Module 2 Flashcards

1
Q

Define pharmacokinetics

A

the study of drug movement into the body

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2
Q

Pharmacokinetics is composed of which four basic processes?

A

ADME -
Absorption
Distribution
Metabolism
Excretion

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3
Q

Describe drug absorption

A

drug absorption is the movement of the drug from the site of administration into the blood

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4
Q

What determines how quickly the drug effect will occur?

A

the rate of absorption

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5
Q

What determines how intense the effect of the drug will be?

A

the amount of drug absorption

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6
Q

List the factors affecting absorption

A

1) Rate of Dissolution
2) Surface Area
3) Blood Flow
4) Lipid Solubility
5) pH Partitioning
6) Activity of Drug Transport Proteins

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7
Q

Define dissolution

A

dissolving in solution

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8
Q

Drugs must what before they can be absorbed?

A

dissolve

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9
Q

Drugs with a fast rate of dissolution will have what?

A

a faster onset of action than drugs with slow dissolution

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10
Q

What does a larger surface area mean (in relation to drug absorption)?

A

Faster drug absorption

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11
Q

Which has the greater surface, the stomach or the small intestine?

A

Small intestine
While the stomach has folds called rugae, the intestine has thousands of finger-like projections called villi. The villi that line the intestine make the surface area very large.

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12
Q

Describe blood flow

A
  • Drug absorption is fastest in areas with high blood flow.
  • Areas with a high blood flow maintain a concentration gradient which drives absorption.
  • Areas with low blood flow do not maintain as great of a concentration gradient.
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13
Q

Exercise does what to blood flow?

A

increases blood flow and can increase drug absorption

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14
Q

Blood flow is what in heart failure, severe hypotension, hypothermia and circulatory shock?

A

decreased

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15
Q

What may be the greatest determinant in the absorption of a drug?

A

Surface area

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16
Q

Are lipophilic or hydrophilic drug absorbed more rapidly?

A

Lipophilic
* Lipophilic drugs are able to cross the cell membrane whereas hydrophilic drugs can’t

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17
Q

Describe pH partitioning and the effect it has on drug absorption

A
  • Drug absorption is greater when there’s a difference between the pH at the site of administration and the blood such that the drug is ionized in the blood.
  • Remember the effect of pH dependent ionization from Module 1!
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18
Q

Which type of drug transporters increase the absorption of drugs?

A

Uptake

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19
Q

Which type of drug transporters decrease the absorption of drugs?

A

Efflux

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20
Q

What are the 8 major routes of drug administration?

A

1) Oral (PO = per os which is latin for by mouth)
2) Sublingual
3) Transdermal
4) Rectal
5) Intravenous (IV)
6) Subcutaneous (SubQ or SC)
7) Intramuscular (IM)
8) Pulmonary

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21
Q

Routes of administration are often referred to as what?

A

enteral or parenteral

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22
Q

Describe enteral

A

routes of administration that involve the gastrointestinal tract

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23
Q

Describe parenteral

A

routes of administration that do not involve the gastrointestinal tract. In reality though, clinical practitioners consider parenteral to be routes of administration that include injections.

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24
Q

What is the most common method of drug administration?

A

oral

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25
Q

What are the advantages of oral drug administration?

A

safety, convenience, economical

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26
Q

What are the disadvantages of oral drug administration?

A

incomplete and variable absorption

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27
Q

Where would oral drug absorption be the greatest?

A

intestine
the intestine has a surface area over 200 m squared

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28
Q

What about drugs that are weak acids, wouldn’t they be better absorbed in the stomach?

A
  • Based on the pH effects weakly acidic drugs should be better absorbed in the acidic environment of the stomach because they would unionized.
  • However, the surface area of the stomach is small and the stomach is covered with a thick layer of mucous.
  • Therefore the rate of drug absorption in the intestine will be greater than the stomach, even if the drug is ionized!
  • The bottom line is for most drugs, oral absorption is greatest in the intestine.
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29
Q

Describe the pharmaceutical phase

A
  • The pharmaceutical phase occurs after the patient swallows a tablet.
  • It involves the disintegration of the tablet and the dissolution of the drug.
  • If the drug does not completely disintegrate or does not go into solution, absorption is reduced.
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30
Q

Describe gastric emptying

A
  • Gastric emptying is quite simply the movement of the stomach contents into the intestine.
  • Since the rate of drug absorption is greater in the intestine, things that increase gastric emptying also increase the rate of drug absorption.
31
Q

What are the modifiable factors that increase gastric emptying?

A
  • Taking medications on an empty stomach
  • Taking medications with cold water
  • Lying down on the right side
  • High osmolality feeing (tube feeding)
  • Taking a pro-kinetic drug (a drug that increases GI motility)
32
Q

What are the modifiable factors that decrease gastric emptying?

A
  • High fat meal
  • Heavy exercise
  • Lying down on the left side
  • Taking a drug that inhibits the vagus nerve (i.e., anticholinergic drugs)
33
Q

What is an enteric coating?

A

Drugs with enteric coating are covered with a special coating that prevents their dissolution in the acidic environment of the stomach.

34
Q

When are drugs with an enteric coating absorbed?

A

Once the drug passes into the more alkaline duodenum, the enteric coating dissolves and can be absorbed in the small intestine

35
Q

What is bioavailability?

A

Bioavailability is the fraction of a dose of drug that reaches the systemic circulation unchanged.

36
Q

What has a large influence on a drugs bioavailability?

A

drug formulation

37
Q

Which drug formulations have the highest bioavailability?

A

Aqueous solutions and syrups, next suspension and chewable tablet

38
Q

What is a suspension?

A

particles of drugs suspended in a liquid (it is not in solution, it is in suspension, so no disintegration phase associated with it)

39
Q

What drug formulations have the lowest bioavailability?

A

Lowest: time release; second lowest: enteric coated tablets

40
Q

What drug formulations have a mid bioavailability?

A

granules, capsules, compressed tablet (drug must disintegrate and dissolve before being absorbed)

41
Q

What does it mean to administer a drug sublingually?

A

to place it under the tongue

42
Q

Describe sublingual

A
  • Involves placing a drug under the tongue.
  • The drug dissolves and is absorbed across the oral mucosa.
  • Venous drainage from the oral mucosa is to the superior vena cava. Superior vena cava takes blood to the heart.
  • Drugs administered sublingually avoid first pass metabolism through the liver.
  • In order to be absorbed drugs must be lipophilic and uncharged.
43
Q

What does the transdermal route of administration involve?

A

Involves a drug penetrating the barrier layer of the skin

44
Q

Describe transdermal

A
  • Not all drugs penetrate the skin.
  • The epidermis provides a lipid barrier, therefore drugs must be lipophilic enough to penetrate the skin.
  • Drugs must also be relatively hydrophilic in order to dissolve in the extracellular fluid.
  • Ideal transdermal preparations have some degree of lipophilicity and some degree of hydrophilicity and are usually small (< 600 Da) molecules.
45
Q

Transdermal drugs are typically administered as what?

A

patches, ointments, sprays, and lotions

46
Q

How does one avoid tolerance when dealing with transdermal drug preparations?

A

Tolerance may develop unless drug-free period’s are enforced. Typically patches are removed for 6 – 10 hours per day to avoid tolerance.

47
Q

What is one of the advantages of the transdermal route of administration?

A

Transdermal administration provides constant plasma drug levels with minimal peaks and troughs.

48
Q

What factors affect transdermal absorption?

A

1) Thickness of the skin – Transdermal absorption is inversely proportional to skin thickness.
2) Hydration – Transdermal absorption is increased when the skin is well hydrated.
3) Hair follicles – Provide routes for drugs to bypass the barrier function of the epidermis. In general the greater the number of hair follicles, the greater the transdermal absorption is.
4) Application Area – The greater the application area, the greater the transdermal absorption.
5) Integrity of the barrier – In conditions such as psoriasis, burned or abraded skin, transdermal absorption is increased.

49
Q

When is the rectal route of administration particularly useful?

A

When the patient is unconscious or vomiting

50
Q

Define suppository

A

a solid medical preparation in a roughly conical or cylindrical shape, designed to be inserted into the rectum or vagina to dissolve.

51
Q

What are the major disadvantages of the rectal route of administration?

A
  • Incomplete rectal absorption
  • Some drugs may actually irritate the rectal mucosa
52
Q

Approximately 50% of rectally administered drugs bypass what?

A

the liver (an important site for drug metabolism)

53
Q

How is a rectal suppository administered?

A

Administration: The drug is inserted into the rectum as a suppository. The suppository dissolves and the drug crosses the rectal mucosa into the blood.

54
Q

What is a common route of administration for hospital settings?

A

Intravenous (IV)

55
Q

Describe intravenous (IV)

A

Drug is injected directly into a peripheral vein.

56
Q

What are the most commonly used veins when administering IV?

A

Most commonly used veins are those on the back of the hand or the median cubital vein at the elbow although any visible vein may be used.

57
Q

Define bolus

A

An IV bolus is a single dose administered over a short time period.

58
Q

How can intravenous drugs be given?

A

As a bolus or by an IV drip

59
Q

How is an IV drip medication administered?

A

In an IV drip a drug is administered under continuous infusion over a prolonged period. Drugs are typically diluted in a “vehicle” such as saline in an IV bag.

60
Q

What are the advantages of the IV route of administration?

A
  • No barriers to absorption, bioavailability is 100%.
  • Allows precise control of the drug dosage and duration of action.
  • Allows administration of poorly soluble drugs that must be diluted in a large volume.
  • Allows the injection of drugs that are irritants (i.e. many chemotherapeutic drugs) as they can be injected slowly so they are diluted in the blood.
61
Q

What are the disadvantages of the IV route of administration?

A
  • Expensive, invasive and inconvenient.
  • Drug cannot be removed once injected.
  • Risk of infection and fluid overload.
  • Risk of injecting wrong formulation (IM formulation sometimes injected IV by accident).
62
Q

Describe the subcutaneous route of administration

A
  • Drug is injected beneath the skin into the subcutaneous tissue.
  • Irritant drugs must not be injected subcutaneously as this will cause severe pain and/or tissue sloughing.
63
Q

What is the only barrier to absorption when administering a drug subcutaneously

A

The only barrier to absorption is the capillary wall.

64
Q

Describe intramuscular (IM) parenteral route of administration

A

drug is injected directly into muscle tissue

65
Q

What are the advantages to the IM route of administration?

A
  1. Can be used for poorly soluble drugs.
  2. Can use it to administer depot preparations (preparations in which the drug is absorbed slowly over time).
66
Q

What are the disadvantages to the IM route of administration?

A
  1. Pain/discomfort
  2. May cause local tissue and/or nerve damage if the injection is done improperly.
67
Q

What are the primary determinants of rate of absorption with the IM route of administration?

A

The primary determinants of rate of absorption are blood flow and water solubility.

68
Q

What are the primary determinants of rate of absorption with the subcutaneous route of administration?

A

The primary determinants of rate of absorption are blood flow and water solubility.

69
Q

How is absorption determined with the IM route of administration?

A

Absorption is determined by the ability of the drug to pass through fenestrations in the capillary wall.

70
Q

List the factors affecting intramuscular absorption

A
  • Blood flow is different depending on which muscle is used for injection. In general blood flow is deltoid > vastus lateralis> gluteal.
  • Exercise increases blood flow and may therefore increase absorption for IM drugs.
  • Blood flow may be decreased in heart failure, severe hypotension and hypothermia.
71
Q

What are the advantages of the pulmonary route of administration?

A
  • Absorption is very rapid (almost instantaneous) due to the large surface area of the lung.
  • In the case of pulmonary disease (i.e. asthma), the drug is delivered to its site of action which is a major advantage.
72
Q

Describe the pulmonary route of administration

A

Gaseous and volatile drugs inhaled and absorbed into the blood through the pulmonary epithelium (such as with an inhaler)

73
Q

What is a commonly used class of drugs that are administered by the pulmonary route of administration (aside from drugs administered by inhaler)

A

general anaesthetics used in surgery are also commonly administered by the pulmonary route of administration

74
Q

What can bioavailability be influenced by?

A

1) Drug formulation
2) Route of Administration
3) Degree of Metabolism