Introduction to Toxicology and ADRs 2
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Questions and Answers

Idiosyncratic reactions to drugs are typically:

  • Predictable from pharmacological profiles
  • Unpredictable and dose-independent (correct)
  • Linked to the drug’s primary mechanism of action
  • Dose-dependent and mediated by immune complexes

    • Which of the following describes mutagenicity?

  • The effect of a drug on DNA synthesis rates
  • The cumulative toxicity of a substance over time
  • The ability of a substance to cause cancer
  • The ability of a substance to cause genetic mutations (correct)

    • All carcinogens act through direct DNA damage.

    False (B)

    Which of the following is an example of a pharmacodynamic drug interaction?

    <p>Concurrent use of a beta-blocker and a calcium channel blocker, leading to bradycardia (D)</p> Signup and view all the answers

    A pharmacokinetic drug interaction occurs when one drug affects the [BLANK] of another drug.

    <p>absorption, distribution, metabolism, or excretion</p> Signup and view all the answers

    What is a potential consequence of inducing cytochrome P450 metabolizing enzymes?

    <p>Reduced drug levels and decreased therapeutic effect (B)</p> Signup and view all the answers

    What are the main categories of drug interactions?

    <p>Pharmacokinetic and pharmacodynamic interactions.</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Idiosyncratic reaction = An unusual, unpredictable response to a drug, often due to genetic factors. Mutagenesis = The ability of a substance to cause genetic mutations. Pharmacokinetic interaction = One drug affects the absorption, distribution, metabolism, or excretion of another. Pharmacodynamic interaction = Two drugs affect each other's actions at the receptor level. Carcinogen = A substance that can cause cancer.</p> Signup and view all the answers

    What is the primary mechanism of action of sildenafil?

    <p>Inhibiting phosphodiesterase type 5 enzyme (PDE5) (C)</p> Signup and view all the answers

    Coadministration of nitroglycerin with sildenafil can cause severe hypertension.

    <p>False (B)</p> Signup and view all the answers

    What does TDM stand for in the context of drug therapy?

    <p>Therapeutic drug monitoring</p> Signup and view all the answers

    The therapeutic range for a drug is an approximation of the average plasma drug concentrations that are ______ and efficacious in most patients.

    <p>safe</p> Signup and view all the answers

    Therapeutic drug monitoring is valuable when there is a relationship between:

    <p>Both A and B (B)</p> Signup and view all the answers

    Many drugs with a wide therapeutic range require therapeutic drug monitoring.

    <p>False (B)</p> Signup and view all the answers

    Besides plasma drug concentration, what other type of parameters can be monitored for certain drugs?

    <p>Pharmacodynamic or surrogate parameters</p> Signup and view all the answers

    Match the following monitoring parameters with the associated drugs or conditions:

    <p>Clotting time = Warfarin Glucose concentrations = Insulin FEV1 = Bronchodilators Severity of side effects = Cancer chemotherapy</p> Signup and view all the answers

    Which of the following best describes an allergy reaction to a drug?

    <p>An adverse reaction of the immune system to a drug after previous exposure. (C)</p> Signup and view all the answers

    All idiosyncratic drug reactions are predictable based on a drug's known pharmacology.

    <p>False (B)</p> Signup and view all the answers

    What is the term for a substance that causes or induces cancer?

    <p>carcinogen</p> Signup and view all the answers

    A tumor that is capable of spreading to other organs through metastasis is classified as ______.

    <p>malignant</p> Signup and view all the answers

    What is the first step in an allergy reaction?

    <p>Sensitization. (D)</p> Signup and view all the answers

    Which of the following best describes a pharmacokinetic drug interaction?

    <p>One drug altering the absorption, distribution, metabolism, or excretion of another. (C)</p> Signup and view all the answers

    Inhibition of P-glycoprotein would likely decrease the absorption of drugs that are Pgp substrates.

    <p>False (B)</p> Signup and view all the answers

    Match the following pharmacokinetic interactions with their descriptions:

    <p>GI pH alteration = A change in stomach pH affecting drug absorption Adsorption = A drug binding to another substance, preventing absorption Protein binding displacement = One drug displacing another from protein binding sites CYP450 induction = Increased metabolism of other drugs through an enzymatic upregulation</p> Signup and view all the answers

    What is meant by 'mutagenicity'?

    <p>The ability of a substance to cause changes in DNA</p> Signup and view all the answers

    Drugs that are substrates of CYP450 enzymes may have their metabolism increased by drugs that ______ these enzymes.

    <p>induce</p> Signup and view all the answers

    Which of the following is an example of a drug interaction affecting elimination?

    <p>An NSAID decreasing the renal clearance of lithium. (D)</p> Signup and view all the answers

    Which type of drug interaction occurs when two drugs act on the same receptor, resulting in a combined effect?

    <p>Pharmacodynamic interaction. (D)</p> Signup and view all the answers

    All pharmacodynamic drug interactions are harmful.

    <p>False (B)</p> Signup and view all the answers

    An interaction that leads to a decrease in drug effect is known as a ______ interaction.

    <p>antagonistic</p> Signup and view all the answers

    Match the different types of pharmacodynamic interactions with their definitions:

    <p>Additive effect = Two drugs have a combined effect that is the sum of their individual effects. Synergistic effect = The combined effect of two drugs is greater than the sum of their individual effects Potentiating effect = One drug enhances the effect of another when given together Antagonistic effect = One drug reduces or cancels out the effects of another drug</p> Signup and view all the answers

    Study Notes

    Introduction to Toxicology and Adverse Drug Reactions 2

    • Course: Principles of Drug Structure and Action
    • Instructor: Amal Aburahma, PhD
    • Semester: Spring 2025
    • Institution: Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy

    Objectives

    • Define allergic reactions and describe the cascade of allergic reactions.
    • Define idiosyncratic reactions and describe their characteristics.
    • Differentiate between mutagenicity and carcinogenicity and list general tumor types.
    • Describe pharmacokinetic drug-drug interactions and their role in adverse drug reactions and toxicity.
    • Describe pharmacodynamic drug-drug interactions and their role in adverse drug reactions and toxicity.
    • Describe therapeutic drug monitoring (TDM) and its significance.
    • Describe the principles of TDM.

    Allergy (Hypersensitivity) Reactions

    • Adverse immune response to a drug or similar chemical following prior exposure.
    • Sensitization: Initial exposure to the drug leads to the formation of an antigen-antibody complex.
    • Subsequent reaction: Exposure to the drug triggers antibody response, resulting in allergic response.
    • Allergic reactions can be dose-dependent and range from mild to severe, even fatal.

    Types of Allergic Reactions

    • Type I (Immediate): IgE-mediated, rapid response.
    • Type II (Antibody-Dependent): Antibodies directly attack target cells.
    • Type III (Immune Complex): Immune complexes deposit in tissues, causing inflammation.
    • Type IV (Cell-Mediated): Delayed-type hypersensitivity, T-cell response to antigens.

    Idiosyncratic Reactions

    • Rare adverse reactions not predictable from drug pharmacology or toxicology.
    • Not due to the drug itself but to a unique patient characteristic.
    • Not reproducible in laboratory settings (in vitro and in vivo).
    • Dose-independent, meaning the severity isn't directly related to the drug dose.
    • Factors include genetic predisposition, age, gender, and lack of drug-metabolizing enzymes.

    Mutagenicity vs. Carcinogenicity

    • Mutagenicity: Ability of a chemical or drug to alter DNA, causing genetic mutations.
    • Carcinogenicity: Ability of a chemical or drug to induce tumors.
    • Carcinogens can be chemical, physical, or biological (viruses).
    • Tumors are classified as malignant (invasive, spreadable) or benign (stays in primary tissue).

    Drug-Drug Interactions

    • Pharmacokinetic interactions: Alterations in drug absorption, distribution, metabolism, or elimination affecting drug levels.

      • Absorption: Changes in GI pH or adsorption can affect the absorption.
      • Distribution: Interactions at transporters (e.g., P-glycoprotein) can alter drug distribution, absorption, and elimination.
      • Metabolism: Some drugs can affect the metabolism of other drugs via CYP450 activity. Induction increases metabolism, while inhibition decreases it.
      • Elimination: Renal clearance can be altered leading to toxicity, such as in cases with lithium and NSAIDs.

    • Pharmacodynamic interactions: Interactions related to the pharmacological action of drugs at the receptor site or through physiological effects.

      • Agonistic interactions: Increased effect.
      • Antagonistic interactions: Decreased effect.

    Therapeutic Drug Monitoring (TDM)

    • Clinical laboratory measurement of drug levels to guide prescribing procedures.

    • Crucial when drugs have narrow therapeutic ranges or their effects are not directly linked to plasma concentrations.

    • Used to adjust dosage regimens based on patient factors and drug response, ensuring appropriate drug levels and minimizing adverse reactions.

    • Examples: Warfarin, insulin, bronchodilators in asthma, cancer chemotherapy.

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    Introduction to Toxicology and Adverse Drug Reactions 2 PDF

    Description

    This quiz covers key concepts from the 'Principles of Drug Structure and Action' course related to allergic reactions, idiosyncratic reactions, mutagenicity, carcinogenicity, and drug-drug interactions. Students will explore the importance of therapeutic drug monitoring in managing adverse drug reactions and toxicity. Test your understanding of these critical topics this Spring 2025.

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