DIT review - Pharm basics Flashcards

1
Q

Describe the difference between zero-order and first-order velocity in enzyme kinetics (comparing velocity of reaction to concentration of substrate)

A
  • At first, as you increase substrate concentration the reaction velocity increases
    • First order velocity – reaction velocity is directly proportional to substrate concentration
  • As you add more substrate the enzyme becomes saturated and you cannot increase velocity of reaction
    • Zero order velocity – reaction velocity is independent of substrate concentration
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2
Q

Vmax is proprtional to the concentration of what?

A
  • Proportional to the enzyme concentration
    • After enzyme is saturated, the only way to increase velocity (Vmax) of the reaction is to increase enzyme
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3
Q

What is Km and what is it affected by

A
  • Is the concentration of substrate that brings reaction velocity to half of Vmax
  • Is inversely related to the affinity of the enzyme for its substrate
    • If enzyme has high affinity for substrate, the slope of the graph will be steeper and Km will be a smaller number
    • If enzyme has low affinity for substrate, the slope will be less steep and Km will be a larger number
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4
Q

Label the points on a Lineweaver-Burk plot (Y-intercept, X-intercept, and Slope)

A
  • Y-intercept = 1/Vmax
  • X-intercept = 1/-Km
  • Slope = Km/Vmax
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5
Q

Using a Lineweaver-Burk plot, interpret what it means when the y-intercept decreases

A
  • Decreased y-intercept = decreased 1/Vmax = increased Vmax, which means that more enzyme was added
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6
Q

Using a Lineweaver-Burk plot, interpret what it means when the x-intercept is moved to the right

A

X-intercept moved to the right = 1/-Km moving closer to 0 = Km increasing = decreased enzyme affinity for substrate

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7
Q

Describe the changes of a Michaelis-Mentin graph in the case of a competitive and noncompetitive inhibitor

(Changes in Km and Vmax)

A
  • Competitive inhibitor (reversible)
    • Resembles substrate and competes for active site on enzyme
      • Can be overcome by increasing amount of substrate
    • Effects:
      • Increases Km – more substrate needed in order to achieve 1/2Vmax
      • Does not affect Vmax – can still reach Vmax with increased [S]
  • Noncompetitive inhibitor (irreversible)
    • Binds to a separate site on the enzyme, causing a conformational change so the substrate can no longer bind
      • Cannot be overcome with increased substrate
    • Effects:
      • Decreases Vmax
      • Does not affect Km – changing substrate concentration will not help
        • Km increases by default because 1/2Vmax is a new number
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8
Q

Describe the changes of a Lineweaver-Burk plot in the case of a competitive and noncompetitive inhibitor

(Changes in Km and Vmax)

A
  • Competitive inhibitor (reversible)
    • Increases Km – more substrate needed in order to achieve 1/2Vmax
      • X-intercept moves to the right
    • Does not affect Vmax – can still reach Vmax with increased [S]
      • Y-intercept remains the same
  • Noncompetitive inhibitor (irreversible)
    • Decreases Vmax
      • Y-intercept increases
    • Does not affect Km – changing substrate concentration will not help
      • X-intercept remains the same
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9
Q

What is the equation for volume of distribution

A
  • Vd = (amount of drug in body) / (plasma drug concentration)
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10
Q

What is the equation for clearance

A
  • CL = (rate of elimination of drug) / (plasma drug concentration)
  • CL = Vd x Ke (elimination constant)
    • Ke = 0.7 / (half-life of drug)
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11
Q

What is the equation for loading dose

A
  • LD = (concentration at steady state) x (volume of distribution)
    • Concentration at steady state (Css) = desired concentration
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12
Q

What is the equation for maintenance dose

A
  • MD = Steady state concentration x Clearance
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13
Q

When determining how many half-lives it takes to reach steady state, what is an important number to remembr

A

In first-order kinetics, a drug infused at a constant rate takes 4 half-lives to reach 94% of steady state

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14
Q

What is the equation for half life in first order kinetics

A
  • Half life = (0.7 x Vd) / CL
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15
Q

Describe the difference between efficancy and potency of a drug

A
  • Efficacy = maximum effect that a drug can produce
    • Increased Vmax = increased efficacy
    • Partial agonists have less efficacy than full agonists
  • Potency = amount of drug needed for a given effect
    • Decreased EC50 = increased potency = less drug needed
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16
Q

Will efficacy or potency be affected by:

  • Competitive antagonists
  • Non-competitive antagonists
A
  • Efficacy will be decreased by non-competitive antagonists (decrease Vmax)
    • Competitive antagonists will have no effect on efficacy (do not change Vmax)
  • Potency will be decreased (curve shift to R) by competitive antagonists (increase Km)
    • Non-competitive antagonists have no effect on potency (do not change Km)
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17
Q

What is the equation for therapeutic index

A
  • Therapeutic index:
    • TD50 / ED5
      • TD50 = drug dose that toxic to 50% of population
      • ED50 = drug dose that is effective in 50% of population
    • THINK: TITE à _T_herapeutic _I_ndex = _T_D50 / _E_D50
    • Safer drugs have higher therapeutic index
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18
Q

Which type of drug metabolism (phase 1 vs phase 2) occurs via CYP450 enzymes

A

Phase I

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19
Q

What reactions fall under the category of Phase I reaction

A
  • Hydrolysis, Oxidation, Reduction
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20
Q

What are the characteristics of metabolites resulting from phase I reactions

A
  • Result in metabolites that are:
    • Slightly polar
    • Water-soluble
    • Still active
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21
Q

What reactions occur in Phase II metabolism

A
  • Conjugation reactions – joining drug to some other group
    • Methylation, Glucuronidation, Acetylation, Sulfation
22
Q

What are the characteristics of the metabolites that result from Phase II reactions

A
  • Results in metabolites that are:
    • Very polar
    • Inactive
    • Renally excreted (polar drugs get trapped in urine and thus excreted)
23
Q

Which hepatic metabolism phase is lost first by geriatric patients?

A

Phase I

24
Q

Which medication inhibits alcohol dehydrogenase

A

Fomepizole

Used for:

  • Methanol poisoning
    • Prevents coversion of methanol to formaldehyde (toxic)
  • Ethylene glycol poisoning (anti-freeze)
    • Prevents conversion of ethylene glycol to oxalic acid
25
Q

Describe the premise behind zero order elimination

A
  • Zero order:
    • Constant amount of drug is eliminated per unit time
      • Basically behaves as if the enzyme is concentrated; rate of elimination will not change by adding more substrate
    • Plasma concentration decreases linearly with time
26
Q

What drugs have zero-order elimination

A
  • Phenytoin, Ethanol, Aspirin
    • THINK: PEA – pea is round and shaped like a “0”
27
Q

Describe the premise behind first order elimination

A
  • Constant proportion of drug is eliminated per unit time
  • Plasma concentration decreases exponentially with time
28
Q
A
29
Q

Treatment for acetaminophen toxicity

A

N-acetylcysteind (replenished glutathione)

30
Q

Treatment for acetylchonine esterase inhibitor (or organophosphate) toxicity

A

Atropine

Pralidoxime

31
Q

Treatment for amphetamine toxicity

A

NH4Cl (will acidify the urine, trapping amphetamines which are weak bases)

32
Q

Treatment for antimuscarinic toxicity

A

Physostigmine

33
Q

Treatment for benzodiazepine toxicity

A

Flumazenil

34
Q

Treatment for beta-blocker toxicity

A

Glucagon (increases cAMP –> increased Ca2+ –> increased heart contractility)

Calcium

Atropine (increases HR)

35
Q

Treatment for Carbon monoxide poisoning

A

100% O2

36
Q

Treatment for copper toxicity (Wilson disease)

A

Penicillamine

37
Q

Treatment for cyanide poisoning

A

Nitrate

38
Q

Treatment for digitalis (digoxin) toxicity

A

Anti-dig Fab fragments

39
Q

Treatment for Heparin toxicity

A

Protamine sulfate

40
Q

Treatment for Iron toxicity

A

Deferoxamine

41
Q

Treatment for lead toxicity

A

EDTA, Dimercaprol

42
Q

Treatment for mercury toxicity

A

Dimercaprol

43
Q

Treatment for Methanol or Ethylene glycol toxicity

A

Fomepizole (inhibits alcohol dehydrogenase, preventing the breakdown to toxic metabolites)

44
Q

Treatment for Methemoglobin

A

Methylene blue

Vitamin C

45
Q

Treatment for opioid toxicity

A

Naloxone, Naltrexone

46
Q

Treatment for Salicylate toxicity

A

NaHCO3 (alkalinize urine since ASA is an acid)

47
Q

Treatment for TCA toxicity

A

NaHCO3 (alkalinize urine)

48
Q

Treatment for Warfarin toxicity

A

Vitamin K (delayed effect)

Fresh frozen plasma (immediate effect)

49
Q

Treatment for fibrinolytic reversal (tPA, streptokinase)

A

Aminocaproic acid

Transexamic acid

50
Q

Treatment for Theophylline (caffeine) toxicity

A

Beta-blockers