What are the key responsibilities of prescribing?
A sound understanding of drugs and the conditions that they are used to manage
Be deliberate in decision-making process
Do not prescribe for family or friends
Document thorough history and physical for the records, including education provided on drug
Have a documented plan for monitoring and titration
What should be used in making prescribing decisions?
Cost, follow current guidelines, availability, interactions, side effects, allergies, hepatic/renal function, need for
monitoring, special populations
PK and PD changes in older adults and how that affects how you prescribe?
Very high risk of adverse drug reactions and drug-drug interactions
D/t altered PK, multiple and severe illnesses, polypharmacy, poor adherence
Beer's Criteria
List of potentially inappropriate medications to use in the older populations
Updated annually
Prescribers ultimately decide whether to prescribe or not
Impacts/outcomes of polypharmacy?
Increased ADRs and drug-drug interactions
What are CYP450?
Enzymes responsible for drug metabolism (biotransformation)-oxidization, reduction, hydrolyzed to promote renal
dug excretion
Hepatic enzyme system, composed of 12 enzyme families
What do CYP450 enzymes do?
Promote drug excretion by making them more "excretable"--hydrophilic/water soluble and charged (ion)
Inactivate drugs, increase therapeutic action through metabolism, activate a prodrug, decrease drug toxicity
,CYP450 inhibitor examples?
VISA credit card debt inhibits spending on designers like CK to look GQ
Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconzaole
Grapefruit juice
Quinidine
What do CYP450 inhibitors do?
Decrease the rate of metabolism
Act on liver through process of inhibition
Slows rate of metabolism, increases active drug accumulation which can lead to adverse reactions and drug toxicity
What do CYP450 inhibitors do if not used correctly?
Can lead to adverse effects and drug toxicity
What happens when someone has a poor metabolism phenotype?
Associated with accumulation of drugs in the body and they may experience drug toxicity
What does the US FDA regulate when it comes to medications?
Regulates safety and effectiveness of drugs sold in US
Reviews manufacturers' applications to market new drug; cant be sold unless it has FDA approval
Once drug is on market, FDA continues oversight of drug safety and effectiveness
, Reasons for medication nonadherence?
Forgetfulness, lack of planning, cost, dissatisfaction, altered dosing
Black Box Warnings
Strongest safety warning a drug can carry and still remain on the market
Required by the FDA on drugs with serious or life-threatening risks
Neonate and infant drug absorption
Drug sensitivity d/t organ immaturity-increased risk of ADRs
Drug action unusually intense and prolonged
Transdermal absorption in neonates?
Infants have thin skin with high blood flow- increased absoprtion and increased risk of toxicity
IM absorption in neonates and infants?
Neonate- absorption is slow and erratic d/t low blood flow through muscle in first days of life
Early infancy- absorption is faster d/t increased blood flow
PO absorption in neonates and infants?
Gastric emptying delayed (adult emptying by 6-8mos)
Increased absorption of drugs absorbed in stomach, decreased for those absorbed in intestines
Low gastric acid for first 24 hours, adult acidity by 24 months--increased absorption of acid-labile drugs
A sound understanding of drugs and the conditions that they are used to manage
Be deliberate in decision-making process
Do not prescribe for family or friends
Document thorough history and physical for the records, including education provided on drug
Have a documented plan for monitoring and titration
What should be used in making prescribing decisions?
Cost, follow current guidelines, availability, interactions, side effects, allergies, hepatic/renal function, need for
monitoring, special populations
PK and PD changes in older adults and how that affects how you prescribe?
Very high risk of adverse drug reactions and drug-drug interactions
D/t altered PK, multiple and severe illnesses, polypharmacy, poor adherence
Beer's Criteria
List of potentially inappropriate medications to use in the older populations
Updated annually
Prescribers ultimately decide whether to prescribe or not
Impacts/outcomes of polypharmacy?
Increased ADRs and drug-drug interactions
What are CYP450?
Enzymes responsible for drug metabolism (biotransformation)-oxidization, reduction, hydrolyzed to promote renal
dug excretion
Hepatic enzyme system, composed of 12 enzyme families
What do CYP450 enzymes do?
Promote drug excretion by making them more "excretable"--hydrophilic/water soluble and charged (ion)
Inactivate drugs, increase therapeutic action through metabolism, activate a prodrug, decrease drug toxicity
,CYP450 inhibitor examples?
VISA credit card debt inhibits spending on designers like CK to look GQ
Valproate
Isoniazid
Sulfonamides
Amiodarone
Chloramphenicol
Ketoconzaole
Grapefruit juice
Quinidine
What do CYP450 inhibitors do?
Decrease the rate of metabolism
Act on liver through process of inhibition
Slows rate of metabolism, increases active drug accumulation which can lead to adverse reactions and drug toxicity
What do CYP450 inhibitors do if not used correctly?
Can lead to adverse effects and drug toxicity
What happens when someone has a poor metabolism phenotype?
Associated with accumulation of drugs in the body and they may experience drug toxicity
What does the US FDA regulate when it comes to medications?
Regulates safety and effectiveness of drugs sold in US
Reviews manufacturers' applications to market new drug; cant be sold unless it has FDA approval
Once drug is on market, FDA continues oversight of drug safety and effectiveness
, Reasons for medication nonadherence?
Forgetfulness, lack of planning, cost, dissatisfaction, altered dosing
Black Box Warnings
Strongest safety warning a drug can carry and still remain on the market
Required by the FDA on drugs with serious or life-threatening risks
Neonate and infant drug absorption
Drug sensitivity d/t organ immaturity-increased risk of ADRs
Drug action unusually intense and prolonged
Transdermal absorption in neonates?
Infants have thin skin with high blood flow- increased absoprtion and increased risk of toxicity
IM absorption in neonates and infants?
Neonate- absorption is slow and erratic d/t low blood flow through muscle in first days of life
Early infancy- absorption is faster d/t increased blood flow
PO absorption in neonates and infants?
Gastric emptying delayed (adult emptying by 6-8mos)
Increased absorption of drugs absorbed in stomach, decreased for those absorbed in intestines
Low gastric acid for first 24 hours, adult acidity by 24 months--increased absorption of acid-labile drugs
