Pharm week 1

Question 1

The volume of distribution (Vd) is the relationship between:

Answer 1

Administered dose and plasma concentration

Question 2

Vd =

Answer 2

amount of drug/plasma concentration

Question 3

__________ is a measurement of an amount of drug in a given volume

Answer 3

concentration

Question 4

a drug that is lipophilic has a ______ volume of distribution, requiring a ______ dose

Answer 4

larger, higher

Question 5

a drug that is hydrophilic has a ______ volume of distribution, requiring a ______ dose

Answer 5

smaller, smaller

Question 6

clearance is the _______ that is cleared of drug per unit time

Answer 6

volume of plasma

Question 7

CL is directly proportionate to:

Answer 7

blood flow to clearing organ
extraction ratio
drug dose

Question 8

CL is indirectly proportional to:

Answer 8

half-life
drug concentration in central compartment

Question 9

to maintain “steady state in plasma the ______ must equal the rate of clearance

Answer 9

infusion rate/interval dosing

Question 10

how many half-times are required to reach a steady state? what can decrease this?

Answer 10

5, administering a loading dose

Question 11

Define steady state

Answer 11

steady state is when the amount of drug entering the body is equivalent to the amount of drug being eliminated from the body

Question 12

the alpha phase of the plasma concentration curve represents

Answer 12

distribution into the peripheral compartment (tissues)

Question 13

The beta phase of the plasma concentration curve represents:

Answer 13

elimination from the central compartment

Question 14

most drugs we administer follow a ______ model

Answer 14

multi-compartment model

Question 15

The slope of line A (plasma concentration curve) is influenced by the drugs _______

Answer 15

volume of distribution

Question 16

The more _______ the drug, the larger the Vd, the ________ the slope

Answer 16

lipophilic, steeper

Question 17

which kinetic model describes the process that metabolizes a constant amount of drug per unit time

Answer 17

Zero order

Question 18

which kinetic model describes the process that metabolizes a constant fraction of a drug per unit time?

Answer 18

first order

Question 19

what occurs in phase II?

Answer 19

Conjugation

Question 20

what occurs in phase 1?

Answer 20

Modification: oxidation, reduction, hydrolysis, de methylation

Question 21

what occurs in phase 3?

Answer 21

Excretion

Question 22

drugs with ester linkage are MOST susceptible to which type of metabolism

Answer 22

Hydrolysis

Question 23

The clearance of which drug is best categorized by perfusion dependent elimination

Answer 23

Ketamine

Question 24

which drugs accelerate methadone metabolism

Answer 24

ethanol and phenobarbital

Question 25

Which drugs may exhibit increased potency in a patient who frequently drinks grapefruit juice?

Answer 25

Fentanyl and midozalam 

Question 26

which local anesthetic is least likely to accumulate in a hypoxic fetus?

Answer 26

Chloroprocaine

Question 27

What molecular bond is strongest?

Answer 27

Covalent

Question 28

Which bond keeps liquids together and drugs in medications?

Answer 28

Van der Waals forces

Question 29

Which bonds do we prefer in anesthesia?

Answer 29

Non-covalent: vanderwaal/ionic because they are more easily reversed lipid soluble/volatile anesthetics

Question 30

What is a stereoisomer?

Answer 30

a compound differing only with the spatial arrangement of atoms

Question 31

Dextrotary:

Answer 31

clockwise rotation

Question 32

Levorotatory:

Answer 32

counter clockwise rotation

Question 33

what is chirality?

Answer 33

a mirror image of another atom/molecule that cannot be superimposed

Question 34

Which inhaled anesthetic is not chiral?

Answer 34

Sevoflurane

Question 35

Enationerism:

Answer 35

a pair of molecules existing in two forms mirror image of each other/classified by rotation

Question 36

pharmacokinetics:

Answer 36

what your body does to the drug- metabolism, clearance

Question 37

Pharmacodynamics:

Answer 37

what drug does to body - receptor interactions, potency

Question 38

Which receptor requires an enzyme to activate?

Answer 38

G-protein coupled receptors

Question 39

Which medications used G-protein coupled receptors?

Answer 39

haloperidol, morphine, losartan, plavix

Question 40

Example of enatiomers that make a racemic mixture:

Answer 40

ropivicaine and bupivicaine

Question 41

racemic mixture:

Answer 41

50%/50% enatomer mixture

Question 42

Ligand-gated ion channel:

Answer 42

ligand (signaling molecule) binds to receptor to open gate to initiate cellular response/gate closes when ligand moves

Question 43

which channels are activated by neuromuscular blocking agents?

Answer 43

Ligand-gated channels

Question 44

What type of drugs move across the cell membrane, BBB, and placenta?

Answer 44

Non-ionized

Question 45

Active transport against the gradient requires _____

Answer 45

ATP

Question 46

4 parts of pharmacokinetics

Answer 46

1. Absorption 2. Distribution 3. Metabolism 4. Excretion

Question 47

Cmax =

Answer 47

peak plasma concentration

Question 48

Tmax =

Answer 48

time when Cmax is observed

Question 49

Bioavailability is:

Answer 49

how much drug is absorbed

Question 50

What medication rate has the highest bioavailability?

Answer 50

Intravenous route

Question 51

What three things affect absorption rate?

Answer 51

site of administration, drug formulation, clinical effectiveness of a drug

Question 52

What is down regulation?

Answer 52

When you're on a medication for a long time, desensitizes/enzyme removal of protein molecule

Question 53

what is efficacy?

Answer 53

the ability to produce an intended effect

Question 54

What is potency?

Answer 54

the power of something to influence or make an impression

Question 55

What is included in the Vessel rich group?

Answer 55

Brain, Heart, Kidneys, Liver, Endocrine tissues, Gi tract

Question 56

Why is the Vdss larger than Vdcc?

Answer 56

at Vdss you have equal concentrations throughout all the compartment/tissues vs in Vdcc your drug is to the vessel rich group only

Question 57

What are the three phases of the multi compartment model?

Answer 57

Rapid distribution Slow distribution Terminal phase

Question 58

Why is fentanyl long acting?

Answer 58

because its highly fat soluble, which increases its VD and it is extensively redistributed

Question 59

What is the therapeutic index?

Answer 59

Safety profile of the drug

Question 60

what is metabolism?

Answer 60

conversion of parent drug into active metabolites to be excreted

Question 61

which organ has the largest metabolic capacity?

Answer 61

Liver

Question 62

what are the four processes that occur in phase 1 metabolism?

Answer 62

oxidation, reduction, hydrolysis, de-methylation

Question 63

what is the goal of phase 2 metabolism?

Answer 63

Conjugation, and to become more water soluble

Question 64

What are the four types of conjugation reactions?

Answer 64

Sulfonic acid glutathione glucuronic acid acetylation

Question 65

What liver enzyme is MOST important?

Answer 65

CYP 450

Question 66

what three things effect enzyme induction?

Answer 66

Acute alcohol ingestion, chronic alcohol ingestion, cigarette smoking

Question 67

What is the bioavailability of topical medications?

Answer 67

100% IF target tissue is localized

Question 68

Which drugs undergo first pass in the lungs?

Answer 68

lidocaine, propranolol, fentanyl

Question 69

What are the two ways medications are excreted?

Answer 69

kidneys into urine, bile into stool

Question 70

What is a half-life?

Answer 70

Time it takes for half of drug to be removed

Question 71

Which receptors are most frequently used in anesthesia?

Answer 71

G-coupled protein receptors

Question 72

Which medications are metabolized by zero order effects?

Answer 72

Aspirin, ethanol, phenytoin

Question 73

what is the curve for medications of high efficacy?

Answer 73

Up and to the LEFT

Question 74

what is an inverse agonist?

Answer 74

binds to a receptor and causes the opposite effect to that of a full agonist

Question 75

What is Rocuronium?

Answer 75

competitive antagonist

Question 76

define ED50

Answer 76

dose that produces clinical response in 50% of population

Question 77

Define therapeutic index

Answer 77

measurement of drug safety. ration of the LD50 to the ED50

Question 78

What is aspirins pharmacodynamic action?

Answer 78

non-competitive antagonism

Question 79

What does the slope tell us in the dose-response curve?

Answer 79

number of receptors that are occupied to produce a clinical effect

Question 80

What is up-regulation?

Answer 80

producing more receptors

Question 81

What drug routes bypass the first pass effect?

Answer 81

Intravenous, intramuscular, sublingual, inhalation, and Intradermal (if dermis is target tissue)

Question 82

Continuous administration of an agonist may cause ______ of the target receptors

Answer 82

down regulation

Question 83

______ is the tetrahedral bonding of carbon (carbon binding to 4 different atoms)

Answer 83

Chirality

Question 84

what factor could cause a drug to be avidly taken up in the first pass through the lungs?

Answer 84

being highly fat soluble

Question 85

What occurs in Phase 2 metabolism?

Answer 85

covalent linkage of drug/metabolite to high polar molecule

Question 86

Where in the body does metabolism occur?

Answer 86

Liver: hepatic microsomes enzymes which are located in hepatic smooth endoplasmic reticulum

Question 87

what are the three parts of renal clearance?

Answer 87

1. glomerular filtration 2. active tubular secretion 3. passive tubular reabsorption

Question 88

what type of drug is normally reabsorbed during renal clearance?

Answer 88

lipid soluble deugs

Question 89

what are the two factors that influence the rate of reabsorption?

Answer 89

pH and rate of urine flow

Question 90

clearance =

Answer 90

elimination/plasma concentration