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Questions and Answers
Which factor contributes substantially to large differences among people in metabolic clearance of drugs?
Which factor contributes substantially to large differences among people in metabolic clearance of drugs?
- Genetic factors (correct)
- Gender
- Age
- Plasma protein binding
What is the major cause of intersubject variability in drug metabolism?
What is the major cause of intersubject variability in drug metabolism?
- Genetic factors (correct)
- Age-related changes
- Gender differences
- Plasma protein binding
In which group does the concentration of plasma proteins tend to fall gradually?
In which group does the concentration of plasma proteins tend to fall gradually?
- Children
- Pregnant women (correct)
- Young adults
- Elderly individuals
What is the ratio of kidney weight to total body weight in newborns compared to adults?
What is the ratio of kidney weight to total body weight in newborns compared to adults?
Which age group shows a decline in organ function with advancing age?
Which age group shows a decline in organ function with advancing age?
What is the probability of experiencing adverse effects as age increases?
What is the probability of experiencing adverse effects as age increases?
In which population does renal excretion risk for adverse drug effects remain high?
In which population does renal excretion risk for adverse drug effects remain high?
Which factor better correlates dosing requirements in children than body weight?
Which factor better correlates dosing requirements in children than body weight?
What contributes to unusually rapid elimination of drugs during pregnancy?
What contributes to unusually rapid elimination of drugs during pregnancy?
Which factor decreases progressively with age after $20$ years old?
Which factor decreases progressively with age after $20$ years old?
What is a principal source of variability in response to drugs?
What is a principal source of variability in response to drugs?
What is directly proportional to body weight in adults with normal lean-to-fat ratios?
What is directly proportional to body weight in adults with normal lean-to-fat ratios?
Which factor may affect the completeness of drug absorption?
Which factor may affect the completeness of drug absorption?
$ADME$ subject to individual variation refers to variability in which aspect of drug response?
$ADME$ subject to individual variation refers to variability in which aspect of drug response?
What is a wide range of blood levels seen in the same subject taking a drug on different occasions indicative of?
What is a wide range of blood levels seen in the same subject taking a drug on different occasions indicative of?
What are factors contributing to variability?
What are factors contributing to variability?
Which of the following factors is related to body weight?
Which of the following factors is related to body weight?
In which patient population are adjustments for weight usually made?
In which patient population are adjustments for weight usually made?
What is defined as the weight at which a patient's total body weight is more than 25% above desirable weight?
What is defined as the weight at which a patient's total body weight is more than 25% above desirable weight?
Which index is considered superior to total body weight for prescribing proper levels of medications?
Which index is considered superior to total body weight for prescribing proper levels of medications?
How do water-soluble drugs distribute in adults compared with neonates?
How do water-soluble drugs distribute in adults compared with neonates?
What may be increased to a similar or greater extent in obese patients?
What may be increased to a similar or greater extent in obese patients?
What do larger volume of distribution lead to in terms of blood levels?
What do larger volume of distribution lead to in terms of blood levels?
What do children require and tolerate larger mg/kg doses of than adults?
What do children require and tolerate larger mg/kg doses of than adults?
What is the relationship between initial blood levels and apparent volume of distribution following a single or loading dose of a drug?
What is the relationship between initial blood levels and apparent volume of distribution following a single or loading dose of a drug?
In which patient population are adjustments for weight usually made?
In which patient population are adjustments for weight usually made?
$Water$-$soluble$ drugs show decreased volume of distribution in adults compared with neonates, while lipid-soluble drugs show:
$Water$-$soluble$ drugs show decreased volume of distribution in adults compared with neonates, while lipid-soluble drugs show:
Which age group requires and tolerates larger mg/kg doses of many drugs than adults?
Which age group requires and tolerates larger mg/kg doses of many drugs than adults?
What contributes to intersubject variability in drug response?
What contributes to intersubject variability in drug response?
What contributes substantially to large differences among people in metabolic clearance of drugs?
What contributes substantially to large differences among people in metabolic clearance of drugs?
In which population does renal excretion risk for adverse drug effects remain high?
In which population does renal excretion risk for adverse drug effects remain high?
What is the principal variation resulting from a given dose called?
What is the principal variation resulting from a given dose called?
Which factor contributes to a wide range of blood levels seen in the same subject taking a drug on different occasions?
Which factor contributes to a wide range of blood levels seen in the same subject taking a drug on different occasions?
What is the term used to describe differences in effect produced by a given drug concentration?
What is the term used to describe differences in effect produced by a given drug concentration?
Which type of variability is much greater between individuals than within the same individual?
Which type of variability is much greater between individuals than within the same individual?
What contributes to unusually rapid elimination of drugs during pregnancy?
What contributes to unusually rapid elimination of drugs during pregnancy?
Which factor decreases progressively with age after 20 years old?
Which factor decreases progressively with age after 20 years old?
What is a principal source of variability in response to drugs?
What is a principal source of variability in response to drugs?
What may be increased to a similar or greater extent in obese patients?
What may be increased to a similar or greater extent in obese patients?
$Water$-$soluble$ drugs show decreased volume of distribution in adults compared with neonates, while lipid-soluble drugs show:
$Water$-$soluble$ drugs show decreased volume of distribution in adults compared with neonates, while lipid-soluble drugs show:
What do larger volume of distribution lead to in terms of blood levels?
What do larger volume of distribution lead to in terms of blood levels?
Which factor contributes to altered drug disposition in the elderly?
Which factor contributes to altered drug disposition in the elderly?
What affects drug distribution in elderly patients?
What affects drug distribution in elderly patients?
What changes with age for apparent volume of distribution?
What changes with age for apparent volume of distribution?
How does drug metabolism change with age in children?
How does drug metabolism change with age in children?
What contributes to the need for higher mg/kg doses of certain drugs in children?
What contributes to the need for higher mg/kg doses of certain drugs in children?
What contributes to the increased probability of experiencing adverse effects with age?
What contributes to the increased probability of experiencing adverse effects with age?
What is the Boer formula used to calculate?
What is the Boer formula used to calculate?
What is the definition of obesity according to the text?
What is the definition of obesity according to the text?
What does the apparent volume of distribution of drugs depend on?
What does the apparent volume of distribution of drugs depend on?
What is the contributing factor to intersubject variability in drug response according to the text?
What is the contributing factor to intersubject variability in drug response according to the text?
When are weight adjustments thought necessary according to the text?
When are weight adjustments thought necessary according to the text?
$ADME$ subject to individual variation refers to variability in which aspect of drug response?
$ADME$ subject to individual variation refers to variability in which aspect of drug response?
What does ideal body weight ($IBW$) refer to?
What does ideal body weight ($IBW$) refer to?
What contributes to individual variation in $ADME$ according to the text?
What contributes to individual variation in $ADME$ according to the text?
What is calculated by subtracting body fat weight from total body weight?
What is calculated by subtracting body fat weight from total body weight?
What are dosing guidelines for neonates, infants, and children compared to those for adults according to the text?
What are dosing guidelines for neonates, infants, and children compared to those for adults according to the text?
What affects the completeness of drug absorption according to the text?
What affects the completeness of drug absorption according to the text?
How do age-related changes in body composition affect drug distribution in elderly patients?
How do age-related changes in body composition affect drug distribution in elderly patients?
What contributes to altered drug disposition in the elderly?
What contributes to altered drug disposition in the elderly?
How does drug metabolism in children compare to that in adults?
How does drug metabolism in children compare to that in adults?
What affects drug kinetics, with females showing different drug clearances?
What affects drug kinetics, with females showing different drug clearances?
What contributes to large differences among people in metabolic clearance of drugs?
What contributes to large differences among people in metabolic clearance of drugs?
What is the most correct statement about drug elimination in children?
What is the most correct statement about drug elimination in children?
How does hepatic blood flow change with age?
How does hepatic blood flow change with age?
What contributes to sex-related differences in acetaminophen and salicylic acid clearance?
What contributes to sex-related differences in acetaminophen and salicylic acid clearance?
Which factor may decrease progressively with age after 20 years old?
Which factor may decrease progressively with age after 20 years old?
How do water-soluble drugs distribute in adults compared with neonates?
How do water-soluble drugs distribute in adults compared with neonates?
Which factor contributes to variability in drug response related to changes in body composition in obese patients?
Which factor contributes to variability in drug response related to changes in body composition in obese patients?
What is the Boer formula used to calculate in men and women based on body weight and height?
What is the Boer formula used to calculate in men and women based on body weight and height?
What requires dosing adjustments if an individual's weight differs by more than 50% from the average adult weight?
What requires dosing adjustments if an individual's weight differs by more than 50% from the average adult weight?
What is usually defined based on height for men and women?
What is usually defined based on height for men and women?
What is a component of body composition and is calculated by subtracting body fat weight from total body weight?
What is a component of body composition and is calculated by subtracting body fat weight from total body weight?
What affects the apparent volume of distribution of drugs as well as drug clearance?
What affects the apparent volume of distribution of drugs as well as drug clearance?
What is the formula used to calculate lean body mass (LBM) for men and women based on body weight and height?
What is the formula used to calculate lean body mass (LBM) for men and women based on body weight and height?
Which of the following factors is a principal source of variability in drug response?
Which of the following factors is a principal source of variability in drug response?
What is the term used to describe individual variation in absorption, distribution, metabolism, and excretion (ADME) of drugs?
What is the term used to describe individual variation in absorption, distribution, metabolism, and excretion (ADME) of drugs?
What is the definition of obesity in terms of total body weight compared to desirable weight?
What is the definition of obesity in terms of total body weight compared to desirable weight?
What requires dosing adjustments when an individual's weight differs by more than 50% from the average adult weight?
What requires dosing adjustments when an individual's weight differs by more than 50% from the average adult weight?
What type of drugs show decreased volume of distribution in adults compared with neonates, while lipid-soluble drugs show increased volume of distribution in adults compared with neonates?
What type of drugs show decreased volume of distribution in adults compared with neonates, while lipid-soluble drugs show increased volume of distribution in adults compared with neonates?
In which patient population are dosing adjustments usually made due to differences in body weight?
In which patient population are dosing adjustments usually made due to differences in body weight?
What contributes to changes in drug partitioning into various body compartments?
What contributes to changes in drug partitioning into various body compartments?
Study Notes
Pharmacokinetic Considerations in Drug Dosing Based on Body Weight and Age
- Apparent volume of distribution is particularly evident for drugs poorly bound in the body
- Initial blood levels following a single or loading dose of a drug depend largely on the apparent volume of distribution
- Larger volume of distribution leads to lower blood levels
- Body weight, organ size, function, and blood flow are related to drug distribution
- Drug clearance and body weight show a poor correlation in normal young adults
- Adjustments for weight are usually made for children and unusually small or obese adult patients
- Ideal body weight (IBW) is defined as the weight at which a patient's total body weight is more than 25% above desirable weight
- Lean body mass is considered an index superior to total body weight for prescribing proper levels of medications
- Drug distribution changes due to changes in body composition in obese patients
- Renal clearance may be increased to a similar or greater extent in obese patients
- Children require and tolerate larger mg/kg doses of many drugs than adults
- Water-soluble drugs show decreased volume of distribution in adults compared with neonates, while lipid-soluble drugs show lower volume of distribution in neonates.
Pharmacokinetic Considerations in Drug Dosing Based on Body Weight and Age
- Apparent volume of distribution is particularly evident for drugs poorly bound in the body
- Initial blood levels following a single or loading dose of a drug depend largely on the apparent volume of distribution
- Larger volume of distribution leads to lower blood levels
- Body weight, organ size, function, and blood flow are related to drug distribution
- Drug clearance and body weight show a poor correlation in normal young adults
- Adjustments for weight are usually made for children and unusually small or obese adult patients
- Ideal body weight (IBW) is defined as the weight at which a patient's total body weight is more than 25% above desirable weight
- Lean body mass is considered an index superior to total body weight for prescribing proper levels of medications
- Drug distribution changes due to changes in body composition in obese patients
- Renal clearance may be increased to a similar or greater extent in obese patients
- Children require and tolerate larger mg/kg doses of many drugs than adults
- Water-soluble drugs show decreased volume of distribution in adults compared with neonates, while lipid-soluble drugs show lower volume of distribution in neonates.
Pharmacokinetic Variability and Dosing Adjustments
- Midazolam, an intravenous benzodiazepine, is a contributing factor to intrasubject variability.
- Factors contributing to variability in drug response include physical activity, bioavailability of drug, and renal clearance.
- Age-related phenomena, genetic and environmental factors, and consequences of disease can lead to individual variation in ADME (absorption, distribution, metabolism, and excretion).
- Body weight and size affect the apparent volume of distribution of drugs, as well as drug clearance.
- Concomitant administration of other drugs is an important source of variability in drug response.
- Weight adjustments are thought necessary when an individual's weight differs by more than 50% from the average adult weight.
- Obesity, defined as a total body weight more than 25% above desirable weight, requires dosing adjustments.
- Ideal body weight (IBW) is usually defined based on height for men and women.
- Drug distribution changes due to changes in body composition in obese patients.
- Lean body mass (LBM) is a component of body composition and is calculated by subtracting body fat weight from total body weight.
- The Boer formula is used to calculate LBM for men and women based on body weight and height.
- Changes in drug partitioning into various body compartments can be influenced by factors such as obesity, renal clearance, age, and body size. Dosing guidelines for neonates, infants, and children are more complicated than those for adults.
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Description
Test your understanding of the differences in drug levels at the site of action as inferred by drug concentration in the plasma, and the effects produced by a given drug concentration. Explore the sources of variability in drug response, with a focus on pharmacokinetic and pharmacodynamic variability.
