L4: Principles of Pharmacology

Question 1

Digitalis

Answer 1

-contains cardiac glycoside (digoxin)
-inhibits Na/K ATPase and acts as cardiac inotrope

Question 2

If 2 graphs, one has Rx effect close to Tx effect and the other has Rx effect farther from Tx effect, which drug would be better?

Answer 2

The drug with Rx and Tx farther apart is better.
-If had to double the dose, the Tx being farther apart would mean less chance of getting adverse/toxic effects
-Whereas the closer Tx line is, the more likely to experience negative effects

Question 3

Pharmacokinetics

Answer 3

ADME
“What the body does to a drug”

Question 4

Pharmacodynamics

Answer 4

“What a drug does to the body”

Question 5

“Alternative” and “complementary” treatments
have been increasingly promoted but generally have not undergone validation with appropriately designed ___ and do not require ___ approval!

Answer 5

-RCTs
-FDA

Question 6

Magic bullet

Answer 6

Drug that precisely targets a disease or a receptor
– Magic bullets would have a very wide therapeutic window
– But there are few magic bullets: antimicrobials that target bacterial cell walls (not found in humans/animals)

Question 7

Specificity

Answer 7

• Drugs are almost never specific
  -Drug with one and only one site of action is specific
  -But even a drug with one main site of action may act at other receptors, especially at higher doses

Question 8

Selectivity

Answer 8

• Drugs can be selective
  -Drug mainly affects a particular target
  -Drug mainly affects a particular tissue

Question 9

Achieving Selectivity

Answer 9

Selectivity depends on several factors
* Chemical nature of drug
* Dose (keep it low)
* Route of administration (target a specific organ)
* Unpredictable differences between patients (e.g., due to genetics, age, co-existing diseases, other drugs)

Question 10

Selectivity is especially important for ____ drugs

Answer 10

-chemotherapeutic (anticancer, antimicrobial)

Goal is to “kill” the target without harming the host

Question 11

Risk-Benefit Ratio

Answer 11

Acceptable ratio depends on:
* Severity of the disease being treated (or prevented)
* Economics
* Societal factors
* Patient’s medical history and current/past drug use

Question 12

Drug-related threats to quality of care

Answer 12

– Misuse: errors and defects in treatment
– Overuse: receiving treatment of no value
– Underuse: failing to receive needed treatment

• Drug safety initiatives often address only misuse – but overuse and underuse also need attention!

Question 13

Drugs have many names

Answer 13

– Chemical name: scientific name, based on molecular structure
– Generic name: nonproprietary name, officially approved during drug development process
– Brand name: commercial name; aka trade name

Question 14

Drugs in the same class often share a common suffix
-Cardio Examples

Answer 14

• -lol for β antagonists (e.g., propranolol)
• -osin for α1 antagonists (e.g., prazosin)
• -pril for ACE inhibitors (e.g., enalapril)

Question 15

Generic version of a drug

Answer 15

– Copy of an approved brand name drug
* Manufactured and marketed after a brand name drug is off-patent
* Generally less expensive than brand name drug
* Same dose, route of administration, approved indications, safety, adverse effects, etc

– Required to meet bioequivalence standards defined by the FDA
* Chemical, manufacturing, and pharmacokinetic equivalence
* Therapeutic equivalence, which is generally but not always achieved by the generic version of a drug

Question 16

Precision Medicine

Answer 16

Personalization of drug therapy to consider genetic and environmental factors

BUT
* Testing of multiple sub-populations is costly
* Number of individuals in a sub-population may be too small to provide conclusive data in a clinical trial

Question 17

Post-marketing surveillance is essential for detection of rare – but potentially very serious – _____!

Answer 17

complications