Lecture 1

Question 1

Where do you initially look for a dose/frequency when recommending a drug?

Disadvantages: package inserts get data from clinical trials. Obviously clinical trials CANNOT enroll all kinds of patients

Question 2

Where do you initially look for a dose/frequency when recommending a drug?
Answer: _________, __________, guidelines, facts,comparison, clinical pharmacology in other words you can go through some of the references and databases. Each hospital usually they subscribe a preferred database depending which hospital like Micromedex and some hospital chose Lexicomp

Answer 2

Lexicomp, package insert

Question 3

The dose and frequency listed in package insert and all the databases are for normal adults. The package insert and database only showing you doses for the this patient population you have to individualize the patient especially what if the patient had liver function problem, kidney problem, what about ICU or how do you tackle the new disadvantages?

Answer 3

pharmacokinetics

Question 4

Besides kinetic factors to drive a dose / frequency to give a drug a therapeutic or toxic effect you also have Non-Kinetic factors to consider:
Ex.
* Non-compliance or __________ by the patient
* Lab __________
* Inaccurate ________ drug given to patient written down by RN
* Sampling time errors

Answer 4

adherence

errors

times

Question 5

Absorption: affected by drug solubility, GI emptying time, bioavailability, etc

Question 6

Lets say this patient is on vancomycin therapy and then we need to dose the patient after patient was administered several doses and then lab report a concentration level before you need to take any action on the laboratory level what do you have to think about you have to think about did we give the patient vancomycin at the _________-…did the nurse draw the level at the right time. Otherwise if you do not analyze those factors…the lab reported me this level Im going to use this level to adjust the dose many times you could be wrong

Answer 6

right time

Question 7

Distribution: VD, protein binding effects

Question 8

Metabolism: Hepatic, if so by CYP450 to active or inactive metabolites (liver and enzymes)

Elimination: renal insufficiency or failure, skin, feces

Need to consider these factors before dispense ANY drugs to patient.

Elimination is mainly through the?

Answer 8

kidneys

Question 9

Dose is not just impacted with pharmacokinetic parameters there’s also impact by a lot of other ways called non-kinetic factors for instance the adherence of the patient. Lets say package insert says you should draw drug level after a couple of doses after the drug reaches steady state you draw the level but before you draw the level what do you have to verify. Does the patient actually take the medication are you drawing at the right time in the lab errors. Nurses sometimes they care for multiple patients they may draw level at the wrong time

Question 10

Check levels and appropriate time for pt

Some drugs are highly protein bound and the metabolism mainly the liver and the enzymes and elimination is through the kidneys so you have to check the patient’s kidney function

For any drug its dose,frequency, and what else, route of administration…can this drug give orally…can this give IV or IM…will the drug formulation I recommend get to the site of action and produce optimal effect

For instance you have heard of blood brain barrier…some drugs can cross some canal and what about those frequency optimal for the patient

People of different ages present different pk parameters like their volume distribution, their metabolism, and gender.

Gender also plays a role

Question 11

Larger volume of distribution what drug is going to impact more? _________…lipophilic drugs going to be impacted more because lipophilic drugs love to go into fat tissue

Answer 11

Lipid soluble

Question 12

Pts should be at ideal body weight and there’s a lot of obese patients and some patients may be below then you have to use actual body weight so sometimes the package insert will tell you when you dose you should be based on ideal body weight and the GI function. Sometimes package insert will say you have to be dosed on ideal body weight

Ph affects GI function

For any patients with liver problems…low liver function may impact the metabolism of the drug

Question 13

Renal function is mainly elimination

Why cardiac function can impact pharmacokinetics?

Answer 13

Distribution

Question 14

Drug has to be distributed throughout the body by blood flow someone has heart failure may have reduced blood flow and nutritional status

Question 15

How nutritional status going to impact pharmacokinetics?

Answer 15

Albumin

Question 16

Malnourished patient or someone with chronic kidney disease they may have low albumin level

Question 17

How low albumin level going to impact the drug? poor Distribution, less __________

Answer 17

binding

Question 18

Some drugs are heavily bound to proteins and what they do to albumin if you have low levels of albumin…there’s less albumin bound if you have low levels of albumin there’s less albumin bound drugs then you have more free drug.