Pharmacodynamics

Question 1

Therapeutic window/index

Answer 1

relationship between beneficial and adverse effects

Question 2

Wide therapeutic window

Answer 2

generally considered safer

Question 3

Narrow therapeutic window

Answer 3

closer monitoring and higher rate of dangerous toxicities

Question 4

Minimal effective concentration

Answer 4

all drugs have a minimum blood level below which they are ineffective

Question 5

Maximal safe concentration

Answer 5

max level above which serious side effects and toxicities may occur

Question 6

Toxicity

Answer 6

interchangeably with adverse drug reaction or side effects. Refers to more serious or unexpected ADRS that tend to occur above the maximal safe concentration or when drug is not monitored properly

Question 7

Steady State

Answer 7

drug input equals drug output
stabilize/plateau
4-5 half lives to occur

Question 8

Onset of action

Answer 8

when the drug begins to take effect, depends on drug’s mechanism of action and long that takes to become physiologically visible

Question 9

Duration of action

Answer 9

length of time a drug can be expected to exhibit its pharmacological effects

Question 10

Receptor theory

Answer 10

drug produces an effect by combining with some specific molecular constituent (receptor). The function of the receptor or cell is modified to produce a measurable effect

Question 11

Agonist

Answer 11

drug that mimics some natural compound by binding with the receptor and stimulating some cellular response

Question 12

Antagonist

Answer 12

a drug that binds with a receptor, blocks the receptor from stimulation, and prevents it from being triggered normally

Question 13

Affinity

Answer 13

strength of attraction between a drug and its receptor; describes the tightness of the bond

Question 14

Selectivity

Answer 14

refers to the degree to which a drug acts upon one site relative to all possible sites

Question 15

Alteration of Enzyme Activity

Answer 15

altering the activity of the various body enzymes and thus increasing or decreasing production of neurotransmitters, hormones, etc.

Question 16

Adverse drug reaction

Answer 16

broad term that can encompass a variety of types of reactions

Question 17

Adverse effect/side effect

Answer 17

undesired pharmacological effect of a drug

Question 18

Exaggerated drug response

Answer 18

for example, a blood pressure medication that unexpectedly bottoms out the patients blood pressure or a sedative that makes the patient unresponsive or sedated for an extended period of time

Question 19

Allergic reaction

Answer 19

immune system mediated, patient is usually allergic to all drugs of that same chemical class

Question 20

Pseudoallergic drug reactions

Answer 20

reactions resemble allergic reactions but they are not mediated by the immune system; there is no antibody production

Question 21

Toxicity

Answer 21

often used interchangeably with ADR or side effect. Toxicity refers to serious or unexpected ADRs that occur above the therapeutic window or when not monitored properly

Question 22

Intolerance

Answer 22

term used to describe any type of ADR that the patient feels intolerable thus limiting the drug’s usefulness or acceptance to the patient

Question 23

High risk drugs

Answer 23

include those with a narrow therapeutic window, high incidence of side effect, high incidence of allergic reactions

Question 24

High risk patients

Answer 24

include patients who would be least likely to tolerate ADRs or loss of efficacy. (neonates/infants, elderly, frail, & malnourished; patients with difficult to control diabetes, arrhythmias, heart disease, & epilepsy

Question 25

Immediate Allergic Reactions

Answer 25

IgE mediated activation of mast cells and basophils; generally begins within 2 hours of exposure. High potential to progress to anaphylaxis

Question 26

Delayed allergic reaction

Answer 26

begins 6 hrs to days after exposure

Question 27

Stevens-Johnson Syndrome & Toxic Epidermal Necrolysis (TEN)

Answer 27

blistering rash with prodromal fever & influenza-like symptoms and sloughing of skin

Question 28

Pseudo-allergic Drug reactions

Answer 28

ADRS with symptoms that mimic drug allergy

Question 29

Intolerance

Answer 29

broad term for any ADR that limits usefulness or acceptance of the drug by the patient

Question 30

Tolerance

Answer 30

higher doses of a drug are needed over time to elicit the same response

Question 31

Physical Dependence

Answer 31

the drug is needed to function normally, stopping the drug will cause withdrawal symptoms

Question 32

Withdrawal symptoms

Answer 32

usually the opposite effects of the drug

Question 33

Psychological dependence or substance use disorder

Answer 33

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

Question 34

Categories of Drug Interactions

Answer 34

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

Question 35

1) Altered GI Absorption

Answer 35

Altered Intestinal Flora-impact the absorption and metabolism of orally ingested drugs

Question 36

1) Altered GI Absorption (altered pH)

Answer 36

more or less ionized, some drugs absorb better in an acidic

Question 37

1) Altered GI Absorption (drug induced mucosal damage)

Answer 37

drugs that tear up the gut lining can reduce absorption of medications and nutrients leading to nourishment (chemotherapy)

Question 38

1) Altered GI Absorption (chelation)

Answer 38

Chelation interactions is a form of strong chemical bonding of two substances that reduces their solubility and thus prevents oral absorption

Question 39

1) Altered GI Absorption

Answer 39

effects of food-1 hr before food or 2 hrs after

Question 40

1) Altered GI Absorption (transport protein interactions)

Answer 40

Transport Protein Interactions - multiple drugs competing PGPs may reduce PGP binding of one or both drugs (maybe be inhibitors or inducers of PGPs thus increasing or decreasing absorption)

Question 41

2) Protein Displacement

Answer 41

drugs bound to plasma proteins are pharmacologically inactive & exist in equilibrium between bound and unbound. there are a limited number of binding sites available on serum albumin

Question 42

3) Altered Metabolism is

Answer 42

concurrent administration of two drugs metabolized by the same liver enzyme system can increase or decrease in blood levels of one or both drugs; most of these interactions involve the cytochrome p450 system

Question 43

3) Altered Metabolism (enzyme induction)

Answer 43

caused when one drug induces or speeds up the shared metabolic pathway

Question 44

3) Altered Metabolism (enzyme inhibition)

Answer 44

most common type of drug interaction of all the different types of drug interactions. Enzyme inhibition occurs when two or more drugs create a "traffic jam"

Question 45

Cytochrome p450 System

Answer 45

Inducers: drugs that increase metabolism Inhibitors: drugs that reduce metabolism Substrates: drugs that are affected by other drugs that either induce or inhibit

Question 46

Pharmacogenetics: Ultra metabolizer

Answer 46

has higher than normal levels of certain isozymes = faster than expected drug metabolism

Question 47

Pharmacogenetics: Extensive metabolizer

Answer 47

has normally functioning and normal levels of that isozyme and thus, metabolize drugs at expected rates

Question 48

Pharmacogenetics: Poor metabolizer

Answer 48

abnormally low levels of certain isozymes

Question 49

4) Synergistic/Antagonistic Drug Interactions

Answer 49

occurs when the effects of two drugs together are greater/worse than would have been predicted from each of their effects alone

Question 50

Strategies to Prevent Drug Interactions

Answer 50

perform complete medication history be familiar with most common drug interactions avoid unnecessary drugs separate chelating or pH interacting rugs select non interacting medication

Question 51

Inter patient Variability in Drug Response

Answer 51

``` Pharmokinetic differences allergy history age weight and body size disease states genetics polypharmacy complaince ```

Question 52

Medication non adherence

Answer 52

degree to which a patient follows a treatment regimen "America's other drug problem" just as high in pediatric population