Pharmacokinetics Test 3 Set 2

Front 1

Aminoglycoside absorption
a)orally
b)IV intermittent infusion

Back 1

a)minimal
b)preferred method over 30-60 minutes

Front 2

Aminoglycoside absorption
a)continuous IV infusion
b)IM

Back 2

a)unsafe due to toxicity
b)good in ppl under 40, not good in ppl over 40

Front 3

Broad categories of AG's ADR's (3)

Back 3

1)ototoxicity
2)nephrotoxicity
3)neuromuscular paralysis

Front 4

AG's ear adverse effects (4)

Back 4

1)ototoxicity (2-10%) w/ trough levels great than 2
2)vestibular toxicity (dizziness)
3)tinnitus, high freq. hearing loss
4)hearing unlikely to improve if drug is dc'd

Front 5

AG's kidney adverse effects (4)

Back 5

1)nephrotoxicity
2)occurs in all pts who take it longer than 3 days
3)associated w/ trough's greater than 2
4)usually reversible

Front 6

Neuromuscular paralysis will occur w/ AG's when... (4)

Back 6

use of:
a)Mg
b)curare
c)botulism
d)myasthenia gravis
IS ALSO INVOLVED

Front 7

AG's spectrum (2)

Back 7

1)G(-)
2)if used w/ B-lactams they can kill staph/enterococcus

Front 8

AG's bactericidal mechanism (2)

Back 8

1)inhibit protein synthesis by binding ribosomal mRNA
2)uptake INTO bacteria is energy and O2 dependent via active transport

Front 9

Normal dosing of AG's
a)peaks
b)trough's

Back 9

a)5-10
b)less than 2

Front 10

Once daily dosing
a)peaks
b)troughs

Back 10

a)15-20+
b)0-1

Front 11

Why use ONCE-daily dosing for AG's (5)

Back 11

1)normal may result in suboptimal []s
2)timing of doses and serum []s have significant error=delayed interpretation and longer periods suboptimal
3)[] dependent killing, so higher peaks = more bacteria killed
4)post antibiotic effect allows for the really low peaks of once daily dosing
5)resistance of bacteria after first dose

Front 12

How is once-daily dosing good for the toxicities of AG's

Back 12

1)allows for rest of the organs suffering the toxicities b/c of uptake saturation @ the organs

Front 13

Hepatic cells where drugs are metabolized and is ____ dependent

Back 13

Parenchymal Cells
oxygen dependent

Front 14

Hepatic drug transporter he wanted us to know

Back 14

p-glycoprotein (MDL1, MDR3)

Front 15

CYP2C19, CYP2C9/10, CYP2D6, CYP3A4 all have the same 3 inducers

Back 15

1)phenobarbital
2)phenytoin
3)rifampin

Front 16

Phase II metabolic drug rxns (6)

Back 16

1)conjugation systems
2)glucuronic acid
3)sulfate
4)acetylation
5)methylation
6)glutathione

ALL END IN TRANSFERASE

Front 17

Measurement of hepatic impairment (4 of many)

Back 17

1)ALT,AST predict liver damage NOT fxnal impairment
2)serum albumin/PT
3)serum bilirubin
4)C14 breath test, caffeine (as marker compounds)

Front 18

Ultrafiltration
a)adv
b)factros affecting protein binding results (4)

Back 18

a)less expensive but reliable

1)drug binding to membrane
2)sieve effect
3)protein leakage
4)[] dependence

Front 19

Albumin properties (6)

Back 19

1)binds to acidic drugs
2)60% of ttl protein in most pts
3)60-70% intravascular, 30-40% extravascular
4)low and high capacity (saturable)
5)high and low affinity binding depending upon binding site
6)normal [] = 35-50g/L

Front 20

Alpha-acid glycoprotein (AAG) properties (2)

Back 20

1)binds basic drugs
2)acute phase reactant

Front 21

Common way to describe protein binding

Back 21

scratchard plot

Front 22

IM admin of theophylline

Back 22

precipitation in muscle and painful DO NOT DO THIS

Front 23

Drugs incr CL of theophylline (4 of many)

Back 23

1)phenytoin
2)tegretol
3)rifampin
4)corticosteroids

Front 24

Drugs decr CL of theophylline*** (3 of many)

Back 24

1)erythromycin
2)ciprofloxacin
3)OC's

Front 25

Theophylline mechanism of axn (3)

Back 25

1)inhibits cyclic nucleotide PDE enzymes that catalyze the breakdown of cAMP and GMP
2)this enhances activites of autocoids, hormones and NTs that signal via cyclic nucleotides
3)adenosine antagonist