Women As Patients

Question 1

Describe how women grow and develop after puberty.

Answer 1

Women- during puberty, increases in estrogen and progesterone prepare women for fertility and reproduction.

Menopause signals the cessation of reproductive capability for females.

Question 2

Describe how men grow and develop after puberty.

Answer 2

Men- during puberty, an increase in androgens trigger a cascade of changes such as increased height, weight, and muscle mass and the genital changes that accompany the ability to reproduce.

Sperm production begins at puberty and continues until levels of testosterone start to wane, usually in their 6th or 7th decade.

Question 3

What negative outcomes are associated with teenage pregnancy?

Answer 3

• Inconsistent prenatal care
• Smaller infants
• Preterm labor
• Infants at a high risk for developmental disorders and other medical conditions associated with low birth weight
• Neglect and abuse account for 2 deaths per 1,000 healthy infants born to adolescents 15 years or younger
• Risk from sudden infant death syndrome (SIDS) increases

Question 4

What is dementia?

Answer 4

Clinically apparent cognitive decline

Question 5

What is the most commonly occurring form of dementia?

Answer 5

Alzheimer’s disease (AD)

Question 6

What are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat cognitive dysfunction?

Answer 6

Acetylcholinesterase inhibitors

Question 7

What are the gender differences of absorption and bioavailability?

Answer 7

• Gastric emptying time is slower in females, mainly related to the effects of estrogen. Drugs absorbed in the stomach will have longer exposure to absorption sites.
• Gastric levels of alcohol dehydrogenase are lower in females. Plasma concentrations are greater in females than males after ingestion of similar amounts of alcohol.
• Gastric acid secretion, pH, osmolality, electrolyte concentrations, and levels of bile acids and proteins do not vary significantly between sexes.

Question 8

What are the gender differences of distribution?

Answer 8

• Females have lower body weights and BMI than males.
• Females have a higher proportion of body fat. Lipophilic drugs are more readily absorbed and have relatively greater volumes of distribution than hydrophilic drugs.
• Plasma volume is lower in females. Drugs with high volumes of distribution will be more concentrated in the plasma of females.
• Organ blood flow is lower in females.
• Estrogen is distributed attached to a serum-binding globulin. Exogenous estrogens increase levels of many serum-binding globulins such as corticosteroid-binding globulin and thyroxine-binding globulin resulting in less free drug.

Question 9

What are the gender differences of metabolism?

Answer 9

• Studies have been inconsistent in showing differences in CYP450 substrates; the general trend is toward high rates of metabolism for CYP450 3A4 substrates and lower rates for 1A2 and 2D6 substrates.
• Females have lower levels of p-glycoprotein and higher rates of drug clearance for drugs that are substrates of p-glycoprotein.

Question 10

What are the gender differences of of excretion?

Answer 10

• Gender differences in rates of renal excretion of most drugs are probably more related to simple weight differences.
• Drugs that are actively secreted by the kidney may show gender differences, but further study is required to demonstrate this difference.

Question 11

Why is a greater fraction of ingested alcohol oxidized in men?

Answer 11

• Gastric levels of alcohol dehydrogenase are lower in women,
• So a greater fraction of ingested alcohol would be oxidized in men prior to absorption than in women.
• Why blood alcohol levels are disproportionately higher in women after ingestion of similar amounts of alcohol

Question 12

What is the CYP450 system?

Answer 12

a major group of enzymes involved in drug metabolism and bioactivation

Question 13

What is the CYP 3A4 enzyme?

Answer 13

• CYP 3A4 is

- activity is 24% higher in women

Question 14

What is the CYP 1A2 enzyme?

Answer 14

• CYP 1A2 is

- lower in women

Question 15

Is diazepam (Valium) water-soluble or fat-soluble?

Answer 15

• fat-soluble drug

- has a significantly larger Vd in women

Question 16

Is metronidazole (Flagyl) water-soluble or fat-soluble?

Answer 16

• water-soluble
• demonstrates a lower Vd, although increased clearance in women accounts for a lower area under the curve (AUC) for this drug in females.

Question 17

What influences the absorption and bioavailability of some drugs in women?

Answer 17

Women have longer gastric emptying times.

Question 18

Why is erythromycin more rapidly cleared in women than it is in men?

Answer 18

Thought to be related to its CYP450 3A4–mediated effect.

Question 19

W by is orally administered verapamil (Isoptin, Calan) clears more quickly in men than it does in women?

Answer 19

• based in part on its CYP 3A4 metabolism
• higher absolute bioavailability of this drug in women may explain the greater pharmacodynamic effects on blood pressure and heart rate in women

Question 20

What is the CYP 2D6 isoenzyme important in?

Answer 20

• the metabolism of many psychotropic drugs
• one study showed that tardive dyskinesia develops more frequently in female Chinese schizophrenics secondary to increased frequency of a defective CYP 2D6 allele in Chinese women

Question 21

Which benzodiazepines undergo oxidative metabolism?

Answer 21

• alprazolam
• diazepam
• midazolam

Oxidative metabolism is higher in women; these drugs are more rapidly metabolized than those that undergo conjugation.