Final part 1 Flashcards
1
Q
Why TDM?
A
- maximize efficacy
- minimize toxicity
- PK changes
- monitor adherence
2
Q
individualize
A
Use PK/PD parameters
3
Q
maximize
A
best therapeutic response
4
Q
minimize
A
watch for those adverse effects
5
Q
context
A
treat the patient, not the number
6
Q
narrow therapeutic drugs
A
- AGs
- Vanc
- Anti-epileptics (carbamazepine/ phenytoin/ valproic acid)
- anticoags
- anti-arrhythmics (digoxin/procainamide)
- immunosuppressants (cyclosporine)
- methylxanthines (theophylline/caffeine)
- anidepressanets (lithium)
7
Q
PK
A
absorption
distribution
metabolism
elimination
8
Q
PD
A
therapeutic effects
adverse effects
9
Q
neonate
A
0-28 days
10
Q
infant
A
1 month- 1 year
11
Q
child
A
1 year- 12 years
12
Q
adolescent
A
13- 18 years
13
Q
elderly
A
> 65
14
Q
very elderly
A
> 80
15
Q
young old
A
65-74
16
Q
old
A
75-84
17
Q
old old
A
85-94
18
Q
oldest old
A
> 95
19
Q
absorption- pediatrics
A
- relative achlorhydria in newborns
- acid production fluctuates widely
- per kg production at adult liver by ~2yrs
- delayed gastric emptying in newborns
- increases quickly; adult rates by 6-8 months
20
Q
absorption- geriatrics
A
- increased PH/ decreased acidity (similar to infants)
- delayed GI transit
- incr. T max
- AUC unchaged
- drugs using active transport can have decr. F
21
Q
distribution- geri
A
- decreased body water
- decr. Vd of hydrophilic drugs; incr concentration
- increased fat content; incr Vd lipo drug; & terminal half-life
- albumin/alpha-1 acid decreased
22
Q
Metabolism- Peds
A
- phase 1: variable rates; ~1 year to have adult rates
- phase II; variable rates; ~2 yrs to adult rates
- reduced glucuronidation
- reduced acetylation
23
Q
metabollism- geri
A
- hepatic blood flow and liver size decr.
- phase I decreased
- phase II mostly unchaged
- decr clearance
- increased half life
24
Q
elimination-peds
A
- GFR: sig. incr in 1st mon
- adult rates ~1 year
25
Q
elimination- geri
A
- decr nephron function & kidney mass
- decr. GFR & renal blood flow
- incr T1/2 of drugs removed by kidney
- incr. exposure to toxic metabolites