Lifespan Considerations Flashcards
3 different types of tolerance
- pharmacodynamic tolerance
- metabolic tolerance
- Tachyphylaxis
Response from drug decreases with increase dosing
Tachyphylaxis
-have to have drug free time to replenish effectiveness
Require increase amount of drug to achieve same effect/pain relief
Pharmacodynamic tolerance
- ex: opioids, alcohol
- what we most think of related to tolerance
Accelerated rate of drug metabolism
Metabolic Tolerance
Any response to a drug that is based solely on individuals psychological reaction to the idea of taking the drug
Placebo
Study of relationship between genetic variation and how our body responds to medication
Pharmacogenomics
3 genetic metabolic classifications related to P450
- ultra metabolizers
- extensive metabolizers (normal)
- poor metabolizers
What is the benefit of pharmacogenomics?
better match drug to person to achieve response needed
Kidney disease affects which stage of medication in the system
Excretion
Kidney failure changes drug half life from ____ hours to ____ hours
1.5 , 25
2 measures of kidney function used to adjust medication dose
- creatinine clearance (24 hour urine + bld)
2. GFR- usually use this
Liver disease affects which stage of medication in the system
metabolism
What effects liver metabolism? (conditions)
- ESLD, Cirrhosis, Hep B
- hepatotoxic medications
3 ways that women have different drug metabolism
- metabolize alcohol more slowly
- increase effectiveness of certain opioid drugs
- Quinidine causes increase QT interval prolongation
2/3 of all pregnant women take at least ___ medications
1
3 physiological changes effecting dosing during pregnancy
- 3rd trimester = doubled renal bld flow and excretion
- Bowel decrease tone and mobility causing increased absorption
- increased hepatic metabolism
Which drugs cross the placenta?
ALL- some just do it easier then others like Lipid Soluble ones
Cause of the majority of birth defects?
unknown
Percent of birth defects caused by drugs
< 1%
3 factors effecting a drugs effect on baby
- stage of fetal development
- amount of drug ingested
- frequency of drug ingested
When do gross malformations caused by teratogens in fetus occur?
embryonic period- week 3-8
When are fxns disrupted by teratogens in fetus?
fetal period- week 9-term
2 ways to know drugs effects on pregnant women/fetus
- drug registry
2. Retrospective studies
2020 label change for pregnancy and lactation risk categories
-includes male and female reproductive harm
Lactation increased risk of drug doing harm to baby
- fat solubility
- oral bioavailability
- half life
Lactation decreased risk
- molecular size
- protein binding availability
- acidity
How to decrease infant risk during lactation
- take drugs immediately after breast feeding
- avoid drugs that have a long half life
- choose drugs that tend to be exliucded from milk
- avoid drugs known to be hazardous
Pediatrics age range
<16 yrs of age
2 ways to determine dose for pediatrics
- area BSA (body surface area * adult dose / 1.73 m2)
2. Weight (mg/kg/day)
Pedes have delayed elimination resulting in
prolonged response
Pedes have organ immaturity until age
1
kids have elevated drugs levels causing
more intense reponse
Metabolism in pedes….
increase until age 2 and then gradually declines
Topical absorption is ____ in pedes
greater
No BBB until age
1
1 way to help medication adherence in kids
education
CYP450 and poor metabolizers- active drug and pro drug
Active drug: increase toxicity
Prodrug: decrease effect
CYP450 and ultrarapid metabolizer- active drug and pro drug
Active drug: decrease effect
Prodrug: increase toxicity
During the first two weeks of conception what are the risks from teratogenic drugs?
All or none effect: spontaneous abortion or proceed normally
