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FPT > Pharmacodynamic Principles - 2 > Flashcards

Pharmacodynamic Principles - 2 Flashcards

1
Q

Action of one drug is facilitated or increased by use of another drug

A

Synergism

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2
Q

Synergism can be which?

A

1- additive.
2- Supra-additive / potentiation

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3
Q

The effect of two drugs is in the same direction and adds up

A

Additive synergism

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4
Q

What are the advantages of additive synergism?

A

1- side effects of the combination may not add up.
2- combination is better tolerated than higher dose of one drug.

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5
Q

Give 2 examples of additive synergism?

A

1- aspirin + paracetamol.
2- glibenclamide + metformin

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6
Q

Effects of the combination is greater than the individual effect of the drugs?

A

Supra-additive synergism.

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7
Q

When does Supra-additive synergism occur?

A

When one drug is inactive, but enhances the effect of the other.

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8
Q

Give 2 examples of Supra-additive synergism?

A

1- levodopa + carbidopa.
2- acetylcholine + physostigmine.

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9
Q

One drug decreases or abolishes the action of another drug

A

Antagonism

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10
Q

List the 4 types of antagonism?

A

1- physical antagonism.
2- chemical antagonism.
3- physiological / functional antagonism.
4- receptor antagonism.

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11
Q

Give an example of physical antagonism?

A

Charcoal in alkaloid poisoning.

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12
Q

Give an example of Chemical antagonism?

A

Chelating agents complex toxic metals.

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13
Q

Give an example of physiological/ functional antagonism?

A

Histamine and adrenaline on bronchial wall

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14
Q

Give an example of receptor antagonism?

A

Acetylcholine and atropine on M receptor.

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15
Q

One drug blocks the receptor action of the other - it is selective in nature

A

Receptor antagonism

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16
Q

List the 3 types of receptor antagonism?

A

1- competitive antagonism.
2- non - competitive antagonism.
3- non - equilibrium antagonism.

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17
Q

Extent of shift in competitive antagonism depends on what?

A

Concentration of the antagonist.

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18
Q

List the 10 factors that affect drug action?

A

1- body size.
2- age.
3- sex.
4- ethnicity.
5- genetics.
6- routes of drug administration.
7- environmental factors and Time of administration
8- physiological factors.
9- pathological states.
10- other drugs.

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19
Q

Which factors affecting drug action influences the concentration of the drug attained at the site of action?

A

Body size.

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20
Q

How do we calculate individual dose using BW?

A

Individual dose = BW(kg)/70 x average adult dose

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21
Q

How do we calculate individual dose using BSA?

A

Individual dose = BSA(m2)/1.7 x average adult dose

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22
Q

Individual dose using BSA is used for which type of drugs?

A

Anti cancer drugs

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23
Q

The dose of a drug for children is often calculated from the _____ dose

A

Adult

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24
Q

What is young’s formula for calculating children’s dose?

A

Child’s dose= age/(age+12) x adult dose

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25
Q

What is dilling’s formula for calculating children’s dose?

A

Child’s dose = age/20 x adult dose

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26
Q

Infants and children have important _______ differences from adults

A

Physiological

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27
Q

In children which type of absorption is efficient?

A

Rectal absorption

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28
Q

Which drug is given for febrile convulsions in children?

A

Diazepam PR

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29
Q

Drugs are easily absorbed from ____ in children?

A

Thin skin

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30
Q

The BBB is more permeable is which age group?

A

Children

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31
Q

Risk of _____ in neonates following displacement of _____ from protein-binding sites by which vitamin and drugs?

A

Risk of Kernicterus in neonates following displacement of bilirubin from protein-binding sites by vitamin K, sulphonamides, and indomethacin.

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32
Q

Drugs metabolizing enzymes are immature at ____?

A

Birth

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33
Q

Inadequate metabolism of which drug causes “grey baby syndrome”?

A

Chloramphenicol

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34
Q

Kidney function is immature in which age group?

A

Neonates

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35
Q

Adult kidney function values are reached in infants after _____ of age?

A

5 months.

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36
Q

Which 3 drugs cause immature kidney function in neonates?

A

1- aminoglycosides.
2- penicillins.
3- diuretics.

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37
Q

List the 3 adverse effects that children are susceptible to?

A

1- suppression of growth.
2- early fusion of epiphysis > stunting of stature.
3- discoloring and deformation of teeth.

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38
Q

Which drugs cause suppression of growth in children?

A

Corticosteroids

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39
Q

Which drugs promote early fusion of epiphysis > stunting of stature in children?

A

Androgens

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40
Q

Which drugs get deposited in growing teeth and discolor/deform them in children?

A

Tetracyclines

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41
Q

Which dosage forms are difficult to administer in children?

A

1- solid dosage forms.
2- metered dose inhalers.

42
Q

Oral drugs can be absorbed slowly in which age group?

A

Elderly

43
Q

Why are drugs absorbed slowly in elderly patients?

A

Because of reduced blood flow and motility.

44
Q

Body fat increases in which age group?

A

Elderly

45
Q

Increased body fat in elderly acts as what?

A

Drug reservoir

46
Q

In elderly patients what happens to total body water levels?

A

Decreases

47
Q

What happens to water soluble drugs’s volume of distribution in elderly patients?

A

Decreases

48
Q

In elderly patients metabolism decreases with decline in which organ’s function?

A

Decline in Hepatic function and liver blood flow

49
Q

In elderly, drugs eliminated via first pass metabolism attain _____ concentrations in blood (____ the dose)

A

Higher concentrations.
Lower the dose.

50
Q

Renal blood flow, glomerular filtration and tubular secretion _____ with age.

A

Decline

51
Q

In elderly patients, there is eisk of adverse effects with drugs which are eliminated via which organ?

A

Kidneys

52
Q

_______ dose of drugs with narrow therapeutic range, in elderly?

A

Decrease

53
Q

Give examples of drugs with narrow therapeutic ranges which doses should be decreased in elderly patients?

A

Aminoglycosides, digoxin.

54
Q

In elderly, drugs that act on CNS, produce which type of response?

A

Exaggerated

55
Q

Sedatives and hypnotics have greater ______ effect, in elderly

A

Hangover

56
Q

In elderly, sedatives and hypnotics can have which effect (other than the hangover effect)?

A

They can depress respiration

57
Q

Response to drugs acting on ___ receptors _____ with age.

A

Beta receptors.
Decrease.

58
Q

Response to drugs acting on beta receptors decrease with age due to what?

A

Reduced number of receptors.

59
Q

Due to prostatism in elderly males, even mild _______ activity of drugs can worsen _____ ______ ______

A

Anticholinergic.
Bladder voiding difficulty.

60
Q

The incidence of adverse drug reactions increase after ___ years of age.

A

65

61
Q

List the 3 factors that increase the incidence of side effects with age?

A

1- increasing number of drugs that elderly need.
2- poor compliance.
3- bodily changes with aging.

62
Q

We should assume that new symptoms to be adverse drug effects in which age group?

A

Elderly

63
Q

Which group of drugs interfere with sexual function in males but not in females?

A

Antihypertensives

64
Q

Give examples of antihypertensive drugs that interfere with sexual function in males but not in females?

A

Clondine, methyldopa, beta-blockers, diuretics.

65
Q

Gynecomastia in males is a side effect of which drugs?

A

Ketoconazole, metoclopramide, cimetidine.

66
Q

Androgens are unacceptable to____ (men, women).
And estrogens are unacceptable to ______ (men, women)?

A

Androgens are unacceptable to women.
Estrogens are unacceptable to men.

67
Q

In women consideration must be given to which factors?

A

1- menstruation.
2- pregnancy.
3- lactation.

68
Q

Does reduced GIT motility during pregnancy has an effect on oral absorption?

A

It has no major effect on oral absorption.

69
Q

During pregnancy what happens to total body water?

A

Increases.

70
Q

What happens to the volume of distribution in pregnancy?

A

Increases

71
Q

In pregnancy, Plasma ____ level falls.
And ___ ____ _______ increases?

A

Plasma albumin decreases.
Alpha 1 acid glycoprotein increases.

72
Q

During pregnancy, The unbound fraction of ______ (acidic, basic) drugs increases, but that of _____ (acidic, basic) drugs decreases.

A

Acidic drugs increase.
Basic drugs decrease.

73
Q

Hepatic microsomal enzymes undergo what in pregnancy?

A

Induction.

74
Q

During pregnancy, renal blood flow _____ and there is _____ loss of renal excreted drugs.

A

Doubles.
More loss.

75
Q

Give an example of a renal excreted drug?

A

Penicillin.

76
Q

List the 5 categories of drugs according to their effect on fetus during pregnancy, and what does it mean?

A

1- A: no risk.
2- B: no evidence of risk in humans.
3- C: risk cannot be ruled out.
4- D: benefit may outweigh potential risk.
5- X: contraindicated.

77
Q

Shortening of bowel following gut surgery, can cause which effect of absorption?

A

Malabsorption.

78
Q

Give examples of drugs that get malasbsorped after bowel following gut surgery?

A

Iron, fat soluble vitamins, vit B12.

79
Q

Delayed gastric emptying during migraine ______ drug absorption.

A

Decreases.

80
Q

Low cardiac output ______ absorption from which routes?

A

Decrease.
IM and SC routes

81
Q

Which disease increases free (unbound) fraction of the drug?

A

Hypoalbuminemia

82
Q

List causes for hypoalbuminemia?

A

Burns, malnutrition, sepsis, renal and hepatic diseases.

83
Q

Hepatic diseases _____ metabolism of drugs= ____ concentration in blood.

A

Reduces.
High.

84
Q

Drug metabolism _____ in hyperthyroidism. And _____ in hypothyroidism.

A

Increases.
Decreases.

85
Q

Renal disease _____ elimination of drufs via kidneys. So, they can attain ____ levels.

A

Decreases.
Toxic.

86
Q

Asthmatic attacks can be precipitated by which group of drugs?

A

Beta blockers.

87
Q

MI predisposes to cardiac arrhythmias with which drug?

A

Digitalis.

88
Q

Brisk diuresis can precipitate mental changes in patients with impending of which disease?

A

Hepatic encephalopathy.

89
Q

Which group of drugs are less effective as antihypertensive in afro-Caribbean?

A

Beta-blockers.

90
Q

Indians tolerate which drug better than whites?

A

Thiacetazone.

91
Q

Atypical pesudocholinesterase results in what?

A

Prolonged succinylcholine apnea.

92
Q

G-6PD deficiency causes what with primaquine and other oxidizing drugs?

A

Hemolysis.

93
Q

Which drugs should we not give to people with G-6PD?

A

1- primaquine.
2- dapsone.
3- cotrimoxazole.
4- nalidixic acid.
5- methyldopa.
6- sulfasalazine.
7- nitrofurantoin.
8- sulfonamides.

94
Q

Which route of administration produces more rapid and more predictable drug action?

A

Parenteral

95
Q

Give an example of a drug that may have different uses through different routes?

A

Magnesium sulfate.
Orally: causes purgation (diarrhea).
Applied on sprained joints: decreases swelling.
Intravenously: CNS depression and hypotension.

96
Q

List 4 environmental factors that induce drug metabolism?

A

1- insecticides.
2- carcinogens.
3- tobacco smoke.
4- consumption of charcoal broiled meat.

97
Q

Give an example of 2 drugs that should be given at night?

A

1- hypnotics.
2- cholesterol.

98
Q

An inert substance which is given in the grab of a medicine?

A

Placebo

99
Q

Individual which are more suggestible and easily respond to a placebo are called what?

A

Placebo reactors.

100
Q

Placebo effect largely depends on what?

A

Physician- patient relationship.

101
Q

What is the opposite of placebo?

A

Nocebo.

FPT (17 decks)

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