Special Populations

Question 1

Pharmacokinetics

Answer 1

How the body changes the drug

Changes in ADME

Question 2

Pharmacodynamics

Answer 2

Drug response caused by drug-receptor interactions

Question 3

6 factors that influence hepatic and renal effects on pharmacokinetics

Answer 3

Organ size
Tissue composition
Blood flow
Enzyme activities
Transport activities
Protein binding

Question 4

Ganciclovir

Answer 4

Antiviral used to treat cytomegalovirus

Eliminated primarily through kidney excretion

Question 5

ACE inhibitors in diabetes

Answer 5

Renoprotective
Diabetics have high afferent flow that causes higher pressure in the glomerulus and results in protein secretion
Dilating the efferent arteriole reduces the pressure in the glomerulus

Question 6

How do ACE inhibitors work

Answer 6

Angiotensin 2 receptor blockers
Results in efferent arteriole dilation
Decreases pressure in the glomerulus

Question 7

ACE inhibitors and chronic kidney disease

Answer 7

People with CKD often have lowered afferent flow, so dilation of the efferent vessel drops the pressure even further
Can lead to renal failure

Question 8

What classification is used for liver function?

Answer 8

Child-Pugh classification and scoring

Total score is classified as mild, moderate or severe

Question 9

The amount of drug removed by the liver is dependent on what?

Answer 9

Hepatic blood flow

Hepatic impairment -> decreased blood flow -> decreased metabolism

Question 10

Cirrhosis

Answer 10

Complication of liver disease
Commonly caused by long term alcohol abuse and hep B/C
Loss of liver cells and permanent scarring
Liver function greatly decreased

Question 11

Chlormethiazole

Answer 11

Has high hepatic extraction ratio
Oral bioavaliability is increased in cirrhosis
Used to treat and prevent symptoms of acute alcohol withdrawal
Alcohol use can lead to overdose

Question 12

4 physiological changes that occur during pregnancy

Answer 12

Increased GFR
Altered hepatic metabolism
GI motility slows
Changes in drug volume of distribution
Other changes in respirator rate, BP, plasma albumin changes, HR, etc
All of these changes affect pharmacokinetics

Question 13

Teratogenic

Answer 13

An agent that can disturb the development of embryo or fetus

Question 14

Tetracycline

Answer 14

Antibiotic
Causes permanent discolouration of teeth in infants and children when used during pregnancy
Due to an uptake in iron during bone development

Question 15

Thalidomide

Answer 15

Sedative used for morning sickness in the 50s

Withdrawn from market due to teratogenicity and neuropathy

Question 16

Midazolam

Answer 16

Used for procedural sedation or trouble sleeping
Cleared primarily by CYP3A4
Greater activity in females leading to greater clearance of the drug

Question 17

Long QT syndrome

Answer 17

Prolonged QT interval
Many people have no signs or symptoms, but it can lead to fainting, seizures, and sudden death
Women have a higher risk of drug induced Long QT syndrome

Question 18

What are 2 explanations for the sex difference in Long QT syndrome?

Answer 18

Females have longer baseline QT interval

Women have more K cardiac channels

Question 19

Differences in distributions of 
1. Extracellular body water
2. Body fat
3. Proteins
in children vs adults

Answer 19

1. Children have higher percentage of extracellular body water (hydrophilic drugs may distribute more)
2. Differences in body fat affect hydrophobic drug distribution
3. Children have a lower proportion of proteins (protein binding is lower which changes drug distribution)

Question 20

How does renal elimination change during development?

Answer 20

Normal as a newborn, increases until 5 years old, and then begins to decline

Question 21

Hepatic elimination in children

Answer 21

Slower elimination rates and increased half-life in newborns

Toddlers tend to have higher metabolic activity than adults

Question 22

Gray baby syndrome

Answer 22

Adverse event occurring in newborn infants following IV administration of chloramphenicol (antimicrobial)

Question 23

2 causes of gray baby syndrome

Answer 23

Reduced glucuronidation of chloramphenicol

Reduced renal elimination of chloramphenicol

Question 24

Reye’s syndrome

Answer 24

Rare adverse event associated with giving aspirin to children who have viral infections
Death in 20-40% of instances of Reye’s syndrome
Causes swelling in the liver and brain
Exact cause is unknown

Question 25

Changes in geriatrics (7)

Answer 25

Reduction in hepatic mass and blood flow
Change in plasma protein composition
Reduction in renal mass and GFR
Increase in body fat
Decrease in plasma volume
Decrease in total body water
Decrease in extracellular body fluid

Question 26

Effects of pregnancy on amoxicillin and why this happens

Answer 26

Concentration is decreased during pregnancy

Because of the increased GFR