Special topics

Question 1

what are some age-related physiological changes that can affect pharmacokinetics?

Answer 1

clearance

Question 2

what are physiological changes in pregnancy?

Answer 2

• cardio: potential changes in distribution due to decreases in serum albumin concentration, increase CO, PV, SV, and HR, compression of vena cava by uterus
• renal: increase renal blood flow and glomerular filtration rate
• liver: changes in enzymes (certain CYP450 increase and CYP1A2 decreases)
• stomach/intestines: delayed gastric emptying, reflux, prolonged small bowel transit time
• AVD can vary

Question 3

why are pregnant women more vulnerable to caffeine intake?

Answer 3

since have decreased CYP1A2, which removes methyl groups from caffeine via oxidation reactions, so have longer half-life. also baby is vulnerable (everything goes through placenta)

Question 4

how do rapid-diffusing and slow-diffusing drug affect the mother and it’s embryo?

Answer 4

• rapid: will go into circulation of both mother and fetus quickly, but will also be eliminated in both fairly quickly
• slow: gradual accumulation since hard to cross membranes, so even after mother starts eliminating, may still be in placenta

Question 5

what are ways that drugs can affect the fetus?

Answer 5

• no effect
• transient effect (same mother and fetus)
• irreversible structural malformation
• delayed effects on behavior or reproductive function

Question 6

what is the effect of zika virus if a pregnant women is infected?

Answer 6

• baby has major malformations (small head and eye issues)

Question 7

what is the effect of covid-19 on pregnant women?

Answer 7

• more risk for preterm birth
• more risk for poorer outcomes such as loss of pregnancy

Question 8

what was thalidomide used for? what was the effect on newborn babies?

Answer 8

• used to treat symptoms of nausea and vomiting during pregnancy
• phacomelia (flipper-like limbs)
• if used at days 27-30 - arm defects
• if used at days 30-33 - leg defects
• also issues in neural system development

Question 9

what are the consequences of drinking alcohol when pregnant?

Answer 9

• fetal alcohol spectrum disorder
• growth retardation, facial features, CNA abnormalities

Question 10

why can you not take retinoids when pregnant?

Answer 10

• retinoic acids are important signaling molecules during development (they put in action different patterns of gene expression to control limb and organ development)

Question 11

what is the effect of folic acid during pregnacny?

Answer 11

• prevents neural tube defects

Question 12

why should the mother still be careful with what drug she is taking even after giving birth?

Answer 12

since chemicals can get into breast milk

Question 13

what are things that should be considered when looking at therapeutic effects/uses of drugs for children?

Answer 13

• big difference in proportion of body water vs body weight
• lower amount of fatty tissue in children (so drugs don’t get stored in fats)
• less developed liver metabolism
• less developed renal elimination

Question 14

in premature babies, how is drug absorption and elimination altered?

Answer 14

• increased skin permeability
• high gastric pH
• slow gastric emptying time
• absence/presence of GI flora
• differences in renal system and liver function
• CYP450s very deficient until ~1 month

Question 15

what is polypharmacy and what may this lead to?

Answer 15

• taking may drugs at once (to treat different chronic diseases)
• may lead to adverse drug related hospitalizations

Question 16

what are considerations that we must take for elderly patients?

Answer 16

• difference in proportion of body water vs body weight
• higher amount of fatty tissue
• decrease liver metabolism
• decrease renal function
• increase in bioavailability (less first pass)