The Effects of Liver and Renal Dysfunction on the Pharmacokinetics of Sedatives and Analgesics in the Critically Ill Patient

Nursing Challenges in the Administration of Oral Antidepressant Medications in Gastric Bypass Patients

“…50,51,54 Changes in the percentage of adipose tissue over time after surgery may result in changes in the distribution of lipid-soluble medications that may necessitate an alteration in dosing. 49 The loading dose should be based on total body weight for those drugs that distribute freely into adipose tissue, and adjustment of the maintenance dose depends on clearance rates.…”

“…Drug-binding proteins are albumin, ␣-1-acid glycoprotein (AAG), and lipoproteins. 50,54 The degree of change in protein binding of medications in obese patients is controversial. 49 The serum concentration of AAG has been reported to double in the obese population.…”

“…Bioavailability is the percentage of the medicated dose that is passed into the bloodstream. 35,50 Pharmacokinetics is the movement and changes of the medication within the body's plasma. 51 Vitamins, minerals, and drugs may have inadequate absorption when taken orally.…”

“…Changes in dissolution may have a sensational effect on the pace and/or duration of drug absorption. 47, 50 The majority of medications have a coating to make them more tasteful, but that coating requires the presence of stomach acid to begin the breakdown of the drug. 47 As such, the dissolution of instant-release tablets of psychiatric drugs can be affected, resulting in an alteration in the solubility of these drugs in post-GBP patients.…”

“…The anatomic changes postoperatively shorten the intestinal travel time, increase the gastric pH environment, and reduce the surface area available for medication absorption. 52-54 A majority of medications are absorbed into the body through the small intestine 50,54 and are often dependent on the pH environment. 35 Medications that depend on acid hydrolysis to be absorbed may have a more varied rate and absorption as a result of the decreased gastric acid in the stomach of a GBP patient.…”