Pharmacokinetics Flashcards

1
Q

ADME

A

Absorption
Distribution
Metabolism
Excretion/Elimination

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2
Q

bioavailability

A

fraction of the administered drug enteric systemic circulation

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3
Q

3 types of bypass barriers to bioavailability

A

physical
chemical
biological

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4
Q

factors affecting bioavailablity

A

route of administration
formulation of the drug

drug characteristics like lipophilicity, molecular weight and ionization

patient characteristics like GI enzymes, pH, presence of food, hepatic metabolism

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5
Q

Advantages and Disadvantages of enteral administration

A

Advantages: Simple, self administration, painless, no infection

Disadvantages: Harsh GI environment, first pass metabolism, slow delivery to site

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6
Q

first pass metabolism

A

drug PO to GI tract

from there through capillary network to hepatic portal vein all of which is called the hepatic portal system

from there to liver that metabolizes drugs and there to general (systemic) circulation

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7
Q

Advantages and Disadvantages of parenteral administration

A

Advantages: rapid delivery, highest bioavailability, no first pass metabolism or GI environment

Disadvantages: infection, pain, poss need skilled personnel, irreversible

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8
Q

4 types of parenteral administration and their characteristics

A

SubQ: slower onset, small volumes

IM: oil based drugs

IV: reaches target organ fast, amount of drug not limited

intrathecal: reaches target organ fast, bypass BBB

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9
Q

Advantages and Disadvantages of mucous membrane administration

A

Advantages: rapid delivery, no first pass or GI environment, painless, low infection chance, direct delivery to affected tissue

disadvantages: few rx can be administered this way

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10
Q

Advantages and Disadvantages of transdermal administration

A

Advantages: convenient, prolonged continuous admin, no 1st pass or GI

Disadvantages: need highly lipophilic rx, slow delivery to site of pharmacologic action, may be irritating

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11
Q

characteristic of organ and tissue distribution

A

organs and tissues vary in capacity to take up rx and in proportion of systemic blood flow

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12
Q

volume of distribution definition and equation

A

fluid volume required to contain the total amount of absorbed drug in the body at a uniform concentration equivalent to that in the plasma at steady state

If you have 2 equal potent drugs but one is more highly distributed youll need a higher initial dose to achieve a therapeutic plasma concentration than that is less highly distributed

Vd = Dose/[Drug]plasma

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13
Q

plasma protein binding and how it works with drugs

A

drugs bind through hydrophobic and electrostatic forces

Can change how much of a drug reaches the target where the drug just stays in circulation and doesnt arrive at destination in the body

Albumin is a marker of protein in blood, if low then less bound and free concentration may be higher which can lead to toxicity if too much free/unbound

Note highly bound protein drugs could compete for binding and push each other off causing a drug interaction which could mean higher free concentration of one of the drugs

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14
Q

biotransformation

A

the key to metabolism

Drug molecules are transformed into other molecules, some are therapeutic and some are not, some could be toxic

Example: Tylenol usual metabolic pathway could be overwhelmed by alcohol and shifted into a diff pathway that leads to a toxic metabolite

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15
Q

Liver metabolism phase 1

A

transform drugs into more hydrophilic metabolites

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16
Q

liver metabolism phase 2

A

modify compounds through attaching hydrophilic groups

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17
Q

examples of the liver metabolism phase 1

A
  • Add or expose polar functional groups
  • Cytochrome P450 enzyme oxidations
  • P450 independent oxidations
  • Alcohol dehydrogenation
  • Monoamine oxidase
  • Hydrolysis
  • Reductions
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18
Q

examples of the liver metabolism phase 2

A
  • Glucuronidation
  • Acetylation
  • N-Methylation
  • O-Methylation
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19
Q

Induction and inhibition in metabolism

A

CYP 450 enzymes can be induced or inhibited incidentally or deliberately by drugs, environmental pollutants, industrial chemicals

affects many psychotropics

20
Q

BBB

A

i. Specialized tight junctions to prevent circ to cerebral
ii. To pass need hydrophobic or use transport proteins
iii. Could do intrathecal drug infusion

21
Q

Example of plasma protein binding

A

Ex: valproic acid

For patients with low plasma proteins they could have total serum VPA normal but free concentration could be elevated and lead to toxicity

22
Q

What contains the most metabolic enzymes of any tissue?

A

liver

23
Q

What is the goal of liver in metabolism

A

to make molecules more lipophilic so they can be eliminated from the body

This is done in phase 1 and 2

24
Q

p450 refers to

A

450 nanometer absorption peak characteristics of these heme proteins when they are treated with carbon monoxide

25
Q

the metabolic pathway described in phase 1 and 2 in the liver is different for every

A

drug

some are subject to genetic variation or being induced or inhibited by external influences

26
Q

CYP3A4 inhibitors

A

-azoles
grapefruit
marijuana
ritonavir

27
Q

CYP3A4 inducers

A

carbamazepine

28
Q

CYP2D6 inhibitors

A

fluoxetine
paroxetine
sertraline
buproprion
duloxetine
propranolol

29
Q

CYP2D6 inducers

A

not inducible but subject to genetic polymorphisms

30
Q

CYP2C19 inducers

A

omeprazole/PPIs
fluoxetine
fluconazole
fluvoxamine

31
Q

CYP2C19 inhibitors

A

carbamazepine
phenytoin
st johns wort

32
Q

CYP2C9 inducers

A

carbamazepine
phenytoin

33
Q

CYP2C9 inhibitors

A

fluoxetine
fluconazole
marijuana
gemfibrozil

34
Q

CYP1A2 inducers

A

smoking
phenytoin
carbamazepine

35
Q

CYP1A2 inhibitors

A

ciprofloxacin
fluvoxamine
acyclovir

36
Q

CYP 450 enzymes can be induced and inhibited incidentally or deliberately by

A

drugs
environmental pollutants
industrial chemicals

37
Q

4 factors that affect metabolism

A

pharmacogenomics such as polymorphisms (CYP 45o enzymes, cholinesterase, phase 2 acetylation)

Age and sex. Note aging affects CYP 450 enzymes

Diet and environment like grapefruit juice and smoking

Disease of liver, cardiac, thyroid

38
Q

drug form filtered into the renal tubule

A

free drug

39
Q

4 major parts of renal excretion

A

1) Glomerular filtration
2) Tubular reabsorption
3) Tubular secretion
4) Urine

40
Q

Biliary excretion is

A

enterohepatic circulation

drugs secreted into the bile duct enter the GI tract and may be reabsorbed into the small intestine and retained in the systemic circulation

example: oral contraception

41
Q

clearance =

A

metabolism + excretion/(drug) plasma

42
Q

clearance is

A

It’s the rate of elimination of the drug from the body relative to the concentration of the drug in the plasma expressed in units of volume over time

43
Q

half life is

A

Amount of time over which drug concentration in plasma decreases
to one-half its original value

Basically the amount of drug that is metabolized/excreted in a given unit of time is directly proportional to the concentration of the drug

assuming this proportional relationship the half life of a rx is dependent on the volume of distribution and the clearance of the drug

44
Q

factors that affect half life r/t distribution

A

aging
obesity
pathologic fluid

45
Q

factors that affect half life r/t drug clearance

A

CYP 450 induction/inhibition
hepatic failure
cardiac failure
renal failure

46
Q

steady state

A

when rate of drug input and output are equal

point of equilibrium between tissue distribution and plasma concentrations of the drug

affected by bioavailability, clearance and dosing interval

it takes about 4-5 half lives to achieve steady state

47
Q

loading dose

A

Distribution causes the initial plasma drug concentration to decrease

Loading doses can be used to compensate for distribution into the tissues

Maintenance doses only need to replace the drug lost to elimination