251 Pharma Study Cards - Chap 4 & 7 Flashcards
Throughout the life spectrum, when is there increased risk of adverse drug effects and toxicity?
at both ends of spectrum of life (pediatric and geriatric)
How do drugs primarily cross the placenta?
Via diffusion
What are the three factors that affect the safety of using medications during pregnancy?
Drug properties
Fetal gestational age
Maternal factors
What is the ‘Pregnancy and Lactation Labelling Rule’?
FDA rule that sets standards for how information about using medicines during pregnancy and breastfeeding is presented in the labeling of prescription drugs and biological products. The pregnancy letter categories – A, B, C, D and X will be replaced by a narrative risk summary based on available data.
What are the 3 subsections within the Pregnancy and Lactation summary?
- Pregnancy
- Lactation
- Females and Males of Reproductive Potential
True or false: Breast milk is the primary route for maternal drug excretion
False. Drug levels in breast milk are usually lower than in maternal circulationExposure depends on volume of consumed milk.
What is the term used for age range of younger than 38 weeks gestation?
Premature or preterm infant
What is the term for age range born but younger than 1 month?
Neonate or newborn infant
What is the term for the age range 1 month to younger than 1 year?
Infant
What is the term for the age range for 1 year to younger than 12 years?
child
What considerations are in place for pediatric patients relative to pharmacokinetics and absorption?
- Gastric pH less acidic until 1 to 2 years of age
- Gastric emptying slowed
- First-pass elimination reduced
- Reduced bile salt formation decreases bioavailability
- Intramuscular absorption faster and irregular
What considerations are in place for pediatric patients relative to pharmacokinetics and distribution?
- Total body water differences result in increased distribution and dilution of water-soluble drugs.
- Greater total body water means lower fat content.
- Decreased level of protein binding
- Immature blood–brain barrier means more drugs enter the brain.
What considerations are in place for pediatric patients relative to pharmacokinetics and metabolism?
- Liver immature; does not produce enough microsomal enzymes
- Older children may have increased metabolism, requiring higher doses or more frequent administration than infants.
- Other factors: liver enzyme production, genetic differences, and substances to which the mother may have been exposed during pregnancy
What considerations are in place for pediatric patients relative to pharmacokinetics and excretion?
- Kidney immaturity affects glomerular filtration rate and tubular secretion.
- Decreased perfusion rate of the kidneys may reduce excretion of drugs.
What factors affect pediatric drug dosage?
- Skin is thin and permeable.
- Stomach lacks acid to kill bacteria.
- Lungs have weaker mucus barriers.
- Body temperatures are less well regulated, and dehydration occurs easily.
- Liver and kidneys are immature, impairing drug metabolism and excretion.
What methods are there for dosage calculation for pediatric patients?
- Body surface area method
- Uses the West nomogram
- Always use weight in kilograms, not pounds.
- Always use height in centimeters, not inches.
- Body weight dosage calculations
- Uses mg/kg
What are some considerations for older adult patients?
- Older adults: older than age 65 years
- High use of medications
- Polypharmacy
- Nonadherence
- Increased incidence of chronic illnesses
- Sensory and motor deficits
What physiological changes occur with the cardiovascular system for older adults?
- Decreased cardiac output = decreased absorption and distribution
- Decreased blood flow = decreased absorption and distribution
What physiological changes occur with the gastrointestinal system for older adults?
- Increased pH (alkaline gastric secretions) = altered absorption
- Decreased peristalsis = delayed gastric emptying
What physiological changes occur with the liver for older adults?
- Decreased enzyme production = decreased metabolism
- Decreased blood flow = decreased metabolism
What physiological changes occur with the kidney for older adults?
- Decreased blood flow = decreased metabolism
- Decreased kidney function = decreased excretion
- Decreased glomerular filtration rate = decreased excretion
What affects absorption in older adults?
- Gastric pH less acidic
- Gastric emptying slowed
- Movement through gastrointestinal (GI) tract slowed because of decreased muscle tone and activity
- Blood flow to GI tract reduced
- Absorptive surface of GI tract reduced
What affects distribution in older adults?
- Lower total body water percentages
- Increased fat content
- Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)
What factors affect metabolism in older adults?
- Aging liver produces fewer microsomal enzymes, affecting drug metabolism.
- Blood flow to the liver is reduced.
- Leads to a prolonged half-life of many drugs
- Potential for accumulation if not monitored
What factors affect excretion in older adults?
- Decreased glomerular filtration rate
- Decreased number of intact nephrons
What are some common complications of opioids in older adults?
- Confusion
- constipation
- urinary retention
- nausea
- vomiting
- respiratory depression
- falls
What are some common complications of NSAIDs in older adults?
- Edema
- Nausea
- Gastric ulcerations
- Bleeding
- Kidney toxicity
What are some common complications of anticholinergics and antihistamines in older adults?
- Blurred vision
- Dry mouth
- Constipation
- Confusion and sedation
- Urinary retention
- Tachycardia
What are some common complications of anticoagulants (heparin sodium, warfarin sodium) in older adults?
- Major and minor bleeding episodes
- Many drug interactions
- Dietary interactions
What are some common complications of antidepressants in older adults?
- Sedation and strong anticholinergic adverse side effects
What are some common complications of antihypertensives in older adults?
- Nausea
- Hypotension
- Diarrhea
- Bradycardia
- Heart failure
- Impotence
What are some common complications of cardiac glycosides (digoxin) in older adults?
- Visual disorders
- Nausea
- Diarrhea
- Dysrhythmias
- Hallucinations
- Decreased appetite
- Weight loss
What are Beers criteria?
A listing of drug and drug classes to be avoided in older adults
Identified disease states considered to be contraindications for some drugs
Three categories:
- Potentially inappropriate drugs and classes in older adults
- Potentially inappropriate medications to avoid with certain diseases
- Medications to be used with caution in older adults
What is the fastest growing population in Canada?
Indigenous population
What is ethnopharmacy?
Provides an expanding body of knowledge for understanding specific impact of cultural factors on patient drug response
Genotype versus phenotype.
Genotype versus phenotype. An organism’s genotype is the set of genes that it carries. An organism’s phenotype is all of its observable characteristics — which are influenced both by its genotype and by the environment.
What is polymorphism as it relates to medications?
Same drug may result in different result in different people. Refers to the effect of a patient’s age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs.
What is involved in an ethnocultural assessment?
- Languages
- Health practices and beliefs
- Past uses of medicine
- Use of herbal treatment, folk or home remedies, natural health products
- Use of over-the-counter drugs
- Usual response to illness
- Responsiveness to medical treatment
- Religious practices and beliefs
- Support for patient’s ethnocultural community
- Dietary habits
Which domain of learning is the level at which basic knowledge is learned and stored?
Cognitive domain
Which domain of learning is the level at which conduct expresses feelings, needs, beliefs, values, and opinions?
Affective domain
Which domain of learning is the level of learning of a new procedure or skill; often called the doing domain?
Psychomotor domain
What aspects should be looked at during the assessment phase of patient education?
- Adaptation to any illness
- Age
- Barriers to learning
- Cognitive abilities
- Coping mechanisms
- Cultural background
- Developmental status
- Education, including literacy level
- Emotional status
- Environment at home and work
- Folk medicine, home remedies, and alternative or complementary therapies
- Family relationships
- Financial status
- Health literacy
- Psychosocial growth and development
- Health beliefs
- Information patient understands about past and present medical conditions
- Language(s) spoken
- Level of knowledge about current medications
- Misinformation about drug therapy
- Mobility and motor skills
- Current medications, including over-the-counter and herbal medications
- Motivation
- Nutritional status
- Past and present health behaviours
- Past and present experience with drug regimens and other therapies
- Race and ethnicity
- Religion or religious beliefs
- Readiness to learn
- Self-care ability
- Sensory status
- Social support
Infant (birth to 1 year)
Trust vs. Mistrust
Toddler 1 -3 years
Autonomy versus shame and doubt
Preschooler 3 - 6 years
Initiative versus guilt
School-aged: 6 -12 years
Industry versus inferiority
Adolescent 12 -18 years
Identity versus role confusion
Young adult 18 - 45
Intimacy versus isolation
Middle-aged adult (45 to 64 years old)
Generativity versus stagnation
Older adult (older than 65 years old)
Integrity versus despair
Common nursing diagnoses for patient education
- Deficient knowledge
- Readiness for enhanced knowledge
- Falls, risk for
- Ineffective self-health management
- Readiness for enhanced health management
- Impaired memory
- Injury, risk for
- Nonadherence
- Readiness for enhanced communication
- Readiness for enhanced power
- Readiness for enhanced decision making
- Sleep deprivation
At what grade level should written communications be developed?
8th grade level
What should be documented for patient education?
- Learner assessment
- Outcomes
- Content provided
- Strategies used
- Patient response to the teaching session
- Overall evaluation of learning
