RCP PHARM midterm Flashcards

Question

First-Pass effect

Answer 1

= If a drug is highly metabolized by the liver enzymes and is administered orally, most of the drug's activity is terminated in its passage through the liver before it ever reaches the general circulation and the rest of the body (…the concentration of a drug is greatly reduced before it reaches the systemic circulation)

Answer 2

=measure of the ability of the body to rid itself of the drug - kidneys

Answer 3

= To achieve a steady level of drug in the body, dosing must equal the rate of administration.

Answer 4

= The time required for the plasma concentration of a drug to decrease by one-half; a measure of how quickly a drug is eliminated from the body

Answer 5

=topical deposited agent, inhaled aerosol strictly affects the upper or lower airways - exemplified by a nasally inhaled vasoconstricting agent (decongestant) or by an inhaled bronchodilator aerosol

Answer 6

= inhaled aerosol for the drug to be absorbed and distributed in the blood - exemplified by the administration of inhaled zanamivir (Relenza) to treat influenza, inhaled morphine for pain control, or inhaled insulin aerosol for systemic control of diabetes

Answer 7

= Referring to the depth within the lung reached by particles - 50%-60% of the drugs impacts the mouth or oropharynx - 90% reaching the stomach - 10%-30% being delivered to lower respiratory tract (depending on delivery device) - Newer aerosol-generating devices are proving efficiency of 30% to 50% (more of the dose)

Answer 8

= perfectly efficient inhalation device would deliver all the drugs to the luing and none to the oropharynx or GI tract

Answer 9

= Proportion of drug available from the lung, out of the total systemically available drug

Answer 10

(Lung dose) / (lung dose + GI dose) - higher the ratio, the more efficient the aerosol drug delivery to the respiratory tract

Answer 11

= Describing the process by which particles deposit out of suspension to remain in the lung - An increase in mean residence time or tidal volume enhances drug deposition in lungs, while an increase in air flow decreases the mean residence time, resulting in the decrease of total deposition of drug particles

Answer 12

= Functional size and time of particle in the last five to six generations of airways (smaller bronchi and bronchioles), where air velocity is low - use of a “breath hold” can increase settling of particles

Answer 13

= decreasing intensity of response to drug over time

Answer 14

= allergy or immune-mediated reaction to a drug, which can be serious, requiring airway maintenance or ventilatory assistance

Answer 15

= rapid decrease in responsiveness to a drug

Answer 16

= a drug or chemical that binds to a corresponding receptor (has affinity) and “initiates” a cellular effect or response (has efficacy)

Answer 17

= a drug or chemical that is able to bind to a receptor (has affinity) but causes no response (zero efficacy) –> Inhibits or Blocks

Answer 18

= occurs when 2 drugs act on a target organ by different mechanism of action, and the effect of the drug pair is greater than the sum of the separate effects on the drugs

Answer 19

= proportion of a drug that reaches the systemic circulation

Answer 20

= Suspension of liquid or solid particles between 0.001 and 100 µm (micrometers; aka: Microns) in diameter in a carrier gas. Three main uses: - Humidification using bland aerosols - Improved mobilization and clearance of secretions - Delivery of aerosolized drugs to respiratory tract

Answer 21

MMAD= Mass median aerodynamic diameter - size of interest for pulmonary applications is in the range of 1 to 10 µm (micrometers; aka: Microns) Particles greater than 10um= useful to treat the nasopharyngeal and oropharyngeal regions Particles 5-10um= shift deposition in central airways or oropharyngeal - early airway generations (first six generations) Particles 2-5um= overall lower respiratory tract (larger airways to peripheral) - considered useful for the bronchoactive aerosols currently in use Particles 0.8-3um= Increased delivery to the lung parenchyma, including the terminal airways and alveolar region

Answer 22

= release aerosol only during inspiration because they are designed to increase aerosol drug delivery to patients by reducing loss of medication during expiration

Answer 23

= Small-reservoir, gas-powered (pneumatic) aerosol generators - Commonly used and exhibits a large amount of drug wastage - Pt compliance is directly proportional to convenience! - Use a jet-shearing principle for creation of an aerosol from the drug solution

Answer 24

1. Jet nebulizer with reservoir tube (only 10% to 20% of emitted dose is inhaled) 2. Jet nebulizer with collection bag/elastomeric ball 3. Breath-enhanced jet nebulizer 4. Breath-actuated jet nebulizer (aka: AeroEclipse)

Answer 25

= type of aerosol generator that converts liquid drug solutions or suspensions into aerosol

Answer 26

= Electrically powered devices - Operate on the piezoelectric principle - Capable of high output - Small, portable units that can operate on direct current (DC) voltage

Answer 27

= Excellent choice for drug delivery - Should be paired with right patient (pt) - Used spacer or valved-holding chamber to help overcome any limitations

Answer 28

= Main advantage is that the DPI is breath-actuated

Answer 29

SVN= Operate at 6-8 Lpm Breath-actuated nebulizer= inhalation flow rate close to 25 L/min USN= Rate of flow: 0-2 mL per min, or 0-120 mL per hour. MDI= Flow rates: between 30 and < 60 L/min ( flow rate of 60 L/min allows for optimum inhalation) DPI= Inspiratory flow rate between 30 and 90 L/min is needed!!

Answer 30

= one CFC molecule can destroy 100,000 molecules of statospheric ozone - removed from market/FDA banned them

Answer 31

= propellants that were nontoxic to the atmosphere and to the patient and that also had properties suitable for MDI aerosol generation 53%

Answer 32

SVNs advantages: - ability to aerosolized many drug solutions - ability to aerosolized drug mixtures - minimal cooperation or coordination required for inhalation - useful in very young or very old, debilitated patients, and patients in acute distress - effective with low inspiratory flows or volumes - normal breathing pattern can be used, and inspiratory pause - drug concentrations and dose can be modified SVNs disadvantages: - equipment required for use is expensive and cumbersome - treatment time lengthy - variability in performance - contamination possible - assembly and cleaning required - wet, cold spray - may deposit in eyes - power source needed

Answer 33

Ultrasonic nebulizer advantage: - small size - rapid nebulizer with short treatment time - smaller drug amounts with no diluent for filling volume - can be used during car travel or camping Ultrasonic nebulizer disadvantage: - high expense - fragility, lack of durability - requires electrical sours (either AC or DC) - possible degrading effect on drug must be determined

Answer 34

DPI advantages: - Small and portable - Short preparation and administration times - Breath actuation; no need for hand-breathing coordination - No inspiratory hold or head tilt needed - No CFC propellants (environmentally friendly) - No cold Freon effect to cause bronchoconstriction or inhibit full inspiration - Simple determination of remaining drug doses - Built-in dose counter DPI disadvantages: - Only a limited range of drugs is available to date - Patients (pts) are not as aware of the dose inhaled as with an MDI and may distrust delivery - Moderate to high inspiratory flow rates are needed for powder dispersion - Relatively high oropharyngeal impaction and deposition can occur - A device such as the Aerolizer is a single-dose device and must be loaded before each use - Vulnerable to ambient humidity or exhaled humidity into mouthpiece - Different DPI needed with different drugs - Easy for patient (pt) to confuse directions for use with other devices

Answer 35

MDI advantages: - pMDIs are portable, light, and compact - Drug delivery is efficient - Treatment time is short - They are easy to use - More than 100 doses are available - Fine particle sizes are available in hydrofluoroalkane (HFA) formulations - They are difficult to contaminate - No drug preparation is needed - It is possible to reproduce emitted doses MDI disadvantages: - Complex hand-breathing coordination, proper inhalation pattern, and breath hold are required - Drug concentrations and doses are fixed - Canister depletion is difficult to determine accurately - Reactions to the propellants may occur in small percentage of patients - High oropharyngeal impaction and loss occur if an extension device is not used - Foreign body aspiration of coins and debris from mouthpiece can occur

Answer 36

0.5 cc or 2.5mg (2500mg)

Answer 37

2 puffs or 0.2mg (200mg)

Answer 38

1 Kilogram (kg) → 10^3 → 1000 grams 1 Gram (g) → base unit → 1 gram 1 Milligram (mg) → 10^-3 → 0.001 gram 1 Microgram (mcg or ug) → 10^-6 → 0.000001 gram

Answer 39

1 Liter (L) → Base unit → 1 Liter 1 Centiliter (cL) → 10^-2 → 0.01L 1 Milliliter (mL) → 10^-3 → 0.001L

Answer 40

1 Meter (m) → Base unit → 1 meter 1 Centimeter (cm) →10^-2 → 0.01M 1 Millimeter (mm) → 10^-3 → 0.001M 1 Micrometer (um) → 10^-6 → 0.00001M

Answer 41

= system that includes the brain and spinal cord/controls voluntary and involuntary acts

Answer 42

= portion of the nervous system that includes sensory, sympathetic, and parasympathetic systems

Answer 43

= afferent neurons from heart, light, pressure, and pain receptors sending information from the peripheral to CNS

Answer 44

= under voluntary, conscious control and innervates skeletal muscles for motor actions

Answer 45

= involuntary/unconscious control mechanism of the body, sometimes said to control vegetative or visceral functions (sympathetic/parasympathetic)

Answer 46

= “Block” acetylcholine receptors * Atropine as a prototype parasympatholytic agent → blocks salivary secretion and causes dry mouth - Competitive antagonist - Bronchodilation - Preoperative drying of secretions - Antidiarrheal agent - Prevention of bed-wetting in children - Treatment (tx) of peptic ulcers, organophosphate poisoning, mushroom ingestion, bradycardia

Answer 47

= agent causing stimulation of the sympathetic nervous system

Answer 48

= agent blocking or inhibiting the effect of the sympathetic nervous system

Answer 49

= agent causing stimulation of the parasympathetic system

Answer 50

= agent blocking or inhibiting of the parasympathetic system

Answer 51

= (albuterol/levalbuterol) are indicated for relief of acute reversible airflow obstruction in asthma or other obstructive airway diseases (COPD)

Answer 52

= “controller”/indicated for maintenance of bronchodilation and control of bronchospasm and nocturnal symptoms in asthma or other obstructive diseases (COPD)

Answer 53

= generally classified as a bronchodilator with relatively weak bronchodilating effect - Methyl attachments at N-1 (nitrogen-1) and N-3 (nitrogen-3) enhances bronchodilation/increase side effects Effects associated with a range: - < 5(less than) μg/mL: No effects seen - 10 to 20 μg/mL: Therapeutic range - > 20 μg/mL: Nausea - > 30(greater than)ug/mL: Cardiac arrhythmias - 40 to 45 μg/mL: Seizures - Asthma management= 5 to 15 μg/mL - COPD management= 5 to 10 μg/mL Common side effects: - Gastric upset - Not recommended in pts with peptic ulcer or acute gastritis - Headache - Anxiety and nervousness - Diuresis

Answer 54

- Viral hepatitis - Left ventricular failure

Answer 55

= Additional methyl group at N-7 (nitrogen-7) decreases bronchodilation; causes CNS stimulation to breathe Side effects: - tachycardia - skeletal muscle stimulation

Answer 56

= secretion from surface goblet cells and submucosal glands composed of water, proteins, and glycosylated mucins (the secretion)

Answer 57

= purulent material in the airways

Answer 58

= expectorated phlegm that contains respiratory tract, oropharyngeal, nasopharyngeal secretions, bacteria, and products of inflammation (polymeric DNA/actin)

Answer 59

1. Yellow mucus= infection 2. Green mucus= serious infection 3. White= irritation/allergy 4. Brown= blood in nose/inhalation of dust or particles (common in smokers)

Answer 60

= medications that degrade polymers in secretions

Answer 61

= medications meant to increase the volume or hydration of airway secretions

Answer 62

= any medication or drugs that have an effect on mucus secretions (mucolytic, expectorant, mucospissic, mucoregulatory, mucokinetic)

Answer 63

= airway clearance for theory of CP - Irritant to induce cough - Can improve mucociliary transport and lung function - May increase FEV1 in patients - Alternate effect is an acute decrease in FEV1 - Unpleasant taste; coughing may make it unsuitable for long-term use

Answer 64

= used to prevent Liver damage from acetaminophen overdose and the contrast used in CT Scans - Treatment of conditions associated with secretions of viscous mucus - As an antidote for Acetaminophen (Tylenol) overdose to reduce Hepatic (Liver) injury as well as contrast used in CT scans. - NAC disrupts the structure of the mucus polymer by substituting free thiol (sulfhydryl) groups for disulfide bonds connecting mucin proteins Hazards: - Bronchospasm (especially in Asthmatic pts)= Less common with 10% solution! - May cause nausea or vomiting= Smell - hydrogen sulfide - Mechanical obstruction of airway

Answer 65

= To preserve or improve lung function in CF while reducing the frequency and severity of respiratory infections by improving secretion clearance - First approved mucoactive agent for the tx of CF - For clearance of purulent secretions - To reduce frequency of respiratory infections requiring parenteral Antibiotics (Abx) - To improve or preserve pulmonary function Mode of action (when given by aerosol): - Reduces viscosity and adhesivity by breaking down DNA Dose and administration: - Available as single-use ampule - 2.5 mg of drug in 2.5 mL of clear, colorless solution - Should be refrigerated and protected from light Common side effects: - Voice alteration - Pharyngitis - Laryngitis - Rash - Chest pain (CP) - Conjunctivitis

Answer 66

= physical principle describing and quantifying the relationship between the internal pressure of a drop or bubble, the amount of surface tension, and the radius of the drop or bubble

Answer 67

Pressure= (4 x surface tension)/ radius

Answer 68

Pressure= (2 x surface tension)/ radius

Answer 69

= a surface active agent that reduces surface tension (alveoli) (also called detergents)

Answer 70

= surfactant preparations from “outside” the patient's own body; can be obtained from other humans, from animals, or by laboratory synthesis. - replace missing pulmonary surfactant in respiratory distress syndrome (RDS) of newborns

Answer 71

= kind of surfactant occurs naturally in the body and is produced by alveolar type II cells

Answer 72

= Premature babies often suffer AOP as a physiological consequence of an immature respiratory system. - pauses breathing for more than 15 to 20 seconds. or. pauses breathing for less than 15 seconds, but has a slow heart rate or low oxygen level\ - Caffeine citrate penetrates cerebrospinal fluid (CSF) better and has a higher therapeutic index with fewer side effects compared with theophylline - It appears to be more common during sleep, especially during active sleep — a period when your baby has rapid eye movement (REM) while sleeping - Apnea may be followed by bradycardia (decreased heart rate) - With bradycardia, when your baby’s breathing slows, the heart rate also slows - A common term for apnea with bradycardia is "As and Bs.“

Answer 73

= Clinically indicated for tx or prevention of RDS in newborns - Prophylactic treatment - Beractant (survanta)/Calfactant (Infasurf) → Modified natural surfactant from calf lung (bovine) - Prevention of RDS in very-low-birth-weight infants - Infants with higher birth weights, but with evidence of immature lungs - Infants who are at risk for developing RDS - Rescue treatment - Retroactive or “rescue” treatment of infants who have developed RDS - Basic problem in RDS is lack of pulmonary surfactant as a result of lung immaturity resulting in high surface tension in the liquid-lined, gas-filled alveoli (Without Exogenous Surfactant, increased ventilating pressure is required to expand the alveoli during inspiration)

Answer 74

Time course and disposition of a drug in the body based on its absorption

Answer 75

Mechanisms of drug action by which a drug molecule causes its effect in the body

Answer 76

= asks the patient to provide narrative information THOUGHT PROVOKING Begin the interview, introduce new questions, and gather further information whenever the patient introduces a new topic Unbiased Examiner stops and listens to patients concerns (long answers) “Tell me about it” “Anything else?” type of questions examiners ask (build and enhance rapport)