Describe effect on low and high albumin levels on active drug levels
especially for drugs that are highly protein bound - ANSWER- Albumin
is the plasma protein with the greatest capacity for binding drugs.
Binding plasma proteins affect drug distribution into tissues, because
only drug that is not bound is available to penetrate tissues, bind to
receptors, and exert activity. As free drug leaves the blood stream, more
bound drug is released from binding sites.
Low albumin levels - ANSWER- malnutrition, chronic illness
, Highly protein bound drugs can lead to - ANSWER- toxicity in patients
with low albumin levels, example malnutrition or chronic illness. This is
because there are fewer than the normal sites for the drug to bind
Describe the ways the hepatic first pass effect- which is metabolism
during first pass through the liver - ANSWER- Alternative routes
include: suppository intravenous intramuscular inhalational aerosol
transdermal
sublingual
These allow drugs to bypass the first-pass effect and be absorbed
directly into systemic circulation
Be able to calculate creatinine clearance using Cockgraft Gault equation:
- ANSWER- Male = 140-age times weight in kilograms divided by
serum creatinine times 72.
Women = CRCL (male) times 0.85
Describe what determines the frequency of drug administration -
ANSWER- half life
plasma concentration
Be familiar with the beers criteria and how to use it - ANSWER-
Potentially Inappropriate Medication Use in Older Adults
to call attention to medications that are most commonly problematic and
thus should be avoided in older adults
Describe factors that affect absorption - ANSWER- low blood state
(shock or arrest), contact time with GI tract too fast (diarrhea = cant
absorb), delayed stomach emptying (large meal = delayed
absorption)Drug- to drug or drug to food interactions
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