ยา

คุณสมบัติของยาและ pharmacokinetics: ADME -- โครงสร้างของยา ที่มาของยา

Pharmacogenomics มีผลต่อ ADME

พิจารณา Drug-drug interaction

พิจารณาว่าเป็น loading dose หรือว่า maintenance dose

Pharmacodynamics -- รูปร่างของยา, กลไกการออกฤทธิ์ ส่วนหนึ่งของ drug-drug interaction ก็อยู่ตรงนี้ด้วย

ต้องรู้เพื่อใช้กับ:- toxicology, geriatrics

Source of drugs & properties

• Plant alkaloids
• Fungal
• Chemical alterations (pharmaceutical company)

What makes it lipid-soluble? cationic/anionic at a specific pH? How can antidote possibly work?

กลุ่มยา (Home medication // Hospital care)

• Autonomic drugs
• +ACh
• Direct cholinomimetics -- pilocarpine, bethanechol
• AChEI -- physostigmine, pyridostigmine, neostigmine -- SLUDGE, BBB มี diaphoresis
• -ACh
• Antimuscarinics -- atropine, benztropine, scopolamine, ipratropium, oxybutynin, methscopolamine
• Sympathomimetic
• Injection, PO, nasal, IV emergency
• Recreational drug use
• Sympathoplegic = sympatholytic -- clonidine, methyldopa : central alpha-2 agonist
• Alpha, beta blockers
• Antimicrobial
• Drug by systems

Drug ADR ถ้าเป็นผู้สูงอายุเน้น GI, cardiovascular symptoms หรืออาจจะ atypical

• Cardiovascular
• Vascular -- cocaine, sumatriptan (coronary); vancomycin, niacin, diltiazem, CCB (cutaneous); TCA (atropine-like)
• Heart muscle -- doxorubicin (dilated cardiomyopathy)
• Heart conduction -- quinidine, cisapride (torsades)
• Hematologic
• Production -- clozapine, carbamazepine, colchicine, PTU, dapsone (agranulocytosis); cholramphenicol, benzene, NSAID (aplastic anemia); phenytoin, methotrexate, sulfa drugs (megaloblastic anemia)
• Hemolysis -- methyldopa (direct Coomb positive); isoniazid, sulfonamide, ibuprofen (G6PD)
• Abnormal function -- estrogens, progestins (thrombosis)
• Accumulation (?) -- chloramphenicol (gray baby syndrome)
• Respiratory
• Airway -- enalapril, other ACEIs (cough)
• Lung parenchyma -- bleomycin, amiodarone, busulfan (pulmonary fibrosis)
• GI
• Hepatic -- macrolides (acute cholestatic hepatitis); isoniazid (hepatitis); halothane, valproate, paracetamol, Amanita phalloides (hepatic necrosis)
• Bacterial overgrowth -- clindamycin, ampicillin (AAD)
• Reproductive/endocrine
• Thyroid -- lithium, amiodarone (hypothyroid)
• Adrenocortical -- glucocorticoid withdrawal
• Sex hormone -- tamoxifen, clomiphene (hot flushes); spironolactone, digitalis, cimetidine, ketaconazole (gynecomastia)
• Musculoskeletal/connective tissue
• Skin -- lamotrigine, carbamazepine, sulfa drugs, penicillin (rash/SJS); sulfonamide, amiodarone, tetracycline (photosensitivity)
• Connective tissue -- phenytoin (gingival hyperplasia); hydralazine, isoniazid, phenytoin (SLE-like); furosemide, thiazides (gout)
• Tendon -- fluoroquinolones (tendon, and cartilage damage in children)
• Bone -- heparin, corticosteroids (osteoporosis)
• KUB
• Renal tubules -- expired tetracycline (Fanconi's syndrome)
• Kidney interstitium -- methicillin, NSAID, furosemide (interstitial nephritis)
• Post-renal -- cyclophosphamide, ifosfamide (hemorrhagic cystitis)
• Neurologic
• Focal central -- bupropion, imipenem/cilastatin, isoniazid (seizure); haloperidol, chlorpromazine, metoclopramide (parkinson-like); antipsychotics (tardive dyskinesia); lithium, demeclocycline (DM)
• Diffused central -- quinidine, quinine (cinchonism)
• Multiorgan
• N/V, flush -- metronidazole, cephalosporin, 1st gen. sulfonylureas (disulfiram-like)
• Nephro/neuro -- polymyxins
• Nephro/oto -- aminoglycoside, cisplatin, loop diuretics, vancomycin

Drug interactions

• Inducers -- quinidine, griseofulvin, rifampin, carbamazepine, barbiturates, chronic alcohol use, สมุนไพร St. John's wort; (นั่งรถฟรีไล่ kiss บาร์บี้ -- credit: เหมย)
• Inhibitors -- sulfonamides, cimetidine, ketoconazole, erythromycin, น้ำ grapefruit, acute alcohol use; (ชื่อเพื่อนหลายๆคนในคณะ -- credit: เหมย)