Intro To Pharm

Question 1

IM

Answer 1

Intramuscular
Rapid admin
Quick onset

Question 2

IV

Answer 2

Intravenous
Most rapid form
100% bioavailability
Immediate onset but also toxic

Question 3

Oral

Answer 3

Most convenient 
GI transit time- prolong time decreases absorption
Gastric pH- acidic enviro malabsorption 
Bioavailability- 
Co-admin

Question 4

SL

Answer 4

Sublingual or Buccal
Under cheek or tongue
Ease of admin
Rapid absorption
Subsequent bioavailability

Question 5

SQ

Answer 5

Subcutaneous
Injection into fat
Great for long acting injection
Variable absorption
Stomach and arm faster absorption

Question 6

IT

Answer 6

Spinal cord

Rare elderly Pt with poor venous access

Question 7

Rectal

Answer 7

High perfusion area
For ancillary treatment
If they have nausea or vomiting

Question 8

Inh

Answer 8

Lung tissues large SA for absorption
Rapid onset
Popular for abuse

Question 9

Transdermal

Answer 9

Skin admin
Look for multiple patches
Patches cut open
Predetermined time period
Fetanyl-chronic pain

Question 10

Oral liquids

Answer 10

Peds and elderly
Bypass barrier for absorption
Great Bioavailability!

Question 11

Fastest to Slowest

Onset

Answer 11

IV-IM-SL-oral liquid-oral solid-depot injection(SQ)

Question 12

What is the #1 reason people stop taking their meds?

Answer 12

Side effect

Question 13

BA (F)

Answer 13

Bioavailability
True total amount of drug that reaches gen circulation
F=1 is 100%

Question 14

Bioequivalence

Answer 14

Brand vs generic

Same drug in similar doses reaches gen circulation at same relative rate and extent (super impossible)

Question 15

Clinical or Therapeutic Equivalence

Answer 15

Same drug 2 or more doses gives identical effect or 2 drugs from same class compared
Bioequivalent has to be clinical equivalent not other way around
Clinical outcome is similar

Question 16

What’s most important when looking at drug studies?

Answer 16

Pharmacodynamic effect of drug on body and safety endpoint

Question 17

Pharmacodynamic

Answer 17

What drug does to body

Question 18

Pharmacokinetic

Answer 18

What body does to drug

Question 19

Potency

Answer 19

Amount of med must be admin to achieve dynamic response
Therapeutic or toxic response
Compare activity of drug in same class
Reciprocal of dose
Only significant if fewer side effects or admin less often

Question 20

Absorption

Answer 20

Time for dose to enter circulation
Determines bioavailability
Pt variability
Most psychotropics absorbed in GI Tracy

Question 21

Distribution

Answer 21

Time for dose to reach desired site of action
BBB
Can delay pharmacodynamic effect
Factors-
Molecule size
Lipophilicity
CSf fluid ph
Protein binding
Side effect because distribute to other organ
More fat - more prolonged drug distribution
Only unbound drug is active

Question 22

Metabolism

Answer 22

Bio transformation
Body’s way of getting drugs ready for elimination
Occurs in liver 99% of time
If you inhibit you block metabolism and body can’t eliminate so bp keeps dropping
Cyt P450 enzyme system in liver
Isoenzymes indidually responsible for metabolism of enzymes
HUGE source of drug and adverse rxn

Question 23

Metabolite

Answer 23

Transformed molecule
Often more active then parent
Ability to metabolize impaired in chronic ill
Increased in kid under 12 and pregnant
Most psych meds metabolize in liver excrete via urine

Question 24

Enterohepatic recycling

Answer 24

Liver excretion reabsorb in intestine

Question 25

Renal

Answer 25

Kidney Most excreted Declines with age and disease

Question 26

Half life

Answer 26

Time for dose to undergo pharmacokinetic response Lower blood by 50% Takes 6-7 half life's to completely eliminate drug

Question 27

Steady state (SS)

Answer 27

5-6 half life's required to have passed with routine admin When the amount of drug absorbed or administered is =to the amount eliminated over each dosing interval Only time PT can be objectively assessed Test for clinical effectiveness Independent of dose admin or dosing interval Toxicity checked earlier

Question 28

Drug level monitoring

Answer 28

When there is no clear therapeutic or toxic endpoint Lithium changes quickly Safe serum is narrow

Question 29

Psych meds that require monitoring

Answer 29

``` Trycyclic antidepress Elavil Tofranil Pamelor Mood stabilizers Carbamazepine Lithium Valproic acid ```

Question 30

``` Protein bound shuts it down Patients age Renal hepatic fxn More useful in assessment of adverse drug rxn Clinical eval more useful ```

Answer 30

Drug level monitoring

Question 31

Drug interactions

Answer 31

Occurs with co admin of two or more drugs Similar therapeutic or synergistic effect: additive or synergistic Diminished or enhanced absorption Grapefruit inhibit Cyt P450 Inducer- drug levels decrease faster Enzyme inhibitor- stop metabolism of drug

Question 32

ED and LD

Answer 32

Lethal dose and effective dose | Look at LD1:ED99

Question 33

ADR

Answer 33

``` Adverse drug rxn Undesirable effect of med Go to site of action when you don't want to Onset is variable Drug interaction Switch class Discontinue Reduce dose Manage with other drug ```

Question 34

Common ADR with psych meds

Answer 34

``` Drowsiness/Insomnia Antidepress, neuroleptic, hypnotic, mood stabilizer N/V All meds Sex dysfunction SSRI antidepressant Weight gain/loss Antidepressant, neuroleptic, mood stabilizer Cognitive impairment Psychotropic Dry mouth TCA/anticholinergic Movement disorder 1st gen neuroleptic, ```

Question 35

Geriatrics

Answer 35

``` Thyroid disorders Polypharmacy Delayed gastric emptying Decreased aplchnic blood flow Elevated gastric ph Impaired intestinal motility Extent not affected - do not fully absorb Decreased body water Increased half life because fat Decrease protein binding increase toxicity 50% renal excretion age 70 BUN helpful 5-25 blood Uria nitrogen Renal number up renal fxn down ```