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last part of unit three power point with voice over

last part of unit three power point with voice over

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  • What is pharmacogenomics? Pharmacogenomics is the study of how an individual's genetic inheritance affects the body's response to drugs. The term comes from the words pharmacology and genomics and is thus the intersection of pharmaceuticals and genetics. Pharmacogenomics holds the promise that drugs might one day be tailor-made for individuals and adapted to each person's own genetic makeup. Environment, diet, age, lifestyle, and state of health all can influence a person's response to medicines, but understanding an individual's genetic makeup is thought to be the key to creating personalized drugs with greater efficacy and safety. Pharmacogenomics combines traditional pharmaceutical sciences such as biochemistry with annotated knowledge of genes, proteins, and single nucleotide polymorphisms
  • What is polypharmacy?Polypharmacy means "many drugs" and refers to problems that can occur when a patient is taking more medications than are actually needed. It is a particular concern for older adults, who make up 13% of the population but account for almost 30% of all prescribed drugs. The typical older adult takes one or more prescription drugs plus several OTC remedies, such as antacids, laxatives or pain-killers, often used without informing their physician. Some people have no problems at all, but others suffer because of the combination of drugs they take. Indeed, research has found that higher rates of depression and lower quality of life were results of a person's perception that they were taking too many drugsMrs. P., age 89, has appointments this week with her primary physician, a specialist for rheumatoid arthritis, an ophthalmologist, and a pulmonary specialist. What can be done to prevent possible polypharmacy with Mrs. P.?

Transcript

  • 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