Toxicology Quiz

What is polypharmacy?

people using 5+ Rx drugs in the past month

3 multiple choice options

What are the most frequently prescribed medications?

Statins

Describe phase 1 of clinical trials

20-100 healthy volunteers, safety and optimal dosage

3 multiple choice options

Describe phase 2 of clinical trials

several hundred people w/disease, drug efficacy and side effects

3 multiple choice options

Describe phase 3 of clinical trials

300-3000 volunteers w/disease, drug efficacy and monitoring adverse reactions

3 multiple choice options

Describe phase 4 of clinical trials

post-marketing surveillance and inspections

3 multiple choice options

Is a higher or lower NNT better?

lower

2 multiple choice options

Describe the interaction between monoamine oxidase inhibitors (MAOIs) and high-tyramine foods

monoamine oxidase enzymes degrade tyramine, patients on MAOIs need to avoid high tyramine foods to

Describe the interaction between St. Johns Wart and CYP3A4 substrate

St. Johns War is a CYP3A4 inducer, which means it can decrease the levels of drugs metabolized by CYP450

Describe the interaction between grapefruit and CYP3A4 substrate

grapefruit inhibits metabolism of CYP3A4, which means it can increase the level of drugs metabolized by CYP 3A4

Describe the interaction between St. Johns Wart and high-tyramine foods

St john warts increases activity of CYP enzymes so you much avoid high-tyramine foods

Describe the four types of nutrient depletions

major: most people need supplementation

moderate: minor symptoms, try food first then supplement

insignificant: food first, most people wont need supplement

insufficient evidence: no clinical proof of depletion

What are some ways drugs can decrease absorption?

forming complexes with nutrients, altering gastric pH and damaging the intestinal lining

What are some ways drugs can create a higher requirement for nutrients?

increaseing the metabolism of nutrients

What are some ways drugs can decrease the availability of nutrients?

causing vitamin antagonism, causing side effects that alter food intake

What nutrients do SSRI's (antidepressants) usually deplete?

sodium

3 multiple choice options

What nutrients do oral corticosteroids (anti-inflammatory) usually deplete?

caclium, chromium, magnesium, potassium and vitamin D

3 multiple choice options

What nutrients does prilosec (acid reducing) usually deplete?

magnesium and B12

3 multiple choice options

What nutrients does questran (lipid lowering) usually deplete?

folic acid, vitamin A and D and K

3 multiple choice options

What nutrients does Lasix (diuretic) usually deplete?

potassium, magnesium, calcium and thiamine

3 multiple choice options

What nutrients does microzide (diuretic) usually deplete?

potassium, magnesium, thiamine, zinc

3 multiple choice options

Omeprazole causes a major depletion in...

magnesium

Metformin causes nutrient depletion in

folic acid and B12

What are some MSK side effects of Angiotension 2 inhibitors like losartan?

back pain

What are some MSK side effects of proton pump inhibitors like omeprazole and pantoprazole?

hypomagnesemia, increased bone fx risk, disorder of muscles

What are some MSK side effects of anticholinergic medications?

cant see, cant pee, cant spit, cant poop

What are some MSK side effects of gabapentins?

back pain and myalgia

What are some MSK side effects of albuterol?

back pain

What are some MSK side effects of fluoroquinolone antibiotics?

tendonitis, tendon ruptur, peripheral neuropathy, CNS symptoms

What are some MSK side effects of statins?

myalgia, soreness, cramps, weakness and fatique

What are some suspected causes of statin-associated muscle symptoms (SAMS)?

drug interactions or comorbidities that increase drug plasma concentrations

What are some behavioral risk factors for SAMS?

alcohol use, new or strenous exercise with stimulant use

What are some demographic risk factors for SAMS?

asian, female, familiy hx and older

What are some conditions that are risk factors for SAMS?

chronic kidney disease, diabetes mellitus, hypothyroidism, vitamin D and preexisting muscle disease

What is LD50?

dose that will kill half of animals tested

What is TI?

Ld50/ED50 that is used to establish doages levels

What is the ED50?

dose necessary to produce half of the maximum response

What is NOAEL and LOAEL?

NOAEL: no observed adverse effect level

LOAEL: lowest observed adverse effect level

What is a schedule 1 drug?

no current accepted medical use, high potential for abuse

What is a schedule 2 drug?

accepted medical use with high potential for abuse

What is a schedule 3 drug?

accepted medical use with moderate potential for abuse

What is a schedule 4 drug?

accepted medical use with low potential for abuse

What is a schedule 5 drug?

accepted medical use with lower risk than 4

Give an example of schedule 1 drug

heroin

Give an example of schedule 2 drug

vicodin

Give an example of schedule 3 drug

anabolic steroid

Give an example of schedule 4 drug

xanas

Give an example of schedule 5 drug

lyrica

What is the maximum dose?

largest amount of a drug that will produce desired effect WITHOUT producing symptoms

What are some examples of analgesics?

NSAIDS, aspirin, acetaminophen (pain relievers)

What is a drug agonist?

bind to a specific receptor to produce an action

What is a drug antagonist?

bind to a specific receptor to prohibit an effect

What is the target organ toxicity associated with analgesics?

ototoxicity - tinnitus and reversible sensorineural hearing loss

GO LOOK AT THE DOSE RESPONSE CURVE

GRAPH: ceiling effect when maximal response is eventually reached!

What is acute exposure defined as?

<24 hours

What is subacute exposure defined as?

< 1 month

What is a subchronic exposure defined as?

1 to 3 months

What is chronic exposure?

over 3 months typically a year

What is considered the bodys master antioxidant?

glutathione - most abundant in hepatocytes

Why is the CYP3A4 enzyme important?

most common cytochrome P-450 isozymes which are important in oxidation and reduction reactions