14. iii) Pregnancy
Avoid drugs during pregnancy due to teratogenic effects
Reasons
Lipophilic drugs cross placental barrier
CO
GFR & renal elimination
Vd
Metabolism of some drugs
E.g., pregnant uterus becomes more sensitive to oxytocin
15. iv) Lactation
Drugs easily appear in milk but < therapeutic dose
E.g., tetracycline, sedatives, hypnotics, opoids
16.
17.
18.
19. Plasma choline estrase variant (suxamethonium)
Hydrooxylase polymorphism (extensive or poor
metabolism of debrisoquine)
23. IV. Environmental factors
Microsomal enzyme inducers
e.g., Hydrocarbons in tobacco smoke, charcoal
broiled meat induce CYP1A
Smokers metabolize drugs more rapidly than non
smokers
24. II. Pathological state
• Pathological condition modify drug action
E.g., impaired renal function = drug excretion = drug accumulation
Liver disease= metabolism of drug=accumulation
25. Gastrointestinal (g.i.) diseases
• NSAIDs- aggravate peptic ulcer disease
• Achlorhydria – aspirin absorption by favouring its ionization
26. Liver disease
Cirrhosis - * Bioavailability of drugs with high first pass metabolism
*Serum albumin more drug in free form
*Metabolism and elimination of Morphine ,Lidocaine ,
Propranolol dose to be reduced
*Prodrug – Bacampicillin less effective
Brisk diuresis Hepatic encephalopathy ( NH4 NH3)
27. Renal diseases
• Cl cr Clearance of Aminglycosides, Digoxin
Phenobarbitone maintainance dose to be
reduced
28. Renal disease
• BBB permeability in renal failure CNS depression( Opiates
,barbiturates)
• . Nephrotoxic drugs – Aminoglycosides, Tetracyclines ,Vancomycin to
be avoided in renal failure
• . Potassium sparing diuretics contraindicated
29.
30. V) Psychological state
•General anesthetics required in ↑dose for nervous
& anxious patients
•Higher doses of chlorpromazine needed in
schizophrenics
•Placebos (inert dosage form) produce therapeutic
benefits in psychomotor angina pectoris &
bronchitis in asthma
31. VI) Interaction with other drugs
Ampicillin /Amoxicillin + OCP = Contraceptive
failure
Probenecid + Penicillin = Prolongation of
Penicillin activity (Inhibits tubular secretion )