Therapeutic Dose

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Therapeutic dose

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the average dose for an adult required to produce a therapeutic effect

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therapeutic index

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lethal dose/therapeutic dose

if <=2 the drug has narrow therapeutic window and should be used with caution

if it greater than 2 the drug is safe

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loading dose

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a large initial dose given to achieve a rapid high plasma therapeutic level e. g chloroquine 4tabs firstly

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Factors modifying the dosage and action of drug

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Age.Weight.body surface area.Sex Route of administrationTime of administrationHypersensitivity, tolerance

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children Doses

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In children there is:Underdevelopment of many microsomal enzyme Reduced renal excretion of drug due to lower glomerular filtration, tubular reabsorption and secretion in neonates.Lower total plasma protein and albumin in newbornImmaturity of the BBB leads to increased sensitivity of newborn to drugs e.g. morphine

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Dose in elderly

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Elderly people 60-70 years required lower doses. They have increased sensitivity to most drug because of:impaired ability to metabolize and excrete drugs (decreased organ function), thus drugs stay longer in the body and have longer/greater effects compared to young adultsresponse may alter with age e.g. decreased number of B-receptor

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For molecules to pass across membranes they should be:

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1. Lipid soluble 2. Non-polar3. Uncharged 4. Small in size (200-1000 Da)

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First pass effect

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is metabolism that occurs in the liver before entering the general circulation.

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drugs inactivated by enteral rout

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propranolol (antihyopertensive) lignocaine (antiarrythmatic) mprphine (analgesic) glyceryltrinitrate (anti-angina)

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drug activated by enteral route

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enalipril-------> enaliprilate

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Absorption from intramuscular rout could be enhanced with:

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- selecting a site for injection that is rich in blood supply. Intramuscular absorption is higher in athletes.- local massage - applying warmth (IR source)- Using hyaloronic acid (bacterial enzyme) which breaks down the muscle matrix and enhances absorption

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Absorption from intramuscular rout could be enhanced with:

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- selecting a site for injection that is rich in blood supply. Intramuscular absorption is higher in athletes.- local massage - applying warmth (IR source)- Using hyaloronic acid (bacterial enzyme) which breaks down the muscle matrix and enhances absorption

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Intrathecal:

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drug is injected into the subarachinoid cavity. The administered drug would have rapid action on the CNS and in high concentrations. Drugs that do not cross blood-brain barrier could be easily given.

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Intra-arterial:

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injection is given into the artery. It is used many for critical situations or in diagnosis (anogiography).