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Pharm > Lifespan COPY > Flashcards

Lifespan COPY Flashcards

1
Q

Renal disease usually leads to drug _______.

A

Accumulation

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2
Q

What is the most important cause of adverse drug reactions in older adults?

A

Kidney disease/aging kidney

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3
Q

Liver disease usually leads to drug ______.

A

Accumulation

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4
Q

Definition: Tolerance

A

Decreased drug responsiveness due to repeated drug administration

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5
Q

pharmacodynamic tolerance

A

upregulation/downregulation of receptors (cell adjusts based on continuous agonist/antagonist activity)

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6
Q

metabolic tolerance

A

CYP450 induction (some drugs increase activity of this enzyme system resulting in more rapid metabolism)

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7
Q

tachyphylaxis

A

decreased responsiveness to a drug due to multiple doses over a short period of time.

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8
Q

Low albumin (low protein concentration) results in _______ (higher or lower) drug concentration

A

higher

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9
Q

Does decreased protein binding decrease drug toxicity?

A

No - the opposite. It increases drug toxicity

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10
Q

Drugs can get trapped in the fetal circulation due to:

A

ion trapping

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11
Q

teratogenesis

A

production of congenital anomalies

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12
Q

list the pregnancy drug categories

A

A: safe, no demonstrated fetal harm
B: animal research suggests safety (inadequate human studies)
C: animal research suggests risk (inadequate human studies)
D: fetal risks are shown, but benefits may outweigh risks in certain situations
X: never an indication to use during pregnancy

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13
Q

Does a higher or lower concentration of drug pass through the blood brain barrier in neonates/infants?

A

Higher due to immature BBB development

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14
Q

Is the CYP450 system faster or slower in neonates/infants? What are the implications?

A

Slower. Drug accumulation

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15
Q

Is renal drug excretion faster or slower in neonates/infants? What are the implications?

A

Slower. Drug accumulation

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16
Q

At what age do pediatric pharmacokinetics approach adult values?

A

1year

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17
Q

List some causes of adverse drug reactions in the older adult

A

*decrease renal function
other pharmacokinetic abnormalities
comorbidities
polypharmacy
poor adherence
wider variation in response
multiple healthcare prescribers

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18
Q

pharmacogenomics

A

how genes affect a person’s response to drugs

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19
Q

Why is a drug that is excreted in the urine a bad choice for an elderly patient?

A

Elderly patient’s have decreased GFR, higher effective dose, drug is excreted slower —> toxicity

20
Q

How should you treat someone who has an adverse reaction to a drug that acts as a positive allosteric modulator?

A

Target the receptor system in an opposite way, give antagonist to receptor

21
Q

What is a more suitable drug for a patient with low GFR?

A

Drug with a shorter 1/2 life, drug that is not dependent on the kidney to be excreted

22
Q

General variances in drug responses

A
  • body weight, body composition
  • pathologies
  • tolerance
  • variances in absorption (gastroparesis, food intake, diarrhea/constipation)
  • diet and malnutrition
  • non adherence
  • age
  • placebo effect
23
Q

How does body fat affect drug response?

A
  • more fat = store more drug / larger reservoir
  • less fat = more side effects (smaller reservoir / overflow bucket —> more drug is in the blood)
  • people w/ lower body fat have higher potency and need lower dose
24
Q

First pass metabolism & pathologies

A
  • drug travels from lumen of GI to liver via portal vein
  • issues w/ portal vein (HTN) = poor metabolism of drug due to less blood flow to liver
  • cirrhosis = poor metabolism
25
Q

Tolerance requires

A

Higher dose to produce equal effects

26
Q

Example of a drug that is susceptible to tachyphylaxis

A

Nitroglycerin - taken for heart pain, works well 1st time but works less and less well after subsequent doses

27
Q

Risks is increased with ____ protein bound drugs

A

Highly

28
Q

Drugs affected by specific nutrients

A
  • MAOIs + tyramine (cheese, deli meat, pickles) —> malignant HTN
  • Many drugs (statins) + grapefruit juice (string CYP450 inhibitor)
29
Q

Guidance from 1977 to 1993 related to testing drugs on pregnant women

A

Females of childbearing age should be excluded from clinical trials

30
Q

Basic considerations for drugs and pregnancy / breastfeeding

A

Do not give drugs that:
- can transfer through the placenta
- are secreted in breast milk
Only want maternal system to be exposed to drug

31
Q

Physiological changes in pregnant women

A

Increased GFR and effective renal plasma flow (drugs are excreted and metabolized faster)

32
Q

What types of drugs pass through the placenta?

A
  • lipid soluble
  • unionized
  • not protein bound (lower concentration of albumin in pregnant women due to large blood volume)
33
Q

Drugs to avoid in pregnancy

A
  • adverse drug reactions affecting the pregnant individual —> systemic effects that can have secondary effect on fetus
  • drugs that can complicate pregnancy / cause spontaneous abortion (avoid drugs that cause smooth muscle contraction)
    -drugs that have special side effects during pregnancy (heparin = osteoporosis)
  • drugs that can cause physical dependence in newborn (withdrawal symptoms and/or physiologic alterations)
  • drugs that are teratogenic
34
Q

Pregnancy drug categories

A

Pregnancy, lactation, females & males of reproductive potential

35
Q

Basic considerations for pediatrics

A
  • greater variability in response to drugs (every child develops differently)
  • immature organ systems in very young —> altered PK & PD
  • many drugs have not been tested in children specifically, lack of reliable dosing info
36
Q

Splanchnic circulation

A

Aorta —> coeliac, superior mesenteric & inferior mesenteric artery —> GI organs —> portal vein —> liver —> inferior vena cava

37
Q

What organs are fed by the coeliac artery?

A

Stomach, spleen, pancreas

38
Q

What organs are fed by the superior mesenteric artery?

A

Pancreas, small & large intestine

39
Q

What organs are fed by the inferior mesenteric artery?

A

Large intestine

40
Q

Splanchnic circulation in older adults

A

Decreased, blood takes longer to reach liver

41
Q

Neonate metabolism & excretion

A

CYPs & UGTs decreased
Albumin decreased
Renal function decreased

42
Q

Infant (4 weeks - 1year) metabolism & excretion

A

CYPs = very increased
UGTs same as adults
Albumin & renal function same as adult

43
Q

Child metabolism and excretion

A

CYPs increased
UGTs, albumin & renal function = same as adults

44
Q

Elderly metabolism and excretion

A

Decreased CYPs & UGTs
Decreased albumin & renal function

45
Q

PD changes in older adults

A
  • changes in # of receptors
  • alterations in receptor affinity for drug binding
  • beta blockers = less effective (decreased receptors and receptor affinity)
46
Q

Ultra rapid metabolizes

A
  • use CYP2D6 to convert codeine (doesn’t go to CNS) into morphine (does go to CNS)

Pharm (26 decks)

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