2-Individual Variation

Front 1

What determines the intensity of the drug response?

Back 1

The concen of a drug at its sites of action

Front 2

Which two groups are more sensitive to drugs?

Back 2

Infants and elderly

Front 3

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

Back 3

liver and kidney

Front 4

Explain pharmacodynamic tolerance

Back 4

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

Front 5

Explain metabolic tolerance

Back 5

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

Front 6

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

Back 6

Nitroglycerin patches

Front 7

Define the placebo effect

Back 7

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

Front 8

What are the 3 types of pharmacogenomics alterations?

Back 8

Immune response, metabolism, and target

Front 9

Why do some patients have no pain relief from codeine?

Back 9

A variant cytochrome P450 is unable to convert codeine to its active drug which is morphine

Front 10

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

Back 10

Decreased binding to albumin increases the drug level in the bloodstream

Front 11

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

Back 11

The increased glomerular filtration increases the renal excretion of drugs

Front 12

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

Back 12

Slowed motility allows more drug to be absorbed

Front 13

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

Back 13

lipid soluble = easy; ionized = difficult; highly polar = difficult; protein bound = difficult

Front 14

What percentage of birth defects is caused by drugs?

Back 14

less than 1%

Front 15

What is the risk of malformations by a teratogen?

Back 15

10%

Front 16

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

Back 16

2 weeks. first trimester (3-8 weeks)

Front 17

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

Back 17

Week 9

Front 18

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

Back 18

Immediately after breast-feeding

Front 19

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

Back 19

Class A

Front 20

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

Back 20

NO

Front 21

What type of drugs readily enter the breast milk?

Back 21

Lipid - soluble drugs

Front 22

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

Back 22

Immediately after breast-feeding

Front 23

Pediatrics refers to patients under what age?

Back 23

16 years old

Front 24

Define neonates and infants?

Back 24

neonates = first 4 weeks
infants = 5 weeks to 1 year

Front 25

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

Back 25

neonates = slower than infants and adults due to slow and erratic blood flow
infants= faster than neonates of adults

Front 26

Discuss how decreased protein binding in neonates and infants effect drug distribution?

Back 26

Low albumin levels provide fewer binding sites which increased the free drug levels

Front 27

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

Back 27

Sensitivity to CNS effects of drugs

Front 28

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

Back 28

One year

Front 29

When does the infant's GFR reach adult levels?

Back 29

One year

Front 30

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

Back 30

2 years. greater than adult from 1-12 years

Front 31

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

Back 31

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

Front 32

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

Back 32

Apsirin

Front 33

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

Back 33

Body surface area (BSA)

Front 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 concen?

Back 34

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

Front 35

The elderly show what change in hepatic metabolism of drugs?

Back 35

A decrease in hepatic metabolism of drugs

Front 36

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

Back 36

Decreased renal excretion

Front 37

What lab most accurately assesses renal clearance?

Back 37

Creatinine Clearance

Front 38

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

Back 38

Blood Urea Nitrogen (BUN), creatinine

Front 39

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

Back 39

Drugs with low therapeutic indexes

Front 40

How do multiple drugs affect the risk of drug interactions?

Back 40

Increases risk of drug interactions