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This Concept Map, created with IHMC CmapTools, has information related to: Lecture 1, Interactions can be 6. Drug-Laboratory test interaction ????, Optimizing therapeutic dosage regimens Ensures that the patients recieves the: *Right drug * Appropriate dose *Correct duration *Appropriate supervision *Appropriate surveillance of the response,guiding modification and refinement of the dose regimen, Drug Interactions One drug's activity (object drug) altered by the simultaneous use of another drug (precipitant) or by the presence of other subsances (precipitant) ↑s chances of toxiciy, Synergism is either beneficial or harmful, Therapeutic Agents in Elderly Patients Insert picture ????, Use and Choice of Therapeutic agents for Drug Therapy Critical Questions: What dose? Drug doses recommended on product labels are derived from dose determination studies/clinical trials where the clinical effects of various doses are examined *Ineffective dose *Minimally effective dose *Effective dose *Toxic dose *Lethal dose, Loading Dose First dose/initial HIGHER dose given at the beginning of a multiple drug administration protocol/course of treatment before dropping to a lower maintenace dose Useful for drugs that are eliminated slowly i.e have a long systemic 1/2 life (3-5 1/2lives), Pharmacokinetics ???? Metabolism, Interactions can be 1. Drug-drug interactions Pharmacokinetic, Types of Treatment - 3S3P ???? Specific - eliminate the 1° cause of dz's process surgically Supportive - Correct abnormalities that occur 2° to a dz's process Symptomatic - eliminates or suppresses CS w/o affecting or knowing the underlying cause Palliative - treatment for patients w/ untreatable dz's in order to make them more comfortable Preventative - includes a combination of supportive and symptomatic treatments in terminally ill patients Production - purpose is to increase feed efficiency or growth rate, CHEMOTHERAPEUTIC AGENTS Drug Use and Choice of Therapeutic agents for Drug Therapy Critical Questions:, Use and Choice of Therapeutic agents for Drug Therapy Critical Questions: What dosing interval and frequency? Dosage interval - how frequently the dosage is given e.g BID (twice daily) or TID (3 times taily), Drugs are given concurrently (polypharmacy) to: 1. treat multiple medical conditions 2. use multiple approaches to treat a single dzs expect drug interactions when 2 more drugs are co-administered, interaction of 2 drugs chemcially or physcially during administration or absorption 1. the amt of drug available for absorption is reduced/altered (inactivation) 2. reduced bioavailability Inactivation and precipitation eg. of penicillin when mixed in the same syringe or infusion set w/ phenytoin or B-complex vitamins OR carbenicillin and gentamicin, Increase in D = increased Css Decrease in D = decreased Css Decrease in T = decreased Css Increased in T = deceased Css Decreased T and decreased D = decereased Css Decreased Cl= increase in Css Decreased Cl + decreased D/T = constant Css Drug Clearance (Cl) Decreases in Cl may occur as a result of renal and liver dz's, Drugs can be split into two types Given repeatedly For a Prolonged effect e.g antibiotics, NSAIDS, anticonvulsants, Drug Interactions One drug's activity (object drug) altered by the simultaneous use of another drug (precipitant) or by the presence of other subsances (precipitant) Drugs are given concurrently (polypharmacy) to: 1. treat multiple medical conditions 2. use multiple approaches to treat a single dzs, Metabolism ???? 3. Does the agent present a significant risk factor for the patient?, Synergism is an interaction between 2 or more drugs that causesthe total effect of the drugs to be greater than the sum of the individual effects of each drug, Chelation eg. chelating agents are present in some drugs →reduces bioavailabilty Forms poorly absorbed complexes when combined with metals like Ca, Mg, Al and Fe (found in drugs and foods like antacids, vits and milk) eg. Tetracyclines or fluoroquinolones given with milk (Ca) or Fe (orally)