Ch. 3: Lifespan Considerations Flashcards
What are the 4 groups with special age considerations?
Pregnancy
Newborns
Pediatric
Older Adults
When is the fetus at the greatest risk for birth defects due to drugs?
During which trimester is the greatest % of drugs going to reach the fetus?
First trimester- organs/body developing rapidly
Third- bigger placenta
Explain the FDA Risk Classification system for drug safety during pregnancy (A,B,C,D, X)
A: Human studies show no risk to fetus
B: animal studies show no risk to fetus (no studies on humans)
C: No studies on humans or animals
D: Risk to human fetus, but benefits may outweigh risks
X: Risks > Benefits: NEVER GIVE THESE
What drug characteristics increase the risk of a drug transferring into breast milk?
Low molecular weight
Fat solubility
High concentration
How is absorption affected in neonatal and pediatric patients?
Gastric pH is higher- less acidic
Slower Gastric Emptying
Immature liver: First Pass Effect is decreased
IM absorption is fast/irregular
How is Distribution affected in neonatal/pediatric patients?
Greater total body water=lower fat content
Neonate: 85% total body water
Infant: 70-80% total body water
Child: 64% total body water
Decreased level of protein binding
Immature blood-brain barrier allows more drugs into brain
How is metabolism affected in neonatal and pediatric patients?
Immature liver: insufficient microsomal enzymes- slower drug metabolism
Older children may have increased metabolism, requiring higher doses than infants
How is excretion affected in neonatal and pediatric patients?
Kidney immaturity: slower excretion
Decreased kidney perfusion: reduces excretion
What are some factors affecting pediatric drug dosing?
More susceptible to interactions, toxicity, and idiosyncratic reactions
Thin and permeable skin
Stomach acid deficiency
Weaker mucus barriers in lungs
Less regulated body T
Easily dehydrated
Immature liver/kidneys
Older adults are age ___ and over
Drug therapy in older adults is most likely to result in____________
65+
Adverse effects and toxicity
Why are older adults at a higher risk of drug interactions?
How do we prevent toxicity?
Often take a lot of meds
Start Low and Go Slow- may be 1/3-2/3 of standard adult dose
Explain the difference between noncompliance and nonadherence
Noncompliance: Saying No to a drug or its methods
Nonadherence: Not doing it right, even if they try to (motor functions, memory, understanding, hearing ability, etc)
How is absorption affected in older adults?
Gastric pH less acidic
Slower gastric emptying
Slower GI peristalsis
Reduced blood flow to GI
Reduced GI absorptive surface
How is distribution affected in older adults?
Lower total body water %
Increased fat content
Decreased proteins from liver decreases protein binding of drugs and increases circulation of free drugs
How is metabolism affected in older adults?
Aging liver produces fewer enzymes
Reduced blood flow to liver
How is excretion affected in older adults?
Decreased filtration rate
Decreased nephron number
Decreased excretion causes less effective clearance
Explain the Beers Criteria
A list of medications that could be inappropriate for patients over 65
Lists possible/common drug interactions
What are some pediatric considerations for safe med administration?
Mixing meds to disguise taste: use nonessential fluid/food, ensure volume is fully measurable
Don’t lie/call it candy
Keeps meds out of reach with protective lids
What are some older adult considerations for safe med med administration?
Take as directed- don’t double up doses or discontinue!
Clear/large print instructions
Consider polypharmacy
