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Pharmacology Exam 2
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Types of DI/ADR
augmented pharmacologic effect
Bizarre effects
chronic effects
delayed effects
end of treatment effects
failure of therapy
Chronic effect example
reversible
hairloss due to drug
Delayed effect example
damage to DNA caused by chemo which later causes cancer
birth defects
levels of severity of ADR
Death
Life-threatening
disability
congenital anomaly
Prevalence of ADR
2 million ADR/year
100,000 deaths / year
6th leading cause of death
350,000 per year in nursing homes
Costs associated with ADR
136 billion /year
cost of bringing drugs to market and then having them removed due to ADR
increasing hospital stay, cost and mortality for ADR pts.
Common Drug classes of ADR
Cardiac
Liver
Drugs eliminated from development due to ADR
38%
Stages at which drug interactions occur
pharmacodynamics
pharmaceuticals
pharmacokinetics
Pharmacodynamic
Antagonists/agonist competition
Additive/synergistic effects
Fluid/e- imbalance
Indirect interactions
Pharmaceutical
incompatibility between two drugs
precipitation (physical)
change in the nature of the drug (chemical)
Pharmacokinetic
Altered absorption
Altered distribution
Altered metabolism
Altered elimination
Altered absorption (non transporter based)
changes in GI pH
chelation
changes in GI flora
change in GI motility
malabsorption caused by other drug
Altered absorption (transporter based)
modulation of transporter activity (inh. or ind. by other drug)
polymorphisms of transporters (genetic)
nonlinear kinetics result
P-glycoprotein inhibition
increased plasma levels of digoxin
p-glycoprotein induction
decreases plasma digoxin
Altered metabolism
toxic drug metabolites
inhibition or induction of CYP 450
CYP polymorphism
Reason for toxic metabolite formations with drugs metabolized by CYP
80% of drugs are metabolized by CYP
induction of CYP
increased metabolism
changes efficacy
increases toxicity
inhibition of cyp
decreases metabolism
changes efficacy
increases toxicity
CYP304
50%of drugs metabolized
Inducers of CYP
ethanol
st. john's wart
Polymorphism with no CYP2D6
slow metabolism
high drug levels
high risk for ADR
no response from some prodrugs
Polymorphism with increased CYP2D6
too rapid metabolism
no drug response at normal dose
Altered Excretion
1-2% of DI
change in active excretion
change in biliary excretion
change in renal blood flow
change in urine pH
Which of the following are examples of DI/ADR due to non-transport mediated altered absorption?
A. change in GI pH
B. Chelation
C. Physical interaction
D. change in GI pH, Chelation and GI Flora
E. GI Flora
D. change in GI pH, Chelation and GI Flora
What is the most prevalent stage of DI?
A. Pharmacokinetics
B. Pharmaceutical
C. Pharmacodynamics
A. Pharmacokinetics (metabolism)
Author
Rx2013
ID
39012
Card Set
Pharmacology Exam 2
Description
Drug Interactions, Adverse Drug Reactions
Updated
2010-10-02T02:23:46Z
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