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As repeated
doses of a drug are administered its plasma concentration builds up
and reaches what is known as a steady state. This is when the amount
of drug in the plasma has built up to a concentration level that is
therapeutically effective and as long as regular doses are administered
to balance the amount of drug being cleared the drug will continue
to be active. The time taken to reach the steady state is about five
times the half life of a drug. Drugs like digoxin and warfarin with
a long half life will take longer to reach a steady state than drugs
with a shorter half life.
We can
show this using a bucket to represent the body as a container and water
to represent the drug. To be effective
the drug must reach a certain level and so must our water in the
bucket but the body is not a closed system and the drug can be lost
by being
broken down in the liver and excreted from the kidneys. This loss
of drug from the body can be represented by putting a small hole in
the
bucket so that some water is constantly leaking out. Like the drug
level in the body, the level of water drops and needs to be topped
up by giving regular doses.
Sometimes
a loading dose may be administered so that a steady state is reached
more quickly then smaller ‘maintenance’ doses
are given to ensure that the drug levels stay within the steady state. |