chapter 48 women as patients

Question 1

factors influencing drug distribution in females

Answer 1

• higher proportion of body fat-lipophillic drugs more easily absorbed and greater distribution than hydrophillic drugs
• plasma volume lower-higher concentration of drugs in plasma
• estrogen attaches to serum-binding globulin-exogenous estrogen increases serum-binding globulin leaving little free drug

Question 2

influences on drug metabolism in females

Answer 2

• different concentration of hepatic enzymes effects clearance rates of different drugs
• with lower levels of p-glycoprotein-have higher rates of drug clearance with p-glycoprotein substrates

Question 3

influences of drug excretion in females

Answer 3

-renal clearance most likely influenced by weight not by gender

Question 4

female athlete triad

Answer 4

combination of symptoms including amenorrhea, disordered eating, and osteoporosis
-disruption of growth and development due to inadequate nutrition and over exercising

Question 5

common problems that require medication for females

Answer 5

• menopause
• dysmenorrhea-usually due to prostaglandins-NSAIDS-inhibit prostaglandins throughout body
• PMS-tx: ibuprofen, vitamin B6, calcium carbonate
• premenstrual dysphoric disorder-must have symptoms>5 months to be diagnosed; tx: spiralactone, NSAIDS, oral contraceptives
• endometriosis-can lead to scaring; tx: diet change, NSAIDS, oral contraceptives, Ca, Mg, Omega 3 supplements
• HIV/AIDS in pregnancy
• infertility
• polycystic ovarian syndrome-can lead to infertility, higher risk for DM; tx: oral contraceptives, metformin/insulin for infertility

Question 6

absorption and bioavailability in women

Answer 6

-gastric emptying slower mainly related to effects of estrogen-longer exposure to absorption site
-gastric levels of alcohol dehydrogenase lower leading to higher BAC after same amt of ETOH ingested
-lower body weight with increased ratio of fat-increased absorption of lipophilic drugs
-specific drug examples:
opioids-greater analgesic effects
ASA, coumadin/warfarin-bleed easier
Psychotropic–greater improvement
anti-viral-more side effects

Question 7

pregnancy

Answer 7

-absorption in lungs increased
-pharmacokinetic changes
-iron deficiency anemia a concern
teratogen risk from drugs, etoh, and tobacco use
-caffeine should be limited
-smoking/tobacco use affects o2 availability to fetus
-herb use in pregnancy still a lot unknown