Pharm Test 1 Flashcards
1
Q
ADME stands for…..
A
Absorption
Distribution
Metabolism
Excretion
The 4 key physiological processes that govern movement of a drug in the body
2
Q
T/F. A drug is not absorbed when given intravascularly
A
True
3
Q
Name 3 factors that affect the rate and extent of drug absorption
A
Route of administration Availability of drug at site if absorption Local blood flow Physical barriers Physicochemical properties
4
Q
T/ F. In the GIT divalent and trivalent cations inhibit absorption of fluoroquinolones and tetracyclines administered orally
A
True
5
Q
Drugs that increase gastric pH ( antacids, omeprazole) inhibit the oral absorption of what type of drugs? A. Antibiotics B. Inhaled sedation C. Azole antifungals D. Antivirals
A
C
6
Q
The process of drug absorption is important because it influences 4 fundamental events of pharmacological outcomes. Name those 4 fundamentals
A
- Onset of drug action
- Intensity of effect
- Extent of drug effect
- Adverse effects
7
Q
Name some organs that are better protected than others
A
Testicles
Uterus
Eyes
Collies and their mdr stuff
8
Q
What does MDR1 cause regarding drug transportation
A
It causes efflux of drugs. Therefore a mutation prevents efflux of drugs outside the cells
9
Q
What are the 2 forms of drug elimination?
A
Bio transformation and excretion
10
Q
What are some anatomical sites for bio transformation
A
Kidney Liver Lungs GI Blood vessels
11
Q
T/F Drug interactions involving CYP enzymes are uncommon
A
False. They are common Either by inhibiting the enzyme or inducing the enzyme in phase 1 reactions
12
Q
Which of the following does not cause a decrease activity of enzymes when it comes to bio transformation A. Co- administration of another drug B. Hepatic disease C. Nutritional deficits D. Age E. High body temperature
A
E- low body temperature effects this
13
Q
T/F an inhibitor of an enzymatic system is more likely to lead to toxic effect than an inducer of enzymatic system
A
True
Inducers can lead to lower concentrations and less effectiveness of the drug while inhibitors can cause too high / toxic concentrations.
14
Q
Which of the following is/ are dose dependent pharmacokinetic parameters? A. Tmax B. Cmax C. Clearance D. Bioavailability E. AUC F. Volume of drug distribution G. Half Life
A
B and E. Cmax and AUC
The rest are dose independent PK parameters
15
Q
T/ F drug accumulation depends on the property of the drug
A
False. There are no drugs that aren’t cumulative (All drugs are cumulative)
16
Q
Administration of drug every ____ or more half lives will result in little accumulation.
A
3
17
Q
A smaller RDI results in _______ accumulation (differences between cmax and cmax ss) and ______ fluctuation (difference between cmax ss and cmin ss)
A. More, More
B. More, Less
C. Less, Less
D. Less, More
A
B ( better for a narrow therapeutic window)
A larger rdi is less accumulation and more fluctuation (better for a wide therapeutic window)
18
Q
T/F. Combined effects of factors leading to inter individual variability are often unpredictable
A
True.
Physiologic
Pathological and pharmological interindividual effects
19
Q
Trial and error approach to therapeutic drug monitoring is appropriate in what instances?
A
When response can be easily measured (iso)
Illnesses that are not serious/ do not need immediate resolution
Drugs with large therapeutic windows
Safe at high doses
20
Q
TDM is useful in all but which of these cases? A. Wide therapeutic window B. Steep- dose response curve C. A difficult to detect end point D. Drugs with serious toxicity
A
A.
Narrow range
21
Q
Name some factors that would characterize a patients as high risk for drug to drug interactions
A
Old Young Very sick Multiple diseases Chronic treatment Renal or liver impairments
22
Q
Name some characteristics of a drug that could identify it as a high risk drug for DDIs
A
Narrow therapeutic windows
Enzyme inhibitors or inducers
23
Q
What are the mechanisms of drug to drug interactions
A
Displacement of drug from binding site
Alteration of drug transporters
24
Q
Name the ABCB 1 BLOCKERS
A. Itraconazole B. Cyclosporine C. Vincristine D. Vinblastine E. Rifampin F. Dexamethasone G. Chloramphenicol H. Clarithromycin I. Ivermectin J. Loperamide K. Acepromazine L. Verapamil
A
A itraconazole B cyclosporine G chloramphenicol H clarithromycin L verapamil
25
Name the ABCB 1 SUBSTRATE
```
A. Cortisol
B. Cyclosporine
C. Vincristine
D. Vinblastine
E. Doxorubicin
F. Dexamethasone
G. Mitoxantrone
H. Clarithromycin
I. Ivermectin
J. Loperamide
K. Digoxin
L. Verapamil
```
```
A. Cortisol
C. Vincristine
D. Vinblastine
E. Doxorubicin
G. Mitoxantrone
I. Ivermectin
J. Loperamide
K. Digoxin
```
26
Name the ABCB 1 INDUCERS
```
A. Itraconazole
B. Cyclosporine
C. Vincristine
D. Vinblastine
E. Rifampin
F. Dexamethasone
G. Chloramphenicol
H. Clarithromycin
I. Ivermectin
J. Loperamide
K. Acepromazine
L. Verapamil
```
E. Rifampin
F. Dexamethasone
K. Acepromacine
27
T/F inhibition of metabolism does not require multiple doses over time
True.
| Induction does though
28
CYP 450 BLOCKERS
```
A. Phenobarbital
B. Phenytoin
C. Quinidine
D. Opioids
E. Ketoconazole
F. Enrofloxacin
G. Chloranphenicol
H. Barbiturics
I. Propofol
J. Erythromycin
K. Fluoxetine
L. Glucocorticoids
```
```
C. Quinidine
E. Ketoconizole
F. Enrofloxacin
G. Chloranphenicol
J. Erythromycin
K. Fluoxetine
```
29
CYP 450 SUBSTRATES
```
A. Ketamine
B. Propranolol
C. Benzodiazepines
D. Opioids
E. Ketoconazole
F. Carvedilol
G. Chloranphenicol
H. Barbiturics
I. Propofol
J. Cyclosporine
K. Fluoxetine
L. Atenolol
```
```
A. Ketamine
B. Propranolol
C. Benzodiazepines
D. Opiods
F. Carvedilol
H. Barbiturics
I. Propofol
J. Cyclosporine
L. Atenolol
```
30
CYP 450 INDUCERS
```
A. Phenobarbital
B. Phenytoin
C. Quinidine
D. Opioids
E. Ketoconazole
F. Enrofloxacin
G. Chloranphenicol
H. Rifampin
I. Propofol
J. Erythromycin
K. Fluoxetine
L. Glucocorticoids
```
A. Phenobarbital
B. Phenytoin
H. Rifampin
L. Glucocorticoids
31
What is responsible for regulating/ enforcing laws related to drug use in vet med
FDA
32
Who/ what is responsible for safety and efficacy of nutritional supplements, compounded drugs and drugs used in an extra label fashion?
Vet
33
T/F. GFR affects drugs clearance, is affected by certain drugs and is estimated via a BUN/ creatinine.
True
34
```
Which of the following resorbs the most water and solute?
A. Glomerulus
B. Proximal Tubules
C. Loop of henle
D. Distal Tubule
```
B
65-85 % of total
Spillover or loss occurs here
35
The descending portion of the loop of henle is impermeable to (solutes/ water) while the ascending portion is impermeable to (solutes/ water)
Solutes. Water
36
ADH causes ______ to open
Aquaporins
37
Drug molecules are taken up by membrane ______ proteins and then deprive red the the lumen of the tubules
Transport
38
What are secreted by the organic acid transporters?
Loop diuretics
Furosemide
Thiazides diuretics
Acetazolamide
39
Name 2 reasons that furosemide would have a decreased efficacy
Patients with renal disease (limited delivery of diuretic to site of action)
Excess organic acids/anions (endogenous like keyoglutarate, or exogenous like NSAIDS) that compete with furosemide for tubular secretion
(Endogenous organic acids may accumulate during renal disease)
40
```
How do diuretics generally (primarily) accomplish increasing water excretion?
A. Increase Na excretion
B. Increase Na reabsorption
C. Decrease Cl excretion
D. Decrease Cl reabsorption
```
A
| Along with alteration of elongation of K, H, Cl, HCO3 and altering renal hemodynamic (decreased blood flow to kidney)
41
Match
1. Carbonic anhydrase (acetazolamide)
2. Osmotic diuretics (mannitol)
3. Loop diuretics (furosemide)
4. Thiazides (hydrochlorothiazide)
5. K sparing (amiloride or spironolactone)
```
A. Collecting duct
B. Ascending loop of henle
C. Proximal tubule
D. Proximal tubule and descending loop
E. Distal convoluted tubule
```
1. C
2. D
3. B
4. E
5. A
42
What is the most common indication for diuretic use
Mobilisation of tissue edema
Heart failure. Hepatic dz. renal dz
43
How do carbonic anhydrase inhibitors (such as acetazolamide) act? Multiple correct
A. Decrease H
B. Increase H
C. Decreased Na absorption (Na/ H antiporter)
D. Increased Na absorption (Na/ H antiporter)
E. K wasting
F. HCO3 secretion
A
C
E
F- makes it alkaline diuresis
44
T/F: as a diuretic acetazolamide is primarily used for edema
False. Metabolic alkalosis (favors elongation if bicarb), Glaucoma, Hyperkalemia paralysis (horses)
45
When would you not want to use acetazolamide
Sulfonamide allergy cross sensitivity
Animals with metabolic acidosis
If we are worried about electrolyte balance
46
What class of diuretic expands extracellular fluid volume (pulls water out of intracellular compartments) and inhibits water + Na reabsorption
Osmotic
| Mannitol
47
When is mannitol used
Relieve intratubular obstruction Increase GFR
Urine production in renal failure
Decrease intracranial pressure (contraindicated with intracranial hemorrhage)
Glaucoma
48
```
Which is not a mechanism of furosemide?
A. Inhibit Na K Cl symporter
B. Decreased trans cellular Na transport
C Decreased release if prostaglandins
D. Lower hypertonicity of medulla
```
C- increased Helps renal blood flow
49
Furosemide is (slow/ fast) acting, (short/ long) lived, and needs to be transported by organic anion transporter in proximal tubule to have the greatest effect.
Fast
Short
Lasix- 3-8 hours
50
T/F. Furosemide increases the release of renin
True
51
What is not an indication for use of furosemide?
A. Edema
B. Renal Failure for increased urine output
C. Hypocalcemia
D. Hypercalemia
E. Exercise induced pulmonary hemorrhage (horses)
C- hypercalcemia
52
What loop diuretic may cause an additive risk for nephrotoxicity when used with with other nephrotoxinc drugs such as aminoglycosides, cosplaying, NSAID
Furosemide
Also is inhibited by NSAIDS by prohibiting PGE2 production and competing with furosemide into renal tubules
53
What decrease furosemide oral bioavailability?
Portal hypertension
54
Name some contraindications for furosemide
```
Anuria
Impaired hepatic function
Preexisting water or electrolyte imbalance or cases that may lead to that (vomiting diarrhea)
Hypotension
Hepatic encephalopathy
Hypersensitivity to sulfonamides
```
55
What are 2 examples of thiazides diuretics
Chlorothiazide
| Hydrochlorothiazide
56
What is the mechanism of thiazides
Inhibits Na Cl cotrabsporter. Na in tubular fluid excretion of Na Cl and water, K, Mg, phos, iodide and bromide
Decrease Ca excretion
57
What diuretic is used to prevent oxalate uroliths in dogs
Thiazides. Also decrease PU PD in nephrogebuc DI. enhances diazoxide in treatment of insulinomas
HYPP- horses
58
What are some toxic effects of chlorothiazide and hydrochlorothiazide
```
Dehydration
Hypo kale Mia
GI effects
Alkalosis
Sulfonamide hypersensitivity
Hyperglycaemia
Ulcerative facial dermatitis
```
Weak diuretic
59
Name a Aldosterone antagonist (which competitively inhibits aldosterone binding)
spironolactone
60
T/F Decreased excretion of K, ammonium and phosphate while increasing excretion of Na, Cl, and water describes spironolactone
True
61
Spironolactone is used in conjunction with which other diuretics when treating congestive heart failure
Furosemide and ACE Inhibitors
RAAS activation
Is also used with loop and thiazides to decrease K wasting, also used for ascites
62
T/F spironolactone can cause metabolic acidosis
True
63
Name some k sparing diuretics
Spironolactone
Triamterene
Amiloride
64
How do k sparing diuretics work
Block Na channels on luminal side. Less na to exchange for K
65
High phosphorus causes (high/ low) iCa in renal secondary hyperparathyroidism
Low > PTH> increase Ca eventually> parathyroid hyperplasia developed
66
What is the primary hypocalcemia treatment
Calcitroil
67
Calcitriol replaces activated vitamin D not being made in _____
Kidneys
Does this by increasing GI Ca absorption. Inhibits PTH production
Used is renal 2 hyperparathy. And hypocalcemia
68
Do not use calcitriol if phosphorus is above ____ mg/dl
6
69
Epoetin alfa is (human product/ biosynthetic)
Human product. Biosynthetic agent (darbepoetin alfa)
Both directly replace EPO
70
Indication for use of erythrocyte stimulating agent is when anemia is below
20% due to EPO deficiency (CKD)
71
(T/F) Autoantibodies in ESA drugs occur in very few cases
False. 70%
72
T/F- opiates are more effective than non-opiates regarding antitussive drug treatments
True
Morphine codeine hydrocodone butorphanol
Vs
Dextromethorphan
Tramadol
73
T/F opiates directly depress cough Center in the medulla via either mu or kappa receptors
True
74
In what animals do opiates cause excitation or dysphoria as a side effect
Cats and horses
75
```
Which opiate is FDA approved antitussive in dogs?
A. Morphine
B. Codeine
C. Hydrocodone
D. Butorphanol
```
D. Schedule IV
76
T/F codeine and morphine are highly bioavailable orally
False. Very poor
Same with butorphanol but because it’s high potency it is less important
77
should formulations containing acetaminophen, antihistamines, decongestants in combination with dextromethorphan be used in dogs and cats?
No not useful
78
What does tramadol act on for its MOA
Opiate
Serotonin
Alpha 2
79
What type of drugs decrease formation of the active metabolite and reduces efficacy of tramadol
Drugs that inhibit CYP 2D (serotonin reputable inhibitors)
Tramadol is more bioavailable orally than opiates
80
What are bronchodilators used to treat
```
Reactive airway in cats (asthma)
Recurrent airway obstruction
Chronic obstructive airway disease (heaves)
Allergic bronchitis (dog)
```
81
T/F it is common that a bronchodilator alone will control clinical signs of airway diseases
False. Need anti inflammatory too
82
Name the B 2 adrenergic agonists
```
Epinephrine
Isoproteranol
Terbutaline
Metaproterenol
Albuterol
Salmeterol
Clenbuterol
```
83
Name anticholinergics
Atropine
Glycopyrrolate
Ipratropium bromide
84
What is the enzyme family that catalyzes breakdown of cAMP to inactive products This results in decreased release of inflammatory mediators from mast cells and bronchial smooth muscle relaxation
Methylxanthines
| Inhibition of phosphodiesterase (PDE)
85
What are the indications for methylxanthines
Feline asthma
Canine allergic bronchitis
Recurrent airway obstruction (others have fewer side effects)
Poor efficacy in cattle
86
Drugs that inhibit ___ enzymes can increase plasma concentrations of methylxanthines resulting in toxicity (CNS stimulation, tachycardia, nausea, diuresis)
CYP
| Fluoroquinolones and cimetidine are examples of these drugs
87
Beta 2 adrenergic receipts in bronchial smooth muscle (increase/ decrease) intracellular cAMP
Increases. Resulting in relation of smooth muscle
May also increase mucociliary clearance
88
Short acting epinephrine stimulate alpha and beta 1+2 receptors therefore effects include _____
Hypertension
Tachycardia
Isoproteranol (beta 1 and 2= tachycardia)
89
What is the indication of use for anticholinergics
Short term bronchodilator (crisis) adverse effects for long term use
90
What are toxicities of anticholinergics
```
Tachycardia
Illeus
Constipation
CNS excitation and depression
Decreased mucociliary clearance
```
91
Match
1. Used IV in horses and relieved bronchoconstriction but crosses the BBB causing CNS effects and colic
2. Injectable formulation has fewer adverse effects since it does not cross BBB
3. Aerosol but not absorbed from airways therefore no systemic adverse effects
A. Atropine
B. Ipratropium bromide
C. Glycopyrrolate
A
C
B
92
Name some corticosteroids used for anti inflammatory
```
Flunisolide
Budesonide
Triamcinolone
Beclomethasone
Ciclesonide
Fluticasone propionate
```
93
What is cromolyn’s MOA
Inhibits mast cell degranulation by interfering with calcium transport across cell membrane
Only effective if used before exposure to allergen
94
How are corticosteroids administered for reactive airway disease to minimize systemic side effects
Metered dose inhalers (in feline asthma, RAO, SPAOPD used for speed)
Allergic bronchitis and nonseptic pulmonary disease (leukocyte infiltrates in dogs)
95
What are oral corticosteroids for reactive airway disease
Prednisone/prednisolone
Dexamethasone
Methylprednisolone acetate (IM For mean cats like Lilly)
96
What corticosteroid is not bioavailable to cats and horses
Prednisone
97
T/F: expectorant are used to increase output if bronchial secretions, enhance clearance of bronchial exudates and promotes a more productive cough
True. But no established treatment for vet
98
T/F : Acetylcysteine has mucolytic effects that are a result of sulfhydral groups available to break the disulfide bond on mucoproteins
True
99
T/F. Doxapram stimulates the respiratory center, CNS, stimulators effects or carotid and aortic chemoreceptors
True
100
Is it safe to doxapram on neonates
True
101
Sildenafil treatment (increase/decreases) pulmonary arterial pressure in patients with pulmonary arterial hypertension (PH)
Decreases
Along with tadalafil
