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PHAR3309 > Module One: Clinical Pharmacology > Flashcards

Module One: Clinical Pharmacology Flashcards

1
Q

Therapeutics

A

Right drug and dose for the right patient

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2
Q

Clinical toxicology

A

Identifying poisons in clinical and forensic cases (via clinical manifestations, measurable indices)

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3
Q

Clinical drug trials

A

Testing drugs in man

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4
Q

Drug regulation

A

Drug choices for nation, hospitals and practitioner

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5
Q

The link between drug dose and drug level is dependent on:

A 
Patient: age, sex, size, history of drug response 
Genetics: Pk and response 
Disease: elimination and target organs 
Other therapies: interactions 
Therapeutic drug monitoring 
Drug effect 
Pk and PD
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6
Q

Rationale for TDM

A

Pk variability
Narrow therapeutic range
Response itself is difficult to quantify

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7
Q

What’s the definition for therapeutic range?

A

Concentration range where efficacy without toxicity maybe expected in most patients

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8
Q

Drugs with narrow therapeutic range, where response is difficult to quantify clinically

A 
Digoxin
Cyclosporine, sirolimus, tacrolimus
Anticonvulsant drugs
Lithium
Amino glycoside antibiotics
Methotrexate
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9
Q

What does the AUC estimate?

A

Target organ exposure - steady state

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10
Q

What are drugs that follow non-linear pharmacokinetics?

A

Perhexiline, phenytoin, alcohol

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11
Q

How to calculate drug dose for renal impairment?

A

Dose = clearance x AUC

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12
Q

How is clearance measured?

A

Measure the amount of creatinine in the blood plasma and urine

CLcr (L/hr)= amount excreted (uMol/hr) / serum concentration (uMol/L)

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13
Q

Examples of phase one reactions

A

Oxidation, hydroxylation, deamination, dealkylation, hydrolysis

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14
Q

Examples of phase II reactions

A

Conjugation- mainly glucuronidation or sulphate

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15
Q

Excess 6-thioGTP causes what

A

Neutropaenia

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16
Q

Warfarin is a competitive antagonist for

A

Vitamin K for VKORC1

17
Q

VKORC1 is polymorphic. What are the consequences of different sensitisation to warfarin?

A

Too little anticoagulation: blood clots forms in circulation, embolism and lethal
Too much: bleeding, may be lethal in brain or other critical area

18
Q

What are the three VKORC1 polymorphisms?

A

Changes number of VKORC1 transcribed

1639GG: less sensitive needs larger dose
1639GA: intermediate sensitivity
1639AA: more sensitive, smaller dose

19
Q

What is the second warfarin metabolism polymorphism?

A

CYP2C9:
1/1: rapid metaboliser
1/(2/3): intermediate metaboliser
2/3* / 2/3: poor metaboliser

20
Q

Symptoms of stimulant (amphetamine, cocaine etc.) toxicity

A

Tachycardia, hypertension, agitation, dilated pupils, seizures

21
Q

Symptoms of opioids (heroin, morphine etc.) overdose?

A

Drowsy => coma, hypo ventilation, miosis (tiny pupils)

22
Q

Symptoms of sedative (benzodiazepines, ethanol etc.) overdose?

A

Drowsy: coma, staggering, slurred speech, hypo ventilation

23
Q

Symptoms of cholinesterase inhibitor (organophosphate insecticide) poisoning?

A

Bradycardia, bronchconstriction, small pupils, sweating

24
Q

Symptoms of antimuscarinic (TCA, deadly nightshade) poisoning

A

Tachycardia, vasodilation, pyrexia, dilated pupils (e.g. Atropine)

25
Q

How is paracetamol metabolised?

A

Renal elimination with sulfate and glucoronide conjugates (phase II metabolism)

26
Q

What is the antidote for paracetamol toxicity?

A

N-acety cysteine

27
Q

When is the concentration measured for the treatment predation of paracetamol overdose?

A

4 hours

28
Q

What causes toxicity in paracetamol overdose?

A

NAPQUI - electrophile

29
Q

What is the toxic metabolite in methanol poisoning?

A

Formic acid: disturbs proton gradient in mitochondrial membrane, inhibiting ATP production and oxidative phosphorylation

30
Q

What is the antidote for methanol poisoning?

A

Ethanol

31
Q

What is the antidote for opiate overdose?

A

Naloxone my opioid receptor antagonist

32
Q

What is the antidote for metal poisoning (As, Pb, Hg)?

A

Cheating agent e.g. Succimer (2,3 dimercapto succinate)

Water soluble sulphlyhydral complexes with metals

33
Q

Symptoms of acetylchoinestrase poisoning

A

Muscarinic, nicotinic activation, impaired conciousness, small pupils, bradycardia and bronchconstriction, gut cramping, vomiting, diarrhoea, weak, twitching muscles, sweating

34
Q

What is the antidote for anticholinesterase poisoning?

A

Atropine

35
Q

What is an example of the antidote for organophosphate poisoning?

A

Pralidoxime

PHAR3309 (6 decks)

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