Pharmacy Foundations

Question 1

What are the two subtypes of the peripheral nervous system?

Answer 1

Somatic (Voluntary) and Autonomic (Involuntary)

Question 2

What type of neurotransmitter does the somatic nervous system send? What receptor does it act on?

Answer 2

Acetylcholine, Nicotinic receptors

Question 3

What are the two divisions of the autonomic nervous system?

Answer 3

Parasympathetic and sympathetic

Question 4

What physiological responses occur when the parasympathetic system is activated?

Answer 4

Rest and Digest (SLUDD):

Salivation, Lacrimation, Urination, Diarrhea/Defecation, Digestion

Question 5

What physiological response occurs when the sympathetic system is activated

Answer 5

Fight of Flight:

Increased HR, BP, pupil dilation, glucose dilation, bronchodilation.

Question 6

What neurotransmitters are used and what receptors are acted on in the parasympathetic system?

Answer 6

Acetylcholine acts on the nicotinic receptor to release more acetylcholine to activate the muscarinic receptor.

Question 7

What neurotransmitters are used and what receptors are acted on in the sympathetic system?

Answer 7

Acetylcholine act on the nicotinic receptor to release norepinephrine and epinephrine on to the adrenergic receptors (Alpha-1, Beta-1, and Beta-2 receptors)

Question 8

Activation of the Alpha-1 Receptors result in what physiologic response?

Answer 8

Smooth muscle (including blood vessel) constriction/ Vasoconstriction

Question 9

Beta-1 activation results in what physiological response?

Answer 9

Increased heart rate, contraction and cardiac output

Question 10

Beta-2 activation results in what physiologic response?

Answer 10

Bronchodilation

Question 11

What neurotransmitters do monoamine oxidase inhibitors break down?

Answer 11

Dopamine, norepinephrine, serotonin, tyramine

Question 12

About how long should the wash out period be between use of an MAO inhibitor and a drug that increases neurotransmitters (i.e. SSRI)?

Answer 12

~14 days

Question 13

What is pharmacodynamics?

Answer 13

The effect or change that a drug has on some type of organism (i.e. bacteria, human). “What the drug does to the body”

Question 14

What is pharmacokinetics?

Answer 14

The effect the body has on the drug: ADME; “What the body does to the drug”

Question 15

What is ADME?

Answer 15

Absorption
Distribution
Metabolism
Excretion

Question 16

How can we increase the serum concentration of penicillin to allow it to cross the BBB?

Answer 16

Providing Probenecid will block the renal excretion of penicillin.

Question 17

How do you treat salicylate (Aspirin) overdoses?

Answer 17

Give IV Sodium Bicarbonate to alkalinize the urine. This causes salicylate to become ionized.

Question 18

What is phase I metabolism?

Answer 18

Chemical reactions that change the parent molecule into a metabolite. Mostly oxidation reactions but can be hydrolysis or reduction reactions. This step primarily inactivates the compound.

Question 19

What is phase II metabolism?

Answer 19

Phase II metabolism are conjugation reactions that may increase water solubility to help facilitate excretion. (i.e. glucuronidation)

Question 20

What are the 6 main CYP 450 enzymes that metabolize most drugs?

Answer 20

CYP 2C8/9, 
3A4, 
2E1, 
2D6, 
1A2

Question 21

What drugs are strong (big) inducers?

Answer 21

PS CORPS:
Phenytoin
Smoking
Carbamazepine (also an autoinducer)
Oxcarbazepine (and eslicarbazepine)
Rifampin (and rifabutin, rifapentine)
Phenobarbital
St. John's Wort

Question 22

What drugs are known to be big (strong) inhibitors?

Answer 22

G <3 Pacman
Grapefruit
Protease Inhibitors
Azole Antifungals 
Cyclosporine/Cimetidine/Cobicistat
Macrolides
Amiodarone (and dronedarone)
Non-DHP CCB (Diltiazem and verapamil)

Question 23

How long does it take for the full effect of induction to be seen? How long could it take for the effects of induction to disappear?

Answer 23

Up to 4 weeks as additional enzyme production must be built up; it may take 2-4 weeks for the induction effects to disappear completely based on the enzyme’s half life (degradation)

Question 24

What is the purpose of the P-glycoprotein pump?

Answer 24

They act as efflux pumps to pump out foreign substances out of the body and into the gut for excretion.

Question 25

What is enterohepatic recycling?

Answer 25

Already metabolized drugs that is reabsorbed from the gut, enter the portal vein and travel back to liver. Results in increased duration of action of many drugs.