Exam 2

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tichelle2
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71560
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Exam 2
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2011-03-08 19:32:52
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233 exam 2
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  1. What is Pharmacokinetic?
    • drug movement in the body
    • absorption, distribution, metabolism, excretion
  2. What is pharmacodynamic?
    drug action the body
  3. Where does most of oral absorption occur?
    small intestine
  4. what are enteral route of medications?
    • oral (po)
    • rectal
  5. What are parenteral routes of medication?
    • intravenous IV - quick
    • intramuscular IM - slower to work
    • subcutaneous SQ - rapid absorption but limited to a smaller amount
    • intradermal ID - takes 72 hours to see if there is a reaction
  6. Peak & Onset for Morphine sulfate:
    oral
    sq
    IV
    IM
    ID
    • oral: onset variable, peak 60-120 min
    • sq: onset 10-20 min, peak 30-60 min
    • IM: onset 10-30 min, peak 30-60 min
    • IV: onset immediate, peak 20 min
    • ID: onset up to 18 hrs, peak 72 hrs
  7. Where does most drug metabolism occur?
    liver
  8. Where does the first pass effect occur?
    liver`
  9. What's usually larger? oral or parenteral dose? why
    ORAL because parentral medications don't go through the first pass effect so a lower dose is neccessary to not be toxic
  10. Lipophillic vs. hydrophillic
    • Lipophillic - fat loving - older adults
    • Hydrophillic - water loving - babies
  11. Where does most excretion occur?
    urine
  12. Who has more creatinine and why?
    Men, comes from muscle.
  13. what is the difference between serum creatinine level and creatinine clearance?
    Creatinine levels should be high in urine and low in serum
  14. Why is creatinine clearance important and how do we measure/estimate it?
    It tells us how well your kidneys are working
  15. How does creatinine clearance vary with age?
    Older people don't have as much creatinine.
  16. What are some special considerations with neonates/infants?
    • decreased/erratic drug absorption
    • decreased protein binding
    • decreased protein binding
    • decreased integrity of BBB
    • decreased hepatic metabolism
    • decreased renal excretion
    • increased topical drug absorption
  17. What is a special consideration for children >1 year old?
    Most pharmokinetics similar to adult except increased hepatic metabolism until puberty. Weight plays a major factor (mL/kg/day)
  18. What are some special considerations for older adults?
    • few absorption differences
    • decreased/no change in hepatic metabolism
    • increased body fat relative to lean tissue
    • longer half-lives for lipophillic drugs
    • decreased total body water
    • high serum concentration of hydrophillic drugs
    • ***decreased renal excretion
  19. What are the FDA Pregnancy Categories
    • A- no risk to fetus in good studies
    • B- Risk in animals but not human or no risk in animals but insufficient data in humans
    • C- adverse effects in animals but insufficient data in humans. Weigh benefits/risks risk demonstrated. Weight benefits/risks.
    • X- Risk > benefits. Do not use in pregnancy
    • D- Human fetal
  20. What is an agonist receptor?
    • + affinity
    • stimulation
  21. What is an antagonist receptor?
    • + affinity
    • blockade
  22. What is the therapeutic level?
    optimum level of the drug before toxicity.
  23. What are peak/trough levels?
    • Pre- trough
    • Post - peak

    determines the therapeutic levels
  24. What is a fast acting insulin? onset, peak & duration
    • Novolog
    • onset: 15-30 min
    • peak: 30-90 min
    • duration: 3-4 hours
  25. What is a fast acting insuling?
    -has a long peak than Novolog.
    • Regular - HumulinR and NovolinR
    • can be given SQ or IV
    • onset: 30 min
    • peak: 2-3 hours
    • duration: 3-6 hours
  26. What is an intermediate acting insulin?
    -has a slower onset, but longer peak
    • HumulinN - NovolinN
    • onset: 1-4 hours
    • peak: 4-12 hours
    • duration: up to 24 hrs, usually given 2xdaily
  27. What is a long acting insulin?
    • Lantus - basal insulin (given mostly to type I)
    • onset: 1-2 hrs
    • NO PEAK
    • duration: 20-24 hrs, given once a day.
  28. Why don't we check blood levels on most drugs?
    because we don't have a very narrow therapeutic level window.
  29. Why do we check blood levels on some drugs?
    Becuase it does have a very narrow therapeutic level window and we don't want to cause toxicity. We adjust the amount accordingly.
  30. What are the following allergic reactions?
    • Type I: anaphylactic (usually doesnt happpen on the first dose)
    • Type II: cytotoxic/autoimmune
    • Type III: immune complex reaction
    • Type IV: cell mediated, delayed hypersensitivity
  31. What is Iatrogenesis?
    problem caused by medications/hospitals
  32. What is idiosyncratic?
    having reaction uncommon (genetic disposition)
  33. What is Paradoxical?
    Having the opposite effect as intended. Example: Benadryl. Making you energized rather than sleepy(intended)
  34. Morphine Sulfate binds to Mu & Kappa receptors (affinity & efficacy)
    • Mu: analygesia, decreased peristalsis, euphoria, physical dependence, respiratory depression, CNS depression
    • Kappa: analgesia, decreased peristalsis, miosis(pupil constriction), CNS depression
  35. Can you guess some possible side effects of morphine?
    constipation, euphoria, drowsy
  36. what is a opoid antagonist??
    • Naloxone (Narcan)
    • binds to mu and kappa receptors (affinity but no efficacy)
    • reverses repiratory depression and analgesia
  37. Sympatetic vs Parasympathetic?
    • Sympathetic: pupils dilated, decreased salivation, increased heartrate, peripheral vasoconstriction, bronchioles dilated, slowed peristalsis, bladder detrusor relaxes, bladder sphincter contricts, glycogenolysis, gluconeogenesis
    • Parasympathetic: Pupils constricted, increased salvation, decreased heart rate, peripheral vasodilation, bronchioles constricted, increased peristalsis, bladder detrusor contracts, bladder sphincter relaxes, glycogen synthesis
  38. Sympathetic NS: Neurotransmitter & drug classes
    • Norepinephrine
    • Drug classes: sympathomimetics, adrenergic agonists, anticholintergics
  39. Parasympathetic NS: Neurotransmitter & drug classes
    • Acetylcholine
    • Drug classes: parasympathomimetics, cholinergics, adrenergic antagonists or blockers
  40. Adrenergic Subreceptors: Agonist Effects
    ALPHA 1:
    • peripheral vasoconstriction
    • pupil dilation
    • bladder sphincter contraction (adrenergic effects)
  41. Adrenergic Subreceptors: Agonist Effects
    ALPHA 2 in CNS:
    lower BP (anti adrenergic effects)
  42. Adrenergic subreceptors: Agonist Effects
    BETA 1
    increased heart rate and force of contraction
  43. Adrenergic Subreceptors: Agonist Effects
    BETA 2
    bronchiole dilation, uterine relaxation, glucogenolysis, gluconeogenesis
  44. Parasympathomimetics; acetylecholineresterase inhibitor main use is?
    Alzheimer's and/or vacular dementia
  45. Anticholinergic Side Effects (Sympathetic)
    • constipation
    • urinary retension
    • dry, dilated eyes
    • dry mouth (xerostomia)
    • inhibition of sweating (hyperthermia)
    • mental confusion, agitation (blocks acetylcholine in the CNS)
  46. Cholinergic Side Effects (parasympathetic)
    • S:alvation
    • L:acrimation
    • U:rination
    • D:efacation
    • G:I
    • E:mesis
  47. What kinds of cells do antibiotics kill?
    kill off normal flora, thrush, growing cells
  48. Where do we have bacteria in the body?
    mouth, vagina, skin
  49. What are some of the possible side effects of therapy with broad spectrum antibiotic?
    CDIF, normal flora take over
  50. Injuries can be prevented by...
    • 1. intrinsic (internal to the person)
    • 2. extrinsic (posted speed limit, other drivers)
  51. What are risk factors related to infants?
    • aspiration
    • falls
    • sids
    • motor vehicle accidents
  52. What are risk factors for toddlerS?
    • falls
    • burns
    • poisoning
    • aspiration
    • electrical outlets
    • traffic
    • drowning
  53. What are risk factors for preschoolers and school age kids?

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