How does hypoalbuminemia affect the process of prescribing? - CORRECT ANSWER Low albumin = more free drug (bc the drug can't bind to albumin aka
... [Show More] protein) = increased adverse effects
What is a Black Box Warning: - CORRECT ANSWER is considered a contraindication to administer that drug.
What is the drugs half-life? - CORRECT ANSWER Half-life specifically means the amount of time it takes for an administered drug to be halfway cleared from the system.
Peak of action: - CORRECT ANSWER the time between drug administration and maximum concentration of drug in the blood stream. Best therapeutic effect.
Duration of action: - CORRECT ANSWER the time between onset of action and metabolism of drug below the minimum needed for an effect. The length of time you have the drug in your system.
According to the WHO what is the first step in the prescribing process? - CORRECT ANSWER The first step is to define the patient's problem
The second step is to - CORRECT ANSWER specify the therapeutic objective
The third step is to - CORRECT ANSWER choose which drug or treatment is needed.
Step 4 of the WHO approach: - CORRECT ANSWER Start the treatment
Step 5 of the WHO approach: - CORRECT ANSWER Educate the patient
Step 6 of the WHO approach: - CORRECT ANSWER Monitor the treatment
Phase 1 of drug development: - CORRECT ANSWER The drug is tested on healthy volunteers
Phase 2 of drug development: - CORRECT ANSWER trials with people who have the disease for which the drug is thought to be effective
Phase 3 of drug development: - CORRECT ANSWER Large numbers of patients in medical research centers receive the drug in phase 3. This larger sampling provides information about infrequent or rare adverse effects. The FFA will approve a new drug application if phase 3 studies are satisfactory.
Phase 4 of drug development: - CORRECT ANSWER This phase is voluntary and involves postmarket surveillance of the drug's therapeutic effects at the completion of phase 3. The pharmaceutical company receives reports from doctors and other health care professionals about the therapeutic results and adverse effects of the drug. Some medications, for example, have been found to be toxic and have been removed from the market after their initial release.
Explain first pass metabolism - CORRECT ANSWER much of the drug is lost in the absorption process. The liver metabolizes many drugs, thus reduces the bioavailabilty of the drug.
What is the fasted route of absorption: - CORRECT ANSWER The fastest route of absorption is inhalation, and not as mistakenly considered the IV administration.
Why does the GI tract take longer to absorb? - CORRECT ANSWER The GI tract is lined with epithelial cells; drugs must permeate through these cells in order to be absorbed into the circulatory system.
What is One particular cellular barrier that may prevent absorption of a given drug? - CORRECT ANSWER the cell membrane. Cell membranes are essentially lipid bilayers which form a semipermeable membrane. Pure lipid bilayers are generally permeable only to small and uncharged solutes, hence whether or not a molecule is ionized will affect its absorption, since ionic molecules are charged.
What is solubility? - CORRECT ANSWER Solubility favors charged species, permeability favors neutral species. Some molecules have special exchange proteins and channels to facilitate movement from the lumen into the circulation.
Why does absorption occur at a slower rate for oral, IM, SQ routes? - CORRECT ANSWER Absorption occurs at a slower rate because the complex membrane systems of GI mucosal layers, muscle, and skin delay drug passage.
The ability of a drug to cross a cell membrane depends on: - CORRECT ANSWER whether the drug is water or lipid (fat) soluble. Lipid-soluble drugs easily cross through cell membranes; water-soluble drugs can't. Lipid-soluble drugs can also cross the blood-brain barrier and enter the brain.
As a drug travels through the body, it comes in contact with? - CORRECT ANSWER proteins such as the plasma protein albumin. The drug can remain free or bind to the protein. The portion of a drug that's bound to a protein is inactive and can't exert a therapeutic effect. Only the free, or unbound, portion remains active. A drug is said to be highly protein-bound if more than 80% of the drug is bound to protein.
Identify drug metabolism and the role of isoenzymes in the p450 system - CORRECT ANSWER CYPs are the are the major enzymes involved in drug metabolism accounting for about 75% of the total metabolism.
Naturally occurring compounds may induce or inhibit CYP activity. - CORRECT ANSWER For example, bioactive compounds found in grapefruit juice and some other fruit juices including dihydroxy forgotten and parasitin A have been found to inhibit CYP3a4 mediated metabolism of certain medications leading to increased bioavailability and the strong possibility of overdosing.
What does grapefruit have to do with CYP? - CORRECT ANSWER Grapefruit is an inhibitor and will decrease the metabolism of drugs by the cyp enzymes.
When 2 drugs are both metabolized by the p450 system the drug should be - CORRECT ANSWER administered at separate times to prevent the metabolism of one drug resulting in toxic effects of the other drug. (because it would have less protein to bind too, thus more free floating drug)
What is the efficacy of a drug? - CORRECT ANSWER Efficacy is the maximum response achievable from a drug. Effectiveness refers to the ability of the drug to produce a beneficial effect.
On the drug concentration curve what is the first sign of a therapeutic effect? - CORRECT ANSWER The onset of action
What is the purpose of a peak and trough level? - CORRECT ANSWER To determine if the drug is in therapeutic range.
Describe the purpose of blood brain barrier - CORRECT ANSWER The BBB is a highly selective permeability barrier that separates the circulating blood from the brain and extracellular fluid in the CNS. The BBB is formed by brain endothelial cells which are connected by tight junctions with an extremely high electrical resistivity of at least 0.1 micron. The BBB allows the passage of water, some gases, and lipid soluble molecules by passive diffusion as well as the selective transport molecules such as glucose and amino acids that are crucial to neuro function.
Describe the purpose of the fetal placental barrier - CORRECT ANSWER the so-called placental barrier impedes certain chemicals although it allows most fat soluble chemicals to cross. Drugs that are more water soluble and that possess a higher molecular weight tend not to cross the placental barrier. In addition, if a drug binds to a large molecule, such as a blood-borne protein like albumin, it is even less likely to come into contact with fetus.
How will renal insufficiency affect drug elimination? - CORRECT ANSWER The kidney is the primary organ of excretion for most drugs. General theme of metabolism is to produce drug metabolites that are more water soluble and more easily removed by the kidneys. The rate at which the drug is excreted by the kidneys depends on several factors. Renal blood flow influences the glomerular filtration rate (GFR) which is how much plasma is filtered per minute by the glomerulus.
Renal excretion of drugs is typically well-characterized, what is variable is the - CORRECT ANSWER level of renal function the patient.
It is common to monitor renal function in patients by the clinical setting and to adjust dosages based on renal function. This is typically assessed by the - CORRECT ANSWER serum creatinine.
Patients with poor renal function may have higher levels of drugs secondary to - CORRECT ANSWER decreased excretion of metabolites.
What is off-label prescribing? - CORRECT ANSWER Off-label use is the use of pharmaceutical drugs for an unapproved indication or an unapproved age group, dosage or route of administration.
What factors place an infant and child at risk when prescribing medication? - CORRECT ANSWER In general, there is a lack of safety and efficacy studies in the pediatric population most medications are studied in adult populations which because of age-related differences and medication metabolism and mechanisms of action don't necessarily apply to pediatric populations. Children are not just small adults. Adverse drug reactions are most common in this age group. Kids do not have a fully mature liver and renal function, and are at higher risk for toxicity and adverse drug effects.
In kids, meds should be - CORRECT ANSWER weight based. Kids do not have a fully mature liver and renal function, and are at higher risk for toxicity and adverse drug effects.
What ADRs are the elderly at risk of developing? - CORRECT ANSWER Physiologic changes in older adults increase the risk of harm for medication metabolized by the liver and kidneys.
In the elderly, Hepatic blood flow decreases by - CORRECT ANSWER nearly one-half or 40% in older adults.
Some degree of chronic kidney disease is present in X of older adult - CORRECT ANSWER 50%
Furthermore, the median renal blood flow decreases by X by the time the patient reaches 80 years of age, and x - CORRECT ANSWER x of older adults maintain normal kidney function/50%, 1/3. Although, the normal individual rate of decline varies and one-third of older adults maintain normal renal function.
Heart failure, which affects more than forty percent of persons older than 80 years, can - CORRECT ANSWER further reduce the function of the aging kidneys and liver.
Other factors influence pharmacokinetics in older adults include - CORRECT ANSWER aging decreases first-pass clearance in the liver, and a number of commonly prescribed medications like warfarin, benzos, and opiates require much lower doses in older adults. Distribution of drugs to body compartments has changed by the decrease in the ratio of lean body weight to body fat. Levels of serum protein, which bind many drugs, decrease in older adults because of malnutrition and dietary changes that are common for both intentional and unintentional regions. Drug metabolism can be affected by substance abuse including alcohol, up to ten percent of older adults are heavy or problem drinkers. Polypharmacy.
What are the adverse drug reactions related to special populations? - CORRECT ANSWER These can come into the categories of genetics, age, gender, drug interactions, and medical conditions.
Type 1 hypersensitivity or immediate hypersensitivity is an - CORRECT ANSWER allergic reaction provoked by re-exposure to a specific type of antigen, referred to as an allergen. Symptoms vary from mild irritation to sudden death from anaphylactic shock, called type 1 anaphylactic shock.
In type 2 hypersensitivity or cytotoxic hypersensitivity, - CORRECT ANSWER the antibodies produced in the immune response bind to antigens of the patients on cell surfaces. The antigens recognized in the way may either be intrinsic (a self-antigen, part of the patient's cells) or extrinsic (absorbed onto the cells during exposure to some foreign pathogens possibly as part of an infection with a pathogen).
An example of type 2 hypersensitivity is the - CORRECT ANSWER ABO blood incompatibility where the red blood cells have different antigens causing them to be recognized different. B-cell proliferation will take place in antibodies until foreign blood types are produced. IgG and IgM antibodies bind to these antigens to form complexes that activate the classical pathway of the complement activation to eliminate cells presenting foreign antigens. that is mediators of acute inflammation are generated at the site and the membrane attack of complexes cause cell lysis and death. This reaction takes between hours to a day.
Type-3 hypersensitivity occurs when - CORRECT ANSWER there is an accumulation of immune complexes or antigen-antibody complexes that may not have been adequately cleared by innate immune cells, giving rise to an inflammatory response and attraction of leukocytes. Such reactions progress into the point of disease producing immune-complex diseases. The reaction can take hours, days, or even weeks to develop depending on whether or not there is immunologic memory of the precipitating antigen. Typically, clinical features emerged a week following initial antigen challenge from the deposited immune complexes that can precipitate the inflammatory response. Type 4 hypersensitivity is often called delayed-type hypersensitivity, as a reaction take 2-3 days to develop. unlike other types it is not antibody-mediated but rather cell mediated response.
Which medications interact with St. John's Wort? - CORRECT ANSWER SSRI antidepressants, warfarin, and birth control It is also known to decrease the efficacy of HIV medications, cholesterol medications, as well as transplant medications
Which medications interact with St. John's Wort? - CORRECT ANSWER St. John's Wort is a medicinal herb with antidepressant activity and potent anti-inflammatory properties. St. John's wort has interactions with medications such as SSRI antidepressants, warfarin, and birth control. Combining St. John's Wort and SSRI antidepressants, could lead to an increased serotonin level causing serotonin syndrome. Combining estrogen containing oral contraceptives with St. John's Wort can lead to a decreased efficacy of the contraceptive and eventually unplanned pregnancies. It is also known to decrease the efficacy of HIV medications, cholesterol medications, as well as transplant medications. It should be noted however that traditional SSRI antidepressants such as fluoxetine carry similar contraindications. Use nonjudgmental approach so they tell u what herbs they take. Tricyclics and SJW can increase the risk for serotonin syndrome.
How does doxazosin work? - CORRECT ANSWER It is an alpha-1 adrenergic receptor blocker that inhibits the binding of norepinephrine released from sympathetic nerve terminals to the alpha 1 receptors in the membrane of vascular smooth muscle cells. the primary effect of this inhibition is relaxed vascular smooth muscle tone or vasodilation, which decreases peripheral vascular resistance leading to decrease blood pressure. is used to treat high blood pressure and urinary retention associated with benign prostatic hyperplasia (BPH). Doxazosin also shows potential for treatment of benign prostatic hyperplasia and erectile dysfunction. Doxazosin has shown some efficacy in in treating chronic epididymitis. Adverse effects include orthostatic hypotension and reflex tachycardia.
Alpha blockers end in "zosin" are mostly used for - CORRECT ANSWER BPH and sometimes HTN. Adverse effects of orthostatic hypotension. They block the effects of catecholamines at the alpha 1 receptors in vascular smooth muscle and also smooth muscle of the bladder neck and prostate
How does doxazosin work? - CORRECT ANSWER --pharm made easy: Most adrenergics produce their effects by stimulating alpha receptors and beta receptors. These drugs mimic the action of norepinephrine and epinephrine.
Doxazosin - CORRECT ANSWER relaxes your veins and arteries so that blood can more easily pass through them. It also relaxes the muscles in the prostate and bladder neck, making it easier to urinate.
What is the action of effective beta-blockers? - CORRECT ANSWER Beta-blockers are a class of drugs that are particularly used for the management of cardiac arrhythmias, protecting the heart from a second attack after first heart attack, which is called secondary prevention.
Betablockers - first choice for HTN? - CORRECT ANSWER They have been used in hypertension but no longer our treatment of first choice.
Beta-blockers block the action of - CORRECT ANSWER endogenous [Show Less]