Gender differences in relation to pharmacokinetics and medication compliance
• Can affect success of medication tx
• Seeking medical attention, compliance with medications, elimination rates differ
• Side effects of meds can be gender specific and affect compliance
o Anti-hypertensives can cause male impotence problems
o FDA mandates that drugs are tested on both genders
o Insurance coverage differences (ie. OCP and females)
5 rights
Pharmacokinetic principles
Buccal
tablet or capsule is placed in the oral cavity between the gum and the cheek. This route is preferred over the sublingual route for sustained-release delivery because of the greater mucosal surface area
Sublingual
medication is placed under the tongue and is allowed to dissolve slowly. This route results in a more rapid onset of action because of the rich blood supply
Sustained Release (SR)
tablets or capsules are designed to dissolve very slowly. This releases the medication over an extended time and results in a longer duration of action for the medication
Extended-release (XR) or long-acting (LA)
allow for the convenience of once or twice day dosing. Must not be crushed or opened
Topical drugs
applied locally to the skin or the membranous lining of the eye, ear, nose, respiratory tract, vagina, and rectum
o Applications include:
• Dermatological preparations- drugs applied to the skin, the topical route most commonly used. Formulations include creams, lotions, gels, powders, and sprays.
• Instillations and irrigations- drugs applied into the body cavities or orifices. These routes may include the eyes, ears, nose, urinary bladder, rectum, and vagina
• Inhalations- drugs applied to the respiratory tract by inhalers, nebulizers, or positive-pressure breathing apparatuses
Intra-dermal (ID)
injection is administered into the dermis layer of the skin. This layer contains more blood vessels than the deeper subQ layer allowing for drugs to be more easily absorbed. Limited to small volumes of drug
Pharmacokinetics (absorption) during pregnancy trimesters
ADRs Adrenergic agents (Sympathomimetics) (phenylephrine (neo-synephrine))
tachycardia, hypertension, dysrhythmias, CNS excitation and seizures, dry mouth, nausea and vomiting, anorexia
ADRs Anticholinergic agents (benzotropine mesylate (Cogentin))
dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, glaucoma
ADRs Cholinergic agents (Parasypathomimetic)(miniopress))
profuse salivation, sweating, increased muscle tone, urinary frequency, bradycardia
ADRs
Salicylates (Aspirin)
with high doses may cause GI distress and bleeding, may increase action of oral hypoglycemic agents
ADRs
Vancomycin
nephron/ototoxicity, peak/trough with the 3rd dose, Red Man Syndrome
ADRs Hydantoins phenytoin (Dilantin)
CNS depression, gingival hyperplasia (soft bristle tooth brush), skin rash, cardiac dysrhythmias, hypotension
ADRs
Succinylcholine
malignant hyperthermia (fast rise in temp. and severe muscle contractions), (Dantrolene Sodium is the preferred tx)
ADRs
Glucocorticoids (Corticosteroids) (Prednizone)
adrenal gland suppression, hyperglycemia, mood changes, cataracts, peptic ulcer disease, osteoporosis and “masking infections”, Cushing’s Syndrome as a result from long term therapy
ADRs
Aminoglycosides (Gentamicin)
ototoxicity, nephrotoxicity
ADRs
Fluoroquinolones (Cipro)
may cause tendon inflammation/irritation/rupture
ADRs
Rifampin
can turn body fluids orange
Penicillin injections
highest allergy incidence, observe pt for 30 minutes after dose, given IM because it has a poor oral absorption rate
Dilantin
given IV deserves caution because it can cause tissue damage, do not use hand veins, it may also cause a severe rash
Tylenol
liver damage with high doses