Therapeutics (Part 3)

Question 1

What are treatment decision processes based on?

Answer 1

• clinical factors, e.g diagnosis, symptoms & severity
• drug factors, e.g. mode of function, t1/2, formulation, route of delivery
• patient factors, age, liver, + renal function, other diseases

Question 2

What are drug factors and when are they considered?

Answer 2

• early in decision making process, considerations being:
• pharmacodynamic, biopharmaceutical, pharmacokinetic
• each stage may be modififed/constrained by patient, economic and prescriber factors

Question 3

What does ADME stand for?

Answer 3

• administration/absorption
• distribution
• metabolism
• elimination

Question 4

What do patient factors include?

Answer 4

Age:
- young, organs not fully developed, incleased % of water
Old, failing organs, high % of fat, low lean body mass, low total body water
- shows atypical response to drugs
E.g. increased sensitivity to drugs acting on CNS/exaggerated response to vasodilators - older generation

Question 5

What are other patient factors?

Answer 5

• race/ pharmacognetics, difference in enzyme systems e.g. renin/angiotensin - poor responders in afro-carribeans to B-blockers/ACEI
• adherence - intentional/non-intentional
• pregnancy/breastfeeding
• allergy, will limit choice e.g. penicillin
• concurrent disease
• interactions (reduced efficacy due to multiple drugs taken)
• adverse events ( ascertain from patient in order to avoid repearing event)

Question 6

What is concurrent disease?

Answer 6

• mutiple morbidities resulting in polypharmacy
• drug handling can be affected by disease e.g. renal/heart failure
• having lots of drugs to choose from affects adherence, how well drugs = taken
• affects how drugs might work

Question 7

What is polypharmacy?

Answer 7

• when someone is on multiple medicines at once
• might reduce efficacy of a drug
• “do you take any other medication?” e.g. NSAIDS and antihypertensives