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