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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
Q

example of upregulation

A

sudden discontinuation of propranolol in angina pectoris -

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26
Q

down regulation

A

continued intense receptor stimulation causes desnesitization of refractoriness and the desired effect is not produced,
the receptor becomes less sensitive to the agonist

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27
Q

ex of downregulation

A

continuous use of beta 2 agonists in pateints with bronchial asthma

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28
Q

down regulation may occur due to

A

masking or internalization of the receptor,

decreased synthesis/increased destruction of the receptor

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29
Q

masking or internalization of the receptor

A

receptors become inaccessible to the agonists, refractoriness develops as well as fades quickly

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30
Q

decreased synthesis/increased destruction of the receptor

A

refractroiness develops over weeks or months and recedes slowly

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31
Q

therapeutic drug monitoring

A

measuring and monitoring of plasma concentration of a drug in a patient at different time intervals during treatment

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32
Q

when is therapeutic drug monitoring done

A

drugs whose therapeutic index is too low (toxic drugs) or whose therapeutic window is too narrow

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33
Q

drug concentration may vary from patient to patient due to

A

ogarnacijubetuc varuabkes – absirotuibm dustrubytion, and clearance (also half-life)

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34
Q

most TDM drugs work over a

A

small range

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35
Q

below the range the tdm drug

A

is not effective and the patient begins having symptoms again

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36
Q

above the range the tdm drug

A

produces toxicity

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37
Q

ex tdm drug

A

phenytoin (antiepileptic drug) plasma conc. Should be 10 - 20 ug/mL plasma

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38
Q

less than 10 ug phenytoin

A

failure of therapy

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39
Q

more than 20 ug phenytoin

A

toxicity – nystagmus, diplopia

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40
Q

Examples of drugs that need TDM

A

antiepileptics,
cardiac drugs,
antibiotics,
phychiatric drugs

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41
Q

antiepileptics

A 
phenobarbital, 
phenytoin, 
valproic acid, 
arbamazepine, 
ethosuximide
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42
Q

cardiac drugs

A

digoxin,
quinidine,
procainamide

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43
Q

antibiotics

A

aminoglycosides (gentamicin, tobramycin, amikacin)

44
Q

psychiatric drugs

A

lithium,

desipramine

45
Q

adverse drug reactions

A

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
Q

advers drug reactions are associated with

A

substantial morbidity and mortality

47
Q

incidence of serious ADRs

A

6.70%

48
Q

ards in hospital admissions

A

0.3 - 7 %

49
Q

__.cause of death among hospitalized patients

A

4th to 6th

50
Q

classification fo adr’s is based on

A

onset,
severity,
type

51
Q

onset can be

A

acute,
subacute,
latent

52
Q

acute occurse w/in

A

60 min

53
Q

sub-acute

A

1 to 24hrs

54
Q

latent

A

greater than 2 days

55
Q

severity is classified into

A

mild, moderate, severe

56
Q

mild

A

bothersome but requires no change in therapy

57
Q

moderate

A

requires change in therapy,
additional treatment,
hospitalization

58
Q

severe

A

disabling or life-threatening

59
Q

severity

A 
results in death,
 is life-threatening, 
requires hospitalization, 
prolongs hospitalization, 
causes disability, 
causes congenital anomalies, 
requires intervention to prevent permanent injury
60
Q

Types of ADRs

A 
A - augmented, 
B- bizzare, 
C -cumulative, 
D- delayed, 
E - end-of-use
61
Q

type A -augmented

A

extension of pharmacological effect,
often predictable and dose dependent,
responsible for at least 2/3 of ADRs

62
Q

type A eg

A

propranolol causes heart block,

anticholinergics cause dry mouth

63
Q

type B - bizzarre

A

nature of reaction can’t be predicted,
idiosyncratic or immunologic reactions,
rare and unpredictable

64
Q

Type B eg

A

chloramphenical and aplastic anemia

65
Q

Type C - cumulative

A

associated with long-term use,

involve dose accumulation

66
Q

Type C eg

A

phenacetin - interstitial nephritis,

antimalarials - ocular toxicity

67
Q

Type D -delayed

A

delayed efects (dose independent)

68
Q

Type D eg

A

carcinogenicity - immunosuppressants,

Teratogenicity - fetal hydantoin syndrome

69
Q

Type E - End of use

A

associated with the withdrawl of a medicine,

70
Q

Type E eg

A

insomnia anxiety and perceptual distrubances following the wothdrawal of benzodiazepines

71
Q

Types of hypersensitivity

A

I-immediate or anaphyalactic (IgE),
II - cytotoxic antibody (IgG, IgM),
III - serum sickness/ag-ab complex (IgG, IgM),
IV- delayed hypersensitivity (cell mediated)

72
Q

type I eg

A

anaphylaxis w/ penicillins

73
Q

type II eg

A

methyldopa causes hemolytic anemia

74
Q

type III eg

A

procainamide - induced lupus –>anti histone ab

75
Q

type IV eg

A

contact dermatitis

76
Q

common drugs causing ADRS

A 
antibiotics, 
antineoplastics, 
anticoagulants, 
cardiovascular drugs, 
hypoglycemics, 
nsaid/analgesics, 
diagnostic agents, 
CNS drugs
77
Q

Body systems commonly involved in ADR

A 
hematologic, 
cns, 
dermatologic/allergic, 
metabolic, 
cardiovascular, 
gastrointestinal, 
renal/genitourinary, 
respiratory, 
sensory
78
Q

ADR Risk Factors

A

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
Q

Pharmacovigilance - ADR detection

A 
subjective report , 
objective report, 
medication order screening, 
spontaneous reporting (most common), 
medication utilization review
80
Q

subjective report

A

patient complaint

81
Q

objective report

A 
direct observation of event, 
abnormal findings (physical exam, laboratory test, diagnostic procedure)
82
Q

medication order screening

A

abrupt medication discontinuation,
abrupt dosage reduction,
orders for “tracer” or “trigger” substances,
orders for special tests or serum drug concentrations

83
Q

spontaneous reporting

A

most common

84
Q

medication utilization review

A

computerized screening,

chart review and concurrent audits

85
Q

Idiosyncracy

A

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
Q

idosyncracy eg

A

INH toxicity in slow/rapid acetylators,

G6PD deficiency

87
Q

idiosyncracy for no genetic reasoning

A

barbiturates cause excitement and mental confusion in some individual

88
Q

drug dependence

A

physical, psychological (withdrawl symptoms)

89
Q

teratogenicity

A

thalidomide,
anticancer drugs,
androgens,
phenytoin

90
Q

thalidomide

A

phocomelia

91
Q

anticancer drugs

A

multiple defects,

fetal death

92
Q

androgens

A

virilization,

limb esophageal cardiac defects

93
Q

phenytoin

A

cleft lip/cleft palate

94
Q

mutagenicity and carcinogenicity

A

anticancer drugs,
radioisotopes,
estrogen

95
Q

mutagenicity is determined by

A

Ames test

96
Q

Iatrogenesis

A

adverse effects or complications caused by or resulting from medical treatment or advice (drug-or-physician induced adverse effects)

97
Q

iatrogenesis ex

A

steroid induced diabetes mellitus and osteoporosis,

drug-induced parkinsonism

98
Q

tramadol induces

A

vomitting,

observed with oral, parenteral and continuous release preparations

99
Q

contact dermatitis due to

A

Vit-K injury

100
Q

clonidine induces

A

urticaria

101
Q

teeth and nail discoloration due to

A

iron capsules

102
Q

erythromycin induces

A

mobilliform rashes

103
Q

s-amlodipine induces

A

pedal edema

104
Q

heparin induces

A

contact dermatitis

105
Q

dapsone induces

A

toxic epidermal cecrolysis

106
Q

cotrimoxazole induces

A

fixed drug eruption

107
Q

acetaminophen can cause

A

fixed drug reaction

Pharmacology (15 decks)

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