Test 1 Flashcards
The development of phocomelia in children whose mothers used thalidomide to assist sleep during pregnancy resulted in the passage of
Kefauver-Harris Amendment to the Food, Drug, and Cosmetic Act
The first apothecare opened in which city?
Baghdad
The first inter-professional work agreement was between
apothecaries and physicians
The physician who first described acute and chronic illnesses was
Thomas Sydenham
Until the 20th century, virtually all medications were derived from which source?
Plants
Who first “proved” scientifically that the leaves of the foxglove plant were therapeutic in treating patients with heart failure?
William Withering
The incidence of adverse drug reactions documented in US hospitals in 1998 was
6.7%
Which drug-related legislation was enacted due to the contamination of smallpox and diphtheria vaccines by tetanus organisms, killing some children?
Biologics Control Act of 1902
Who noted that newer antibiotics were needed because of PCN’s “Achilles heel”?
Alexander Fleming
Who said: “with regard to infection, I say where there is infection, the fault is in those who have charge of the disease, not in the disease?”
Florence Nightengale
Within the catastrophic phase of the Standardized Medicare Part D plan, the patient pays what percentage of drug costs?
5%
The initial out-of-pocket amount each patient who has enrolled in a Medicare Part D plan in 2014 will pay for drugs is
$310
This was the only federal program that had cost less than the projected amount anticipated
Medicare Part D
The lack of an adequate profit margin has inhibited many drug manufacturers from producing…
generic drugs
During the first phase of the Medicare Part D plan, the patient pays what percentage of drug costs up to a maximum?
100%
The Medicare Modernization Act that started the Medicare Part D plan was signed into law on
2003
substance not normally found in the body
xenobiotic
The drug with which a metabolic enzyme, transporter, or receptor is altered, moved, or changes physiological response.
substrate
examples of prodrug
codeine, enalapril, and tamoxifen
The prodrug codeine is not active until it is metabolized into
morphine
provides protection by pumping xenobiotics out of cells
P-gp
An efflux pump that uses ATP to remove the drug from the cell and out of the body.
P-gp
major substrate of P-gp is
digoxin
When drugs inhibit P-gp function, what will happen to digoxin levels?
will rise
Drugs that induce P-gp function
rifampin and St. John’s Wort
CYP3A enzyme is mostly found in
liver and small intestine
CYP enzyme and drug metabolism
many drugs can be metabolized by more than one CYP enzyme, resulting in a patient’s variable responses to meds.
enzyme used to metabolize dextromethorphan
CYP2D6
Bergamottin, found in grapefruit juice, is an inhibitor of
CYP34A
Enzyme that metabolizes NSAIDS
CYP2C9
Enzyme that metabolizes oral meds for type 2 diabetes
CYP2C9
Enzyme that metabolizes angiotensin II receptor blockers
CYP2C9
Enzyme that metabolizes the active form of warfarin
CYP2C9
in early course of therapy, phenytoin is a..
substrate and an inhibitor of CYP2C9
ADRs are rarely fully known during
phase 3 clinical trials
If a patient is an extensive metabolizer of a drug and given another drug that inhibits the metabolism, then the dose of the needed medication would need to be
decreased- concentration in blood will increase, causing a lower dose needed
inhibition of the metabolism of this drug would make it ineffective in relieving symptoms
codeine
Codeine
prodrug and CYP2D6
hydrocodone (Lortab)
prodrug and CYP2D6
Enalapril (vasotec)
prodrug
this CYP450 enzyme metabolizes most drugs in use today
CYP34A
The safety profile of a new drug is determine during which phase of new drug process
Post marketing phase 4
CYP1A2 inhibitor that is available OTC and cause drug interaction
cimetidine (Tagamet)
phenytoin later in course of therapy is a
inducer of CYP2C9
The effect of phenytoin is most notable when..
more than one inhibitor of CYP2C9 is used simultaneously.
common interacting drugs with narrow therapeutic index drugs
amiodarone, clarithromycin, and azole antifungals
inhibitors g-pg function
clarithromycin, erythromycin, amiodarone, cardizem, cardene, verapamil, felopdipine
Meds metabolized by CYP34A
antihistamines, antibiotics, lipid-lowering drugs, antihypertensives, protease inhibitors, and azole antifungals
Meds metabolized by CYP2D6
SSRIs, pain meds, beta blockers
Meds metabolized by CYP2C19
proton pump inhibitors, NSAIDs, beta blockers
Meds metabolized by CYP2C9
NSAIDs, type 2 diabetes, angiotensin II blockers, active warfarin
Meds metabolized by CYP1A2
acetaminophen, warfarin, theophylline, caffeine, Valium
Not included in the Medicare Part D total cost of drugs during plan year
monthly premiums
Who assured that only physicians could prescribed meds in the US?
Hubert Humphrey in 1951
When did written prescriptions first appear?
In the 18th century by apothecaries
Where did apothecaries first write written prescriptions?
Europe
special populations
geriatric, pregnant women, and the elderly
legislation that helped develop drugs fro less common illnesses like HIV, Huntingtons, and ALS
Orphan Drug Act of 1983
what the body does to the drug
pharmacokinetics
pharmacokinetics involes
absorption, distribution, metabolism, and elimination
how the drug influences the body
phamacodynamics
The official name assigned by the manufacturer with approval of the US adopted name council
Generic name
The patent name given to the med by the company marketing the drug
Trade name
Which of the drug names can vary?
Trade name
Drug leaving the site from which it was administered
absorption
amount of an administered drug that reaches its final site of action
bioavailability
Indicates that two drugs contain the same active ingredients, are identical in strength, dosage, and route.
bioequivalence
Bioequivalence indicates that a generic drug will have a variability in bioavailability of…
+ or - 20%
Bioavailability is most important for drugs that have
a narrow therapeutic index or window
The four factors governing drug absorption are
drug characteristics, routes of administration, blood flow, and cell membrane characteristics.
Non-ionized drugs are ___ soluble than ionized drugs
more
Non ionized drugs are
lipophilic drugs
Acidic drugs become this in the acidic environment of the stomach
non-ionized
interactions between food and drugs interfere with which phase of pharmacokinetics?
absorption
Non-ionic drugs with high lipid solubility are ideally suited for which route?
sublingual
Meds passed orally pass through liver and become extensively metabolized causing little or no drug to remain active.
First-pass metabolism
This type of skin will absorb drugs more readily
non-intact skin
Does first pass occur with meds taken rectally?
Yes but less first pass metabolism
routes that avoid first-pass
sublingual and inhalation
Proteins embedded in the lipid bilayer.
Integral proteins
Proteins located at one surface or another and bound to an integral protein.
Peripheral proteins
What kinds of molecules are moved by ABC pumps?
small molecules, phospholipids, and lipophilic drugs
P class pumps use ATP to move __ across cell membranes
ions
AV class pumps move ___ across cell membranes
protons
Two phases of distribution phase
movement into bloodstream and delivery of drug into tissue.
Description of the amount of space into which a drug can be spread or distrubted
volume of distribution
If a drug has a large volume of distribution, then it is found…
throughout the body
This drug has the highest volume of distribution
lipophilic
These drugs will accumulate in geriatric patients due to less muscle
lipophilic
If a geriatric patient loses weight, what can happen if taking lipophilic drugs?
The patient is losing muscle and gaining more fat, placing them at risk of accumulation and toxicity.
