Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology II > Special Populations > Flashcards

Special Populations Flashcards

1
Q

4 types of special populations

A

Comorbidity
Pregnancy
Age
Sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most of understanding of special populations are from _____________
Less is known about ____________

A

pharmacokinetics

pharmacodynamics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Two impairments that are the primary affect on pharmacokinetics in diseas?

A

hepatic and renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
GFR over 90mL/min : represents what in chronic kidney disease?
60-89?
30-59?
15-29?
less than 15?
A
  • kidney damage w/ normal GFR
  • kidney damage with mild decrease in GFR
  • moderate decrease in GFR
  • severe decrease in GFR
  • Kidney failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Renal impairment can slow ______________________

A

drug excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Example of drug that is poorly excreted renally in kidney disease?

A

ganciclovir

used to treat cytomegalovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is used as a proxy for GFR measurements?

A

creatinine clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ACE I renoprotection in diabetes?

A

Diabetes has a high afferent flow so it increases pressure in glomerulus and increases GFR.
ACE I inhibits angiotensin II which decreases the pressure and therefor GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ACE I and renal failure?

A

If you already have chronic kidney disease (reduced afferent flow), taking ACE I can decrease GFR even more and cause renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Classification of liver disease:

5 clinical/biochemical indicators? what are their ranges?

A 
serum bilirubin (2-3)
serum albumin (3.5-2.8)
prothrombin (4-6)
encephalopathy (0-4)
ascites (absent, slight, moderate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Classification of liver disease:

How many points is mild? moderate? severe?

A 
mild = 5-6
moderate = 7-9
severe = 10-15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The amount of drug removed by liver is dependent on what?

A

hepatic blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In the case of hepatic impairment, this decreases ____________ and ____________

A

blood flow

metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

True of False : Hepatic impairment affect all CYP450 genes the same way.
Why?

A

False

Because CYP450 genes metabolize drugs differently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q 
When hepatic function decreases, which of these is most affected? (put in order)
CYP2E1
CYP1A2
CYP2C19
CYP2D6
A

CYP2E1 (least affected)
CYP2D6
CYP1A2
CYP2C19 (most affected)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cirrhosis is caused by what?

A

alcohol abuse

viral hepatitis B and C

17
Q

Liver impairment affects what?

This depends on the extent of ____________

A

Oral drug bioavailability

Hepatic extraction

18
Q

Highly extracted drugs from the liver : difference in plasma concentration in healthy and cirrhosis patients?
What about low extraction drugs?

A

Healthy : low conc.
Cirrhosis : high conc.

Low extraction : no difference

19
Q

Which drug has a high hepatic extraction ratio?

It is used to treat what?

A

Chlormethiazole

Treats acute alcohol withdrawal

20
Q

What are some physiological changes that happen in pregnancy? (5)

A
  1. increased GFR
  2. altered hepatic metabolism
  3. GI motility slows
  4. Changes in drug distribution
  5. Others (BP, HR, etc…)
21
Q

What is an example of a drug that changes during pregnancy? Explain

A

Amoxicillin
Concentrations lower during pregnancy
Due to increased GFR during pregnancy (drug has higher clearance)`

22
Q

Can drugs pass through the placental barrier?

A

Yes

23
Q

What is a teratogenic drug?

A

Disturbs the development of embryo or fetus

24
Q

5 FDA categories of safety in pregnancy? Explain

A

A - Lowest risk : no risk to woman or fetus
B : Animals studies do NOT show a risk, not proven in women
C : Animal studies show risk, no studies on women
D - Shows a risk to fetus, but could save woman in life-threatening situation
X - High Risk : Significant risk to woman and fetus

25
Q

2 examples of drugs that are dangerous to pregnant women? Why?

A

Tetracycline : discoloration of teeth in infant and children

Thalidomide: 40% survival with major deformities

26
Q

Male/Female differences? (4)

A

Male weigh more
Females have higher body fat
GFR higher in men
Diff. in drug metabolizing enzyme activities

27
Q

Effect of renal excretion male vs. female? Pregnancy?

A

M>F

Increased

28
Q

What is midazolam used for? It is cleared by what? Higher clearance by what administration? Higher clearance in males or females?

A

Used for sedation or trouble sleeping
Cleared by CYP3A4
Higher clearance orally
Higher clearance in women

29
Q

Example of a sex-dependent difference in pharmacodynamics?

Why is this thought to be? (2)

A

Females have higher risk of drug-induced Long QT syndrome

  1. Women have longer baseline QT intervals
  2. Differences in abundance of potassium cardiac channels
30
Q

Difference in distribution children vs. adults? (3)

A
  1. More extracellular body water in children
  2. Difference in body fat
  3. Lower proportion of proteins in children
31
Q

How does renal elimination change in children?

A

Decreased in newborns
Increased in children
(decreases again with age)

32
Q

Hepatic elimination in children : What two things take time to develop?

A

CYP and glucuronidation activity

33
Q

What is gray baby syndrome? Thought to be caused by what? (2)
Why are newborns more susceptible to toxic levels? (2)

A

Adverse event in newborns due to toxic levels of chloramphenicol

  1. Reduced glucuronidation of chlor.
  2. Reduced renal elimination of chlor.
    - Toxic levels could be the result of direct administration or passing through breast milk
34
Q

What is reye’s syndrome? Causes what?

A

Rare adverse event associated with giving aspirin to children with viral infections
-Causes swelling in the liver and brain

35
Q

What are 3 factors/risks associated with elderly people and drugs?

A
  1. Increased health issues
  2. Frailty
  3. Adverse drug interactions
36
Q

4 changes in body composition in the elderly?

A
  1. Increase body fat
  2. Decrease in plasma volume
  3. Decrease in total body water
  4. Decrease in extracellular body fluid
37
Q

3 changes in metabolism in the elderly?

A
  1. Drugs metabolized more slowly
  2. Decrease in ability for the liver to recover from injury
  3. Cardiac disease and malnutrition decreases hepatic function
38
Q

What are three measurements of drug elimination that decrease with age?

A

GFR
Cardiac index
Maximal breathing capacity

Pharmacology II (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions