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last part of unit three power point with voice over

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  1. 1. Pharmacogenomics<br /><br />
  2. 2. Factors that influence medication actions<br />
  3. 3. Drug levels<br />Time course of drug response<br />Plasma drug levels<br />Half life<br />Plateau<br />Reducing fluctuations <br />
  4. 4. Pharmacology<br /> Drug tolerance<br />Unusually low physiologic activity in response to a drug<br />Person requires increased doses to get therapeutic effect<br />
  5. 5. Pharmacology<br />Cumulative effect<br />Increasing response to repeated doses<br />Occurs when rate of administration exceeds rate of metabolism<br />Drug builds up; toxicity occurs<br />
  6. 6. Pharmacology<br />Idiosyncratic effect<br />Under or over response<br />Unexpected, unpredictable, unexplainable<br />Drug interaction<br />Occurs before, during, after administration of another drug<br />Can be synergistic or potentiating or can be inhibiting<br />
  7. 7. Side effect – unintended effect<br />Adverse effect- unexpected and can be severe<br />Drug toxicity- buildup of drug in blood<br />Drug allergy- occurs after administration and can be anaphylactic<br />SOB, tachy, hypotension, stridor<br />Emergency<br />
  8. 8. Neonatal and Pediatric Considerations: Pharmacokinetics<br />Absorption<br />Gastric pH less acidic<br />Gastric emptying is slowed<br />Intramuscular absorption faster and irregular<br />
  9. 9. Neonatal and Pediatric Considerations: Pharmacokinetics (cont’d)<br />Distribution<br />The younger the person, the greater the % of total body water<br />Greater TBW means fat content is lower<br />Decreased level of protein binding <br />Immature blood-brain barrier—more drugs enter the brain<br />
  10. 10. Neonatal and Pediatric Considerations: Pharmacokinetics (cont’d)<br />Metabolism<br />Liver immature, does not produce enough microsomal enzymes<br />Older children may have increased metabolism, requiring higher doses than infants<br />Other factors<br />
  11. 11. Neonatal and Pediatric Considerations: Pharmacokinetics (cont’d)<br />Excretion<br />Kidney immaturity affects glomerular filtration rate and tubular secretion<br />Decreased perfusion rate of the kidneys may reduce excretion of drugs<br />
  12. 12. Factors Affecting Pediatric Drug Dosages<br />Skin is thin and permeable<br />Stomach lacks acid to kill bacteria<br />Lungs have weaker mucus barriers<br />Body temperatures less well regulated and dehydration occurs easily<br />Liver and kidneys are immature, impairing drug metabolism and excretion<br />
  13. 13. Methods of Dosage Calculation for Pediatric Patients<br />Body surface area method<br />Using the West nomogram<br />Body weight dosage calculations<br />Using mg/kg<br />
  14. 14. The Elderly<br />Elderly: older than age 65<br />Healthy People 2010: older than age 55<br />Use of OTC medications<br />Increased incidence of chronic illnesses<br />Polypharmacy<br />
  15. 15. Physiologic Changes in the Elderly Patient<br />Cardiovascular<br />Gastrointestinal<br />Hepatic<br />Renal<br />
  16. 16. The Elderly: Pharmacokinetics<br />Absorption<br />Gastric pH less acidic<br />Slowed gastric emptying<br />Movement through GI tract slower<br />Reduced blood flow to the GI tract<br />Reduced absorptive surface area due to flattened intestinal villi<br />
  17. 17. The Elderly: Pharmacokinetics (cont’d)<br />Distribution<br />TBW percentages lower<br />Fat content increased<br />Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)<br />
  18. 18. The Elderly: Pharmacokinetics (cont’d)<br />Metabolism<br />Aging liver produces fewer microsomal enzymes, affecting drug metabolism<br />Reduced blood flow to the liver<br />
  19. 19. The Elderly: Pharmacokinetics (cont’d)<br />Excretion<br />Decreased glomerular filtration rate<br />Decreased number of intact nephrons<br />
  20. 20. The Elderly:Problematic Medications<br />Analgesics, including NSAIDs<br />Anticoagulants<br />Anticholinergics<br />Antidepressants<br />Antihypertensives<br />Cardiac glycosides (digoxin)<br />Sedatives and hypnotics<br />Thiazide diuretics<br />
  21. 21. Factors effecting medication action<br />Developmental factors<br />Gender<br />Cultural, ethnic, genetic<br />Diet<br />Environment<br />
  22. 22. Developmental considerations:<br />Children<br />Don’t say candy<br />Use liquid<br />Don’t lie about injections<br />Older adults<br />Altered memory<br />Renal function, liver function<br />Decreased absorption in GI tract<br />Altered quality of organ response to drug<br />
  23. 23. The end<br />