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Flashcards in lecture 2- pharmacokinetics con't Deck (77):
1

creatinine clearance is based on

muscle mass

2

why is it significant if you have too much creatinine in your blood

mean your kidneys aren't functioning properly

3

creatinine clearance definition

s the volume of blood plasma that is cleared of creatinine per unit time. from Cockcroft and Gaul

4

females have a correction factor for cc and this does what

makes it lower, 85%

5

in calculating IBW for a female, compare actual body weight to ideal body weight and use which one ?

the lower value

6

MDRD calculation

more accurate calculation for excessive body weight and renal dysfunction , but really not practical/ used

7

what qualifies a patient as being obese

30% over their IBW

8

if a patient is obese, use

adjusted body weight

9

dialysis diffusion vs ultrafiltration

diffusion moves across the barriers. ultrafiltration is taking off a lot of fluid.

10

during dialysis, med will be removed if unbound volume is

<3.5L/kg. so if highly bound to albumin, it wont be removed.

11

during dialysis, med will be removed if clearance is

<10ml/min/kg. if highly renal eliminated, its already a med that is hydrophilic and small so it will move easily through dialysis filters

12

if the med has a dosing interval longer than its half life

you can expect it might be removed during dialysis

13

if a med has a molecular weight less than 1000 daltons

it will be removed during dialysis

14

when you put someone on dialysis, you assume that they have a creat clearance of about

30ml/min

15

single dose concentration graph

med peaks and then eliminates slowly at consistent rate.

16

continuous IV infusion

if you want to maintain something that has a short half life, redistributes quickly

17

intermittent dosing

get to therapeutic, wears off.

18

we cannot tell the effect of a med until

that med is ate steady state

19

steady state

amount of drug administered over time = amount of drug eliminated during the same time period. rate in = rate out. how quickly are you taking it in vs how quickly are you eliminating it.

20

how to do half life percentages

1 half life is 50%, and then each next one is halfway between the previous and 100%.... 50, 75, 87.5, 93.75, 96.875

21

does a loading dose shorten the time to ready steady state

NO. loading doses bring you to therapeutic but elimination hasn't caught up

22

would you reach steady state faster if the dose was given at one half of the medications life?

no. you cant just change the dosing interval. have to account for elimination. rate in vs rate out.

23

tips for interpreting drug levels

never treat an isolated number and check the dosing history. treat the pt not the #!

24

trough checks

efficacy

25

peaks check

toxicity

26

trough level

is the lowest concentration reached by a drug before the next dose is administered

27

peak level

he highest concentration of a drug in the patient's bloodstream.

28

if an elderly person has reduced first pass metabolism

more drug gets to general circulation, can lead to toxicity

29

elderly fat % and free water

increased rat, reduced free water

30

what is the impact of the elderly having reduced albumin concentration and/or increased alpha1 acid glycoprotein ?

increased toxicity because reduced carrier proteins so more free levels

31

gastric pH and emptying time in neonates and infants

higher, reduced

32

CYP450 in neonates and infants

reduced/immature

33

protein binding in neonates and infants

reduced

34

renal clearance in neonates/infants

reduced

35

pharmacodynamics

the effects of drugs and mechanisms of their actions

36

drugs will either..

find their target cell, or be distributed, metabolized, and excreted.

37

most drugs bind to

cellular receptors

38

what do drugs do on cellular receptors

initiate biochemical reactions that alter the cell's physiology

39

where do drugs exert their primary action

the cellular level

40

drug receptors are generally made up of what

proteins or glycoproteins present on the cell surface, on an organelle within the cell or in the cytoplasm

41

receptor mediated responses plateau once...

....receptor saturation occurs. (you can give a med, not get the effect you want, and doesnt matter how much more you give. you only have so many receptors.

42

although we have a finite number of receptors on a given cell, how does the body compensate?

thru up and down regulation. defense mechanism. body will produce more receptors. so you can't just d/c a drug without considering this. must taper

43

once a drug has bound to a receptor, what are the 3 things that could occur?

1) an ion channel is opened or closed
2) biochemical messengers, often called second messengers are activated
3) a normal cellular function is physically inhibited or initiated

44

biochemical messengers aka second messengers

(cAMP, cGMP, Ca+++, inositol phosphates) these initiate a series of chemical reactions within the cell, and transfuce the signal stimulated by the drug.

45

affinity

strength of binding between a drug
and its receptor. makes the receptor do what it normally does

46

dissociation constant (Kp)

the measure of a drug’s affinity for a given receptor. The concentration of drug required in solution to
achieve 50% occupancy of its receptors.

47

agonist

drugs which alter the physiology of a
cell by binding to plasma membrane or
intracellular receptors.
agonist's stop the normal effect

48

strong agonist

an agonist which causes
maximal effects even though it may only occupy a small fraction of receptors on a
cell.

49

weak agonist

an agonist which must
be bound to many more receptors than
a strong agonist to produce the same
effect.

50

antagonist

inhibit or block actions caused by agonists.

51

competitive antagonist

competes with agonist for
receptors.
-During the time that a receptor is occupied by an
antagonist, agonists cannot bind to the receptor. Because the antagonism can be overcome by high
doses of agonists, competitive antagonism is said to
be “surmountable.

52

noncompetitive antagonist

binds to a site
other than the agonist-binding domain. Induces a conformational change in the receptor such that the agonist no longer “recognizes” the agonist-binding domain.
§ “Insurmountable” because even high doses of
agonist cannot overcome this antagonism.

53

irreversible antagonism

with the receptor.
-Rate of antagonism can be slowed by high
concentrations of antagonist.
-Once an irreversible antagonist binds to a
particular receptor that receptor cannot be
“reclaimed” by an agonist.
with agonists for the agonist-binding receptor.
-Irreversible antagonists combine permanently
agents compete

54

efficacy

The degree to which a drug is able to cause maximal effects.
- If Drug A reduces blood pressure by
20mmHg and Drug B reduces blood pressure by 10mmHg, then Drug A has greater efficacy than Drug B.

55

potency

the amount of drug required to produce 50% of the maximal response that the drug is capable of causing. potency has more to do with dosing

56

potency is used to compare drugs that are..

in the same chemical class. drugs within the same chemical class will usually have similar maximal efficacy if a high enough dose is given.

57

efficacy

used to compare drugs with different mechanisms. like toradol (NSAID) and morphine (narc)

58

dose response curves show

the magnitude of drug action against the concentration/dose of drug required to induce those actions.
-the curve represents the effects and dose of a drug within an individual animal or tissue rather than in the population

59

effective concentration50% EC50

The concentration of drug which induces a specified clinical effect in 50% of
the subjects to which the drug is administered.

60

Lethal Dose 50% LD50

the conc of drug which induces death in 50% of the subjects to which the drug
is administered.

61

therapeutic index

a measure of the safety of a drug. calculated by dividing the LD50 by the ED50

62

margin of safety

the margin between therapeutic and lethal doses of a drug

63

Altered absorption

Drugs may inhibit absorption of other
drugs across biologic membranes (antiulcer agents that
coat the stomach may decrease GI absorption of other
drugs)

64

Altered metabolism:

Clinically important drug interactions
can occur when the P450 isoenzymes are inhibited or
induced.

65

Plasma protein competition:

Drugs that bind to plasma
proteins may compete with other drugs for the protein
binding sites. Displacement of drug ‘A’ from plasma
proteins by drug ‘B’ may increase the concentration of
unbound drug ‘A’ to toxic levels.

66

Altered Excretion:

Drugs may act on the
kidney to reduce excretion of specific
agents (e.g. probenecid competes with
sulfonamides for the same carrier,
increasing the risk of sulfonamide toxicity).

67

addition

the response elicited by combined drugs
is EQUAL TO the combined responses of the
individual drugs. 1+1=2

68

synergism

the response elicited by combined
drugs is GREATER THAN the combined responses of
the individual drugs. 1+1=3

69

potentiation

A drug which has no effect enhances
the effect of a second drug. 0+1=2

70

antagonism

Drug inhibits the effect of another
drug. Usually, the antagonist has no inherent activity.
1+1=0

71

Midazolam is a significant substrate of
CYP3A4. Erythromycin is a CYP3A4 inhibitor.
How would you manage this drug interaction?

substrate means metabolized by.
so too much free versed... this patient may be hard to wake up
use a different drug than erythromycin.

72

propofol is a strong CYP3A4 inhibitor. What
types of side effects would you expect from
sedatives that are metabolized by this
enzyme when given together?

so if you give prop with versed... more sedated, longer emergence

inhibition causes buildup

73

Carbamazepine is a very strong inducer
of CYP3A4. How might you have to
alter the dose of midazolam if given
together?

you'll need more versed because its getting metabolized faster

74

tolerance

represents a deresponsed to a drug. Clinically, this is observed when the dose of a drug must be increased to achieve the same effect.

75

tolerance can be ___ or ___ in nature

metabolic(drug metabolized more rapidly after chronic use) or cellular(decreased number of receptors, "downregulation"

76

dependence

patient needs drug to function normally. noted when cessation produces withdrawal symptoms.
dependence maybe physical and/or psychological

77

withdrawal

occurs when a drug is not administered to a person who has been dependent it