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Y3 Principles of Pharmacology > Units 1-8 principles > Flashcards

Units 1-8 principles Flashcards

1
Q

Drugs either work via … or …

A

Receptors: agonist; antagonist
Enzymes: ACEi

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2
Q

When do pharmacodynamic interactions happen

A

2 drugs work via different pathways to have the same effect

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3
Q

Principles of pharmacokinetics (ADME)

A

Absorption
Distribution
Metabolism
Elimination

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4
Q

Lipophilic drugs are distributed

A

Around the whole body

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5
Q

Hydrophilic drugs

A

Stay in the plasma

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6
Q

The most important enzyme involved in metabolism

A

P450 system

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7
Q

The two phases of metabolising drugs from lipophilic to hydrophilic in the liver

A

Phase I - oxidation/reduction/hydrolysis

Phase II - conjugation with glucuronide/sulphate

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8
Q

Inducers of P450 system

A 
Carbamazepine 
Phenytoin 
Rifampicin 
Chronic alcohol intake 
Barbecued meat 
St John’s Wort
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9
Q

Inhibitors of P450 system

A 
Erythromycin 
Ciprofloxacin 
Miconazole 
Sodium valproate 
Grapefruit juice 
Cranberry juice
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10
Q

Which type of drugs are excreted unchanged

A

Hydrophilic

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11
Q

Drugs that are metabolised into active metabolites and may accumulate in liver failure

A

Opioids

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12
Q

Therapeutic window

A

Range in which the drug is clinically effective without causing toxic side effects

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13
Q

Drug half-life

A

Time taken for plasma concentration of a drug to decrease to 50% of its original value

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14
Q

A steady state of a drug is reached after how many half-lives

A

4

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15
Q

Why is a loading dose necessary for drugs with a long half-life

A

Drugs with long half-lives take longer to reach steady state

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16
Q

4 cases of drug monitoring

A
  • cannot predict how much drug px requires
  • narrow therapeutic window
  • if symptoms are due to side effects
  • concern that px is not taken the drug
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17
Q

Examples of monitored drugs

A 
Digoxin 
Lithium 
Carbamazepine 
Phenytoin 
Theophylline 
Certain IV antimicrobials
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18
Q

Pros oral

A

Convenience

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19
Q

Cons oral

A
  • nauseated px
  • NBM/swallowing problems
  • first pass metabolism
  • compliance
  • time to reach steady state
20
Q

Pros rectal, sublingual & buccal

A
  • avoids first pass metabolism
  • good for nauseated/NBM
  • no need for IV access
  • topical tx
21
Q

Cons rectal, sublingual & buccal

A

Local irritation

22
Q

Pros IV

A
  • fast
  • reliable
  • bolus or infusion
23
Q

Cons IV

A
  • requires IV access
  • drugs reactions common
  • avoid in IVDUs
24
Q

Pros IM

A
  • fast
  • reliable
  • no IV access needed
25
Q

Cons IM

A
  • painful

- not if clotting problems

26
Q

Pros subcutaneous

A
  • avoids first pass metabolism
  • no IV access needed
  • relatively painless
  • px can self-inject
27
Q

Cons subcutaneous

A
  • local irritation
  • px acceptability
  • needle-phobias
28
Q

Pros topical

A
  • avoids first pass
  • px acceptability
  • avoid systemic side effects
29
Q

Cons topical

A
  • local irritation

- require adequate technique/appropriate dosing

30
Q

Consider this safety aspect when prescribing

A

ALLERGY

31
Q

Compliance

A

Extent to which px behaviour matches prescriber’s recommendations

32
Q

Adherence

A

Extent to which px behaviour matches agreed recommendations form prescriber

33
Q

Concordance

A

Consultation process in which doctor and patient agree therapeutic decisions that incorporate their perspective views

34
Q

Five divisions of side effects

A 
Predictable 
Bizarre 
Chronic 
Delayed 
End of treatment effects
35
Q

When does prescribing cascade happen

A

Medication given to counteract the side-effects of another medication

36
Q

Safety wise, attention should be paid with what 4 drugs in particular

A

Insulin
Opiates
Warfarin
DOACs

37
Q

4 potential fates of drugs in terms of first metabolism (absorption)

A
  • not metabolised before entering general circulation
  • substantially metabolised but that can be overcome by prescribing large amounts
  • completely metabolised before entering circulation (GTN)
  • become active after 1st pass
38
Q

A hydrophilic drug such as digoxin is prescribed in the same quantities in a 90kg or a 65kg. How so without accounting for the extra weight?

A

Extra weight is fat

39
Q

Int ems of drug safety, what are the characteristics of drugs that make you worry in terms of P450 interactions

A
  • narrow therapeutic window

- old-fashioned drugs

40
Q

Why should you initially start slow and then increase the dose of carbamazepine and phenytoin

A

They induce their own metabolism

41
Q

Drugs the patient is on that should make you alert regarding interactions

A 
Warfarin 
Theophylline 
Carbamazepine 
Phenytoin 
OCP
42
Q

4 general considerations when prescribing a new medication

A

Allergy
Comorbidities & drug interaction
Pregnancy/breastfeeding
Hepatic/renal failure

43
Q

Alternative classification of drug administration

A

Enteral: GI tract eg oral/rectal
Parenteral: non-GI eg IV/IM/subcutaneous
Topical

44
Q

Patient-centred factors for non-compliance

A

Age
Psycho-social factors
Ethnicity
Patient-prescriber relationship

45
Q

Therapy-centred factors for non-compliance

A

Route of administration
Duration of treatment
Complexity of regime
Side effects

46
Q

Five types of side effects of drugs

A

Type A: predictable, common & rarely fatal
Type B: unpredictable, rare, fatal (can be), should document
Type C: chronic, taking meds for too long
Type D: delayed, uncommon, after completing tx
Type E: end-of-tx, if stopped abruptly

47
Q

2 Abx please look for them for P450 interaction

A

Ciprofloxacin

Clarythromycin

Y3 Principles of Pharmacology (1 decks)

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