Pharmacology Exam 1

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1.

a1
receptor

arterioles, veins, glands, eye, intestine,

myocardium
vasoconstriction, decreased glandular secretion,
constriction of radial muscle, decreased motility

12.

Alpha
receptors

present in the neurons in the vascular smooth

muscle - a1 in the myocardium, a2 in larger
blood vessels (skin mucosa, gut, kidney).
arteriolar vasoconstriction

2.

a2
receptor

CNS post and post synaptic terminals - b islet cells

in pancreas, larger vessels, skin, mucosa, kidney
decreased sympathetic outflow from brain,
decreased NE release, decreased islet cell
secretion

13.

Altered
absorption

3.

aa

of each

4.

ACh

stored in storage vesicles. Ca release causes

vesicles to fuse with the plasma membrane and
release ACh. diffuses through synaptic cleft and
may bind to nicotinic receptors on muscle cells or
muscarinic receptors on ganglionic synapses of
the ANS
rapidly hydrolyzed in the synaptic cleft

When a combination of two or more drugs

impedes or inhibits the absorption of one or
more of the drugs being taken/administered.
Drugs may inhibit absorption of other drugs
across physiological membranes
antibiotics - take on an empty stomach and not
with anacids

14.

Altered
excretion

5.

AC PC

before meals, after meals.

drugs may act on the kidneys to reduce or

enhance excretion of specific drugs
-adding mannitol to cisplatinum therapy
minimizes renal tubular damage - the diuretic
effect of mannitol prevents prolonged
cisplatinum time and contact with the renal
tubes

6.

active
transport

energy and transport carrier needed - ATP

activity is necessary to transport a drug against a
concentration gradient in these cases

-probenecid inhibits active tubular secretion of

penicilillin
15.

Altered
metabolism

interactions can occur when P450 enzymes are

inhibited or induced

Additive
effects

response elicited by combined drugs is EQUAL to

the combined response of the individual drugs linear - two drugs where each has CNS
depressants - antidepressants and alcohol

16.

anabolic

conserves energy, decreases heart rate,

stimulates GI function, rest and digest, PNS
predominates

8.

Adjusted
Body
Weight
equation

ideal body weight + 0.4(actual body weight - ideal

body weight)

17.

Antagonism

durg inhibits the effect of another drug.

Naloxone and morphine (narcan)
cardiovascular and respiratory depression will
be reversed

9.

Adverse
Drug
Events

injuries resulting from medication use including

physical harm, mental harm, or loss of function.
ADE's (compared to medication errors) are a more
direct measure of patient harm

18.

ATC

around the clock

19.

B1 receptor

Adverse
Drug
Reaction

Any response to a drug which is noxious and

unintended, and which occurs at doeses normally
used in man for prophylaxisis, diagnosis, or
therapy of a disease, or for the modification of
physiological function. Becomes an ADE if theres
injury

heart: myocardial tissue and conduction system

increased HR, increased contractility, increased
conduction velocity, increased automaticity

20.

B2
receptors

trachea, broncioles, bronchi, uterus, arterioles

(except brain and skin), veins, vascular smooth
muscle, liver
tracheal/bronchial relaxation, uterine
relaxation, circulatory dilation

Agonists

change cellular physiology by binding to

intracellular receptors or plasma membranes must be present at more than one binding site for
a significant change to occur.
weak agonist must bind to many more receptors
to produce the same effect as a strong agonist
mixed - fails to produce maximal effects even
when all of the receptors are occupied by the
partial agonist

21.

best pass
through
plasma
membranes

lipid soluble drugs that are composed of

smaller molecules which are not ionized

22.

Beta
Receptors

b1 in myocardial tissue which leads to

increased cardiac contractility and heart rate.
B3 located in vascular smooth muscle tissues in
the bronchi and liver. stiumulation leads to
coronary and peripheral vasodilation and
bronchodilation

23.

BID

two times a day

7.

10.

11.

24.

carrier
assisted
diffusion

noncovalent binding of drugs to carriers

which facilitate diffusion.

25.

catabolic

extends energy - increases HR, dilates

bronchi, decreases secretions, Fight or Flight,
increase tissue oxygenation and cardiac
output, SNS predominates

26.

categories of
pregnancy
risk factors

A: no risk to fetus
B: no risk in animal studies but no human
studies or animal studies are bad but
human studies are fine
C: adverse animal studies and no controlled
studies for women or studies in women and
animals are not available. weigh risks v
benefits
D: positive evidence of human fetal risk but
benefits are worth it (life threatening
situation)
X: risk in pregnant women totally outweighs
any benefit. kids and animals are deformed.
drug is totally contradicted

27.

CC

with meals

28.

Chelation

aluminum, magnesium, calcium, iron

containing medications can irreversibly bind
to antibiotics like doxycycline or oral
antibiotic thereby reducing the amount of
drug absorbed

29.

Clinically
significant
drug
interactions

more likely to occur between substrates and

either inhibitors or inducers of the same CYP
enzyme

30.

Clinical
Pharmacology

effects of drugs on physiologic systems and

or patients

Competition
for serum
protein
binding

drugs that bind to serum proteins may

compete with other drugs for the protein
binding sites. Displacement of drug A from
serum proteins by drug B may increase the
concentration of unbound drug A in the
serum

31.

if serum albumin levels are significantly

decreased the amount of free drug will be
increased
32.

competitve
antagonism

antagonist competes with agonists for

receptor sites. high doses of agonist can
overcome antagonism

33.

continuous
infusion

the serum concentration of the drug will

reach steady state after 4 to 5 half lives.
increasing the rate of infusion will increase
the serum concentration of the drug, but will
not shorten the time needed to achieve
steady state levels

34.

Creatinine
clearance
calculation

Males = (140-age) x body weight in kg/

72xreported SCr
Females = CrCl for males x 0.85
less than 30 is super bad! adjust for anything
less than 50

35.

CYP3A4
Inducers

carbamazepine
phenobarbital
phenytoin
rifampin
increase metabolic rate, serum drug levels
decrease

36.

CYP3A4
Inhibitors

ketoconazole
erthyromycin
grapefruit juice
ritonavir
decrease metabolic rate, drug level increases

37.

CYP3A4
Substrates

nifedipine
erythromycin
midazolam
testosterone

38.

CYP
enzymes are
involved in
the
metabolism
of what
percentage
of drugs

75% of all drugs

39.

CYP
Induction

occurs in response to the presence of a

chemical which is metabolized by P450 - more
enzyme is produced to handle the chemical
load. Once the enzyme is induced, it will
metabolize the inducing agent more rapidly.
inducers are drugs that induce the production
of one or more CYP enzymes.
Other drugs metabolized by the enzyme will
also metabolize more quickly.

40.

CYP
inhibition

CYP inhibitor drug competitvely binds to the

active site on the enzyme, preventing the
normal enzyme bindnig and routine
metabolism from occuring.
Inhibitors are drugs which inhibit one or more
CYP enzymes

41.

cytochrome
P450

liver microsomal drug oxidation/reduction

system is responsible for the metabolism of
many drugs. isoenzymes are located in the ER
of hepatocytes, gastric mucosa, and elsewhere.
ETC uses NADPH as a proton carrier, a drug
bound the cytocrome p450 can be
oxidized/reduced

42.

DC

discontinue

54.

43.

Diagnostic
drugs

used to aid in examination, evaluation, and

diagnosis of the patient or a patient condition
- contrast media, adenosine, fluorescein

Drug
distribution

process by which a drug leaves the blood

stream and enters the extracellular fluid and
then the cells of the tissues.

55.

drug efficacy

degree to which a drug is able to induce

maximal effects. used to compare drugs with
different mechanisms of action

56.

drug factors
that affect
absorption
through
tissues and
membranes

formulation, molecular weight, ionizatio,

solubility.
absence or presence of food in the stomach,
changes in concentration of stomach acidity,
peristaltic activity, degree of blood flow
in/around the GI tract
topical drugs: skin thickness, location,
available circulation.

57.

drug
formulation
depends on:

capability of the drug to pass through body's

barriers (oral must pass through GI walls
and blood vessel walls)
intended use of the drug (setting - hospital v
optometrist)
clinical situation (urgency)
first pass effect

58.

drug
idiosyncracy

unusual or unexpected response to a drug

(allergy, etc)

59.

drug
monograph

drug name, pharmacologic category, use,

pregnancy and lactation info, safety,
mechanism, dynamics/kinetics,
contraindications, warnings and
precautions, adverse reactions, drug
interactions, dosage, administration, storage,
forms

60.

drug potency

amount of drug required to produce 50% of

the maximal response that the drug is
capable of inducing. used to compare drugs
in the same class

61.

Drug stability

more than just the expiration date - how

stable in different dosage forms, stability in
different physiological environments
(different PH, steam from shower, etc)
drugs like insulin arent effective orally
because they are denatured by stomach's
PH

62.

Duration of
action

the period of time in which the concentration

of the drug is in the therapeutic range and
the desired clinical effects of the drug are
evident. half life, drug metabolism, and
excretion are related

63.

effective
concentration

concentration of a drug which induces a

specified clinical effect in 50% of the subjects
to whom the drug is administered.

44.

Dissociation
constant (Kd)

describes the degree of a drugs affinity for

the receptor site - concentration of drug in
solution necessary for 50% of given receptors
to be occupied

45.

Distribution
half life

decrease in the drug serum concentration of

the drug as it is distributed through the body

46.

Do not
abbreviate

U - units, micrograms, QD, QOD, SC, Trailing

zero or lack of leading zero. TIW - three times
of week, D/C - discharge. HS - half strength.
cc- cubic centimeters. MS MSO4 MgSO4.

47.

dopamine

postganglionic sympathetic transmitter in

renal blood vessels

48.

dopaminergic
receptors

mainly in the renal and mesenteric

vasculature, lead to different responses
based on degree of stimulation.

49.

Drug

substance intended for use in the diagnosis,

cure, mitigation, treatment, or prevention of a
disease.
other than food that is intended to affect the
structure or any function of the body

50.

Drug
absorption

transfer of drug from its site of administration

to the bloodstream.

51.

Drug
absorption
for topical
ophthalmic
medications

membranes are lipophilic so highly water

soluble drugs do not generally pass well.
ionization makes a drug less lipid soluble.

drug binding
to receptor
sites causes

1. activation of cellular function (DNA

transcription, steroid production, stimulation
of RBC production)
2. inhibition of cellular fxn (inhibition of
protein synthesis, inhibition of DNA
synthesis)
3. activation of biochemical processes (cAMP,
Ca, etc which transduce a signal stimulated
by a drug)
4. opening or closing of ionic channels
(stimulation/inhibition of Na or K channels)

52.

53.

drug
deposition

some drugs can deposit in specific tissues

and accumulate there which may result in
slower drug release or eventual changes in
the tissues.
amiodarone - optic neuritis and can deposit
in cornea (heart med)
doxycycline - localize in specific organs and
tissues including bone, liver, spleen and
teeth

64.

Elimination half
life

decrease in drug serum concentration

as the result of metabolic and excretion
processes - unique for elimination half
life to exceed distribution half life.

65.

Factors that affect

drug distribution

permeability of tissues/membranes propofol - rapid and extensively

distributed in body and quickly crosses
blood brain barrier. trop - rapidly
absorbed through the cornea to block
the sphincter
serum protein binding - when drugs
bind to albumin or other serum proteins
the amount of free unbound drug is
reduced. protein bound drugs can
reach higher concentrations between
the blood and tissues - decreased free
serum means theres less available drug
to concentrate a target organ

66.

first pass effect

liver gets first pass at metabolizing drugs

before it passes to other organs- does
not occur with injection, oral doses must
be a lot greater

67.

gtt

drop

68.

half life

the amount of time that it takes for 50%

of the serum level or plasma
concentration of a drug to be eliminated
or to attain 50% steady state
concentrations. steady state input=output.

69.

H.S.

at bedtime

70.

hydrophillic
channels

molecular weight below 200 are able to

diffuse along concentration gradient by
crossing through aqueous channels

71.

hypoalbuminemia

can affect drug serum concentration

and target tissue concentrations- may
not have full expected drug action

72.

73.

Ideal Body Weight

IH

males: 50kg + 2.3 kg per inch over 5 feet

females: 45.5 kg + 2.3 kg per inch over 5
feet
inhilation - medications intended for
absorption through pulmonary capillary
beds - systemic absorption may occur
which is not always desirable. rapid and
immediate effects. dose can be titrated,
localized for lungs. Most addictive route.
patients may have difficulty regulating
dose.

74.

IM

injection into intramuscular tissue and

subsequent absorption through capillaries
into the systemic circulation. formulation affets
the rate, onset, and duration. good for oily
vehicles or irritating substances. better self
administration than IV.can be painful or cause
intramuscular hemorrhage.

75.

include on a
prescription

patient name, date of birth, medication,

strength (mg), amount (1 tab), frequency, how
much, route, refills, date, sign.

76.

INJ

inject

77.

intermittent
dose

serum concentration peaks are the high points

in the concentration fluctuations, troughs are
the low points.

78.

Intradermal

between the non-vascular epidermis layer

and the subcutaneous layer - enters systemic
circulation through the capillaries

79.

irreversible
antagonism

compete with agonists for agonist binding

domain and bind permanently with the
receptor

80.

Isoenzymes
responsible
for P450
catalyzed
reactions

CYP3A4/5 - most common

CYP2D6
CYP2C8/9
CYP1A2

81.

IV

intravenous - continuous or intermittent. drug

solubility, formulation, and drug solution
compatability may limit the ability of some
drugs to be administered .
immediate effects, ideal if dosed in large
volumes.
unsuitable for oily or poorly absorbed
substances - bolus injection may lead to
adverse effects.

82.

Lbs to Kg

2.2lb/kg

83.

lethal dose

concentration of drug which induces death in

50% of subjects to which the drug is
administered

84.

Liver
function
tests

ALT (most specific)

AST
alkaline phosphatase levels

85.

Loading
dose

therapeutic drug levels can be reached more

rapidly generally by administering an initial
loading dose - the first dose of drug that is
calculated to be higher than the doses that will
follow. loading doses are given to reach
therapeutic serum drug concentrations more
quickly than administering routine
intermittent doses.

86.

maitenance
doses

routine doses that keep steady state drug

serum concentrations in therapeutic range

87.

88.

89.

90.

major modes of
drug excretion

margin of safety
Medication Error

Medication Errors

renal: occur within the glomeruli and

the renal tubes
Hepatobiliary excretion - liver > gall
bladder > bile>feces
Fecal - clearance through intestine >
feces
Drug deposition, serum derived fluids,
perspiration
margin between therapeutic dose and
the lethal dose
preventable event that may cause or
lead to inappropriate medication use or
patient harm while the medication is in
the control of the health care
professional, patient, or consumer. Such
events may be related to professional
practice, health care products,
procedures, and systems including
prescribing, order communicaion,
product labeling, packaging, and
nomenclature, compounding
(preparation), dispensing, distribution,
administration, education, monitoring
and use
mistakes occuring in the medication use
process, regardless of whether an injury
occured or whether the potential for
injury was present (before it becomes
an ADE)

91.

medication
history list

medication, dose, taken how often, for

what reason, prescribed by

92.

Microsomal
(membrane
bound)OXIDATION

phase 1
hydroxylation
dealkylation
oxidation
polarizing atom exchange

93.

Microsomal
Membrane bound
REDUCTION

azoreduction
nitroreduction

94.

Most common and

preventable
causes of
medication errors

ambiguous medical notations misinterpretation may lead to mistakes

that result in patient harm.

95.

Most rapid
onset/most
bioavailability

intravenous, intramuscular,
subcutaneous, oral, rectal, inhalation,
transdermal

96.

non competitve
antagonism

antagonist binds to sites other than the

agonistic binding domain. high doses of
agonists can not overcome the
antagonist

97.

Non microsomal
oxidation and
reduction

alcohol oxidation (NAD+)

alcohol reduction (NADH)

98.

Norepinephrine

primary transmitter at most sympathetic

postganglionic nerve endings.
synthesized from tyrosine. can bind with
a1, b1 or b2 adrenergic receptors.
reuptake into nerve terminal. released
into

99.

P450 inducer

phenobarbital, rifampin, and

carbazepine can increase the synthesis
of more CYP iso - decreases the plasma
concentration of the drug

100.

P450 inhibitor

omeprazole is a potent inhibitor of three

of the CYP isoenzymes responsible for
warfarin metabolism - more warfarin
around = more anticoagulation
erythromycin, ketoconazole, and
ritonavir
cimetidine blocks the metabolism of
theophylline
grapefruit juice inhibits CYP3A4 leading
to higher levels of nifedipine,
clarithromycin, and simvastatin

101.

Parasympathetic
- cranial sacral

cardiac and smooth muscle, gland cells,

nerve terminals.
ACh - ACh
long preganglionic short postganglionic
ganglia within or near target organs
minimal preganglionic fiber branching
limited distribution and descrete
response

102.

Parasympathetic
transmission

ACh transmits all parasympathetic

signals to end organs like heart and
lungs by binding to muscarinic receptors

103.

Parenteral

bypass the gastrointestinal tract for med

absorption

104.

passive diffusion

quick for small, nonionic, lipophilic drug

molecules. slow for larger ionic
hydrophilic molecules

105.

Pharmacodynamics

properties of drug effects,

including time to onset of action,
time to reach peak effects,
duration of action, and expected
times for drug clearance. can be
impacted by pharmacokinetic
changes
What the drug does to the body
ie. dilated pupil

106.

Pharmacogenetics

relationships between genetic

factors and drug response

107.

Pharmacogenomics

relation of an individual's genetic

makeup to his or her response to
specific drugs

108.

Pharmacokinetics
(ADME)

distinct processes and factors

whereby drugs are absorbed,
distributed, biotransformed,
metabolized, and excreted from
the body
What the body does to a drug.

109.

Pharmacology

the study and science of the

effects of drugs on organisms and
systems

110.

Pharmacotherapeutics

the use of drugs for therapeutic

purposes

111.

112.

113.

Phase 2 reactions

Phases of drug
metabolism

Physiologic Drug
Dependence

glucuronide conjugation
ethereal sulfate conjugation
acetylation
transulfuration
glutathione conjugation

116.

PO

oral administration - acid stable to withstand

stomach - outer coating only lasts so long so it
may not be ideal to take on a full stomach.
absorbed and passed through intestinal
lining.
safest and most common, convenient,
economical.

117.

Potentiation

a drug which has no prinicpal effect

enhances the effect of a second drug 0+1=2
amoxicillin with clavulanate = augmentin
clavulanate protects the amoxicillin molecule
from being degraded by some of the beta
lactamases produced by some bacteria - net
result is the bacteria that may have shown
resistance to amoxicillin alone may
demonstrate sensitivity.

118.

PR

rectal - drug absorption through the

capillary bed in the rectum. erratic
absorption may result since not drugs are
able to be reliably absorbed via this route may use as an alternative when other routes
arent available. partially bypasses first pass
effect and bypasses destruction of stomach
acid. ideal in patients who are vomiting or
comatose. may irritate the rectal mucosa.

119.

Prevention of
absorption

dicloxacillin and bisphosphonates - food

decreases absorption and binding

120.

PRN

as needed

121.

prodrug

an inactive or less active form of a drug that

can become more active and less easily
excreted than the parent drug after
metabolism.

Phase 1 - drugs are oxidized or

reduced to a more polar form
Phase 2 - a polar molecular group
is conjugated to the drug which
substantially increases its polarity
occurs when the body physically
develops reliance on a drug.
Abrupt drug discontinuance can
lead to adverse effects including
withdrawl, rebound, etc.
prednisone, clonidine

114.

pKa for weak bases

pKa = pH + log (BH)/B

when pH>pKa for weak base the
uncharged deprotonated form
predominates

115.

pKa weak acids

pH + log (HA)/A
pH<pKa for a weak acid, the
uncharged protonated form
predominates

enalapril
procainamide
napafenac
122.

Prophylactic
drugs

used to prevent an illness, infection,

complication, adverse effect, etc. vaccination,
proparacaine so dilation drops dont sting

123.

Psychological
dependence

occurs when an individual develops strong

psychological reliance on a drug. Individuals
will continue to seek the drug to continue
feeling the drugs effects or to minimize
consequential feelings of being off the drug opiate, narcotics, cocaine

124.

every

125.

qDay

once a day

126.

QID

four times a day

127.

QOD

every other day

128.

qs

up to

129.

referral plan

SBAP - situation, background, assessment,

plan

130.

renal excretion

blood urea nitrogen and serum creatinine

levels, maybe GFR. SCr (rate the kidneys
can clear creatinine) is much more
sensitive indicator of renal function than
the BUN.

131.

sig

directions to be written on lable

132.

ss

one half

133.

steady state

between 4 and 5 half lives

134.

subcutaenous

beneath the cutaneous layer of the skin.

enters systemic circulation through the
capillaries. aqueous solution has prompt
effects, depot perparations are slow and
sustained. suitable for slow released drugs
or poorly soluble suspensions. unsuitable
for large volumes.

135.

Sublingual

placed under tongue for absorption

through sublingual capillaries. don't use
abbreviation. most erratically or
incompletely absorbed. bypasses first pass
effect and destruction by stomach acid

136.

Substrates

drugs which are metabolized by one or

more CYP enzymes

137.

Sympathetic thoracolumbar

sweat glands (ACh - ACh), cardiac and

smooth muscle, nerve terminals (ACh - NE),
renal vascular smooth muscle (ACh, D),
skeletal muscle (no post synaptic area, ACh
straight to muscle)
short preganglionic, long post ganglionic,
ganglia close to spinal cord, extensive
preganglionic fiber brancing, wide
distribution, diffuse response

138.

Syngerism

the response elicited by combined drugs is

GREATER than the combined responses of
individual drugs
(1+1=3)
vancomycin causes cell wall damage and
gentamicin has more penetration to treat
bacterial endocarditis
combination is more effective

139.

therapeutic
effect

desired pharmacological effects of a drug

140.

therapeutic
index

measure of the safety of a drug calculated

by dividing the lethal dose by the effective
concentration

141.

TID

three times a day

142.

tolerance

decreased effectiveness of a drug over

time with repeated use

143.

Topical

local administration of meds:

ophthalmic
dermatologic
nasal - through mucous membranes into the
nasal capillary beds
vaginal (PV) - local effects
otic - usually for local effect

144.

Transdermal

patch - slow and sustained absorption.

bypasses the first pass effect, ideal for drugs
that are quickly eliminated from the body.
ideal for lipophilic drugs. some patients may
be allergic, may have delayed delivery.

145.

Treatment
drugs

used in the therapeutic management of

disease or medical conditions
moxifloxacin for bacterial conjunctivitis.

146.

Type A
Reactions

85-90% of all ADRs. These can affect any

individual, given sufficient dose and
exposure, and are predictable from the
known pharmacologic properties of a drug.
Diarrhea in response to antibiotics

147.

Type B
Reactions

10-15% of ADRs. hypersensitivity reactions,

mediated by immunologic or other types of
mechanisms which occur in a susceptible
subgroup of patients - signs and symptoms
that are different than the action of the drug
and usually not predicted. Anaphylaxis, skin
rashes, or immune mediated
thrombocytopenia

148.

UD

as directed

149.

Ung

ointment

150.

WA

while awake

151.

When to use
adjusted
body weight

weight is more than 20% over ideal body

weight (10-20kg difference is significant)