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IKE HUSEN Depart.of Pharmacology & Therapy Medical Faculty Padjadjaran University
I. EXTERNAL FACTORS
Patient compliance
Temporary Easy to correct without alter dose of drug or the regimen
Medication errors
A. Pharmacokinetic factors
Drug level at the receptor
B. Pharmacodynamic factors
Responses of the body to the drugs
1. 2. 3. 4. 5. 6. 7. 8.
Physiological conditions Pathological conditions Genetic factors Drug interactions Development of tolerance Placebo effects Environmental factors Biological rhythmic.
1. Diseases
Without symptom Chronic diseases Diseases which is needs preventive therapy Decreases patient compliance
2. Drugs/therapy
Multiple drugs Complex regimen dose The tablet is difficult to be swollen or bad tasty Adverse drug reactions Decreases patient compliance
3. Patient
Very old/ very young Low intellectuality Psychiatric problem
4. Doctor
Optimistic Skillfully Increase patient compliance
B. Elderly person
Deceasing of metabolic capacity Decreasing of plasma protein capacity Decreasing of excretion functions of kidney Increasing of receptor sensitivity
Pulmonary diseases: decreases circulation to lever and kidney Kidney diseases: decreasing of drugs clearance Hypo and Hyperthyroids
Bioavailability (riboflavin) Biotransformation (Propilthiourasil) Renal excretion (digoxin)
Pregnancy
Decreasing plasma protein binding capacity (phenytoine) Increasing renal excretion Alter of metabolism
Qualitative :
Drugs which are have specific toxicity in persons with abnormal genetic factors (exp. G6PD)
Tolerance: decreasing pharmacological effect in repeated dose (exp. CNS depressants, opioid, organic nitrite May appear cross-tolerance among drugs which have the same receptor Pharmacokinetic tolerances: metabolism Pharmacodynamic tolerances: cellular adaptations (exp. Chronic uses of opioids, barbiturates, ethanol, organic nitrite) Tachyphilacis: acute tolerance
Net effect = pharmacological + placebo effect placebo effect may different interindividual and intraindividual (intraindividual in different time)
Alcohol and smoking are suspected interfere drug responses Cigarette is containing polycyclic hydrocarbon may increasing metabolism of specific drugs (exp. Theophylline) Alcohol may alter responses of some drugs
Acute : Inhibition of drug biotransformation Chronic: Induce of drug biotransformation