Clinical Pharm Mid Term

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Clinical Pharm Mid Term
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2014-02-09 17:39:20
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Mid-term
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  1.  

    The _____________ test is used to test whether potential
    drugs are likely to cause cancer.
    Ames
  2. Human trials of a new drug on small numbers of sick humans to determine how well it works and to  look for adverse effects are phase ____
    trials.
    Phase I
  3. A drug which increases the risk of birth defects is called a
    _____________________.
    Teratogen
  4. This drug caused a flipper like birth defect
    Thalidomide
  5. It causes p_________________________, the medical name for a
    condition in which

     

    babies are born with ____________________________.  This drug was being widely

     

    used in __________________, but had not been approved in the
    US. More recently this

     

    drug has found use in the treatment of the skin
    disease:____________________.
    phocomelia,flipper like hands, Germany, acne
  6. Accutane is an example of a drug which has a high risk of
    causing birth defects and is rated ______.
    X
  7. ______________ is a common OTC drug which can
    cause closure of the ductus arteriosus in the fetus.
    Ibuprofen
  8. A drug such as _________________ which is regarded as completely
    safe for pregnant women  is rated  A on the risk schedule.
    Levothyroxine
  9. Phase 2 drug metabolism covalently adds a molecule with multiple OH groups called______ onto drug molecules.
    glucoronic acid
  10. ___________ is a drug which reduces urination urges by acting as an ________ of the ______ receptors.
    Oxybutinin, antagonist, Beta 1 (kidneys)
  11. The specific type of adrenergic receptors found in the peripheral blood vessels:__________.
    Alpha 1
  12. Post-ganglionic neurons of the parasympathetic system release neurotransmitter which binds to cholinergic or ____________ receptors.
    muscarinic
  13. Can catecholamines be taken orally.
    no
  14. When a drug is metabolized virtually completely upon passing through the liver, it is called the _________ effect.
    First pass
  15. A drug for treatment of anaphylactic shock:________.
    epinephrine
  16. The decongestant that is "behind the counter" in most states is ________.
    pseudoephedrine
  17. ____________is an OTC that is no better than a placebo.
    phenylephrine
  18. ________ was an OTC dietary supplement "stimulant" also used in traditional Chinese medicine ma haung.
    Ephedrine
  19. Meth abusers often suffer from attack of formication which means______________.
    hallucinations of ants crawling on them.
  20. _______ and _________ are popular drugs at raves.
    MDA (methylenedioxyamphetamine), MDMA (methylenedioxymethamphetamines)
  21. Cathinone and methcathinoneare active ingredients in ______ a herb that grows in the Arabian peninsula.
    Quat
  22. Organic chemists now synthesize similar pure compounds and market them as ________'
    Bath salts
  23. The major drugs used for ADHD are __________ (generic/trade) and __________ (generic/trade).
    methylphenidate(Ritalin), amphetamine
  24. Methylphenidate and amphetamines are both_________ drugs.
    schedule II
  25. A drug used for treating sleep shift disorder and off-label for ADHD and "cognitive enhancement:"  _________.
    Modafinil
  26. The most common fast acting drug for treating asthma, ___________, acts as an ________ of the ___________ receptor.
    Albuterol, agonist, Beta 2
  27. A few people using this drug experience tachycardia because it also effects their_________ receptor.
    Beta 1
  28. This drug is most commonly administered with a ________ _______ ________.
    MDI, metered dose inhaler.
  29. Phase 2 drug metabolism covalently adds a molecule with multiple OH groups called __________ onto drug molecules.
    Glucoronic acid
  30. The general term for a drug that is actually activated (rather than inactivated) is a ___________.
    Pro-drug
  31. One specific example of this is ____________.
    Codiene
  32. A drug with a therapeutic index (TI) of 50 is ________.
    Safe
  33. A pain medication commonly given transdermally  _____________.
    Fentanyl
  34. A drug for depression with a half life of approximately 1 week is, ___________.
    Prozac
  35. Babies frequently need a lower drug dosage even after correcting for weight because  they do not have fully developed function of the _____ (organ).
    Liver
  36. A high potency drug ______ always more effacious than a low potency drug.
    is not
  37. Continued administration of a drug resulting in fewer receptors is an example of ___________.
    Pharmacodynamics
  38. Continued administration of a drug resulting in increased metabolic enzymes to inactivate the drug is known as _________ tolerance.
    Metabolic tolerance
  39. Another term for the increase of metabolic enzymes is enzyme_______.
    induction
  40. An increase in metabolic enzymes results in  a ________ in drug efficacy.
    decrease
  41. A common fruit_____________, contains molecules which inhibit the metabolic isozyme _________.
    CYP3A4
  42. Two drugs together resulting in more than a simple addictive effect is called a __________ effect.
    synergistic
  43. The serum protein which binds and transports lipophilic molecules in the blood is called ________.
    serum albumen
  44. The type of receptor found at the sympathetic ganglia between  pre- and post-ganglionic neurons:____________.
    Nicotinic
  45. The neurotransmitter released by the pre-ganglionic neuron of the sympathetic system:__________.
    Acetylcholine
  46. The neurotransmitter released by the post-ganglionic neuron of the parasympathetic system is, _____________, and binds to __________ receptors in the affected organs.
    Acetylcholine, muscarinic
  47. Acetylcholine is inactivated by_______________.
    Acetylcholinesterase
  48. The primary neurotransmitter released by the adrenal medulla is______________.
    epinephrine
  49. Epinephrine is inactivated by the enzyme__________ found in high concentrations in the _______(organ).
    monoamine oxidase
  50. the neurotransmitter whose action is stopped primarily by re-uptake by post-ganglionic neurons is ________________.
    norepinephrine
  51. A drug used to promote urination after abdominal surgery is_______________.
    Bethanecol
  52. Sarin, a military nerve gas, works by inhibiting the enzyme ______________.
    acetylcholinesterase
  53. Sarin gas is quickly lethal to humans by inhibiting the action of the ________(organs).
    Lungs (diaphragm)
  54. An anticholinergic effect on the pupils is _______.
    myodriasis (pupil dilation)
  55. An anticholinergic effect on the mouth is _______.
    Dry mouth
  56. This drug is used pre-operatively to reduce salivation and gi motility.
    Atropine
  57. Atropine is also used in ambulance to cause _______________.
    tachycardia
  58. Atropine used to be used to cause ________ in women but is no longer used due to its___________.
    Pupil dilation, half life
  59. This drug reduces the urge to urinate by acting as an ____________ of the ___________ receptors.
    Oxybutynin (Ditropan) or Tolterodine (Detrol), antagonist, cholinergic
  60. The most common side effect of Oxybutynin(Ditropan), and Tolterodine (Detrol) is ___________.
    Dry mouth
  61. The specific type of adrenergic receptor of the heart is _______.
    Beta1
  62. The specific type of adrenergic receptor found in the lungs is _______.
    Beta 2
  63. the specific type of adrenergic receptor found in the peripheral blood vessels is ________.
    Alpha 1
  64. The general term for an adrenergic drug that can not be given orally is ___________.
    Catecholamine
  65. The Ames test is used to test whether potential drugs are __________.
    carcinogenic
  66. Phase ____ human trials of a new drug on healthy humans to determine any adverse effects and how quickly it is eliminated from the body.
    Phase 1
  67. A drug which increases the risk of birth defects is called ____________.
    teratogen
  68. The drug ____________, was used in the 1950's in Europe for the treatment of morning sickness but resulted in the birth defect __________.
    Thalidomide, phocomelia
  69. Thalidomide is not used in the treatment of _______ and ________.
    leprosy, cancer
  70. An x-rated drug, ___________, is still widely used for the treatment of __________.
    Accutane, acne
  71. ______ was widely used to prevent miscarriages in the 50's and 60's, but was discovered to cause health problems in ______.
    daughters (DES daughters).
  72. use of ibuprofen in pregnant women is not recommended because of increased risk of ______________.
    premature closure of the ductus arteriosus
  73. The scale of drug addictive potential runs from __ to __.
    I to V
  74. ac
    before meals
  75. pc
    after meals
  76. bid
    twice daily
  77. tid
    three times a day
  78. qid
    four times a day
  79. qd
    everyday
  80. hs
    bedtime
  81. PRN
    as needed
  82. PO
    by mouth
  83. NPO
    nothing by mouth
  84. SC
    subcutaneous
  85. IM
    intramuscular
  86. OTC
    over the counter
  87. What was Viagra (sildenafil) originally intended for?
    hypertensive
  88. The generic name for Tylenol is ___________.
    acetaminophine
  89. Are amines soluble in water?
    no
  90. If you add acid to an amine group what happens to it?
    it becomes an ammonium ion.
  91. If you change an amine into an ammonium ion does it become more soluble in water?
    yes
  92. As acid is added to an amine the pH goes ____, and the ratio of polar/ionic form of the N group _______.
    down, decreases
  93. If swisherol has a pKa of 9, it will exist primarily as the __________, form in arterial blood.
    ionic
  94. If hysterical has a pKa of 4 it will exist primarily in the _________ in arterial blood.
    polar
  95. Drugs will have a maximum efficacy if their pKa is close to _____.
    7.4 pH
  96. An enzyme family that commonly adds OH groups to drug molecules is called ________.
    cytochrome P-450.
  97. Specific numbers of this enzyme family are known as _______ or _______.
    isoforms, isozyms
  98. Name the board that is supposed to ensure the safety of humans in the drug tests.
    Institutional review board
  99. When a researcher does not do his/her own experimental trials, but redoes the analysis from this trials it is called ___________.
    meta-analysis
  100. Medical expenses contribute to approx. _____ of personal bankruptcies in the US.
    50%
  101. A long acting bronchodilator ___________ is most frequently combined with the steroid ___________ as the product __________.
    salmeterol, fluticasone, Advair
  102. Advair is administered with a  ______ _____ _____.
    dry powder inhaler
  103. What is the adrenergic drug used to stop premature birth.
    Terbutaline
  104. The alpha 1 antagonist  ____________ or ___________, is most commonly used for treatment of __________ ___________ ________.
    Doxa' zosin (Cardura), Tamsu' losin (Flomax), Benign Prostate Hypertrophy
  105. If medication does not work for BPH what other option do men have?
    TURP trans-urethral resection of the prostate
  106. ___________ is an antagonist to both alpha and beta receptors.
    Carvedilol
  107. Two specific beta 1 blockers, _________ and _______ are commonly used for treatment of ____________.
    Metoprolol, Atenolol, hypertension
  108. This CNS active adrenergic antagonist is also available in a patch and can be used for hypertension and withdrawal symptoms.
    Clonidine
  109. This neuromuscular blocker acts quickly and has a low incidence of vomiting.
    succinylcholine
  110. Succinylcholine has a mild adverse effect of ______. A more dangerous side effect is ____________ ___________.
    Soreness, malignant hyperthermia
  111. This neuromuscular blocking agent is put on the arrows of Amazon Indians.
    Tubocurarine
  112. This partial agonist is used to aid in smoking cessation.
    Chantix
  113. This seed contains an analog of nicotine and is commonly used as "chew" in Indonesia and other parts of Southeast Asia.
    Betel
  114. Montelukast (Singulair) is used for the treatment of ____________ and acts by inhibiting the formation of inflammatory molecules called ____________.
    asthma, antileukotrienes
  115. Teratogen Rating:

    Category A
    Well controlled testing no significant risk of birth defects.

    Levothyroxine
  116. Teratogen Rating:

    Category B
    • Available data in human tests show no evidence of birth defects, inconclusive data though
    • amoxicillin
  117. Teratogen Rating:

    Category C
    • adverse effects shown in animal studies, insufficient data on humans. May be prx when benefits outweigh risk.
    • ibuprofen (during 1 & 2 trimester, Cat. D 3rd trimester)
  118. Teratogen Rating:

    Category D
    • Clinical data on humans suggests increased risk of birth defects
    • Diazepam(Valium), Phenytoin (Dilantin)
  119. Teratogen Rating:

    Category X
    clear evidence of substantial risk of birth defects

    Thalidomide
  120. Drug Abuse potential:

    Control I (Schedule I)
    • illegal drugs with no known medical purpose
    • phencyclidine (PCP), heroin, GHB, marijuana
  121. Drug Abuse Potential:

    Control II (Schedule II)
    • legal drugs w/ high potential for abuse
    • dexroamphetamine (Adderall)
    • methylphenidate(Ritalin)
    • oxycodone, methadone, hydrocodone, morphine, cocaine.
  122. Drug Abuse Potential:

    Control III (Schedule III)
    • legal drugs with potential for abuse
    • codeine + acetaminophen(Tylenol 3), hydrocodone + Tylenol (Vicodin), anabolic steroids, dronabinol(Marinol)
  123. Drug Abuse Potential:

    Control IV (Schedule IV)
    • legal drugs with moderate potential for abuse
    • Benzodiazepine sedatives, diazepam(Valium), alprazolam(Xanax), zolpidem(Ambien), eszoplicone(Lunesta)
  124. Drug Abuse Potential:

    Control V (Schedule V)
    • legal drugs w/ lowest potential for abuse
    • pregabalin(Lyrica),
  125. Which has a longer shelf life polar group or ionic group
    ionic
  126. Which form of drug works better in a patch
    Amine or Ammonium Ion.
    Amine, is more lipophilic
  127. What blood thinning drug is transported on _________ ________ protein.
    Coumadin, serum albumen
  128. Metabolism of drugs is done in 2 phases name each phase and the enzyme that is responsible for it.
    • Phase I Cytochrome P-450
    • Phase II (glucuronyl transferase) adds glucuronic acid.
  129. How do Cytochrome P-450, and Glucuronic Acid make drugs easier to metabolize?
    They both add OH groups.
  130. Define Therapeutic Index.
    • LD50/ED50=TI
    • LD50=lethal dose in 50% of population
    • ED50=Effective dose in 50% of population
    • TI should be high, higher the number the safer the drug
  131. Bioavailability is a catch all term for how much of the orally administered drug is __________.
    absorped
  132. If the drug activates the receptors it is known as an _________.
    Agonist
  133. If the drug inactivates or blocks a receptor it is known as ____________.
    antagonist or blocker.
  134. If the drug partially activates a drug it is a ______ _______.

    If the drug partially inactivates the drug it is a _____________ ____________.
    • partial agonist
    • partial antagonist
  135. Drug Efficacy is _____ _____ a drug is.
    how effective
  136. When two drugs are taken together and they increase the efficacy of the effects by the sum of their total is known as _______ effect.
    addictive
  137. When two drugs are taken together and their efficacy is greater than their sum it is known as _________ effect.
    synergistic
  138. When the liver is stimulated to produce more metabolizing enzymes the result is faster deactivation of the drug and a lower efficacy, this is known as,__________ __________.
    Enzyme induction
  139. NE is eventually inactivated in the afferent neuron by two enzymes: ______ ______ (   ) and ________ _______ ______ (    ).
    • Monoamine oxidase (MAO)
    • Catechol Orthomethyl Transferase (COMT)
  140. Receptors activated by epinephrine (adrenaline) are known as ________ receptors.
    adrenergic
  141. Receptors that are activated by acetylcholine are known as __________.
    Cholinergic receptors/ muscarinic receptors
  142. Epinephrine is inactivated by ______ ______.
    monoamine oxidase
  143. What are the parasympathetic effects on
    eye,
    heart
    lungs
    bladder
    Gi tract
    genitals
    • pupil constricts (near vision)
    • HR decreases
    • bronchoconstriction
    • voiding
    • salivation, gi motility
    • erection
  144. What systems does the sympathetic system affect and their receptors and effect?
    • Heart B1, increased hr/contractility
    • kidney B1, renin release
    • arterioles in heart B2, vasodilation
    • bronchi B2, bronchodilation
    • uterus B2, relaxation
    • Blood Glucose B2, glycogenisis
    • peripheral arterioles A1, vasoconstriction
    • visceral arterioles A1, vasoconstriction
    • eye, A1 pupil dilation
    • genitals A1, ejactualtion
  145. Bethanecol
    • promotes urination, abdominal post-op
    • cholinergic(muscarinic) receptors
    • agonsit
  146. Cholinesterase inhibitors
    • increase ACh activity by blocking inactivation of ACh. Causes salivation, bronchoconstriction, continuous stimulation results in muscular and respiratory paralysis, death.
    • Sarin Nerve Gas
  147. Atropine
    • Given Pre-op to decrease salivation and gi motility.
    • Causes pupil dilation (Myodriasis)
    • long half life
    • Bella Donna Plant
  148. Tropicamide (Myodriacyl)
    • replaced atropine for pupil dilation
    • shorter half life
  149. ipratropium bromide (Atrovent)
    • anticholinergic
    • Tx: emphysema, COPD, chronic bronchitis
  150. Combivent
    ipratropium bromide + albuterol
  151. Tiotropium Bromide (Spiriva)
    • newer anticholinergic admisnistered by DPI
    • longer half life of Combivent
  152. Epinephrine
    • adrenergic B1, B2, A1 receptors
    • use asthma, anaphylactic shock (epipen)
    • adjunct in cardiac arrest (causes tachycardia)
    • can't be given orally
  153. Norepinephrine
    adrenergic receptors except B2
  154. Pseudoephedrine (Sudafed)
    • non-catecholamine
    • A1, B1, B2
    • A1 nasal vasoconstriction
    • used to make methamphetamine
  155. Phenylephrine (Sudafed-PE)
    • replacing pseudoephedrine
    • studies suggest not any better than placebo
  156. Ephedrine
    • isomer of pseudoephedrine
    • found in Chinese herb Mahuang
    • several deaths contributed to it
  157. Amphetamine(Benzedrine)
    (methylamphetamine)
    synthetic analogues of epinephrine
  158. Meth abuser's suffer from an oral condition referred to as ______ ______.
    meth mouth
  159. Meth abusers often hallucinate about bugs crawling on them this is known as ____________.
    formication
  160. This drug is known as the mellow drug of America.
    • MDA, methylenedioxyamphetamine
    • produces a energy rush and self-awareness
    • popular at raves
    • Schedule I
  161. This drug is knows as ecstasy or molley.
    • MDMA methylenedioxymethamphetamine
    • may change serotonin receptors
    • Adverse effects:
    • tachycardia, hyperthermia
    • (sometime results in coma and death)
    • Schedule I
  162. Quat
    • shrub grown in Arabian peninsula
    • adrenergic agonist
    • cathinone
    • (non-catecholamine)
  163. Bath Salts
    synthetic derivatives of cathinone
  164. Methylphenidate (Ritalin)
    • used for Tx of ADHD
    • inhibits uptake of dopamine and NE
    • Schedule II
  165. Dexmethylphenedate (Focalin)
    right hand glove of methylphenidate
  166. Amphetamine (Adderall)
    Control II also used for tx of ADHD
  167. Modafinil (Provigil)
    • approved for Tx of narcolepsy, shift work sleep disorder, inc. release of monoamines like epinephrine and NE.
    • cognitive enhancement (off-label)
  168. Beta 2 agonist cause
    • bronchodilation
    • uterine relaxation
    • glycogenolysis
  169. MDI or DPI
    • metered dose inhaler
    • dry powder inhaler
  170. Inhalers used to use _____________ they now are using _____________.
    • chlorofluorcarbons (CFC's)
    • hydrofluoralkines (HFA)
  171. Albuterol or Salmeterol
    • B2 agonist
    • 5-15 min. onset
    • rescue inhaler
  172. Salmeterol
    • long lasting agonist B2
    • used in combination w/ Fluticasone
  173. Terbutaline
    • prevention of premature parturition
    • B2 agonist
  174. Doxa' zosin (Cardura)
    • used in treatment of BPH
    • originally used for hypertension
    • AE: orthostatic hypotension, nasal congestion, inability to ejaculate
  175. Tamsu' losin (Flomax)
    used in tx of BPH
  176. Define BPH
    Benign Prostate Hypertrophy
  177. Define TURP
    Tran-urethral resection of the Prostate
  178. Carvedilol
    • non-specific adrenergic blocker
    • causes: decrease hr. Peripheral vasodilation
    • should not be used in respiratory problems
  179. Propranolol
    • B1/B2 blocker
    • decr. Hr, and intensity
    • may cause vasoconstriction
  180. Metoprolol
    • Specific B1 blocker
    • bid
    • Toprolol qd
    • commonly used antihypertensive drug, prevent tachycardia (bad for diabetics)
  181. Atenolol
    • B1 blocker
    • qd
    • long term use of Atenolol inc. risk of T-2 diabetes.
  182. Clonidine
    • Tx for blocks CNs receptors
    • is available in patch form(only antihypertensive in patch form) adjunct for tx of ADHD
    • decreases HR
    • AE: dry mouth
    • drowsiness
    • teratogen
  183. Tubocurarine
    neuromuscular blocker in curare, used on arrow in South America
  184. L-Dopa/carbidopa
    • used in treatment of Parkinsons Disease
    • slows down metabolism of Dopamine
  185. DOPA decarboxylase
    • metabolizes L-DOPA into dopamine,
    • dopamine can not be given orally ( first pass effect)
  186. Parkinsons Disease Meds
    • Pramipexole (Mirapex)
    • AE: somnolence, sudden sleep attacks
  187. Selegiline (Eldepryl, Deprenyl)
    inhibits type B monoamine oxidase
  188. Topiramate (Topomax)
    • inhibits NA+ channels, FDA approved fro migraines, off-label use for neuropathic pain
    • TX: partial complex seizures
  189. Carbama'zepine (Tegretol)
    • NA+ channel blocker
    • tx: Grand Mal and complex seizures, not Absence Seizures
    • efficacy in Bi-polar disease and neuralgia
    • (stimulates production of Cytochrome P-450)
    • decrease efficacy
    • AE: sedation, ataxia, agranulocytosis, Cat C., Steve Johnson syndrome
  190. Oxcarbazepine
    • tx for grand mal &comlex seizuresSimilar to Carbamazepine
    • does not have risk of agranulocytosis or aplatic anemia(bone marrow loss)
  191. Phenobarbital
    • works on GABA receptors
    • effective against all seizures except Absence seizures
    • Cat D teratogen (probable)
    • AE: sedation, lethargy, CNS depression(respiratory depression)
  192. Valproic Acid (Depakane)
    • Only seizure medicine to work on ALL types of seizures (including Absence seizures).
    • Has hi rate of nausea, vomiting. Divalproex enteric coated Depakane reduces vomiting
    • AE: nausea, vomiting, hepatoxicity, teratogenicity (Cat. D)
  193. Lamotrigine (Lamictal)
    • NA+ channel blocker
    • primarily used for partial seizures and tonic-clonic
    • mood stabilizer in Bi-polar disorder
    • AE: ataxia, headache, nausea, rarely Steven Johnson syndrome.
  194. Levetiracetam (Keppra)
    adjunct drug in tx of partial and tonic-clonic seizures
  195. Benzodiazepines for seizures

    Lorazepam(Ativan)
    Diazepam(Valium)
    both commonly used for tx of status epilepticus, given IV or rectal
  196. Benzodiazepines for seizures
    Clonazepam (klonopin)
    commonly used in tx of absence seizures
  197. Benzodiazepines for seizures

    Gabapentin (Neurotin)
    • antagonist to CNS, inhibits NA+ channels in the brain
    • adjunct therapy in partial and secondary generalized seizures
    • large TI
    • AE: sedation ataxia
  198. Benzodiazepines for seizures

    Pregabalin(Lyrica)
    • newer version of gabapentin
    • tx of partial seizures, neurological pain assoc. with diabetes and shingles
    • FDA approved for tx of Fibromyalgia
  199. Alternative TX for Seizures
    • Extreme ketogenic diets, high fat low carb diet
    • reduces seizures usually in children.
    • Vagus nerve stimulation- stimulation of vagus nerve for 30 sec. every 5 min. reduces freq. and severity of seizures.

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