Chapter 4 Flashcards
1
Q
-barrier in the central nervous system composed of capillaries with tight bonds, which acts to prevent the passage of most ions and large molecular weight compounds, including some drugs, from the blood to the brain
A
Blood-Brain barrier
2
Q
-surface of a human body expressed in square meters
A
Body Surface area
3
Q
-person(s) between birth and 18 years of age
A
Child(ren)
4
Q
-amount of water w/in the body (both intracellular and extracellular)
A
Total body water
5
Q
- evaluation and management of all children
- divided into 5 subgroups
1) premature infants-less than 38wk of gestation age
2) neonate-a full term newborn 0-4 wk of age
3) infant-greater than 4wk-1yr of age
4) child-greater than 1-12 yr of age
5) adolescent-greater than 12-18 yr of age - ea group is characterized by a select set of physiologic changes that affect pharmacology
- the younger the pt, the greater the variation in med action
- a child’s immature systems mean that molecular binding, receptor reactions, and intended actions of meds may not mimic those in adults
- as a pt goes thru puberty, they begin to respond more like adults physiologically, but they are still immature psychologically and may lack the ability to dose, administer, or evaluate the effectiveness of their meds
- divided into 5 subgroups
A
Pediatrics
6
Q
- compelled the pharmaceutical industry to submit all known data about pharmacokinetics, safety, and efficacy of meds used for children
- they provide incentives to companies who perform research to determine the safety, efficacy, dosage, and unique risks associated with meds for children
- research has now uncovered other gaps in pediatric studies, including a need for pediatric formulations, preclinical studies, and pediatric outcome measures
- prescribers must still treat pediatric pts w/drugs for which they lack info; therefore, they must practice good assessment, dosing, and evaluation during the administration of any medication to a pediatric pt
A
FDA and pediatrics
7
Q
- basis is based on weight (5 mg/kg/24 hrs)
- determining drug dosages is highly dependent on the growth and development changes that occur across the lifespan
- Body surface area can also be used to calculate dosages
A
Calculating drug dosages for children
8
Q
- greatly affects a prescriber’s ability to dose pediatric drug effectively
- to account for immature or impaired body systems in neonates and younger children, it is often necessary to dramatically change drug therapies
A
Pharmacokinetics
9
Q
- affected by age, gastric emptying, intestinal motility, routes of administration, and skin permeability
- age is an important factor
- during infancy, neonates have delayed, irregular gastric emptying and reduced gastric acidity
- leads to greatly increased drug levels
- decreased acidity results in greater absorption of acid-labile meds or reduced absorption of weakly acidic meds
- during infancy, neonates have delayed, irregular gastric emptying and reduced gastric acidity
- route of administration
- prescribers avoid the use of IM injections because of the associated pain and unpredictable absorption
- thin and highly permeable skin increases the rate of absorption of topical drugs, and careful administration is important to avoid toxicity
A
Absorption
10
Q
- dependent on percentage of body water, liver function, degree of protein binding, and the development of the blood brain barrier
- water soluble drugs readily move into intercellular tissue
- serum drug concentrations are lower, and increased dosages of water soluble drugs may be necessary to maintain therapeutic drug levels in neonates and premature infants
- liver function leads to very low plasma protein levels, limits the amount of protein binding drugs
- serum concentrations of highly protein bound drugs may be higher than expected and toxicity may occur
- blood brain barrier
- can make drug delivery to the neurons more difficult
- neonates: poorly developed, drugs and other chemical easily affect the CNS
- nurse must be alert for other chemicals or drugs that may cause unwanted CNS effects (vital sign irregularities, sedation, excitability, and seizures)
A
Distribution
11
Q
- neonates:very low because of the immaturity of the liver and the resultant inability to break down drugs
- prescriber needs to calculate drug doses carefully, and the nurse must monitor infants and young children closely until the liver is more mature (end of 2nd yr)
A
Metabolism
12
Q
- young children have immature kidneys, a reduced glomerular filtration rate, and slower renal clearance
- neonates are especially prone to increased levels of drugs that are eliminated primarily by the kidneys
- prescriber should order appropriate small doses and the nurse should monitor carefully until renal function reaches maturity
A
Elimination
13
Q
-presents its own set of challenges because of difficulties in communication, cooperation, and adherence
A
Medication Administration in Pediatrics
14
Q
- calculation of the correct dosages, safety in administration, and teaching parents how to deliver meds correctly
- oral meds are administered with a dropper or oral syringe
- IM injections: use the smallest needle in the vastus lateralis
- comfort care is important
- IV sites are often found in the scalp, hands, or feet
- use 22 to 24 gauge needle
A
Med Admin in Infants
15
Q
- involve the toddlers and preschoolers in med admin by having them hold items or choose the bandage or cup
- explanations should be short and simple
- adults need to control administration
- IM injections: ventrogluteal area
- IV sites: occasionally on the scalp, feet, hands, or antecubital are more preferable
A
Med Admin in Toddlers and Preschoolers
