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Pharmaceutics 2 Winter Final > 7 - Geriatric & Pediatric > Flashcards

7 - Geriatric & Pediatric Flashcards

1
Q

Define elderly

A

Those aged 65 years or more

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2
Q

What are the effects of aging on drug absorption?

A
  • Decrease in gastric secretion elevates pH in GI tract
  • May result in some dissolution of enteric-coated formulations in stomach and cause GI irritation, incomplete absorption of acidic compounds from stomach, or decreased rate of absorption of poorly soluble weak bases
  • IM absorption affected from loss of muscle
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3
Q

What are the effects of aging on drug distribution?

A
  • Loss of muscle mass and increase in adipose mass
  • Increase in Vd for lipid-soluble drugs and decrease for water soluble drugs (increased Vd prolongs half life; reduced Vd for water-soluble drugs balanced by reduction in renal clearance has little net effect on t1/2)
  • Decrease in albumin levels
  • Amount of unbound drug may increase for drugs that are highly protein bound (clinical significance unclear)
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4
Q

What are the effects of aging on drug metabolism?

A
  • Decreased liver volume and hepatic blood flow => decreased first-pass metabolism
  • Decreased rate of metabolism for some drugs
  • Decline in phase 1 oxidative reactions; phase 2 conjugative processes appear consistent
  • Reduction in renal function (may affect drug metabolism in liver)
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5
Q

What are the effects of aging on drug excretion?

A
  • Decline in renal blood flow

- Slowing of glomerular filtration rate (GFR)

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6
Q

What does it mean when GFR slows?

A
  • Drugs excreted primarily by kidney may require dosage adjustment
  • Creatinine clearance often used to calculate these adjustments
  • Affects clearance of many water-soluble drugs
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7
Q

What does arthritis cause?

A

Deterioration of cartilage components of hands, hips, knees, and spine

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8
Q

What are options to help px w/ swallowing issues?

A
  • Artificial saliva
  • Dosage forms like quick-dissolve films or ora-dispersible tablets
  • Formulation into suspensions or other liquids
  • Crushed tablets or capsule contents mixed w/ food (like pudding) just prior to administration
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9
Q

Which route is most desirable for elderly?

A

Oral

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10
Q

Which oral dosage forms AREN’T recommended for elderly and why?

A
  • Chewable tablets – decrease in chewing ability
  • Capsules – potential for mucosal adherence
  • Sublingual and buccal tablets – reduced bioavailability for px w/ dry mouth
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11
Q

What are some alternatives to solid oral dose forms?

A
  • Granules
  • Effervescent tablets
  • Dispersion or soluble tablets
  • Concentrated oral solutions
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12
Q

What are advantages for granules?

A
  • Circumvent difficulty in swallowing and provide some rehydration
  • Not affected by changes in gastric-emptying rate
  • Solid, so stable
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13
Q

What is an advantage to effervescent tablets?

A

Provide an easy-to-swallow form which also rehydrates px

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14
Q

How does the skin change w/ aging?

A

Decreased transdermal absorption of medications

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15
Q

What are the major concerns w/ adherence in elderly?

A
  • Take multiple medications

- Various physical impairments

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16
Q

What are some approaches to improve adherence in elderly?

A
  • Taste preference
  • Package and label design
  • Compliance aids
17
Q

Define the different stages of childhood

A
  • Pediatric = 0-18 years
  • Premature = under 37 week gestational age
  • Neonate = 1 day to 1 month
  • Infant = 1 month to 1 year
  • Child = 1-12 years
  • Adolescent = 12-18 years
18
Q

How are the most accurate pediatric doses determined?

A

Using weight and age

19
Q

How does drug absorption differ in pediatrics?

A
  • Gastric acid output approaches adult levels by 3 months
  • Achlorhydria present for first 2 weeks
  • Gastric-emptying and intestinal transit time erratic in neonates, but generally protracted so absorption delayed
  • Pancreatic enzyme activity and concentration of bile salts low so lipid-soluble drugs poorly absorbed in early infancy
  • Colonization and metabolic activity of GI bacterial flora don’t approach adult values until 2-4 y/o
20
Q

Only ____ release products should be used in pediatrics

A

Immediate

21
Q

How does absorption of topical medication differ for infants and children?

A
  • Have 3x the skin surface area of adults relative to weight
  • Skin is thinner and more hydrated so prone to increased absorption and systemic exposure
22
Q

Do infants have a higher or lower ratio of body water to body fat than adults? What does this cause?

A
  • Higher
  • Causes higher Vd for hydrophilic drugs and lower Vd for lipophilic drugs
  • Means that hydrophilic drugs require higher per weight dose for neonates
23
Q

Do neonates have a more or less permeable BBB than adults? What does this mean for narcotic analgesics?

A
  • More permeable

- Increased response to narcotic analgesics

24
Q

Do children under 6 m/o have higher or lower albumin levels than adults? What does this mean for highly protein bound drugs?

A
  • Lower albumin levels

- Have higher than expected unbound fractions of drugs that are highly protein bound

25
Q

When do children reach adult levels of phase 1 reactions?

A

4-6 m/o

26
Q

When do children reach adult levels of phase 2 conjugation reactions?

A

3-4 y/o

27
Q

When do children reach adult levels of tubular secretion?

A

2-6 m/o

28
Q

When are the greatest effects of maturation on drug disposition observed?

A

In first 6 months of life

29
Q

Which dosage forms are preferred for pediatrics?

A

Those that readily allow for small adjustments in dose (ex: liquid dose forms)

30
Q

What should ethanol be replaced w/ for pediatric formulations?

A

Propylene glycol

31
Q

Is the rectal route recommended for pediatrics?

A

No b/c results in a wide variability in rate and extent of absorption, and inflexibility of a fixed dose

32
Q

Are IM injections recommended in neonates? Why?

A

No b/c often erratic due to small muscle mass and inadequate perfusion

33
Q

Is drug delivery to the lungs effective in pediatrics?

A

Yes

Pharmaceutics 2 Winter Final (9 decks)

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