Sie sind auf Seite 1von 28

Pharmacodynamics

Dr.U.P.Rathnakar
MD.DIH.PGDHM

Factors modifying fuel efficiency??? Factors modifying drug action

New
Driver Mfr.defect Bad road Over loaded Engine problem

[Age?]
[M or F] [Genetic?] [Envn.] [Obesity?] [Patho.states]

Traffic congestion [DI, polypharmacy]

Factors modifying drug action


Quantitative changes-plasma concentration and the action of drug is altered. This can be corrected by altering the dose-COMMON Qualitative-UNCOMMON-Allergy, idiosyncrasy[response is altered]-drug may have to be discontinued

Factors Modifying Drug Action


Age Body size Sex[Gender] Species & race Genetics Route Environment Psychological Diseases[Pathological state] Other drugs Cumulation Tolerance Drug resistance

Factors Modifying Drug Action:


1. Route Quantitative- Oral dose more than i.v. dose Qualitative Mgso4 Locally- Reduces edema Mgso4 orally - Purgative Mgso4 i.v. - CNS depressant

Presence of other drugs


Combined effect-synergism or antagonism

Cumulation:
When elimination is slower- may accumulate and produce toxic effect- Digoxin

Factors Modifying Drug Action:


Age: Infants & Children: not just small adults! Low GFR and immature tubular transport Penicillin G is given BID Inadequate hepatic metabolizing system Chloramphenicol gray baby syndrome Blood brain barrier is more permeable -kernicterus Skin is more permeable Rectal absorption is faster

Factors Modifying Drug Action:


Children

Tablets & aerosols difficult to administer Tetracyclines get deposited in teeth Drug metabolism may be faster in childrenhigher dose of digoxin Children are definitely not Miniature adults

Factors Modifying Drug Action: Children


Youngs formula Child's Dose = Dillings formula Child's Dose

Adult Dose X Age Age+12


Adult Dose X Age 20

Factors Modifying Drug Action:


Elderly: - decline in renal function -reduced hepatic activity -reduced intestinal motility -altered volume of distribution -drug interactions -prostatic hypertrophy - urinary retention ADE [Adverse effects] more Dose to be lowered- Eg.Aminoglycosides

Body Wt. And Surface Area


Body weight: Individual = Body weight (kg) X Adult dose Dose 70 BSA Individual = BSA x Adult dose Dose 1.7

7. Sex[gender]
Females-smaller size Androgens[Females] & estrogens[Males] Betablockers-affect sexual function only in males Ketaconozloe-libido in men, gynecomastia Pregnancy: GI motility low-delayed absorption Renal blood flow increases-Fast elimination of drugs Terratogenic

Environment and time of administration


Environment: Pollutants like DDT, Cigarette smoke, Insecticides, Alcohol-Enzyme inducers- Eg. Oral Contarceptive Pills Hypnotics more effective at night Glucocorticoids given in mornings-Least HPA axis

Genetic factors
Pharmacogenetics- Study of genetic basis for variability of drug response Pharmacogenomics- Use of this information for the choice of drugs in an individual INH [Isoniazid]-Fast and slow acetylators Succinylcholine-Apnoea [Atypical pseudocholinesterase]

Emotional factors
Placebo [I will please] [Nocebo-I will harm] Dummy medicine without Pharmacological effect [Psychodynamic
effect]

Some may have endogenous activity [Naloxone blocks analgesic effect of placebo]

1. 2.

Placebo reactors Uses Relief of subjective symptoms- Eg .Anxiety In Clinical trials to reduce bias Factors affecting placebo action Pt factors-With neurotic symptoms Drug factor-Injection, Capsules, colored tablets Doctor factor-Personality, Fame, Dr - Pt relationship

Pathological states
Gastrointestinal diseases: Malabsorption syndrome: Achlorhydria: Decreases aspirin absorption Liver disease: First pass metabolism B.A of Lidocaine, Propranalol Kidney disease Clearance of drugs that are excreted in unchanged form. Aminoglycosides

Kidney disease
[Aminoglycosides, Digoxin, Phenobarbitone]

Tolerance
Tolerance occurs when the person no longer responds to the drug in the way that person initially responded. A state in which higher dose is required to achieve the same effect Eg. Nitrates in Angina Morphine in pain relief

Types of Tolerance
Natural

Tolerance

Acquired

SPECIES Rabbits are resistant to Atropine

RACE In Afro Carribeans blockers Less effective

On repeated exposure

Morphine Not to Constipation and Miotic actions

May be only to some effects of a drug

Tolerance: Mechanism
Pharmacokinetic: Increased Metabolism, reduced absorption [Barbiturates] Pharmacodynamic Cells of the target organ become less sensitive Morphine, Barbiturates, Nitrates, Alcohol

Tachyphylaxis (acute tolerance)


Rapid development of tolerance, can not be overcome by increasing the dose Ephedrine, Amphetamine, Nicotine Cross tolerance: Development of tolerance to pharmacologically related drugs Eg. Alcohol and Barbiturates Morphine and Barbiturates Morphine and Pethidine

Others
Antipyeretics lower body temp.-Fever Thiazides marked diuresis-Edema Myesthenics-sensitive to curare Hypnotics in a pt. with pain-mental confusion and delirium

12. Drug interactions


When the action of one drug is affected by another Drug interactions may be defined as an Alteration in duration and/or onset of action or effect Of one drug produced by another drug. Beneficial or harmful Polypharmacy may be a necessity!

Hypertension Congestive cardiac failure Multiple diseases

Drug interactions may be unavoidable

Drug interactions classification


Pharmacokinetic, which occur at the level of Absorption, Distribution, Metabolism and Excretion of one drug by another. Pharmacodynamic:
Response of a drug target is modified by a second drug Eg. NSAIDs and ACE inhibitors Nitrates and Sildenafil

PD interactions
The direct pharmacodynamic interactions Antagonism or synergism The indirect pharmacodynamic interactions Digoxin and spironolactone Salicylates and warfarin

Drug interactions
Beneficial or harmful [Make a list from text book] Common with drugs exhibiting
Steep DRC Low TI Enzyme induction / inhibition Zero order kinetics

Severely ill patients Impaired renal / liver function

Das könnte Ihnen auch gefallen