0:03 okay for the next question you're going
0:06 to need to know just five suffixes which
0:08 are the ones that I've talked about most
0:11 in module one so the question will be
0:14 worded the following are fictitious
0:17 drugs using your knowledge of drug
0:20 suffixes choose the one that for
0:24 instance would be a benzo dipene or I
0:26 may say choose the one that is a beta
0:28 blocker or the one that is a
0:30 corticosteroid or the one that is an
0:32 alpha blocker or the one that is a
0:35 proton pump inhibitor I don't want to
0:37 give you the exact question because
0:40 you'll just learn one suffix and this
0:43 way you're going to learn five suffixes
0:46 so there are five fictitious drugs
0:48 obviously if you look up a fictitious
0:51 drug you're not going to find anything
0:54 about that drug it doesn't exist so uh
0:57 remember what the generic name is it's a
1:00 shortened version of the chemical name
1:03 so for meta prolol that is an
1:06 abbreviated version of this full
1:09 chemical name and you see exactly how we
1:11 actually derive that meta prolol from
1:13 that chemical name
1:14 name
1:18 other drugs are not as straightforward
1:21 as this it they you won't find exactly
1:25 the uh the word exactly in the chemical
1:27 name but you get the point from this
1:30 example we're never going to need to to
1:32 know the chemical name but it is best to
1:35 know the generic name and normally we
1:38 learn at least one of the popular brand
1:41 names as well but it's the key portion
1:43 of the drug name that we look for to
1:46 identify drugs that we've never heard
1:49 before for instance beta
1:53 blockers uh have the suffix o lol
1:56 l and for
1:58 corticosteroids they're a bit more
2:00 difficult because corticosteroids have
2:03 different affixes and some of them come
2:05 in the middle portion of the word some
2:07 of them come as prefixes and some of
2:10 them come at the end portion known as a
2:12 suffix most of them actually come at the
2:14 end portion but like I said it's
2:18 variable and uh suffixes are actually
2:20 coming at the end portion of the
2:23 word this is an example of different
2:27 cortico steroids uh look for the pr the
2:31 aone and the court in the in a portion
2:34 of the generic name and that's going to
2:36 be a corticosteroid corticosteroids are
2:39 so diverse though that they have many
2:42 different affixes those are the most
2:46 common the pr asone and Court in the
2:48 somewhere in the
2:51 name going back to this list the zosin
2:55 is z o s i n is an alpha blocker
2:58 remember we learned that in module 2 uh
3:03 praos Saosin those are used for benign
3:06 prostatic hyperplasia they're used for
3:08 hypertension but they actually
3:11 selectively block the alpha
3:15 receptor the alpha adrenergic receptor
3:20 and what is the oprol o p r a z o l e
3:24 suffix it's a proton pump inhibitor
3:27 remember that was in module one when we
3:31 talked about them being in irreversible
3:36 inhibitor the aapam or AOL Lam is a
3:39 benzo dipine remember benzodiazapines
3:44 are like xanx and Valium they're a
3:46 medication that's used for
3:49 anxiety so there's just five different
3:50 suffixes that you need to learn and I
3:52 guarantee that one of those is going to
3:54 be in the quiz and hopefully that's
3:56 enough information for you to get in
3:58 that habit of looking for that little
4:01 snippet of the word of the drug uh name
4:03 of the generic drug name to identify
4:07 which drug class it is actually
4:10 in okay so hopefully you do uh develop
4:13 that habit uh with those five uh
4:16 examples and we'll go on to the next
4:18 question the next multiple choice
4:21 question has is this one right here it's
4:23 which of the following is incorrect
4:25 About Cellular
4:28 receptors so the first choice is when
4:30 the cellular receptor is B by the
4:32 natural liand or a drug that mimics the
4:35 natural liand that is the signal for the
4:36 cell to do
4:41 something and if you take a look at this
4:43 right here this diagram right here it's
4:46 depicted in this diagram where the liand
4:49 binds to the receptor and indeed that is
4:52 the signal for the cell to do something
4:55 when our cells start to communicate with
4:57 each other that's the very process that
5:00 we use we send out a messenger molecule
5:02 and then it's going to land on the
5:05 proper receptor on certain cells and
5:07 that's the cell that's that signal for
5:10 the cell to do something so it's our
5:13 communication Network the second choice
5:15 is cellular receptors can be increased
5:18 or decreased by the cell thereby
5:20 increasing or decreasing the number of
5:23 messages to that cell and this is
5:25 depicted in this diagram here with the insulin
5:26 insulin
5:29 receptors one of the notable examples
5:32 with respect to this has to do with the
5:35 number of opioid receptors on the cell
5:38 surfaces when we start taking opioids on
5:41 a regular basis it's part of the reason
5:43 that when somebody takes opioids for a
5:46 few weeks they become tolerant of the
5:49 opioids and they need more and because
5:51 of the fact that um we are decreasing
5:54 the number of opioid receptors on the
5:57 surface of the cell of the surface of the
5:58 the
6:01 neuron so indeed cellular receptors can
6:04 be increased or decreased by the cell
6:06 thereby increasing or decreasing the
6:09 number of messages to that
6:12 cell so that statement it was correct
6:14 and the next one the cellular receptors
6:17 that most of our drugs buy to in order
6:19 to perform their therapeutic actions are
6:22 involved in communication between other
6:24 cells or other parts of the body and
6:25 pretty much uh that's something that
6:27 we've kind of taken already that is a
6:30 correct statement there are a very few
6:33 exceptions to that rule but generally
6:35 the drug is basically acting to
6:38 communicate with the cell as it binds to the
6:38 the
6:42 receptor and statement D is most
6:44 commonly when the cellular receptor is
6:48 bound by the natural liand that results
6:50 in a confirmational change in the shape
6:53 of the receptor uh thus signaling other
6:57 actions in the cell and that one is
7:00 correct as well for instance when two
7:04 insulin molecules bind to their insulin
7:06 receptor as depicted in this picture the
7:10 protein changes shape and that change of
7:13 the shape actually is the start of a
7:16 Cascade that happens inside the
7:19 cell uh the one statement that is
7:24 missing from the PowerPoint is choose
7:26 this one if you believe that each of the
7:28 comments about cellular receptors is
7:31 correct just just remember with this one
7:34 you can get really pedantic about it and
7:36 you can get really pedantic about just
7:38 about anything in Pharmacology but
7:40 please don't think that I'm trying to
7:43 trick you in any of these questions it's
7:45 just testing your general
7:49 knowledge not your ability to pick up
7:52 pedantic little points so there's always
7:54 exceptions to the rule in medicine
7:57 nothing happens 100% of the time but
7:59 this is an introductory pharmacology unit
8:00 unit
8:02 and all of the statements in the uh
8:07 question here is uh generally correct so
8:11 if you would like to contest that answer
8:14 or any of the answers that we go through
8:18 or the uh questions within the modules
8:21 as well so there's activities in the
8:23 modules and some of the questions on the
8:24 quiz are going to be in the from the
8:27 activities if you're going to question
8:30 any of the answers to those I want you
8:32 to do it before the
8:35 quiz it is too late to contest it after
8:37 youve taken the quiz and you're
8:40 desperately trying to find some source
8:42 that actually makes it look like your
8:46 answer was correct so yeah just make
8:49 sure that you can test it before that
8:51 and we can talk about it and I'll tell
8:53 you which answer to actually put down if
8:55 it's in the
8:58 quiz now the next question is this one
9:01 here it has to to do with cmax or
9:05 concentration Max now what is cmax cmax
9:08 is the maximum or Peak serum
9:11 concentration of that a drug achieves
9:13 okay and it's kind of a standard
9:16 measurement in pharmacokinetics and it's
9:18 important to understand it because of
9:20 the fact that with the understanding of
9:22 that you're going to understand why one
9:24 type of administration is chosen over
9:27 another uh important safety issues about
9:31 for instance um U drug that are going to
9:33 be administered via the lungs or drugs
9:37 that are administered by IV and so forth
9:39 so it is an important concept the
9:41 question is going to go which of the
9:43 following is
9:45 incorrect and the first statement is
9:48 cmax or concentration Max is the maximum
9:51 or Peak serum concentration that a drug
9:53 achieves and of course that's is correct
9:56 that is the definition of cmax or
10:00 concentration Max it's the maximum serum
10:02 concentration that a drug achieves after
10:03 the Drug's been
10:06 administered the next statement is a
10:07 mode of administration that achieves a
10:10 very high concentration Max is going to
10:12 result in that drug being metabolized
10:15 faster in the initial stages of
10:18 metabolism so if you take a look at
10:22 these graphs here these two graphs first
10:26 of all time is on the x axis and plasma
10:28 concentration is on the Y AIS can you
10:31 tell me me which of these two would be
10:34 depicting IV or Administration by the
10:38 lungs versus which one is depicting
10:40 orally administered
10:43 drug yeah okay so the one that is on the
10:46 right the one that has a high cmax is
10:49 indeed the one that's inhaled or it
10:54 could depict the type of cax that's
10:57 evident in a
11:00 intravenously administered drug as well
11:02 uh and the one to the left actually
11:04 depicts the oral
11:06 Administration and just by looking at
11:09 the graph though look at these and say
11:12 which of those is metabolized faster in
11:13 the initial
11:16 stages you you see how quickly the one
11:19 with the higher cmax is metabolized in
11:21 comparison to the other in that first
11:24 portion and you may be thinking you know
11:26 why is the one on the left the oral
11:29 Administration such a low cmax
11:33 well when you take a medication orally
11:35 what happens is that it starts to get
11:38 absorbed and there's a whole process of
11:39 getting absorbed some of it may actually
11:41 go through the stomach some of it may go
11:45 through the intestines and um it's a
11:47 it's a longer process a much longer
11:49 process to even get absorbed and then it
11:54 goes into the liver first and that's uh
11:55 going to take some time to get
11:58 metabolized and so forth and that's the
12:02 reason you have this low cmax for an
12:05 orally administered medication and
12:06 conversely when you administer
12:08 anesthesia by
12:10 inhalation or or you inject the drug
12:14 that goes straight into the blood and it
12:16 doesn't go through the liver at all it's
12:18 goes straight into the blood and you get
12:21 that response almost immediately so the
12:23 statement a motive Administration that
12:25 achieves a very high concentration Max
12:27 is going to result in the drug being
12:30 metabolized in the fast in the initial
12:32 stages of metabolism is
12:36 correct and the next statement is there
12:38 is a greater potential for overdose side
12:41 effects and complications with the mode
12:43 of administration that gets the medicine
12:46 into the system the fastest and looking
12:49 at this graph again which of these is
12:51 most likely to have side effects and
12:53 from the graph obviously it's very
12:56 obvious the one that has the highest
12:59 concentration Max or cmax is actually
13:01 going to wind up with the greatest and
13:04 there's a number of Reason greatest side
13:06 effects there's a number of reasons for
13:10 that which we've uh taken in module
13:14 one okay and one of the other options is
13:17 intravenus Administration has a greater
13:19 cmax than oral Administration and that
13:23 one is of course correct um that that
13:27 one's obvious um and and final the final
13:29 statement is when a drug is in High
13:32 concentration it is less likely to bind
13:35 to enzymes or receptors that it's not
13:37 supposed to bind to and that one is
13:40 categorically incorrect In fact it is
13:42 the opposite a correct statement would
13:45 be when a drug is in low concentration
13:47 it is less likely to bind to receptors
13:49 or enzymes that it's not supposed to
13:52 bind to in the modules we
13:54 explained that with this example in a low
13:55 low
13:59 concentration a selective beta 2
14:02 antagonist for instance would bind only
14:05 to the beta 2 receptor but when the drug
14:07 is administered in a bit higher
14:10 concentration it starts binding to for
14:13 instance the alpha adrenergic receptors
14:16 so there's a bit of a crossover effect
14:20 um at the higher
14:22 concentrations and that additional
14:24 binding is one of the reasons that a
14:26 drug has greater side effects with
14:29 higher doses so does everybody
14:32 understand cax and the important issues
14:33 around that
14:36 concept I've got a follow-up question
14:39 about cmax but I'm going to hold off on
14:41 taking that right now I think it'll be
14:43 probably a little bit better for the two
14:46 cmax questions to be
14:49 divided uh just remember uh that brings
14:51 up a point well as I'm presenting these
14:54 to you obviously what's going to happen
14:58 is as as these are going to be in the uh
15:01 quiz is they won't be in any particular
15:04 order so you may get the 10th one that I
15:07 Pro provide to you today as being number
15:10 one in your quiz also the different
15:12 choices will be mixed up as well so
15:15 they're randomized in two separate ways
15:18 do just be prepared for that
15:22 one let's go to this next question here
15:25 and uh this one has to do with
15:28 pharmacokinetics the movement of drugs
15:29 around the body
15:32 and let's take a look at which of the
15:34 following is incorrect the very first
15:36 choice has to do with suppositories
15:38 should be placed in the lower portion of
15:41 the rectum if they're to avoid the
15:42 hepatic first
15:46 pass remember what the first pass is it
15:48 has to do with the fact that the blood
15:51 supply that goes to every cell in the
15:54 git from the middle portion of the
15:56 esophagus all the way down to the middle
15:58 portion of the rectum is going to go
16:02 through the liver first before it gets
16:05 into systemic circulation so if there's
16:07 any blood containing any nutrient or
16:10 poison from that area it's going to go
16:14 into the liver to detoxify it and that's
16:16 one of our protective
16:18 mechanisms but suppose you had a drug
16:21 that will get metabolized to an inactive
16:24 form once it goes through the liver well
16:27 that kind of drug needs to be delivered
16:29 by something other than a pill for
16:32 instance it needs to find a different
16:35 pathway and some of our drugs are made
16:37 as suppositories to do just that to
16:41 avoid the first pass the hepatic first
16:44 pass and the point of this topic is that
16:47 if you place the suppository too high
16:50 into the rectum so let's say that you're
16:52 you're placing it right here where is it
16:54 going to go first it's going to go
16:56 straight into the liver which is exactly
16:59 what we're trying to avoid doing and
17:02 therefore uh yes suppositories the the
17:04 statement suppositories should be placed
17:06 in the lower portion of the rectum if
17:08 they're to to avoid the hepatic first
17:10 pass is a correct
17:13 statement the next statement has to do
17:15 with lipophilic drugs and lipophilic
17:18 drugs often access a protein carrier
17:20 molecule so that they can be carried
17:22 through the water soluble
17:26 plasma uh lipophilic of course means fat
17:30 loving so a fat loving drugs a a fatty
17:33 drug is going to access a protein
17:35 carrier and absolutely that statement is
17:38 correct if you put a greasy pan into the
17:43 dishwater before the detergent is in all
17:45 of the oil goes to the top of the water
17:47 and it just kind of sits there doesn't
17:50 it uh and in the body we can't use a
17:53 detergent so we get those fat soluble
17:55 substances the fat soluble drugs the fat
17:57 soluble messenger molecules in the in
18:00 the body and so forth all of those fat
18:02 soluble substances are going to access a
18:06 carrier and protein carrier
18:09 molecule the the next statement is each
18:11 drug is different as to the percent of
18:13 the drug that is bound to plasma
18:17 proteins sometimes it is a high protein
18:19 binding and other times it's a low
18:22 protein binding and I'm going to take
18:25 this along with another one of the
18:27 statements uh which is not actually in
18:29 your study notes uh so you have to take
18:32 this one down only the Unbound portion
18:35 of the drug is active and it's only the
18:37 Unbound portion of the drug that can be
18:40 metabolized so both of those statements
18:43 are actually true and let's take a
18:45 example used in module one the example
18:48 that we use in module one has to do with
18:52 this drug which is 80% bound to protein
18:55 so that means 20% of it is free and that
18:58 is the 20% that can get into the cells
19:01 and be metabolized or it it I can act on
19:04 receptors or it's free to do just about
19:07 anything right but you know this other
19:11 80% is bound to proteins so this is
19:13 where some of the students actually get
19:14 unstuck because they think well if it's
19:16 bound to if 80% is bound to proteins
19:19 that 80% is never really going to get
19:21 metabolized is it but that's totally
19:24 untrue because as soon as you know this
19:27 portion a portion of this 20% over here
19:29 this free drug is as soon as this free
19:33 drug is bound to a receptor or something
19:36 it it leaves a little bit of room for
19:39 something to dissociate from the protein
19:42 so another one of the particles of drugs
19:45 is going to dissociate from the proteins
19:48 and then it's free to do its job so only
19:50 the Unbound portion of the drug is going
19:53 to be metabolized and that means that a
19:56 drug which is highly bound to proteins
19:59 may take a bit longer to get out of this
20:02 system it's kind of waiting around to be
20:03 released from the protein carrier
20:07 molecules until you know the free drug
20:09 is actually bound to
20:12 something and finally The Last Choice is
20:14 obviously going to be false since every
20:16 other statement that we've taken already
20:19 is true so far there if there is a high
20:22 motility in the git drugs are going to
20:24 be absorbed faster because everything is
20:28 sped up and that one is incorrect
20:32 um a high motility actually decreases
20:35 absorption because there's an inadequate
20:38 amount of time to absorb the drug okay
20:40 is everyone happy with that and feels
20:42 like they can answer that question correctly
