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Pharmacology > Pharm 5 > Flashcards

Pharm 5 Flashcards

1
Q

factors modifiying drug action

A 
body size, 
age, 
routes of administration, 
psychological factors, 
pathological states, 
other drugs, 
tolerance
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2
Q

individual does wt formula

A

dose = bd wt/70 * average adult dose

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3
Q

individual dose BSA

A

Individual dose (BSA) = BSA (M2)/1.7 x average adult dose

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4
Q

young’s formula

A

Child dose =( age/age+12) x average adult dose (Young_s formula)

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5
Q

diling’s formula

A

Child dose = age/20 x average adult dose (Dilling_s formula)

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6
Q

tolerance

A

requirment of a higher dose of a drug to produce the effect

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7
Q

natural tolerance

A

if individual is inherently less sensitive to the drug

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8
Q

ex of natural tolerance

A

african ppl to hypertensives

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9
Q

acquired tolerance

A

repeated use of drug in an individual who was initially responsive,
results in less response

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10
Q

tolernace is seen more in

A

CNS depressants

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11
Q

tolerance need not develop equally to all effects of a drug, for example

A

tolerance develops to analgesic and euphoric actions of morphine but not to its constipating and mitotic actions

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12
Q

mechanisms of tolerance

A

pharmacokinetic/drug disposition tolerance,

pharmacodynamic/cellular tolerance

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13
Q

pharmacokinetic/drug disposition tolerance

A

the effective concentration of the durg at the active site is decreased, mostly by enhancement of drug elimination on cronic ues

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14
Q

eg of pharmacokinetic/drug disposition tolerance

A

barbiturates, carbamazepine

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15
Q

pharmacodynamic/cellular tolerance

A

drug action is reduced;
cells of target organ become less responsive;
may be due to downregulation of receptors, weakening of response effectuation or other compensatory homeostatic mechanisms

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16
Q

eg of pharmacodynamic/cellular tolerance

A

morphine,
barbiturate,
nitrates

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17
Q

cross tolerance

A

development of tolerance to pharmacologically related drugs

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18
Q

cross tolerance eg

A

alcoholics are relatively tolerant to barbiturates and general anesthetics

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19
Q

tachyphylaxis (acute tolerance)

A

literally means fast - protection
rapid development of tolerance, due to doses of a drug repeate in quick succession result in marked reduction in response

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20
Q

eg of tachyphylaxis

A

usually seen with indirectly acting drugs like
ephedrine,
tyramine,
amphetamine

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21
Q

how do these tachyphylactic drugs act

A

by releasing catecholamines in the body,
synthesis of which is unable to match release and as a result stores get depleted,
other mechanisms involved slow dissociation of drugs from its receptors,
internalization of receptors

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22
Q

receptor regulation

A

upregulation and down regulation

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23
Q

upregulation

A

prolonged deprivation of the agonist (by denervation or continued use of an antagonist or a drug which reduces input),
supersensitivity of the receptor as well as the effector system to the agonist

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24
Q

upregulation may occur due to

A

unmasking of receptors or their proliferations or accentuation of signal amplification by transducer

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25
example of upregulation
sudden discontinuation of propranolol in angina pectoris -
26
down regulation
continued intense receptor stimulation causes desnesitization of refractoriness and the desired effect is not produced, the receptor becomes less sensitive to the agonist
27
ex of downregulation
continuous use of beta 2 agonists in pateints with bronchial asthma
28
down regulation may occur due to
masking or internalization of the receptor, | decreased synthesis/increased destruction of the receptor
29
masking or internalization of the receptor
receptors become inaccessible to the agonists, refractoriness develops as well as fades quickly
30
decreased synthesis/increased destruction of the receptor
refractroiness develops over weeks or months and recedes slowly
31
therapeutic drug monitoring
measuring and monitoring of plasma concentration of a drug in a patient at different time intervals during treatment
32
when is therapeutic drug monitoring done
drugs whose therapeutic index is too low (toxic drugs) or whose therapeutic window is too narrow
33
drug concentration may vary from patient to patient due to
ogarnacijubetuc varuabkes -- absirotuibm dustrubytion, and clearance (also half-life)
34
most TDM drugs work over a
small range
35
below the range the tdm drug
is not effective and the patient begins having symptoms again
36
above the range the tdm drug
produces toxicity
37
ex tdm drug
phenytoin (antiepileptic drug) plasma conc. Should be 10 - 20 ug/mL plasma
38
less than 10 ug phenytoin
failure of therapy
39
more than 20 ug phenytoin
toxicity -- nystagmus, diplopia
40
Examples of drugs that need TDM
antiepileptics, cardiac drugs, antibiotics, phychiatric drugs
41
antiepileptics
``` phenobarbital, phenytoin, valproic acid, arbamazepine, ethosuximide ```
42
cardiac drugs
digoxin, quinidine, procainamide
43
antibiotics
aminoglycosides (gentamicin, tobramycin, amikacin)
44
psychiatric drugs
lithium, | desipramine
45
adverse drug reactions
a response to a medicine used in humans or animals, which is noxious and unintended, including lack of efficacy, and which occurs at any dosage and can also result from overdose, misuse or abuse of a medicine
46
advers drug reactions are associated with
substantial morbidity and mortality
47
incidence of serious ADRs
6.70%
48
ards in hospital admissions
0.3 - 7 %
49
__.cause of death among hospitalized patients
4th to 6th
50
classification fo adr's is based on
onset, severity, type
51
onset can be
acute, subacute, latent
52
acute occurse w/in
60 min
53
sub-acute
1 to 24hrs
54
latent
greater than 2 days
55
severity is classified into
mild, moderate, severe
56
mild
bothersome but requires no change in therapy
57
moderate
requires change in therapy, additional treatment, hospitalization
58
severe
disabling or life-threatening
59
severity
``` results in death, is life-threatening, requires hospitalization, prolongs hospitalization, causes disability, causes congenital anomalies, requires intervention to prevent permanent injury ```
60
Types of ADRs
``` A - augmented, B- bizzare, C -cumulative, D- delayed, E - end-of-use ```
61
type A -augmented
extension of pharmacological effect, often predictable and dose dependent, responsible for at least 2/3 of ADRs
62
type A eg
propranolol causes heart block, | anticholinergics cause dry mouth
63
type B - bizzarre
nature of reaction can't be predicted, idiosyncratic or immunologic reactions, rare and unpredictable
64
Type B eg
chloramphenical and aplastic anemia
65
Type C - cumulative
associated with long-term use, | involve dose accumulation
66
Type C eg
phenacetin - interstitial nephritis, | antimalarials - ocular toxicity
67
Type D -delayed
delayed efects (dose independent)
68
Type D eg
carcinogenicity - immunosuppressants, | Teratogenicity - fetal hydantoin syndrome
69
Type E - End of use
associated with the withdrawl of a medicine,
70
Type E eg
insomnia anxiety and perceptual distrubances following the wothdrawal of benzodiazepines
71
Types of hypersensitivity
I-immediate or anaphyalactic (IgE), II - cytotoxic antibody (IgG, IgM), III - serum sickness/ag-ab complex (IgG, IgM), IV- delayed hypersensitivity (cell mediated)
72
type I eg
anaphylaxis w/ penicillins
73
type II eg
methyldopa causes hemolytic anemia
74
type III eg
procainamide - induced lupus -->anti histone ab
75
type IV eg
contact dermatitis
76
common drugs causing ADRS
``` antibiotics, antineoplastics, anticoagulants, cardiovascular drugs, hypoglycemics, nsaid/analgesics, diagnostic agents, CNS drugs ```
77
Body systems commonly involved in ADR
``` hematologic, cns, dermatologic/allergic, metabolic, cardiovascular, gastrointestinal, renal/genitourinary, respiratory, sensory ```
78
ADR Risk Factors
age (children and elderly, multiple medications (polypharmacy), altered physiology, multiple co-morbid conditions, inappropriate medication prescribing use or monitoring, prior history of ADRs, extent (dose) and duration of exposure, genetic predisposition
79
Pharmacovigilance - ADR detection
``` subjective report , objective report, medication order screening, spontaneous reporting (most common), medication utilization review ```
80
subjective report
patient complaint
81
objective report
``` direct observation of event, abnormal findings (physical exam, laboratory test, diagnostic procedure) ```
82
medication order screening
abrupt medication discontinuation, abrupt dosage reduction, orders for "tracer" or "trigger" substances, orders for special tests or serum drug concentrations
83
spontaneous reporting
most common
84
medication utilization review
computerized screening, | chart review and concurrent audits
85
Idiosyncracy
genetically determined abnormal reactivity to a drug/chemical, also bizzare drug effects occure due to peculiariteis of an indifidual for no definate genotypic reason
86
idosyncracy eg
INH toxicity in slow/rapid acetylators, | G6PD deficiency
87
idiosyncracy for no genetic reasoning
barbiturates cause excitement and mental confusion in some individual
88
drug dependence
physical, psychological (withdrawl symptoms)
89
teratogenicity
thalidomide, anticancer drugs, androgens, phenytoin
90
thalidomide
phocomelia
91
anticancer drugs
multiple defects, | fetal death
92
androgens
virilization, | limb esophageal cardiac defects
93
phenytoin
cleft lip/cleft palate
94
mutagenicity and carcinogenicity
anticancer drugs, radioisotopes, estrogen
95
mutagenicity is determined by
Ames test
96
Iatrogenesis
adverse effects or complications caused by or resulting from medical treatment or advice (drug-or-physician induced adverse effects)
97
iatrogenesis ex
steroid induced diabetes mellitus and osteoporosis, | drug-induced parkinsonism
98
tramadol induces
vomitting, | observed with oral, parenteral and continuous release preparations
99
contact dermatitis due to
Vit-K injury
100
clonidine induces
urticaria
101
teeth and nail discoloration due to
iron capsules
102
erythromycin induces
mobilliform rashes
103
s-amlodipine induces
pedal edema
104
heparin induces
contact dermatitis
105
dapsone induces
toxic epidermal cecrolysis
106
cotrimoxazole induces
fixed drug eruption
107
acetaminophen can cause
fixed drug reaction

Pharmacology (15 decks)

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