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PK/PD en AM y PD

QuestionAnswer
PK AM - ABSORCIÓN: ¿Cómo afecta el envejecimiento? ↑ pH gástrico → ↓ absorción ácidos débiles (hierro, AAS). ↓ Flujo sanguíneo GI → ↑ biodisponibilidad nifedipino. Fármacos chilenos: Hierro (ajustar dosis), Vit B₁₂ (monitorear niveles).
PK AM - DISTRIBUCIÓN: Cambios clave ↑ % grasa → ↑ Vd diazepam (↑ vida media). ↓ % agua → ↓ Vd digoxina (↑ riesgo toxicidad). ↓ Albúmina → ↑ libre warfarina (↑ sangrado). Fármacos chilenos: Warfarina (INR), Diazepam (evitar).
PK AM - METABOLISMO: ¿Por qué ajustar dosis? ↓ Tamaño hepático/flujo → ↓ metabolismo fármacos alto clearance (morfina). Fase I > Fase II afectada. Preferir LORAZEPAM sobre diazepam. Chile: Evitar amitriptilina.
PK AM - EXCRECIÓN: Ajustes en IRC ↓ TFG (-1 mL/min/año) → ↑ vida media digoxina/metformina/enalapril. Evitar metformina si TFG<30. Fórmula: Cockcroft-Gault.
PD AM - CAMBIOS SNC: Riesgos clave ↑ Permeabilidad BBB → ↑ delirium anticolinérgicos. ↓ Receptores GABA → ↑ sensibilidad benzos (caídas). Fármacos chilenos: Evitar difenhidramina (Atosil®). Alternativa: Quetiapina.
FÁRMACOS INAPROPIADOS AM (Beers): TOP 3 Chile 1. DICLOFENACO (Voltaren®): ↑ úlcera/IRC >75 años. 2. ALPRAZOLAM (Tafil®): ↑ 50% riesgo caídas. 3. NIFEDIPINO IR: Hipotensión brusca. Alternativas: Paracetamol/amlodipino.
STOPP-START: Aplicación Chile STOPP (suspender): AINEs con HTA no controlada. Benzodiacepinas en demencia. START (agregar): IECA en ICC. Estatinas en diabetes + riesgo CV.
PK PEDIATRÍA - ABSORCIÓN: Neonatos pH gástrico NEUTRO → ↑ absorción penicilinas. Suplementos: Vit K IM (neonatos). Vit D 400 UI/día (lactantes). Chile: Protocolo MINSAL Norma 051.
PK PEDIATRÍA - METABOLISMO: Niños vs adultos ↑ Actividad CYP450 → dosis ↑ por kg. Ej: FENITOÍNA <3 años: 8-10 mg/kg vs adulto 5 mg/kg. Chile: Ajustar en epilepsia.
PK PEDIATRÍA - EXCRECIÓN: Vancomicina RN pretérmino: t½=6-10h → dosis c/12-24h. Preescolares: t½=2-3h → dosis c/6h. Chile: Meta niveles 10-20 mg/L.
KIDs LIST CHILE: Fármacos PROHIBIDOS <3 años: LIDOCAÍNA viscosa (metahemoglobinemia). <12 años: CODEÍNA (depresión respiratoria). Chile: Evitar Lidopain®/Tussipax®.
KIDs LIST CHILE: Fármacos PRECAUCIÓN <1 año: METOCLOPRAMIDA (distonía). <6 años: VALPROATO (hepatotoxicidad). <8 años: TETRACICLINAS (mancha dientes). Chile: Plasil®/Depakine®.
Caso CLÍNICO AM (Teodoro): MPI MPI: ASPIRINA 325 mg (↑ sangrado). TRAMADOL (↑ caídas). STOPP: Suspender AAS >100 mg/día. START: Evaluar espironolactona en ICC.
PD PEDIATRÍA: Riesgo SNC ↑ Permeabilidad BBB → ↑ neurotoxicidad. Fármacos: FLUOROQUINOLONAS (convulsiones). CORTICOIDES (↑ PIC). Chile: Evitar ciprofloxacino <18 años.
Created by: EliasPoblete
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