last part of unit three power point with voice over

1. Pharmacogenomics http://www.stjude.org/stjude/v/index.jsp?vgnextoid=2a654597ef7ea210VgnVCM1000001e0215acRCRD&vgnextchannel=708113c016118010VgnVCM1000000e2015acRCRD&emailthisarticle=ETASJ

2. Factors that influence medication actions

3. Drug levels Time course of drug response Plasma drug levels Half life Plateau Reducing fluctuations

4. Pharmacology Drug tolerance Unusually low physiologic activity in response to a drug Person requires increased doses to get therapeutic effect

5. Pharmacology Cumulative effect Increasing response to repeated doses Occurs when rate of administration exceeds rate of metabolism Drug builds up; toxicity occurs

6. Pharmacology Idiosyncratic effect Under or over response Unexpected, unpredictable, unexplainable Drug interaction Occurs before, during, after administration of another drug Can be synergistic or potentiating or can be inhibiting

7. Side effect – unintended effect Adverse effect- unexpected and can be severe Drug toxicity- buildup of drug in blood Drug allergy- occurs after administration and can be anaphylactic SOB, tachy, hypotension, stridor Emergency

8. Neonatal and Pediatric Considerations: Pharmacokinetics Absorption Gastric pH less acidic Gastric emptying is slowed Intramuscular absorption faster and irregular

9. Neonatal and Pediatric Considerations: Pharmacokinetics (cont’d) Distribution The younger the person, the greater the % of total body water Greater TBW means fat content is lower Decreased level of protein binding Immature blood-brain barrier—more drugs enter the brain

10. Neonatal and Pediatric Considerations: Pharmacokinetics (cont’d) Metabolism Liver immature, does not produce enough microsomal enzymes Older children may have increased metabolism, requiring higher doses than infants Other factors

11. Neonatal and Pediatric Considerations: Pharmacokinetics (cont’d) Excretion Kidney immaturity affects glomerular filtration rate and tubular secretion Decreased perfusion rate of the kidneys may reduce excretion of drugs

12. Factors Affecting Pediatric Drug Dosages Skin is thin and permeable Stomach lacks acid to kill bacteria Lungs have weaker mucus barriers Body temperatures less well regulated and dehydration occurs easily Liver and kidneys are immature, impairing drug metabolism and excretion

13. Methods of Dosage Calculation for Pediatric Patients Body surface area method Using the West nomogram Body weight dosage calculations Using mg/kg

14. The Elderly Elderly: older than age 65 Healthy People 2010: older than age 55 Use of OTC medications Increased incidence of chronic illnesses Polypharmacy

15. Physiologic Changes in the Elderly Patient Cardiovascular Gastrointestinal Hepatic Renal

16. The Elderly: Pharmacokinetics Absorption Gastric pH less acidic Slowed gastric emptying Movement through GI tract slower Reduced blood flow to the GI tract Reduced absorptive surface area due to flattened intestinal villi

17. The Elderly: Pharmacokinetics (cont’d) Distribution TBW percentages lower Fat content increased Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)

18. The Elderly: Pharmacokinetics (cont’d) Metabolism Aging liver produces fewer microsomal enzymes, affecting drug metabolism Reduced blood flow to the liver

19. The Elderly: Pharmacokinetics (cont’d) Excretion Decreased glomerular filtration rate Decreased number of intact nephrons

20. The Elderly:Problematic Medications Analgesics, including NSAIDs Anticoagulants Anticholinergics Antidepressants Antihypertensives Cardiac glycosides (digoxin) Sedatives and hypnotics Thiazide diuretics

21. Factors effecting medication action Developmental factors Gender Cultural, ethnic, genetic Diet Environment

22. Developmental considerations: Children Don’t say candy Use liquid Don’t lie about injections Older adults Altered memory Renal function, liver function Decreased absorption in GI tract Altered quality of organ response to drug

23. The end