Pharmacokinetics & Dynamics Review

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Questions and Answers

What is the most important mechanism for drug absorption across the placenta?

  • Facilitated diffusion
  • Endocytosis
  • Active transport
  • Passive diffusion (correct)

Which factor decreases free drug concentration in fetal circulation?

  • Increased body fat
  • Increased protein binding (correct)
  • Lower body water content
  • Higher cardiac output

The metabolism of some drugs in the fetus operates at what capacity compared to adult levels?

  • Completely inactive
  • Always higher than adults
  • Functionally at adult levels (correct)
  • Always lower than adults

What occurs during the elimination phase of pharmacokinetics in fetuses?

<p>Renal excretion into amniotic fluid (B)</p> Signup and view all the answers

Which of the following statements regarding first-pass metabolism is correct?

<p>Intravenous drugs do not undergo first-pass metabolism (C)</p> Signup and view all the answers

Which of the following could increase drug delivery to the fetal brain?

<p>Increased maternal cardiac output (C)</p> Signup and view all the answers

Ion trapping in amniotic fluid refers to which of the following?

<p>Concentration of water-soluble drugs in amniotic fluid (B)</p> Signup and view all the answers

Which of the following best describes the physiological change affecting drug metabolism in fetuses experiencing hypoxia?

<p>Decreased clearance results in greater drug accumulation (D)</p> Signup and view all the answers

Which channels open as a delayed response causing the membrane potential to become more negative?

<p>Voltage-gated potassium channels (D)</p> Signup and view all the answers

What process returns the neuron back to its resting membrane potential?

<p>Active transport of ions by the sodium-potassium pump (B)</p> Signup and view all the answers

What is the term for the delay between peak plasma concentration and peak central nervous system concentration?

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

Which anesthetic achieves rapid equilibration between plasma and effect site?

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

What describes the term 'ke0' in effect-site elimination?

<p>Rate constant of drug elimination from the effect site (B)</p> Signup and view all the answers

What generally affects the time to peak effect site concentration?

<p>Size of intravenous bolus dose (D)</p> Signup and view all the answers

Which statement is true regarding the mechanisms of drug clearance?

<p>Hepatic metabolism and renal excretion are crucial for drug clearance. (B)</p> Signup and view all the answers

How is the time to reach 50% of plasma concentration defined mathematically?

<p>T 1/2 ke0 (A)</p> Signup and view all the answers

Which anesthetics are characterized by slow equilibration between plasma and effect site?

<p>Morphine and ketorolac (A)</p> Signup and view all the answers

What is the relationship between a drug's half-life and dosing interval?

<p>Dosing interval is indirectly related to half-life. (A)</p> Signup and view all the answers

Which of the following best describes Phase II reactions in drug metabolism?

<p>They involve conjugation to increase water solubility. (C)</p> Signup and view all the answers

Which factor does NOT directly affect the extraction capacity of a drug?

<p>The volume of distribution of the drug. (B)</p> Signup and view all the answers

Which of these processes is associated with the termination of drug action?

<p>Distribution of the drug out of circulation. (C)</p> Signup and view all the answers

When considering the neuronal action potential, what is the first action that occurs?

<p>Voltage-gated sodium channels open. (A)</p> Signup and view all the answers

What factor primarily affects the spontaneous chemical reactions involved in drug metabolism?

<p>Temperature and environmental conditions. (B)</p> Signup and view all the answers

Which of the following is NOT a typical outcome of drug metabolism?

<p>Enhanced pharmacologic action of the parent drug. (A)</p> Signup and view all the answers

Which of the following statements about ionized drugs is true?

<p>Nonionized drugs are more lipophilic. (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of unionized drugs?

<p>Hydrophilic (C)</p> Signup and view all the answers

At pH 2.5, is aspirin primarily in a lipid-soluble form?

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

At pH 7.4, how does the ionization of the basic drug promethazine (pKa 9.1) compare to its ionization at pH 2?

<p>More ionized at pH 7.4 (B)</p> Signup and view all the answers

Is absorption of a weakly basic drug likely to occur faster from the stomach than from the intestine?

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

Does acidification of the urine accelerate the secretion of a weak base with a pKa of 8?

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

What term describes the process when a ligand binds to a receptor and enhances cellular response?

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

Which statement regarding the distribution of drugs to specific tissues is false?

<p>Drugs that are strongly bound to plasma proteins have increased distribution. (D)</p> Signup and view all the answers

What is characterized as the amount of a drug divided by the desired plasma concentration?

<p>Volume of distribution (D)</p> Signup and view all the answers

What is the role of an intracellular chemical messenger following receptor activation?

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

What is the immediate consequence of activating a G-protein coupled receptor?

<p>Conformational change (D)</p> Signup and view all the answers

Which neurotransmitter-receptor complex is considered inhibitory?

<p>GABA receptor (A)</p> Signup and view all the answers

What term refers to the maximum response a drug can produce, regardless of the dose given?

<p>Max efficacy (A)</p> Signup and view all the answers

What can be inferred if drug X is significantly more effective than drug Y at lower dosages?

<p>Drug X is about 100 times more potent than drug Y. (A), Drug Y is less efficacious than drug X. (C)</p> Signup and view all the answers

What describes a drug that acts as a full receptor activator?

<p>Full agonist (C)</p> Signup and view all the answers

What is the therapeutic index primarily a measure of?

<p>Safety margin of the drug (A)</p> Signup and view all the answers

Flashcards

Drug Elimination

The process by which a drug is eliminated from the body.

Drug Metabolism

The process by which a drug is chemically altered in the body.

Drug Distribution

The movement of a drug from the bloodstream to other tissues.

Drug Half-Life

The time it takes for the concentration of a drug in the body to decrease by half.

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Drug Clearance

The rate at which a drug is removed from the body.

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Steady-State Concentration

The concentration of a drug in the body that is maintained over time.

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Extraction Ratio

The ability of a drug to be extracted from the blood by the liver or kidneys.

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Peak Effect

The point at which the drug reaches its maximum effect.

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What is pharmacokinetics?

The study of how a drug moves through the body, including absorption, distribution, metabolism, and elimination.

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Absorption

The process of a drug entering the bloodstream from the site of administration.

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Distribution

The movement of a drug from the bloodstream to the tissues and organs.

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Metabolism

The breakdown of a drug by the body into inactive metabolites.

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Elimination

The removal of a drug and its metabolites from the body.

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What is the typical sequence of drug transfer and absorption for a PO drug?

This refers to the sequence of events that a drug taken by mouth (PO) undergoes to reach the bloodstream and be absorbed: Gut > liver > vein > heart > lung > artery > brain.

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Do intravenous drugs undergo first-pass hepatic metabolism?

FALSE. Intravenous drugs bypass the first-pass hepatic metabolism because they are directly injected into the bloodstream.

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How do inhaled drugs (INH) reach the bloodstream?

Drugs administered via inhalation (INH) reach the bloodstream rapidly, resembling an intravenous (IV) drug.

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pKa

The pH at which 50% of a drug is in its ionized form and 50% is in its unionized form.

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Lipophilic

Drugs that are more easily absorbed into the bloodstream because they can cross cell membranes more readily. They tend to be neutral or uncharged.

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Hydrophilic

These drugs are more likely to stay in aqueous environments like blood plasma or the interstitial fluid, and have a harder time crossing cell membranes.

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Non-ionized drugs

Drugs that are in their non-ionized form are better able to cross cell membranes because they are more lipid-soluble.

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Ionized drugs

Drugs that are in their ionized form have a more difficult time crossing cell membranes because they are less lipid-soluble.

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First-order kinetics

This phenomenon describes how the rate of elimination of a drug is proportional to the drug concentration in the body. If the concentration is high, the rate of elimination is high. If the concentration is low, the rate of elimination is low.

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Loading dose

The amount of drug in the body divided by the desired plasma concentration to describe how much drug is needed to reach a therapeutic level.

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Signal Amplification

Ligand binding to a receptor causes an increased cellular response, amplifying the signal.

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Signal Integration

Multiple signals converge and interact within a cell, integrating information for a unified response.

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Signal Relay

A signal is passed from one molecule to another, relaying the message across the cell.

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Antagonist

A drug that blocks the activity of a receptor, preventing the natural ligand from binding and causing a response.

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Max Efficacy

The ability of a drug to produce a maximum effect, regardless of the dose.

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Drug Potency

The dose of a drug required to produce 50% of its maximum effect.

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Therapeutic Index

The ratio of the toxic dose (LD50) to the effective dose (ED50) of a drug.

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Partial Agonist

A drug that only partially activates a receptor, producing a weaker response than a full agonist.

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Repolarization

Potassium channels open, allowing potassium ions to flow out of the neuron, causing a return to a negative membrane potential.

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Sodium-potassium pump

The sodium-potassium pump actively transports sodium ions out of the neuron and potassium ions back into the neuron, restoring the resting membrane potential.

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Effect Site

The site where a drug exerts its pharmacological effect.

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T 1/2 ke0

The time it takes for a drug's concentration in the effect site to reach 50% of its concentration in the plasma.

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Hysteresis

The delay between the peak plasma concentration of a drug and the peak concentration of the drug in the effect site.

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Effect-Site Elimination

The process of drug elimination from the effect site.

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Effect-Site Equilibration

The rapid movement and distribution of a drug from the plasma to the effect site.

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ke0

The rate constant of drug elimination from the effect site.

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Study Notes

Pharmacokinetics & Dynamics Review

  • Pharmacokinetics is the study of how the body processes drugs.
  • This includes absorption, distribution, metabolism, and elimination.

Spotlight on Fetal Pharmacokinetics

  • Absorption:
    • The placenta is the primary absorption route.
    • Passive diffusion is the primary mechanism.
    • Anesthetics, opioids, benzodiazepines quickly cross the placenta.
    • Neuromuscular blockers cross slowly.
  • Distribution:
    • Increased delivery to the fetal brain, related to cardiac output.
    • Decreased protein binding increases free drug concentration.
    • Lower body fat and higher body water can affect distribution.
    • Ion trapping in amniotic fluid serves as a reservoir for water-soluble drugs.
  • Metabolism:
    • Fetal enzyme function may be at adult levels, or less active with delayed metabolism (e.g., opiates, NSAIDs, local anesthetics).
    • Drug clearance is decreased in hypoxia.
  • Elimination:
    • Fetal renal excretion into amniotic fluid.
    • Drug transfer to the mother via umbilical vessels and placenta.
    • Drug recirculation via amniotic fluid re-ingestion is possible.

Questions & Answers

  • Question #1: Drugs taken orally most likely follow the sequence Gut > liver > vein > heart > lung > heart > artery. (C)

  • Question #2: Intravenous drugs do not undergo first pass hepatic metabolism. (B)

  • Question #3: Match drug routes (PO, IV, inhalation) to their corresponding absorption/distribution curves. Relevant information on slide.

  • Question #4: Nonionized drugs are more lipophilic. (C)

  • Question #5: Hydrophilic is NOT a characteristic of unionized drugs. (B)

  • Question #6: BH+ readily crosses the placenta. (A)

  • Question #7: Aspirin (acetylsalicylic acid, pKa 3.5) is primarily in a lipid-soluble form at pH 2.5. (A)

  • Question #8: Promethazine (pKa 9.1) is more ionized at pH 7.4 than at pH 2. (A)

  • Question #9: Absorption of a weakly basic drug is faster from the stomach than the intestine. (A)

  • Question #10: Acidification of the urine accelerates the secretion of a weak base (pKa 8). (A)

  • Question #11: Uncharged molecules readily cross cell membranes. (A)

  • Question #12: Distribution of drugs to tissues depends on the unbound drug concentration gradient between plasma and tissues. (C)

  • Question #13: Drugs must be excreted to terminate drug action. (A)

  • Question #14: Ligand binding to a receptor to increase cellular response is known as amplification. (A)

  • Question #15: Receptor activation causes another intracellular chemical messenger to cause a cellular or tissue response. This is known as Relay. (C)

  • Question #16: Conformational change happens when receptor is activated immediately. (D)

  • Question #17: Drug X is 100 times more potent than Drug Y. (B)

  • Question #18: Partial competitive agonist. (C)

  • Question #19: Max efficacy. (B)

Additional Concepts

  • Volume of distribution: The theoretical volume of fluid required to contain the drug if it were uniformly distributed at the same concentration as in plasma.
  • Water vs. Lipid solubility: Lipid-soluble drugs distribute more extensively than water-soluble drugs.
  • Matching: Review the provided matching key for specific definitions.

Other Topics Mentioned

  • Pharmacodynamics: Study of how drugs affect the body (i.e., dose, activity, mechanisms).
  • Neuron Action Potential: (depolarization by Na, repolarization by K) & Na-K pumps
  • Hotspot Matching of Nervous System Components: Review diagram.
  • Biophase & Anesthetics: Relevant information related to effects and action.

Further Study Points

  • Review the provided diagrams and figures/tables related to these concepts.

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