3, and Glc is in NS? (Don’t memorize numbers but be able to differentiate NS from D5W from LR)
Na = 154 Cl = 154 K = 0 Ca = 0 HCO3 = 0 Glc = 0
How much Na, Cl, K, Ca, HCO3, and Glc is in D5W? (Don’t memorize numbers but be able to differentiate NS from D5W from LR)
Na = 0 Cl = 0 K = 0 Ca = 0 HCO3 = 0 Glc = 50g
How much Na, Cl, K, Ca, HCO3, and Glc is in LR? (Don’t memorize numbers but be able to differentiate NS from D5W from LR)
Na = 130 Cl = 109 K = 4 Ca = 3 HCO3 = 28 Glc = 0
What should be done to the dose of a drug that binds to plasma proteins if serum albumin is low?
Decrease the dose
What are symptoms of hypoNa and what is greatest risk?
S/S: cramping, twitches, fasciculations. HypoNa patients are at increased risk for seizures.
What is the treatment for hyperK from least severe to most severe?
Sodium Polystyrene Sulfonate (Kayexalate)
K wasting diuretics
D50 and Insulin (Glc takes K into cells when it enters)
Sodium Bicarbonate
Calcium Chloride
Describe the relationship between K and pH.
Inverse relationship –> if K goes up pH decreases and vice versa.
What is the fastest rate of K administration when treating hypoK?
10 mEq/hour IV
Differentiate the use of hydrophilic steroids from lipophilic steroids.
Hydrophilic: inhalers and joint injections –> stay where you put them
Lipophilic: drug then needs to get into CNS or have systemic effect –> high Vd
What does it mean for a drug to have a narrow therapeutic index?
Small effective dose range
Describe the effect alkalinizing or acidifying the urine would have on drug excretion.
-If drug is basic, making the urine more basic will decrease excretion.
If drug is basic, making the urine more acidic will increase the rate of excretion.
If drug is acidic, making the urine more acidic will decrease excretion.
If drug is acidic, making the urine more basic will increase the rate of excretion.
Describe where acidic drugs and basic drugs that are ingested are more likely to be absorbed.
Acidic drugs are more likely to be absorbed in the stomach because the stomach is more acidic
Basic drugs are more likely to be absorbed in the duodenum because it is more basic than the stomach.
