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Individual Drug Response

IKE HUSEN Depart.of Pharmacology & Therapy Medical Faculty – Padjadjaran University

EXTERNAL FACTORS • Patient compliance – Temporary – Easy to correct without alter dose of drug or the regimen • Medication errors .I.

Pharmacodynamic factors – Responses of the body to the drugs .II. INTERNAL FACTORS (Drug-body interaction) • A. Pharmacokinetic factors – Drug level at the receptor • B.

3. 4. 8. 2. Physiological conditions Pathological conditions Genetic factors Drug interactions Development of tolerance Placebo effects Environmental factors Biological rhythmic.II. INTERNAL FACTORS 1. 5. . 7. 6.

Diseases – Without symptom – Chronic diseases – Diseases which is needs preventive therapy Decreases patient compliance .EXTERNAL FACTORS Patient compliance Factors 1.I.

Drugs/therapy – Multiple drugs – Complex regimen dose – The tablet is difficult to be swollen or bad tasty – Adverse drug reactions Decreases patient compliance .EXTERNAL FACTORS Patient compliance Factors 2.I.

I.EXTERNAL FACTORS Patient compliance Factors 3. Patient – Very old/ very young – Low intellectuality – Psychiatric problem 4. Doctor – Optimistic – Skillfully Increase patient compliance .

Condition of Physiological Factors A.II. INTERNAL FACTORS 1. Neonates and Premature Infants – – – – – Lower biotransformation function of lever Low plasma protein binding capacity Undeveloped blood-brain barrier Low excretion function of kidney High receptor sensitivity .

Elderly person – Deceasing of metabolic capacity – Decreasing of plasma protein capacity – Decreasing of excretion functions of kidney – Increasing of receptor sensitivity .Condition of Physiological Factors B.II. INTERNAL FACTORS 1.

II. INTERNAL FACTORS 2. Condition of Pathophysiological Factors • GIT: alter absorption of drugs • Lever dysfunctions: – Plasma protein binding capacity – Circulation to the lever – Metabolic capacity • Congestive heart failure: clearance of lidocaine .

Condition of Pathophysiological Factors • Pulmonary diseases: decreases circulation to lever and kidney • Kidney diseases: decreasing of drugs clearance • Hypo and Hyperthyroids – Bioavailability (riboflavin) – Biotransformation (Propilthiourasil) – Renal excretion (digoxin) . INTERNAL FACTORS 2.II.

Condition of Pathophysiological Factors • Pregnancy – Decreasing plasma protein binding capacity (phenytoine) – Increasing renal excretion – Alter of metabolism • Diseases which are alter the receptor sensitivity – Myasthenia gravis – Parkinson's . INTERNAL FACTORS 2.II.

Genetic Factors • Contribute in pharmacological activity differences (qualitative and quantitative) • Quantitative : – Metabolic capacity (INH-slow/fast acetylators) • Qualitative : – Drugs which are have specific toxicity in persons with abnormal genetic factors (exp.II. G6PD) . INTERNAL FACTOR 3.

II. INTERNAL FACTOR 4. Drug Interaction • Will be discussed in other session .

INTERNAL FACTOR 5. organic nitrite • May appear cross-tolerance among drugs which have the same receptor • Pharmacokinetic tolerances: metabolism • Pharmacodynamic tolerances: cellular adaptations (exp. Chronic uses of opioids. barbiturates. CNS depressants. organic nitrite) • Tachyphilacis: acute tolerance . Development of tolerance • Tolerance: decreasing pharmacological effect in repeated dose (exp. ethanol.II. opioid.

Placebo Effects • Net effect = pharmacological + placebo effect • placebo effect may different interindividual and intraindividual (intraindividual in different time) .II. INTERNAL FACTOR 6.

Theophylline) • Alcohol may alter responses of some drugs – Acute : Inhibition of drug biotransformation – Chronic: Induce of drug biotransformation . Environmental Factors • Alcohol and smoking are suspected interfere drug responses • Cigarette is containing polycyclic hydrocarbon may increasing metabolism of specific drugs (exp.II. INTERNAL FACTOR 7.

Biological Rhythmic • Physiological sensitivity (Chronesthesi) • Drug dispositions (Cjronopharmacokinetic) • Circadian • Circatrigintan • Circanual . INTERNAL FACTOR 8.II.