Illness
Pathologic conditions may alter rate of absorption, distribution, metabolism, and excretion of drug
Psychology
Attitudes and expectations play a major role in a patient’s response to therapy; willingness to take medication as prescribed
Metabolic rate
Patients with higher-than-average metabolic rate tend to metabolize drugs more rapidly
Placebo effect
Patient’s positive expectation can positively affect the outcome
Nocebo effect
Patient’s negative expectations can result in a less-than-optimal outcome
Cumulative Effect
Drug accumulation occurs when the next dose is given before the previously given drug has been metabolized or excreted
Carcinogenicity
Ability of a drug to induce living cells to mutate and become cancerous
Absorption
Process by which drugs are absorbed in the body; most common is via GI tract; other routes are parenteral and topical
what depends on the ph of enzymes
Absorption by passive diffusion across the membranes and gastric emptying time depend on the pH of the environment.
Newborns have an absence of enzymes needed for hydrolysis.
Process whereby the body inactivates medications; primarily occurs in the liver
Metabolism
As the body ages, important physiologic changes take place in the kidneys, including decreased renal blood flow caused by atherosclerosis and reduced cardiac output, a loss of glomeruli, and decreased tubular function and urine-concentrating ability.
Metabolites
Products of metabolism.
What is intestinal transit
refers to speed at which the intestine moves foods, secretions, and other ingested matter along, and this rate varies with age.
Therapeutic Drug Monitoring
Measurements of drug concentration in blood sample
Therapeutic Drug Monitoring
Dosage and frequency of medications can be adjusted to maintain therapeutic level of potentially toxic drugs
Aspirin
use linked with Reye’s syndrome
Potentially Inappropriate Medications for Geriatric Patients
Includes medications that should be avoided and those that are rarely appropriate: Some barbiturates, benzodiazepines, and some narcotics
Which patient has the greatest percentage of body water?
infant
Which type of topical drug is more readily absorbed by infants?
water soluble
Which form of medication is more easily administered for a toddler who requires a course of antibiotics?
liquid
Due to the decreased protein-binding capacity in preterm infants, what adjustment in dosage of protein-binding drugs would need to made?
The dosage should be increased.
Teratogens
Drugs that cause abnormal development of fetal tissues
Drugs Known to be Teratogenic
Androgenic and estrogenic hormones
ACE inhibitors, ethanol, tetracycline
Thalidomide, vitamin A, warfarin
Genetics
Study of how living organisms inherit the traits of their ancestors, including function of metabolic pathways
Genome
Complete package of genetic coding of an organism
Pharmacogenetics
Study of how drug response may vary according to inherited differences
Monoclonal antibodies
antibodies are early examples of medicines that were synthesized to attack certain types of cancers