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What can be done to excrete a drug faster?
- alter pH of blood and urine
- alter electrolytes
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What is pharmacodynamic tolerance?
receptor sites are always occupied so you need a higher amt to produce same effect
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Metabolic Tolerance
- Tolerance resulting from accelerated drug metabolism.
- This form of tolerance is brought about by the ability of certain drugs (eg, barbiturates) to induce synthesis of hepatic drug-metabolizing enzymes, thereby causing rates of drug metabolism to increase.
- Because of increased metabolism, dosage must be increased to maintain therapeutic drug levels.
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Tachyphalaxis
tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time.
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more intense effects and possible toxicity could be a result of malnutrition because
- Lower amounts of plasma proteins (albumin) causing levels of free drug to rise
- Decreased oxidative metabolism & decreased glomerular filtration rate
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Phamacogenetics
is the study of genetically inherited conditions that affect the way drugs act on the body and modify the way the body acts on drugs
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Based on research for risks posed to the fetus, what are the categories?
- Category A and B (remote risk)
- Category C (if benefit outweighs the risk) Mom may fall ill if not given to her. Monitor mom and baby closley
- Category D and X (proven risk)
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What is the difference in absorption in children when it comes to parenteral, enteral, and topical?
- Enteral: absorption rate goes up
- Parenteral : muscles arent as large so we must use smaller volume
- Topical: absorb faster cuz skin is thinner and higher water.
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What are the differences in distribution when it comes to children?
- Higher water concentration, lower fat
- Immature blood brain barrier
- Limited protein binding capacity
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Who is at risk for the most intense adverse affects?
- Neonates (1st 4 weeks of life)
- Infants (week 5-52 of life)
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In the older adult, distribution decreases, medications don't dissolve as well, and medications are stored in fat cells. Why?
- Decreased CO = distribution decreases
- Decreased body water= meds don’t dissolve well
- Increase body fat= resevior for meds
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How can we avoid adverse effects?
- Obtain a solid baseline assessment
- Benefit:Risk ratio
- Strategies to help unintentional noncompliance
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Because the degree of renal impairment among the elderly varies, what test should be done for pts that are about to take a drug excreted by the kidneys?
creatinine clearance test to test how well kidneys function
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