Definitions

Question 1

Clearance

Answer 1

Volume of plasma cleared of a drug per unit time

Question 2

Half life

Answer 2

Time taken for drug concentration to halve - dependent on volume of distribution and clearance

Question 3

Volume of distribution

Answer 3

Volume into which drug distributes

Question 4

What type of drugs have high volume of distribution?

Answer 4

Lipid soluble

Question 5

What types of drugs have low volume of distribution?

Answer 5

Water soluble

Question 6

First order kinetics

Answer 6

Clearance of drug is proportional to concentration

Question 7

Zero order kinetics

Answer 7

Clearance of drug is NOT necessarily proportional to concentration

Question 8

Name three drugs which follow zero order kinetics

Answer 8

Ethanol
Salicylate (aspirin)
Phenytoin

Question 9

Bioavailability

Answer 9

% of the dose which reaches systemic circulation

Question 10

Which mechanism of drug delivery has 100% bioavailability?

Answer 10

IV

Question 11

Multiple dosing

Answer 11

The principle of giving drugs at intervals allowing the concentration to reach a steady state

Question 12

In how many half lives will most multiple dosing drugs reach steady state?

Answer 12

5

Question 13

Loading dose

Answer 13

A larger initial dose used to decrease the time needed to reach steady state

Question 14

Name some drugs where multiple dosing strategies are employed

Answer 14

Phenytoin
Digoxin
Amiodarone
Theophylline

Question 15

First pass metabolism - definition and location

Answer 15

Metabolism and inactivation of a drug before it reaches systemic circulation

Common in gut wall and liver

Question 16

Name some drugs which experience first pass metabolism

Answer 16

Propranolol
Morphine
Nitrates

Question 17

List the 3 pathways of drug metabolism and elimination

Answer 17

Excretion of unchanged drug

Phase 1 metabolism and renal excretion

Phase 2 metabolism and renal excretion

Question 18

Phase 1 metabolism

Answer 18

Creation of reactive functional groups

Question 19

List some methods of phase 1 metabolism

Answer 19

Oxidation - P450 system
Reduction
Hydrolysis

Question 20

Phase 2 metabolism

Answer 20

Production of polar compounds

Question 21

What kinds of reaction occur in phase 2 metabolism?

Answer 21

Conjugation reactions

Question 22

What are the 2 most common P450 enzymes?

Answer 22

CYP 3A4

CYP 2D6

Question 23

What are the conditions of the CURB-65 mnemonic and what is it used for?

Answer 23

Use - determine severity and treatment of CAP: a score >2 requires admission and Rx with IV abx

C = confusion: AMTS < 8/10
U = urea > 7.5 mmol/L
R = resp rate > 30 
B = BP systolic < 90 mmHg
65 = age > 65

Question 24

What are the 4 main principles of pharmacokinetics

Answer 24

Absorption
Distribution
Metabolism
Excretion

Question 25

# Define the following types of drug allergies (1) Type 1 (2) Type 2 (3) Type 3 (4) Type 4

Answer 25

Type 1 - anaphylaxis Type 2 - cytotoxic antibodies Type 3 - immune complexes Type 4 - cell-mediated

Question 26

List some drugs that can cause neutropenia

Answer 26

Carbamazapine Carbimazole Clozapine Sulfasalazine

Question 27

Name a class of drug that is likely to produce cholinergic side effects

Answer 27

Anti-cholinesterases

Question 28

List some cholinergic side effects

Answer 28

``` Salivation Bronchoconstriction Lacrimation Urination Diarrhoea Emesis Miosis - pupillary constriction Sweating ```

Question 29

Name some drugs likely to produce anti-muscarinic/cholinergic side effects

Answer 29

Anti-muscarinics... ipratropium, anti-histamines, TCAs, antipsychotics, atropine

Question 30

list some anti-muscarinic/cholinergic side effects

Answer 30

``` Constipation Urinary retention Mydriasis - pupillary dilation Blurred vision Bronchodilation Drowsiness Dry skin / eyes ```

Question 31

List some P450 enzyme inducers (HINT: think PC BRAGS)

Answer 31

Phenytoin Carbamazepine ``` Barbiturates Rifampicin Alcohol (chronic use) Griseofulvin St. John's Wart ```

Question 32

List some P450 enzyme inhibitors (HINT: think AO DEVICES)

Answer 32

Allopurinol Omeprazole ``` Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute intoxication) Sulphonamides ```

Question 33

List some drugs you should stop before surgery (HINT: think I LACK OP)

Answer 33

Insulin Lithium Anticoagulants COCP K-sparing diuretics Oral hypoglycaemics Perindopril (i.e. ACEi)

Question 34

List the drugs that require monitoring | guys with large dongles make totally perfect internet connections

Answer 34

``` Gentamycin / Vancomycin Warfarin Lithium Digoxin Methotrexate Theophylline Phenytoin Insulin Ciclosporin ```

Question 35

List some drugs (apart from enzyme inhibitors) that augment the actions of warfarin

Answer 35

Alcohol Statin NSAIDs Amiodarone

Question 36

List some drugs that are affected by renal impairment

Answer 36

Digoxin Gentamicin Atenolol Amoxicillin

Question 37

List some nephrotoxic drugs

Answer 37

Gentamicin - ototoxic and nephrotoxic (tubular damage) Lithium - nephrogenic DI and tubular damage Ciclosporin - decreases GFR and tubular damage ACEi - decreases GFR ARB - decreases GFR NSAIDs - decreases GFR and papillary necrosis

Question 38

List some hepatotoxic drugs and the effects they have

Answer 38

Cholestatic damage - flucloxacilli, erythromycin, OCP, TCA Hepatocellular damage - paracetemol, anti-epileptics (eg: valproate), anti-TB (eg: rifampicin), methotrexate, statins Chronic hepatitis - methyldopa Gallstones - COCP