Pharmacology Nu 420 1st exam

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Pharmacology Nu 420 1st exam
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2013-02-17 12:19:02
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Boston College CRNA Pharm
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Flash cards for Nu 420
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  1. What is Phamacokinetics?
    what the body does to a drug
  2. What are the three characteristics of pharmacokinetics?
    Absorbtion-transfer of a drug from site of administration to the blood  (must cross cell membrane- active/passive transport)

    distribution: moving of drug from blood to various compartments in the body

    drug metabolism: biotransformation and excretion
  3. What is phamacodynamics?
    what drug does to the body
  4. What is up regulation?
    Hypersensitivity:if a receptor’s activity is chronically reduced by antagonists, a state of up-regulation may occur and the if the drug is rapidly withdrawn the receptors react strongly to the natural agonists, resulting in an exaggerated response
  5. What is down regulation?
    • Continual bombardment of receptors causes and decrease in the total receptor thereby decreasing the overall effect of the medication.
    • AKA desensitization.
  6. What is a reversible agonist?
    Actions ends when the drug leaves the receptor site.
  7. What is an Irreversible agonist?
    A drug that binds and occupies the receptor permanently.
  8. What is a competitive agonist?
    A drug that works opposite of the antagonist and competes with the agonist at the receptor sites, will occupy the same site as the antagonist.
  9. What is a non competitive inhibitor?
    A drug that irreversibly binds to a receptor and has a greater affinity to the receptor than does the other drug it is inhibiting.
  10. What is a partial agonist?
    A drug that when bound to a receptor only exerts a partial effect when compared to a full agonist.
  11. What is tachyphylaxis?
    A sudden decrease in the response to a drug following administration.
  12. What reactions occur in the liver regarding drugs?
    Phase I: Oxidation, hydrolysis, or reduction to increase water solubility of drug.

    Phase II: conjugation or union with water soluble molecule.
  13. What is the first pass effect?
    Metabolism of orally administered drug before it reaches the systemic circulation.  If the drug is absorbed via the stomach, or intestine then it will pass through the liver first.
  14. Describe enterohepatic recycling.
    After passing through the liver and circulation to the systemic circulation the drug then return back to the liver and be "re-phased."
  15. What is the Phase I enzyme?
    CYP 450
  16. What is a Pro drug?
    Drug that is administered in it's inactive form and the through biotransformation is turned into the active form.
  17. What is an example of a pro drug?
    Most ACEI
  18. Name the three ways by which a drug can be filtered in the renal system?
    • Passive Glomerular filtration
    • Active tubular secretion
    • tubular re-absorption
  19. How are drug excreted by the GI system?
    Biliary excretion.
  20. What is the bioavailability of a drug given IV?
    100%
  21. What is the bioavailability of a drug given IM?
    75-100%
  22. What is the bioavailability of a drug given SQ?
    75-100%
  23. What is the bioavailability of a drug given PR?
    30 to <100%
  24. What is the bioavailability of a drug given PO?
    5 to <100%
  25. What is the bioavailability of a drug given INH?
    5 to<100%
  26. What is the bioavailability of a drug given transdermal?
    80 to 100%
  27. How is drug dose determined?
    • Dose response relationship
    • therapeutic index
    • plasma level profile
    • Half-life
    • Bioavailability
  28. What is the potency of a drug?
    the amount of drug needed to produce an effect.
  29. What is the efficacy of a drug?
    The maximum effect that can be produced by a drug.
  30. What is onset of action?
    the time between administration and first sign of drug effect.
  31. What is peak of action?
    • Th time required to meet the maximum concentration of drug.
    • -amount of drug being absorbed and distributed is equal to the amount being metabolized and and excreted.
  32. What is the duration of action?
    Time that the blood levels are above the minimum effective concentration(MEC).
  33. what is termination?
    The drug level drops below the MEC.
  34. What comprises the plasma level profile?
    • Onset of action
    • peak of action
    • duration of action
    • termination action
  35. What is the therapeutic index (range).
    MTC-MEC

    • (MEC)- level below which therapeutic effects will occur
    • (MTC)- level above which toxic effects begin
  36. What is Half Life?
  37. How do you figure maintenance dosing?
  38. How do you figure a loading dose?
  39. How do you adjust the dose for renal disease?
  40. How do you figure Creatinine clearance?
  41. What is Volume of distribution?
  42. What effects the Vd?
    • Physicochemical Characteristics:
    • Lipid Solubility
    • Protein Binding
    • Molecular Size
    • Distribution by Compartment:
    • Plasma: low molecular weight, high protein binding, hydrophilic
    • ECF: low molecular weight, lipophilic
  43. Prior to prescribing what 7 items should an NP review?
    pharmacokinetics, pharmacodynamics, therapeutic issues, safety, and cost
  44. The FDA Regulatory Jurisdiction over drugs encompasses?
    • Standardization of nomenclature
    • Approval process for new drugs and indications
    • Official labeling  
    • Surveillance of adverse drug events
    • Methods of manufacture and distribution
    • Regulation of advertisements for prescription drugs
  45. What are the controls of a schedule 1 drug? What are some examples?
    • A schedule 1 drug is a drug that is:
    • No accepted medical use
    • No legal use permitted
    • For registered research facilities only
    • Examples are:
    • Heroin, LSD, mascaline, peyote, marijuana
  46. What are the controls of a schedule II drug? What are some examples?
    • No refills permitted
    • No telephone orders unless true emergency and followed up by written prescription within 7 days
    • Electronic prescribing permitted as of 2011 with specific software and secure identification processes
    • Examples:
    • Narcotics:  (morphine, codeine, meperidine, opium, hyromorphone, oxycodone, oxymorphone, methadone, fentanyl)
    • Stimulants:  (cocaine, amphetamine, methylphenidate)
    • Depressants:  (pentobarbital, secobartial)
  47. What are the controls of a schedule III drug? What are some examples?
    • Prescription must be rewritten after 5 months or 5 refills
    • Telephone or fax prescription okay
    • Examples:
    • Narcotics: (Codeine in combination with non-narcotic ingredients not to exceed 90 mg/tab; hydrocodone not to exceed 50mg/tab)
    • Stimulants: (Benzphetamine, chlorpehniramine, diethylpropion)
    • Depressants: (butabarbital)
  48. What are the controls of a schedule IV drug? What are some examples?
    • Prescription must be rewritten after 5 months or 5 refills
    • Telephone or fax prescription okay
    • *Penalties differ for illegal possession*

    Penazocine, propoxyphene, phentermine, benzodiazepines, meprobamate
  49. What are the controls of a schedule V drug? What are some examples?
    May be dispensed without a prescription unless regulated by the state
  50. First generation Antihistamine (benedryl) Indications.
    • Indications:
    • Allergic rhinitis, Vasomotor rhinitis, pruritis, conjunctivitis, upper respiratory allergies
    • Action:
    • Complete antagonist of histamine at the H1 receptor sites in the GI, uterus, large vessels and bronchial muscle. Binds non-selectively to central H1 receptors; can cause cns depression and stimulation.
  51. First generation Antihistamine (benedryl) action.
    • Action:
    • Complete antagonist of histamine at the H1 receptor sites in  the GI, uterus, large vessels and bronchial muscle. Binds non-selectively to central H1 receptors; can cause cns depression and stimulation.
  52. First generation Antihistamine (benedryl) side effects.
    • sedation and anticholinergic side effects common (drymouth, urinary retention, dysuria
    • Central: dizziness, tinnitus, lassitude, disturbed coordination, fatigue, headache, irritability, nervousness, blurred vision, diplopia, and tremors
    • GI related: increased or decreased appetite, nausea, epigastric distress, vomiting, constipation, diarrhea
  53. First generation Antihistamine (benedryl) contraindications:
    • In patients with narrow-angle glaucoma, lower respiratory tract infections (thicken secretions and impair expectoration), stenosing peptic ulcer, symptomatic prostatic hypertrophy, bladder neck obstruction, pyloroduodenal obstruction, and MAOI use
    • Newborns and premature infants: may convulsions
  54. SECOND GENERATION ANTIHISTAMINE (Clarinex, Claritin, Claritin-D, Allegra, Zyrtec) indications:
    Seasonal or perennial rhinitis, chronic uticaria, pruritis, allergic rhinitis
  55. SECOND GENERATION ANTIHISTAMINE (Clarinex, Claritin, Claritin-D, Allegra, Zyrtec) Action:
    • Selective for peripheral H1 receptors and therefore as a group are less sedating
    • They do not cross the blood-brain barrier in appreciable amounts
  56. SECOND GENERATION ANTIHISTAMINE (Clarinex, Claritin, Claritin-D, Allegra, Zyrtec) side effects.
    Minimal compared to first generation: benefit incidence of drowsiness greatly reduce, tolerated well in GI system, minimal incidence of dry mouth.
  57. SECOND GENERATION ANTIHISTAMINE (Clarinex, Claritin, Claritin-D, Allegra, Zyrtec) contraindications:
    • In patients with significant hepatic dysfunction
    • Number of drugs in this class cannot be used in conjunction with: mycins, zoles, quinine, HIV drugs, SSRI’s
  58. CROMOLYN (Intal) Indications:
    • Long term asthma care
    • first-line agent for long term prophylactic therapy of moderate asthma
  59. CROMOLYN (Intal) Side effects:
    Coughing, throat irritation, wheezing
  60. CROMOLYN (Intal) action:
    • Inhalation Mechanism:
    • Suppressing inflammation
    • Stabilizing the cytoplasmic membrane of mast cells preventing release of histamine and other mediators
    • Suppressive effect on other inflammatory cells (macrophage, eosinophils, monocytes)
  61. CROMOLYN (Intal) Contraindication:
    Hypersensitivity.
  62. Methylxanthines (THEOPHYLLINE) Indications:
    • Bronchospasm associated with asthma, COPD, and bronchitis
    • Maintenance therapy of chronic stable asthma
    • Oral theophylline is indicated for patients that experienced nocturnal attacks of asthma
    • Used to be widely used, now being replaced with safer and more effective medications
    • second line, low dose treatment for COPD
  63. Methylxanthines (THEOPHYLLINE) side effects:
    • plasma levels at <20 mcg/ml: adverse effects are uncommon
    • plasma levels 20-25 mcg/ml: nausea, vomiting, diarrhea, insomnia, restlessness
    • plasma levels >30 mcg/ml: Seizures, tachycardia, arrhythmias
    • CNS stimulant: cause insomnia, excitability, tremors, increase gastric secretions, increased sodium and chloride secretion, causes diuresis
  64. Methylxanthines (THEOPHYLLINE) action:
    • Bronchodilation by relaxing smooth muscle of the bronchi
    • Possible mechanisms include blockade of receptors of adenosine, inhibiting phosphodiesterase enzyme
  65. Methylxanthines (THEOPHYLLINE) contraindications:
    hypersensitivity to xanthine, peptic ulcer disease, and underlying seizure disorder
  66. LONG ACTING BETA 2 ADRENERGIC Receptor AGONISTS (SALMETEROL INHALER OR SEREVENT DISKUS) Indications:
    • Long term treatment of
    • allergen-, exercise-, histamine-, and methacholine- caused bronchospasm
  67. LONG ACTING BETA 2 ADRENERGIC Receptor AGONISTS (SALMETEROL INHALER OR SEREVENT DISKUS) Action:
    • Effects are delayed but persist for up to 12 hours
    • exert long-lasting bronchoprotection effects against allergen-, exercise-, histamine-, and methacholine- caused bronchospasmNOT first choice agent for long term controlDosing on a fixed schedule, not PRN
  68. LONG ACTING BETA 2 ADRENERGIC Receptor AGONISTS (SALMETEROL INHALER OR SEREVENT DISKUS) Side effects:
    may increase the risk of severe asthma, asthma-related intubation and death
  69. LONG ACTING BETA 2 ADRENERGIC Receptor AGONISTS (SALMETEROL INHALER OR SEREVENT DISKUS) Contraindications:
    • avoid concurrent use with Beta blockers, causes mutual inhibition
    • MAOIs, Tricyclic antidepressants
    • should be used only in patients taking a recommended medication for long-term control, and only if that medication has been inadequate by itself
  70. BETA TWO Receptor AGONIST (Albuterol) indications:
    • reversible bronchoconstriction caused by asthma or restrictive airway disease
    • control episodic bronchoconstriction
    • Preventative for exercise-induced asthma
  71. BETA TWO Receptor AGONIST (Albuterol) action:
    • act on smooth muscle to reverse bronchospasm
    • stimulate beta 2 adrenergic receptors in the lung to increase production of cyclic adenosine monophosphate (cAMP): increased cAMP concetrations relax bronchial smooth muscle and inhibit release of mediators of immediate hypersensitivity from cells, especially from mast cells
    • Effects begin immediately, peak in 30-60 minutes, and persist for 3-5 hours
  72. BETA TWO Receptor AGONIST (Albuterol) Side effects:
    Cardiac arrhythmias- tremor, tachycardia,hypotension, angina, headache, dizziness, nausea, etc.
  73. BETA TWO Receptor AGONIST (Albuterol) contraindications:
    • Diabetics potential for drug induced hyperglycemia
    • Any patients with digoxin therapy or cardiac history: contraindicated due to this drugs effect on the cardiovascular system (Albuterol increases the volume of distribution of Digoxin)
    • Hypothyroidism- adverse reactions more likely to occur with use of bronchodilator
    • Pheochromocytoma- severe hypotension can occur when Bronchodilator used
  74. Corticosteriods/ Glucocorticoids: belcomethasone (Qvar) Indications:
    Asthma, Allergic Rhinitis
  75. Corticosteriods/ Glucocorticoids: belcomethasone (Qvar) Action:
    • Primary action is anti-inflammatory: ibhibit IgE and mast cell mediated migration of inflammatory cells into the bronchial tissue
    • Most potent and effective anti-inflammatory medication currently available
    • lead to reduction in the severity of asthma symptoms, increased peak flow readings, and decreased airway hyperresponsiveness
  76. Corticosteriods/ Glucocorticoids: belcomethasone (Qvar) Side effects:
    • Xerostomia, hoarseness, tongue and mouth irritation, flushing, dysgeusia, rash, uticaria
    • Local immunosuppression can lead to oral candidiasis
    • Cataracts can be induced with corticosteroid use
    • Systemic: Adrenal suppression, bone loss, can slow growth rate of children, but does not reduce adult height
  77. Corticosteriods/ Glucocorticoids: belcomethasone (Qvar) contraindications:
    • Contrindicated in acute status asthmaticus
    • Adrenal insufficiency when switching from inhaled to oral
    • Avoid use in patients with Cushings Syndrome
    • In combination with other steroids, risk for hypothalamic pituitary adrenal suppression is increased
  78. Leukotriene modifiers
    Montelukast (singular) Indications:
    Prophylaxis and chronic treatment of asthma
  79. Leukotriene modifiers
    Montelukast (singular) Action:
    • Suppresses the effect of leukotrienes
    • Maximum effect develop within 24 hours of the first dose, and are maintained once daily dosing in the evening
  80. Leukotriene modifiers
    Montelukast (singular) Contraindications:
    • Reported adverse reactions of those taking montelukast are similar to those taking placebo
    • In leukotrience modifiers:
    • Neuropsychiatric events have been reported: agitation, aggression, anxiousness, dream abnormalities, hallucinations, depression, insomnia, irritability, restlessness, suicidal ideation, tremor
  81. Leukotriene modifiers
    Montelukast (singular) Contraindications:
    Contraindicated in patients with hypersensitivity to any of the components of the medication
  82. Anticholinergic Bronchodilators IPRATROPIUM (Atrovent) Indications:
    Bronchospasms associated with asthma or COPD
  83. Anticholinergic Bronchodilators IPRATROPIUM (Atrovent) action:
    • Blocks muscarinic cholinergic receptors
    • Blocks the effects of acetylcholine released from cholinergic nerves in the airways
    • Block reflex bronchoconstriction caused by inhaled irritants
    • Less potent bronchodilators than inhaled beta-2 agonists, in general, have a slower onset of action (Atrovent: alternative bronchodilator for patients who experience adverse effects from beta 2 agonists)
  84. Anticholinergic Bronchodilators IPRATROPIUM (Atrovent) side effects:
    • Most common side effect is cough
    • Dryness of the mouth, bitter taste, hoarseness, throat irritation, dysgeusia, nausea, vomiting, dyspepsia
    • Systemic effects are minimal
  85. Anticholinergic Bronchodilators IPRATROPIUM (Atrovent) contraindications:
    • Contraindicated in patients with hypersensitivity to atropine, atropine derivatives, and bromine sensitivity
    • Inhaled anticholinergics should be avoided for patients with urinary retention, bladder neck obstruction, or prostatic hypertrophy, and closed angle glaucoma (can increase intraocular pressure)
    • Safety has not been established for children under 12 years old
  86. What meds could be termed respiratory "relievers." or for use in acute situations.
    • B-2 Aderenergic agents
    • Anti-colinergics
  87. What meds could be termed as "controllers," or long acting resiratory drugs?
    • B-2 Adrenergic Agents
    • Methylxanthines
    • Cromolyn sodium
    • leukotriene inhibitors
    • anti-IgE monoclonal antibodies
  88. What is the Patho of TB?
    caused by M. Tuberculosis; inhaled into the alveolus and spread from lungs; grows slowly; infection is spread almost exclusively by aerosolization of contaminated lung secretions
  89. What are the goals of treatment for TB?
    Accurate diagnosis: PPD screenings, chest xray; Completion of the recommended therapy; Effective treatment to treat patients and prevent transmission; Risk stratifications: HIGH RISK: children <4 years, HIV/AIDS patients, foreign-born patients
  90. Name the four principle for drug therapy with TB?
    • 1. Regimen to contain multiple drugs to which the organisms are susceptible to.
    • 2.The drugs must be taken regularly
    • 3. Drug therapy must continue for a sufficient period of time
    • 4. Never add a single drug to a failing regimen
  91. What are the two phases of TB treatment and how long do they last?
    • 1. Initiation phase for the first 2 months
    • 2. continuation phase for the last 4-7 months
  92. What are the commonly used drugs to treat TB?
    • INH-Isoniazidi: risk for hepatitis, and peripheral nueropathy
    • RIF-Rifampin
    • EMB-Ethambutol
    • PZA-pyrazinamide
  93. What are the important monitoring parameters used in the treatment of TB?
    • Sputum cultures monthly until negative, TB-free after two months of treatment
    • Chest xray at completion of therapy to document post TB CXR
    • Monitor for drug adverse effects: Baseline liver enzymes, bilirubin, creatinine, CBC, platelets
  94. + PPD but no signs of infection?
    INH alone for 6-9 months, monitor monthly, directly observed therapy if necessary, successful treatment is determined by absence of the disease, patient education is CRITICAL to a successful treatment
  95. What are the two main drug types used for treating pain?
    • Exogenous morphines and their derivatives (opiates): MODERATE TO SEVERE PAIN
    • Anti-inflammatory agents
  96. Exogenous morphines and their derivatives (opiates) work at what receptor?
    mu receptor
  97. Name some agonists that work on the mu receptor.
    • Morphine
    • hydromorphone
    • levorphanel
  98. Name a partial agonist that work on the mu receptor.
    • buprenorphine
    • Because it is only a partial agonist, it does not produce as much euphoria but it does suppress withdrawal and cravings. (http://www.buppractice.com/howto/whatisbup/mechanism)
  99. What are some weak agonists that bind to the mu receptor?
    meperidine, methadone, tramadol, tapentadol
  100. What are the adverse effects for the exogenous morphines and derivatives?
    euphoria, respiratory depression, constipation, urinary retention, drug dependence
  101. Name some drugs that bind the Kappa receptors.
    • Strong agonist: morphine, pentazocaine, nalbuphine, butorphanol
    • Little or no activity: methadone, levorphanel,
    • meperidine
  102. What are some adeverse effects for drugs analgesics that bind to the Kappa receptor?
    produce sedation but NO euphoria, respiratory depression, constipation, or urinary retention
  103. Name some non-opioid medications that are used for analgesia.
    Aspirin, salicylates, NSAIDS, acetaminophen, corticosteroids
  104. What is the action of aspirin?
    Inhibition of COX enxymes, prostoglandin synthesis. Because of prostoglandin inhibition may predispose patient to peptic ulcers.
  105. What is the action of ibuprophen?
    Inhibition of COX enxymes, prostoglandin synthesis. Because of prostoglandin inhibition may predispose patient to peptic ulcers.
  106. What is the action of Acetominophen?
    • Exact mechanism unknown, thought to increase the pain threshold.
    • Limited anti-inflamitory effect.
  107. What is the pain threshold?
    point at which a stimulus is experienced as pain
  108. Pain sensation involves interactions from what three major systems?
    • Sensory/discriminatory system
    • motivational/ affective system
    • congnitive//evaluative system
  109. What is perceptual dominance?
    If there are multiple "pains" that a person is experiencing, only the strongest stimulation will be reported.
  110. What is Pain tolerance?
    duration or intensity of pain that a person will tolerate before seeking action to relive it?
  111. How long is acute pain?
    up to 6 months
  112. Pain can an indication of ______ _____ and my be classified as somatic, visceral, referred, or neuropathic.
    Tissue injury
  113. What is central pain?
    Pain caused by a lesion or dysfunction in the CNS (infarction, hemorrhage, abscess, degeneration, tumors, or traumatic injury); migraines and headaches also fall into this category.
  114. What is non-neuropathic pain?
    Nonneuropathic Pain- results of any lesion that is noncancerous and not the result of nerve damage. The most common causes are inflammatory in nature, but the exact physiological basis may be unclear; fibromyalgia, myositis, myalgia, and muscle strain fall into this category
  115. What is neuropathic pain?
    Result of trauma or disease of the peripheral nerves; pain is often paroxysmal, burning, or shooting; examples include hyperesthesias, phantom limb pain
  116. What is Psycogenic pain?
    pain related to a psychological disorder, pain that is purely psychogenic (conversion disorder) is extremely rare.
  117. What are the goals of treatment for acute pain?
    • reduction or elimination of the pain sensation with a minimum of adverse reactions
    • Because acute pain is a short-term phenomenon, lifestyle modifications are largely directed toward reduction of the source of the painful stimulus, rest or immobilization of the affected part, elevation when possible, ice, or compession.
    • Oral administration of any pain drug is route of choice if the patient has a functioning GI system
  118. What are the goals of treatment for chronic pain?
    • would prefer elimination of the pain, but with chronic pain this may not be possible. An acceptable goal for treatment in chronic pain is the reduction of pain to level that the patient finds tolerable with a minimum of medication side effects.
    • Goals should be: (1) negotiated between the patient and provider (2) specific (3) measurable

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