Test 1 Flashcards
1
Q
The development of phocomelia in children whose mothers used thalidomide to assist sleep during pregnancy resulted in the passage of
A
Kefauver-Harris Amendment to the Food, Drug, and Cosmetic Act
2
Q
The first apothecare opened in which city?
A
Baghdad
3
Q
The first inter-professional work agreement was between
A
apothecaries and physicians
4
Q
The physician who first described acute and chronic illnesses was
A
Thomas Sydenham
5
Q
Until the 20th century, virtually all medications were derived from which source?
A
Plants
6
Q
Who first “proved” scientifically that the leaves of the foxglove plant were therapeutic in treating patients with heart failure?
A
William Withering
7
Q
The incidence of adverse drug reactions documented in US hospitals in 1998 was
A
6.7%
8
Q
Which drug-related legislation was enacted due to the contamination of smallpox and diphtheria vaccines by tetanus organisms, killing some children?
A
Biologics Control Act of 1902
9
Q
Who noted that newer antibiotics were needed because of PCN’s “Achilles heel”?
A
Alexander Fleming
10
Q
Who said: “with regard to infection, I say where there is infection, the fault is in those who have charge of the disease, not in the disease?”
A
Florence Nightengale
11
Q
Within the catastrophic phase of the Standardized Medicare Part D plan, the patient pays what percentage of drug costs?
A
5%
12
Q
The initial out-of-pocket amount each patient who has enrolled in a Medicare Part D plan in 2014 will pay for drugs is
A
$310
13
Q
This was the only federal program that had cost less than the projected amount anticipated
A
Medicare Part D
14
Q
The lack of an adequate profit margin has inhibited many drug manufacturers from producing…
A
generic drugs
15
Q
During the first phase of the Medicare Part D plan, the patient pays what percentage of drug costs up to a maximum?
A
100%
16
Q
The Medicare Modernization Act that started the Medicare Part D plan was signed into law on
A
2003
17
Q
substance not normally found in the body
A
xenobiotic
18
Q
The drug with which a metabolic enzyme, transporter, or receptor is altered, moved, or changes physiological response.
A
substrate
19
Q
examples of prodrug
A
codeine, enalapril, and tamoxifen
20
Q
The prodrug codeine is not active until it is metabolized into
A
morphine
21
Q
provides protection by pumping xenobiotics out of cells
A
P-gp
22
Q
An efflux pump that uses ATP to remove the drug from the cell and out of the body.
A
P-gp
23
Q
major substrate of P-gp is
A
digoxin
24
Q
When drugs inhibit P-gp function, what will happen to digoxin levels?
A
will rise
25
Drugs that induce P-gp function
rifampin and St. John's Wort
26
CYP3A enzyme is mostly found in
liver and small intestine
27
CYP enzyme and drug metabolism
many drugs can be metabolized by more than one CYP enzyme, resulting in a patient's variable responses to meds.
28
enzyme used to metabolize dextromethorphan
CYP2D6
29
Bergamottin, found in grapefruit juice, is an inhibitor of
CYP34A
30
Enzyme that metabolizes NSAIDS
CYP2C9
31
Enzyme that metabolizes oral meds for type 2 diabetes
CYP2C9
32
Enzyme that metabolizes angiotensin II receptor blockers
CYP2C9
33
Enzyme that metabolizes the active form of warfarin
CYP2C9
34
in early course of therapy, phenytoin is a..
substrate and an inhibitor of CYP2C9
35
ADRs are rarely fully known during
phase 3 clinical trials
36
If a patient is an extensive metabolizer of a drug and given another drug that inhibits the metabolism, then the dose of the needed medication would need to be
decreased- concentration in blood will increase, causing a lower dose needed
37
inhibition of the metabolism of this drug would make it ineffective in relieving symptoms
codeine
38
Codeine
prodrug and CYP2D6
39
hydrocodone (Lortab)
prodrug and CYP2D6
40
Enalapril (vasotec)
prodrug
41
this CYP450 enzyme metabolizes most drugs in use today
CYP34A
42
The safety profile of a new drug is determine during which phase of new drug process
Post marketing phase 4
43
CYP1A2 inhibitor that is available OTC and cause drug interaction
cimetidine (Tagamet)
44
phenytoin later in course of therapy is a
inducer of CYP2C9
45
The effect of phenytoin is most notable when..
more than one inhibitor of CYP2C9 is used simultaneously.
46
common interacting drugs with narrow therapeutic index drugs
amiodarone, clarithromycin, and azole antifungals
47
inhibitors g-pg function
clarithromycin, erythromycin, amiodarone, cardizem, cardene, verapamil, felopdipine
48
Meds metabolized by CYP34A
antihistamines, antibiotics, lipid-lowering drugs, antihypertensives, protease inhibitors, and azole antifungals
49
Meds metabolized by CYP2D6
SSRIs, pain meds, beta blockers
50
Meds metabolized by CYP2C19
proton pump inhibitors, NSAIDs, beta blockers
51
Meds metabolized by CYP2C9
NSAIDs, type 2 diabetes, angiotensin II blockers, active warfarin
52
Meds metabolized by CYP1A2
acetaminophen, warfarin, theophylline, caffeine, Valium
53
Not included in the Medicare Part D total cost of drugs during plan year
monthly premiums
54
Who assured that only physicians could prescribed meds in the US?
Hubert Humphrey in 1951
55
When did written prescriptions first appear?
In the 18th century by apothecaries
56
Where did apothecaries first write written prescriptions?
Europe
57
special populations
geriatric, pregnant women, and the elderly
58
legislation that helped develop drugs fro less common illnesses like HIV, Huntingtons, and ALS
Orphan Drug Act of 1983
59
what the body does to the drug
pharmacokinetics
60
pharmacokinetics involes
absorption, distribution, metabolism, and elimination
61
how the drug influences the body
phamacodynamics
62
The official name assigned by the manufacturer with approval of the US adopted name council
Generic name
63
The patent name given to the med by the company marketing the drug
Trade name
64
Which of the drug names can vary?
Trade name
65
Drug leaving the site from which it was administered
absorption
66
amount of an administered drug that reaches its final site of action
bioavailability
67
Indicates that two drugs contain the same active ingredients, are identical in strength, dosage, and route.
bioequivalence
68
Bioequivalence indicates that a generic drug will have a variability in bioavailability of...
+ or - 20%
69
Bioavailability is most important for drugs that have
a narrow therapeutic index or window
70
The four factors governing drug absorption are
drug characteristics, routes of administration, blood flow, and cell membrane characteristics.
71
Non-ionized drugs are ___ soluble than ionized drugs
more
72
Non ionized drugs are
lipophilic drugs
73
Acidic drugs become this in the acidic environment of the stomach
non-ionized
74
interactions between food and drugs interfere with which phase of pharmacokinetics?
absorption
75
Non-ionic drugs with high lipid solubility are ideally suited for which route?
sublingual
76
Meds passed orally pass through liver and become extensively metabolized causing little or no drug to remain active.
First-pass metabolism
77
This type of skin will absorb drugs more readily
non-intact skin
78
Does first pass occur with meds taken rectally?
Yes but less first pass metabolism
79
routes that avoid first-pass
sublingual and inhalation
80
Proteins embedded in the lipid bilayer.
Integral proteins
81
Proteins located at one surface or another and bound to an integral protein.
Peripheral proteins
82
What kinds of molecules are moved by ABC pumps?
small molecules, phospholipids, and lipophilic drugs
83
P class pumps use ATP to move __ across cell membranes
ions
84
AV class pumps move ___ across cell membranes
protons
85
Two phases of distribution phase
movement into bloodstream and delivery of drug into tissue.
86
Description of the amount of space into which a drug can be spread or distrubted
volume of distribution
87
If a drug has a large volume of distribution, then it is found...
throughout the body
88
This drug has the highest volume of distribution
lipophilic
89
These drugs will accumulate in geriatric patients due to less muscle
lipophilic
90
If a geriatric patient loses weight, what can happen if taking lipophilic drugs?
The patient is losing muscle and gaining more fat, placing them at risk of accumulation and toxicity.
91
the most common protein that can alter the distribution of drugs
albumin
92
Drugs that are highly protein bound should be prescribed in ___ doses for patients with low serum albumin
lower
93
chemical inactivation of a drug through conversion to a more water-soluble compound
biotransformation
94
biotransformation occurs mostly in ....
the liver
95
Makes drugs more soluble through oxidation, reduction, or hydrolysis. Drug still has some pharmacologic activity.
Phase I
96
Makes drugs even more soluble in water and results in drug having no pharmacological activity.
Phase II
97
Major groupings of cytochrome system are...
numbered and are involved in drug interactions.
98
Groupings based upon similarity in chemical structure is indicated by
letters A, B, and C
99
Subgroupings are indicated by
numbers
100
individual variations in the P450 enzyme are due to variations in genetic material
genetic polymorphism
101
Any drug that causes the enzyme to metabolize slowly
inhibitor
102
a drug that causes the enzyme to metabolize the substrate more quickly
inducer
103
amount of time required for the amount of drug in the body to decrease by one half
half life
104
Half life depends on
clearance and volume distribution.
105
Half life is useful for
estimating time it takes to reach a steady state of a drug after dosage regimen has been started.
106
Steady state of a drug is reached after
4-5 half lives
107
A drug that has affinity for and stimulates physiologic activity at cell receptors.
agonist
108
A drug that inhibits or counteracts effects produced by other drug or eliminates undesired effects caused by illness.
antagonist
109
Alcohol/drug interaction
alcohol can inhibit a drug's metabolism by competing for the same set of metabolizing enzymes.
110
measure of drug safety calculated by dividing the toxic dose by the therapeutic dose.
therapeutic index.
111
-olone
corticosteroids and anabolic steroids
112
-tadine
antihistamine and antiviral
113
Herd immunity is dependent on
the number of vaccine protected individuals
114
Against which benign illnesses does HPV vaccine protect?
anogenital wards and recurrent respiratory papillomatosis (RRP)
115
HPV should be given for these malignant conditions
oropharynx and anogential
116
If live vaccines cannot be given on the same day, then
they should be given 30 days apart
117
Vaccines that contain live viruses
1. smallpox
2. typhoid
3. adenovirus
4. influenza
4. rotavirus
5. smallpox
6. MMR
7. varicella
8. herpes zoster
9. yellow fever.
118
When is it appropriate to delay vaccinating a child?
immunocompromised, severe allergic reaction, corticosteroids
119
Who should receive the pneumococcal vaccine?
adults age 65 or older, or adults 19-64 with immonocompromised conditions
120
Which pneumococcal vaccine should be given first to a unvaccinated adult age 35?
PPSV23
121
Influenza vaccine is indicated for...
all persons age 6 and older
122
Which Hepatitis is more urgent to prevent?
Hep B
123
Hep A dosing
2 doses 6 months apart
124
Hep B dosing
3 doses over a period of 6 months
125
Recommendation to make sure a healthcare worker is immune to hepatitis B
blood titer testing for antibody antigens 1-2 months after the last dose of vaccine.
126
Pertussis vaccine is now available in
acellular form that is safer.
127
problem with acellular pertussis vaccine
has waning immunity and results in pertussis outbreaks.
128
The definition of antimicrobial resistance includes...
all groups, bacteria, viruses, fungi, and parasites.
129
otitis media is primarily caused by
viruses
130
Who first noted antimicrobial resistance?
Fleming
131
Standard treatment for uncomplicated gonorrhea is
one dose of Rocephin 250 mg IM
132
A drug given to a patient with group A beta-hemolytic streptococcal pharyngitis (GABHS) who is allergic to PCN is given...
macrolide
133
The best antibiotic is
narrowest spectrum and lowest toxicity
134
macrolides
erythromycin, clarithromycin, and azithromycin
135
important teaching for macrolides
can reduce efficacy of birth control
136
education for tetracyclines
avoid sun exposure
137
types of fluroquinolones
ciprofloxacin, moxifloxacin, and levofloxacin
138
treatment of fluroquinolones should be reserved for...
moderate infections, infections that are resistant to other atx, UTIs.
139
fluroquinolones should not be taken with
milk, antacids, or iron products
140
sulfonamides are mostly used for
UTIs
141
common sulfonamides
TMP/SMX
142
can a person receive a vaccine if on atx?
Yes
143
Concerning vaccines, pregnant women cannot receive
live vaccines
144
Avoid giving this during a viral cold in children
aspirin
145
The most important determinant of teratogenicity is
Timing of drug exposure.
146
Most critical time for a pregnant woman to avoid drug exposure
Weeks 3-8
147
Neonates have the highest proportion of
Body water
148
Avoid aspirin in
Children
149
If a drug in stored in adipose tissue (lipophilic) then it cannot
Excreted
150
Patients undergoing splenectomy or immunosuppressive therapy should receive the pneuomococcal vaccine
at least 2 weeks prior
151
Vaccine indicated for newborn children
Hep B
152
There is an association between the varicella vaccine with
ASA and Reye's syndrome
153
Dosing for adults 65 and older who want the varicella vaccine
one dose needed
154
DOC for GABHS
PCN
155
Which special populations are at risk for altered metabolism of drugs by the kidney?
Elderly and children
156
Changing a prodrug into its active form occurs during which stage?
Metabolism
157
ADR of sulfa drugs
Steven Johnson Syndrome
158
% of population that has a polymorphism of one of the CYP450 enzymes
1%
159
A patient has a polymorphism of a drug metabolizing enzyme that inhibits a drug's metabolism. If the drug is a prodrug, you will anticipate that...
patient will have poor response to the drug
160
A pt on a good med for HTN is given a new drug, but then his BP is high again. What is an explanation for this?
The new drug induced the metabolism of the first drug.
161
A drug that increases risk for Reyes syndrome
ASA
162
PCN has one of the
narrowest spectrums
163
Why is doxycycline contraindicated in children?
discoloration of teeth
164
Why are fluoroquinolones contraindicated in children?
can cause tendon rupture.
165
ADRs are usually caused by
drug-drug interaction
166
Large amounts of this can increase level of drugs up to threefold.
Grapefruit juice.
167
Effect of chronic alcoholism on drug interaction
Can decrease drug availability and diminish its effects
168
risk factors for cellulitis
immunosuppressed, injury, lympahdema
169
trx for cystitis (UTI)
Bactrim
170
Contraindication for DTaP
encephalopathy
171
Doses of DTaP for kids
5 doses
172
Adults who never recieve TdaP should recieve
one dose then 2 series of Td
173
Good to give this after children receive DTap
Tylenol
174
DOC for UTIs
Fluoroquinolones
175
Fluoroquinolones have an increased risk for
tendon rupture
176
Avoid this drug in patients with myasthenia gravis
Fluoroquinolones
177
Furuncles are usually caused by
Staphylococcus aureus
178
DOC for furuncle
dicloxacillin
179
I&D for furuncles
decrease the need for atbx treatment
180
used the dye on animals infected with streptococci to inhibit bacterial growth; led to the development of sulfa drugs
Gerhard Domagk
181
GABHS can cause
pharyngitis, rheumatic fever, impetigo, endocartitis
182
DOC for GABHS
PCN
183
Course of trx for GABHS
10 days
184
Hamophilus influenzae causes
sinusitis, otitis, bronchitis, and pneumonia
185
Hib vaccine for children
Given at 2 months, with boosters at 4, 6, and 12 months.
186
Vaccine not indicated for those 60 and older
Hib vaccine
187
Hep B vaccine is given to
newborns before hospital discharge
188
Influenza vaccine is given to those
6 and up
189
Treatment for Lice
Permethrin
190
Second DOC for scabies
Lindane
191
Can penetrate the skin and has a potential for CNS toxicity in children
Lindane
192
MOA for cephalosporins
bactericidal- interferes with cell wall synthesis
193
MOA for fluoroquinolones
inhibit enzyme involved in bacterial DNA replication and transcription
194
MOA for macrolides
bacteriostatic and bactericidal- inhibit protein synthesis
195
Macrolide with most GI side effects
erythromycin
196
MOA for sulfa drugs
bacteriostatic- inhibit enzyme that produces folic acid
197
MOA for PCN
bactericidal- disrupt cell wall synthesis
198
outpatient treatment for MRSA
TMP-SMX (bactrim)
199
Patients with gonorrhea are also treated for
chlamydia
200
Newborns are given this to prevent gonorrhea
erythromycin eye gtts
201
Neisseria meningtides
Moraxella organism causing bacteremia
202
Oropharyngeal candidiasis is known as
oral thrush
203
risk factors for oropharyngeal candidiasis
immunocompromised, infant & elderly, taking corticorsteroids/chemo
204
Trx for oropharyngeal candidiasis
nystatin antifungal swish and spit
205
Otitis media is caused by bacteria when
it accompanies a bulging red or yellow tympanic membrane
206
Otitis media with simple effusion means
probably caused by virus.
207
bacterial otitis media is caused by
moraxella, s. pneumonia, or h. influenza
208
viral otitis media is caused by
resp viruses
209
Oral PCNs are absorbed better when
taken on empty stomach
210
Pharyngitis trx is for
10 days
211
Can determine if empirical testing is needed for pharyngitis
antigen detection test
212
PCV13 is given to
children 2 months to 10 years
213
Second dose of pneumococcal is given...
if last dose was given before 65.
214
Polio vaccine dosing
4 doses
215
Adults who work in healthcare or travel should recieve how many doses of polio
2 doses then a booster 1 year later
216
Pregnancy category X
positive evidence for fetal abnormalities
217
rotavirus dosing
3 doses orally at 2, 4, and 6 months of age
218
complication of rotavirus
intussusception.
219
Shingles pathophysiology
virus remains dormant until older and more immunocompromised
220
unilateral, painful, vesicular rash on skin
shingles
221
Recommend to vaccinate for herpes zoster for people
age 60 and older
222
SJS is caused by
sulfa drugs and tylenol
223
streptococcus pneumonia causes
TB
224
Tertracyclines are contraindicated in children because
causes tooth discoloration
225
The 5 cardinal points of treatment when rx an antibiotic
most effective, most cost-effective, narrowest spectrum, lowest toxicity, lowest potential for allergy
226
Trx for otitis media
amoxicillin
227
When giving Tamiflu for influenza virus, it must be given
within 48 hours symptoms began
