PharmacoTherapeutics. Exam 1

Question 1

What are three factors that influence drug effects?

Answer 1

1. Pharmacokinetic differences
2. Pharmacodynamic differences
3. Secondary Factors

Question 2

A _______ difference exists if a drug is given at a specific dose but reaches a difference concentration in different people.

Answer 2

pharmacokinetic

Question 3

A ________ difference exists if a drug present at a given concentration produces difference responses in different people.

Answer 3

pharmacodynamic

Question 4

________ is a very important concept in pharmacokinetics that determines dosage differences within a specific drug that will produce either a therapeutic effect or a toxic side effect.

Answer 4

Therapeutic Index

Question 5

What is more dangerous, a low TI or a high TI?

Answer 5

a low TI is dangerous (there is only a slight difference between the dosage that has effect and the dosage that is deadly)

Question 6

True or False: Both pharmacokinetic and pharmacodynamic differences exist in children.

Answer 6

True.

Question 7

In general, dosing in children is based on ______ because complexities and uncertainties make prediction difficult.

Answer 7

clinical data

Question 8

True or False: Geriatric patients tend to be hyporeactive to drugs.

Answer 8

False. More often they are hyper-reactive

Question 9

Dosage for women tends to be _____, but much data is missing to base dose on sex alone.

Answer 9

lower

Question 10

What is a drug induced arrhythemia?

Answer 10

an alteration in cardiac rhythm due to influence on the conduction system or physiological changes

Question 11

True or False: In lactating women, drugs may be excreted through breast milk.

Answer 11

True

Question 12

What are four environmental factors that can have influences on drug effects?

Answer 12

1. Temperature
2. Sunlight
3. Altitude
4. Diet

Question 13

Nitrous oxide is _____ effective at high altitude.

Answer 13

less

Question 14

True or False: Eating cheese or drinking red wine with antidepressant medications could cause a hypertensive crisis.

Answer 14

True

Question 15

How could cheese or red wine cause hypertensive crisis?

Answer 15

If taking antidepressants, the MAO enzymes are blocked from breaking down norepinephrine and serotonin. Tyramines in cheese/wine release norepinephrine which is not metabolized as it should be.

Question 16

_______ is responsible for metabolism of 60% of all drugs.

Answer 16

CYP3A4

Question 17

How does grapefruit juice effect drug metabolism?

Answer 17

Grapefruit juice reduces the expression of CYP3A4

Question 18

The ________ has a significant effect on metabolism of drugs and changes the pharmacokinetics of a drug when the patient is taking antibiotics.

Answer 18

bacteria in the gut

Question 19

_______ is a decreased responsiveness to drug upon repeated or continuous administration.

Answer 19

Tolerance

Question 20

What effect does pharmacokinetic tolerance have on the drug?

Answer 20

the effective drug concentration is diminished

Question 21

In pharmacodynamic tolerance, the _____ is diminished.

Answer 21

response

kinetic = concentration, dynamic = response

Question 22

Tachyphylaxis is a _____ loss of response after repeated drug administration in short intervals. For example, it may occur with ______ because norepi. stores are depleted.

Answer 22

rapid

tyramine

Question 23

What are two mechanisms of pharmacodynamic tolerance?

Answer 23

1. Down regulation of receptors

2. impairment in signal transduction

Question 24

Drugs can induce changes in ________ such as the over-expression of proteins that pump drugs out of cells.

Answer 24

cellular distribution

Question 25

What are extension effects?

Answer 25

adverse drug effects in which the drug does too much of what you expected it to do. For example, Warfarin = inhibits clotting...extension = hemorrhaging

Question 26

When you see side effects from an overdose, the drug is acting at _______ targets.

Answer 26

Unintended

Question 27

What are idiosyncratic reactions?

Answer 27

effects that occur rarely and unpredictably among the population; unusual metabolism, distribution, binding affinity for receptor

Question 28

What drug interaction account for 10% of all adverse effects?

Answer 28

``` drug allergies (IgE = immediate reaction, IgG = cytotoxic) ```

Question 29

Drugs taken orally are ____ allergenic; Drugs taken topically are _____ allergenic.

Answer 29

less | more

Question 30

What is a pseudo-allergy?

Answer 30

a reaction produced by the direct release of mediators from mast cells and basophils that shows a downstream effect that mimics that of an allergy

Question 31

True or False: Drugs can cause cancer.

Answer 31

True

Question 32

How many categories exist for the labeling of drugs based on fetal risk?

Answer 32

five: A, B, C, D, X

Question 33

Sodium Fluoride is labeled as drug class ____.

Answer 33

A

Question 34

If the potential risk of a drug to a fetus clearly outweighs the potential benefit, the drug is labeled as class ____.

Answer 34

X (ex. warfarin, estradiol)

Question 35

What is pharmacogenetics?

Answer 35

field of study that attempts to understand the genetic basis for differences in how patients respond to drugs

Question 36

By using pharmacogenomics, patients can be _______ for a drug in order to identify who will benefit and who will suffer adverse effects.

Answer 36

pre-screened

Question 37

What is a monogenic phenotype?

Answer 37

variation in a single gene

Question 38

What is a polygenic phenotype?

Answer 38

variation in multiple genes that complicates its predictive value

Question 39

Pharmacokinetic (concentration) variations usually result from differences in ________ and are ________ understood.

Answer 39

``` metabolism better understood (many examples) ```

Question 40

Pharmacodynamic (response) variations usually result from differences in _______ or ______ and are not well understood (few examples).

Answer 40

targets | downstream elements

Question 41

Polymorphisms of drug-metabolizing enzymes can effect ______.

Answer 41

``` plasma concentration (homozygote wild type vs homozygote variant) ```

Question 42

Phase II conjugation by N-acetyltransferase effects drug metabolism by acting on drugs that contain aromatic _____, _______, and hydroxylamines. Slow acetylator phenotype is most common in which population?

Answer 42

amines alcohols Egyptian (85%)

Question 43

True or False: Some consequences of slow acetylation include neurophathy, systemic lupus, and cancer predisposition.

Answer 43

True

Question 44

Oxidation of many drugs occurs through which enzyme?

Answer 44

Cytochrome P450 enzymes (many alleles)

Question 45

Which four alleles of Cytochrome P450 are most important?

Answer 45

CYP3A4 CYP2D6 CYP2C9 CYP2C19

Question 46

What does CYP2D6 do?

Answer 46

about 25% of drugs are metabolized by this particular allele of CYP. it removes methyl groups from oxygen*

Question 47

_______ is a muscarinic agonist that is used to treat dry mouth and is metabolized by CYP2D6. Poor metabolizers of CYP2D6 could experience nausea and vomiting because of _____poisoning.

Answer 47

Cevimeline | muscarinic

Question 48

Why would poor metabolizers have generally poorer outcomes when treated for breast cancer with tamoxifen?

Answer 48

Tamoxifen is the prodrug for the active form (Endoxifen). CYP2D6 is required to create the functional antagonist to estrogen.

Question 49

Codeine is an _______ that is converted to morphine by CYP2D6.

Answer 49

Opioid Agonist

Question 50

For 10% of the population, codeine is ineffective as an analgesic. Why?

Answer 50

poor metabolizers cannot convert codeine to morphine

Question 51

Ultra metabolizers of CYP2D6 experience ______ in response to codeine.

Answer 51

severe abdominal pain

Question 52

CYP2C9 poor metabolizers may have serious _______ complications with drugs such as Warfarin.

Answer 52

bleeding

Question 53

Succinylcholine is a muscle relaxant that can induce prolonged _____ in poor metabolizers.

Answer 53

apnea

Question 54

The ________ receptor mediates calcium-mediated calcium release from the sarcoplasmic reticulum in muscle and a mutant allele for this receptor could cause _________.

Answer 54

Ryanodine | malignant hyperthermia

Question 55

Malignant Hyperthermia (ryanodine receptor) is an example of a ________ polymorphism in drug targets.

Answer 55

pharmacodynamic (response from target is different not the metabolism)