Pharm Week 2

Question 1

Describe a True Drug Allergy.

Answer 1

It is an immune system mediated response.

Question 2

Describe a Type I Immediate Hypersensitivity Reaction.

Answer 2

Acute, life-threatening allergic reaction.
Multiple organ system involvement.
Begins within 30 min - 2 hrs.
Acute hives occurring within 2 hrs.
Antibodies produced.
Anaphylaxis

Question 3

What are the main symptoms of a type I reaction?

Answer 3

Bronchoconstriction, shortness of air, edema, wheezing, angioedema, swelling of lips, face, throat, or tongue, severe hypotension, hives.

Question 4

Why must patients with a type I response be continuously monitored?

Answer 4

Symptoms may reoccur within 6-8 hours after treatment. Must be observed for at least 12 hours.

Question 5

What is polymorphism?

Answer 5

The occurrence of genetic variation (such as CYP450 variations)

Question 6

How does genetic polymorphism affect drug metabolism?

Answer 6

The variant gene will encode a different protein (enzyme) which will vary the rate of metabolism - altered drug metabolism = altered patient response

Question 7

What criteria of a reaction indicate a true drug allergy?

Answer 7

Occurs in a small percentage of patients
Reaction does not resemble the drug’s pharmacological effect
Similar to other allergic reactions
Lag time between first exposure and reaction
Reaction is reproduced even by minute doses
Reaction is reproduced by agents with similar chemical structure
Eosinophilia is present
Reaction resolves after drug is discontinued

Question 8

Describe a Type IV (Delayed) Hypersensitivity reaction.

Answer 8

Rash, Hives, Itching
Onset of 24-48 hours after exposure
T-Cells produced.

Question 9

Describe anaphylaxis?

Answer 9

Life threatening allergic reaction involving multiple organ systems, such as:
vasodilation, bronchoconstriction, slowed heart rate, angioedma
Occurs within 30 min - 2 hours of exposure

Question 10

When might you see hives?

Answer 10

In a mild allergic reaction.
If they occur within 2 hours of drug administration, might be related to anaphylaxis. Do not take drug again!
If occurs 24-48 hours, just a mild reaction. no big deal

Question 11

What’s the difference between an allergy and an intolerance/adverse effect?

Answer 11

An allergy is immunologically mediated, while an intolerance/adverse effect is just undesired effects of the drugs

Question 12

How do allergies relate to dosage?

Answer 12

Even minute amounts will produce the allergic effects.

Question 13

How do adverse effects relate to dosage?

Answer 13

They are dose related, meaning that the more drug given, the more bad effects you will see

Question 14

Describe tolerance.

Answer 14

When prolonged usage of a drug produces less of an effect on the body.
More drug is needed to elicit the same effect.
Tolerance is not permanent.
Tolerance can also be built up to side effects.

Question 15

Describe physical dependence.

Answer 15

When withdrawal symptoms occur with removal of the drug.

Question 16

Describe withdrawal symptoms.

Answer 16

The withdrawal symptoms are the opposite of what the drug does.

Question 17

Describe addiction.

Answer 17

Deviant behavior causing an overwhelming involvement in the use of and acquisition of a drug for euphoria.

Question 18

What is a drug interaction?

Answer 18

The modification of the effects of one drug by the prior or concomitant administration of another drug

Question 19

What are the four types of drug interactions?

Answer 19

1. Altered GI Absorption
2. Protein Displacement
3. Altered Metabolism
4. Synergistic Effects & Antagonistic Effects

Question 20

Describe Altered GI Absorption.

Answer 20

A drug interaction altering the mucosa or flora of the GI tract, which in turn alters the absorption of another drug

Question 21

Describe Protein Displacement.

Answer 21

When drugs compete for attachment to proteins, changing each other’s bioavailability.

Question 22

Describe Altered Metabolism.

Answer 22

When drugs alter the production of enzymes that metabolize other drugs at faster or slower rates.

Question 23

Describe Synergistic and antagonistic effects

Answer 23

When one drug may either enhance the effects of another drug, or block the effects of another drug

Question 24

Describe altered intestinal flora and how it relates to drug interactions.

Answer 24

Some drugs (digoxin) are metabolized by intestinal flora. If the patient is given an antibiotic which wipes out the intestinal flora, the drug cannot be metabolized.

Question 25

Describe altered pH and how it relates to drug interactions.

Answer 25

When a drug that alters the pH of the GI tract interferes with the ionization of another drug that can only be absorbed in a specific pH.

Question 26

Describe transport protein interactions and how they relate to drug interactions.

Answer 26

Transport proteins in the GI tract can either be inhibited or accelerated by drugs, and these drugs compete for spots on this transport protein.

Question 27

How do chelation interactions related to drug interactions?

Answer 27

Chelation is a form of strong chemical bonding which reduces their solubility and prevents absorption.

Question 28

How does food affect drug interactions?

Answer 28

The presence or absence of food can play a significant role in the absorption of medications. It is often multifactorial and include many different processes.

Question 29

What factors may alter drug metabolism?

Answer 29

Drugs that inhibit certain enzymes.
Drugs that induce certain enzymes.
The body’s ability to produce certain enzymes (polymorphism - CYP450 stuff)

Question 30

What are three different classes of metabolizers in relation to pharmacogenetics?

Answer 30

Ultra metabolizers - higher than normal levels of certain isozymes, faster than expected drug metabolism
Extensive metabolizers - normally functioning metabolism
Poor metabolizers - abnormally low levels of certain isozymes, slower than expected drug metabolism

Question 31

What are ways to prevent drug interactions?

Answer 31

Complete medication history.
Be familiar with most common interactions and adverse effects
Avoid using unnecessary drugs
Select non-interacting medications
Separate chelating or pH interacting drugs by at least 2 hours

Question 32

How can grapefruit juice affect drug metabolism?

Answer 32

It can cause significant CYP450 suppression.

Question 33

How might caffeine cause a drug interaction?

Answer 33

Can increase theophylline toxicity.

Question 34

How can vitamin K interact with drugs?

Answer 34

It can decrease efficacy of Warfarin

Question 35

How can alcohol interact with drugs?

Answer 35

It increases acetaminophen toxicity.

Can increase drowsiness.

Question 36

What are different patient variables that can affect drug responses?

Answer 36

Pharmacokinetics
Allergies
Age
Weight and Body Size
Disease states
Genetics
Polypharmacy
Compliance

Question 37

What is Medication Adherence?

Answer 37

The degree to which a patient follows a treatment regimen.

Question 38

What is “America’s other drug problem?”

Answer 38

Medication Nonadherence

Question 39

How does nonadherence in the pediatric population compare to the rest of the population?

Answer 39

Just as common, if not higher

Question 40

How might compliance be complicated in the elderly population?

Answer 40

Multiple medications.
Multiple prescribers.
Complex drug regimens.

Question 41

What are four main sources of medication nonadherence?

Answer 41

Prescriber-Related (lack of trust, poor communication)
Patient-Related (difficulty understanding…)
Medication-Related (cost, complex regimens)
Pharmacy-Related (lack of trust, poor communication)