Professional Documents
Culture Documents
Dr.U.P.Rathnakar
MD.DIH.PGDHM
New
Driver Mfr.defect Bad road Over loaded Engine problem
[Age?]
[M or F] [Genetic?] [Envn.] [Obesity?] [Patho.states]
Cumulation:
When elimination is slower- may accumulate and produce toxic effect- Digoxin
Tablets & aerosols difficult to administer Tetracyclines get deposited in teeth Drug metabolism may be faster in childrenhigher dose of digoxin Children are definitely not Miniature adults
7. Sex[gender]
Females-smaller size Androgens[Females] & estrogens[Males] Betablockers-affect sexual function only in males Ketaconozloe-libido in men, gynecomastia Pregnancy: GI motility low-delayed absorption Renal blood flow increases-Fast elimination of drugs Terratogenic
Genetic factors
Pharmacogenetics- Study of genetic basis for variability of drug response Pharmacogenomics- Use of this information for the choice of drugs in an individual INH [Isoniazid]-Fast and slow acetylators Succinylcholine-Apnoea [Atypical pseudocholinesterase]
Emotional factors
Placebo [I will please] [Nocebo-I will harm] Dummy medicine without Pharmacological effect [Psychodynamic
effect]
Some may have endogenous activity [Naloxone blocks analgesic effect of placebo]
1. 2.
Placebo reactors Uses Relief of subjective symptoms- Eg .Anxiety In Clinical trials to reduce bias Factors affecting placebo action Pt factors-With neurotic symptoms Drug factor-Injection, Capsules, colored tablets Doctor factor-Personality, Fame, Dr - Pt relationship
Pathological states
Gastrointestinal diseases: Malabsorption syndrome: Achlorhydria: Decreases aspirin absorption Liver disease: First pass metabolism B.A of Lidocaine, Propranalol Kidney disease Clearance of drugs that are excreted in unchanged form. Aminoglycosides
Kidney disease
[Aminoglycosides, Digoxin, Phenobarbitone]
Tolerance
Tolerance occurs when the person no longer responds to the drug in the way that person initially responded. A state in which higher dose is required to achieve the same effect Eg. Nitrates in Angina Morphine in pain relief
Types of Tolerance
Natural
Tolerance
Acquired
On repeated exposure
Tolerance: Mechanism
Pharmacokinetic: Increased Metabolism, reduced absorption [Barbiturates] Pharmacodynamic Cells of the target organ become less sensitive Morphine, Barbiturates, Nitrates, Alcohol
Others
Antipyeretics lower body temp.-Fever Thiazides marked diuresis-Edema Myesthenics-sensitive to curare Hypnotics in a pt. with pain-mental confusion and delirium
PD interactions
The direct pharmacodynamic interactions Antagonism or synergism The indirect pharmacodynamic interactions Digoxin and spironolactone Salicylates and warfarin
Drug interactions
Beneficial or harmful [Make a list from text book] Common with drugs exhibiting
Steep DRC Low TI Enzyme induction / inhibition Zero order kinetics