The metabolism of a drug and its passage from the liver into the circulation – A drug given via the oral route may be extensively metabolized by the liver before reaching the systemic circulation (high first-pass effect) – The same drug—given IV—bypasses the liver, preventing the first-pass effect from taking place, and more drug reaches the circulation
Intrathecal – intraspinal Intraarticular- joint
Acute- rapid onset Maintenance – for treatment of chronic illness, e.g. hypertension Supplemental – due to insufficient quantity e.g. insulin, iron Palliative – comfort the end of treatment, e.g. opioid analgesics in cancer, O2 in end-stage pulmonary disease Supportive – fluids Prophylactic- antibiotic prior to surgery Empiric – based on previous experience with the drug. E.g. acetaminophen for fever with unknown cause.
Pregnancy- First trimester is the period of greatest danger for drug-induced developmental defects. Drugs cross the placenta by diffusion During the last trimester the greatest percentage of maternally absorbed drug gets to the fetus. FDA pregnancy safety categories BREASTFEEDING - Breast-fed infants are at risk for exposure to drugs consumed by the mother Consider risk-to-benefit ratio
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