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NU 600

Exam 2 - Cultural Environmental and Genetic Influences on Drug Therapy

What are some undesirable side effects that accompany the use of anesthetics? Apnea, bradycardia, hypotension, increased ICP
Propofol induces what two undesirable side effects? Apnea, hypotension
What two IV induction agents increase ICP? Succinylcholine, ketamine
What is ethnopharmacology (aka ethnic pharmacology)? The study of ethnic groups and their use of drugs
What types of diseases has skunk cabbage been used to treat? Asthma, respiratory and nervous disorders, rheumatism, dropsy
Skunk cabbage has been used to stimulate the removal of ____________ in asthma. Phlegm
Skunk cabbage was successfully used by what native American tribe(s)? Winnebago, Dakota
The ______________ has a tea made from its leaves that alleviates bronchial and other respiratory problems. Creosote bush
What type of root can be boiled in order to remedy pneumonia? Pleurisy root
Besides being used as a remedy for bronchitis, what other ailments has it been used for in ethnic pharmacology? Pneumonia, expulsion of phlegm
What function does the wormwood leaf have when its leaves are boiled? Curative for bronchitis
What group of native Americans used the wormwood leaf for bronchitis? Yokia Indians
Bronchitis has been treated with what 4 plants? Creosote bush, pleurisy root, wormwood, skunk cabbage
What are two ethnic pharmaceuticals used to speed childbirth? Partridgeberry (leaves) and blue cohosh (root)
The role of genetics and pharmacology is recorded as far back as the _____________. Early 1800s
What type of enzyme is plasma cholinesterase and how is its activity in the body determined? Non-CYP450, genetically
What does pharmacogenomics study? How a person's genome or genetic code affects their response to pharmacologic agents
What is a xenobiotic? A chemical substance that creates an effect on the body
What are the two body responses to xenobiotics? Elimination or accomodation
What system mediates the majority of drug metabolism in the body? CYP450
How many CYP450 enzymes are responsible for the majority of drug breakdown? 50
What is responsible for giving each enzyme a certain construction? genetic code
In what two ways can CYP enzyme activity be altered? Via stimulation or inhibition
What vitamin alters the metabolism of warfarin in the body? Vitamin K
What are 4 herbal plants that prolong bleeding time? Garlic, ginger, ginseng, gingko
What are phytochemicals? Naturally occurring plant compounds that provide a variety of organoleptic (experienced by the senses) properties
What are two beneficial effects of phytochemicals? Anti-oxidant, anti-inflammatory
What types of vegetables are known to have phytochemicals? Cruciferous, pumpkins, carrots, and tomatoes
Give 3 examples of cruciferous vegetables. Broccoli, brussel sprouts, cauliflower
How do cruciferous vegetables affect enzymatic activity? Induces CYP1A2, increasing the rate of Phase I metabolism
How do grapefruits interfere with drug metabolism? Inhibits intestinal P450 activity
What are three medications that are affected by the consumption of grapefruit? Felodipine, midazolam, erythryomycin
How do solanaceous glycoalkaloids alter drug metabolism? Inhibits acetylcholinesterase and plasma cholinesterase
What are three food sources that contain solanaceous glycoalkaloids? Potatoes, tomatoes, eggplants
What are types of medications affected by the presence of solanaceous glycoalkaloids in the body? Esmolol, ester local anesthetics, succinylcholine
What demographic has the highest rate of alcohol consumption? White males 18-44
Acute alcohol consumption can result in changes in _______________. Sensorium
What are effects to the sensorium that are caused by acute alcohol consumption? Psychomotor impairments, vomiting, delayed gastric emptying, inability to make rational decisions
How does alcohol affect the metabolism of other drugs and why? Increases sensitivity to other drugs due to the additive depressant effects
What two physiological processes lead to altered drug distribution and metabolism from ETOH use? Hypoalbuminemia and impaired blood flow
The effects of NMBDs is [shortened/prolonged] due to the influence of alcohol. Prolonged
How does alcohol influence the dosing of induction agents? (i.e. propofol, phenobarbital, opioids, inhaled anesthetics) Alcohol causes CYP induction and therefore increased amounts of induction agents to achieve a therapeutic effect
Besides altering enzyme function how else do CYP enzymes affect the body? Plays a role in some diseases, producing toxic metabolites in some instances
A hepatotoxic effect can occur as a result of toxic metabolites from the degradation of what two medications? Acetaminophen and halothane
What types of particulate components and gaseous compounds do cigarettes contain? Benzene, polyphenols, arsenic, carbon monoxide, polycyclic aromatic hydrocarbons
Besides toxic effects in the lungs, tobacco also influences what other metabolic system? Enzymes of the CYP450 system
What element in cigarettes causes enzyme induction and is thought to contributing to the potential development of certain cancers? Aromatic hydrocarbons
What post-op effect occurs more often in smokers? PONV
The enzyme induction effect of smoking affects that two types of medications in anesthesia? NMBDs and opioids
What is the name of the chemical compounds in plants that influence CYP450 enzymes? phytochemicals
Approximately how many genes does a human contain? 30,000
What is the name for a complete instructional gene map? Genome
What are genes composed of? Molecules of DNA arranged in a double helix
What type of bond is responsible for providing the double helix structure of DNA? Hydrogen
What are the four nitrogenous bases that pair together to form DNA helices? Adenine, thymine, cytosine, guanine
Name each nitrogenous base and what it pairs with. Adenine pairs with thymine, cytosine pairs with guanine
How many DNA base pairs does the human genome have? Over 3 billion
The DNA sequence is comprised of the combination of __________________. Base pairs
How is DNA stored? In package units called chromosomes
How many sets of chromosomes do humans contain? 23 sets (total of 46 chromosomes)
How are chromosomes subdivided? 44 autosomes and 2 sex chromosomes
Any chromosome that is not a sex chromosome is called a/an ____________________. autosome
What is the representation of the male and female chromosomal pairs? XX=F, XY=M
DNA mutations are a result of _____________. Genotypic variation
What role do mutations have in biology? Serve as a form of adaptation
What is a single nucleotide polymorphism and what does it lead to? It is a substitution or replacement of a nucleotide for another and results in individual differences in drug responses
Single nucleotide polymorphism results in changes in _____________ and _____________. Pharmacokinetics and pharmacodynamics
True/False: Some ethnic groups have higher polymorphisms than others. True
How can polymorphism affect enzyme activity? May result in greater, reduced, or no enzyme activity
How does the presence of red hair affect MAC concentration? People with red hair have been shown to require higher concentrations of MAC for anesthesia
What affects drug distribution and metabolism in chronic alcoholism? Hypoalbuminemia and impaired blood flow through the liver (ex. duration of NMB may be prolonged)
How do CYP enzymes contribute to some disease processes? Can lead to toxic metabolites (seen with metabolites of APAP and halothane)
1a2 metabolizes caffeine, zofran, theophylline, affected by cruciferous vegetables
Which CYP enzyme metabolizes caffeine, zofran, and theophylline? P1A2
What genetic mutation in red-haired individuals increase MAC concentration? Mutation in the melanocortin-1 receptor gene
blue for boys, berries for girls
How does elevated levels of K affect clotting time? Prolongs clotting time
What 3 drugs does CYP3A4 breakdown? Decadron, fentanyl, oxycodone
What was the first plant used in the U.S. pharmacopeia? Skunk cabbage
What two drugs can increase ICP? Ketamine and succinylcholine
Which CYP enzyme metabolizes alcohol? 2E1
What products does CYP1A2 metabolize? Caffeine, Zofran, theophylline
Which CYP enzyme breaks down caffeine, Zofran, and theophylline? P1A2
What does CYP1A2 metabolize? caffeine, zofran, and theophylline
Which CYP enzyme breaks down decadron, fentanyl, and oxycodone? P3A4
What does CYP3A4 break down? decadron, fentanyl, and oxycodone
What vegetable affects CYP1A2 activity and how does it affect it? Cruciferous vegetables. Causes enzyme induction of CYP1A2
Which CYP enzyme breaks down alcohol? P2E1
What does CYP2E1 break down? alcohol
Which Native American plant has been used to treat pneumonia and phlegm expulsion? Pleurisy root
The boiled leaves of which plant aids in childbirth? Partridgeberry
What plant is prepared in warm water in order to promote rapid delivery in pregnancy? Blue cohosh
What was the first Native American plant to be featured in the U.S. Pharmacopoeia and when was it included? Skunk cabbage, featured in the U.S. Pharmacopoeia from 1880-1882
What diseases are effectively treated with skunk cabbage? Respiratory and nervous disorders, rheumatism, dropsy
What two native American plants are used to treat bronchitis? creosote bush, wormwood
What native American plant was used for pneumonia and found to promote phlegm expulsion? Pleurisy root
What two plants were used in the weeks preceding childbirth to facilitate a rapid delivery? Which was prepared boiled and which was prepared in warm water? Partridgeberry and blue cohosh. Partridgeberry=boiled, blue cohosh=warm water
What are two medications that can increase ICP? Ketamine, succinylcholine
What determines the amount of plasma cholinesterase in an individual? Genetics
Created by: philip.truong