Therapeutic response

Setting aside issues of compliance and administration errors, the therapeutic response experienced by each patient may be influenced by variations in pharmacokinetics (rate and extent of absorption, distribution, elimination) and pharmacodynamics (physiologic, pathologic, and genetic factors receptor interactions and tolerance). 

At one time scientists thought the elimination of pharmacokinetic variability 

When there is no differentiation between LD50 and ED50 (TI = 1), the drug is 

The therapeutic index defined in this manner is a very crude estimate of safety 

For example, acyclovir with TI — 10 against herpes simplex virus is safer or more selective [9] than its derivative, ganciclovir (TI = 2-3 against cytomegalovirus) [10]. 

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Concepts and Processes. Contemporary dosage forms are dmg dehvery systems, designed and manufactured to achieve safe and effective therapeutic responses each time the forms are used as part of an appropriate regimen. Thus, the intent of the prescriber is accompHshed when the product is used compliantly by the patient (12—14). Each dmg product involves several interrelated concepts that must be considered in its design and manufacture (15). Examples include the following ... 

Intravenous aqueous injections provide an excellent means of achieving a rapid therapeutic response. Parenteral product design, eg, vehicle and other excipient selection, as well as choice of route of adrninistration, can prolong therapeutic activity and increase onset times. Thus, oily solutions, suspensions, or emulsions can be adrninistered by subcutaneous or intramuscular routes to create prolonged effect, ie, depot injection (28). 

Prolonged Action Parenterals Injections. Intramuscular injections have been developed to achieve prolonged therapeutic effects. This can be accompHshed by suspension of dmg particles in oils or flowable gels, from which the dmg slowly diffuses. Aqueous suspensions can also provide such therapeutic response. In these cases, the soHd dmg crystals generally are quite water insoluble and of a controlled particle size and crystallized form. 

Clinical Pharmacokinetics. Clinical pharmacokinetics attempts to define the relationship between dmg concentration and therapeutic response. The underlying assumption is that response is proportional to dmg concentration at the site of action. This concentration is dependent on many... 

Normally, dietary tyramine is broken down in the gastrointestinal tract by MAO and is not absorbed. In the presence of MAOI, however, all of its potent sympathomimetic actions are seen. Other side effects of MAOI include excessive CNS stimulation, orthostatic hypotension, weight gain, and in rare cases hepatotoxicity. Because the monoamine oxidase inhibitors exhibit greater toxicity, yet no greater therapeutic response than other, newer agents, clinical use has been markedly curtailed. The primary use for MAOIs is in the treatment of atypical depressions, eg, those associated with increased appetite, phobic anxiety, hypersomnolence, and fatigues, but not melancholia (2). 

Polymorphisms have been described for all (3-adrenergic receptors while initial studies, notably of the (3i-subtype, suggested that these might be predictors of diseases as well as of therapeutic responses, these results have more recently been questioned. Alterations in responsiveness may be limited to certain compounds and a causative role in diseases has not been or remains to be substantiated in larger trials. 

Discovery of new diagnostic and prognostic indicators and biomarkers of therapeutic response, and prediction of patients most likely to benefit from the diug and use in general pharmacogenomic studies (Fig. 2)... 

Agonists are dru that bind with a receptor to produce a therapeutic response Dru that bind only partially to the receptor will most probably have some, although slight, therapeutic response Figure 1-3 identifies the different drug-receptor interactions. Partial agonists are dm that have some drug receptor fit and produce a response but inhibit other responses. 

In addition to administering the drug, the nurse monitors the therapeutic response (desired response) and reports adverse reactions. In the home setting, the nurse is responsible for teaching the patient and family members the necessary information to administer drugp safely in an outpatient setting. 

The expected outcomes for the patient depend on the reason for administration of the antifungal drag but may include a therapeutic response to the antifungal drag, management of adverse reactions, and an understanding of and compliance with the prescribed treatment regimen. 

The miscellaneous drugp are used to treat a variety of musculoskeletal disorders. Ffenicillamine, methotrexate (MTX), and hydroxychloroquine are used to treat rheumatoid arthritis in patients who have had an insufficient therapeutic response to or are intolerant of other antirheumatic drugp such as the sailcylates and NSAIDs. The Summary Drug Table Drug s Used to Tream Musculoskeletal Disorders provides additional information about these and other drug s. One compound, hylan G-F 20, listed in the Summary Drug Table is not used for rheumatoid arthritis, but rather, for osteoarthritis knee pain. It is a viscous, elastic... 

Benzodiazepines are excreted more slowly in older adults causing a prolonged drug effect. The drugs may accumulate in the blood, resulting in an increase in adverse reactions or toxicity. For this reason, the initial dose should be small, and the nurse should increase dosages gradually until a therapeutic response is obtained. 

B. assess the patient in 30 minutes for a therapeutic response to the drug... 

Have periodic blood tests during therapy to determine tiie therapeutic response... 

Androderm, anotiier transdermal system, is applied nightly to clean, dry skin on the abdomen, tiiigh, back, or upper arm. This system is not applied to die scrotum. Sites are rotated, witii 7 days between application to any specific site The system is applied immediately after opening the pouch and removing die protective covering. If the patient has not exhibited a therapeutic response after 8 weeks of tiierapy, another form of testosterone replacement therapy should be considered. 

Educating the Patient and Family The treatment regimen is explained to the patient and family (when appropriate). The nurse answers any questions the patient may have regarding treatment. The patient is instructed to report any adverse reactions. The patient and family are informed of therapeutic response during administration of the drug. If nasal spray is to be used, the patient is taught proper use ... 

If diuretic therapy is warranted, monitor for therapeutic response by assessing weight loss and improvement of fluid retention, as well as exercise tolerance and presence of fatigue. 

Titration in increments of 0.05 mg/kg/minute every 10-15 minutes as tolerated by blood pressure until the desired therapeutic response has been obtained, limiting symptoms develop, or a dose of 0.20 mg/kg/minute is reached... 

Based on all information presented, create a care plan for this patient s bipolar disorder. Your plan should include (1) a statement of the drug-related needs and/or problems, (2) the goals of therapy, (3) a patient-specific therapeutic plan, and (4) a plan for follow-up to assess therapeutic response and adverse effects. 

Capsule 150, 300, therapeutic response and 12-hour maintenance treatment... 

Since POAG is a chronic, often asymptomatic condition, the decision of when and how to treat patients is difficult since the treatment modalities are often expensive and have potential adverse effects or complications. The clinician should evaluate the potential effectiveness, toxicity, and the likelihood of patient adherence for each therapeutic modality. The ideal therapeutic regimen should have maximal effectiveness and patient tolerance to achieve the desired therapeutic response. The American Academy of Ophthalmology (AAO) publishes Preferred Practice Patterns for POAG and POAG Suspect.2... 

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