Age Considerations Flashcards
1
Q
Absorption in children
A
- 🤮 During infancy, neonates have delayed, irregular gastric emptying and reduced gastric acidity that leads to increased drug levels.
- ❌💪🏽Prescribers often avoid IM injections in pediatrics due to pain and unpredictable absorption from low blood flow to skeletal muscles and weak muscle contractions.
- ⬆️Increased absorption with topicals-greater blood flow to thinner skin.
2
Q
Distribution in children
A
- Varies due to difference in body water percentage, liver function, protein biding ability, and the development of the Blood Brain Barrier- (increased CNS effects due to undeveloped BBB).
- 💧Adults total body water is approx. 60% and in newborns its 80% -dilutes water soluble meds.
-⬇️🫀Decreased BP – increased flow to liver and brain and decreased flow to the kidneys
-⬇️Decreased Protein Binding sites in the serum – increase serum level of protein binding meds
3
Q
Metabolism in children
A
- ⬇️Decreased first-pass metabolism
In neonates, the ability to metabolize drugs is very low because of the immaturity of the liver which results in the inability to break down drug. (The liver matures around the end of year 2)
4
Q
Elimination in children
A
- Young children have immature kidneys, reduced glomerular filtration rate, and slower renal clearance, also making them at risk for increased levels of drugs. (Renal function reaches maturity, btw. 1-2 years)
- Before age 12, most medication doses are based on Body Surface Area (BSA)
- By age 12, children have matured sufficiently to develop pharmacokinetics responses that resemble adults.
5
Q
Infants Drug Administration
A
Be aware that most meds do not undergo testing on children.
ALWAYS verify dosage is accurate for weight or BSA before administration!
- 👄Oral medications are often given in a dropper or oral syringe and given in the inner aspect of the cheek, allowing time to swallow
- 🤰🏽May also give med with nipple with some formula or breastmilk (controversial-some think infants will then begin to refuse feedings)
- 💪🏽IM injections using the smallest needles and preferably in vastus lateralis
- Many medications are also in suppository form
- Comfort and care needed with infants shortly after medication administration (holding, cuddling, pacifier)
- IVs often found in scalp, hands, or feet- (22/24 gauge)
6
Q
Toddler/Preschooler Drug Administration
A
- Inquisitive and controlling, the nurse can involve the patient in medication administration (also give written and verbal info to caregiver)
- 🍇Medications mixed with flavors or fruit purees
- 🦵🏽IM injections- vastus lateralis (preferred) or ventrogluteal/ IV- (limited sites) hands, feet, antecubital (admin push with luer lock & use syringe/smart pumps)
- Short and simple explanation of suppositories
7
Q
School Age Children/Adolescents Drug Administration
A
- 👄Chewable and swallow forms
- 💪🏽IM injection- need praise and encouragement or rewards
- 🥃💊Assess adolescents for risky behavior (laxatives, drugs, alcohol, abuse of prescription meds)
- Teaching adolescents about self-care, the use of acne medications, and birth control
8
Q
Adult & Geriatric Patients
A
- 🧑🏽🦱Adults aged 19 to 64 years old
- 👨🏽🦳Older Adults- 65 yrs. and older: Largest consumers of healthcare
- ❌💊Prone to Antibiotic Resistance
- Polypharmacy – the use of multiple medications
- Risk to benefit ratio – do the positive effects outweigh the negative ones?
9
Q
Absorption in Older Adults
A
- Delayed absorption or lack of absorption with medications
- Diminished gastric emptying; increased risk for n/v thus eliminating medication through emesis and promoting fluid volume deficit
- Increased gastric pH (alkaline) Slower absorption
- Decreased circulation also leads to slow absorption of the medication
10
Q
Distribution in Older Adults
A
- Lipid soluble drugs like anesthetics stay in fat tissue for longer periods; placing risk for respiratory depression after surgery
- Water soluble drugs such as antibiotics are distributed in smaller volumes with less total body fluid; increasing the risk of toxicity
- Decreased Protein Binding sites in the serum (lower serum albumin)– increase serum level of protein binding meds
11
Q
Metabolism in Older Adults
A
- At 60 years old, the liver begins to decrease in size and decrease in hepatic circulation, lowering the rate of metabolism.
- Medications with long half-lives will remain in the body for a greater amount of time.
12
Q
Excretion in Older Adults
A
- Diminished renal blood flow and glomerular filtration rate leads to slower excretion
- Assess creatinine clearance before some medication administration
13
Q
Altered Drug Responses in Older Adults
A
- Reduced receptor sites for medications or capability of meds to produce the desired effect
- More prone to adverse drug reactions because the decreased number of receptors for distribution
- BEERS CRITERIA- list of potentially inappropriate medications used by older adults
14
Q
Prevention of Adverse Affects in Older Adults
A
- Assess the patient’s health history and of list of medications taken
- Assess the patient’s kidney and liver function (BUN/Creatinine and Liver Enzymes)
- Start at the lowest doses and Assess therapeutic drug levels
- Education about all medications, including generic and trade names to prevent confusion
- Assess adherence and provide medication administration aid to promote adherence
15
Q
Risks with Aging
A
- 💊 Difficulty remembering medications
- 😵💫 Altered mental status
- 👀 Decreased visual acuity
- Economic factors
*To improve adherence & keep care inexpensive, use generic prescriptions, easy to follow, & using fewest number of doses required.
