Pharm I, Exam 1

Front 1

Definition of Pharmacology

Back 1

the study of the effect of chemicals on living tissue

Front 2

Pharmacokinetics is...

Back 2

the study of absorption, distribution, metabolism, and excretion of drugs

(what the body does to the drug)

Front 3

Pharmaceutics

Back 3

formulation and preparation of drugs

Front 4

Pharmacoeconomics

Back 4

study of the economic impact of drugs

Front 5

Toxicology

Back 5

the study of the harmful effects of chemicals

Front 6

This is the study of the medicinal uses of naturally occurring compounds (from plants and animals)

Back 6

pharmacognosy

Front 7

This is the preparation and dispensing of drugs

Back 7

pharmacy

Front 8

Pharmacogenetics

Back 8

genetic influences by and on drugs

Front 9

Pharmacodynamics

Back 9

physiological and biochemical mechanism of action of drugs

(What drugs do to the body)

Front 10

This identifies discrete genetic differences among individuals that play a critical role in drug response

Back 10

Pharmacogenomics

Front 11

This is the study of the use and effects of drugs on large groups of people

Back 11

Pharmacoepidemiology

Front 12

_____ is the range of medication dosage that effectively treats the majority of the population

Back 12

Therapeutic window

Front 13

How many mg are in 2% lidocaine per mL?

Back 13

20 mg/mL (just add a zero!)

Front 14

Chemical substances that bind to a specific receptor (proteins) are referred to as ______.

Back 14

ligands

Front 15

Two types of ligands:

Back 15

agonists (bind to receptor and stimulate its function)

antagonists (bind to receptor and block its function)

Front 16

_____ binding is reversible, and this is found in most drugs. _____ binding is nonreversible, and an example is aspirin.

Back 16

competitive, noncompetitive

in noncompetitive binding, in order to get rid of the drug's effects, you must make new cells/receptors -- will aspirin, it takes 5-7 days to make more platelets

Front 17

What does it mean if a receptor is stereospecific?

Back 17

receptor has a specific shape, and their ligand must have complementary shape, "lock and key"

Front 18

ED50 means...

Back 18

effective dose in 50% of the population

Front 19

TD50 means...

Back 19

toxic dose in 50% of the pop. -- does not necessarily mean death, but organ damage

Front 20

LD50 means...

Back 20

lethal dose in 50% of the pop.

Front 21

Therapeutic Index =

Back 21

LD50/ED50

want this number to be as high as possible for drug to be safe

if therapeutic window is narrow (low #) drug is unsafe!

Front 22

Therapeutic Window =

Back 22

TD50/ED50

index for estimation of drug dosage which can treat issue effectively while staying within safety range

Front 23

The Receptor Theory states:

Back 23

a drug receptor is a macromolecular complex which acts as the site of action for a drug
usually proteins involved in production of normal cellular function
may include membrane proteins, enzymes, carrier molecules, ion channels, nucleic acids

Front 24

Endogenous Transmitter

Back 24

body's own ligand that stimulates a receptor

Front 25

An allosteric agonist or antagonist binds at one location but...

Back 25

its effects are felt elsewhere.

Front 26

This is the study of the medicinal uses of naturally occurring compounds (from plants and animals)

Back 26

pharmacognosy

Front 27

This is the preparation and dispensing of drugs

Back 27

pharmacy

Front 28

Pharmacogenetics

Back 28

genetic influences by and on drugs

Front 29

Pharmacodynamics

Back 29

physiological and biochemical mechanism of action of drugs

(What drugs do to the body)

Front 30

This identifies discrete genetic differences among individuals that play a critical role in drug response

Back 30

Pharmacogenomics

Front 31

List the types of chemical bonds from strongest to weakest

Back 31

Covalent, Ionic, Hydrogen, Hydrophobic, Van der waals

Pnemonic: Cobras In Hawaii Have Venom!

Front 32

_____ is the ability of a drug to bind to a receptor, whereas _____ is the ability of a drug to produce a response.

Back 32

affinity, efficacy

Front 33

_____ is governed by affinity, whereas ____ is governed by efficacy.

Back 33

occupation, activation

Front 34

What is the shape of a dose response curve and what 4 things does it determine?

Back 34

sigmoidal, determines what dose produces what effect

1. affinity (potency)
2. efficacy
3. variability
4. slope

Front 35

ED99 is ...

Back 35

the actual dose recommended for administration

Front 36

If the LD 50 of a drug is 400 mg, and the ED 50 of a drug is 100 mg, the therapeutic index tells you...

Back 36

400/100 = 4

it takes 4 x as much to kill you as is needed to produce desired effect

Front 37

Receptors are (almost always/never) subject to feedback regulation by their own signaling outputs.

Back 37

almost always

Front 38

Continued stimulation of cells with agonists generally results in desensitization referred to as ______. Continued or subsequent exposure to same concentration of drug is diminished

Back 38

down-regulation

decr. in number of receptors during over-stim.

Front 39

Chronic administration of an antagonist results in ______. The number and sensitivity of receptors increases as a response to chronic blockade.

Back 39

up-regulation

incr. in number of receptors during under-stim.

Front 40

Both up-regulation and down-regulation of receptors require:

Back 40

higher doses of drugs to achieve desired response.

Front 41

Why can't drug companies do good studies on fetal effects of drugs?

Back 41

unethical

Front 42

Most drugs are part of this pregnancy category:

Back 42

C

Front 43

Pregnancy Cat A

Back 43

no risk to fetus, remote possibility of fetal harm

Front 44

Pregnancy Cat B

Back 44

no harm shown in animal studies, but no controlled studies done in pregnant women, or animal showed adverse effect not demonstrated in humans

Front 45

Preg Cat C

Back 45

studies unavailable, or have shown teratogenic effects, only give if benefit > risk

Front 46

Why can't drug companies do good studies on fetal effects of drugs?

Back 46

unethical

Front 47

Most drugs are part of this pregnancy category:

Back 47

C

Front 48

Pregnancy Cat A

Back 48

no risk to fetus, remote possibility of fetal harm

Front 49

Pregnancy Cat B

Back 49

no harm shown in animal studies, but no controlled studies done in pregnant women, or animal showed adverse effect not demonstrated in humans

Front 50

Preg Cat C

Back 50

studies unavailable, or have shown teratogenic effects, only give if benefit > risk

Front 51

Pregnancy Cat D

Back 51

evidence of human fetal risk, but allowed to use in life-threatening situations and safer drugs cannot be used or are ineffective

Front 52

Pregnancy Cat X

Back 52

risk of use in pregnancy clearly outweights benefits, contraindicated in women who are or may become pregnant

Front 53

The percentage of a drug contained in a drug product that enters systemic circulation in unchanged form after administration is called _____. (includes both amt. of drug and rate of entry)

Back 53

bioavailability

Front 54

______ refers to the alteration in the therapeutic action of a drug by concurrent administration of other exogenous chemicals.

Back 54

interaction

Front 55

1+1=2

Back 55

addition: combined effect of 2 drugs acting via same mechanism is equal to that expected by simple addition of each's actions

Front 56

1+1=3

Back 56

synergism: the combined effect of 2 drugs together is greater than each's individual effects

Front 57

1+0=3

Back 57

potentiation: enhancement of action of one drug by a second drug that has no detectable action of its own
ex: pcn and probenacid -- PCN is antibiotic and probenacid prevents drug from being excreted by kidneys so that its actions stay longer

Front 58

1+1=0

Back 58

antagonism: action of one drug opposes that of the other
ex: morphine and narcan

Front 59

If something is ionized, it is ________ soluble, whereas something that is unionized is ________ soluble.

Back 59

water soluble, lipid soluble

Front 60

what is pKa?

Back 60

the ionization constant of a chemical compound -- the pH at which the drug will exist in olution as 50%ionized and 50% non-ionized

Front 61

All drugs are salts of a weak ____ or _____.

Back 61

acid, base

Front 62

If a drug has a charge and is ionized, it is 100% (water/lipid) soluble, and (will/won't) make it to bloodstream unless given in IV, thus making it easier to eliminate.

Back 62

water, won't

Front 63

If a drug has no charge (unionized), it is 100% (water/lipid) soluble and (will/won't) cross the blood brain barrier or placenta, thus making it harder to eliminate.

Back 63

lipid, will

Front 64

Can you use regional anesthesia in an acidotic limb?

Back 64

NO

Front 65

if pH > pKa,

Back 65

drug is basic

Front 66

if pH <pKa,

Back 66

drug is acidic

Front 67

If pH-pKa =0

Back 67

50% will be ionized and 50% will be unionized

Front 68

If pH-pKa=0.5,

Back 68

75%/25% ionized/unionized

Front 69

if pH-pKa=1,

Back 69

99%/1% ionized, unionized

Front 70

An acid drug in an acid pH will be (ionized/unionized).

Back 70

unionized

Front 71

A base drug in an acid pH will be (ionized/unionized)

Back 71

ionized

Front 72

Find solubility: Drug A is an acid compound with pKa 7.1, placed into acid environment pH 6.0....

Back 72

7.1-6.0=1.1

99/1

99% non-ionized/1% ionizied

lipid soluble!

Front 73

pKa does not measure acid base status, rather the extent of:

Back 73

ionization

Front 74

In bases:
pH>pKa ____ predominates
pH=pKa ____
pH<pKa ____ predominates

Back 74

nonionized,
nonionized=ionized
ionized
pg 20 workbook

Front 75

In acids:
pH>pKa ____ predominates
pH=pKa _____
pH<pKa____ predominates

Back 75

ionized
non-ionized=ionized
non-ionized
pg 20 workbook

Front 76

For acidic drugs:
pH-pKa<0 means:
pH-pKa>0 means:

Back 76

nonionized, ionized

Front 77

For basic drugs:
pKa-pH<0 means:
pKa-pH>0 means:

Back 77

nonionized, ionized

Front 78

Lipophilic drugs are metabolized to form more ____ metabolites than parent drugs, making metabolites more easily excreted.

Back 78

hydrophilic/water-soluble

Front 79

Grapefruit juice changes the _____ of a drug, whether it is the drug or its metabolites that take action, this value will change what pt was intended to _____.

Back 79

bioavailability, absorb

grapefruit juice selectively inhibits CYP3A in enterocytes

Front 80

_____ refers to when drugs, environmental chemicals, air pollutants, and components or cigarette smoke stimulate synthesis and elevate level of hepatic drug-metabolizing enzymes

Back 80

enzyme induction

Front 81

Enzyme inhibitions occurs when:

Back 81

a substance cause less metabolism of a drug, leading to incr. in their effects

Front 82

Because nonionized drug molecules are ____ soluble, they can diffuse across _______ such as the blood-brain, gastric, and placental barriers to reach the effect site.

Back 82

lipid, cell membranes

Front 83

____ molecules/drugs are usually unable to penetrate lipid cel membranes easily because of their low ___ solubility. This results from the electric charges exerted by the ______ drug molecules.

Back 83

Ionized, lipid, ionized

Front 84

The (higher/lower) the degree of ionization, the less access the drug has across tissues such as GI tract, blood-brain and placental barriers.

Back 84

higher

Front 85

Oral drugs that are ionized (will/won't) be metabolized by the liver, and are commonly excreted through the _____ system.

Back 85

won't, renal

Front 86

Acids are proton ____ and bases are proton ____.

Back 86

donors, recipients

Front 87

When pH and pKa are equal, the drug will be...

Back 87

50% ionized/50% unionized

Front 88

This equation determines a drug's state of ionization:

Back 88

henderson-hasselbach

Front 89

A ganglion is:

Back 89

a collection of nerve cells outside of CNS

Front 90

A parasympathetic receptor for acetylcholine is called _____ and may be ____ at ganglion synapse or _____ at effector organ synapse.

Back 90

cholinergic, nicotinic, muscarinic

Front 91

A sympathetic receptor for adrenaline (norepinephrine) is called _____ at the effector organ synapse.

Back 91

adrenergic

Front 92

At the tissue site, sympathomimetic drugs do this:

Back 92

mimic norepinephrine and stimulate alpha, beta, or dopamine receptors

Front 93

At the tissue site, sympatholytic drugs:

Back 93

block adrenergic receptors

Front 94

At the tissue site, parasympathomimetic drugs:

Back 94

mimic Acetylcholine (Ach)

Front 95

At the tissue site, parasympatholytic drugs:

Back 95

block muscarinic cholinergic receptors.

Front 96

If the effector organ is the heart, sympathetic stimulation ______ whereas parasympathetic stimulation ____.

Back 96

speeds up, slows down

Front 97

Beta blockers inhibit

Back 97

sympathetic adrenergic receptors

Front 98

Atropine is a ______, therefore it _____ HR.

Back 98

parasympatholytic, anticholinergic, antimuscarinic

Front 99

anticholinergic is the same as

Back 99

antimuscarinic

Front 100

Inhaled anesthetics are great for _____ but poor at _____.

Back 100

anesthetia/amnesia, analgesia

Front 101

In abdominal surgery, Total muscle relaxation is important for:

Back 101

prevention of evisceration

and also "table glue" =)

Front 102

Objective of general anesthesia:

Back 102

reduce sensory awareness and suppress reflexes sufficiently to permit surgery

Front 103

Stage 1 of anesthesia

Back 103

awake to loss of consciousness (hypnosis), "analgesia"

Front 104

Stage 2 of anesthesia

Back 104

"excitement,"
amnesia, cv instability and excitation, emesis, dysconjugate occular movements

Front 105

Stage 3 of anesthesia

Back 105

"surgical anesthesia,"
movement in response to pain is suppressed, 4 planes

Front 106

Stage 4 of anesthesia

Back 106

"medullary paralysis, death,"
cessation of spontaneous respiration and medullary cardiac reflexes can lead ot death

Front 107

4 planes of stage 3 anesthesia:

Back 107

1. deep respiration, coordinated thoracic and diaphragmatic muscle activity, papillary constriction
2. diminished respiration, fixed midline and dilated pupils
3. continued diaphragmatic mvmt, diminished thoracic mvmt, further papillary dilation
4. thoracic immobility, diminished diaphragmatic mvmt.

Front 108

General character and relative duration of stages are same for all IAs, but ____ and _____ differ.

Back 108

speed of induction, details of signs

Front 109

Stage one ends when....

Back 109

pt loses consciousness!

Front 110

3 planes of stage 1:

Back 110

1. no amnesia/analgesia
2. total amnesia partial analgesia
3. total amnesia and analgesia, skin incision feels like blunt instrument dragged across skin

Front 111

Scary things about stage 2:

Back 111

- violent/combative behavior
- struggling
- muscle tone increase
- jaw sets
- breath holding and retching
- nystagmus

Front 112

Corneal reflex and laryngeal reflex are lost during this stage, making it a good time for intubation:

Back 112

stage 3 plane 2

Front 113

Hypotension and tachycardia are seen starting in this stage:

Back 113

stage 3, plane 3

Front 114

Stage 3 begins with the onset of....

Back 114

regular rhythmic respiration

Front 115

It's easier to (inhibit/excite) with drugs

Back 115

inhibit!

Front 116

Disinhibition

Back 116

causes intense paranoia and fear, pt psychologically reacts, frequently caused by droperidol

Front 117

Greatest danger during stage 2:

Back 117

during emergence, pt can suck back against a closed glottis, creating a negative pressure in the lungs --> flash noncardiogenic pulm edema, treat with reintubation and PEEP, common in YOUNG HEALTHY MALES, will see pink frothy sputum

Front 118

The more complex the brain function, the (Easier/harder) it is to knock it out w a drug

Back 118

easier!

Front 119

The more simple the brain function, the (easier/harder) it is to knock it out w a drug

Back 119

harder!

w/ neuro injury, brain stem function is last to go

Front 120

Sequence for loss of reflexes:

Back 120

lips to lungs
oral reflexes go first

Front 121

Children require (lower/higher) MAC than adults, but also go to sleep (slower/faster), this is due to:

Back 121

higher MAC, sleep faster, due to incr. metabolism, HR, RR

Front 122

This is the plane of stage 3 where corneal reflex is lost:

Back 122

stage 3 plane 3

Front 123

This is the plane of stage 3 of anesthesia when pupillary light reflex disappears:

Back 123

stage 3 plane 4

Front 124

These reflexes are the strongest and last to go:

Back 124

corina and bronchial

Front 125

2 questions when deciding to extubate:

Back 125

1. can they breathe without the tube?
2. will they vomit/aspirate? (swallow and gag, trying to protect airway)

Front 126

Patients must be deeper for which: intubation or surgical incision?

Back 126

intubation!

Front 127

Fi means

Back 127

inspired gas concentration (%)

determined by FGF, breathing circuit volume, circuit absorption

Front 128

FA means

Back 128

alveolar gas concentration

determined by uptake, ventillation, concentration effect, second gas effect

Front 129

Fa means

Back 129

arterial gas concentration

affected by V/Q mismatching

Front 130

Due to shunting in the lungs during anesthesia, minimum fi02 must always be

Back 130

30%

Front 131

MAC means

Back 131

minimum alveolar concentration required to achieve surgical anesthesia (Stage 3)

Front 132

lung (Alveolar) concentration =

Back 132

brain concentration

Front 133

This makes an anesthetic faster:

Back 133

low blood gas coefficient

Front 134

Machine factors:

Back 134

1. liter flow (the higher the gas flow, faster the pt sleeps)
2. absorption into plastic

Front 135

Lung Factors:

Back 135

1. ventilation
2. concentration
3. blood gas solubility
4. v/q problems
5. second gas effect
6. n20 diffusions into closed spaces

Front 136

Blood Factors:

Back 136

Cardiac output

central compartment/vessel-rich/vital organs go to sleep first because they receive 75% of c.o., (Then muscle, then fat)

increases in CO sow speed of induction

CO affects slow-acting IAs more

Front 137

Tissue Factors:

Back 137

1. oil/gas solubility
2. metabolism
3. diffusion hypoxia
4. pediatrics (go to sleep faster even though MAC is higher, peaks at 6 mo.)
5. obesity (induction time is the same but longer for emergence -- depot/reservoir effect)
6. hypothermia (slower elimination of anesthetics, slower emergence)

Front 138

Ventilation: The faster you breathe, the (Faster/slower) you go to sleep

Back 138

faster

Front 139

Concentration: as you increase dose, the drug works (faster/slower)

Back 139

faster

Front 140

Blood gas solubility: the (lower/higher) the b.g. coefficient, the faster the drug works

Back 140

lower

Front 141

V/Q problems: bad lungs/one lung/CLD (slows/speeds) delivery of anesthetics, and therefore (slows/speeds) drugs

Back 141

slows, slows

faster drugs have a more pronounced slowing effect

Front 142

second gas effect: if you give 2 gases together (1 fast and 1 slow), the slow drug will go in (Faster/same speed) than normally, and occurs during this part of case _____.

Back 142

faster, occurs during beginning (First 5 min) of case

Front 143

N20 diffusions into closed spaces: N20 (contracts/expands) more than air, which will (increase/decrease) pressure in a closed space.

Back 143

expands, increase

incr. size of air emboli, pneumothorax, etc

Front 144

oil/gas solubility indicates this:

Back 144

potency

increased number means increased potency

Front 145

all IA metabolism is trace except for this drug:

Back 145

sevoflurane/ultane
5-7%

Front 146

diffusion hypoxia means...

Back 146

high concentration used for n20 causes high exiting concentration through lungs, requiring 3-5 min of 100% fi02 at end of case to prevent hypoxia

Front 147

MAC 50 is used for _____, and is the minimum alveolar concentration required to achieve surgical anesthesia/immobility in 50% of pts

Back 147

maintenance

Front 148

Relationship between MAC and dose:

Back 148

inversely proportional -- higher # of mac means lower dose is required

Front 149

MAC awake:

Back 149

alveolar concentration of anesthetic that inhibits responses to command in half of pts (open eyes)

Front 150

MAC bar:

Back 150

alveolar concentration wher autonomic responses are blocked, 1.6x higher tan MAC 50

Front 151

Partition coefficient: Sevoflurane

Back 151

MAC 2
b/g 0.6
oil/gas 50

Front 152

Partition coefficient:
Isoflurane

Back 152

MAC 1.15
b/g 1.4
o/g 99

Front 153

Partition coefficient:
N20

Back 153

MAC 105
B/G 0.47
O/G 1.4

Front 154

Partition coefficient:
Desflurane (suprane)

Back 154

MAC 5.8
b/g 0.42
o/g 18.7

Front 155

this is the number 1 trigger for malignant hyperthermia:

Back 155

inhaled anesthetics/volatile gases!

Front 156

oil gas coefficient indicates:

Back 156

potency
increased # means increased potency!

Front 157

low solubility means:

Back 157

fast in fast out

Front 158

high solubility means:

Back 158

slow in slow out

Front 159

this IA cant be used for mask induction because it causes coughing and tastes caustic

Back 159

desflurane

use sevoflurane instead!

Front 160

blood gas coefficient means the number of molecules of a drug stay in the blood for every 1 molecule that...

Back 160

leaves the blood

Front 161

the (higher/lower) the b/g coefficient, the (Faster/slower) the rise of anesthetic in the lungs

Back 161

lower, faster

Front 162

n20 is faster than desflurane in spite of a higher b/g coefficient due to:

Back 162

the concentration effect

Front 163

N20 expansion in closed spaces can be deleterious when:

Back 163

pneumothorax
bowel obstruction
inner ear sx
neurosurg procedures w air injection
air embolism
within 4 wks of use of sulfur hexafluoride gas injection in occural sx
laparoscopy

can lead to expansion of PA cath balloon or ETT cuff volume

Front 164

(Increases/decreases) in CO slow the onset of all anesthetics; (highest/lowest) blood gas agents are affected the most.

Back 164

increases, highest

Front 165

If blood is moving slowly during decreased CO, it has this effect:

Back 165

more time to exchange gas and higher alveolar levels

Front 166

max fiN20 used during anesthesia:

Back 166

70%

Front 167

What is the effect of pregnancy on anesthesia?

Back 167

both CO and Minute ventilation are increased in pregnant women --> offset each other and rate of rise of IA is similar to nonpregnant people