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Equine > Pharm Test 1 > Flashcards

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

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2
Q

T/F. A drug is not absorbed when given intravascularly

A

True

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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
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4
Q

T/ F. In the GIT divalent and trivalent cations inhibit absorption of fluoroquinolones and tetracyclines administered orally

A

True

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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

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6
Q

The process of drug absorption is important because it influences 4 fundamental events of pharmacological outcomes. Name those 4 fundamentals

A
  1. Onset of drug action
  2. Intensity of effect
  3. Extent of drug effect
  4. Adverse effects
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7
Q

Name some organs that are better protected than others

A

Testicles
Uterus
Eyes
Collies and their mdr stuff

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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

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9
Q

What are the 2 forms of drug elimination?

A

Bio transformation and excretion

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10
Q

What are some anatomical sites for bio transformation

A 
Kidney
Liver
Lungs
GI 
Blood vessels
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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

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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

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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.

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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

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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)

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16
Q

Administration of drug every ____ or more half lives will result in little accumulation.

A

3

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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)

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18
Q

T/F. Combined effects of factors leading to inter individual variability are often unpredictable

A

True.
Physiologic
Pathological and pharmological interindividual effects

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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

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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

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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
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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

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23
Q

What are the mechanisms of drug to drug interactions

A

Displacement of drug from binding site

Alteration of drug transporters

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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
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25
Q

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 
A. Cortisol
C. Vincristine
D. Vinblastine
E. Doxorubicin
G. Mitoxantrone
I. Ivermectin 
J. Loperamide
K. Digoxin
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26
Q

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
A

E. Rifampin
F. Dexamethasone
K. Acepromacine

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27
Q

T/F inhibition of metabolism does not require multiple doses over time

A

True.

Induction does though

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28
Q

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
A 
C. Quinidine
E. Ketoconizole
F. Enrofloxacin
G. Chloranphenicol
J. Erythromycin 
K. Fluoxetine
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29
Q

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 
A. Ketamine 
B. Propranolol 
C. Benzodiazepines
D. Opiods
F. Carvedilol
H. Barbiturics
I. Propofol
J. Cyclosporine 
L. Atenolol
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30
Q

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

A. Phenobarbital
B. Phenytoin
H. Rifampin
L. Glucocorticoids

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31
Q

What is responsible for regulating/ enforcing laws related to drug use in vet med

A

FDA

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32
Q

Who/ what is responsible for safety and efficacy of nutritional supplements, compounded drugs and drugs used in an extra label fashion?

A

Vet

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33
Q

T/F. GFR affects drugs clearance, is affected by certain drugs and is estimated via a BUN/ creatinine.

A

True

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34
Q 
Which of the following resorbs the most water and solute?
A. Glomerulus
B. Proximal Tubules
C. Loop of henle
D. Distal Tubule
A

B

65-85 % of total
Spillover or loss occurs here

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35
Q

The descending portion of the loop of henle is impermeable to (solutes/ water) while the ascending portion is impermeable to (solutes/ water)

A

Solutes. Water

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36
Q

ADH causes ______ to open

A

Aquaporins

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37
Q

Drug molecules are taken up by membrane ______ proteins and then deprive red the the lumen of the tubules

A

Transport

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38
Q

What are secreted by the organic acid transporters?

A

Loop diuretics
Furosemide
Thiazides diuretics
Acetazolamide

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39
Q

Name 2 reasons that furosemide would have a decreased efficacy

A

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)

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40
Q 
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

A

Along with alteration of elongation of K, H, Cl, HCO3 and altering renal hemodynamic (decreased blood flow to kidney)

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41
Q

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
A
  1. C
  2. D
  3. B
  4. E
  5. A
42
Q

What is the most common indication for diuretic use

A

Mobilisation of tissue edema

Heart failure. Hepatic dz. renal dz

43
Q

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

A
C
E
F- makes it alkaline diuresis

44
Q

T/F: as a diuretic acetazolamide is primarily used for edema

A

False. Metabolic alkalosis (favors elongation if bicarb), Glaucoma, Hyperkalemia paralysis (horses)

45
Q

When would you not want to use acetazolamide

A

Sulfonamide allergy cross sensitivity
Animals with metabolic acidosis
If we are worried about electrolyte balance

46
Q

What class of diuretic expands extracellular fluid volume (pulls water out of intracellular compartments) and inhibits water + Na reabsorption

A

Osmotic

Mannitol

47
Q

When is mannitol used

A

Relieve intratubular obstruction Increase GFR
Urine production in renal failure
Decrease intracranial pressure (contraindicated with intracranial hemorrhage)
Glaucoma

48
Q 
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
A

C- increased Helps renal blood flow

49
Q

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.

A

Fast
Short

Lasix- 3-8 hours

50
Q

T/F. Furosemide increases the release of renin

A

True

51
Q

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)

A

C- hypercalcemia

52
Q

What loop diuretic may cause an additive risk for nephrotoxicity when used with with other nephrotoxinc drugs such as aminoglycosides, cosplaying, NSAID

A

Furosemide

Also is inhibited by NSAIDS by prohibiting PGE2 production and competing with furosemide into renal tubules

53
Q

What decrease furosemide oral bioavailability?

A

Portal hypertension

54
Q

Name some contraindications for furosemide

A 
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
Q

What are 2 examples of thiazides diuretics

A

Chlorothiazide

Hydrochlorothiazide

56
Q

What is the mechanism of thiazides

A

Inhibits Na Cl cotrabsporter. Na in tubular fluid excretion of Na Cl and water, K, Mg, phos, iodide and bromide

Decrease Ca excretion

57
Q

What diuretic is used to prevent oxalate uroliths in dogs

A

Thiazides. Also decrease PU PD in nephrogebuc DI. enhances diazoxide in treatment of insulinomas
HYPP- horses

58
Q

What are some toxic effects of chlorothiazide and hydrochlorothiazide

A 
Dehydration 
Hypo kale Mia
GI effects
Alkalosis
Sulfonamide hypersensitivity
Hyperglycaemia
Ulcerative facial dermatitis

Weak diuretic

59
Q

Name a Aldosterone antagonist (which competitively inhibits aldosterone binding)

A

spironolactone

60
Q

T/F Decreased excretion of K, ammonium and phosphate while increasing excretion of Na, Cl, and water describes spironolactone

A

True

61
Q

Spironolactone is used in conjunction with which other diuretics when treating congestive heart failure

A

Furosemide and ACE Inhibitors
RAAS activation

Is also used with loop and thiazides to decrease K wasting, also used for ascites

62
Q

T/F spironolactone can cause metabolic acidosis

A

True

63
Q

Name some k sparing diuretics

A

Spironolactone
Triamterene
Amiloride

64
Q

How do k sparing diuretics work

A

Block Na channels on luminal side. Less na to exchange for K

65
Q

High phosphorus causes (high/ low) iCa in renal secondary hyperparathyroidism

A

Low > PTH> increase Ca eventually> parathyroid hyperplasia developed

66
Q

What is the primary hypocalcemia treatment

A

Calcitroil

67
Q

Calcitriol replaces activated vitamin D not being made in _____

A

Kidneys

Does this by increasing GI Ca absorption. Inhibits PTH production

Used is renal 2 hyperparathy. And hypocalcemia

68
Q

Do not use calcitriol if phosphorus is above ____ mg/dl

A

6

69
Q

Epoetin alfa is (human product/ biosynthetic)

A

Human product. Biosynthetic agent (darbepoetin alfa)

Both directly replace EPO

70
Q

Indication for use of erythrocyte stimulating agent is when anemia is below

A

20% due to EPO deficiency (CKD)

71
Q

(T/F) Autoantibodies in ESA drugs occur in very few cases

A

False. 70%

72
Q

T/F- opiates are more effective than non-opiates regarding antitussive drug treatments

A

True

Morphine codeine hydrocodone butorphanol

Vs
Dextromethorphan
Tramadol

73
Q

T/F opiates directly depress cough Center in the medulla via either mu or kappa receptors

A

True

74
Q

In what animals do opiates cause excitation or dysphoria as a side effect

A

Cats and horses

75
Q 
Which opiate is FDA approved antitussive in dogs?
A. Morphine
B. Codeine
C. Hydrocodone
D. Butorphanol
A

D. Schedule IV

76
Q

T/F codeine and morphine are highly bioavailable orally

A

False. Very poor

Same with butorphanol but because it’s high potency it is less important

77
Q

should formulations containing acetaminophen, antihistamines, decongestants in combination with dextromethorphan be used in dogs and cats?

A

No not useful

78
Q

What does tramadol act on for its MOA

A

Opiate
Serotonin
Alpha 2

79
Q

What type of drugs decrease formation of the active metabolite and reduces efficacy of tramadol

A

Drugs that inhibit CYP 2D (serotonin reputable inhibitors)

Tramadol is more bioavailable orally than opiates

80
Q

What are bronchodilators used to treat

A 
Reactive airway in cats (asthma)
Recurrent airway obstruction
Chronic obstructive airway disease (heaves)
Allergic bronchitis (dog)
81
Q

T/F it is common that a bronchodilator alone will control clinical signs of airway diseases

A

False. Need anti inflammatory too

82
Q

Name the B 2 adrenergic agonists

A 
Epinephrine
Isoproteranol
Terbutaline
Metaproterenol
Albuterol
Salmeterol
Clenbuterol
83
Q

Name anticholinergics

A

Atropine
Glycopyrrolate
Ipratropium bromide

84
Q

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

A

Methylxanthines

Inhibition of phosphodiesterase (PDE)

85
Q

What are the indications for methylxanthines

A

Feline asthma
Canine allergic bronchitis
Recurrent airway obstruction (others have fewer side effects)
Poor efficacy in cattle

86
Q

Drugs that inhibit ___ enzymes can increase plasma concentrations of methylxanthines resulting in toxicity (CNS stimulation, tachycardia, nausea, diuresis)

A

CYP

Fluoroquinolones and cimetidine are examples of these drugs

87
Q

Beta 2 adrenergic receipts in bronchial smooth muscle (increase/ decrease) intracellular cAMP

A

Increases. Resulting in relation of smooth muscle

May also increase mucociliary clearance

88
Q

Short acting epinephrine stimulate alpha and beta 1+2 receptors therefore effects include _____

A

Hypertension
Tachycardia
Isoproteranol (beta 1 and 2= tachycardia)

89
Q

What is the indication of use for anticholinergics

A

Short term bronchodilator (crisis) adverse effects for long term use

90
Q

What are toxicities of anticholinergics

A 
Tachycardia
Illeus
Constipation
CNS excitation and depression
Decreased mucociliary clearance
91
Q

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

A
C
B

92
Q

Name some corticosteroids used for anti inflammatory

A 
Flunisolide
Budesonide
Triamcinolone
Beclomethasone
Ciclesonide
Fluticasone propionate
93
Q

What is cromolyn’s MOA

A

Inhibits mast cell degranulation by interfering with calcium transport across cell membrane

Only effective if used before exposure to allergen

94
Q

How are corticosteroids administered for reactive airway disease to minimize systemic side effects

A

Metered dose inhalers (in feline asthma, RAO, SPAOPD used for speed)
Allergic bronchitis and nonseptic pulmonary disease (leukocyte infiltrates in dogs)

95
Q

What are oral corticosteroids for reactive airway disease

A

Prednisone/prednisolone
Dexamethasone

Methylprednisolone acetate (IM For mean cats like Lilly)

96
Q

What corticosteroid is not bioavailable to cats and horses

A

Prednisone

97
Q

T/F: expectorant are used to increase output if bronchial secretions, enhance clearance of bronchial exudates and promotes a more productive cough

A

True. But no established treatment for vet

98
Q

T/F : Acetylcysteine has mucolytic effects that are a result of sulfhydral groups available to break the disulfide bond on mucoproteins

A

True

99
Q

T/F. Doxapram stimulates the respiratory center, CNS, stimulators effects or carotid and aortic chemoreceptors

A

True

100
Q

Is it safe to doxapram on neonates

A

True

101
Q

Sildenafil treatment (increase/decreases) pulmonary arterial pressure in patients with pulmonary arterial hypertension (PH)

A

Decreases

Along with tadalafil

Equine (10 decks)

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