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20 Cards in this Set

  • Front
  • Back
what are the factors modifying drug activity
age, rate, gender, pharmacogenetic, drug interactions, effect of dx on drug activity
drug response changes assoc with aging (nonpharmacokinetic)
changes in receptors
changes in postreceptor signaling mechanisms
changes in homeostatic control (like baroreceptors)
disease-induced changes
issues with elderly
-may absorb more slowly or less completely
-reduced gastric acidity may dec absorption of drugs
-qualitative changes in drug-binding sites
-reductions in relative muscle mass
-inc prop of body fat. (lipid soluble drugs have larger Vd in the elderly)
-dec in total body water (water soluble drugs a smaller volume distribution in elderly)
-reduced hepatic enzymatic activity - dec metabolism
-reduction in hepatic mass, volume and blood flow
-phase I oxidative pathways are dec with age, while phase II conjugation pathways are unchanged
-changes in drug half-life with inc age suggesting elderly have reduced metabolism, drug clearance, or both
-reduced renal blood flow, reduced glomerular fxn, reduction in number of functional nephrons - reduced renal elimination
- dec cardiac output with redistribution of blood flow favoring the brain, heart and kidney, and reduction in hepatic blood flow
impaired homeostatic mechanisms in elderly
-dec activity of aortic and carotid body chemoreceptors
-reduced baroreceptor reflexes
-impaired thermoregulation
-inappropriate response of blood glu and insulin to glu
-altered neurological control of bowel and bladder
drug disposition pediatric patients - preterm
-gfr 1/10 of term newborn
-limitations on tubular reabsorption - inc urinary loss of filtered substances
- glucouronidation pathways appear after 20 wks of gestation - are limited in extremely premature infants
- gastric acid raarely found in stomach in infants <32 wks
-most metabolism and elimination systems do not fxn during fetal life
-skin not have same protective capacity until 2-3 wks of life
- dec plasma albumin and total plasma protein concentrations. also dec drug-binding affinity
drug disposition pediatric patients - term infants from birth through first month of life body water
2.dec body fat
3.dec exocrine pancreatic fxn
4.dec albumin conc and binding
5.dec total plasma protein
6.cyt P450 sys fully developed at birth, but fxns slowly
7.phase I oxidation rxns and demethylation enzyme system are significantly reduced
8.reductive enzymes systems approach adult levels and the methylation pathways are enhanced at birth
9. immaturity of gluco
drug disposition pediatric patients - children 1 mo to 2 yrs age
period is a time of rapid growth and maturation. by end of period most systems fxn at adult levels
drug disposition pediatric patients - 2-12 yrs age
drug disposition pediatric patients - 12-18 yrs age
drug disposition pediatric patients - children with chronic illnesses
special consideration
drug action unique action in children vs. adults
-caffeine - used to treat apnea of prematurity
-also adverse rxn - ex. tetracyclines - discolored teeth
calculation of pediatric dosages is usu done
-on the basis of wt for infants and toddlers
-on the basis of wt or body SA for older children
-plan drug therapy for age
define pharmacogenetics
abnormal biotransformation and/or rxn to a drug due to a genetic difference. Reactivity may be quantitatively or qualitatively different from normal. ex. include
1. abnormally prolonged effect (succinlcholine (abnormal catabolic enzyme longer expectedd apnea)
2. novel effect (rxn occurs which is unrelated to pharmacological effect of drug. Primaquine-induced hemolytic anemia (lack of G-6-PO4 dehydrogenase)
define concomitant drug therapy
effect of one drug may be altered significantly by the administration of another drug. these drug interactions can reduce or enhance therapeutic effects; they can also dec/inc toxicity. exs include:
1. GI absorption - cholestyramine
2. plasma binding proteins
3. biotransformation -
frequency of drug administration
1. uniform response
-acute administration - response to each dose is generally the same
-chronic administration - produce blood level in therapeutic range. steady state condition must be achieved which means amount of drug entering blood equals amount of drug leaving the blood.
define cumulation
concentration of drug in body inc with each dose when time btw doses is too short for complete removal of drug. can occur for any drug when it is given at a time interval shorter than its elimination t1/2.
define tolerance
decreased pharmacological response to unusual dose of a drug resulting from its repeated administration. their reduced response may result from 1. enzyme induction, 2. receptor up-regulation or down-regulation. normal effectiveness retursn upon discontinuation of administration of drug.
types of tolerance
1. pseudo-tolerance - false tolerance; may be due to dec absorption (alocholic) or inc excretion (diarrhea)
2. tachyphylaxis - rapid dev't of tolerance after only a few doses in a relatively short period of time
3. cross tolerance - reduced response to drugs having a molecular structure and/or pharmcological aciotn which is similar to the drug that caused the tolerance.
4. resistance - term usu reservced for reduced therapeutic effect of chemotherapeutic drugs. Microorganisms or viruses directly develop the tolerance; patient is tolerant, but on an indirect basis.
why some patients do not comply
1. patient is self-conscious
taking medicaince can draw attention to their dx, and do not want to be different from peers.
2. patient reminded of dx
3. patient does not feel sick
bp meds does not hurt, but inc morbidity and mortality
4. adverse drug reactions
-actual - some undesired effects when taking drugs (drowsiness, dizziness, NVD, impotency)
-potential - unfounded fear of addiction (narcs) or inc chance of some condition developing from taking a drug
how to inc compliance
be certain the pt understands
1. what drugs are being taken
2. why they are prescribed
3. which ADR's may develop
4. what will occur if meds are not taken as directed
be available to answer pts questions, and provide reassurance