Pharmacology Exam 2

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Author:
Rx2013
ID:
39024
Filename:
Pharmacology Exam 2
Updated:
2010-10-01 23:27:07
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Factos affecting DI ADR
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Description:
Factos affecting DI/ADR
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  1. Internal risk factors for ADR
    • Age
    • Disease
    • Species differences
    • Gender
    • Pregnancy
  2. Elderly
    • decreased metabolism and excretion
    • decreased enzyme induction
    • usually take multiple drugs
  3. Very Young
    • metabolism not fully developed
    • no phase II enzymes
  4. Fetus
    only has CYP3A
  5. Diseases
    general decrease in CYP enzymes
  6. Species differences
    different enzymes
  7. Use of rats in clinical trials
    • rats have six CYP2D
    • Humans have 1
  8. Erythromycin in females vs. males
    Female metabolizes faster than male
  9. Propranolol oxidation in m vs. f
    M>F
  10. Nicotine metabolism in M vs. F
    • F>M
    • females may become addicted faster
  11. Pregnancy
    • 50% of drugs are metabolized by CYP3A4
    • fetus does not have this enzyme!
  12. Consequences to fetus or neonate given wrong drugs
    • teratogenicity
    • carcinogenicity
    • hepatotoxicity
  13. External risk factors
    • Multiple drugs
    • Diet, supplements, and alternative medicines
    • Alcohol
    • Tobacco
    • substances of abuse
  14. Multiple drug risks
    • Disease co-existance
    • Combination therapy
  15. Diet and supplements
    • special diet due to disease or culture
    • OTC products
  16. Alternative medicine vs. Antiretrovirals may inhibit or induce CYP
    • inhibitors increase ARV concentration
    • Inducers decrease ARV concentration
  17. All ARVs except 1 are metabolized by
    CYP3A4
  18. Alcohol, tobacco and other substance of abuse
    • induce CYP
    • produce oxidative stress
    • decrease response to ARVs
  19. Alcohol induces
    CYP2E1 and CYP3A4
  20. Tobacco induces
    CYP 2A6 and CYP 2E1
  21. Pharmacogenetics as risk factors
    • variation of metabolizing enzymes
    • variation of drug transporters
    • variation in drug targets
  22. Genetic polymorphism
    >1% incidence in the population
  23. Poor metabolizers via CYP2D6
    • 5-10% of caucasians
    • 1-2% of asians
  24. decreased CYP2D6 function
    • increase in drug levels
    • lower dose to avoid toxicity
  25. Increase in CYP2A...
    • increase nicotine dependance
    • increased cancer risk

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