PKPD

Question 1

Dec liver blood flow

Answer 1

• impacts drugs with high 1st pass effect
• high concentrations of drug
• propranolol, morphine, coreg

Question 2

Morphine

Answer 2

titrate to effect, change to diff agent

Question 3

Coreg, Propranolol

Answer 3

Titrate to effect

Question 4

Loss of hepatocyte function

Answer 4

• dec metabolic capacity
• effects phase I metabolism more than phase II
• increases therapeutic effect
• use agents that undergo phase II met
• benzos:
  
  • diazepam (phase I)
  • lorazepam (phase II)

Question 5

Dec albumin production

Answer 5

• heavily protein bound, more unbound drug, more therapeutic effect
• Phenytoin (dec dose if needed to compensate)
• dec renal function in setting of inc SCr
• inc therapeutic response (inc permeability of BBB)
  
  • opioids, benzos (dec dose to compensate)