Week 3- Individual Variation

Question 1

What determines the intensity of the drug response?

Answer 1

The concentration of a drug at its sites of action

Question 2

Which two groups are more sensitive to drugs?

Answer 2

Infants and the elderly

Question 3

Diseases of which two organs can cause the accumulation of drug to toxic levels?

Answer 3

Kidney and liver

Question 4

Explain pharmacodynamic tolerance

Answer 4

Adaptive responses occur with long-term administration requiring higher drug levels to get the same response.

Question 5

Explain metabolic tolerance.

Answer 5

Because of increased drug metabolism, an increased dosage is needed to maintain therapeutic drug levels.

Question 6

Which drug commonly demonstrates tachyphylaxis over a short time of administration?

Answer 6

Nitroglycerin patches

Question 7

Define the placebo effect.

Answer 7

The placebo effect is defined as that component of a drug response that is caused by psychological factors.

Question 8

What are the three types of pharmacogenomics alterations?

Answer 8

Immune response, metabolism, and target.

Question 9

Why do some patients have no pain relief from codeine?

Answer 9

A variant cytochrome P450 is unable to convert codeine to morphine.

Question 10

How does starvation increase the free drug concentration level of some drugs?

Answer 10

Decreased binding to albumin increases the drug level in the bloodstream.

Question 11

How does the change in glomerular filtration in the third trimester affect drug clearance?

Answer 11

The increased glomerular filtration increases the renal excretion of drugs.

Question 12

How does intestinal motility affect drug levels in a pregnant woman?

Answer 12

Slowed motility allows more drug to be absorbed.

Question 13

List 4 types of drugs and explain their likelihood of crossing the placenta.

Answer 13

Lipid-soluble – easy, Ionized – difficult, Highly polar – difficult, Protein-bound - difficult

Question 14

What percentage of birth defects is caused by drugs?

Answer 14

Less than 1%.

Question 15

What is the risk of malformations by a teratogen?

Answer 15

10%

Question 16

How many weeks after conception do gross malformations begin to occur? In what trimester?

Answer 16

2 weeks. First trimester (3-8 weeks).

Question 17

From what week are the developmental processes of the brain affected?

Answer 17

Week 9

Question 18

When is the best time for a breastfeeding mother to take a short-acting drug to limit drug levels in the breast milk?

Answer 18

Immediately after breastfeeding

Question 19

What FDA drug classification has adequate studies in pregnant women to demonstrate no risk to fetus of woman?

Answer 19

Class A

Question 20

Is a lack of teratogenesis in animals proof of safety in humans?

Answer 20

No

Question 21

What type of drugs readily enters breast milk?

Answer 21

Lipid-soluble drugs

Question 22

When should a nursing mother take a medicine in order to minimize transfer of the drug into the breast milk?

Answer 22

Immediately after breastfeeding

Question 23

Pediatrics refers to patients under what age?

Answer 23

16 years

Question 24

Define neonates and infants.

Answer 24

Neonates – first 4 weeks, Infants – weeks 5 through 1 year

Question 25

Discuss the effect of blood flow on the absorption of IM medications in neonates and infants.

Answer 25

Neonates – slower than infants and adults due to slow and erratic blood flow, Infants – more rapid than neonates or adults

Question 26

Discuss how decreased protein binding in neonates and infants affect drug distribution.

Answer 26

Low albumin levels provide fewer binding sites which increases the free drug levels.

Question 27

An immature blood-brain barrier in the infant increases the likelihood of what kind of effects?

Answer 27

Sensitivity to CNS effects of drugs

Question 28

The infant’s hepatic metabolism reaches an adult level at what age?

Answer 28

One year.

Question 29

When does the infant’s GFR reach adult levels?

Answer 29

One year.

Question 30

A child’s hepatic metabolism peaks at what age? The child’s metabolism is greater than an adult during what ages?

Answer 30

Two years. 1-12 years.

Question 31

How do sulfonamides cause neurological toxicity in infants under 2 months old?

Answer 31

Sulfonamides displace the bilirubin from the plasma proteins. Bilirubin crosses the blood-brain barrier causing neurological toxicity.

Question 32

What drug is implicated with Reye’s syndrome when administered in children with chicken pox or influenza?

Answer 32

Aspirin

Question 33

What is the most accurate method of determining dosage in children?

Answer 33

Body Surface Area (BSA)

Question 34

A decrease in lean body mass in the elderly is associated with what change in total body water? How does this total body water change affect water-soluble drug concentrations?

Answer 34

A decrease in lean body mass is associated with a decrease in total body water. This decrease in total body water will increase a concentration of water-soluble drugs.

Question 35

The elderly show what change in hepatic metabolism of drugs?

Answer 35

A decrease in hepatic metabolism of drugs

Question 36

What is the most important cause of adverse reactions in the elderly?

Answer 36

Decreased renal excretion

Question 37

What lab most accurately assesses renal clearance?

Answer 37

Creatinine clearance

Question 38

What labs are frequently used instead of creatinine clearance to monitor renal function?

Answer 38

Blood urea nitrogen (BUN), Creatinine

Question 39

Drugs with what type of therapeutic indexes are most likely to cause adverse reactions?

Answer 39

Drugs with low therapeutic indexes

Question 40

How do multiple drugs affect the risk of drug interactions?

Answer 40

Increases the risk of drug interactions