Pharmacotherapeutics

Question 1

Patient related factors affecting drug response requiring a higher dose

Answer 1

hyporeactivity
tolerance
tachyphylaxis (desensitization)

Question 2

Patient related factors affecting drug response requiring a lower dose

Answer 2

hyperreactivity
supersensitivity
hypersensitivity

Question 3

Types of tolerances to drugs

Answer 3

pharmacodynamic (cell tolerance)
immune (antibodies bind to drug)
pharmacokinetic (induction of enzymes of metabolism)
cellular distribution (changes in cell)
learned tolerance (individual)

Question 4

Drug-drug intolerances are mostly

Answer 4

unintentional

Question 5

Causes of drug-drug interaction

Answer 5

other drugs prescribed by clinicians
self-prescribed drugs
environmental and dietary chemicals

Question 6

Types of drug-drug interaction

Answer 6

pharmaceutical
pharmacokinetic
pharmacodynamic
pharmacotherapeutic

Question 7

Types of drug-drug interactions effects

Answer 7

antagonism
potentiation
summation
synergism

Question 8

Combined use of antibiotics that inhibit cell wall synthesis and protein synthesis via receptor competition

Answer 8

Antagonism

Question 9

Effects of antagonism

Answer 9

increased metabolic inactivation or excretion

Question 10

Physiological examples of antagonism

Answer 10

CNS stimulants and depressants

Question 11

Chelation of divalent cations in antiacids by tetracycline

Answer 11

example of chemical antagonism

Question 12

Two drugs do not share similar effects but one drug increases the effect of the other

Answer 12

potentiation

Question 13

Physical or chemical incompatibilities and administration

Answer 13

examples of pharmaceutical drug-drug interactions

Question 14

Absorption
Distribution
Transport
Biotransformation
Excretion

Answer 14

examples of pharmacokinetic drug-drug interactions

Question 15

CNS depressants

Answer 15

examples of pharmacodynamic drug-drug interactions

Question 16

Caused by increasing active concentration of drug

Answer 16

potentiation

Question 17

Succinylcholine neuromuscular blockage increased by administration of acetylcholinesterase inhibitor
neostigmine

Answer 17

example of potentiation

Question 18

Local anesthetic action enhanced and prolonged
when administered with vasoconstrictor

Answer 18

effects of potentiation

Question 19

Combination of two or more drugs
produces effect greater than summation of
drug effects

Answer 19

synergism

Question 20

Minimize development of drug resistance
* Treatment of tuberculosis
* Treatment of cancer

Answer 20

synergism effects

Question 21

Hepatotoxicity from alcohol and carbon
tetrachloride

Answer 21

synergism can cause

Question 22

a more accurate dose adjustment vs age

Answer 22

BSA

Question 23

Environmental effects

Answer 23

diet
temperature
indigenous microflora

Question 24

How can diet effect absorption and metabolism

Answer 24

Insulin and meals
Grapefruit juice: inhibition of CYP 3A enzymes
Monamine oxidase inhibitors and tyramine containing foods (hypertension)

Question 25

How can temperature effect drug interactions

Answer 25

Sunlight worsens some antibiotic hypersensitivities Atropine and drug induced hyperthermia

Question 26

How can indigenous microflora effect drug interactions

Answer 26

Drug metabolism by bacterial enzymes can impact absorption of drugs Antibiotic therapy effects

Question 27

At what times during pregnancy are the most susceptible to having a toxic effect on the fetus

Answer 27

first trimester and term

Question 28

How can drug allergy be distinguished from other forms of drug toxicity

Answer 28

The severity of response is dose independent

Question 29

Prior exposure to the drug or a closely related compound is necessary to elicit this reaction

Answer 29

drug allergy

Question 30

What causes the effects of a drug allergy

Answer 30

the unfavorable effect is a function not of the drug but of the immune mechanism

Question 31

Typical reaction to a drug allergy

Answer 31

Reaction is unpredictable; occurs in a small portion of the population, sometimes in patients who had been previously treated with the drug on multiple occasions without mishap

Question 32

Drug allergy types

Answer 32

Type 1: anaphylactic responses Type 2: cytotoxic reactions Type 3: immune complex reactions Type 4: cell mediated immunity

Question 33

Symptoms appear in minutes of hours of taking the drug IgE GI cramps, erythema, urticaria, edema, bronchoconstriction, vasodilation, blood vessel permeability increases. Epinephrine to reverse severe response

Answer 33

Anaphylactic response

Question 34

Caused by IgG and IgM Plasma membrane constituent can be hapten carrier (i.e platelets) or complete antigen adsorbed on membrane, Ig binding followed by complement fixation and cell lysis occurs Drug induced hemolytic anemia, leukopenia, and thrombocytopenia. Delayed and manifest from hours to days after drug exposure

Answer 34

cytotoxic reactions

Question 35

Antigen-antibody complexes form in intravascular or interstitial spaces go onto small blood vessel walls Activation and migration of neutrophils Degranulation of immune cells causing lysosomal enzymes Local tissue damage Looks like disease states (neuropathy, glomerulonephritis etc) Can be cytotoxic

Answer 35

immune complex reactions

Question 36

T-lymphocytes exposed to the drug hapten or its conjugate, release lymphokines, attracting additional cells (lymphocytes, macrophages, cytotoxcic T cells). Lysosomes and toxic lymphokines produce tissue damage Dentists experience this type of delayed reaction via “contact dermatitis” due to exposure to ester local anesthetics like procaine

Answer 36

cell mediated immunity

Question 37

Mediator of type 1 reactions

Answer 37

IgE

Question 38

Effector of type 1 reactions

Answer 38

Mast-cell activation

Question 39

Example of hypersensitivity rxn for type 1

Answer 39

anaphylaxis, allergic rhinitis, asthma

Question 40

Mediator of type 2 reactions

Answer 40

IgG and IgM

Question 41

Effector of type 2 reactions

Answer 41

FcR+ cells (phagocytes and NK cells)

Question 42

Example of hypersensitivity rxn for type 2

Answer 42

hemolytic anemia and thrombocytopenia

Question 43

Mediator of type 3 reactions

Answer 43

IgG

Question 44

Effector of type 3 reactions

Answer 44

FcR+ cells complement

Question 45

Example of hypersensitivity rxn for type 3

Answer 45

serum sickness, arthus reaction

Question 46

Mediator of type 4 reactions

Answer 46

T cell

Question 47

Effector of type 4 reactions

Answer 47

T cells

Question 48

Example of hypersensitivity rxn for type 4

Answer 48

contact dermatitis, delayed hypersensitivity

Question 49

Indirect and often unpredictable consequences of a drugs primary pharmacologic action

Answer 49

secondary reactions

Question 50

Example of a secondary reaction

Answer 50

antibiotics can cause supra infection due to suppression of normal microflora

Question 51

Any agent capable of altering DNA

Answer 51

a potential carcinogen

Question 52

Example of a carcinogen (social drug mix)

Answer 52

tobacco and EtOH

Question 53

How long does latency period of a carcinogen last

Answer 53

can span decades

Question 54

Amount of exposure required for a carcinogen

Answer 54

Dose dependent but dose or duration of exposure below which tumors will not occur is difficult to establish