Pharmacokinetics Final Exam 2

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kyleannkelsey
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248845
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Pharmacokinetics Final Exam 2
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2013-11-24 17:56:54
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Pharmacokinetics Final Exam
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Pharmacokinetics Final Exam 2
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  1. What is considered elevated SCr?
    >1.5 mg/dL
  2. For a drug to be approved by the FDA does it need to be tested on renaly insufficient patients?
    Yes
  3. Breakdown of the kidney’s function can be at any point where what is occurring?
    Filtration, Reabsorption, Secretion and Excretion
  4. Absorption can be altered by what parameters (as listed in class)?
    Changes in GI tract, Vomiting or Diarrhea, Antacid use, edema, transit time in GI
  5. (True/False) There are a wealth of absolute bioavailability studies in patients with chronic kidney disease.
    False, there are a limited number
  6. Since there are limited numbers of bioavailability studies in patients with chronic kidney disorders, how can you extrapolate absorption?
    Estimate it, assuming that absorption is slowed or the extent is reduced
  7. What factors can alter Distribution (Vd) in reduced renal function patients?
    ∆ in body composition (like Water), ↑ or ↓ in protein binding or tissue binding
  8. Does the Vd of a drug increase of decrease in end stage renal disease?
    Can either increase or decrease
  9. What drugs would you expect to have an increased Vd in a patient with end stage renal disease?
    Cefazolin, Gentamycin, Vancomycin and Phenytoin
  10. What drugs would you expect to have a decreased Vd in a patient with end stage renal disease and why?
    Digoxin, due to ↓ tissue binding
  11. Why is it important that Dialysate is aqueous in nature?
    Tends to remove drugs that are soluble in aqueous solutions at a higher rate
  12. What type of drugs are removed by Dialysate more readily?
    Water soluble drugs or drugs with a low Vd
  13. What type of drugs are removed by Dialysate less readily?
    Lipid soluble drugs or those with a high Vd
  14. Protein binding of acidic drugs are generally increased or decreased in ESKD?
    Decreased
  15. Protein binding of basic drugs are generally increased or decreased in ESKD?
    Increased or Decreased
  16. (True/False) Serum concentration is representative of how much drug is bound to protein.
    False, need to correct for this value
  17. Clonidine is a basic drug, will it increase or decrease in protein binding in patients with ESKD?
    Increase
  18. Morphine is a basic drug, will it increase or decrease in protein binding in patients with ESKD?
    Decrease
  19. In patients with ESKD, would you expect metabolism to be enhanced or reduced?
    Reduced
  20. What does reduced metabolism in ESKD patients often lead to?
    Accumulation of parent compound or active metabolites
  21. Can CKD reduce non-kidney metabolism?
    Yes
  22. What is the most common drug to have an active metabolite that can accumulate in ESKD patients?
    Demerol
  23. Should Demerol be used in patients with ESKD, why or why not?
    No, has an active metabolite that may accumulate and cause seizures
  24. What aspects of excretion can be altered by ESKD?
    Glomerular filtration, Tubular secretion and Tubular reabsorption
  25. What does the Rate of Excretion =
    Rate of filtration + Rate of secretion – Rate of absorption
  26. Reduction in glomerular filtration rate results in an increased or decreased drug exposure?
    Increased
  27. Describe how Dialysis works:
    Patients own blood and dialysate solution are perfused on opposite sides of a semipermeable membrane, substance are removed from the blood due to diffusion and ultrafiltration
  28. Is the patient’s own blood replaced or returned back to the patient in Dialysis?
    Returned
  29. (True/False) Dialysis can remove drugs at variable rates based on MW.
    True
  30. (True/False) The amount of drug being pumped from a patient on Dialysis can affect the amount of medication removed.
    True
  31. (True/False) The Dialysate pump rate can influence the amount of drug removed from a patient.
    True
  32. (True/False) The ultrafiltration rate for has no effect on the amount of drug removed from a patient on Dialysis.
    False, can effect
  33. (True/False) Peritoneal dialysis pulls off more meds that renal replacement therapies/Dialysis.
    False, pulls off fewer meds
  34. Are small or large MW drugs removed more easily during dialysis?
    Small MW drugs
  35. What is considered a small molecular weight drug?
    <300 daltons
  36. What is considered a medium molecular weight drug?
    300-12,000 daltons
  37. What is considered a large molecular weight drug?
    >12,000 daltons
  38. What type of drugs will have a higher likelihood of needing removal by a convective process ( a diff. setting on the machine)?
    Large MW drugs
  39. (True/False) MW of drugs is usually easily accessible.
    False
  40. (True/False) Generally, only free/unbound drugs can pass through membrane pores on a Dialysis filter.
    True
  41. Define IPD:
    Intermittent Peritoneal Dialysis
  42. Define CAPD:
    Continuous Ambulatory Peritoneal Dialysis

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