Lifespan COPY

Question 1

Renal disease usually leads to drug _______.

Answer 1

Accumulation

Question 2

What is the most important cause of adverse drug reactions in older adults?

Answer 2

Kidney disease/aging kidney

Question 3

Liver disease usually leads to drug ______.

Answer 3

Accumulation

Question 4

Definition: Tolerance

Answer 4

Decreased drug responsiveness due to repeated drug administration

Question 5

pharmacodynamic tolerance

Answer 5

upregulation/downregulation of receptors (cell adjusts based on continuous agonist/antagonist activity)

Question 6

metabolic tolerance

Answer 6

CYP450 induction (some drugs increase activity of this enzyme system resulting in more rapid metabolism)

Question 7

tachyphylaxis

Answer 7

decreased responsiveness to a drug due to multiple doses over a short period of time.

Question 8

Low albumin (low protein concentration) results in _______ (higher or lower) drug concentration

Answer 8

higher

Question 9

Does decreased protein binding decrease drug toxicity?

Answer 9

No - the opposite. It increases drug toxicity

Question 10

Drugs can get trapped in the fetal circulation due to:

Answer 10

ion trapping

Question 11

teratogenesis

Answer 11

production of congenital anomalies

Question 12

list the pregnancy drug categories

Answer 12

A: safe, no demonstrated fetal harm
B: animal research suggests safety (inadequate human studies)
C: animal research suggests risk (inadequate human studies)
D: fetal risks are shown, but benefits may outweigh risks in certain situations
X: never an indication to use during pregnancy

Question 13

Does a higher or lower concentration of drug pass through the blood brain barrier in neonates/infants?

Answer 13

Higher due to immature BBB development

Question 14

Is the CYP450 system faster or slower in neonates/infants? What are the implications?

Answer 14

Slower. Drug accumulation

Question 15

Is renal drug excretion faster or slower in neonates/infants? What are the implications?

Answer 15

Slower. Drug accumulation

Question 16

At what age do pediatric pharmacokinetics approach adult values?

Answer 16

1year

Question 17

List some causes of adverse drug reactions in the older adult

Answer 17

*decrease renal function
other pharmacokinetic abnormalities
comorbidities
polypharmacy
poor adherence
wider variation in response
multiple healthcare prescribers

Question 18

pharmacogenomics

Answer 18

how genes affect a person’s response to drugs

Question 19

Why is a drug that is excreted in the urine a bad choice for an elderly patient?

Answer 19

Elderly patient’s have decreased GFR, higher effective dose, drug is excreted slower —> toxicity

Question 20

How should you treat someone who has an adverse reaction to a drug that acts as a positive allosteric modulator?

Answer 20

Target the receptor system in an opposite way, give antagonist to receptor

Question 21

What is a more suitable drug for a patient with low GFR?

Answer 21

Drug with a shorter 1/2 life, drug that is not dependent on the kidney to be excreted

Question 22

General variances in drug responses

Answer 22

• body weight, body composition
• pathologies
• tolerance
• variances in absorption (gastroparesis, food intake, diarrhea/constipation)
• diet and malnutrition
• non adherence
• age
• placebo effect

Question 23

How does body fat affect drug response?

Answer 23

• more fat = store more drug / larger reservoir
• less fat = more side effects (smaller reservoir / overflow bucket —> more drug is in the blood)
• people w/ lower body fat have higher potency and need lower dose

Question 24

First pass metabolism & pathologies

Answer 24

• drug travels from lumen of GI to liver via portal vein
• issues w/ portal vein (HTN) = poor metabolism of drug due to less blood flow to liver
• cirrhosis = poor metabolism

Question 25

Tolerance requires

Answer 25

Higher dose to produce equal effects

Question 26

Example of a drug that is susceptible to tachyphylaxis

Answer 26

Nitroglycerin - taken for heart pain, works well 1st time but works less and less well after subsequent doses

Question 27

Risks is increased with ____ protein bound drugs

Answer 27

Highly

Question 28

Drugs affected by specific nutrients

Answer 28

- MAOIs + tyramine (cheese, deli meat, pickles) —> malignant HTN - Many drugs (statins) + grapefruit juice (strong CYP450 inhibitor)

Question 29

Guidance from 1977 to 1993 related to testing drugs on pregnant women

Answer 29

Females of childbearing age should be excluded from clinical trials

Question 30

Basic considerations for drugs and pregnancy / breastfeeding

Answer 30

Do not give drugs that: - can transfer through the placenta - are secreted in breast milk Only want maternal system to be exposed to drug

Question 31

Physiological changes in pregnant women

Answer 31

Increased GFR and effective renal plasma flow (drugs are excreted and metabolized faster)

Question 32

What types of drugs pass through the placenta?

Answer 32

- lipid soluble - unionized - not protein bound (lower concentration of albumin in pregnant women due to large blood volume)

Question 33

Drugs to avoid in pregnancy

Answer 33

- adverse drug reactions affecting the pregnant individual —> systemic effects that can have secondary effect on fetus - drugs that can complicate pregnancy / cause spontaneous abortion (avoid drugs that cause smooth muscle contraction) -drugs that have special side effects during pregnancy (heparin = osteoporosis) - drugs that can cause physical dependence in newborn (withdrawal symptoms and/or physiologic alterations) - drugs that are teratogenic

Question 34

Pregnancy drug categories

Answer 34

Pregnancy, lactation, females & males of reproductive potential

Question 35

Basic considerations for pediatrics

Answer 35

- greater variability in response to drugs (every child develops differently) - immature organ systems in very young —> altered PK & PD - many drugs have not been tested in children specifically, lack of reliable dosing info

Question 36

Splanchnic circulation

Answer 36

Aorta —> coeliac, superior mesenteric & inferior mesenteric artery —> GI organs —> portal vein —> liver —> inferior vena cava

Question 37

What organs are fed by the coeliac artery?

Answer 37

Stomach, spleen, pancreas

Question 38

What organs are fed by the superior mesenteric artery?

Answer 38

Pancreas, small & large intestine

Question 39

What organs are fed by the inferior mesenteric artery?

Answer 39

Large intestine

Question 40

Splanchnic circulation in older adults

Answer 40

Decreased, blood takes longer to reach liver

Question 41

Neonate metabolism & excretion

Answer 41

CYPs & UGTs decreased Albumin decreased Renal function decreased

Question 42

Infant (4 weeks - 1year) metabolism & excretion

Answer 42

CYPs = very increased UGTs same as adults Albumin & renal function same as adult

Question 43

Child metabolism and excretion

Answer 43

CYPs increased UGTs, albumin & renal function = same as adults

Question 44

Elderly metabolism and excretion

Answer 44

Decreased CYPs & UGTs Decreased albumin & renal function

Question 45

PD changes in older adults

Answer 45

- changes in # of receptors - alterations in receptor affinity for drug binding - beta blockers = less effective (decreased receptors and receptor affinity)

Question 46

Ultra rapid metabolizers

Answer 46

- use CYP2D6 to convert codeine (doesn’t go to CNS) into morphine (does go to CNS)