Pharmacokinetics Applied to the Treatment of Asthma
|
|
- Maryann Lyons
- 6 years ago
- Views:
Transcription
1 Pharmacokinetics Applied to the Treatment of Asthma 2016 edition by David C. McMillan, PhD Department of Pharmacology and Experimental Neuroscience College of Medicine University of Nebraska Medical Center Originally developed by K.W. Renton, PhD Department of Pharmacology Faculty of Medicine Dalhousie University and A. H. Neims, MD, PhD Department of Pharmacology College of Medicine University of Florida Note to Students The fundamental purposes of all activities in the health-care professions are to help other people. Like all behavior, helping behavior becomes more effective and natural with practice. This exercise enables you to practice by helping your fellow students to learn basic science. Your skill at helping your fellow students should relate to your ability to help your patients in the future. This is a Patient-Oriented Problem-Solving (POPS) exercise designed for four students. Before beginning this session, you should have (a) studied the objectives designed to prepare you for it, (b) taken the pretest, and (c) reviewed the topics listed at the end of the pretest. Now, each of you should take one of the four color-coded parts and follow the directions in it. If your group has only three students, one of you should take two parts. If your group has more than four students, two should take turns with a part. Please begin by discussing the answers to the pretest.
2 Correct Answers to Pretest Questions In the discussion to follow, you are given the correct answers to some of the 10 pretest questions, along with explanations. Other students in your group have been given the answers to other questions. This allocation of answers and explanations is designed to encourage all members of your group to actively exchange ideas and concepts. First, study the answers in your part and then EXPLAIN them to your group. Don't simply read the answers to your classmates, and don't let your classmates read their answers to you. In explaining something to another person, most people gain and often transmit a better understanding of the subject. The pretest discussion and patient-oriented problem-solving parts of this activity are "open book"; be sure to refer to textbooks, notes, and other written resources whenever questions arise. To help you review any questions that you may have missed, you probably will want to make notes on your pretest answer sheets. However, avoid "collecting pages" for later study and understanding." Learn the concepts now so that later you will only need to review them. 4. A is correct. The plasma concentration of drug falls exponentially with time. In first-order kinetics, a constant fraction of drug is removed per unit of time. When concentration of drug is plotted on a logarithmic scale versus time, a straight line is obtained. Refer your colleagues to the Answer Aid for Pretest Question 4 on Handout 1. A two-compartment, first-order system would have yielded a bi-exponential curve in which the first and more rapid disappearance of drug relates more to distribution and the latter portion of the curve relates more to drug metabolism or excretion. At saturation (zero-order) kinetics the plasma concentration-time curve (not the log concentration-time curve) is linear. In zeroorder kinetics, the process by which the drug is eliminated is at a maximum velocity (Vmax). 9. A is correct. The area under the concentration-time curve indicates how much drug in each of the tablets reached the systemic circulation. The areas under the curve for tablets A and B are nearly equal. Although all of the drug in tablets A and B reaches the systemic circulation, comparisons of peak concentrations and times to reach these peaks indicate that the drug is more slowly absorbed from tablet B than from tablet A. The drug in tablet C is much less bioavailable. There may be several reasons for this. The drug might be unstable in tablet C; tablet C might not be absorbed because it does not disintegrate; or the drug in tablet C may be released in such a way that it is metabolized by the liver or GI tract before it reaches the systemic circulation (first-pass effect). When your group has finished discussing the pretest, read the Instructions for the Clinical Problem on the next page of your booklet. 2
3 HANDOUT 1 - aid to pretest questions Aid for Pretest Question 3: Aid for Pretest Question 4: Aid for Pretest Question 7: Css = mmmmmmmmmmmmmmmmmmmmmm dddddddd CCCC Half-life = Vd Cl
4 Instructions for the Clinical Problem In the remainder of this package, you are to use your knowledge of pharmacokinetics to determine appropriate therapy for Mr. Wheeze. Each member of your group has information about one episode in Mr. Wheeze's medical history and part of the data necessary to determine the best therapy for him. Therefore, you must share information and work together to treat Mr. Wheeze. When the episode for which you are responsible comes up, read it to the group and lead a discussion of the questions that are included with the episode. Pose each question to a different member of the group. Use the Discussion Notes provided as a guide for the discussion. DO NOT SIMPLY READ THEM to the group. The interaction with your fellow students should go much farther than just sharing data. You should do your best to teach each other, seek additional information from your textbooks, and determine the appropriate therapy in a logical way. At the end of each part of this exercise, everyone in the group should agree on appropriate therapy. You should also understand the pharmacokinetic principles involved in making the decision. The group member whose booklet contains Episode 1 should begin the discussion. 3
5 HANDOUT 2 - for use with Episode 1 Figure 1. Relationship between plasma theophylline concentration and the one-second forced expiratory volume (FEV1) among six otherwise healthy asthmatic patients during an acute attack. Plots for each subject are presented individually. The dashed line depicts the response of non-asthmatic individuals. Redrawn from: Mitenko, P.A. and Ogilvie R.I. Rational intravenous doses of theophylline. NEJM, 289:602,1973. Abstracted by permission of The New England Journal of Medicine. Figure 2. Mean (±SE) peak expiratory flow in 31 patients treated with high-dose budesonide and 31 patients given low-dose budesonide plus theophylline (250 or 375 mg) twice daily for 3 months. Median serum theophylline concentration was 8.7 µg/ml. Redrawn from: Evans, D.J. et al. A comparison of low-dose inhaled budesonide plus theophylline and high-dose inhaled budesonide for moderate asthma. NEJM 337:1412, 1997.
6 HANDOUT 3 - for use with Episode 2 Figure 1. Number of acute asthmatic attacks in a group of patients who received placebo or theophylline. Patients who received theophylline are further subdivided according to their peak serum theophylline concentrations. Redrawn from: Weinberger, M. Theophylline for treatment of asthma. J. Pediatrics 92:2,1978. Figure 2. Relationship between serum theophylline concentration and prevention of exerciseinduced deterioration in pulmonary function. V50 is a measure of rate of expiration. Redrawn from: Pollock J., Kiechel F., Cooper D., and Weinberger M. Relationship of serum theophylline concentration to inhibition of exercise-induced bronchospasm and comparison with cromolyn. Pediatrics 60:843,1977.
7 HANDOUT 4 - for use with Episode 2 Time (hr) Serum conc. (µg/ml)
8 GRAPH A Time (hr) Serum conc. (µg/ml)
9 GRAPH B Time (hr) Serum conc. (µg/ml)
10 HANDOUT 5 - for use with Episode 3 Serum theophylline concentrations following IV administration of theophylline to adults in an intensive care unit. Seventeen of 49 patients experienced varying degrees of theophylline toxicity as a result of elevated serum drug concentrations. Mild toxicity included nausea, vomiting, headache, insomnia and nervousness. Potentially serious adverse effects included sinus tachycardia with or without symptoms of mild toxicity. Severe toxicity included cardiac arrhythmias and seizures. Redrawn from: Hendeles, L., Bighley, L., Richardson, R.H., Hepler C.D. and Carmichael J. Frequent toxicity from IV aminophylline infusions in critically ill patients. Drug Intell. Clin. Pharm.11:14, 1977.
11 Episode Four Mr. Wheeze has continued to take cimetidine along with his asthma drug regimen for several months. His asthma is well controlled. During the summer, he and his friends go on a camping trip. One week later, Mr. Wheeze experiences a severe asthma attack and is taken to the emergency department of a local hospital. He tells the physician on call that he has asthma that is usually well controlled by ICS and theophylline. The physician immediately treats Mr. Wheeze with albuterol and draws blood for measurement of the theophylline concentration. Use the following questions and the Discussion Notes to guide the discussion Each member of the group should take the lead in answering at least one of the questions. 4.1 Why was albuterol administered? 4.2 Mr. Wheeze does not respond to albuterol. Should theophylline be given to him at this time? Why did Mr. Wheeze not respond to albuterol? 4.3 Mr. Wheeze's serum theophylline concentration is now reported to be <1 µg/ml. Do you believe this report and why? 4.4 Why is there virtually no theophylline in Mr. Wheeze's serum? 4.5 What should be done now? 4.6 Mr. Wheeze admits that he accidentally left his theophylline in his medicine cabinet at home, and he hasn't taken any of the drug for one week. He did remember his cimetidine, however. Is it rational to administer theophylline at this stage? 4.7 The physician plans to give Mr. Wheeze his usual dose of theophylline (400 mg) as the sustained-release tablet every 12 hours. Is this the correct approach? 4.8 How should theophylline be given to get an immediate effect? 4.9 Provide your group with the following information for theophylline: half-life = 12 hours, Vd = 0.45 L/kg, and clearance = L/kg/hr. Then have them calculate a loading dose of theophylline for Mr. Wheeze that will attain a serum concentration of 10 µg/ml. Inform them that theophylline will be administered in an IV drip as aminophylline (80% theophylline) What maintenance dose of aminophylline should be administered by constant intravenous infusion to keep the serum theophylline concentration at 10 µg/ml? 4
12 Discussion Notes for Questions in Episode Four 4.1 To produce bronchodilation. Albuterol is a short-acting bronchodilator by virtue of its action on beta-2 adrenergic receptors on bronchiolar smooth muscle. 4.2 A more common practice would be to administer another dose or two of albuterol at 15- to 30-minute intervals. However, there is still no response. It is important to know Mr. Wheeze's serum theophylline concentration before you give more theophylline. The reason Mr. Wheeze did not respond to albuterol is unknown, but he may have a single-nucleotide polymorphism in the ADRB2 gene for the beta-2 adrenergic receptor that renders him non-responsive to beta-2 agonist bronchodilators. 4.3 It is wise to question an unexpected lab value. In this case, however, we have more than the lab test result. We also have the lack of pharmacologic effect. The low serum theophylline level plus the lack of effect should make you fairly confident in the laboratory report. 4.4 There are two possibilities: he has not taken his medication or, for some reason, he has become a rapid metabolizer. The latter explanation is unlikely. 4.5 It is important to distinguish between the two possibilities in 4.4. The best initial approach is to gently ask Mr. Wheeze again about whether he has taken his theophylline. 4.6 Yes, it is. We know Mr. Wheeze is responsive to theophylline, so it should relieve his symptoms 4.7 No, it s not. It will take 4-5 half-lives to reestablish a therapeutic steady-state concentration of theophylline. The half-life of theophylline is 12 hours; thus, 2-3 days of therapy would be required to achieve a maximally effective concentration. Mr. Wheeze needs the drug's full action immediately. 4.8 An intravenous loading dose of theophylline should be given to rapidly achieve a therapeutic response. 4.9 Remember: loading dose = Vd x Css Therefore, the theophylline loading dose = 0.45 L/kg x 10 mg/l = 4.5 mg/kg. However, aminophylline only contains 80% theophylline by weight. Therefore, the loading dose of aminophylline is 100/80 x 4.5/1 = 5.6 mg/kg. The loading dose should be administered over 30 minutes. Although the distribution of theophylline between blood and other tissues is rapid, it is not instantaneous. Therefore, if the drug is infused too rapidly, most of the dose is in the blood initially and the concentration of theophylline is quite high. Highly perfused tissues such as the heart and brain could be exposed to potentially toxic concentrations during this phase. 5
13 4.10 Remember: maintenance dose = CL x Css For maintenance dosing, the amount of drug lost during each dosage interval must be replaced. The clearance of theophylline in Mr. Wheeze is L/kg/hr, which means that L of serum is completely cleared of the drug every hour for every kg of body weight. Mr. Wheeze's serum concentration of theophylline needs to be maintained at 10 mg/l. Therefore, every hour he will lose 10 mg/l x L/kg/hr of theophylline, i.e., he loses 0.25 mg/kg/hr. Therefore, the rate of administration of the maintenance dose of theophylline should be 0.25 mg/kg/hr. That's about 420 mg per day very close to his oral dose of theophylline before he went camping! As aminophylline, the dose will be 0.30 mg/kg/hr. When you have finished discussing this episode, you have completed the clinical problem. Now, please have each group member, individually, answer the questions on the posttest. 6
PHARMACOKINETICS SMALL GROUP II:
PHARMACOKINETICS SMALL GROUP II: Question 1 Why are some drug therapies initiated with a loading dose? Emphasize that LD establishes initial therapeutic level quickly. The time to reach the steady-state
More informationCLINICAL PHARMACOKINETICS INDEPENDENT LEARNING MODULE
CLINICAL PHARMACOKINETICS INDEPENDENT LEARNING MODULE Joseph K. Ritter, Ph.D. Assoc. Professor, Pharmacology and Toxicology MSB 536, 828-1022, jritter@vcu.edu This self study module will reinforce the
More informationBasic Concepts of TDM
TDM Lecture 1 5 th stage What is TDM? Basic Concepts of TDM Therapeutic drug monitoring (TDM) is a branch of clinical pharmacology that specializes in the measurement of medication concentrations in blood.
More informationLD = (Vd x Cp)/F (Vd x Cp)/F MD = (Css x CL x T)/F DR = (Css x (Vm-DR))/Km Css = (F x D)/(CL x T) (Km x DR)/(Vm DR)
PHARMKIN WORKSHOP A PHARMACOKINETICS TEACHING SIMULATION Joseph K. Ritter, Ph.D. Associate Professor, Pharmacology and Toxicology MSB 536, 828-1022, jritter@mail2.vcu.edu Tompkins-McCaw Libray Room 2-006
More information1. If the MTC is 100 ng/ml and the MEC is 0.12 ng/ml, which of the following dosing regimen(s) are in the therapeutic window?
Page 1 PHAR 750: Biopharmaceutics/Pharmacokinetics October 23, 2009 - Form 1 Name: Total 100 points Please choose the BEST answer of those provided. For numerical answers, choose none of the above if your
More informationPHA Final Exam Fall 2006
PHA 5127 Final Exam Fall 2006 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Please transfer the answers onto the bubble sheet. The question number refers
More informationGeneral Principles of Pharmacology and Toxicology
General Principles of Pharmacology and Toxicology Parisa Gazerani, Pharm D, PhD Assistant Professor Center for Sensory-Motor Interaction (SMI) Department of Health Science and Technology Aalborg University
More informationClinical Pharmacology. Pharmacodynamics the next step. Nick Holford Dept Pharmacology & Clinical Pharmacology University of Auckland, New Zealand
1 Pharmacodynamic Principles and the Course of Immediate Drug s Nick Holford Dept Pharmacology & Clinical Pharmacology University of Auckland, New Zealand The time course of drug action combines the principles
More informationLippincott Questions Pharmacology
Lippincott Questions Pharmacology Edition Two: Chapter One: 1.Which one of the following statements is CORRECT? A. Weak bases are absorbed efficiently across the epithelial cells of the stomach. B. Coadministration
More informationPHA Final Exam. Fall On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5127 Final Exam Fall 2012 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Please transfer the answers onto the bubble sheet. The question number refers
More informationRESPIRATORY PHARMACOLOGY - ASTHMA. Primary Exam Teaching - Westmead ED
RESPIRATORY PHARMACOLOGY - ASTHMA Primary Exam Teaching - Westmead ED Sympathomimetic agents MOA: relax airway smooth muscle and inhibit broncho constricting mediators from mast cells May also inhibit
More informationPharmacokinetics Overview
Pharmacokinetics Overview Disclaimer: This handout and the associated lectures are intended as a very superficial overview of pharmacokinetics. Summary of Important Terms and Concepts - Absorption, peak
More informationNontraditional PharmD Program PRDO 7700 Pharmacokinetics Review Self-Assessment
Nontraditional PharmD Program PRDO 7700 Pharmacokinetics Review Self-Assessment Please consider the following questions. If you do not feel confident about the material being covered, then it is recommended
More informationPharmacodynamic principles and the time course of immediate drug effects
TCP 2017;25(4):157-161 http://dx.doi.org/10.12793/tcp.2017.25.4.157 Pharmacodynamic principles and the time course of immediate drug effects TUTORIAL Department of Pharmacology & Clinical Pharmacology,
More informationC OBJECTIVES. Basic Pharmacokinetics LESSON. After completing Lesson 2, you should be able to:
LESSON 2 Basic Pharmacokinetics C OBJECTIVES After completing Lesson 2, you should be able to: 1. Define the concept of apparent volume of distribution and use an appropriate mathematical equation to calculate
More informationPHA 5127 FINAL EXAM FALL On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5127 FINAL EXAM FALL 1997 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Question Points 1. /14 pts 2. /10 pts 3. /8 pts 4 /8 pts 5. /12 pts 6. /8 pts
More informationPHA 5128 Final Exam Spring 2004 Version A. On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5128 Final Exam Spring 2004 Version A On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name There are 18 questions. Total /120 pts Final 2004 1 1. T.P., a 66-year-old,
More informationPHA Final Exam. Fall On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5127 Final Exam Fall 2010 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Please transfer the answers onto the bubble sheet. The question number refers
More informationThus, we can group the entire loading dose together as though it was given as a single dose, all administered when the first dose was given.
PHA 5128 Dose Optimization II, Spring 2012, Case Study V Solution If you have any questions regarding this case study, do not hesitate to contact Benjamin Weber (benjaminweber@ufl.edu). Please remember
More informationAtrovent Administration
Atrovent Administration ICEMA Training 2007 Sherri Shimshy RN OBJECTIVES Describe the pharmacology of Atrovent Identify the indications for use of Atrovent in the Adult Population Identify the indications
More informationBasic Pharmacokinetic Principles Stephen P. Roush, Pharm.D. Clinical Coordinator, Department of Pharmacy
Basic Pharmacokinetic Principles Stephen P. Roush, Pharm.D. Clinical Coordinator, Department of Pharmacy I. General principles Applied pharmacokinetics - the process of using drug concentrations, pharmaco-kinetic
More informationCOPD. Breathing Made Easier
COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought
More informationMultiple IV Bolus Dose Administration
PHARMACOKINETICS Multiple IV Bolus Dose Administration ١ Multiple IV Bolus Dose Administration Objectives: 1) To understand drug accumulation after repeated dose administration 2) To recognize and use
More informationPHA 4120 Second Exam Key Fall On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 4120 Second Exam Key Fall 1997 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Question Points 1. /10 ponts 2. /20 points 3. /10 points 4. /10 points
More informationClinical Indications. Clinical Indications. RSPT 2317 Methylxanthines. RSPT 2317 Methylxanthines
RSPT 2317 Clinical Indications Theophylline management of asthma and COPD treatment of apnea of prematurity (AOP) diuretic (obsolete use) classified as a bronchodilator, but is weaker than β agonists effects
More informationBIOPHARMACEUTICS and CLINICAL PHARMACY
11 years papers covered BIOPHARMACEUTICS and CLINICAL PHARMACY IV B.Pharm II Semester, Andhra University Topics: Absorption Distribution Protein binding Metabolism Excretion Bioavailability Drug Interactions
More informationPHAR 7633 Chapter 20 Non Compartmental Analysis
Student Objectives for this Chapter PHAR 7633 Chapter 20 Non Compartmental Analysis To understand and use the non compartmental approach to parameter estimation be able to define, use, and calculate the
More informationPACKAGE INSERT TEMPLATE FOR SALBUTAMOL TABLET & SALBUTAMOL SYRUP
PACKAGE INSERT TEMPLATE FOR SALBUTAMOL TABLET & SALBUTAMOL SYRUP Brand or Product Name [Product name] Tablet 2mg [Product name] Tablet 4mg [Product name] Syrup 2mg/5ml Name and Strength of Active Substance(s)
More informationName: UFID: PHA Exam 2. Spring 2013
PHA 5128 Exam 2 Spring 2013 1 Carbamazepine (5 points) 2 Theophylline (10 points) 3 Gentamicin (10 points) 4 Drug-drug interaction (5 points) 5 Lidocaine (5 points) 6 Cyclosporine (5 points) 7 Phenobarbital
More informationAsthma Medications: Information for Children and Families. What You Need to Know about Medicines for Asthma
Page 1 of 8 PED-ALL-005-1992 Asthma Medications: Information for Children and Families What You Need to Know about Medicines for Asthma What Medicines Are used to Treat Asthma? There are two kinds of medicines:
More informationBASIC PHARMACOKINETICS
BASIC PHARMACOKINETICS MOHSEN A. HEDAYA CRC Press Taylor & Francis Croup Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business Table of Contents Chapter
More informationAsthma is global health problem in children,
Paediatrica Indonesiana VOLUME 52 July NUMBER 4 Original Article Efficacy of salbutamol-ipratropium bromide nebulization compared to salbutamol alone in children with mild to moderate asthma attacks Matahari
More informationPHA Second Exam. Fall On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5127 Second Exam Fall 2011 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Put all answers on the bubble sheet TOTAL /200 pts 1 Question Set I (True or
More informationRational Dose Prediction. Pharmacology. φαρμακον. What does this mean? pharmakon. Medicine Poison Magic Spell
1 Rational Dose Prediction Nick Holford Dept Pharmacology & Clinical Pharmacology University of Auckland, New Zealand 2 Pharmacology Pharmacology is derived from a Greek word (pharmakon). The Greeks used
More informationPHARMACOKINETICS SMALL GROUP I:
PHARMACOKINETICS SMALL GROUP I: Question 1 Absorption of the anti-fungal agent, itraconazole, is dependent on a low gastric ph. Calculate the relative concentrations of a weak acid (with a pka of 5.4)
More informationLecture Notes. Chapter 3: Asthma
Lecture Notes Chapter 3: Asthma Objectives Define asthma and status asthmaticus List the potential causes of asthma attacks Describe the effect of asthma attacks on lung function List the clinical features
More informationFrom the Text. Clinical Indications. Clinical Indications. Clinical Indications. Clinical Indications. RSPT 2317 Methylxanthines
From the Text RSPT 2217 Gardenhire Chapter 8 Key Terms and Definitions page 151 Xanthine Derivatives Used as Bronchodilators Table 8-1; page 152 Adverse Reactions Seen with Theophylline Box 8-1; page 157
More information. Although there is a little
PHA 58 Spring 007 Case study 4. Baby girl A, 3kg, 5 days, is receiving phenobarbital because of neonatal seizures. An IV loading dose of phenobarbital sodium of 0mg/kg was given followed by maintenance
More informationA Clinical Guideline for the use of Intravenous Aminophylline in Acute Severe Asthma in Children
For Use in: By: For: Division responsible for document: Key words: Name and job titles of document author: Name and job title of document author s Line Manager: Supported by: Assessed and approved by the:
More informationTamer Barakat. Abdul Aziz ALShamali. Abdul Aziz ALShamali
10 Tamer Barakat Abdul Aziz ALShamali Abdul Aziz ALShamali Dr. Alia Elimination: Refampin is used to treat TB not malaria (Quinacrine is used for malaria) It s the opposite process of absorption. It's
More informationOne-Compartment Open Model: Intravenous Bolus Administration:
One-Compartment Open Model: Intravenous Bolus Administration: Introduction The most common and most desirable route of drug administration is orally by mouth using tablets, capsules, or oral solutions.
More informationBiopharmaceutics Lecture-11 & 12. Pharmacokinetics of oral absorption
Biopharmaceutics Lecture-11 & 12 Pharmacokinetics of oral absorption The systemic drug absorption from the gastrointestinal (GI) tract or from any other extravascular site is dependent on 1. 2. 3. In the
More informationPHA 5128 Spring 2000 Final Exam
PHA 128 Spring 2000 Final Exam On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name TYPED KEY Questions Points 1. /1 2. /1 3. /1 4. /1. /10 6. /10. /10 8. /10
More informationBasic Pharmacokinetics and Pharmacodynamics: An Integrated Textbook with Computer Simulations
Basic Pharmacokinetics and Pharmacodynamics: An Integrated Textbook with Computer Simulations Rosenbaum, Sara E. ISBN-13: 9780470569061 Table of Contents 1 Introduction to Pharmacokinetics and Pharmacodynamics.
More informationIntroduction to. Pharmacokinetics. University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
Introduction to 1 Pharmacokinetics University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 2 Learning objectives Understand compartment models and how they effects
More informationChildren are small adults and babies are young children
1 Children are small adults and babies are young children Nick Holford Dept Pharmacology & Clinical Pharmacology Brian Anderson Dept Anaesthesia & Starship Hospital University of Auckland, New Zealand
More informationLearning Outcomes 1. Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy.
CHAPTER 2 DRUG APPROVAL AND REGULATION Learning Outcomes 1. Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy. Suggested Classroom
More informationBUDESONIDE AND FORMOTEROL (SYMBICORT ): Α A REVIEW
Volume 23, Issue 3 December 2007 BUDESONIDE AND FORMOTEROL (SYMBICORT ): A REVIEW Donna L. Smith, Pharm. D. Candidate More than 22 million people in the United States have asthma according to the Centers
More informationBioequivalence of Inhaled Corticosteroids. -with emphasis on Pharmacokinetic Tools.
Bioequivalence of Inhaled Corticosteroids -with emphasis on Pharmacokinetic Tools? hochhaus@ufl.edu Topics related to Bioequivalence 10-60 % Deposited in lung Complete absorption from the lung Cl muc Mouth
More informationCarbamazepine has a clearance of L/h/kg for monotherapy. For immediate release carbamazepine, the oral bioavailbility is 0.8
PHA 5128 Dose Optimization II, Spring 2013, Case Study IV Solution If you have any questions regarding this case study, do not hesitate to contact Benjamin Weber (benjaminweber@ufl.edu). Please remember
More informationPharmacokinetic Calculations
Pharmacokinetic Calculations Introduction. Pharmacokinetics involves the relationship between concentration of drug (and its metabolites), measured most often in plasma, drug dosage, and time. A vast majority
More informationPHA Second Exam Fall On my honor, I have neither given nor received unauthorized aid in doing this assignment.
PHA 5127 Second Exam Fall 2013 On my honor, I have neither given nor received unauthorized aid in doing this assignment. Name Question/Points Set I 20 pts Set II 20 pts Set III 20 pts Set IV 20 pts Set
More informationPHARMACOKINETICS OF DRUG ABSORPTION
Print Close Window Note: Large images and tables on this page may necessitate printing in landscape mode. Applied Biopharmaceutics & Pharmacokinetics > Chapter 7. Pharmacokinetics of Oral Absorption >
More informationAdjusting phenytoin dosage in complex patients: how to win friends and influence patient outcomes
Adjusting phenytoin dosage in complex patients: how to win friends and influence patient outcomes Brian Hardy, PharmD, FCSHP, FCCP Coordinator Education and Clinical Programs Department of Pharmacy Sunnybrook
More informationSuggested Classroom Activity: Have the students access the FDA.gov website for the
Pharmacology for Nurses A Pathophysiologic Approach 5th Edition Adams SOLUTIONS MANUAL Full download at: https://testbankreal.com/download/pharmacology-for-nurses-apathophysiologic-approach-5th-edition-adams-solutions-manual/
More informationPharmacodynamics & Pharmacokinetics 1
PCTH 325 Pharmacodynamics & Pharmacokinetics 1 Dr. Shabbits jennifer.shabbits@ubc.ca September 9, 2014 Learning objectives 1. Describe the categories of intended drug action 2. Compare and contrast agonists
More informationUnderstand the physiological determinants of extent and rate of absorption
Absorption and Half-Life Nick Holford Dept Pharmacology & Clinical Pharmacology University of Auckland, New Zealand Objectives Understand the physiological determinants of extent and rate of absorption
More informationHistory & Development
RSPT 2317 Anticholinergic Bronchodilators () History & Development Prototypical parasympatholytic agent is atropine an alkaloid found naturally in the plants Atropa belladona (nightshade) and Datura species
More informationCardiac Stress Test [ ] Procedures. Cardiac Studies Stress Tests (Single Response)
Cardiac Stress Test [3041300006] Procedures Cardiac Studies Stress Tests (Single Response) ( ) EKG Only Exercise Stress Test - Treadmill Do Not Order if: Baseline ST segment abnormalities on EKG (LBBB,
More informationPharmacokinetic Phase
RSPT 2317 Principles of Drug Action Part 2: The Pharmacokinetic Phase Pharmacokinetic Phase This phase describes the time course and disposition of a drug in the body, based on its absorption, distribution,
More informationRespiratory Pharmacology. Manuel Otero Lopez Department of Anaesthetics and Intensive Care Hôpital Européen Georges Pompidou, Paris, France
Respiratory Pharmacology Manuel Otero Lopez Department of Anaesthetics and Intensive Care Hôpital Européen Georges Pompidou, Paris, France Programme Bronchomotor tone Drugs and factors influencing airway
More informationSYNOPSIS. First subject enrolled 15 August 2003 Therapeutic confirmatory (III) Last subject completed 03 February 2005
Drug product: SYMBICORT pmdi 160/4.5 μg Drug substance(s): Budesonide/formoterol Study code: SD-039-0728 Edition No.: FINAL Date: 27 February 2006 SYNOPSIS A 52-week, randomized, double-blind, single-dummy,
More informationPATIENT INFORMATION FORM
PATIENT INFORMATION FORM "I am going to ask you a number of questions about your asthma. The set of questions is somewhat long, but I will try to move through it fairly quickly so that we can complete
More informationIntroduction to. Pharmacokinetics. University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
Introduction to 1 Pharmacokinetics University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 2 Learning objectives Understand compartment models and how they effects
More informationREVIEW AMINOPHYLLINE. Background
REVIEW AMINOPHYLLINE Background The current 13 th edition of the WHO Model Essential Medicines List (dated April 2003) includes aminophylline on the Complementary List. The listing is as shown below (together
More informationHow effective is chelation? contrasts in iron and digoxin poisoning. Nick Bateman Edinburgh
How effective is chelation? contrasts in iron and digoxin poisoning Nick Bateman Edinburgh Chelation Chemical chelating agents chemical that bind metal ions and other toxic groups e.g. desferrioxamine
More informationThe clinical effectiveness and costeffectiveness. treatment of chronic asthma in children under the age of 12 years
The clinical effectiveness and costeffectiveness of corticosteroids for the treatment of chronic asthma in children under the age of 12 years Submission of evidence from AstraZeneca UK Ltd regarding the
More informationChapter 55. Changes in the Airway With COPD. Manifestations of Severe COPD. Drugs Used to Treat Obstructive Pulmonary Disorders
Chapter 55 Drugs Used to Treat Obstructive Pulmonary Disorders Changes in the Airway With COPD Manifestations of Severe COPD Air is trapped in the lower respiratory tract The alveoli degenerate and fuse
More informationPHA Spring First Exam. 8 Aminoglycosides (5 points)
PHA 5128 Spring 2012 First Exam 1 Aminoglycosides (5 points) 2 Aminoglycosides (10 points) 3 Basic Principles (5 points) 4 Basic Principles (5 points) 5 Bioavailability (5 points) 6 Vancomycin (5 points)
More information+ Asthma and Athletics
+ Asthma and Athletics Shaylon Rettig, MD, MBA Champion Sports Medicine + Financial Disclosure Dr. Shaylon Rettig has no relevant financial relationships with commercial interests to disclose. + Asthma
More informationAsthma in Pregnancy. Asthma. Chronic Airway Inflammation. Objective Measures of Airflow. Peak exp. flow rate (PEFR)
Chronic Airway Inflammation Asthma in Pregnancy Robin Field, MD Maternal Fetal Medicine Kaiser Permanente San Francisco Asthma Chronic airway inflammation increased airway responsiveness to a variety of
More informationPharmacokinetics I. Dr. M.Mothilal Assistant professor
Pharmacokinetics I Dr. M.Mothilal Assistant professor DRUG TRANSPORT For a drug to produce a therapeutic effect, it must reach to its target and it must accumulate at that site to reach to the minimum
More informationSalapin: Salbutamol BP 2mg as sulphate in each 5mL of a raspberry cola flavoured, sugar free syrup.
Salapin Salbutamol Syrup 2mg/5mL Qualitative and quantitative composition Salapin: Salbutamol BP 2mg as sulphate in each 5mL of a raspberry cola flavoured, sugar free syrup. Clinical particulars Therapeutic
More informationI. Subject: Continuous Aerosolization of Bronchodilators
I. Subject: Continuous Aerosolization of Bronchodilators II. Indications: A. Acute airflow obstruction in which treatment with an aerosolized bronchodilator is desired for an extended period of time, i.e.
More informationSummary of the risk management plan (RMP) for Budesonide/Formoterol Teva (budesonide / formoterol)
EMA/639304/2014 Summary of the risk management plan (RMP) for Budesonide/Formoterol Teva (budesonide / formoterol) This is a summary of the risk management plan (RMP) for Budesonide/Formoterol Teva, which
More informationDelayed Drug Effects. Distribution to Effect Site. Physiological Intermediate
1 Pharmacodynamics Delayed Drug Effects In reality all drug effects are delayed in relation to plasma drug concentrations. Some drug actions e.g. anti-thrombin III binding and inhibition of Factor Xa by
More informationVA/DoD Clinical Practice Guideline Management of COPD Pocket Guide
VA/DoD Clinical Practice Guideline Management of COPD Pocket Guide MODULE A: MAAGEMET OF COPD 1 2 Patient with suspected or confirmed COPD presents to primary care [ A ] See sidebar A Perform brief clinical
More informationPHA Case Studies V (Answers)
PHA 5128 Case Studies V (Answers) 1. A 100 kg patient is to be treated p.o. with sodium phenytoin capsules. Assuming a phenytoin volume of distribution of 0.7 L/kg, Km of 4 mg/l and Vmax of 7 mg/kg/day,
More informationSummary of the risk management plan (RMP) for Vylaer Spiromax (budesonide / formoterol)
EMA/675937/2014 Summary of the risk management plan (RMP) for Vylaer Spiromax (budesonide / formoterol) This is a summary of the risk management plan (RMP) for Vylaer Spiromax, which details the measures
More informationDoses Target Concentration Intervention
1 Doses Target Concentration Intervention 2 Problem 1 Questions 1-2 Susan is a 28 year old woman who has had epilepsy since she was 5 years old. She has been on, and off, anticonvulsant medication since
More informationPHA5128 Dose Optimization II Case Study I Spring 2013
Silsamicin is an investigational compound being evaluated for its antimicrobial effect. The route of administration for this drug is via intravenous bolus. Approximately 99.9% of this drug is eliminated
More informationSummary of the risk management plan (RMP) for DuoResp Spiromax (budesonide / formoterol)
EMA/126654/2014 Summary of the risk management plan (RMP) for DuoResp Spiromax (budesonide / formoterol) This is a summary of the risk management plan (RMP) for DuoResp Spiromax, which details the measures
More informationknowledge of serum theophylline concentration on admission
Thorax 1986;41:759-765 Intravenous aminophylline in patients already taking oral theophylline: effect on calculated dose of knowledge of serum theophylline concentration on admission J WIGGINS, 0 A ARBAB,
More informationOXEZE TURBUHALER formoterol fumarate dihydrate dry powder for oral inhalation
IMPORTANT: PLEASE READ PART III: CONSUMER INFORMATION OEZE TURBUHALER formoterol fumarate dihydrate dry powder for oral inhalation This leaflet is part III of a three-part Product Monograph published when
More informationPharmacokinetic Phase
RSPT 2217 Principles of Drug Action Part 2: The Pharmacokinetic Phase Gardenhire Chapter 2; p. 14-25 From the Text Common Pathways for Drug Box 2-3; page 18 Plasma Half-lives of Common Drugs Table 2-4;
More informationNonlinear Pharmacokinetics
Nonlinear Pharmacokinetics Non linear pharmacokinetics: In some cases, the kinetics of a pharmacokinetic process change from predominantly first order to predominantly zero order with increasing dose or
More informationpharmacy, we need to see how clinical pharmacokinetics fits into the pharmaceutical care process.
Therapeutic drug monitoring (TDM) Is a tool that can guide the clinician to provide effective and safe drug therapy in the individual patient. Monitoring can be used to confirm a plasma drug concentration
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,900 116,000 120M Open access books available International authors and editors Downloads Our
More informationSlide 1. Slide 2. Slide 3. Drug Action and Handling. Lesson 2.1. Lesson 2.1. Drug Action and Handling. Drug Action and Handling.
Slide 1 Drug Action and Handling Chapter 2 1 Slide 2 Lesson 2.1 Drug Action and Handling 1. Differentiate dose, potency, and efficacy in the context of the actions of drugs. 2. Explain the pharmacologic
More informationTDM Lecture 7 5 th Stage. TDM of Digoxin. Uses: Digoxin is usually used in heart failure associated and atrial fibrillation.
TDM Lecture 7 5 th Stage TDM of Digoxin Digoxin uses and elimination Uses: Digoxin is usually used in heart failure associated and atrial fibrillation. Elimination: About 75% of digoxin clearance occurred
More informationComposition Each ml of Ventol solution for inhalation contains 5 mg Salbutamol (as sulphate).
VENTOL Composition Each ml of Ventol solution for inhalation contains 5 mg Salbutamol (as sulphate). Respiratory Solution Action Salbutamol is a short-acting, relatively selective beta2-adrenoceptor agonist.
More informationGeneral Principles of Pharmacology and Toxicology
General Principles of Pharmacology and Toxicology Parisa Gazerani, Pharm D, PhD Assistant Professor Center for Sensory-Motor Interaction (SMI) Department of Health Science and Technology Aalborg University
More informationMEDICATION GUIDE ANORO ELLIPTA
MEDICATION GUIDE ANORO ELLIPTA [a-nor oh e-lip-ta] (umeclidinium and vilanterol inhalation powder) for oral inhalation What is the most important information I should know about ANORO ELLIPTA? ANORO ELLIPTA
More informationMN-221, a Novel Beta2-Adrenergic Agonist for Treatment of Acute Asthma and COPD
MN-221, a Novel Beta2-Adrenergic Agonist for Treatment of Acute Asthma and COPD Brian M. Sadler PhD, Alan Dunton MD, Ernest Kitt, James Bosley PhD, Ron Beaver PhD November 2010 MediciNova, Inc. Rosa &
More informationSteven Berkowitz, DVM Chief, Emergency and Critical Care Saint Francis Veterinary Center
Steven Berkowitz, DVM Chief, Emergency and Critical Care Saint Francis Veterinary Center Outline Anatomy Common Diseases Interventions Oxygen Therapy Medications Nebulization Coupage Respiratory Tract
More information1. Immediate 2. Delayed 3. Cumulative
1 Pharmacodynamic Principles and the Time Course of Delayed Drug Effects Nick Holford Dept Pharmacology & Clinical Pharmacology University of Auckland, New Zealand The time course of drug action combines
More informationNEW ZEALAND DATA SHEET SEREVENT Accuhaler
NEW ZEALAND DATA SHEET SEREVENT Accuhaler Salmeterol xinafoate (50 mcg per inhalation) Presentation SEREVENT Accuhaler is a moulded plastic device containing a foil strip with 60 regularly placed blisters
More informationRecurrent wheezing illnesses 24.9% Similar to Australia Above global averages
Prof Mike South Department of General Medicine Royal Children s Hospital Melbourne Australia www.mikesouth.org.au Asthma is very common in Australia Approx 25% children have recurrent wheezing illnesses
More informationAsthma in the Athlete
Asthma in the Athlete Jorge E. Gomez, MD Associate Professor Texas Children s Hospital Baylor College of Medicine Assist Team Physician UH Understand how we diagnose asthma Objectives Be familiar with
More information