Absorption

How drug particles move from the

GI tract to body fluids can be
passive, active or via
pinocytosis/phagocytosis

Distribution
Process by which drug
becomes available to
body fluids and
tissues. Influenced by
blood flow, drugs
affinity for tissue and
protein binding effect

An absorption interaction is when

one drug blocks, decreases or
increases the rate of absorption of
another drug. This happens in the
following ways:

Distribution reactions
are when there is not
enough protein to bind
two highly bound
protein drugs. This can
lead to toxicity
(because there will be
too much of the
weaker protein bound
drug circulating in the
blood system). Need to
decrease one or both
dosages.

Definition

Drug-drug
interactio
ns

A drug can increase or

decrease the rate of gastric
emptying
A drug can increase or
decrease the pH of the
gastric environment
A drug can form a drug
complex with another drug
A drug can alter the gut
bacteria, which is used to
break down medicines

Metabolism
Process by which the
body inactivates a
drug. The liver is the
primary site, but
several organs can
metabolize drugs. Most
drugs are inactivated
by liver enzymes and
transformed to
inactive state or watersoluble form for
excretion. Liver
disease means
inactivation is not as
quick, which can lead
to toxicity.
A metabolism
interaction is when one
drug increases or
decreases the
metabolism of another
by increasing or
decreasing certain
liver enzymes. Drugs
that increase liver
enzymes are enzyme
inducers; those that
decrease liver
enzymes are enzyme
inhibitors.
If a drug is
metabolized quicker,
there is less drug
action. If a drug is
metabolized slower, it
can lead to toxicity.

Excretion
Mainly happens via
urine, but can also be
via bile, feces, lungs,
saliva, sweat, etc.
Urine pH can influence
rate of excretion
(which is why, for
example, cranberry
juice inhibits the
elimination of aspirin)

The rate of excretion

can either be
increased or
decreased by certain
drugs, meaning they
are in the system not
long enough or too
long. Drugs that use
the same route for
excretion might
compete to be
excreted, keeping one
in the system longer.
The pH of urine can
change excretion
alkaline promotes the
excretion of weak
acids and acidic
promotes the
excretion of weak
bases.

Pediatrics

Geriatrics

Decreased absorption happens to

neonates, infants and adolescents.
In young children, their systems are
not fully developed. In adolescents,
it is due to poor nutrition, changes
in physical maturity and changes in
hormones.
- At birth, gastric pH is
alkaline, doesnt reach adult
pH until 1-3 years
- Gastric emptying is
prolonged in neonates and
infants
- Small children have
immature enzyme function
- Thinner skin means topical
medications are absorbed
quicker
- Effectiveness of circulation
affect subQ and IM injections

Blood flow and GI motility slow,

causing drug absorption to slow.
Acidic drugs are poorly absorbed
and extended release tablets break
down more quickly.

Affected by body fluid,

tissue composition,
protein binding
capability.
- Neonates and
young infants
are 70% water,
so need an
increased
dosage until
about age of 2
- Less body fat,
means they
require less fatsoluble
medications
- Less albumin in
infants means
they need a
smaller dosage
to reach
therapeutic
effect
- Blood brain
barrier is
immature,
meaning
medications
can easily pass
into nervous
system
Loss of protein binding
sites means increased
risk of adverse
reaction. Water soluble
drugs become more
concentrated in the
body due to loss of
body water. Increased
fat means fat soluble

Metabolism is carried
out primarily in the
liver (kidneys and
lungs play a small
part).
- Children
younger than
two have less
liver enzymes,
meaning slower
metabolism
- But children
have higher
rates of
metabolism
than adults,
meaning they
may require
increased
dosages or
decreased time
between
dosages

Glomerular filtration
rate is decreased in
kids under 9 months,
and again at onset of
adolescence, so
excretion rate is
reduced.

Liver blood flow

decreases (40-45%)
and liver shrinks
males affected by this
more than females.
This decreases the
livers ability to detoxify
and metabolize,
meaning an increased

Decreased cardiac
output affects blood
flow to liver and
kidneys. Additionally,
with liver and kidney
dysfunction, the drug
is not moved out of
the body as quickly,
increasing risk for

drugs are absorbed,

leading to decreased
drug effects.

risk for drug toxicity.

toxicity.