pharmacologic principles

Question 1

pharmacokinetics

Answer 1

what the body does to drugs

Question 2

4 parts of pharmacokinetics

Answer 2

absorption
distribution
metabolism
excretion

Question 2

pharmacodynamics

Answer 2

study of what drugs do to the body

Question 3

pharmacodynamics target sites

Answer 3

receptors
ion channels
enzymes
carrier proteins

Question 4

absorption

Answer 4

method and rate at which drugs leave the site of administration

Question 5

distribution

Answer 5

occurs when the drug leaves the systemic circulation and enters the intersititium and cells

Question 6

drugs are redistributed in organs according to their

Answer 6

fat and protein content

Question 7

psychotropic drugs and fat/protein

Answer 7

most are lipophilic and highly protein bound

only unbound (free) portion is active

so low albumin levels like in malnutrition, aging etc, can experience toxicity due to inc free drug

Question 8

older adults and psychotropic drugs based on fat/protein

Answer 8

if high fate to lean body mass, like older adults, could have erratic amounts of active drug in system

Question 9

metabolism

Answer 9

process by which the drug becomes chemically altered in the body

Question 10

first pass metabolism

Answer 10

process by which the drug is metabolized by CYP450 enzymes in the intestines and liver prior to going to the systemic circulation

Question 11

elimination

Answer 11

process by which the drug is removed from the body

Question 12

half life

Answer 12

time needed to clear 50% of the drug from the plasma

also determines the dosing interval and length of time to reach steady state

Question 13

steady state

Answer 13

point at which the amount of drug eliminated between doses is approximately equal to the dose administered.

drugs usually administered once every half life to achieve steady state

takes about 5 half lives to achieve steady state and 5 to completely eliminate a drug

Question 14

what can alter pharmacokinetics

Answer 14

p450 can induce or inhibit

10+ whites
20% asians

1st pass in some p450s

enzyme inducers and inhibitors

liver and kidney dz

Question 15

CYP450 inhibitors

Answer 15

Buproprion
Clomipramine
Cimetidine
Clarithromycin Fluoroquinolones
Grapefruit
Ketoconazole
Nefazodone
SSRIs

Question 16

CYP450 inducers

Answer 16

Carbamazepine
Hypericum (St. John’s Wort)

Phenytoin
Phenobarbital
Tobacco

Question 17

types of pharmacodynamic receptor effects

Answer 17

agonist effect

inverse agonist effect

partial agonist effect

antagonist effect

Question 18

agonist effect

Answer 18

drug bunds to receptors and activates a biological response

Question 19

inverse agonist effect

Answer 19

drug causes the opposite effect of agonist, binds to same receptor

Question 20

partial agonist effect

Answer 20

drug does not fully activate the receptors

Question 21

antagonist effect

Answer 21

drug binds to receptor but does not activate a biological response

Question 22

NTs and ion channels cause

Answer 22

excitatory or inhibitory response

Question 23

excitatory response

Answer 23

depolarization

involves the opening of sodium and calcium channels so these ions can go into the cell

Question 24

inhibitory response

Answer 24

repolarization involves the opening of the chloride channels so chloride goes into the cell, potassium leaves, or both

Question 25

drug actions and enzymes

Answer 25

important for metabolism and chemical alteration ex: MAOI inhibit the action of a specific enzyme to inc availability of the NT

Question 26

drug action and carrier proteins or reuptake pumps

Answer 26

they transport NTs out of the synapse and back some drugs like SSRIs inhibit reuptake pumps to inc synaptic availability of the NT

Question 27

potency

Answer 27

relative dose required to achieve certain effects

Question 28

therapeutic index

Answer 28

ratio of median toxic dose to the median effective dose so high index is safer because the therapeutic dose and toxic dose are far apart

Question 29

tachyphylaxis

Answer 29

an acute dec in the therapeutic response

Question 30

PMHNP pharma mgmt process

Answer 30

1. make dx and identify target sx 2. consider the phase (acute, relapse, recurrence) 3. Assess pt and fam hx of rsponse to certain rx. 4. Assess motivation and misgivings 5. Identify poss drug drug interactions 6. identify cultural implications 7. Discuss risks and benefits 8. Document informed consent and pt understanding of target sx, benefits, risks, and alternatives 9. Monitor response and side effects.

Question 31

Rx categories commonly used to tx schizophrenia and other psychotic disorders

Answer 31

typical antipsychotics 2nd gen antipsychotics

Question 32

Rx categories commonly used to tx mood disorders and bipolar affective disorders

Answer 32

mood stabilizers

Question 33

Rx categories commonly used to tx mood disorders, unipolar affective disorders and depressive disorders

Answer 33

TCAs SSRIs MAOIs SNRIs and other agents

Question 34

Rx categories commonly used to tx anxiety disorders

Answer 34

Benzos anxiolytics other agents like BBs

Question 35

Rx categories commonly used to tx ADHD

Answer 35

stimulants other agents

Question 36

schedule 1 vs schedule 2 drugs

Answer 36

1 is nonmedicinal 2 is medicinal but still high abuse.

Question 37

possible risks of taking psychotropic rx during pregnancy

Answer 37

problems with appetite transient agitation or sedation premature labor drug d/c sx teratogenic of some psychotropics

Question 38

possible risks of NOT taking psychotropic rx during pregnancy

Answer 38

recurrence of sx adverse effects on mother infant bonding poor maternal self care

Question 39

pregnancy and benzos

Answer 39

floppy baby cleft palate

Question 40

pregnancy and carbamazepine (tegretol)

Answer 40

NT defects

Question 41

pregnancy and lithium

Answer 41

epstein anomaly

Question 42

pregnancy and depakote

Answer 42

NT defect (spina bifida) atrial septal defect cleft palate poss long term term dev deficits

Question 43

common rx that can induce depression

Answer 43

BB steroid interferon accutane some retrovirals antineoplastics benzos progesterone

Question 44

common rx that can induce mania

Answer 44

steroids antabuse isoniazid antidepressants in persons with bipolar disorder

Question 45

false pos drug test for amphetamines

Answer 45

stimulants wellbutrin prozac trazodone ranitidine nasal decongestants pseudofed

Question 46

false pos drug test for alcohol

Answer 46

valium

Question 47

false pos drug test for benzo

Answer 47

sertraline (zoloft)

Question 48

false pos drug test for cocaine

Answer 48

amoxicillin most abx NSAIDs

Question 49

false pos drug test for heroin

Answer 49

quinolones rifampin codeine poppy seeds

Question 50

false pos drug test for methadone or PCP

Answer 50

OTC cough meds like nyquil, dextromethorphan