Uptake/Distribution

Question 0

What is pharmacodynamics and what does it consist of?

Answer 0

What a drug does to the body
Mechanism of effect, sensitivity, responsiveness
Note: The most common mechanism is interaction with receptors

Question 1

What is pharmacokinetics? What does it consist of? What are the measured parameters?

Answer 1

What the body does to a drug
Consists of: MADE- Metabolism, Absorption, Distribution, Excretion
Measured parameters: elimination half-time, bioavailability, clearance, volume of distribution

Question 2

What’s the difference between the central and peripheral theoretical space?

Answer 2

Central: highly perfused tissues, “vessel rich” (kidney, liver, lungs, heart, brain) and rapid uptake of drug. Receives 75% of CO but only makes up 10% of body mass
Peripheral: large volume, extensive uptake of drug

Question 3

Does rate of transfer between central and peripheral compartments increase or decrease with aging?

Answer 3

Decreases leading to greater plasma concentration in some drugs (thiopental)

Question 4

What type of drugs do the lungs hold on to (instead of quickly releasing)? Acidic/Basic? Hydrophilic/lipophilic?

Answer 4

The lungs act as a reservoir by uptaking basic lipophilic drugs

Question 5

The blood brain barrier prevents which drugs from crossing to the brain circulation? Ionized/nonionized? Water soluble/ lipid soluble?

Answer 5

BBB prevents ionized water soluble from crossing

Question 6

What is the mathematical equation for volume of distribution?

Answer 6

Vd = dose of IV drug / plasma concentration before elimination

Question 7

What is the relationship between volume of distribution and lipid solubility?

Answer 7

Directly related, the more lipophilic, the larger Vd

Question 8

What is the relationship between volume of distribution and binding to plasma proteins?

Answer 8

They are inversely related, the more a drug binds to plasma proteins, the less Vd

Question 9

What is the relationship between volume of distribution and molecular size?

Answer 9

Inverse, the bigger the size, the smaller the Vd

Question 10

What percent of a drug is gone after 1 half life? 2? 3? 4?

Answer 10

1: 50%
2: 75%
3: 87.5% (1/8 left)
4: 93.8% (1/16 left)

Question 11

What is the first pass effect?

Answer 11

Drugs absorbed from GI enter portal venous blood and pass through the liver before entering systemic circulation, this is why you give a higher dose of PO than IV

Question 12

Do sublingual, buccal, or transmucosal have the first pass effect?

Answer 12

No, they are absorbed directly to systemic circulation

Question 13

Distribution half-time vs. elimination half-time vs. elimination half-life?

Answer 13

Distribution half-time: half the drug transfers from central to peripheral
Elimination half-time: half the drug leave the PLASMA (directly proportional to Vd and inverse to clearance)
Elimination half-life: half the drug is eliminated from the BODY

Question 14

What makes rectal administration of drugs unpredictable?

Answer 14

In the proximal rectum, first pass effect happens, in the distal rectum, the portal system is bypassed or the drug can be too distal and ineffective

Question 15

Ionized vs. Nonionized?

Answer 15

Ionized: charged, water soluble
Nonionized: uncharged, lipid soluble, can diffuse across membranes easier

Question 16

Caution should be used when giving a patient with renal failure ionized or nonionized drugs?

Answer 16

Caution giving a drug with high ionized fraction because the kidneys are responsible for getting rid of the ionized agents that are not metabolized

Question 17

What should you consider when giving an acidic drug to someone with acidosis or alkalosis?

Answer 17

Acidosis: dosage may need to be decreased because of increased availability, more of a nonionized agent
Alkalosis: the drug will become more ionized, use in caution with patients that have renal issues

Question 18

What is ion trapping? What is an example?

Answer 18

Ion trapping is when a nonionized drug moves across a membrane into a more acidic environment and becomes ionized and trapped
ex: stomach, placenta, CNS toxicity

Question 19

What is the relationship between potency and protein binding?

Answer 19

The higher the protein binding, the lower the potency (and lower volume of distribution)

Question 20

What is clearance and what does the rate depend on?

Answer 20

Clearance is getting rid of the drug through metabolism and excretion. Almost all drugs given at a therapeutic dose are cleared at a rate proportional to the amount of drug present in the plasma (first order kinetics)

Question 21

First order kinetics vs. Zero order kinetics?

Answer 21

First: Clearing a drug at a rate proportional to the concentration of the drug in the plasma (constant fraction of drug is metabolized, ex: 10% per min)
Zero: constant amount of drug cleared per unit of time because it exceeds the metabolic capacity of the body to clear drugs by first order kinetics (alcohol, aspirin, dilantin), ex: 10mg/min

Question 22

What is perfusion-dependent elimination vs. capacity-dependent elimination?

Answer 22

Perfusion-dependent: hepatic extraction greater than 0.7, clearance of drug depends on hepatic blood flow
Capacity-dependent: hepatic extraction less than 0.3, changes in blood flow have minimal changes in clearance

Question 23

What is the goal of metabolism?

Answer 23

Turn active, lipid soluble drugs into water soluble (ionized) usually inactive drugs
Note: some drugs have active metabolites such as versed

Question 24

What do phase 1 and 2 of metabolism consist of?

Answer 24

Phase 1: oxidation, reduction, hydrolysis

Phase 2: water-soluble conjugates are formed when a metabolite reacts with a substrate

Question 25

List the sites of metabolism

Answer 25

Liver (hepatic microsomal enzymes in the smooth ER), plasma, kidneys, lungs, GI tract

Question 26

Microsomal vs. Nonmicrosomal Enzymes

Answer 26

Microsomal has cytochrome P-450, protein enzymes that are involved in oxidation, reduction, and conjugation of a large number of drugs, enzyme induction
Nonmicrosomal mostly metabolize by conjugation and hydrolysis, also in the liver, does not undergo enzyme induction, genetic

Question 27

What is the receptor occupancy theory?

Answer 27

The more receptors occupied, the more effect a drug will have

Question 28

Agonist vs. Antagonist drugs?

Answer 28

Agonist drugs mimic cell signaling molecules by activating the same receptors to cause similar effects
Antagonist drugs competitively bind to receptors preventing an effect from the cell signaling molecules

Question 29

Enantiomer

Answer 29

Stereoisomers, chiral molecules that mirror each other

Question 30

Stereoisomer

Answer 30

Same bonds and compound in a different configuration

Question 31

Efficacy vs. potency

Answer 31

Efficacy: ability of a drug to produce a desired effect, how quickly does the drug work
Potency: dose needed to get the desired effect

Question 32

Therapeutic index, ED 50, LD 50

Answer 32

Therapeutic index: how selective the drug is in producing desired effects, ratio of LD 50 to ED 50
ED 50: median effective dose
LD 50: median lethal dose

Question 33

Hyper-reactive vs. hypersensitive

Answer 33

Hyper-reactive: people who only need a low dose to get the desired effect of a drug
Hypersensitive: people who are allergic the drug

Question 34

Additive Effect vs. Synergistic effect

Answer 34

Additive: 1+1=2, first and second drug will produce the sum of effects, ex. tylenol-codeine
Synergistic: 1+1=3, two drugs interact and produce an effect greater than the sum, ex. sedatives on respiratory drive