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CMOD/PCM- Block 2 > Pharm: ADME 1 (Overview) > Flashcards

Pharm: ADME 1 (Overview) Flashcards

1
Q

Drugs produce their effects as a result of their presence at appropriate ____ at their ____ ____ ____.

A

concentration at their site of action

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2
Q

The minimum toxic concentration is also referred to as what?

A

the maximum tolerable concentration

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3
Q

It is the goal of the clinician to maintain drug concentrations where?

A

in the therapeutic window, which is higher than the minimum effective concentration and the minimum toxic concentration

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4
Q

With IV administration, therapeutic drug concentrations are achieved _____, whereas with oral administration drug concentrations are achieved _________.

A

rapidly; in delayed fashion

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5
Q

The onset and termination of drug action occurs when?

A

onset is when the drug concentration rises above the minimum effective concentration, and termination is when it falls below the minimum effective concentration

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6
Q

The decline of drug concentration over time depends on what?

A

characteristic metabolic and elimination processes associated with the drug

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7
Q

What is the intensity of drug action? (from graph)

A

the interval that extends from the minimum effective concentration to the maximum concentration achieved; this is variable

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8
Q

Pharmacokinetics is concerned with what?

A

the fate of the drug within the body, determined by dynamics of drug absorption, distribution, metabolism, and excretion

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9
Q

Absorption is a process reflecting what processes?

A

the rate at which a drug leaves its site of administration and the rise in drug concentration as it enters the systemic circulation; also describes the extent to which that occurs

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10
Q

Within the systemic circulation, what 2 forms can a drug take? Which form makes the drug available to the tissue?

A

free or bound form; in free form it is available to bind tissue/cell receptors

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11
Q

What process is responsible for the decline of drug concentration?

A

metabolism, as it converts drugs to metabolites to be excreted

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12
Q

True or false: free drug can be directly excreted through the process of elimination.

A

True *(it doesn’t always have to be metabolized first)

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13
Q

The process of distribution involves the movement of drug through/between what?

A

the systemic circulation, various tissues/sites of action, and sites of elimination

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14
Q

What is the difference between the rising and falling phases of the plasma concentration vs. time plot?

A

in the rising phase, drug absorption activity is higher than metabolism and excretion; whereas in the falling phase metabolism and excretion are greater than absorption

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15
Q

What two factors are manipulated by the clinician in order to vary the concentration-time profile of a given preparation?

A
  1. different doses

2. different administration frequencies

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16
Q

What is the therapeutic index? What do different TI values indicate?

A

MTC/MEC - min. toxic conc. over min effective conc.

  • high ratio - large window, relatively “safe”
  • low ratio - use caution to keep drug concentration within the window
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17
Q

What size molecules of drugs may pass through cell membrane pores?

A

low MW, like 100-200 Da

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18
Q

True or False: cell membranes are permeable to proteins and peptides.

A

False - they are relatively impermeably to proteins/peptides

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19
Q

Which of the following compounds can pass through cell membranes:

  • lipophilic or lipophobic?
  • polar or non-polar?
  • ionized or non-ionized?
A
  • lipophilic (recall: membranes like higher partition coefficients)
  • non-polar
  • non- ionized
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20
Q

What are the 3 ways that drugs can be biotransported?

A
  1. Passive diffusion
    Carrier-mediated biotransport:
  2. Facilitated diffusion
  3. Active transport
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21
Q

Most drugs pass biological membrane by ____ ____.

A

passive diffusion

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22
Q

The rate of diffusion is governed by what?

A

Fick’s law - depends on the distribution of concentrations, size of drug (smaller the better), partition coefficient (lipid solubility), surface area (larger the better), membrane thickness (thinner the better), and ionization (less charged better)

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23
Q

Carrier-mediated biotransport is used for drugs that are too what?

A

too large or too polar

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24
Q

True or False: transport cycles are irreversible processes of biotransport.

A

False - they are reversible

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25
Q

Name the carrier-mediated biotransport mechanism that’s an enzymatic process, and therefore subject to saturation.

A

PLOT TWIST - both are enzymatic processes:

facilitated diffusion AND active transport

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26
Q

Does facilitated diffusion offer movement against a concentration gradient? Does it utilize ATP?

A

No and No

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27
Q

Does active transport offer movement against a concentration gradient? Does it utilize ATP?

A

Yes and Yes

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28
Q

Riboflavin and Vitamin B12 use which type of transport across cell membranes?

A

facilitated diffusion

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29
Q

5-flurouracil uses which type of transport across cell membranes?

A

active transport

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30
Q

Define, in general terms, co-and counter-transport.

A

when carrier-mediated transport is coupled to transport of other substances, most notably ions

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31
Q

What is pinocytosis?

A

It’s the same as endocytosis; can be clathrin-dependent or clathrin-independent

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32
Q

What is the pH-partition theory?

A

a means to explain the influence of pH and pKa on the extent of the ability of a drug to cross the plasma membrane; assumes that drugs are only absorbed when they are non-ionized (higher lipid solubility)

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33
Q

What supplies the driving force for drug movement across a membrane?

A

the concentration gradient that exists for the non-ionized form of the drug

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34
Q

Most drugs are strong or weak electrolytes? What does that mean?

A

weak - meaning that they exist in both charged and uncharged forms in solution

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35
Q

At steady state:
Basic drugs will accumulate on the more ____ side of the membrane, and acidic drugs will accumulate on the more ____ side of the membrane.

A

Basic drugs –> acidic side

Acidic drugs –> basic side

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36
Q

What is ion trapping?

A

the phenomenon in which basic and acidic drugs are accumulating on the side of the membrane that has a pH opposite of the drugs’ pH; this represents an important determinant for drug absorption, distribution, and excretion

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37
Q

What is bioavailability?

A

a clinically relevant parameter referring to the fractional extent to which a given dose of a drug reaches either its site of action or a biological compartment from which the drug has free access to its site of action; ranges from 0 to 1

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38
Q

What phenomenon severely limits the bioavailability of orally administered drugs?

A

first pass metabolism - metabolism of the drug in the liver which often times inactivates the drug

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39
Q

For all purposes, the bioavailability of IV drugs is given as ____.

A

1

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40
Q

There are 8 factors listed that modify absorption. Name as many as you can. If you can name them all then you are definitely capable of being a doctor. Or at least a pharmacist.

A
  1. route of administration
  2. circulation to site of absorption
  3. formulation factors that affect drug solubility
  4. area of the absorbing surface
  5. membrane thickness
  6. drug concentration
  7. physicochemical factors affecting membrane transport
  8. transport mechanisms
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41
Q

What are the 2 main branches of drug administration?

A
  1. enteral route - via the GI tract (PO, SL, PR)

2. parenteral route - not via GI tract (IV, SQ, IM, IA, Inhal, Top)

42
Q

How do drugs administered as solids get absorbed?

A

they must first undergo dissolution, usually occurs in the GI tract

43
Q

There are many ways to manipulate the drug formulation for absorption advantage. These include:

A
  • delayed or sustained release tablets (enteric coating)
  • depot preparations (injection with delayed release)
  • rapid release formulations (gel caps)
  • transdermal patches
44
Q

What are the advantages of oral drug administration?

A
  • safe
  • cheap
  • no need to sterilize (but must be hygienic)
  • compact
  • multi-dose bottles
  • automated machines can produce large quantities
45
Q

What are the disadvantages of oral drug administration?

A
  • slow onset (usually >1hr)
  • patient non compliance
  • first pass metabolism –> low bioavailability
46
Q

The pH of the GI tract is most acidic in the ____ and most basic in the ____.

A

stomach; intestines

47
Q

True or false: drugs administered through the buccal cavity will by-pass the liver and avoid first-pass metabolism.

A

True

48
Q

What are the 3 main factors affecting GI absorption?

A
  1. acidity of stomach
  2. gastric emptying time
  3. intestinal motility/transit time
49
Q

What happens to acidic drugs in the stomach? How is this different from what happens to basic drugs in the stomach?

A

acidic drugs will be non-ionized and readily enter systemic circuclation, while basic drugs will be ionized and not absorbed until they reach SI

50
Q

Generally drugs are better absorbed in the ____ (piece of GI tract) because of _________.

A

small intestine; larger surface area

51
Q

True or false: increasing gastric emptying will decrease drug absorption.

A

False - increasing gastric emptying will increase drug absorption, because the drug will be moved to the SI where it is better absorbed

52
Q

Faster contraction of the small intestine = ____ transit time.

A

faster

53
Q

Why does sublingual administration have a rapid absorption time?

A

the rich blood supply and relatively neutral pH promote absorption

54
Q

What are the advantages and disadvantages of rectal drug administration?

A

Advantages: useful in children, unconscious/vomiting patients; no first-pass metabolism
Disadvantages: absorption is erratic; not well accepted by patients

55
Q

What is the most rapid drug delivery method?

A

intravenous

56
Q

What are the advantages of IV drug administration?

A
  • patient compliance (as long as they show up)
  • rapid, complete delivery
  • no first pass effect
  • flexible rate of administration
  • vein relatively insensitive to irritation by drugs
57
Q

What are the disadvantages of IV drug administration?

A
  • expensive - to sterilize, pyrogen test, and make the larger solvent volume
  • requires trained personnel
  • no recall
  • infection risk
  • dangerous, toxicity with rapid administration
58
Q

What are the advantages and disadvantages of subcutaneous (SQ) drug administration?

A 
Advantages:
-bypass first pass
-varied absorption
-can be self-administered
Disadvantages:
-pain
-tissue irritation
-volume limited to 2mL
59
Q

What are the advantages and disadvantages of intramuscular (IM) drug administration?

A

drugs generally absorbed well due to high blood flow in muscle and lateral diffusion from site of injection; also avoid first-pass
Disadvantages: trained personnel needed, site of injection influences absorption, gender differences, pain, tissue damage, volume limited to 4-5mL

60
Q

What is intraarterial drug administration?

A

administered into arteries for delivery to specific organs; requires great care and not only trained personnel but EXPERTS. like an endovascular interventionist.

61
Q

Intrathecal route is injection into _______ with the purpose of bypassing the ____ and ____. It’s used for what?

A

subarachnoid space; blood-brain barrier and blood-CSF barrier; used for local effects (like spinal anesthesia) and treatment of acute CNS infections (like meningitis)

62
Q

Examples of inhalation administration with local effects is ____, and with systemic effects is ____.

A

bronchodilators; general anesthesia

63
Q

What are factors to consider (i.e., advantages and disadvantages) in the administration of inhalation agents?

A

rapid and efficient absorption rate, allergic reaction can occur

64
Q

True or False: topically administered agents are useful only for local effects.

A

False - they are useful for local effects but can have systemic effects too.

65
Q

What are the 3 types of topical routes of administration?

A
  1. percutaneous - as in cream, ointment, transdermal patches
  2. mucous membranes
  3. eye - like eyedrops
66
Q

What 3 factors affect the rate of drug distribution?

A
  1. cardiac output and regional blood flow
  2. tissue volume
  3. capillary permeability
67
Q

What 4 factors affect the extent of drug distribution?

A
  1. physicochemical factors affecting membrane transport
  2. plasma protein binding
  3. intracellular binding
  4. permeability/characteristics of specific tissue membranes
68
Q

True or False: the greater the blood perfusion rate, the less drug distributed to an organ

A

False - the greater the blood perfusion rate, the MORE drug distributed to an organ

69
Q

What organs have the highest perfusion rates? And what does this mean for drug concentration?

A

brain, kidney, liver, heart; in these organs it would be expected that total drug concentration rises most rapidly

70
Q

Total blood flow is greatest to which 4 organs/body parts?

A

brain, kidneys, liver, muscle

71
Q

What are major factors controlling transcapillary movement of drugs?

A

lipid solubility & molecular size - because they pass via filtration or passive diffusion through the fenestrated capillary endothelium

72
Q

Transport of substances >____kD is largely mediated by pinocytosis.

A

25kD

73
Q

Which capillaries have larger than normal spaces between endothelial cells?

A

renal capillaries

74
Q

Which capillaries have tight junctions between endothelial cells?

A

brain - this is what makes the BBB

75
Q

What kinds of compounds can pass the BBB and what can’t?

A

lipid soluble can, because they can diffuse through cells; polar substances is severely restricted

76
Q

How does plasma protein limit distribution of free drug to its sites of action?

A

plasma protein binds the drug, keeping it in the central blood compartment

77
Q

____ is a plasma protein that binds the widest range of drugs.

A

Albumin

78
Q

Acidic drugs commonly bind to ____ (what plasma protein?), while basic drugs commonly bind to ____.

A

albumin; globulins

79
Q

Is drug binding to plasma proteins generally specific or non-specific?

A

non-specific - think about albumin–it binds a ton of stuff. How promiscuous.

80
Q

True or false: drug binding to plasma proteins is an irreversible process.

A

False - otherwise, how would the drug ever get off and into its target?

81
Q

What three factors determine the total fraction of drug bound to plasma proteins?

A
  1. drug concentration
  2. affinity for binding sites
  3. number of binding sites
82
Q

At low drug concentrations, the major determinant of the fraction of drug bound to plasma proteins is _________.

A

affinity of binding sites

83
Q

At high drug concentrations, the major determinant of the fraction of drug bound to plasma proteins is _________.

A

the number of binding sites

84
Q

Because the determinants of drug fraction bound to plasma proteins varies with drug concentration, this entails what?

A

that binding to plasma proteins is a saturable and nonlinear process

85
Q

True or false: it is the bound drug that equilibrates with the site of pharmacologic/toxic response.

A

False - how would that work? No, it’s the FREE drug that equilibrates with the site of pharmacologic/toxic response.

86
Q

Why does the clinician need to be concerned with the percent bound vs. unbound drug?

A

because slight changes in the percent free drug can make a difference in the drugs’ effect, especially in drugs with a narrow therapeutic window

87
Q

Do drugs tend to accumulate in tissues or in EC blood/fluids at higher concentrations?

A

they tend to accumulate in tissues

88
Q

Binding of drug to tissue consists of binding either ____ or ____ located ____ or ____, in a process which is generally ____ and ____.

A

proteins or phospholipids; extracellularly or intracellularly; reversible and saturable

89
Q

Binding of drug to tissue is dependent on the ____, ____, and ____ ____ of the tissue as well as physicochemical properties of the drug.

A

concentration, affinity, and binding capacity

90
Q

What are 4 relevant drug reservoirs?

A
  1. stomach - traps basic drugs
  2. albumin - limits free drug availability
  3. tissue - liver, thyroid, bone can accumulate drugs
  4. fat - lipid soluble compounds readily partition into fat tissue
91
Q

What is an important source of interpatient variability in terms of drug bioavailability?

A

drug reservoirs, particularly fat tissue

92
Q

Termination of a drug’s effects usually occurs by ____ and ____, but may also be due to ____.

A

metabolism and excretion; redistribution

93
Q

What is a driving factor behind redistribution of drug?

A

blood flow differences between tissues or organs that see the drug initially

94
Q

What are the 4 drug distribution patterns?

A
  1. vascular system
  2. body water
  3. one/more tissues
  4. non-uniform distribution
95
Q

What are examples of drugs that distribute largely within the vascular system?

A
  • plasma substitutes such as dextran

- drugs that bind strongly to plasma protein

96
Q

What is an example of drugs that follow the body water distribution pattern?

A

low molecular weight water soluble compounds such as ethanol

97
Q

Most drugs exhibit what type of distribution pattern?

A

non-uniform, as their distribution is determined by their membrane permeability and lipid/water solubulity

98
Q

What is volume of distribution (Vd)?

A

clinically relevant parameter that indicates the apparent body volume that a given drug is located within and is generally indicative of the compartment to which it distributes; often used as a diagnostic tool

99
Q

How is Vd calculated?

A

amount of drug administered
- divided by -
plasma drug concentration

100
Q

How many liters of plasma and of total body water does the average human have?

A

4L plasma

40L total body water

CMOD/PCM- Block 2 (41 decks)

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