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Pharmacology > Pharm Quiz 1 > Flashcards

Pharm Quiz 1 Flashcards

1
Q

Prescriptive Authority

A

Has two parts: the ability to prescribe independently (without oversight) and without limitation

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2
Q

What should determine drug selection?

A

Guidelines
Side Effects
Hepatic and Renal Functioning
Drug Monitoring
Interactions
Allergies (Anaphylaxis and face swelling are absolute contraindications while N&V can be trialed if nothing else available).
Availability (Some drugs are only available per certain formularies at a particular pharmacy).
Cost (There are patient assistance programs and pharmaceutical assistance programs to help patients in need).

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3
Q

What documentation needs to accompany a prescription?

A

H&P, Drug Monitoring, and Discussions with other providers

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4
Q

Improve Medication Adherence Through:

A

Adherence, Education, Drug Monitoring, and Scheduled Reviews

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5
Q

Key Prescription Requirements:

A

Name
DEA #
License #
Contact Info
Pt name & DOB
Allergies
Drug Name
Indication
Strength
Frequency
Dose
# of Pills
# of Refills

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6
Q

Is adherence or compliance better?

A

Adherence is better because it views the provider and patient as a team rather than compliance which makes the provider authoritarian.

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7
Q

Telephone Prescription

A

Can be sent to pharmacy through provider or designated representative except for Class II medications, which can only be given in an emergency and a written prescription must accompany it within 7 days.

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8
Q

Refills

A

For newer prescriptions, shorten the refill time. Class II drugs are not eligible for a refill.

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9
Q

What should medication education include?

A

Brand and Generic Name
Indications
Strength
Adverse Effects
Laboratory Testing (What, Why, Where, How to Prepare)\
Storage
Food and Drug Interactions
Duration of Therapy

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10
Q

Adverse Event Education

A

Patients have a right to know about AEs. However, educate them that serious AEs occur in 1-2% of the population. N&V and sedation commonly go away with continued use.

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11
Q

Direct Penetration

A

Because most cell membranes are composed of lipids (and like dissolves like), drugs must be lipid-soluble (lipophilic).

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12
Q

Channels and Pores

A

Few drugs pass this way because they are designed for specific molecules.

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13
Q

Transport System

A

Less selective than channels and pores. A common one is P-Glycoprotein transporter.

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14
Q

Polar Molecules

A

Have no net charge but tend to be negatively or positively charged in one specific area. They dissolve easily in water but not lipids.

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15
Q

Ions

A

Have a net charge and cannot cross cell membranes

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16
Q

pH Partitioning or Ion Trapping

A

Acidic drugs stay on the basic side of a membrane because this works best for their ionization. The opposite is true for basic drugs.

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17
Q

Bioequivalence

A

Drugs are the same if they contain the same amount of chemically available compound.

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18
Q

Equal Bioavailability

A

Drugs have the same availability if they are absorbed at the same rate to the same extent.

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19
Q

Factors that Affect the Rate of Absorption

A

BSA
Rate of Dissolution
Lipid Solubility
pH partitioning if it occurs in the plasma rather than site of administration.

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20
Q

What affects vascular distribution?

A

Not usually an issue except for abscesses, which have no blood flow and must be surgically drained, and solid tumors, which become progressively less vascularized.

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21
Q

BBB

A

Drugs must be lipophilic or go through a transport system to enter narrow membrane.

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22
Q

What does the PGP do in the BBB?

A

It transports drugs back outside the BBB?

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23
Q

How does the BBB change in infants?

A

It is not fully developed, so they have increased sensitivity to CNS drugs.

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24
Q

What does the placental barrier block?

A

Only drugs that are ionized, highly polar, or attached to protein.

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25
Q

How does Albumin affect distribution?

A

Some drugs (like Warfarin) bind to Albumin and cannot easily leave the bloodstream. If two drugs bind to Albumin, this can affect levels. However, usually these free medications are quickly excreted.

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26
Q

Cytochrome 450

A

Group of enzymes in the liver that metabolize endogenous compounds and drugs. CYP1, CYP2, and CYP3 metabolize drugs.

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27
Q

Therapeutic Consequences of Drug Metabolism

A

Lipophilic drugs –> hydrophilic to be excreted by the kidneys.
Increased therapeutic action (codeine –> morphine)
Increased Toxicity (Tylenol –>

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28
Q

What is the most common end of drug metabolism?

A

Inactivation

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29
Q

Prodrugs

A

Pharmacologically inactive until metabolized usually by the CNS to bypass the BBB.

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30
Q

When do infant livers fully develop?

A

1 yr

31
Q

Substrates

A

Drugs metabolized by P450

32
Q

Inducers

A

Act on the liver to increase the production of P450, which increases metabolism.

33
Q

First Pass Effect

A

Drugs taken PO can go straight to the liver and be completely inactivated.

34
Q

How does malnourishment effect metabolism?

A

The liver may not have the cofactors needed to produce P450.

35
Q

Enterohepatic Recirculation

A

Drugs cycle between the duodenum and liver through glucoronidation, which switches drugs from hydrophilic to lipophilic. This leaves drugs in the system for much longer than expected.

36
Q

Glomerular Filtration

A

Forces drugs from blood to urine. Protein and RBCs too big to fit through capillaries.

37
Q

Passive Tubular Reabsorption

A

Drugs are reabsorbed back into the blood farther down the tubule.

38
Q

Active Tubular Secretion

A

Active transporters put drugs back into urine.

39
Q

What modifies tubular excretion?

A

The pH of urine can be changed so that drugs are ionized and do not easily pass back into the bloodstream during passive tubular reabsorption.

40
Q

MEC

A

Minimum Effective Concentration is the lowest level of medication necessary to have a therapeutic effect.

41
Q

Plateau

A

If multiple doses are taken, drug levels are maintained in the body. This usually takes 4.5 days.

42
Q

How to decrease plateau fluctuations?

A

Continuous infusions, Smaller doses with greater intervals, depot concentrations

43
Q

Loading Dose

A

Decreases the time to reach plateau

44
Q

Decline from Plateau

A

94% of the drug will leave the body in 4.5 days.

45
Q

Dose-Response Relationship

A

Increasing the dose –> increases the response of the body. Only phase 2 has an effect.

46
Q

Efficacy v. Potency

A

Efficacy is more important than potency bc doses can be increased.

47
Q

Selectivity

A

A drug only interacts with a specific receptor, which decreases side effects.

48
Q

Simple Occupancy Theory

A

The maximum response will occur when the maximum amount of receptors have been filled. This fails to explain how some drugs are more effective than others.

49
Q

What two factors affect Modified Occupancy Theory?

A

Intrinsic Activity and Affinity

50
Q

Affinity

A

Drugs with high affinity attach to receptors quickly. Affinity and potency are highly related.

51
Q

Intrinsic Activity

A

Drugs with high intrinsic activity will cause increased receptor activity.

52
Q

Non-competitive Agonists

A

Irreversibly bind to receptors. This can last for several days, so these drugs are rarely used.

53
Q

Competitive Agonists

A

Increase the amount of agonists needed to produce a response.

54
Q

Partial Agonists

A

Have low intrinsic activity and can also be called agonist-antagonists.

55
Q

ED50

A

The amount of drug needed to produce a response in 50% of the population. Because of variability the dose needs to be adjusted based on patient response and not clinical guidelines.

56
Q

LD50

A

The amount of drug needed to produce a lethal dose in 50% of the population. The closer the LD50 and the ED50 are, the more dangerous the drug is.

57
Q

Relationship between P450 and PGP

A

Drugs that increase one usually increase the other.

58
Q

How does food affect absorption?

A

Food frequently decreases the rate of absorption and sometimes decreases the extent of absorption.

59
Q

How does grapefruit decrease absorption?

A

It decreases the creation of P450.

60
Q

What food affects MAOI inhibitors?

A

Tyramine causes increased BP.

61
Q

What can cause excessive CNS excitation?

A

Theophylline and caffeine

62
Q

Allergic Reaction

A

Based on immune response more than dose.

63
Q

What medications account for the large amount of allergic reactions?

A

Penicillins and Sulfonamides, which includes some diuretics, ATBs, and hypoglycemic agents

64
Q

Idiosyncratic Event

A

Rare reaction caused by a person’s genes.

65
Q

Iatrogenic Disease

A

Disease caused by hospitalization or a drug.

66
Q

QT Prolongation

A

Drugs –> Torsades de pointes –> Vfib

67
Q

What should be monitored for drugs that causes bone marrow toxicity?

A

CBCs

68
Q

5 Steps to a Med Rec

A
  1. Create a list of current medications.
  2. Create a list of future medications.
  3. Compare both lists
  4. Change medications
  5. Share with patient and next provider
69
Q

Pharmacodynamic Tolerance

A

Adaptive response to chronic receptor stimulation leading to increased MEC

70
Q

Metabolic Tolerance

A

Some drugs increase the hepatic creation of enzymes (barbituates) that does not lead to an increase in MEC.

71
Q

Tachyphylaxis

A

A reduction in drug responsiveness brought about by large doses over a short time. If a nitroglycerin patch is left on for 24 hours, the body does not create enough cofactors for it to react.

72
Q

Bioavailability

A

The amount of drug that reaches systemic circulation from its site of administration. PO drugs have the largest variability.

73
Q
A

Pharmacology (7 decks)

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