Pharm Quiz 1

Question 1

What is a threshold dose?

Answer 1

When the response starts to show

Question 2

What is the ceiling effect?

Answer 2

See no more effect from the dose

Question 3

What is therapeutic range?

Answer 3

When there is an increased response from the dose

Question 4

Dose- response curve refers to response in?

Answer 4

A single patient

Question 5

What does Quantal D-R curve determine?

Answer 5

Dose that causes specific response in a group

Question 6

Higher Ti indicated a safer or more harmful drug?

Answer 6

Safer

Question 7

What are the key issues of pharmacokinetics?

Answer 7

Absorption
Distribution
Metabolism
Excretion

Question 8

What is absorption?

Answer 8

how the drug moves from tissue to bloodstream

Question 9

What are some examples of enteral route of admission?

Answer 9

Oral
Lingual
Buccal
Rectal

Question 10

What are some examples of parenteral route of admission?

Answer 10

Injection
Inhalation
Topical
Transdermal
Other

Question 11

What is the trade off of enteral routes?

Answer 11

Fairly simple but less predicable absorprtion

Question 12

What is the trade off of parenteral routes?

Answer 12

More difficult but more predictable absorption

Question 13

What is bioavailability?

Answer 13

Percent administered dose that appears in bloodstream

Question 14

What is the first pass effect?

Answer 14

Some of the drug is destroyed in first pass of liver

Question 15

What are some factors that affect distribution?

Answer 15

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

Question 16

What are some primary storage sites for drugs?

Answer 16

Fat
Muscles
Bone
Liver
Kidneys
Organs/tissue

Question 17

What are primary problems of storage?

Answer 17

Local tissue damage
Redistribution

Question 18

What does metabolism (biotransformation) do?

Answer 18

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)

Question 19

Where is the primary site of biotransformation?

Answer 19

liver

Question 20

What are other sites of biotransformation?

Answer 20

Lungs
Kidneys
GI tract
Skin

Question 21

What is an active metabolites?

Answer 21

Some can continue to exert effects for a while

Question 22

Where is the primary site of excretion?

Answer 22

Kidneys

Question 23

What are some other significant site of excretion?

Answer 23

Lungs
Gi tract

Question 24

What are some minor sites of excretions?

Answer 24

Sweat
Saliva
Breast milk

Question 25

What is clearance?

Answer 25

Rate that drug can be removed completely from body

Question 26

What causes a drug to be cleared best?

Answer 26

If organ has high blood flow and good extraction ratio

Question 27

What can impair an organs ability to clear drugs?

Answer 27

Any disease or illness that affects blood flow or extraction ratio

Question 28

What is the problem with decreased clearance time>?

Answer 28

Prolonged medication effects and side effects

Question 29

What is a half life?

Answer 29

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

Question 30

What happens if drugs are given continuously?

Answer 30

Maintain fairly stable level of drug in blood stream

Question 31

What happens if drugs are given intermittently?

Answer 31

Cause peaks and troughs in plasma level

Question 32

What are some factors that affect normal pharmacokinetics?

Answer 32

Disease Age Genetics Gender Body compositions Diet Other chemical Physical factors

Question 33

What implication does pharmacokinetics have on implication for rehab?

Answer 33

Timing of session with drugs peak and troughd

Question 34

What is the implication of pharmacokinetics on absorption/ distribution?

Answer 34

Increased by heat, exercise, massage Decreased by cole

Question 35

What are analgesics meds?

Answer 35

Opioids Nonopiods

Question 36

What are some anti-inflammatory agents?

Answer 36

NSAIDs Glucocorticords

Question 37

What does opioids do to pain?

Answer 37

Alter perception

Question 38

When are opioids indicated?

Answer 38

Acute pain Chronic pain

Question 39

What do strong agonist opioids do?

Answer 39

Really good at binding to receptor on tissue to stimulate

Question 40

What do moderate opioids do?

Answer 40

Kinda good at binding to receptor on tissue to stimulate

Question 41

What do antagonist opioids do?

Answer 41

Block receptor

Question 42

What do mixed agonist/antagonist opioids do?

Answer 42

Stimulate certain receptors and block others

Question 43

What is the primary mechanism of action for opioids?

Answer 43

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

Question 44

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

Answer 44

Decrease sensitivity of neuron that initiates painful impulse

Question 45

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

Answer 45

Remove inhibition of central anti-pain circuits

Question 46

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

Answer 46

Certain situation body produces endogenous opioids

Question 47

Are receptors located only in brain and spinal cord?

Answer 47

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

Question 48

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

Answer 48

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

Question 49

What are relatively minor opioids adverse reactions?

Answer 49

Sedation Mood changes Confusion Nausea/Vomiting Constipation

Question 50

What are some more serious opioids adverse effects?

Answer 50

Orthostatic hypotension Respiratory depression Potential for tolerance, dependence and addiction

Question 51

What is opioid tolerance?

Answer 51

Need more drug to achieve same effect

Question 52

What is physical dependence?

Answer 52

Onset of withdrawal if drug suddenly stopped

Question 53

What is the time course of opioid tolerance?

Answer 53

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

Question 54

When can withdrawal begin, peak and last?

Answer 54

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

Question 55

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

Answer 55

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

Question 56

What is chronic opioids analgesic therapy defined as?

Answer 56

> 90 days of continuous use

Question 57

What is PCA?

Answer 57

Patients controlled analgesic

Question 58

PCA benefit?

Answer 58

Better pain control Increase pt satification Require pt awareness

Question 59

What is opioid induced hyperalgesia?

Answer 59

Opioids may be ineffective or increase pain

Question 60

What are the primary effects of NSAIDs?

Answer 60

Analgesic Anti-inflammatory Antipyretic Anticoagulant

Question 61

What is NSAIDs mechanism of action?

Answer 61

inhibit synthesis of prostaglands

Question 62

What are some adverse effects of NSAID?

Answer 62

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

Question 63

What is COX-1?

Answer 63

Synthesize PG to protect and maintain function

Question 64

What is COX-2?

Answer 64

Synthesize PGs that mediate pain, inflammation

Question 65

What do COX-2 selective drugs do?

Answer 65

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

Question 66

Why may COX-2 inhibition promote infarction?

Answer 66

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

Question 67

Acetaminophen overview?

Answer 67

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

Question 68

What are the adverse effects of anti-inflammatory steroids?

Answer 68

Catabolic effect on bone, muscle, ligament, tendon, skin Could cause adrenal suppression

Question 69

When can adrenocortical shock occur?

Answer 69

When glutocorticosteriods are stopped suddenly