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Medicine Year 2 > People and Illness Week 1 > Flashcards

People and Illness Week 1 Flashcards

1
Q

Describe the mechanism of action of psychostimulant drugs

A

Act on D1 receptors in the prefrontal cortex and D2 in the striatum - boost noradrenaline/dopamine signalling

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2
Q

How effective are psychostimulants in the treatment of ADHD?

A

Efficacy = 75%

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3
Q

Describe the bonds which form between a drug and its receptor

A

Covalent bonds are stable and essentially irreversible Electrostatic bonds may be strong or weak, but are usually reversible

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4
Q

Give examples of drug-disease interactions

A
  • Patients with Parkinson’s disease have increased risk of drug induced confusion
  • NSAID (COX-2) can exacerbate heart failure
  • Urinary retention in BPH patients on decongestants or anticholinergics
  • Constipation worsened by calcium, anticholinergics, calcium channel blockers
  • Neuroleptics and quiolones lower seizure thresholds
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5
Q

List the areas of questioning when taking a history for ADHD

A
  • Parental/patient reports of symptoms
  • Systemic enquiry
  • Past history - pregnancy/delivery, past behaviour and development
  • Developmental history
  • Medical history - past/current illness, past operations, head injury, tics/funny turns/faints/seizures, current medication, allergies
  • Family history - medical and social
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6
Q

Which additional ADHD drugs are not used in children?

A
  • Anti-depressants (enhance amount of monoamines at the synapse) e.g. nortriptyline, imipraine
  • Modafinil - weak psychostimulant, weak affinity for dopamine uptake carrier sites, decrease GABA and increase glutamine and control degree of hypothalamic arousal
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7
Q

Describe the dosage schedule of atomoxitine

A

Once daily or bi-daily dosing

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8
Q

Compare the function of agonists, antagonists and partial agonists

A

Agonist has affinity and intrinsic activity Antagonist has affinity but no intrinsic activity, competitive and non-competitive Partial agonist has affinity but less intrinsic activity

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9
Q

When are symptoms of ADHD often more pronounced?

A

In the afternoon

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10
Q

What specialists are part of the CAMHS multi-disciplinary team?

A
  • Psychiatrists
  • Psychologists
  • Social worker
  • Nurses
  • Support workers
  • Occupational therapists
  • Psychological therapists - child, family, play therapists and creative art therapists
  • Primary mental health link workers
  • Specialist substance misuse workers
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11
Q

How long does it take for atomoxitine to provide a therapeutic effect?

A

Within 6 weeks

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12
Q

Describe the mechanism of action of adrenergic drugs

A

Alpha 2 A adrenergic receptor agonist

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13
Q

What requirements do drugs have to meet to bind to a specific receptor?

A

Size, shape, stereospecificity

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14
Q

When is atomoxetine used in the treatment of ADHD?

A

When stimulants ineffective/not tolerated/co-morbidity

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15
Q

Define pharmacodynamics

A

Study of the biochemical and physiological processes underlying drug action (mechanism of drug action, drug-receptor interaction, efficacy and safety profile) - ‘what the drug does to your body’

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16
Q

How does renal disease affect drug metabolism and prescription?

A

Same hepatic metabolism Same/increased volume of distribution and prolonged elimination (half-life increased) Increase dosing interval

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17
Q

List the side effects of guanfacine

A

Sedation, headache, fatigue, bradycardia, agitation, sinus arrhythmia

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18
Q

Define elimination half-life

A

Time for concentration to fall to half

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19
Q

What type of attention normally develops at age 5+ years?

A

Integrated - mature attention control

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20
Q

Are nutritional supplements helpful in managing ADHD?

A

Omega 3/6 fish oils, iron, zinc, vitamin B - inconclusive evidence but may be beneficial

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21
Q

How is phenytoin dosage calculated?

A

15mg/kg

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22
Q

Why are enzymes often the therapeutic target of drugs?

A

Enzymes control metabolic processes - in patient (e.g. ACE inhibitors) or in microbes/tumours (e.g. penicillin)

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23
Q

Describe the preparations of atomoxitine

A

Tablet, long-acting

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24
Q

What is the difference between linear and non-linear pharmacokinetics?

A
  • Linear - Concentration that results from a dose is proportional to the dose (double the dose, double the concentration) Rate of elimination is proportional to the concentration (50% o drug will be eliminated in a given time frame)
  • Non-linear pharmacokinetics - Concentration that results is not proportional to dose Rate of elimination is constant regardless of amount of drug present Dosage increases can saturate binding sites and result in non-proportional increase in drug levels (or opposite in dose decrease)
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25
Q

Define ED50 and LD50

A

ED50 - dose for efficacy in 50% of the population LD50 - dose which causes death in 50% of the population

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26
Q

What structured questionnaire is used to diagnose ADHD?

A

SNAP-IV - teacher and parent rating scale

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27
Q

List the executive difficulties resulting from ADHD

A
  • Organisation - Planning - Working memory - Attention - Response inhibition - Impulse control
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28
Q

How is a history from the patient/parent taken in diagnosis of ADHD?

A
  • Current behaviours, activity levels, impulsivity, emotional reactivity - Ability to sustain interest/attention (with/without adult involvement) - Eating habits - Sleeping patterns - What is the impact on functioning? - Responses to and interactions with others - Parental management strategies - Structured questionnaires (parent and self-report)
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29
Q

To what extent do genetic factors cause ADHD?

A

Genetic-environment interactions - genes can either increase or reduce the impact of an environment or an environment can activate a genetic effect Twin adoption studies show that mean heritability of ADHD is 75% in children and adolescents

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30
Q

Describe the pathological changes which can be seen in a brain with ADHD

A
  • Smaller brain volume - frontal and parietal cortex - Smaller basal ganglia - Right dorsolateral prefrontal lobe reduced - Smaller cerebellar vermis - Attentional systems involve anterior fronto-striatal networks - Posterior parieto-cerebellar circuits
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31
Q

In which co-morbidity is dexamphetamine more useful?

A

ADHD and foetal alcohol syndrome

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32
Q

Where are drug receptors found?

A

Extracellular or intracellular

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33
Q

Describe the changes which contribute to the development of an adult brain during adolescence

A

Morphological and functional changes in the brain, with increasing hormone levels and other biological changes, interact with cultural, economic and psychosocial factors to shape how adolescents think, feel and behave

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34
Q

How does hepatic impairment affect the pharmacokinetics of drugs?

A

First pass metabolism Activation of prodrugs Decreased protein binding Decreased elimination

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35
Q

Describe the preparations of dexamphetamine

A

5mg (three times daily) immediate release Elvanse (lisdexamphetamine dimesylate) - Prodrug (inactive) - less susceptible to abuse - Metabolised to dexamphetamine by RBC at set rate - Rapid onset of action, lasts 13 hours - Can be dissolved in water (ease of administration) Tablet, short and long-acting

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36
Q

How do drugs work?

A

Can stimulate (agonist) or inhibit (antagonist) the receptor action, this usually involves an effect on signal transduction pathway

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37
Q

Describe the neurobiology of arousal systems in ADHD

A

ADHD = deficiency in arousal systems

  • Defective inhibitory response from prefrontal cortex - insufficient information processing
  • Neurons in PFC are unable to distinguish between important signals and ‘background noise’
  • Hypo-arousal - low firing of dopamine/noradrenaline neurones, decreased efficiency of information processing
  • Hyper-arousal - increased phasic firing of dopamine/noradrenaline neurons, stimulates additional receptors, signal-to-noise detection deteriorates causing poor attention and impulsivity
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38
Q

What type of attention normally develops at age 4-5 years?

A

Dual channelled - can do a task and listen to someone at the same time

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39
Q

What are the symptoms of opioid toxicity?

A

Drowsiness, pin-point pupils, decreased respiratory rate, altered blood gases (type II respiratory failure)

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40
Q

Describe management of a child’s environment in the management of ADHD

A
  • Provide a calm environment - reduce background noise e.g. TVs - Avoid too many distracting stimuli when you want the child to concentrate - Initially avoid situations that require quiet, still behaviours for long periods - Maintain structure and supervision longer than you think should be necessary
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41
Q

Describe the SIGN guidelines for diagnosis of ADHD

A
  • Core symptoms have significant impact on child’s development - They impair social, emotional and cognitive function - The symptoms are responsible for considerable morbidity and dysfunction for the child/young person and their family
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42
Q

How long does it take for the therapeutic effect of psychostimulants to become apparent?

A

Within days

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43
Q

Define antagonists

A

Interact with the receptor but do not change the receptor, have affinity but no efficacy, two types - competitive and non competitive

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44
Q

List the factors which affect bioavailability

A

Drug factors - molecular weight/ionisation Absorption - gastric pH/health of GI tract First pass metabolism (hepatic) - phenytoin may reduce F, grapefruit juice may increase

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45
Q

What could change volume of distribution between patients?

A

Difference in weight

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46
Q

With which co-morbidities is atomoxitine more helpful?

A

Tics Anxiety Autism spectrum

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47
Q

Define half-life

A

Time required for serum plasma concentration to decrease by half

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48
Q

How is apparent volume of distribution calculated?

A

Total amount of drug in the body/drug blood plasma concentration

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49
Q

List the side effects of clonidine

A

Sedation, constipation, headaches, hypotension, depression, bradycardia

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50
Q

How does cystic fibrosis affect drug metabolism and prescription?

A

Increased metabolism/elimination Larger volume of distribution Increase dose, decrease dosage interval

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51
Q

Describe the main symptoms associated with ADHD

A

Inattention and lack of persistence in activities requiring attention - e.g. a tendency to move from 1 task to another without completion, defective filtering of information Excessive activity - disorganised/ill-regulated, restless/fidgety, motor hyperactivity/psychomotor agitation Impulsivity - poor awareness of danger/accident prone, social inhibition/excessively talkative, poor peer relationships, emotional dysregulation

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52
Q

How is therapeutic index calculated?

A

TD50 or LD50/ED50

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53
Q

What determines half-life?

A

Clearance and volume of distribution

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54
Q

Describe the mechanism of action of dexamphetamine

A

Facilitates release of dopamine from presynaptic cytoplasmic storage vesicles in synapse and blocks dopamine transporter protein (inhibits re-uptake) - increase in dopamine

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55
Q

Give examples of drugs with non-linear pharmacokinetics

A

Phenytoin, digoxin

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56
Q

What type of attention normally develops at age 3-4 years?

A

Focus - attention is single-channelled, but the child can control this themselves

57
Q

Describe the prevalence of ADHD

A

Male:female - 3-4:1 Females often go undiagnosed 1-5% of child-adolescent population

58
Q

What is the effect of renal disease on the pharmacodynamics of drugs?

A

Altered sensitivity to drug effect Adverse effects

59
Q

List the functional types of drug receptors

A

Regulatory - change the activity of cellular enzymes Enzymes - may be inhibited or activated Transport - e.g. Na/K ATPase Structural - form cell parts

60
Q

What is adolescence?

A

The period following puberty during which a young person develops from a child to an adult

61
Q

How is a treatment plan for ADHD determined?

A

Preschool children - behavioural parent training by trained facilitators School aged children - - Mild ADHD - consider behavioural approaches in the first instance - Moderate/severe: 1. No comorbidity - medication recommended 2. ODD/aggressive behaviour - combination of medication and behavioural treatment 3. Generalised anxiety disorders - combination of medication and behavioural treatments

62
Q

Define bioavailability

A

Fraction of the administered dose of drug that reaches the systemic circulation, expressed as letter F

63
Q

How can morphine dosage be converted from oral to parenteral?

A

Parenteral dose is 1/3 of oral dose

64
Q

What determines loading dose?

A

Desired concentration and volume of distribution

65
Q

How long does it take for drugs to reach a steady state?

A

4-5 half lives

66
Q

How is renal function determined?

A

Serum creatinine is unreliable marker, if accuracy is needed creatinine clearance is used

67
Q

How long does the therapeutic effect of guanfacine take?

A

Within 3 weeks

68
Q

What criteria must clinical features fit in order to diagnose ADHD?

A

Must be - - Apparent before child is age 7 (12 in adults) - Excessive for the child’s age and development - Pervasive i.e. evident in more than 1 environment

69
Q

What behavioural changes occur during adolescence due to changes in brain structure/function?

A

Increased risk taking, sensation seeking and alcohol/drug use due to development of the reward pathway Enhanced reactivity but reduced responsiveness to aversive stimuli/consequences, heightened arousal and emotions (amygdala development) Development of inhibitory self-control

70
Q

Define hyperkinetic disorders and list the types of hyperkinetic disorders

A

Disturbance of activity and attention - hyperkinetic conduct disorder, other hyperkinetic disorder, hyperkinetic disorder unspecified

71
Q

What type of attention normally develops at age 2-3 years?

A

Single-channelled - can only focus on one thing at a time

72
Q

When should a cardiologist assess a patient on psychostimulants?

A

If: - History of congenital heart disease or previous cardiac surgery - History of sudden death in first degree relative under 40 - Shortness of breath on exertion compared with peers - Fainting on exertion or in response to fright/noise - Palpitations that are rapid, regular and start/stop suddenly - Chest pain suggesting cardiac origin - Signs of heart failure - Murmur heard on cardiac examination

73
Q

Describe the mechanism of action of atomoxitine

A

Enhances noradrenaline transmission in the prefrontal cortex

74
Q

How should ACE inhibitors prescription be altered in renal disease?

A

With caution

75
Q

Define clearance

A

Volume of plasma (blood etc) cleared of drug per unit time (e.g. ml/min or L/hour)

76
Q

How does age generally influence pharmacodynamics of drugs?

A

Some effects increased - alcohol (increased drowsiness and lateral sway), fentanyl, diazepam, morphine, theophylline Some effects decreased - diminished HR response to isoproterenol and beta-blockers

77
Q

How does oral morphine administration differ from subcutaneous/intravenous administration?

A

Morphine has low bioavailability when given orally (25-30%), much higher when given IV/subcutaneously (approx 1)

78
Q

Which processes contribute to the changes which occur in the adolescent brain?

A
  • Synaptic pruning - loss of approximately 50% of synaptic connections in some areas - Myelination - less grey matter, more white matter - Development of areas modulating social, aversive and emotional stimuli e.g. amygdala and ventral striatum
79
Q

List the side effects of psychostimulants

A

Common: Reduce sleep and appetite (anorexia) Abdominal discomfort Headaches Potential for growth retardation Less common: Hypertension Tachycardia

80
Q

What determines the prognosis in ADHD?

A

Co-morbidities - organic disorders, psychiatric disorders, learning difficulties Socio-economic disadvantage, negative parent-child interaction, familial ADHD

81
Q

How long does the therapeutic take in alpha adrenergic drugs?

A

4-6 weeks

82
Q

Define a drug receptor

A

A macromolecular component of a cell with which a drug interacts to produce a response, usually a protein

83
Q

Give examples of drugs which are affected by reduced first pass metabolism

A

Profound changes in bioavailability - chlormethiazole, verapamil, paracetamol First pass activation reduced - enalapril, perindopril

84
Q

How does therapeutic index impact the choice of drug?

A

The higher the TI the better the drug, drugs acting on the same receptor or enzyme system often have the same TI

85
Q

How should assessment for ADHD be carried out in a school setting?

A
  • Speak with education staff - behaviours during structured/less structured activities, inattentive/’daydream’ behaviours, concentration and speed of work, impulsivity, quality of relationships with peers/adults, levels of attainment e.g. reading, spelling and numbers - Observation in school setting - Standardised questionnaires for education staff
86
Q

List the subtypes of ADHD

A

Predominantly inattentive, predominantly hyperactive-impulsive and combined type

87
Q

How is IV loading dose calculated?

A

Target concentration (mg/L) x V (L/kg)

88
Q

Define affinity

A

Measure of a propensity of a drug to bind to a receptor, the attractiveness of drug and receptor

89
Q

How is ADHD diagnosed?

A
  • Direct observations in >1 setting - home, school etc. - Psychoeducational assessment - Structured questionnaires - Identifying co-morbid health problems - Developmental history
90
Q

Describe behavioural management of ADHD

A
  • Encourage consistency in managing less desirable behaviour - Do not personalise the behaviour problems - Positively reinforce appropriate and acceptable behaviour - Assist parents to be firm and in control without being coercive - set clear rules with consequences, use routine, countdowns and reminders, use quiet time, planned ignoring and timeout (age appropriate) - Provide feedback using direct observation of interactions between child and parents
91
Q

Compare guanfacine and clonidine use

A

Guanfacine is licensed for ADHD treatment of 6-17 year olds so is being increasingly used as 2nd line treatment, clonidine is not

92
Q

How is education used in the management of ADHD?

A
  • Parents/carers/teaching staff and older patients should be given psychoeducation on ADHD, potential co-morbidities, possible management options - Regular communication between health/education/social work etc.
93
Q

What are the risks associated with methylphenidate?

A

Abuse Tics Epilepsy Increased BP Hyperthyroid

94
Q

What should be considered in patients with decreased elimination?

A

Determination of renal function Alteration of dosing schedule Monitoring drug concentrations

95
Q

Which genes contribute to increased risk of ADHD?

A
  • Candidate susceptibility ADHD genes
  • Associated LD disorders e.g. fragile X syndrome, Klinefelter syndrome, William’s syndrome
96
Q

How is loading dose affected by renal function?

A

It isn’t - loading dose only depends on desired concentration and volume of distribution

97
Q

In which co-morbidities is clonidine helpful?

A

Tics, aggression, sleep disorder

98
Q

What type of attention normally develops at age 1-2 years?

A

Rigid - can attend to a task of their choosing

99
Q

Describe the preparations of guanfacine

A

Oral prolonged release tablet formulation, available as 1mg, 2mg, 3mg and 4mg Tablets should not be crushed, chewed or broken before swallowing

100
Q

What are the risks associated with dexamphetamine?

A

Abuse Tics Epilepsy Increased BP

101
Q

What is elimination half-life used to determine?

A

Time to eliminate drug, time to reach steady state and dosage interval

102
Q

Describe the mechanism of action of methylphenidate

A

Blocks dopamine and noradrenaline re-uptake via transporter

103
Q

What additional physiological assessments should be carried out in diagnosis of ADHD?

A
  • Hearing screening checks - Vision screening checks - As appropriate to previous/current health problems e.g. cardiac, epilepsy - Examination for neurological signs and physical anomalies - Baseline height and weight (record on centile growth chart) - Baseline blood pressure/pulse/heart sounds
104
Q

Define agonists

A

Drugs that interact with and activate receptors, they possess both affinity and efficacy Two types - full and partial

105
Q

How should a patient on ADHD medication be monitored?

A

Regular review (<6 monthly) but more frequent when titrating medicines Monitor response to medication Monitor side effects Monitor height, weight, pulse and BP

106
Q

What effect does hepatic impairment have on pharmacodynamics?

A
  • Sensitivity to sedatives
  • Sensitivity to oral anticoagulants
  • Precipitation of encephalopathy
  • Fluid retention
  • Hepatorenal syndrome
107
Q

Must drug holidays be taken on psychostimulants?

A

Yes

108
Q

Define volume of distribution

A

The volume in which the amount of drug would need to be uniformly distributed to produce observed blood concentration

109
Q

What co-morbidities are often seen alongside ADHD?

A
  • Sleep disorders (up to 50%) - Behavioural difficulties - oppositional defiant disorder or conduct disorder (25-50%) - Specific learning disabilities e.g. dyslexia (30%) - Developmental coordination disorders (30%) - Social communication difficulties (25%) - Anxiety symptoms (25%) - Tic disorders e.g. Tourette syndrome (20%) - Mood difficulties (20%)
110
Q

Which drugs should have a lower dose prescribed in renal disease?

A

Antibiotics, LMWH, digoxin, phenytoin

111
Q

How does myelination occur during adolescence?

A
  • Myelination increases speed of transmission while reducing energy needed - thinning of grey matter but increase in white matter - Occurs back to front - sensory/motor function areas first, prefrontal cortex and other areas involved in advanced cognitive function last
112
Q

Define potency and explain its significance

A

Relative position of the dose-effect curve along the dose axis Has little clinical significance for a given therapeutic effect (a more potent drug is not clinically superior) Low potency is a disadvantage only if the dose is so large that it is awkward to administer

113
Q

How does hepatic disease affect drug metabolism and prescription?

A

Same renal elimination Same/increased volume of distribution and slower rate of enzyme metabolism (half life and bioavailability increased) Decrease dose, increase dosing interval

114
Q

Which drugs should be avoided in renal disease?

A

Metformin, NSAIDs

115
Q

List the risk factors for ADHD

A
  • Premature birth - Low birth weight - Prenatal tobacco exposure - Non-intact family/single parent household - Paternal history of anti-social behaviour - Maternal depression - Lower maternal education - Lower social class - Young maternal age at birth of affected child - Inconsistent parenting - Adverse childhood environment/psychosocial distress
116
Q

What should be monitored in patients on psychostimulants?

A

Height/weight BP, pulse Efficacy Side-effects

117
Q

How is arousal normally mediated?

A

By dopamine and noradrenaline, mostly in prefrontal cortex Dopamine - mesocortical, nigrostriatal and mesolimbic pathways from substantia nigra/ventral tegmental area to pre-frontal cortex Noradrenaline - from locus ceruleus to frontal and limbic regions

118
Q

List the side effects of atomoxitine

A
  • Nause/vomiting - Excessive tiredness - Insomnia - Abdominal pain, appetite suppression, weight loss - Constipation - Headaches - Mood swings/rage - Hepatic impairment (monitor LFTs, parents should recognise symptoms) - Increased HR/BP - Suicidal ideation (raised awareness amongst parents/carers)
119
Q

What is CAMHS?

A

Child and adolescent mental health services - Work with children or young people who have difficulties with their emotional/behavioural wellbeing - Multidisciplinary teams - Up to age 16/18 or later - Support in depression, problems with food, self-harm, abuse, violence or anger, bipolar, schizophrenia, anxiety etc. - Referred by parents, teacher, GP or self if old enough

120
Q

In which co-morbidities is guanfacine helpful?

A

Tics, poor sleep

121
Q

Describe the preparations of methylphenidate

A

Tablet and liquid, short and long-acting - Immediate release 5mg tablets (3-4x per day) - Various preparations - duration 8-12 hours - Rapid onset of action - Cannot be manipulated for ease of administration (can’t break capsule) - Usually give long acting in morning with immediate release later afternoon/early evening - Brand names e.g. Ritalin, Medikinet

122
Q

How does hepatic impairment affect the pharmacodynamics of drugs?

A

Altered drug effect

123
Q

Compare the potency of common analgesic drugs

A

Hydromorphone > morphine > codeine > aspirin

124
Q

List the types of drug receptor

A
  1. Enzyme linked (multiple actions) 2. Ion-channel linked (speedy) 3. G protein linked (amplifier) 4. Nuclear (gene) linked (long-lasting)
125
Q

Define efficacy

A

Intrinsic activity - ability of a bound drug to change the receptor in a way that produces an effect (some drugs possess affinity but not efficacy)

126
Q

What is the effect of renal disease on the pharmacokinetics of drugs?

A

Decreased elimination Decreased protein binding Decreased hepatic metabolism

127
Q

What is the action of a competitive antagonist?

A

Competes with agonist for receptor Surmountable with increasing agonist concentration Displaces agonist dose response curve to the right (dextral shift) Reduces the apparent affinity of the agonist

128
Q

What is the difference between a full and partial agonist?

A

Full - agonist with maximal efficacy Partial - an agonist with less than maximal efficacy

129
Q

What is the legal status of pschyostimulants? How does this impact prescribing?

A
  • Schedule 2 controlled drugs - prescription required - Rx has 28-day validity - Rx signed on collection (need proof of identity) - 30-day supply (may give more if requested but prescriber must state why) - Must state - form and strength of preparation, total quantity to be supplied in words and figures, dose to be administered, signed and dated by prescriber
130
Q

How long does the therapeutic effect of clonidine take?

A

Within 6 weeks

131
Q

Define pharmacokinetics

A

The science of the rate of movement of drugs within biological systems, as affected by the absorption, distribution, metabolism and elimination of medications - ‘what your body does to the drug’

132
Q

Define ADHD

A

Attention deficit hyperactivity disorder, hyperkinetic neurodevelopmental mental disorder

133
Q

What type of attention normally develops at age 0-12 months?

A

Fleeting - focuses very briefly and very quickly distracted

134
Q

What commonly occurs when prescribing for the elderly?

A

Under-treatment: Coronary artery disease - beta blockers/aspirin Anticoagulation in atrial fibrillation Hypertension Pain Particular fear of narcotics in the elderly

135
Q

List the pharmacological treatment options for ADHD

A

1st line - psychostimulants (methylphenidate, dexamphetamine) 2nd line - atomoxetine 3rd line - adrenergic drugs (guanfacine or clonidine)

136
Q

Give examples of drug-drug interactions

A

Statins and erythromycin and other antibiotics Verapamil (calcium channel blocker) and beta-blockers Warfarin and multiple drugs (including aspirin) ACE inhibitors increase hypoglycaemic effect of sulfonylureas

137
Q

How does having a long half-life impact administration of a drug?

A

Need to use loading dose to quickly reach therapeutic index

138
Q

How effective is atomoxitine in ADHD treatment?

A

Efficacy = ?75%

139
Q

How does age influence GFR?

A

GFR generally declines with age, but is extremely variable - 30% have little change 30% have moderate decrease 30% have severe decrease

Medicine Year 2 (41 decks)

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