Pharm Exam 1

Front 1

What was the benefit of Pure food and Drug Act? When was it established?

Back 1

1906- Had to prove the ingredients, strength, purity, and quality of pharmaceuticals.

Front 2

What was the Shirley Amendment?

Back 2

In 1912, had to prove therapeutic benefit - no more false claims!

Front 3

When was the Federal Food, Drug, and Cosmetic Act established? What was its significance?

Back 3

1938- it established the FDA, and said that drugs had to be approved by this board to be true to it's therapeutic claim, ingredients, and no lethal side effects

Front 4

This amendment promised better safety regulation of medications and had to prove safety to be approved by the FDA.

Back 4

1962- Kefauver-Harris amendment

Front 5

What was the significance of the Comprehensive Drug Abuse Prevention and Control Act?

Back 5

1970- controlled dispensing of controlled drugs to prevent abuse and determined Rx vs OTC.

Front 6

What was the Food and Drug Administration Modernization Act?

Back 6

1997- make it easier for generic drugs to be made without requiring repeat trials as long as they had the same ingredients.

Front 7

Describe the 5 schedules of drugs.

Back 7

C1- no medical use, highest potential for abuse (Heroin)
C2 - accepted use, high risk of abuse (percocet)
C3 - accepted use, less potential for abuse
C4 - accepted use, low potential for abuse
C5 - accepted use, lowest potential for abuse

Front 8

What are the phases of Drug Development?

Back 8

1- small number of healthy people (safety)
2 - more people who have target disease (efficacy)
3 - 100s of people, several years
4 - goes to market (we are involved) - post marketin surveilance

Front 9

What role do providers play during phase 4 of a medication development?

Back 9

Adverse drug event reporting

Front 10

What are black box warnings?

Back 10

Warnings that appear on prescription drugs informing patients of potentially serious side effects.

Front 11

1 inch = ____ cm

Back 11

2.54cm

Front 12

1 tsp = ___ mL

Back 12

5mL

Front 13

1kg = ___ lb

Back 13

2.2 LBs

Front 14

What is the median effective dose?

Back 14

the amount that produces the intensity of effect in 50% of individuals

Front 15

The term "%" represents what?

Back 15

The rate per 100.

Front 16

a) %w/v = ___
b) %v/v = ___
c) %w/w = ___

Back 16

a) grams/100mL
b)mL/100mL
c) grams/100g

Front 17

1:1000 is equivalent to what?

Back 17

1gram/ 1000mL solution
1mg/mL

Front 18

What is the formula to calculate IBW:

Back 18

Males: 50kg + 2.3*(#in>60)
Females: 45.5 + 2.3*(#in>60)

Front 19

What is the formula to calculate Adjusted BW?

Back 19

IBW+ 0.4(ActBW-IBW)

Front 20

What is the formula for Creatinine clearance?

Back 20

CrCl= [(140-age)xIBW]/(scr x 72)

*multiply entire thing by 0.85 for females
*if actual <IBW, use actual
*if >65 use Scr=1 or if Scr>1 use bigger number

Front 21

decreased creatinine clearance indicates what?

Back 21

Kidneys aren't properly filtering out creatinine

Front 22

List the 10 "rights" to writing a prescription.

Back 22

D- drug
R- route
P- patient
A- amount/ dose
T- time/ schedule
D- date
R- refills
R- right to refuse
I- informed consent
D- duration

Front 23

When should you include a zero with a decimal?

Back 23

always LEAD and never TRAIL
0.1 and 1

NOT .2 or 2.0

Front 24

How should you abbreviate "units" and "micrograms"...

Back 24

you shouldn't. write them out to avoid errors

Front 25

1) bid means ___
2) tid means ___
3) qid means ___

Back 25

1. 2x a day
2. 3x a day
3. 4x a day

Front 26

How would you abbreviate "before meals"?

Back 26

ac

Front 27

How would you abbreviate "after meals"?

Back 27

pc

Front 28

What is the difference between a prescription and physician's orders?

Back 28

Orders include medications AND everything else (labs, therapy, etc)

Front 29

What is the difference between orders and progress notes?

Back 29

Progress notes (SOAP) describe rationale for orders.

Front 30

What is a ligand?

Back 30

the molecule that binds to a receptor (include drugs as well as things like hormones and neurotransmitters)

Front 31

Ligands may have what actions on a receptor?

Back 31

Activate or inactivate

Front 32

Activation of a receptor by a ligand may have what two responses?

Back 32

Increase or decrease a particular cell function

Front 33

What is an "agonist"?

Back 33

a drug that causes the receptor to respond the same way as the naturally occuring substance it mimicks

Front 34

What is an "Antagonist"?

Back 34

A drug that binds to a receptor but doesn't produce the response.

(prevents binding of endogenous hormone or neurotransmitter)

Front 35

What is the difference between a full and partial agonist?

Back 35

Full agonist = activates receptor with maximal efficacy

Partial agonist = activates the receptor but not with maximal efficacy

Front 36

What is the difference between a competitive and non-competitive antagonist?

Back 36

Competitive: binds reversibly to activate the site of the receptor, blocks agonist from binding, but can be overcome by increasing the agonist concentration.

Noncompetitive - irreversible binding or binding to another site that prevents the binding of the activator

Front 37

What are spare receptors?

Back 37

In some systems, there are more receptors available than needed to elicit a full response.

Front 38

In what 5 ways are receptors mediated?

Back 38

1. desensitization - rapid due to change in receptor conformation (

2. Reduction of receptor number-

3. reduction of receptor-coupled signaling - signaling molecules get depleted

4. Increased metabolic degradation - metabolism increases or eliminates drug faster

5. Tolerance - drug effects reduce due to opposing homeostasis

Front 39

The ___ is the dose of drug required to produce a given effect.

Back 39

Potentcy

Front 40

___ is the probability of drug occupying a receptor at any given instance.

Back 40

Affinity

Front 41

What is the "efficacy" of a drug?

Back 41

The magnitude of effect that can be produced by a drug

Front 42

____ and -____ are determined by receptor's chemical structure.

Back 42

Affinity and efficacy

Front 43

what is pharmacodynamics?

Back 43

the study of the biochemcial and physiological effects of drugs on the body and their mechanism of action

Front 44

what is the therapeutic window?

Back 44

the range of doses of a drug tht elicits a therapeutic response without toxicity

Front 45

the ratio that describes the dose that produces toxicity to that that produces desired outcome: Td50/ed50

Back 45

Therapeutic window

Front 46

___ is the way the body handles the drug and what the body does to the drug.

Back 46

Pharmacokinetics

Front 47

What are the 4 stages of pharmacokinetics?

Back 47

1. absorption
2. distribution
3. metabolism
4. elimination

Front 48

what are advantages or disadvantages of PO administration?

Back 48

+: safe, easy, inexpensive
-: irregular absorption, 1st pass in liver, GI upset, pt compliance

Front 49

What are advantages or disadvantages of SL administration?

Back 49

+: rapid, no 1st pass in liver, bypasses GI
-: poor penetration of mucosa by many drugs

Front 50

What are advantages or disadvantages of rectal administration?

Back 50

+: can be given in unconcsous or vomiting, minimal 1st pass, bypasses GI
-: irregular and incomplete absorption

Front 51

Advantages or disadvantages of IV administration:

Back 51

+: rapid, predictable
-: greatest risk of infection, anaphylaxis, embolus, no access

Front 52

Advantages or disadvantages of IM administration:

Back 52

+: moderate volumes, faster than SQ
-: can't be used for irritating substances

Front 53

Advantages or disadvantages of SQ administration?

Back 53

+: slower absorption, pt can self administer
-: slower than IM, doesn't work in vasoconstriction, can be painful

Front 54

Advantages or disadvantages of Intraperitoneal administration?

Back 54

+: large absorbing surface
-: 1st pass effect, risk of adhesion

Front 55

Advantages or disadvantages of topical administration?

Back 55

+: local effects
-: local skin irritation

Front 56

Advantages or disadvantages or inhaled administration?

Back 56

+: very rapid, useful for gassses, vapors, aerosols
-: difficult to control dose

Front 57

__ is the study of the role of inheritance in variation of drug response.

Back 57

pharmacogenomics

Front 58

___ is responsible for the hydrolysis of Succinylcholine

Back 58

BChE- pts with variations have decreased metabolism and result in prolonged paraysis

Front 59

NAT2 catalyzes the acetylation of ___ resulting in __

Back 59

Isoniazid, hydralazine, procainamide

either slow or fast acytylators

Front 60

Someone who acetylates slowly may have ___

Back 60

drug toxicity

Front 61

___ metabolizes tons of medications like metoprolol, haloperidol, codeine, and fluoxetine.

Back 61

CYP2D6

Front 62

Poor metabolizers are at risk for ____ whereas ultra rapid metabolizers are at risk for ___

Back 62

1. overdose/ toxicity
2. under-dosing

Front 63

Describe why poor CYP2D6 metabolizers have a different response to codeine/

Back 63

this gene activates codeine into morphine... so unlike the other drugs, slow metabolizers don't get the active drug andneed more, whereas fast metabolizers risk toxicity

Front 64

___ is metabolized predominately by CYP2C9, and targets vitamin K epoxide reductase.

Back 64

Warfarin.

Front 65

What is an idiosyncratic reaction?

Back 65

A reaction resulting from interaction between the medication and a unique aspect of the patient's physiology.

Front 66

TPMT catalyzes __

Back 66

Thiopurine drugs such as 6-mercaptopurine and azathiprine (immunosuppresants)

Front 67

TPMT*3A results in ___

Back 67

decrease in tissue TPMPT resulting in myelosuppression if treated with nomral doses of thiopurines

Front 68

The ALOX5 gene may have alterations that are the target for which drug?

Back 68

Zileuton (inhibits enzyme that causes airway inflammation) - asthma

Front 69

Aminoglycocides are ____ that must be given ____. They are water soluble and do not distribute into adipose. What adjustment should be made when prescribing these?

Back 69

antibiotics

parenteraly

Dosing should be done with IBW or ABW for most patients

Front 70

Describe the clearance mechanism for aminoglycocides?

Back 70

- almost entirely renal

- within 2-3 hours in nml renal funciton, 30-60h in a dialysis pt

Front 71

Gentamycin and Tobramycin are ____ antibiotics. What is their dose?

Back 71

Aminoglycosides

5-7mg/kg/day either once daily or divided q8 hours

Front 72

When should aminoglycoside levels be checked?

Back 72

if given q8- 1 hour after end of infusion and 30 minutes prior to next

if given high dose: two levels at a peak, a second 2-4 half lives later

Front 73

Vancomycin is usually given ___ except in c.diff. when it is effective ___

Back 73

parenterally

PO

Front 74

What is the usual half life of vancomycin?

Back 74

5-10 hours,

Front 75

What is the usual dosing of vancomycin?

Back 75

q8 or q12, increases with renal problems

Front 76

How is vancomycin cleared?

Back 76

Renally - approximates creatinine clearance

Front 77

Vancomycin is used to treat ___, and toxicity results in ___

Back 77

gram pos bacteria

ototoxicity (deafness

Front 78

Carbamazepine is used to treat ___ and is usually cleared by ___.

Back 78

convulsions

metabolic - one metabolitye also has anticonvulsant activity

Front 79

Carbamazepine is metabolized by ___

Back 79

CYP3A4

Front 80

Carbamazepine has many drug interactions and ____

Back 80

autoinduction

Front 81

Concomitant treatment of ___ with valproate sodium results in ___

Back 81

carbamazepine

higher free fraction of carbamazeine

Front 82

Why is fospheytoin preferred over phenytoin?

Back 82

phenytoin has propylene glycol and can cause cardiac depression

Front 83

What is the dose for phenytoin?

Back 83

200-400mg/day, may use loading dose of 15mg/kg oral or IV

Front 84

What is the max recommended rate of IV admin of phenytoin and fosphenytoin?

Back 84

Phenytoin: 50mg/min

Fosphenytoin: 150mg/min

Front 85

When is phenytoin monitored?

Back 85

- prior to steady state (steady state takes too long) to ensure avoidance of sustained peaks or troughs
- acute setting: 2-3 days after initiation and then 3-5 days after that
- long term: 3-12 months

Front 86

___ is the fraction of administered drug that reaches the systemic circulation following administration by any route

Back 86

Bioavailability

Front 87

What percent of a drug is bioavailable after IV administration?

Back 87

100%

Front 88

During _____ the drug leaves the blood stream and enters the interstitial or cellular fluids.

Back 88

Drug distribution

Front 89

Drug distribution is dependent on what?

Back 89

blood flow,
capillary permeability
drug structure (hydrophobic/ hydrophilic)

Front 90

The concentration of the drug in the ___ is used to define and monitor therapeutic drug levels

Back 90

Plasma

Front 91

The ____ describes the extent to which a drug partitions between the plasma and tissue compartments.

Back 91

Volume of distribution (Dose/[drug in plasma]

Front 92

Drugs with large volumes of distribution may require _____ initial doses. (why?)

Back 92

Higher initial doses because it gets into tissues so fast you need more to establish a therapeutic plasma concentration.

Front 93

Drugs bound to a protein are (active/inactive)

Back 93

Inactive - only free, unbound drug can act on a target site and elicit response

Front 94

The blood-brain barrier is permeable to ___ soluble substances, but not ___.

Back 94

allows lipid-soluble drugs very rapidly, but not water soluble... (water soluble drugs may be used when you want to exclude the brain in target action)

Front 95

what type of drugs move easily through the placenta?

Back 95

Lipid-soluble (water soluble move slowly

Front 96

What is the fastest equilibrium possible between mother and fetus?

Back 96

40 mins

Front 97

___ refers to the removal of a drug from the body without any chemical changes being involved.

Back 97

Elimination

Front 98

___ refers to the disappearance of a drug when it is changed chemically into another compound.

Back 98

Metabolism (biotransformation)

Front 99

What is a prodrug?

Back 99

A drug that is administered in an inactive state to promote absorption and is then metabolized into its active form (codeine)

Front 100

P450 enzymes are metabolized mostly in the ___

Back 100

Liver

Front 101

The P450 primarily involves which families?

Back 101

CYP1, CYP2, and CYP3

Front 102

Metabolism is primarily ______

Back 102

P450-dependent oxidation

Front 103

A non P450 pathway is _____ which oxidizes amino-containing compounds like ____ and ___

Back 103

monoamine oxidase,

catecholamines and tyramine

Front 104

Almost all conjugated products are (active/inactive).

Back 104

inactive

Front 105

What is the primary mechanism of P450?

Back 105

induce the expression of enzymes through increased transcription

Front 106

What are the two types of inhibiition?

Back 106

Competetive - binds to active site so P450 can't
Irreversible - permanently deactivates P450

Front 107

Which drugs inhibit P450?

Back 107

cimetidine, cipro, erythromycin, ketoconazole, OCPs, quinidine, ETOH

Front 108

Which drugs induce p450?

Back 108

barbiturates, phenytoin, steroids, isoniazid, rifampin, ETOH

Front 109

How can ETOH both inhibit and induce P450?

Back 109

It binds competetively to reduce P450 active sites, but when it does, it also induces

Front 110

During renal elimination of a drug, non-protein bound drug will be freely filtered during ___

Back 110

glomerular filtration

Front 111

Proximal tubular secretion is an _____ process while distal tubular reabsorption occurs ____

Back 111

secretion = active pumping out

reabsorption = passive diffusion

Front 112

Drugs that are simply filtered will be cleared at a rate ___ _than GFR or CrCl.

Back 112

Similar

Front 113

Drugs that are filtered and reabsorbed will be cleared at a rate ___ than GFR.

Back 113

Lower

Front 114

Drugs that are filtered and actively secreted are cleared at a rate ___ than GFR

Back 114

higher

Front 115

In addition to renal elimination, what are 4 other possible routes of elimination?

Back 115

1. biliary secretion and enterohepatic cycling
2. exhalation
3. sweat
4. secretion in breast milk

Front 116

What is half life?

Back 116

The time that it takes for a plasma concentration of a drug to be reduced by 50%

Front 117

What is the pharmacokinetic parameter that most significantly limits the time course of action at a target?

Back 117

Clearance of a drug
(Cl renal + hepatic +other)

Front 118

How many half-lifes until most drugs are considered to be at a "steady state"?

Back 118

5

Front 119

In 1st order metabolism, the rate is ___

Back 119

proportional to the concentration of free drug (LINEAR)

Front 120

Most P450 drugs are what order metabolism?

Back 120

1st order

Front 121

What occurs with zero-order metabolism?

Back 121

it is non-linear and unpredictable... may be due to saturation, or may start that way

Front 122

Pharmacokinetic (drug-drug) interactions may occur during what 4 processes?

Back 122

1. absorption
2. distribution
3. metabolism
4. elimination

Front 123

The greater the ___ of an inhibiting drug, the more it blocks binding of the other drug.

Back 123

affinity

Front 124

Why should you be careful with drinking grapefruit juice and medications?

Back 124

deactivates the enzyme for metabolism of many medications (3A4)

Front 125

Vitamin K -____ the effect of warfarin.

Back 125

decreases

Front 126

Cheese, wine, cocoa, coffee, and cola all contain ____, which can result in a HTN effect rxn in pts on _____

Back 126

1. Tyramine
2. MAOIs

Front 127

Which 4 things can cause interactions with drugs?

Back 127

1. other drugs
2. foods
3. disease processes
4. Various patient factors

Front 128

What patient factors may influence drug interactions?

Back 128

heredity
disease
environment
smoking
diet/nutrition
ETOH
Gender
Age

Front 129

A premie is ___ (ages)
A neonate is ___
An infant is __
A child is ___
An adolescent is ___

Back 129

1. <36wks gestation
2. <30 days old
3. 1mo - 1 yr
4. 1-12 yrs
5. 12-18 yrs

Front 130

What is important to remember about oral absorption in young children?

Back 130

1. gastric pH alkaline < age 2
2. neonates have irregular and often enhanced absorption
3. intestinal flora depends on diet - breastfed develops flora sooner

Front 131

What is important regarding rectal administration in kids?

Back 131

1. Hemorrhoidal veins not part of portal system and avoid 1st pass metabolism
2. erratic absorption

Front 132

What are possible problems with IM or SQ absorption in children?

Back 132

Lack of blood flow to undeveloped muscle, highly variable among different children

Front 133

What 6 factors of distribution differ significantly in the pediatric population?

Back 133

1. vascular perfusion
2. body composition (more body water and less fat as neonates)
3. Tissue binding characteristics
4. physiochemical properties (more fat, so lipid soluble has increased risk for toxicity)
5. plasma protein binding is lower
6. Route of administration

Front 134

What is Gray Baby Syndrome?

Back 134

Babies with deficiency in glucoronidation enzymes that are given an antimicrobial medication (chlorampenicol) have poor feeding, decreased breathing, CV collapse, cyanosis, or death

Front 135

At what age does GFR appraoch nomral adult levels?

Back 135

2 years

Front 136

At what age does tubular secreation or reabsorption in the kidneys reach adult values?

Back 136

5-7 mos

Front 137

Elimination in pediatrics has changes that ultimately result in ___ half-lives

Back 137

longer

Front 138

IM injections in pediatrics are limited to ___mL

Back 138

2

Front 139

Pharmacokinetic changes in the elderly include what 10 main things?

Back 139

1. unchanged passive diffusion (same bioavailability)
2. Decreased first pass effect (increased bioavailability of some)
3. reduced gastric acids
4. delayed gastric emptying
5. Decreased esophageal motility
6. decreased blood flow
7. loss of SQ fat
8. increased fragility of veins
9. Drug interactions due to metabolism issues
10. Drugs affect GI motility and constipation can affect absoprtion

Front 140

In what condition would serum albumin levels be altered among elderly pts?

Back 140

Chronic disease or severe malnutrition

Front 141

What age-related changes in the kidney ultimately lower the GFR?

Back 141

- smaller kidney size
-decreased renal blood flow
- decreased functioning nephrons
- decreased renal tubular secretion

Front 142

After age 40, GFR decreases ___ to ___% every 10 years.

Back 142

6-10%

Front 143

In elderly, Serum creatinine _____ reflect creatinine clearance?

Back 143

does not

Front 144

What factors result in increased drug-receptor interactions in the elderly?

Back 144

1. increased sensitivity of the receptor
2. decreased capacity to respond to the drug induced receptor
3. reduced number and affinity of receptors

Front 145

What factors are important for safe prescribing in the elderly?

Back 145

1. explore alternatives to medication
2. choose drugs efficiently
3. simplify the regimen
4. educate patients and caregivers
5. review medications
6. therapeutic monitoring