Pharmacology test 1

  1. Define pharmacology
    The study of the effects of a particular chemical (drug) on a biological system
  2. What is a drug?
    Any chemical, which acts on a biological system
  3. What are drugs used for?
    The diagnosis, prevention or treatment of disease or for the prevention of pregnancy
  4. What are the sources of drugs?
    • Plants, animals, minerals, soils
    • organic synthetic chemistry
    • genetically engineered microbes and cells
  5. What are the 4 characteristics of a drug?
    • selectivity of action (does a specific task)
    • reversibility of action (biotransforms from an active to an inactive form of the drug)
    • certain degree of potency (related to drug's affinity for a receptor)
    • ability to interact chemically (must be able to travel to receptor site)
  6. What does the FDA do?
    • regulates labeling and packaging of drug products
    • establishes standards for purity and strength
    • oversees quality control of manufacturing facilities
    • determines drugs to be marketed in the U.S. after considering safety, efficacy, physical & chemical data
    • determines what drugs are sold by prescription and which are OTC
    • regulates advertising and labeling of prescription drugs
  7. What is the DEA and what do they do?
    • Branch of the Dept. of Justice
    • determines degree of control for substances with abuse potential
    • enforces controlled substances act
  8. What does the Federal trade commission (FTC) do?
    • enforces consumer protection laws
    • regulates marketing practices and advertising on foods, nonprescription drugs, dietary supplements and products promising health benefits.
  9. What does the controlled substance act do?
    • regulates manufacturing, distribution and dispensing of controlled substances.
    • Established 5 schedules of controlled substances according to their abuse potential.
    • Established requirements for prescribing controlled substances
  10. What schedule of drugs cannot be prescribed?
    Schedule 1
  11. What schedule of drugs must have a written prescription and cannot be called in?
    • Schedule 2.  
    • In case of an emergency one can be called in.
  12. What schedule of drugs need either a written or called in prescription?
    Schedules 2-4
  13. What schedule of drugs can either be prescription or OTC?
    Schedule 5
  14. What schedule of drugs cannot be refilled?
    Schedule 2
  15. How many years is a drug patent good for?
    17 years
  16. When can companies make a generic equivalent to a drug?
    Only after the patent expires
  17. What is the chemical name of a drug?
    chemical make-up/molecular structure of the drug
  18. What is the generic name of a drug?
    • The 'official' name given the drug
    • this name is not capitalized
  19. What is the trade name of a drug?
    • This is the brand name/proprietary name
    • Name given by drug manufacturer
  20. Define biological equivalence
    drugs that produce similar concentrations in the blood and tissues
  21. Define chemical equivalence
    drugs that meet the same chemical and physical standards required by the FDA
  22. Define therapeutic equivalence
    • If clinical trials of 2 drugs show equal therapeutic effects, they are therapeutically equivalent.
    • Biologic and therapeutic equivalence are the same
  23. What must a generic drug contain to be bioequivalent to the original drug?
    identical amounts of the same active drug ingredient in the same dosage form and route of administration and meet the same standards for strength, purity, quality and identity.
  24. What is bioavailability?
    • physiological availability of a given amount of a drug.  
    • Regardless of the route of administration, usually only a fraction of unchanged drug reaches the systemic circulation
  25. What should happen when comparing 2 drugs for bioavailability?
    They should get to the target tissue and act equally
  26. What are the 3 types of drugs?
    • Prescription (legend)
    • OTC
    • Combination- multiple drugs in a single dose
  27. What is the only way to get a legend drug?
    with a prescription
  28. What is another name for mechanism of action?
  29. What is mechanism of action?
    • How a drug exerts its effects
    • This occurs at the molecular level and is the event that occurs when the drug attaches to the receptor site
  30. What is the therapeutic effect?
    clinically desirable action of a drug
  31. T/F- Can an adverse side effect be both beneficial and adverse?
  32. What is pharmacokinetics?
    • What the body does to the drug
    • sequence of events, which influences a drug's ability to reach the receptor in sufficient quantity and for sufficient duration of time to exert its desired effect
  33. What is the difference between pharmacokinetics and pharmacodynamics?
    • Pharmacokinetics- what the body does to a drug
    • Pharmacodynamics- what the drug does to the body
  34. What is a receptor?
    specialized area on a call or w/in a cell where a drug acts to initiate a series of biochemical and physiologic effects
  35. How many receptors can be on a single cell?
  36. How many drug molecules can occupy a receptor at one time?
  37. What is an ionic bond?
    • occurs between atoms w/ opposite charges
    • weak bonds and easily reversed
  38. What are hydrogen bonds?
    • bonds among hydrogen atoms and other molecules.
    • Weaker than ionic bonds
  39. What are covalent bonds?
    • sharing of electrons by 2 atoms
    • strongest type of bond
    • often irreversible
  40. What are van der Walls Forces?
    relatively weak electric forces that attract neutral molecules to one another
  41. What is an agonist?
    a drug that has an affinity for a receptor site and binds to it, producing an effect
  42. What is an antagonist?
    • drug that has an affinity for a receptor site and binds to it but produces no effect
    • competitively blocks the effect of an agonist
  43. Define affnity
    the force of attraction of a molecule to a receptor site
  44. Define intrinsic activity
    The ability of an agonist to interact w/ a receptor and initiate a response
  45. What is a partial agonist?
    • Binds and activates a given receptor, but has only partial efficacy at the receptor relative to a full agonist.
    • May inhibit the action of an agonist when given concurrently
  46. What is drug efficacy?
    • maximum intensity of response
    • administering more of a drug will not increae efficacy, but can increase probability of adverse reactions
  47. What is a dose-response curve?
    • relationship between the dose administered and the effect obtained
    • as the dose of a drug increases (x-axis), the percentage of maximum response rises (y-axis) until increasing the dose further produces no increase in the percentage of response
  48. Define ceiling dose
    the dose of a drug at which additional doses would produce no further beneficial effect
  49. Define threshold dose
    the lowest dose of a drug that will produce a measurable response
  50. What is the log dose-response curve used for?
    comparing drugs according to their potency and efficacy
  51. Define drug potency
    • the amount of a drug needed to produce a response
    • the more potent a drug, the less needed to produce a response
  52. what are the differences between potency and efficacy
    • Potency- related to affinity of a drug to its receptor
    • Efficacy- related to intrinsic activity of that drug on e a drug receptor complex is formed.
  53. What is the median effective dose?  How is it written?
    • Dose of the drug required to produce the desired clinical effect in 50% of test animals.  
    • Written as ED50
  54. What is the median lethal dose?  How is it written?
    • Dose of the drug required to produce death in 50% of test animals.
    • Written as LD50
  55. What is the therapeutic index?
    • ratio of the median lethal dose to the median effective dose.
    • Greater the TI, the safer the drug
  56. What is a safe TI?
    at least 10 is considered safe
  57. What is enteral administration?
    • Drug placed directly into GI Tract.
    • Oral or rectal
  58. What is parenteral administration?
    • Drug bypasses GI tract
    • injections, inhalation, and topical administration
  59. What are advantages of oral administration?
    • safest because absorption is slow
    • least expensive
    • good client acceptance
    • allergic reactions less likely to occur
  60. What are disadvantages of oral administration?
    • patient compliance is essential
    • nausea/vomiting side effects
    • slower onset (usually at least an hour)
    • blood levels less predictable
  61. What are advantages and disadvantages of rectal administration?
    • Advantages-
    • No GI upset
    • can be used on unconscious patient
    • Disadvantages-
    • poor and irregular absorption
    • poor patient acceptance
  62. What are advantages and disadvantages of IV administration?
    • Advantages-
    • shortest onset of action (bypasses absorption, causing immediate effect)
    • most predictable route
    • best route for emergency situation
    • Disadvantages-
    • most dangerous form of drug administration
    • potential for reactions at site of injection
  63. What are the advantages and disadvantages of Intramuscular (IM) administration?
    • Advantages-
    • absorption rapid and uniform
    • Disadvantages-
    • can be painful
  64. What are the advantages and disadvantages of subcutaneous (SQ) administration?

    • absorption is uniform
    • Disadvantages-
    • absorption is fairly slow
  65. What are advantages and disadvantages of inhalation?
    • Advantages-
    • rapid onset
    • Disadvantages-
    • difficult to monitor doses
    • Some gases irritating to respiratory tract
  66. What kind of injection is the anesthetic we use?
  67. Is nitrous oxide irritating to the respiratory tract?
  68. What is an intradermal injection, and what is an example?
    • injection that penetrates only the top layers of the skin
    • example: TB skin test
  69. What routes of administration do we use in dentistry and give examples
    • Subcutaneous: dental anesthetic injections
    • Topical: topic anesthetics used prior to injections. 
    • Topical: locally delivered antimicrobials Ex: arestin, atridox, periochip
    • Inhalation: nitrous oxide/oxygen conscious sedation
    • Enteral: antibiotics for pre-med or infection, pain medication, anti-anxiety medication
  70. What is the hepatic first-pass effect?
    • all drugs taken orally must pass through the liver via hepatic portal vein prior to reaching general circulation.
    • The liver metabolizes drugs, sometimes to such ane xtent that only a small amount of active drug emerges from the liver into the circulatory system
    • The first pass through the liver can greatly reduce the bioavailability of the drug
  71. What is the sequence of events after administering drugs?
    • Absorption
    • Distribution- including to the site of action, where interaction with the receptor evokes a response
    • Biotransformation- also called metabolism or detoxification
    • Elimination
  72. What is absorption?
    • process by which drug molecules are transferred from the site of administration to the circulating fluids.
    • requires the drug to pass through biologic membranes
  73. Why is the rate of drug absorption significant?
    it determines when and how much of a drug becomes pharmacologically available to exert its action
  74. What are the physiochemical properties that influence the movement of drug molecules across biologic membranes?
    • molecular size
    • lipid solubility
    • degree of ionization
  75. What compounds cross the cell membranes easily?
    nonpolar (nonionized), lipid-soluble
  76. What compounds have difficulty passing the cell membrane?
    Polar (ionized), water-soluble (hydrophilic)
  77. What is filtration?
    • passage of small, water-soluble substances through small pores in cell membranes
    • most drug molecules are too large to pass through biological membranes by this process
  78. What is passive diffusion?
    • movement of a drug from an area of high concentration (blood stream) to an area with lower concentration (cell)
    • diffusion will continue until concentration gradient has been eliminated
    • passive diffusion does not require energy as compared w/ active transport
  79. What kind of molecules can easily pass through the biologic membrane through passive diffusion?
    nonionized lipid-soluble
  80. What is facilitated diffusion?
    • A drug forms a complex w/ a component of the cell membrane
    • the drug complex is then carried through the membrane, the drug is released and the carrier returns to its original position
  81. What is active transport?
    • Movement of a drug from an area of low concentration to an area of higher concentration.
    • This activity requires energy
  82. How do large, ionized, water-soluble molecules cross biologic membranes?
    through facilitated diffusion and/or active transport
  83. What factors affect absorption?
    • degree of ionization
    • degree of lipid solubility
    • presence or absence of food (if administered enterally)
    • protein binding
    • patient compliance with taking medication
    • age
    • gender
    • genetic variations
    • placebo effects
    • other disease states
    • interaction w/ food, minerals, other drugs
  84. What kind of molecule gets more absorbed?
    • less ionized (charged), more absorbed
    • more lipid-soluble more readily absorbed
  85. Where does most drug absorption occur in the body?
    upper part of duodenum or small intestine
  86. What is the dissociation constant?
    pH at which a drug is 50% ionized and 50% nonionized.
  87. What are the ways of transportation of drugs in the body?
    • Some drugs travel by binding to protein (albumin) receptors
    • Some drugs bind to tissue, which can cause chemical effects
  88. What happens when the blood level decreases below the therapeutic level?
    the drug will not produce the desired effect
  89. what happens if the blood level increases significantly above therapeutic level?
    toxic symptoms may develop
  90. What is the blood brain barrier permeable to?
    small, highly lipophilic (fat-loving) molecules
  91. What is the blood brain barrier
    not a true barrier, but a selective gatekeeper
  92. What is the primary organ of metabolism?
  93. What is phase 1 biotransformation?
    • drugs chemical structure is modified through oxidation, reduction or hydrolysis
    • oxidative metabolism by the hepatic microsomal cytochrome P450 (CYP45) enzyme system is the primary method of drug metabolism
    • a lipid-soluble drug is changed to a more polar (ionized) and more hydrophilic (water-soluble) metabolite so it is more easily excreted
    • Drug interactions involving the cytochrome P450 system are common
  94. What is phase 2 biotransformation
    molecules on the drug or metabolite from Phase 1 are conjugated (linked) with highly water-soluble compounds such as glucuronic acid to make a more water-soluble product
  95. What factors effect biotransformation?
    • individual differences in metabolic rate (genetic polymorphism)
    • age
    • liver disease
    • pulmonary disease (inhaled drugs)
    • endocrine dysfunction
    • drug interactions
    • cigarette smokers (may need more of a particular drug)
    • food interactions
  96. Where are the majority of drugs excreted?
    • Kidneys
    • alcohol is partially excreted from the lungs
  97. Where are anesthetic gases excreted?
  98. What kind of drugs have been found in saliva?
    aspirin, phenytoin, ampicillin, diazepam, penicillin VK and phenobarbital
  99. Where does tetracycline concentrate?
    gingival crevicular fluid
  100. What is in the heading portion of the prescription?
    • prescriber's name, address and phone #
    • date of prescription
    • patient's name, address, age and weight
  101. What is in the body portion of the prescription?
    • Rx: drug name and strength
    • Disp: quantity to be dispensed
    • Sig: directions for use
  102. What is in the closing section of the prescription?
    prescriber's signature, DEA #, refill info
  103. 1kg equals how many grams?
    1000 grams
  104. 1 gram equals how many milligrams?
    1000 mg
  105. 1 liter equals how many milliliters?
  106. 1cc equals how many ml?
    1 ml
  107. What schedule drug is percocet?
    • Schedule 2
    • must have written prescription
    • can call in only in case of emergency
    • no refills
  108. What schedule drugs are vicodin and Tylenol-3?
    • Schedule 3
    • written or oral prescription allowed
    • may refill five times w/in 6 months
  109. What drugs may dental hygienists prescribe?
    fluoride, fluoride varnish, antimicrobial solutions for mouth rinsing or resorbable antimicrobial agents
  110. What is the cardinal principle of pharmacology?
    no drug ever exerts a single action
  111. What age group are most likely to have ADE's?
    • Very young
    • Very old
    • they organ functions are either not fully developed or progressively declining
  112. Type-A ADE's
    • associated with the administration of therapeutic dosages of a drug
    • usually predictable and avoidable
    • responsible for most ADEs
  113. What are Type-B ADEs
    • not dependent upon dosage
    • rarely predictable or avoidable
    • include hypersensitivity/allergic responses
    • may be idiosyncratic (genetically related abnormal drug response)
  114. What are clinical manifestations of Type-A reactions?
    • Cytotoxic reactions: causes by formation of unstable or reactive metabolites following biotransformation.  Related to abnormal metabolism and/or excretion
    • Drug-drug interactions: drugs administered simultaneously may interact w/ each other to cause an unintended response.  (response may be pharmacologic, physiologic, chemical or may cause a receptor alteration)
    • Drug-food interactions: some drugs are incompatible w/ foods when taken simultaneously.  Adverse reactions may interfere w/ absorption, metabolism or excretion
    • Drug-disease interactions: drug prescribed for the treatment of one disease or condition may have an adverse effect on a different medical condition
  115. What is one of the most common drugs associated w/ hepatotoxicity?
    • acetaminophen (APAP)
    • pepole often overdose on this drug because it is contained in so many OTC formulations
  116. What are clinical manifestations of Type-B reactions?
    • idiosyncratic
    • allergic/immunologic reactions
    • oncogenic effects- related to causing malignancy
    • teratogenic effects- drug-induced damage that occurs to the developing fetus
  117. What are 2 types of idiosyncratic reactions?
    • hyporeactive
    • hyperreactive
  118. What is hyporeactive?
    drug produces its usual effect at an unexpectedly high dose, the patient is said to be hyporeactive
  119. what is hyperreactive?
    if a drug produces its effect at an unexpectedly low dosage the patient is said to be hyperreactive
  120. What is tachyphylaxis?
    the rapid development of tolerance to a drug
Card Set
Pharmacology test 1
Test 1 cards for pharmacology