Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Patho-Pharm -- Exam 1 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

controlled substance

A
  • regulated by DEA

- have potential for abuse (stimulants, narcotics, depressants)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the steps new drugs go through before they can get on the market?

A
  1. Preclinical testing on animals (1-5 years)
  2. Apply to FDA as Investigational New Drug (get 20 yr patent)
  3. Clinical testing - (takes 10-15 years)
    • phase 1 - healthy volunteers
    • phase 2 - patients to see if effective
    • phase 3 - bigger sample size to see safety and effectiveness
  4. New Drug Application - approved by FDA allows marketing
    • phase 4 - postmarketing surveillance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Generic drugs

A
  • lower case
  • chemical or official name
  • indicates “drug group”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Trade name

A
  • name used to market drug

- invented by pharmaceutical co.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Six Rights of Drug Administration

A

Right

  • medication
  • dose
  • delivery/route
  • time
  • patient
  • rationale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pharmacokinetics

A
  1. What the BODY does to the DRUGS
  2. Movements of drugs throughout the body to reach target site (cells)
  3. Processes
    - absorption
    - distribution
    - metabolism
    - excretion/elimination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

absorption

A
  • movement of drug from administration site into blood

- how drug is administered will determine how soon effects will take place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Enteral absorption

A

PO - by mouth into blood

SL (sublingual) - from mucous membrane into blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

parenteral absorption

A

IV - intravenous
IM - intramuscular
SC (subQ) - subcutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

topical absorption

A

from skin into blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bioavailability (F): absorption

A

fraction of the dose that gets into systemic blood circulation & is available to act on cells

  • IV route: 100%
  • other routes:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

first pass effect (biotransformation)

A
  • only applied to PO drugs
  • drugs are partially metabolized by liver before they can get into systemic circulation
  • drugs with large first pass effect require much higher PO doses compared to IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Factors affecting absorption

A
  1. route of administration
  2. preparation for oral administration
    Tablets
    - enteric-coated preps
    - sustained-release (extended-release)
    - capsules
    Liquid elixirs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Distribution

A

“Spreading” of the drug throughout the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Factors affecting Distribution

A
  1. blood flow to tissue (cardiac output/CO)
  2. plasma protein (albumin) binding
  3. blood brain barrier (BBB)
  4. pregnancy & lactation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Factors affecting Distribution: blood flow to tissue

A
  • areas that receive large amounts of blood get drug rapidly (liver, kidney, heart)
  • low blood flow areas are difficult to treat (bones, abscess has 0 internal blood vessels; must drain before treating)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Factors affecting Distribution: plasma protein binding

A
  1. most drugs are bound to proteins (albumins) in the blood
    • makes them inactive
    • stored & released slowly / longer duration of drug action
  2. unbound/free drug molecules = pharmacologically active, so reach target cells
    e. g. Warfarin (coumadin) - 99% are protein-bound; duration of action is 3-5 days

if malnourished, there is reduced plasma in blood so higher risk of toxicity (not enough protein to attach to)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Factors affecting Distribution: BBB

A
  • drug distribution in CNS is limited
  • tight junctions between cells & capillaries
    - allow only selected (lipid soluble) drugs (e.g. anti-anxiety and seizure meds)
    - prevent movement of drug molecules into brain

Newborn babies - BBB not fully developed = heightened sensitivity to drugs that act on brain; especially vulnerable to CNS toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Factors affecting Distribution: pregnancy & lactation

A
  • most drugs cross placenta & enter fetal circulation (may affect fetus)
  • no prescription or OTC drugs should be taken (except prenatal vitamins
  • many drugs enter breast milk (may affect nursing infants)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Metabolism (biotransformation)

A

most drugs are chemically changed by hepatic microsomal enzyme system (in liver)

  • Cytochrome P450 system (CYP)
  • changed into inactive form (destruction)
  • changed into active form (activation ) - prodrug

metabolic processes are used to destroy drugs (it’s a natural protective mechanism against poisons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CYP

A

a group of 12 closely related enzyme families that affect drug metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Consequences of drug metabolism

A

increase or decrease therapeutic action
OR
increase or decrease toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Factors affecting Metabolism

A
  1. Liver Function - liver diseases can decrease metabolism –> increases toxicity
  2. Age - infants can decrease metabolism –> increases toxicity
  3. Oral drugs – first pass effect – decreases metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Drug therapy in hepatic impairment

A
  • drugs stay in body longer
  • incr. risk for drug toxicity (avoid hepatoxic drugs, like Tylenol & alcohol; decrease dosage)
  • monitor liver function (liver function test - LFT)
  • CYP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Decreased liver function will show:

A

⇡ Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT)
⇡ alkaline phosphate
⇡ bilirubin
↓ albumin (protein in blood)
↓ prothrombin time (PT) and partial prothrombin time (PTT) - tell you about clotting time & factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Excretion / Elimination of drugs

A
  • in urine (most common)
  • in stool, saliva, sweat

Major organ involved - kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Factors affecting Elimination

A
  1. Renal disease: ↑ risk for drug accumulation and toxicity
    - adjust drug selection (non-nephrotoxic) and dosage
    - monitor renal status (RFT = renal function test, BUN = blood urea nitrogen test, creatine test)
  2. Age
  3. Urine pH: manipulating urine pH = ↑ drug elimination in urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

plasma drug level

A
  1. subtherapeutic concentration: plasma drug level is MEC, so drug is effective, but not toxid
  2. toxic concentration: plasma drug level at excessive level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

therapeutic range (TR)

A
  • enough drug to produce therapeutic effect, but not enough to be toxic

Narrow TR - therapeutic doses are very close to toxic doses / narrow margin of safety / need frequent checks / e.g. coumadin, lithium, digoxin

Wide therapeutic range - safe

30
Q

MEC -

A
  • minimum effective concentration

- lowest drug concentration at which the drug action occurs

31
Q

Peak

A

Highest plasma level of drug

32
Q

Duration

A

Length of drug action

Time during which plasma drug level is > MEC

33
Q

Drug half Life (t1/2)

A
  • time required for plasma concentration of a drug to decrease by 50%
  • E.g after 5 t1//2 - approx 97% of drug eliminated
34
Q

t1/2 determines dosing frequency

A

Shorter half life - need more frequent dosing

Longer half life - can be dosed less frequently

35
Q

steady state concentration

A

Plateau - building up the level of drug w/repeated admin of drug = therapeutic level
- Will be reached in 5 half lives.

36
Q

loading vs maintenance doses

A

bolus = loading dose - given when 1/2 lives are long to help reach plateau

maintenance dose given at lower levels, but more frequent

37
Q

trough level

A
  • the lowest level of drug in blood plasma

- measure right before give dose

38
Q

peak level

A
  • highest level of drug

- measure approx 30 min after dose

39
Q

pharmacodynamics

A
  • what the drug does to the body

- how a drug changes the body

40
Q

Mechanism of drug action & effect in body:

RECEPTOR drug action

A

most drugs work by binding to receptors at cell membrane

41
Q

Mechanism of drug action & effect in body:

NON-RECEPTOR drug action

A

e.g. upset stomach - take medicine to change pH of stomach

42
Q

dose-response curve

A

bigger does are unable to elicit a further increase in response == all receptors are full - any more drug could be toxic

43
Q

drug - receptor interactions

A
  • many drugs work by binding to proteins

- drugs cannot give cells new function

44
Q

agonists

A

activate receptors by mimicking the action of endogenous molecules (“turn on”)

45
Q

antagonists

A

prevent activation of receptors by inhibiting action of endogenous molecules (“turn off”)

46
Q

competitive antagonist

A

competes w/agonist for receptor sites

47
Q

noncompetitive antagonist

A

blocks agonists’ access to receptor site

48
Q

therapeutic index (TI)

A
  • a measure of drug safety
  • ratio of drug’s LD50 (lethal dose that kills 50% of mice) to ED50 (effective dose in 50% of people)
  • higher it is = safer the drug
  • narrow RI = not as safe; more dangerous

E.g. ED50 is 10 & LD50 is 100 = wide range
ED50 is 20 & LD50 is 30 = narrow range

49
Q

pharmacogenetics

A

only since 1950’s
varies from patient to patient due to their genetic variation of CYP (a liver enzyme)
- if overactive = ⇡drug metabolism
- if underactive = ↓ drug metabolism

50
Q

INR

A

international normalized ration = between 2-3
3.0 = risk of bleeding

Warfarin (coumadin) - narrow therapeutic range
- FDA recommends genetic testing

51
Q

personalized medicine

A

= right medication in the right dose for the right patient = fewer side effects

52
Q

drug- drug interaction:

- additive

A

1 + 1 = 2

sum of drugs A & B

53
Q

drug- drug interaction:

- synergistic

A

or potentative = 1 + 1 = 3
Interaction between two or more drugs or agents resulting in a pharmacologic response greater than the sum of individual responses to each drug or agent.

54
Q

drug- drug interaction:

- antidote

A

or antidote = 1 + 1 = 0

cancel each other out

55
Q

drug- drug interaction:

- new response

A
  • combination may produce a new response

- e.g. alcohol & disulfiram (Antabuse - used to try to stop drinking): unpleasant & dangerous response

56
Q

drug- drug interaction: absorption

A

when 2 drugs taken together, one may alter the absorption of the other
e.g. antacid will prevent absorption of digoxin

57
Q

drug- drug interaction: altered metabolism

A

inducer: induction of CYP isoenzymes

- if drug A is inducer; causes ⇡metabolism of drug B; dosage of drug B needs to be ⇡ as drug level will ↓

58
Q

drug- drug interaction: altered metabolism

A

inhibitor: inhibition of CYP isoenzyme

- if drug A is inhibitor, causes ↓ metabolism of drug B; causes ⇡ drug B in plasma. Risk of toxicity of drug B

59
Q

clinical significance of drug-drug interactions

A
  • can ⇡↓ therapeutic effects or ⇡↓ toxicity
  • ⇡risk of serious drug interaction ⇡ # of drugs a patient takes
  • special attn to drugs w/narrow TI
60
Q

Impact of food on drug metabolism:

grapefruit

A

CYP inhibitor
↓ metabolism of many drugs –> ⇡ plasma drug levels –> ⇡ risk of toxicity
- all drugs, but mainly anti-coagulants (w/narrow TI)

61
Q

Impact of food on drug metabolism:

foods w/tyramine (aged cheese, red wine)

A

can cause hypertensive reaction in pt. taking MAOI (for depression)

62
Q

Impact of food on drug metabolism:

foods w/ Vit K

A

can oppose anticoagulant effect of warfarin (coumadin) - which work by inhibiting synthesis of Vit K dependent clotting factors (II,VII, IX, X)

63
Q

drugs + herbs

A
  • need to be included in medical history
  • Warfarin - St. John’s wort, ginseng = CYP inducer
    - Fish oil, Vit E = CYP inhibitor
  • cardiovascular meds & herbs
    • Digoxin + licorice (CYP inhibitor)
    • Ephedra = sympathomimetic
    • Statins + St. John’s wort (CYP inducer)
64
Q

idiosyncratic vs iatroentic effect

A

idiosyncratic = uncommon drug response resulting from a genetic predisposition (e.g. benadryl - hyperactivity in children) - unique to person

iatrogenic = drug caused disease (e.g. Cushing’s syndrome due to long-term steroid therapy)

65
Q

cross tolerance

A
  • tolerance to pharmacologically related drugs

- e.g. alcoholics many need > usual dose of sedative to calm down

66
Q

ways to minimize ADR

A
  1. monitor rights to ↓ med errors
  2. Pt & family education @ signs of what to report to HCP
  3. monitor function of target organs
67
Q

Treatment of Drug OD / poisoning

A
  • supportive care
  • ID cause of OD/poison
  • responses
68
Q

Treatment of Drug OD / poisoning - activated charcoal

A
  • prevents further absorption
  • effects w/in 30 min
  • can absorb 90% of drug
  • eliminated in stool
69
Q

Treatment of Drug OD / poisoning - gastric lavage & aspiration

A
  • flushes stomach w/fluid & aspirated back out
70
Q

Treatment of Drug OD / poisoning - antidotes

A
  • Naloxone (Narcan) - opioid/narcotics OD
  • Flumazenil (Romazicon) - benzodiazepine OD
  • Digoxin Fab (Digibind): - digoxin OD
  • Vitamin K: warfarin (if bleeding; will ⇡ INR
  • Protamine sulfate: Heparin OD
  • Acetylcysteine (Mucomyst): acetaminophen OD

Patho-Pharm -- Exam 1 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions