FINAL FINAL

Chapter Outline

Pharmacokinetics
- Routes of Administration
- Drug Absorption
- Drug Distribution
- Free Versus Bound Drugs
- Drug Metabolism
- Drug Elimination
- Elimination Example
Pharmacodynamics
Specimen Collection
Pharmacogenomics
Drug Categories
- Cardioactive Drugs
  - Digoxin
  - Quinidine
  - Procainamide and N-acetylprocainamide
  - Disopyramide
- Antibiotics
  - Aminoglycosides
    - Gentamicin
    - Tobramycin
    - Amikacin
    - Vancomycin
- Antiepileptic Drugs
  - Primidone
  - Phenobarbital
  - Phenytoin and Free Phenytoin
  - Valproic Acid
  - Carbamazepine
  - Ethosuximide
  - Felbamate
  - Gabapentin
  - Lamotrigine
  - Levetiracetam
  - Oxcarbazepine
  - Tiagabine
  - Topiramate
  - Zonisamide
- Psychoactive Drugs
  - Lithium
  - Tricyclic Antidepressants
    - Clozapine
    - Olanzapine
- Immunosuppressive Drugs
  - Cyclosporine
  - Tacrolimus
  - Sirolimus
  - Everolimus
  - Mycophenolic Acid
- Antineoplastics
  - Methotrexate
- Bronchodilators
  - Theophylline
References
Key Terms
- Bioavailability
- Distribution
- Drug half-life (T½)
- Peak drug concentration
- Pharmacodynamics
- Pharmacogenomics
- Pharmacokinetics
- Therapeutic drug monitoring (TDM)
- Therapeutic range
- Trough drug concentration

Discuss drug characteristics necessitating therapeutic drug monitoring.
Identify factors influencing absorption of orally administered drugs.
List factors influencing drug elimination rates.
Define drug distribution and discuss influencing factors.
Calculate volume of distribution, elimination constant, and drug half-life.
Correlate drug concentrations to pharmacokinetic and pharmacodynamic parameters.
State specimen collection and handling requirements for therapeutic drug monitoring.
Specify therapeutic categories or uses of drugs presented.
Describe potential toxic side effects/toxicity of the therapeutic drugs.
Apply knowledge of therapeutic drug monitoring to interpret laboratory results.

Measurement of prescribed drugs and metabolites in body fluids (mostly blood) to maintain therapeutic benefits.
Avoids ineffectiveness or toxicity due to concentrations outside the therapeutic range.
Essential for drugs with narrow therapeutic ranges or significant pharmacokinetic variability.

Studies the movement of drugs in the body including absorption, distribution, metabolism, and excretion.
Key factors that influence these processes:
- Routes of Administration: Oral, IV, IM, SC, and their bioavailability.
- Drug Absorption: Efficiency influenced by dissociation, solubility, and diffusion across membranes.
- Drug Distribution: Movement between circulation and tissues.
- Free Vs. Bound Drugs: Only free drugs can interact biologically.

John, a man with renal failure, treated with digoxin for congestive heart failure, compliance questioned due to recent international travel.

Thelma, an elderly woman with heart arrhythmia and potential medication adherence issues relating to procainamide.

Adriene, having seizures after a period of severe diarrhea, leading to low serum phenytoin.

Study of the biochemical and physiological effects of drugs.
Focus on the relationship between drug concentrations and pharmacological responses.

Accurate timing of specimen collection is crucial for TDM (trough before the next dose, peak within 1 hour after oral administration).
Patient age, gender, diet, co-administered drugs, and physiologic changes influence drug concentrations and effectiveness.