Lifespan Considerations

Question 1

3 different types of tolerance

Answer 1

1. pharmacodynamic tolerance
2. metabolic tolerance
3. Tachyphylaxis

Question 2

Response from drug decreases with increase dosing

Answer 2

Tachyphylaxis

-have to have drug free time to replenish effectiveness

Question 3

Require increase amount of drug to achieve same effect/pain relief

Answer 3

Pharmacodynamic tolerance

• ex: opioids, alcohol
• what we most think of related to tolerance

Question 4

Accelerated rate of drug metabolism

Answer 4

Metabolic Tolerance

Question 5

Any response to a drug that is based solely on individuals psychological reaction to the idea of taking the drug

Answer 5

Placebo

Question 6

Study of relationship between genetic variation and how our body responds to medication

Answer 6

Pharmacogenomics

Question 7

3 genetic metabolic classifications related to P450

Answer 7

• ultra metabolizers
• extensive metabolizers (normal)
• poor metabolizers

Question 8

What is the benefit of pharmacogenomics?

Answer 8

better match drug to person to achieve response needed

Question 9

Kidney disease affects which stage of medication in the system

Answer 9

Excretion

Question 10

Kidney failure changes drug half life from ____ hours to ____ hours

Answer 10

1.5 , 25

Question 11

2 measures of kidney function used to adjust medication dose

Answer 11

1. creatinine clearance (24 hour urine + bld)

2. GFR- usually use this

Question 12

Liver disease affects which stage of medication in the system

Answer 12

metabolism

Question 13

What effects liver metabolism? (conditions)

Answer 13

• ESLD, Cirrhosis, Hep B

- hepatotoxic medications

Question 14

3 ways that women have different drug metabolism

Answer 14

1. metabolize alcohol more slowly
2. increase effectiveness of certain opioid drugs
3. Quinidine causes increase QT interval prolongation

Question 15

2/3 of all pregnant women take at least ___ medications

Answer 15

1

Question 16

3 physiological changes effecting dosing during pregnancy

Answer 16

1. 3rd trimester = doubled renal bld flow and excretion
2. Bowel decrease tone and mobility causing increased absorption
3. increased hepatic metabolism

Question 17

Which drugs cross the placenta?

Answer 17

ALL- some just do it easier then others like Lipid Soluble ones

Question 18

Cause of the majority of birth defects?

Answer 18

unknown

Question 19

Percent of birth defects caused by drugs

Answer 19

< 1%

Question 20

3 factors effecting a drugs effect on baby

Answer 20

1. stage of fetal development
2. amount of drug ingested
3. frequency of drug ingested

Question 21

When do gross malformations caused by teratogens in fetus occur?

Answer 21

embryonic period- week 3-8

Question 22

When are fxns disrupted by teratogens in fetus?

Answer 22

fetal period- week 9-term

Question 23

2 ways to know drugs effects on pregnant women/fetus

Answer 23

1. drug registry

2. Retrospective studies

Question 24

2020 label change for pregnancy and lactation risk categories

Answer 24

-includes male and female reproductive harm

Question 25

Lactation increased risk of drug doing harm to baby

Answer 25

- fat solubility - oral bioavailability - half life

Question 26

Lactation decreased risk

Answer 26

- molecular size - protein binding availability - acidity

Question 27

How to decrease infant risk during lactation

Answer 27

1. take drugs immediately after breast feeding 2. avoid drugs that have a long half life 3. choose drugs that tend to be exliucded from milk 4. avoid drugs known to be hazardous

Question 28

Pediatrics age range

Answer 28

<16 yrs of age

Question 29

2 ways to determine dose for pediatrics

Answer 29

1. area BSA (body surface area * adult dose / 1.73 m2) | 2. Weight (mg/kg/day)

Question 30

Pedes have delayed elimination resulting in

Answer 30

prolonged response

Question 31

Pedes have organ immaturity until age

Answer 31

1

Question 32

kids have elevated drugs levels causing

Answer 32

more intense reponse

Question 33

Metabolism in pedes....

Answer 33

increase until age 2 and then gradually declines

Question 34

Topical absorption is ____ in pedes

Answer 34

greater

Question 35

No BBB until age

Answer 35

1

Question 36

#1 way to help medication adherence in kids

Answer 36

education

Question 37

CYP450 and poor metabolizers- active drug and pro drug

Answer 37

Active drug: increase toxicity | Prodrug: decrease effect

Question 38

CYP450 and ultrarapid metabolizer- active drug and pro drug

Answer 38

Active drug: decrease effect | Prodrug: increase toxicity

Question 39

During the first two weeks of conception what are the risks from teratogenic drugs?

Answer 39

All or none effect: spontaneous abortion or proceed normally