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