This document discusses principles of drug action and distribution in the body. It defines key terms like pharmaceutical equivalents, alternatives, and bioequivalence. It describes how drugs are absorbed and distributed, factors that influence absorption like ionization and protein binding, and transport mechanisms. The volume of distribution is discussed as well as barriers to drug distribution like the blood brain barrier.
Pharmacodynamics is the study of how drugs act on biological systems and their mechanisms of action. Drugs can interact with receptors to mimic or block physiological messengers. Agonists activate receptors while antagonists reduce or prevent agonist effects. Receptors are often proteins that drugs bind to through covalent, ionic, or hydrogen bonds. Signaling mechanisms involve ligand-gated ion channels, G-protein coupled receptors, and second messengers such as cAMP or calcium ions. Understanding these interactions is important for elucidating drug actions at the cellular level.
The document discusses drugs for lowering lipid levels. It begins by defining optimal LDL levels as 100 mg/dL or lower according to guidelines. Statins such as lovastatin are described as the first-line treatment, lowering LDL by 20-55% by inhibiting cholesterol synthesis. Lifestyle changes including diet and exercise are also recommended to reduce LDL levels. The document provides details on the mechanisms, effects, and proper use of statins and other lipid-lowering drugs that work through different pathways.
This document discusses pharmacokinetics in the elderly. It notes that drug absorption, distribution, metabolism, and elimination can all be affected by the aging process. Specifically, it outlines that drug absorption may be impacted by increased gastric pH, reduced gastrointestinal motility and blood flow, changes in gastrointestinal flora and decreased absorption surface area. Drug distribution can be influenced by changes in blood flow, plasma protein binding, and reduced total body water. Drug metabolism can vary due to impacts on liver function and enzymes. Finally, drug elimination may decrease due to reduced renal function and blood flow. The document also briefly discusses pharmacodynamics, drug-drug interactions, drug-disease interactions, and drug-food interactions which can further complicate treatment in
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
This document discusses pharmacologic considerations for geriatric patients. It covers how physiological changes in aging can impact drug absorption, distribution, metabolism and elimination. Specifically, it notes decreased gastric acidity, gastrointestinal blood flow and renal function in elderly patients. This can affect the bioavailability and clearance of various drugs. It emphasizes that age-related changes in pharmacokinetics require monitoring major drug classes like sedatives, cardiovascular drugs and antimicrobials in geriatric patients. Noncompliance is also a challenge due to factors like forgetfulness and prior experiences. Simplifying drug regimens can help improve medication adherence in the elderly.
The document discusses protein binding and factors affecting protein binding. It provides details on:
- The significance of protein binding is that bound drugs are inactive and have prolonged duration of action.
- Drugs can bind to blood components like plasma proteins, red blood cells, and tissues. The most significant binding is to human serum albumin.
- Factors that affect protein binding include the drug's physicochemical properties, its concentration, its affinity for proteins, the concentration and number of binding sites on proteins, drug interactions, and patient factors like age and disease states.
Pharmacodynamics is the study of how drugs act on biological systems and their mechanisms of action. Drugs can interact with receptors to mimic or block physiological messengers. Agonists activate receptors while antagonists reduce or prevent agonist effects. Receptors are often proteins that drugs bind to through covalent, ionic, or hydrogen bonds. Signaling mechanisms involve ligand-gated ion channels, G-protein coupled receptors, and second messengers such as cAMP or calcium ions. Understanding these interactions is important for elucidating drug actions at the cellular level.
The document discusses drugs for lowering lipid levels. It begins by defining optimal LDL levels as 100 mg/dL or lower according to guidelines. Statins such as lovastatin are described as the first-line treatment, lowering LDL by 20-55% by inhibiting cholesterol synthesis. Lifestyle changes including diet and exercise are also recommended to reduce LDL levels. The document provides details on the mechanisms, effects, and proper use of statins and other lipid-lowering drugs that work through different pathways.
This document discusses pharmacokinetics in the elderly. It notes that drug absorption, distribution, metabolism, and elimination can all be affected by the aging process. Specifically, it outlines that drug absorption may be impacted by increased gastric pH, reduced gastrointestinal motility and blood flow, changes in gastrointestinal flora and decreased absorption surface area. Drug distribution can be influenced by changes in blood flow, plasma protein binding, and reduced total body water. Drug metabolism can vary due to impacts on liver function and enzymes. Finally, drug elimination may decrease due to reduced renal function and blood flow. The document also briefly discusses pharmacodynamics, drug-drug interactions, drug-disease interactions, and drug-food interactions which can further complicate treatment in
Clinical pharmacokinetics and its application--
1)definition
2) APPLICATIONS OF CLINICAL PHARMACOKINETICS
Design of dosage regimens:
a) Nomograms and Tabulations in designing dosage regimen,
b) Conversion from intravenous to oral dosing,
c) Determination of dose and dosing intervals,
d) Drug dosing in the elderly and pediatrics and obese patients.
Pharmacokinetics of Drug Interaction:
a) Pharmacokinetic drug interactions
b) Inhibition and Induction of Drug metabolism
c) Inhibition of Biliary Excretion.
Therapeutic Drug monitoring:
a) Introduction
b) Individualization of drug dosage regimen (Variability – Genetic, Age and Weight, disease, Interacting drugs).
c) Indications for TDM. Protocol for TDM.
d) Pharmacokinetic/Pharmacodynamic Correlation in drug therapy.
e) TDM of drugs used in the following disease conditions: cardiovascular disease, Seizure disorders, Psychiatric conditions, and Organ transplantations
Dosage adjustment in Renal and Hepatic Disease.
a. Renal impairment
b. Pharmacokinetic considerations
c. General approach for dosage adjustment in renal disease.
d. Measurement of Glomerular Filtration rate and creatinine clearance.
e. Dosage adjustment for uremic patients.
f. Extracorporeal removal of drugs.
g. Effect of Hepatic disease on pharmacokinetics.
Population Pharmacokinetics.
a) Introduction to Bayesian Theory.
b) Adaptive method or Dosing with feedback.
c) Analysis of Population pharmacokinetic Data
This document discusses pharmacologic considerations for geriatric patients. It covers how physiological changes in aging can impact drug absorption, distribution, metabolism and elimination. Specifically, it notes decreased gastric acidity, gastrointestinal blood flow and renal function in elderly patients. This can affect the bioavailability and clearance of various drugs. It emphasizes that age-related changes in pharmacokinetics require monitoring major drug classes like sedatives, cardiovascular drugs and antimicrobials in geriatric patients. Noncompliance is also a challenge due to factors like forgetfulness and prior experiences. Simplifying drug regimens can help improve medication adherence in the elderly.
The document discusses protein binding and factors affecting protein binding. It provides details on:
- The significance of protein binding is that bound drugs are inactive and have prolonged duration of action.
- Drugs can bind to blood components like plasma proteins, red blood cells, and tissues. The most significant binding is to human serum albumin.
- Factors that affect protein binding include the drug's physicochemical properties, its concentration, its affinity for proteins, the concentration and number of binding sites on proteins, drug interactions, and patient factors like age and disease states.
Therapeutic drug monitoring (TDM) involves measuring the plasma concentration of a drug to guide dosing for individual patients. TDM is primarily used for drugs with a narrow therapeutic index or steep dose-response curves to maximize efficacy and minimize toxicity. Common drugs monitored include digoxin, lithium, theophylline, phenytoin, and gentamicin. TDM helps optimize dosing, identifies non-compliance or toxicity, and facilitates dose adjustments based on concentration levels.
The presentation gives you a bird eye's view regarding basics of PK-PD modeling, its applications, types, limitations and various softwares used for the same.
Pharmacology of Drugs used in bipolar disorder & maniashikha dwivedi
Bipolar disorder involves mood swings between mania and depression. Drugs used to treat it include lithium, antiepileptics like valproate and carbamazepine, and atypical antipsychotics. Lithium is well-established as an antimanic and mood stabilizing drug. It works by altering signal transduction pathways and inhibiting enzymes like inositol monophosphatase. Lithium, valproate, and atypical antipsychotics are effective for acute mania, while lithium, lamotrigine, and some antipsychotics can help prevent future mood episodes as maintenance therapy. Careful monitoring of lithium levels is needed due to its narrow therapeutic window.
Metabolic Changes of Drugs and Related Organic Compounds describes the human metabolic processes of various functional groups found in therapeutic agents.
The importance of a chapter on metabolism lies in the fact that drug interactions are based on these processes.
For pharmacists, it is necessary for them to understand why certain drugs are contraindicated with other drugs.
This chapter attempts to describe the various phases of drug metabolism, the sites where these biotransformation will occur, the role of specific enzymes, metabolism of specific functional groups, and several examples of the metabolism of currently used therapeutic agents.
This document discusses the various roles of computers in clinical pharmacy. It describes how computers can be used for patient record management, medication order entry, generating medication profiles and lists, screening for drug interactions, maintaining drug information databases, aiding research, managing inventories, and generating administrative reports. The document also discusses several specific computer systems and software programs that are used to support clinical pharmacy activities and optimize patient care.
1) The document discusses pharmaceutical care, which aims to ensure safe and effective drug use through identifying and resolving drug-related problems.
2) It defines pharmaceutical care as the responsible provision of drug therapy to achieve definite outcomes that improve a patient's quality of life.
3) Key aspects of pharmaceutical care include assessing a patient's medication needs, developing and implementing a care plan to address actual or potential drug therapy problems, and monitoring the care plan.
The document discusses pharmacotherapy and adherence to Beers criteria in the elderly. It provides an overview of medication use challenges in older adults, including age-related changes to pharmacokinetics and pharmacodynamics. It also discusses tools to evaluate inappropriate medications like Beers criteria and STOPP/START criteria. Beers criteria lists potentially inappropriate medications or classes to avoid in older adults due to risks of adverse effects. STOPP/START criteria addresses medications that should be avoided as well as those that should be considered.
This document discusses the pharmacotherapy of stroke. It begins by defining stroke and classifying it as either ischemic or hemorrhagic. Risk factors and pathophysiology are described. Clinical presentations include weakness, speech problems, or vision loss. Diagnosis involves imaging like CT or MRI to distinguish ischemic from hemorrhagic stroke. Treatment goals are to reduce injury, prevent complications and recurrence. For ischemic stroke, IV tissue plasminogen activator within 3 hours or aspirin within 48 hours are recommended. Secondary prevention includes managing conditions like atrial fibrillation, hypertension, and diabetes to prevent future strokes.
1. Altered Physiology
2. Pharmaceutical factors
3. Pharmacokinetic factors
4. Pharmacodynamic factors
5. Adverse Drug Reactions in elderly
6. A few examples
7. THANK YOU
This document discusses paediatric pharmacology. It notes that pharmacokinetic and pharmacodynamic processes differ significantly in paediatric patients compared to adults, especially in neonates and infants, due to developmental changes. Absorption, distribution, metabolism and excretion of drugs are often slower in paediatric patients. It also discusses special considerations for drug dosage forms, compliance, and drug use during lactation in paediatric patients. Careful titration of drug dosages is needed due to pharmacological variability between paediatric individuals.
Here are the key steps to solve this problem:
1) Calculate the elimination rate constant (k) using the two measured concentrations and times:
k = (lnC1 - lnC2) / (t1 - t2)
= (ln5.5 - ln6.5) / (8 - 24) hrs
= -0.05 hr-1
2) Calculate the volume of distribution (Vd) using the infusion rate (I), k, and the first measured concentration:
Vd = I / (k * C1)
= 15 mg/hr / (0.05 hr-1 * 5.5 mg/L)
= 15 L
3
Naranjo
WHO-UMC
Bayesian:
Bayesian
Expert Opinion:
CIOMS
Most commonly used:
Naranjo
WHO-UMC
Naranjo Causality Assessment Scale
Criteria Score
1. Previous conclusive reports on this reaction 0
1. Previous conclusive reports on this reaction +1
2. The adverse event appeared after the suspected drug was administered. +2
3. The adverse reaction improved when the drug was discontinued or a specific antagonist was administered. +1
4. The adverse reaction reappeared when the drug was readministered. +2
5. Alternative causes that could solely have
Individuals vary in their response to drugs due to several factors:
1. Body size influences drug concentration - larger individuals may require higher doses and smaller individuals like children require adjusted doses based on age and weight.
2. Age also impacts drug metabolism - children and elderly metabolize and excrete drugs differently than adults.
3. Other factors like sex, diet, alcohol use, genetics, disease states, and psychological factors can increase or decrease a drug's effects between patients. Doses often need adjusting based on these individual characteristics to achieve the desired therapeutic response without toxicity.
This document discusses drugs used to treat cardiac arrhythmias. It begins by describing the physiology of the heart's electrical conduction system. It then discusses pathophysiology of arrhythmias and various treatment approaches including drugs and ablation. Antiarrhythmic drugs are classified into four categories based on their effects on cardiac electrophysiology. The document focuses on properties of Class I, II and III drugs including lidocaine and amiodarone. It provides details on pharmacokinetics, effects, nursing considerations and monitoring for lidocaine and amiodarone.
Pharmacovigilance AND ADVERSE DRUG REACTIONS.
MONITORING REPORTING ROLE OF PHARMACIST.
CLASSIFICATION OF ADR. MECHANISM OF ADR
ROLE OF PHARMACIST IN MANAGING ADR. AUGMENTED, BIZZARE, CONTINOUS, DELAYED, END OF TREATMENT, ABCD, ABCDE.
Therapeutic drug monitoring of lithium involves monitoring lithium levels in patients taking lithium carbonate to treat conditions like bipolar disorder. Key points:
- Lithium is most commonly used as a mood stabilizer to treat manic episodes of bipolar disorder.
- Therapeutic lithium levels range from 0.6 to 1.25 mEq/L, with levels of 0.9 to 1.1 mEq/L favored for treating acute mania.
- Factors like diuretics, dehydration, and medications can impact lithium levels, so monitoring is important to avoid toxicity from levels above 1.5 mEq/L or below therapeutic ranges.
- Blood
Role of pharmacist in pharmacovigilance fieldSollers College
Pharmacists play a crucial role in pharmacovigilance by using electronic health records and pharmacovigilance systems to more quickly identify adverse drug reactions, thereby reducing healthcare costs. They can recognize adverse drug reactions in countries with questionable drug quality control. About 73% of pharmacists work in settings like hospitals and pharmacies where they may encounter adverse drug events. Pharmacists are drug experts trained to ensure medications are generally safe and hazardous drugs are removed from the market. Their involvement in pharmacovigilance is important for improving medication safety and outcomes and decreasing health costs globally.
This document discusses drug utilization research. It defines drug utilization research as studying drug use and effects in populations to support rational and cost-effective drug use. The document outlines the need for drug utilization research to facilitate rational drug use. It describes different types of drug use information that can be collected, including drug-based, problem-based, patient-based, prescriber-based, and cost-based information. The document also discusses various study designs and steps involved in conducting drug utilization research studies.
Pharmacokinetics describes the processes the body undergoes to metabolize and eliminate drugs, including absorption, distribution, metabolism, and excretion. Drugs can be administered topically, systemically, or directly to their target area. Orally administered drugs must dissolve and be absorbed through the stomach and intestines before entering systemic circulation. Some drugs are metabolized in the liver before circulating systemically, resulting in reduced bioavailability. Drugs can also be administered rectally but have disadvantages like slower absorption and potential irritation. A drug's absorption and distribution depend on its properties and formulation.
This document discusses various concepts related to pharmacokinetics including drug absorption, distribution, metabolism, and excretion. It describes how drugs pass through cell membranes via passive diffusion, facilitated transport, or active transport. Factors affecting drug absorption like solubility, ionization, and pharmaceutical formulation are also summarized. The concepts of bioavailability, plasma half-life, and steady state are defined. The document also discusses distribution of drugs to tissues, factors influencing distribution, and drug clearance through metabolism and excretion.
This document discusses pharmacokinetics, specifically absorption and distribution of drugs. It covers several key topics:
1. Modes of permeation and transport across cell membranes including passive diffusion, carrier-mediated transport, pinocytosis, and filtration.
2. Factors that influence absorption including drug properties like size, ionization, and lipid solubility as well as routes of administration.
3. Distribution of drugs in the body and factors that affect it like lipid solubility, ionization, and drug-drug interactions.
Therapeutic drug monitoring (TDM) involves measuring the plasma concentration of a drug to guide dosing for individual patients. TDM is primarily used for drugs with a narrow therapeutic index or steep dose-response curves to maximize efficacy and minimize toxicity. Common drugs monitored include digoxin, lithium, theophylline, phenytoin, and gentamicin. TDM helps optimize dosing, identifies non-compliance or toxicity, and facilitates dose adjustments based on concentration levels.
The presentation gives you a bird eye's view regarding basics of PK-PD modeling, its applications, types, limitations and various softwares used for the same.
Pharmacology of Drugs used in bipolar disorder & maniashikha dwivedi
Bipolar disorder involves mood swings between mania and depression. Drugs used to treat it include lithium, antiepileptics like valproate and carbamazepine, and atypical antipsychotics. Lithium is well-established as an antimanic and mood stabilizing drug. It works by altering signal transduction pathways and inhibiting enzymes like inositol monophosphatase. Lithium, valproate, and atypical antipsychotics are effective for acute mania, while lithium, lamotrigine, and some antipsychotics can help prevent future mood episodes as maintenance therapy. Careful monitoring of lithium levels is needed due to its narrow therapeutic window.
Metabolic Changes of Drugs and Related Organic Compounds describes the human metabolic processes of various functional groups found in therapeutic agents.
The importance of a chapter on metabolism lies in the fact that drug interactions are based on these processes.
For pharmacists, it is necessary for them to understand why certain drugs are contraindicated with other drugs.
This chapter attempts to describe the various phases of drug metabolism, the sites where these biotransformation will occur, the role of specific enzymes, metabolism of specific functional groups, and several examples of the metabolism of currently used therapeutic agents.
This document discusses the various roles of computers in clinical pharmacy. It describes how computers can be used for patient record management, medication order entry, generating medication profiles and lists, screening for drug interactions, maintaining drug information databases, aiding research, managing inventories, and generating administrative reports. The document also discusses several specific computer systems and software programs that are used to support clinical pharmacy activities and optimize patient care.
1) The document discusses pharmaceutical care, which aims to ensure safe and effective drug use through identifying and resolving drug-related problems.
2) It defines pharmaceutical care as the responsible provision of drug therapy to achieve definite outcomes that improve a patient's quality of life.
3) Key aspects of pharmaceutical care include assessing a patient's medication needs, developing and implementing a care plan to address actual or potential drug therapy problems, and monitoring the care plan.
The document discusses pharmacotherapy and adherence to Beers criteria in the elderly. It provides an overview of medication use challenges in older adults, including age-related changes to pharmacokinetics and pharmacodynamics. It also discusses tools to evaluate inappropriate medications like Beers criteria and STOPP/START criteria. Beers criteria lists potentially inappropriate medications or classes to avoid in older adults due to risks of adverse effects. STOPP/START criteria addresses medications that should be avoided as well as those that should be considered.
This document discusses the pharmacotherapy of stroke. It begins by defining stroke and classifying it as either ischemic or hemorrhagic. Risk factors and pathophysiology are described. Clinical presentations include weakness, speech problems, or vision loss. Diagnosis involves imaging like CT or MRI to distinguish ischemic from hemorrhagic stroke. Treatment goals are to reduce injury, prevent complications and recurrence. For ischemic stroke, IV tissue plasminogen activator within 3 hours or aspirin within 48 hours are recommended. Secondary prevention includes managing conditions like atrial fibrillation, hypertension, and diabetes to prevent future strokes.
1. Altered Physiology
2. Pharmaceutical factors
3. Pharmacokinetic factors
4. Pharmacodynamic factors
5. Adverse Drug Reactions in elderly
6. A few examples
7. THANK YOU
This document discusses paediatric pharmacology. It notes that pharmacokinetic and pharmacodynamic processes differ significantly in paediatric patients compared to adults, especially in neonates and infants, due to developmental changes. Absorption, distribution, metabolism and excretion of drugs are often slower in paediatric patients. It also discusses special considerations for drug dosage forms, compliance, and drug use during lactation in paediatric patients. Careful titration of drug dosages is needed due to pharmacological variability between paediatric individuals.
Here are the key steps to solve this problem:
1) Calculate the elimination rate constant (k) using the two measured concentrations and times:
k = (lnC1 - lnC2) / (t1 - t2)
= (ln5.5 - ln6.5) / (8 - 24) hrs
= -0.05 hr-1
2) Calculate the volume of distribution (Vd) using the infusion rate (I), k, and the first measured concentration:
Vd = I / (k * C1)
= 15 mg/hr / (0.05 hr-1 * 5.5 mg/L)
= 15 L
3
Naranjo
WHO-UMC
Bayesian:
Bayesian
Expert Opinion:
CIOMS
Most commonly used:
Naranjo
WHO-UMC
Naranjo Causality Assessment Scale
Criteria Score
1. Previous conclusive reports on this reaction 0
1. Previous conclusive reports on this reaction +1
2. The adverse event appeared after the suspected drug was administered. +2
3. The adverse reaction improved when the drug was discontinued or a specific antagonist was administered. +1
4. The adverse reaction reappeared when the drug was readministered. +2
5. Alternative causes that could solely have
Individuals vary in their response to drugs due to several factors:
1. Body size influences drug concentration - larger individuals may require higher doses and smaller individuals like children require adjusted doses based on age and weight.
2. Age also impacts drug metabolism - children and elderly metabolize and excrete drugs differently than adults.
3. Other factors like sex, diet, alcohol use, genetics, disease states, and psychological factors can increase or decrease a drug's effects between patients. Doses often need adjusting based on these individual characteristics to achieve the desired therapeutic response without toxicity.
This document discusses drugs used to treat cardiac arrhythmias. It begins by describing the physiology of the heart's electrical conduction system. It then discusses pathophysiology of arrhythmias and various treatment approaches including drugs and ablation. Antiarrhythmic drugs are classified into four categories based on their effects on cardiac electrophysiology. The document focuses on properties of Class I, II and III drugs including lidocaine and amiodarone. It provides details on pharmacokinetics, effects, nursing considerations and monitoring for lidocaine and amiodarone.
Pharmacovigilance AND ADVERSE DRUG REACTIONS.
MONITORING REPORTING ROLE OF PHARMACIST.
CLASSIFICATION OF ADR. MECHANISM OF ADR
ROLE OF PHARMACIST IN MANAGING ADR. AUGMENTED, BIZZARE, CONTINOUS, DELAYED, END OF TREATMENT, ABCD, ABCDE.
Therapeutic drug monitoring of lithium involves monitoring lithium levels in patients taking lithium carbonate to treat conditions like bipolar disorder. Key points:
- Lithium is most commonly used as a mood stabilizer to treat manic episodes of bipolar disorder.
- Therapeutic lithium levels range from 0.6 to 1.25 mEq/L, with levels of 0.9 to 1.1 mEq/L favored for treating acute mania.
- Factors like diuretics, dehydration, and medications can impact lithium levels, so monitoring is important to avoid toxicity from levels above 1.5 mEq/L or below therapeutic ranges.
- Blood
Role of pharmacist in pharmacovigilance fieldSollers College
Pharmacists play a crucial role in pharmacovigilance by using electronic health records and pharmacovigilance systems to more quickly identify adverse drug reactions, thereby reducing healthcare costs. They can recognize adverse drug reactions in countries with questionable drug quality control. About 73% of pharmacists work in settings like hospitals and pharmacies where they may encounter adverse drug events. Pharmacists are drug experts trained to ensure medications are generally safe and hazardous drugs are removed from the market. Their involvement in pharmacovigilance is important for improving medication safety and outcomes and decreasing health costs globally.
This document discusses drug utilization research. It defines drug utilization research as studying drug use and effects in populations to support rational and cost-effective drug use. The document outlines the need for drug utilization research to facilitate rational drug use. It describes different types of drug use information that can be collected, including drug-based, problem-based, patient-based, prescriber-based, and cost-based information. The document also discusses various study designs and steps involved in conducting drug utilization research studies.
Pharmacokinetics describes the processes the body undergoes to metabolize and eliminate drugs, including absorption, distribution, metabolism, and excretion. Drugs can be administered topically, systemically, or directly to their target area. Orally administered drugs must dissolve and be absorbed through the stomach and intestines before entering systemic circulation. Some drugs are metabolized in the liver before circulating systemically, resulting in reduced bioavailability. Drugs can also be administered rectally but have disadvantages like slower absorption and potential irritation. A drug's absorption and distribution depend on its properties and formulation.
This document discusses various concepts related to pharmacokinetics including drug absorption, distribution, metabolism, and excretion. It describes how drugs pass through cell membranes via passive diffusion, facilitated transport, or active transport. Factors affecting drug absorption like solubility, ionization, and pharmaceutical formulation are also summarized. The concepts of bioavailability, plasma half-life, and steady state are defined. The document also discusses distribution of drugs to tissues, factors influencing distribution, and drug clearance through metabolism and excretion.
This document discusses pharmacokinetics, specifically absorption and distribution of drugs. It covers several key topics:
1. Modes of permeation and transport across cell membranes including passive diffusion, carrier-mediated transport, pinocytosis, and filtration.
2. Factors that influence absorption including drug properties like size, ionization, and lipid solubility as well as routes of administration.
3. Distribution of drugs in the body and factors that affect it like lipid solubility, ionization, and drug-drug interactions.
Pharmacology is the study of how drugs act on the body. It includes pharmacokinetics, which is what the body does to the drug, and pharmacodynamics, which is what the drug does to the body. Key aspects of pharmacokinetics include absorption, distribution, metabolism and excretion of drugs in the body. Drugs can have intended therapeutic effects as well as unintended adverse effects. Understanding the mechanisms of drug action and factors affecting drug response are important aspects of pharmacology.
Pharmacokinetics is the study of the movement of drug molecules in the body. It includes absorption, distribution, metabolism, and excretion of drugs. Pharmacokinetics is the study of what happens to drugs once they enter the body (the movement of the drugs into, within, and out of the body). For a drug to produce its specific response, it should be present in adequate concentrations at the site of action. This depends on various factors apart from the dose.
Four pharmacokinetic properties determine the onset, intensity, and the duration of drug action (Figure 1.6.1):
• Absorption: First, absorption from the site of administration permits entry of the drug (either directly or indirectly) into plasma.
• Distribution: Second, the drug may then reversibly leave the bloodstream and distribute it into the interstitial and intracellular fluids.
• Metabolism: Third, the drug may be biotransformed by metabolism by the liver or other tissues.
• Elimination: Finally, the drug and its metabolites are eliminated from the body in urine, bile, or feces.
In short, pharmacokinetics means what the body does to the drug.
Drug patents typically last 20 years. However, the effective patent life can be shorter due to the time required for drug development and FDA approval. During this period, the patent is in effect but the drug cannot be sold. Once on the market, drugs generate substantial revenue during the remainder of the patent period. When patents expire, generic competitors can enter the market, reducing prices but also the brand manufacturer's profits. Factors like regulatory review times can impact how long a drug has exclusive patent protection.
Pharmacokinetics and Pharmacodynamic- General Pharmacology Ravinandan A PRavinandan A P
Pharmacokinetics and Pharmacodynamic- General Pharmacology Ravinandan A P - 2. Delivered a guest lecturer on “Pharmacokinetics and Pharmacodynamics” in Continuing Medical Education (CME) program, organized by Taluk Doctor’s Association Chalkere Taluk, Chitradurga District, Karnataka on 28th Sep 2010.
Pharmacokinetics is the study of how the body affects drugs. It involves absorption, distribution, metabolism, and excretion of drugs. Absorption is how drugs enter the bloodstream and distribution is how drugs spread to tissues. Metabolism converts drugs to inactive forms through phase I (oxidation) and phase II (conjugation) reactions. Excretion eliminates drugs from the body. Together, these processes determine the effects of drugs over time.
Pharmacokinetics deals with the absorption, distribution, metabolism, and excretion of drugs in the body. Drug absorption involves movement of a drug from its site of administration into systemic circulation by crossing biological membranes. Distribution refers to the reversible transfer of a drug between blood and tissues. Key factors affecting distribution include a drug's physicochemical properties, binding to plasma proteins, and barriers to tissue permeability. Highly protein-bound drugs are restricted to the vascular compartment and have a prolonged duration of action.
Pharmacokinetics (Greek: Kinesis—movement)
This refers to movement of the drug in and alteration of the drug by the body; includes absorption, distribution, binding/ localization/ storage, biotransformation and excretion of the drug.
Bioavailability: is a subcategory of absorption.
Bioavailability is a measurement of the rate and extent to which a drug reaches at the site of action determined by its concentration-time curve in blood or by its excretion in urine.
Two preparations of a drug are considered bioequivalent when the rate and extent of bioavailability of the active drug from them is not significantly different under suitable test conditions
The clearance of a drug is the theoretical volume of plasma from which the drug is completely removed in unit time.
This document discusses pharmacokinetics and pharmacodynamics concepts as well as drug absorption. It describes the process of absorption including passive diffusion, carrier-mediated transport, endocytosis, and exocytosis. Factors affecting absorption such as drug properties, dosage form characteristics, and physiological factors are explained. Different routes of administration are also compared in terms of bioavailability.
Pharmacokinetics (PK) is the study of how the body interacts with administered substances for the entire duration of exposure (medications for the sake of this article). This is closely related to but distinctly different from pharmacodynamics, which examines the drug’s effect on the body more closely. The four main parameters generally examined by this field include absorption, distribution, metabolism, and excretion (ADME). Wielding an understanding of these processes allows practitioners the flexibility to prescribe and administer medications that will provide the greatest benefit at the lowest risk and allow them to make adjustments as necessary, given the varied physiology and lifestyles of patients.
When a provider prescribes medication, it is with the ultimate goal of a therapeutic outcome while minimizing adverse reactions. A thorough understanding of pharmacokinetics is essential in building treatment plans involving medications. Pharmacokinetics, as a field, attempts to summarize the movement of drugs throughout the body and the actions of the body on the drug. By using the above terms, theories, and equations, practitioners can better estimate the locations and concentrations of a drug in different areas of the body.
The appropriate concentration needed to obtain the desired effect and the amount needed for a higher chance of adverse reactions is determined through laboratory testing. Using the equations given above, a clinician can easily estimate safe medication dosing over a period of time and how long it will take for a medication to leave a patient’s system. These are, however, statistically-based estimations, influenced by differences in the drug dosage form and patient pathophysiology. This is why a deep understanding of these concepts is essential in medical practice so that improvisation is possible when the clinical situation requires it.
The dynamics of drug ABSORPTION and DISTRIBUTIONHimaniTailor
The document discusses the dynamics of drug absorption and distribution. It describes how physicochemical factors like molecular size, ionization, and lipid solubility determine how drugs pass through membranes. Drugs can cross cell membranes through passive diffusion, facilitated transport, or active transport. Absorption involves drugs crossing membranes and entering blood circulation, which depends on factors like solubility, molecular size, and dosage form. Distribution involves drugs spreading throughout tissues, influenced by blood flow, protein binding, and access to different compartments like the brain or placenta.
This document provides an overview of basic biopharmaceutics and how drugs work in the body. It discusses the processes of absorption, distribution, metabolism, and excretion (ADME) that determine a drug's concentration at its site of action over time. Key concepts covered include drug receptors and sites of action, concentration-effect relationships, ionization and protein binding, first-pass metabolism, and factors that influence bioavailability and bioequivalence between drug products.
This document discusses pharmacokinetics and pharmacodynamics of antimicrobials. It defines pharmacokinetics as the process by which drugs enter and leave the body, based on absorption, distribution, metabolism, and excretion. Clinical pharmacokinetics applies these principles to safely and effectively manage drug therapy in individual patients. Pharmacodynamics is defined as how drugs act on the body. The document outlines key concepts in pharmacokinetics like absorption, distribution, metabolism, and excretion. It describes factors that influence these processes and their clinical significance.
Introduction of Veterinary pharmacologyQaline Giigii
This document provides an introduction to veterinary pharmacology. It discusses how pharmacology can be defined as the study of substances that interact with living systems, and how veterinary pharmacology specifically focuses on preventing, diagnosing and treating disease in animals. The document then summarizes that veterinary pharmacology has two main subdivisions: pharmacokinetics, which is what the body does to a drug, and pharmacodynamics, which is what the drug does to the body. Several key pharmacokinetic and pharmacodynamic concepts are then defined, including absorption, distribution, metabolism, excretion, drug receptors, and drug effects.
Introduction of Veterinary pharmacology Somaliland Dr.Osman Abdulahi FarahQaline Giigii
This course was prepared by Dr.Osman Abdulahi Farah
Cismaan shiine Lecturer of Gollis University Faculty of Agriculture and Veterinary Medicine 2014
The main content of this course including introduction of Veterinary Pharmacology, division of pharmacology and list of terms of terminology about veterinay pharmacology
Pharmacokinetics is the study of what the body does to a drug, including absorption, distribution, metabolism, and excretion. Absorption involves a drug entering systemic circulation, which can be impacted by factors like solubility, ionization, and first-pass metabolism. Distribution of drugs is determined by properties like volume of distribution, plasma protein binding, and ability to cross membranes like the blood-brain barrier. Metabolism, usually by the liver, makes drugs more polar through Phase I and Phase II reactions to facilitate excretion. The major routes of excretion are renal and biliary, and metabolism is necessary to make many drugs water-soluble enough to be excreted from the body.
Similar to Advanced practice preparation pharmacokinetics (20)
This document discusses merging or augmenting course sites on Blackboard. It provides examples of when merging or augmenting may be useful, such as for multiple sections, co-taught sections, or co-listed sections. It describes the difference between merging sites, which hides the original sites, and augmenting sites, which makes items shared in a combined site but keeps original sites visible. It also provides instructions for how to request that course sites be merged or augmented by emailing Blackboard support with the course details and specifying whether a merge or augment is needed.
This document discusses how to use a wiki in a Blackboard course. A wiki allows for collaborative writing and editing of content. Wikis can be used for group work, authentic audiences, and writing to learn. To set up a wiki in Blackboard, an instructor first organizes the content and creates a wiki document. They then generate wiki pages and links between pages. The instructor also adds a link from their course to the wiki. Finally, the wiki can be assessed through participation and grading features.
Blackboard Learn Course Customization: Teaching Styles and PropertiesUniversity of Miami
This document discusses how to customize courses by selecting teaching styles and properties. It explains that customization allows instructors to differentiate, organize, plan, and assist students. Teaching styles and properties can be found and selected on specific pages in the course customization tool. The document also provides a demonstration of customizing courses using styles and properties.
This document provides an overview of the Blackboard Calendar tool for instructors. It explains that the Calendar can be used to remind students of upcoming due dates, manually add items like lectures, drag and drop items to move them, and bulk move due dates. It also advertises an upcoming demonstration of the Calendar tool by Bill Vilberg and provides his contact information for questions.
The document discusses Blackboard Mobile, which allows students at UMiami to access course sites, announcements, documents and participate in discussions on their mobile devices. It highlights features like taking tests, using the Respondus Lockdown browser, and integrating with Dropbox and Google Docs. The slides are available online and it encourages keeping the app updated as mobile learning is still a work in progress at the university.
This document provides instructions for creating online sign-up sheets for student presentations using Blackboard Groups. It outlines creating a group set with sign-up sheets only and no other tools enabled. It then explains how to add a tool link to the main menu to make the sign-up sheets available for students to view and sign up for presentation time slots on specific dates.
SafeAssign is a plagiarism detection tool available through Blackboard that analyzes student assignments for originality. When an instructor creates a SafeAssignment, students submit their work which is analyzed on an external server. A report is then made available to both the student and instructor showing how much of the submitted content matches content in SafeAssign's databases, which include the internet, academic databases, and submissions from other institutions. SafeAssign is used across various disciplines at the university, with over 3,000 submissions and 187 assignments in the spring 2014 semester alone.
Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy University of Miami
This document discusses flipping the classroom using Bloom's Taxonomy. It defines flipping as receiving instruction at home (through videos or other media) and doing homework and processing the material in class. The document recommends determining a "cognitive cutoff" point based on Bloom's Taxonomy to decide what content is covered at home versus in class. A six step process is outlined for flipping a lesson that involves writing objectives, organizing by Bloom's level, determining the cognitive cutoff, planning pre-class and in-class activities, and evaluating results to improve the lesson. Potential uses, concerns, and implications of flipping are also addressed.
O documento discute a importância da higiene das mãos para prevenir infecções hospitalares. Estimativas indicam que mais de 1,4 milhão de pessoas no mundo sofrem de infecções adquiridas em hospitais, causando custos significativos. A lavagem correta das mãos é a estratégia fundamental para reduzir a disseminação de microrganismos entre pacientes e profissionais de saúde.
O documento discute prioridades de pesquisa em enfermagem na área de segurança dos pacientes. Aborda a importância da produção de conhecimento científico para melhorar a qualidade e segurança dos cuidados de saúde. Também destaca desafios como o desenvolvimento de uma cultura de segurança e estudos sobre a percepção de profissionais e pacientes em relação aos riscos na assistência à saúde.
O documento discute o papel crucial das enfermeiras na promoção da segurança do paciente. Ele destaca que as enfermeiras são agentes-chave para liderar iniciativas de segurança do paciente e implementar ações comprovadas para reduzir eventos adversos. No entanto, muitos desafios institucionais e culturais dificultam esses esforços, como a falta de mudança cultural e sistemas inadequados. É necessária uma liderança forte e uma cultura de aprendizado para criar um ambiente seguro para os pacientes.
La violencia doméstica ocurre en todas las poblaciones y más de 1 de cada 3 mujeres y hombres en los EE.UU. han sido víctimas de violencia por parte de su pareja íntima. Las mujeres representan la mayoría de las víctimas. La violencia doméstica tiene graves consecuencias para la salud física y mental de las víctimas y sus familias, así como consecuencias sociales y económicas.
Este documento define la violencia doméstica y discute las definiciones legales y sociales. Explica que la violencia doméstica incluye la violencia física, sexual, psicológica y económica entre miembros de una pareja íntima o familia. También describe los diferentes tipos de violencia doméstica y la importancia de tener definiciones comunes para abordar y medir adecuadamente este problema.
Este documento describe las funciones y responsabilidades de los enfermeros al tratar casos de violencia doméstica. Los enfermeros deben prevenir, detectar e intervenir en casos de violencia doméstica mediante la educación, la detección rutinaria, la evaluación del riesgo, el desarrollo de planes de seguridad y la derivación a recursos comunitarios. También deben cumplir con los requisitos de denuncia obligatoria cuando se sospecha abuso de niños o adultos vulnerables.
Este documento presenta varias teorías y marcos conceptuales sobre la violencia doméstica, incluyendo perspectivas psicológicas, biológicas, de sistemas familiares y sociológicas. La teoría más ampliamente utilizada es el modelo ecológico de la OMS, que considera factores a nivel individual, de la relación, comunitario y social. También se describe la rueda del poder y control, que ilustra cómo se establece el control sobre las víctimas a través de diferentes tácticas, y el c
O documento discute os resultados do Estudo IBEAS sobre eventos adversos na América Latina, mostrando que a maioria estava relacionada a infecções. Também apresenta soluções para aumentar a segurança do paciente, como a lista de verificação cirúrgica, que reduziu complicações e mortalidade quando implementada. A instância prévia, momento para checar procedimentos antes de iniciar, também é importante para prevenir erros.
El documento describe las prácticas para prevenir y controlar la infección por VIH y otros patógenos transmitidos por la sangre. Explica que las precauciones estándar como la higiene de manos, el uso de equipo de protección personal y las soluciones de lejía son esenciales para todos los pacientes. También cubre la profilaxis post-exposición, que incluye el tratamiento antirretroviral después de una exposición ocupacional a la sangre infectada para reducir el riesgo de transmisión del VIH y la hepatitis.
Este documento describe el ciclo de vida del virus VIH y las diferentes clases de medicamentos antirretrovirales utilizados para tratar la infección por VIH. Explica las 6 etapas del ciclo de vida del VIH, desde que se une a las células CD4 hasta la muerte celular. También detalla las 6 clases principales de medicamentos antirretrovirales, incluidos los inhibidores de la transcriptasa inversa, la proteasa y la integrasa. Por último, resume las recomendaciones actuales sobre el tratamiento de la infección por VIH
Este documento describe el VIH y las pruebas para detectarlo. Explica que existen dos tipos de VIH (VIH-1 y VIH-2) y que la prueba ELISA se usa primero para detectar anticuerpos, seguida de una prueba de confirmación Western Blot si es positiva. También identifica a las poblaciones con mayor riesgo de contraer VIH y recomienda que los profesionales médicos ofrezcan exámenes de detección como parte de la atención rutinaria. Además, enfatiza la importancia
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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2. Principles of Drug Action
Drugs modify existing functions within the body; they
do not create function.
No drug has a single action.
Drug effects are determined by the drug’s interaction
with the body.
3.
4. Pharmaceutical Equivalents
FDA definition :
Drugs that contain the same active ingredient
Contain the same active ingredients
Same dosage form
Same route of administration
Identical in strength or concentration
5. Pharmaceutical Alternatives
Drugs products that:
Contain the same therapeutic moiety, or its precursor,
but not necessarily in the same amount or dosage for or
as the same salt or ester.
Each product meets applicable standard of:
Identity
Strength
Quality and Purity
Potency
Content Uniformity
Dissolution/Disentigration Rates
6. Bioequivalence
The absence of a significant difference in the rate and
extent to which the active ingredient in
pharmaceutical equivalents or alternatives become
available at the site of action.
The drug is administered at the same dose and under
similar conditions.
Important when considering generic formulations and
altered formulations of a parent moeity.
Drugs are considered bioequivalent as long as there is
no significant difference in the degree.
7. Therapeutic Equivalents
Drugs that have the same clinical effect and safety
profile when given to patients under the conditions
indicated by the labeling.
If therapeutic equivalence is not shown, the FDA will
take no position on considering the drug without
further investigation and review.
8. Drug Constituents
Drug is made up of one or more active ingredients and
various additives that act as the vehicle or to maintain
stability of the active ingredient.
They are categorized based on chemical and physical
properties.
The constituents are used to influence certain
properties of the final formulation.
9. Drug Formulations
Drugs are formulated to produce either local or
systemic effects.
Local – c0nfined to one area of the body.
Antiseptics, Anti-inflammatories, Local Anesthetics
Systemic – drug is absorbed and delivered to body
tissues by way of the circulatory system.
Antibiotics, Anti-hypertensives, Analgesics
10. Drugs for Local Use
Can have effects on the skin, mucous membranes, and
respiratory tract.
May be water or oil based.
Water based preparations are readily absorbed.
Oil based preparations are more slowly absorbed.
Oil based drugs are not used in the respiratory tract since oil may be
carried to the alveoli, resulting in lipid pneumonia.
11. Systemic Drugs
Absorbed into the circulation to affect one or more
tissue groups.
Administered:
PO - SL
Topically
Parenterally – IV, SQ, IM, ID
Applied to Mucous Membranes
12.
13.
14. Transport Mechanisms
The majority of drugs cross cell membranes by simple
passive diffusion.
Only non-ionized (uncharged) lipid molecules diffuse
easily.
Movement of drug molecules also occur by
Carrier-mediated diffusion
Active transport
Pinocytosis
Filtration
15. Simple Passive Diffusion
Drugs move from high to low concentration.
Absorption occurs as drugs move from high
concentrations in the original compartment to areas of
lower concentration in another.
Accounts for absorption of most drugs from:
GI tract Circulation Target Cells
16.
17. Carrier Mediated Diffusion
Also known as Facilitated transport
A carrier is needed.
Occurs in harmony with concentration gradients.
High Low Concentration
A driving force is not required
Transportation of
Glucose, Certain Vitamins, Amino Acids and Organic Acids
Example – B12 – Intrinsic Factor Complex in GI tract.
18.
19. Filtration
Small drug molecules move along with fluid through
pores in cell walls.
No passage through the lipid matrix of cell.
Capillary membrane pores act as barriers to only very
large drug molecules.
Water soluble drugs and some electrolytes are absorbed
through tissue pores
20.
21. Pinocytosis
Drug is engulfed and moved across cell membrane.
Cell wall invaginates, forms vacuole.
Vacuole breaks off and moves into the cell.
Fat soluble Vitamins A, D,E,K
22.
23. Active Transport
Moves drug molecules against a concentration
gradient.
Uses metabolic energy – ATP
ATP-Drug Complex forms on cell membrane surface.
Complex carries drug through the membrane, then
dissociates.
The rate of active transport is proportional to the drug
concentration.
When carrier mechanisms are saturated, transfer rates
cannot increase.
24.
25. Molecular Size of Drug
Size of drug molecule affects drug transport.
Urea molecules pass easily through cell membranes.
Smaller, lipid-soluble, non-ionized
Glucose molecules are larger and pass with more effort.
Larger, water-soluble, ionized
Once drug concentrations on both sides of the cell
membrane are equal, drug movement ceases.
26. Factors Affecting Absorption
Bioavailability
Rate and extent to which an active drug or its metabolite
is absorbed and becomes available at site of action.
Ionization
Solubility
Absorbing Surface
Pre-systemic Biotransformation
27. Bioavailability
The percentage of Drug available (absorbed), after one
route of administration that produces a pharmacologic
effect.
Determined by measuring the drug concentration in
plasma and by assessing the magnitude of response.
28. Bioavailability
Chemical instability – affects bioavailability – example:
penicillin G is unstable to the pH of gastric secretions.
Nature of Drug Formulation – bioavailability may be
decreased based on the formulation of the drug
Particle size
Salt form
Crystal polymorphism
Presence of excipients – binders, dispersing agents
29. Ionization
Movement of drug by one or more transport
mechanisms is influenced by:
polarity of the cell membrane
polarity of the drug molecule
Substances of like charge repel each other.
Unlike charges attract each other.
Drugs are usually weak acids or weak bases.
31. Drug Ionization
Non-ionized drug molecules are usually lipid-soluble
and able to cross cell membranes.
Ionized drug molecules are unable to penetrate lipid
cell membranes.
A charge on a drug similar to that of the membrane
will delay absorption.
Both the dissolution and ionization of drugs are
affected by the pH of body solutions.
32. Drug Ionization
The ratio of non-ionized drug to an ionized drug is
related to two factors:
The pH of the aqueous medium in which it is dissolved.
The pKa value – Ionization Constant
The pH of of an environment in which exactly half of the drug
molecules are charged and the other half is uncharged.
33. Ionization of Aspirin
Aspirin – weak acid
pKa value of 3.5
pH of solution in which the aspirin is dissolved is
greater than 3.5 – ionized – relatively insoluble in lipid
environments.
pH of solution is less than 3.5, almost entirely non-
ionized – lipid soluble.
34. Ionization of Drugs
Ion Trapping
pH dependent
Drug molecules accumulate on pH favorable side of cell
membrane.
Example – acid drug/acid environment
Aspirin – non-ionized in the stomach.
Crosses cell membranes into plasma – pH 7.4 – ionized and
lipid insoluble -Trapped in plasma
Used therapeutically in drug overdose and poisoning
35. Ion Trapping
Alkalinizing urine promotes ionization of an acid drug
such as Phenobarbitol pKa of 7.4
Elimination is facilitated by trapping it in the urine.
36. Basic Drug Ionization
Basic drugs act opposite from acidic drugs.
Accumulate in a more acidic environment when a pH
difference exists.
A weak organic base – codeine
Placed in stomach – acid environment - ionized
Not lipid soluble – not absorbed
Any drug can be absorbed to some extent in the stomach
and intestines.
37. Solubility
Ability of the drug to dissolve and form a solution.
Must be similar to polar characteristics of the
absorption site (electrical charges).
Lipid soluble cross lipid cell membranes more rapidly.
Drug must be largely hydrophobic yet have solubility
in aqueous solution to be readily absorbed.
38. Absorbing Surface
Blood flow – areas of rich circulation promote
absorption – stomach vs. intestine.
Total Surface Area – intestinal absorption is most
efficient with villi and micro-villi increasing surface
area.
Example: Drugs tend to be absorbed more in the
duodenum, less in the jejunum and least in the ileum
Surface area decreases proximal to distal
Contact Time at Absorption Site – delayed or
enhanced transport.
39. First Pass Hepatic Effect
Drug absorbed across GI tract, must enter portal system
before entering systemic circulation.
This is not true of the mouth or rectum.
If drug is rapidly metabolized by liver, the amount of
unchanged drug that gains access to the systemic
circulation is decreased.
Many drugs, such as propanalol, undergo a significant
biotransformation during a single pass through the portal
system.
Drugs with significant first pass effects require much larger
oral than parenteral doses.
Example: Tricyclic Antidepressants, Analgesics and Anti-
arrhythmics
40.
41.
42. Distribution
Several factors influence drug distribution of an
absorbed drug:
Blood flow
Protein binding
Tissue binding
Solubility
Drugs are distributed through circulation to
Inert plasma and tissue binding sites
Site of action
Organs of elimination
43. Blood Flow
The time required for a drug to be distributed to body
tissues is influenced by:
Cardiac Output
Blood Flow
Well perfused tissues – kidney, heart, liver, brain – faster
uptake.
Poorly perfused tissues – muscle, adipose – slower
uptake.
44. Blood Flow
Drugs leave circulation fluid compartment – cross
capillary membrane – site of action.
Drug concentrations equalize between organs
dependent on blood flow to the area.
IV Barbiturate for anesthesia – pt. will awaken within
minutes – half life is several hours.
Rapid awkening due to decline of drug levels in the
brain – drug redistributed to adipose tissue.
Redistribution rather than elimination that terminates
anesthetic effect.
45. Protein Binding
Once absorbed, drugs are bound to various tissues in
the body.
Only free unbound drug is available to cross cell
membranes to site of action.
The release of a drug from protein binding site occurs
due to falling drug concentration.
Release doesn’t always increase drug action.
46. Protein Binding
Bound drugs are pharmacologically inactive .
Bound drugs cannot be bio-transformed or excreted.
2 Exceptions
High-hepatic Clearance Drugs
Drugs Eliminated by Renal Tubular Secretion
47. Protein Binding Sites
Alpha-1-acid
Albumin
Glyocoproteins
Basic Drugs The most abundant plasma
Quinidine protein
Meperidine Acid Drugs
Imipramine Warfarin
Dipyridamole Penicillin
Chlorpomazine Sulfonamides
48.
49. Protein Binding
A number of disease states alter the concentration of
plasma proteins which affects distribution.
Hypoalbuminemia – low serum protein – drug toxicity
The stronger the bond, the longer the duration of drug
action.
As drug molecules are released from their bonds, they
become free acting.
If two drugs are given – the one with stronger protein
binding or higher concentration will bind more
readily.
50. Drug-Protein Binding
Expressed as a percentage, 0-100%.
Percentage of binding in circulation depends largely on
chemical nature of the drug.
Acetaminophen - ~0% protein bound
Short duration of action
More drug reaches site of action
TID-QID administration
Wafarin – 99% protein bound – 1% pharmacologically
active.
Long duration of action
Once daily administration
52. Barriers to Distribution
Placental Membranes
Non-ionized, lipid soluble drugs readily reach fetus
through maternal circulation.
Placenta is not a barrier to drugs as once thought.
Fetus is exposed to same drug concentrations as those in
the mother, possibly higher.
53. Barriers to Distribution
Blood Brain Barrier - BBB
Highly ionized and protein bound drugs cannot enter
CNS
Drugs that are lipid soluble and poorly bound to plasma
proteins can cross BBB and produce effects in the CNS.
BBB has active transport system pumps drug molecules
out of the brain that may have entered by diffusion.
Important to consider in infection – antimicrobials must
be able to cross BBB.
Meningitis – active transport fails – large amounts of
PCN are allowed to remain in the brain.
54. Blood-Brain Barrier
Brain capillaries are covered by glial cells
(astrocytes)
Assist in forming tight junctions
Endothelial cells form tight junctions
Limits the size and type of molecules that can enter
the brain
55.
56.
57. Dilaudid
What is the dose of oral Dilaudid?
What is the dose of Dilaudid IV?
Why the difference?
58. Volume of Distribution
An estimate of the concentration of drug in the plasma
or blood.
Vd
Vd = the amount of drug administered
plasma drug concentration
(one hour after administration)
The amound of fluid necessary to contain the entire
drug in the body in the same concentration as in the
blood.
59. Vd
Lipid soluble drugs, the Vd is greater than the entire
body fluid volume (over 0.6 L/kg).
Drugs with extensive tissue binding can have a greater
Vd than total body volume (over 1 l/kg).
Vd is influenced by:
Age
Gender – sex body mass differences, pregnancy
Extent of protein binding
Solubility
60. Volume of Distribution
and Body Fluids
Total
Body Interstitial Fluids Total
(21%)
Weight Body
Plasma (4%)
100% Water
Intracellular Fluids
(35%) 60%
61. Fig. Body Fluid Distribution (in the normal 70 kg adult male)
proteins Total Body Water (42 L)
lipids ICV (28 L) ECV (14 L)
Intracellular Volume Extracellular
carbohydrates Volume
Blood Volume (5L)
membranes RBC Plasma
nuclei Volume Volume IFV
microtubules (2L) (3L) (11 L)
mitochondria
Interstitial Fluid
actin
Volume
etc.
IFV = ECV – PV
40% Total Body Water = 60% of body weight
ICV = 40% ECV = 20%
PV = 4%
IFV = 16%
62. % of Body Water
Compartment Infant Adult
Total Body Water 73% 60%
ICF 33% 40%
ECF 40% 20%
63. Case
70 kg male given 500mcg of IV digoxin.
Vd in liters = amount of drug adminstered in mcg
Plasma drug concentration in mg/L
645L = 500mcg digoxin
0.775 mg/L
Pt has 9 times total body fluid volume of a
healthy 70 kg male
64. Vd
Vd
Pool of body fluids that is required to evenly distribute
the drug to all portions of the body.
Does not represent a real volume
Example – Digoxin
Hydrophobic
Distributes rapidly to muscle and adipose
Very small amount is in the plasma
65. Vd
High lipid solubility & High tissue binding
Large Vd and lower drug levels
Less frequent dosing
High water solubility & Highplasma protein binding
Small Vd and high blood levels
More frequent dosing
66. Examples of apparent Vd’s for some drugs
Drug L/Kg L/70 kg
Sulfisoxazole 0.16 11.2
Phenytoin 0.63 44.1
Phenobarbital 0.55 38.5
Diazepam 2.4 168
Digoxin 7 490