Midterm EXAM TEST BANK

NUR 635 Advanced Pharmacology Midterm EXAM TEST BANK Pharmacology - CORRECT ANSWER the study of drugs and their structure, targets of action, mechanisms of action (MOA), distribution (how the body disburses them throughout the body), desired physiologic effects (efficacy) and undesirable side effects (toxicity).

Pharmacokinetics includes the following: - CORRECT ANSWER

ADME (absorption, distribution, metabolism and elimination).Pharmacokinetics is... - CORRECT ANSWER How the body effects the drug Absorption - CORRECT ANSWER absorption from the administration site either directly or indirectly into the blood/plasma. 1 / 4

Distribution - CORRECT ANSWER reversibly/irreversibly movement of drug from the bloodstream into the interstitial and intracellular fluid.Metabolism - CORRECT ANSWER drug biotransformation via metabolic pathways, primarily the liver, or by other tissues.Elimination - CORRECT ANSWER how parent drug & its metabolites are eliminated from the body Absorption factors - CORRECT ANSWER · Gastrointestinal pH changes · Gastric emptying · Gastric/intestinal enzymes · Bile acids & biliary function · Gastrointestinal flora (type and quantity of bacteria) · Food & nutrient interactions (most common interaction influencing GI drug absorption) · Lipid solubility of the drug 2 / 4

Distribution factors - CORRECT ANSWER · Membrane permeability: Cross membranes to site of action · Blood brain barrier reduces the speed of drug passage into and out of brain tissue

· Plasma protein binding: drugs bound to plasma proteins do not cross

membranes (Note: Malnutrition = âalbumin = á free drug = greater pharmacologic response) · Aging cause a reduction in production of plasma proteins · Lipophilicity of drug: lipophilic drugs concentrate in adipose tissue; remain in the body for a longer period of time Volume of distribution - CORRECT ANSWER · Body Composition

• Increased Total body water and extracellular fluid

-Decreased Adipose tissue and skeletal muscle · Protein Binding (changes with aging) -Albumin, bilirubin, a1-acid glycoprotein -Albumin affected by nutrition -Low albumin (hypoalbuminemia) can cause less protein-bound drug reaching the tissue site of action.· Tissue Binding

• Compositional changes

Metabolism factors - CORRECT ANSWER o Drugs can undergo metabolism in the lungs, blood, liver, intestines and kidney

• Volatile drugs are primarily excreted by the lungs

· The body changes drugs to more or less active forms (metabolites), increases water solubility to increase elimination. 3 / 4

Phase 1 Metabolism - CORRECT ANSWER · Cytochrome P450 system · Located within the endoplasmic reticulum of hepatocytes.· Through electron transport chain, a drug bound to the CYP450 system undergoes oxidation or reduction.

· Drug metabolism in the liver is also affected by:

-Enzyme induction

• Drug interactions

CYP450 - CORRECT ANSWER · CYP: a set of isozymes primarily found in the liver and GI tract · Convert lipophilic drugs into more polar (and soluble) molecules · Considerable genetic variability exists across race and gender · Results in CYP450 polymorphisms which have a direct effect on drug metabolism.Four isozymes are responsible for the majority of Phase I Metabolism reactions -

CORRECT ANSWER 1. CYP3A4/5

2. CYP2D6

3. CYP2C8/9

• CYP1A2
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