Targeted Pharmacology Flashcards
*Pharmacokinetic and pharmacodynamic principles in PREGNANCY
Absorption, distribution, metabolism, elimination
Absorption:
- oral: decreased gastric motility, nausea and vomiting
- transdermal: increased blood flow, increased water content
Distribution:
- increase blood volume (30-50%)»>reduced serum concentrations
- increase adipose
- decrease albumin»>reduced drug-protein binding creating increased serum levels
Metabolism:
-induced/inhibitied CYP450 enzyme activity
Elimination:
-increased renal blood flow»>increased GFR
Exposure to fetus: fetal hepatic metab develops slowly»>longer duration and extent of exposure
*Pharmacokinetic and pharmacodynamic principles in LACTATION
Rate and extent of passive diffusion depends on physical drug properties – lipophilic, hydrophobic, non-ionized*
minimize exposure to infant by treating w/ non-pharmacological agents or by using minimal effective dose for shortest possible duration
coordinate feeding schedules and medication
*Pharmacokinetic and pharmacodynamic principles in PEDIATRICS
dosages cannot be based on body weight or surface area extrapolated from adult populations
absorption: highly variable depending on age and development
- gut pH
- gastric emptying time
- intestinal motility
- digestive enzmyes
*absorption rate of liquids is generally faster
premature/neonates: increased skin permeability»>increased topical absorption
rectal aborption: 1st pass effect avoided, incomplete and erratic absorption d/t frequent bowel movements, decreased blood flow
Total water composition varies by age-neonates most water to infants (4-6mo)/adults the least
Protein binding reduced in infancy»>increased free drug
immature enzymes»>slower metabolic processes»>longer duration of action (slower elimination)
*Pharmacokinetic and pharmacodynamic principles in GERIATRICS
includes adults >65yo
Absoprtion:
- increase gastric pH
- delayed gastric emptying
Distribution:
- decreased muscle mass
- increased body fat
- decreased drug-protein binding
Metab:
- decreased liver size
- decreased hepatic blood flow and efficacy»>reduced metabolite clearance
- decreased first pass effect (higher peak during concentrations)
- extended half life
Elimination:
- reduced renal function
- decreased rate of active drug and metabolite elimination
- increased side effect sensitivity
- higher sensitivity to drug-receptor interactions
- greater CNS effects
Individualized Pharmacotherapy
all patients are NOT equal, medication therapy must be personalized
kinetic and dynamic principles are different in EVERY patient
