Lifespan considerations

Question 1

Kidney disease

Answer 1

Excretion is impaired

• cumulative kidney dysfunction
• creatinine clearance is a 24 urine sample compared to blood sample
• GFR is close correlative.

Question 2

Liver disease

Answer 2

-impacts metabolism
- cirrhosis
- hepatotoxic drugs cause liver damage
-

Question 3

Tolerance

Answer 3

• decreased responsiveness to a drug

- pharmacodynamic tolerance: increased doses are required over time to get same response

Question 4

Metabolic tolerance

Answer 4

One category of tolerance - accelerated drug metabolism

Question 5

Tachyphylaxis

Answer 5

Response from a drug decreases from repeated doses.

• nitro patches
• drug free time to replenish

Question 6

Placebos

Answer 6

• individuals psychological response to taking the medication
• positive or negative
• could be a good thing

Question 7

Pharmacogenomics

Answer 7

• study of genes affect individual drug responses
• altered drug metabolism
• do genetic testing for individuals
• ultra, extensive,poor metabolizers
• no benefit no toxicity, benefit toxicity, no benefit and toxicity,

Question 8

Gene drug interactions

Answer 8

• based on genetic variation some people may or may not be able to take a drug

Question 9

Ultrarapid metabolizer

Answer 9

Decreased effect in active drug

Increase toxicity in pro drugs

Question 10

Extensive metabolizer

Answer 10

Normal response

Question 11

Poor metabolizer

Answer 11

Increased toxicity in active drug

Decreased prodrug administered

Question 12

Gender

Answer 12

Females metabolize alcohol slower than men

• certain opioid analgesics are more effective in women than men
• quinidine causes a greater QT interval in women

Question 13

Race

Answer 13

Genetic variations and ethnic group

Question 14

Adherence factors

Answer 14

• belief that the drug will work
• manual dexterity
• visual acuhity
• intellectual ability
• psychological State
• attitude towards drugs
• ability to pay
• interactions with drug to drug of food to drugs

Question 15

What happens in then 3rd trimester

Answer 15

-Renal blood flow doubled and renal excretion accelerated

Question 16

Other pregnancy changes

Answer 16

• Tone and mobility of bowel is decreased which leads to prolong transit. (Increased level of drug in body)
• Increased hepatic metabolism

Question 17

Do all drugs cross the placenta?

Answer 17

Yes!

• lipid soluble will pass though easier
• polar, ionized, protein won’t
• withdrawal can be seen in babies when they are born
• assume

Question 18

Teratogenic

Answer 18

• less than 1% of defects are caused by drugs

- 25% is caused by genetics

Question 19

Contributing factors:

Answer 19

• when drug is taken during pregnancy

- amount of ingested and frequency of ingestion.

Question 20

Development

Answer 20

Conception - week 2 
-all or nothing organ development 
- embryonic : gross malformations produced by teratogens 
- fetal period: 9;week to term 
Functions are disrupted by exposure

Question 21

What to do when you are taking a teratogenic med?

Answer 21

• identify first exposure

- monitor for effects

Question 22

How to know if drugs are’s are during pregnancy

Answer 22

• drug registries

- retrospective studies

Question 23

Pregnancy categories

Answer 23

-A is the safest while D&X cause the most harm

Question 24

Pregnancy lactation labeling

Answer 24

• risk summary

- female male reproductive potential ( drugs can have teratogenic effects)

Question 25

Lactation risk

Answer 25

- drugs can be excreted in breast milk | - can effect infant

Question 26

How do you decrease lactation risk?

Answer 26

- take drugs immediately after breast feeding - avoid drugs that have a long half-life - choose drugs that tend to be excluded from milk and are least likely to affect the infant - avoid drugs known to be hazardous

Question 27

Pediatrics are at the risk of what?

Answer 27

They are under 16 and have an increased risk for adverse rxns

Question 28

Pediatric dosing

Answer 28

Based on body surface or weight | -mg/kg/day div q12h

Question 29

Bsa

Answer 29

Body surface area x adult dose / 1.73 m^2

Question 30

Organ immaturity is profound in?

Answer 30

Infants until age 1

Question 31

Elevated drug levels in peds

Answer 31

More intense response

Question 32

Delayed elimination in peds

Answer 32

Prolonged response

Question 33

Metabolism in peds

Answer 33

Markedly faster until Age 2 then it declines . | Increase dose or intervals

Question 34

Is topical absorption much greater in kids

Answer 34

Yes

Question 35

Bbb is not form till what age

Answer 35

Year 1

Question 36

Certain drugs should not be given to kids. T or f?

Answer 36

T

Question 37

Med adherence in kids

Answer 37

- education - demonstration - what to do child spit or spills meds - system of multiple caregivers - ease of measuring (using the right tool) - make it taste good

Question 38

31% of all prescriptions are consumed by?

Answer 38

Older adults

Question 39

More ADR and drug drug interactions

Answer 39

Due to poly pharmacy

Question 40

Older adult organ fuction

Answer 40

Declines

Question 41

Variation in older adults

Answer 41

Some are healthy and some are very sick

Question 42

Co- morbidities

Answer 42

Are increased in older adults

Question 43

Major physiological concerns

Answer 43

- Decreased muscle mass increased body fat: effects drug storage and less sites for protein binding - hepatic metabolism decreases: reduced bf to liver, decreased activity - decreased gastric emptying - decreased kidney fxn

Question 44

Beers criteria

Answer 44

List of drugs older people should not use based on ADR

Question 45

START/STOPP

Answer 45

Start: info about drugs that should be given to elderly due to EVidnece STop: should not be prescribed to adults

Question 46

Med adherence in older adults

Answer 46

- simplified drug regimens - clear concise verbal written instructions - appropriate dosage form - clearly labeled and easy to open container - daily reminders - support systems - frequent monitoring - others: expenses, side effects, drug is not needed, or dose is not right