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Clinical Med (Year 2) > Pharm Quiz 1 > Flashcards

Pharm Quiz 1 Flashcards

1
Q

What is a threshold dose?

A

When the response starts to show

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2
Q

What is the ceiling effect?

A

See no more effect from the dose

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3
Q

What is therapeutic range?

A

When there is an increased response from the dose

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4
Q

Dose- response curve refers to response in?

A

A single patient

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5
Q

What does Quantal D-R curve determine?

A

Dose that causes specific response in a group

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6
Q

Higher Ti indicated a safer or more harmful drug?

A

Safer

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7
Q

What are the key issues of pharmacokinetics?

A

Absorption
Distribution
Metabolism
Excretion

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8
Q

What is absorption?

A

how the drug moves from tissue to bloodstream

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9
Q

What are some examples of enteral route of admission?

A

Oral
Lingual
Buccal
Rectal

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10
Q

What are some examples of parenteral route of admission?

A

Injection
Inhalation
Topical
Transdermal
Other

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11
Q

What is the trade off of enteral routes?

A

Fairly simple but less predicable absorprtion

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12
Q

What is the trade off of parenteral routes?

A

More difficult but more predictable absorption

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13
Q

What is bioavailability?

A

Percent administered dose that appears in bloodstream

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14
Q

What is the first pass effect?

A

Some of the drug is destroyed in first pass of liver

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15
Q

What are some factors that affect distribution?

A
  • Admin routes
  • Properties of drug
  • Binding to plasma proteins
  • Barriers and carriers
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16
Q

What are some primary storage sites for drugs?

A

Fat
Muscles
Bone
Liver
Kidneys
Organs/tissue

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17
Q

What are primary problems of storage?

A

Local tissue damage
Redistribution

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18
Q

What does metabolism (biotransformation) do?

A

Active form of drug is changed chemical to an inactive or less active by product or metabolite
(often creates more polar, water soluble metabolite that can be excreted by kidneys)

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19
Q

Where is the primary site of biotransformation?

A

liver

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20
Q

What are other sites of biotransformation?

A

Lungs
Kidneys
GI tract
Skin

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21
Q

What is an active metabolites?

A

Some can continue to exert effects for a while

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22
Q

Where is the primary site of excretion?

A

Kidneys

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23
Q

What are some other significant site of excretion?

A

Lungs
Gi tract

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24
Q

What are some minor sites of excretions?

A

Sweat
Saliva
Breast milk

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25
Q

What is clearance?

A

Rate that drug can be removed completely from body

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26
Q

What causes a drug to be cleared best?

A

If organ has high blood flow and good extraction ratio

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27
Q

What can impair an organs ability to clear drugs?

A

Any disease or illness that affects blood flow or extraction ratio

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28
Q

What is the problem with decreased clearance time>?

A

Prolonged medication effects and side effects

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29
Q

What is a half life?

A

amt of time required for 50% of active form of drug to be eliminated

30
Q

What happens if drugs are given continuously?

A

Maintain fairly stable level of drug in blood stream

31
Q

What happens if drugs are given intermittently?

A

Cause peaks and troughs in plasma level

32
Q

What are some factors that affect normal pharmacokinetics?

A

Disease
Age
Genetics
Gender
Body compositions
Diet
Other chemical
Physical factors

33
Q

What implication does pharmacokinetics have on implication for rehab?

A

Timing of session with drugs peak and troughd

34
Q

What is the implication of pharmacokinetics on absorption/ distribution?

A

Increased by heat, exercise, massage
Decreased by cole

35
Q

What are analgesics meds?

A

Opioids
Nonopiods

36
Q

What are some anti-inflammatory agents?

A

NSAIDs
Glucocorticords

37
Q

What does opioids do to pain?

A

Alter perception

38
Q

When are opioids indicated?

A

Acute pain
Chronic pain

39
Q

What do strong agonist opioids do?

A

Really good at binding to receptor on tissue to stimulate

40
Q

What do moderate opioids do?

A

Kinda good at binding to receptor on tissue to stimulate

41
Q

What do antagonist opioids do?

A

Block receptor

42
Q

What do mixed agonist/antagonist opioids do?

A

Stimulate certain receptors and block others

43
Q

What is the primary mechanism of action for opioids?

A

Act primarily on spinal cord and brain and bind to specific receptors located on presynaptic nerve terminal and postsynaptic neurons

44
Q

What effect can opioids have on peripheral (sensory) neurons?

A

Decrease sensitivity of neuron that initiates painful impulse

45
Q

what effect can opioids have on descending (efferent) pain pathways?

A

Remove inhibition of central anti-pain circuits

46
Q

Why do we have receipts in our body for drugs like morphine?

A

Certain situation body produces endogenous opioids

47
Q

Are receptors located only in brain and spinal cord?

A

No, found other place which mean they can affect many tissues/organs outside CNS

48
Q

In general what are the 3 ways opioids can control pain?

A
  1. Decrease synaptic activity in ascending pain pathways
  2. Decrease sensitivity of sensory neurons that send painful impulse to cord
  3. Activate descending anti-pain pathways
49
Q

What are relatively minor opioids adverse reactions?

A

Sedation
Mood changes
Confusion
Nausea/Vomiting
Constipation

50
Q

What are some more serious opioids adverse effects?

A

Orthostatic hypotension
Respiratory depression
Potential for tolerance, dependence and addiction

51
Q

What is opioid tolerance?

A

Need more drug to achieve same effect

52
Q

What is physical dependence?

A

Onset of withdrawal if drug suddenly stopped

53
Q

What is the time course of opioid tolerance?

A

Begin: after 1st dose
Obvious: 2 to 3 wks
Lasts: 1 to 2 wks after opiod stopped

54
Q

When can withdrawal begin, peak and last?

A

Begin: 6-10 hours after last dose
Peak: 2-3 days
Last: 5 days

55
Q

When is the risk for addiction low with short term opioids use>

A
  • Used limited (3-7 days)
  • Dosage matches pt pain levels
  • Pt does not have history of substance abuse
  • Pt doesn’t misuse drug
56
Q

What is chronic opioids analgesic therapy defined as?

A

> 90 days of continuous use

57
Q

What is PCA?

A

Patients controlled analgesic

58
Q

PCA benefit?

A

Better pain control
Increase pt satification
Require pt awareness

59
Q

What is opioid induced hyperalgesia?

A

Opioids may be ineffective or increase pain

60
Q

What are the primary effects of NSAIDs?

A

Analgesic
Anti-inflammatory
Antipyretic
Anticoagulant

61
Q

What is NSAIDs mechanism of action?

A

inhibit synthesis of prostaglands

62
Q

What are some adverse effects of NSAID?

A

Stomach irritation
Hepatic, renal toxicity
CV problems
Impaired bone healing
Overdose

63
Q

What is COX-1?

A

Synthesize PG to protect and maintain function

64
Q

What is COX-2?

A

Synthesize PGs that mediate pain, inflammation

65
Q

What do COX-2 selective drugs do?

A

Inhibit synthesis of PGs in pain, inflammation
- Spare production of beneficial PGs in stomach, kidney and lately

66
Q

Why may COX-2 inhibition promote infarction?

A

PG’s that cause vasodilation and contraction are in balance. COX-2 selective drugs inhibit vasodilaitng PG causing constriction

67
Q

Acetaminophen overview?

A

Analgesic & antipyretic effects
- No gastric irritation
- No anti inflame or anticoagulant effect
- High dose= liver toxicity

68
Q

What are the adverse effects of anti-inflammatory steroids?

A

Catabolic effect on bone, muscle, ligament, tendon, skin

Could cause adrenal suppression

69
Q

When can adrenocortical shock occur?

A

When glutocorticosteriods are stopped suddenly

70
Q
A

Clinical Med (Year 2) (17 decks)

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