Chapter 7 Flashcards
Drug administration during pregnancy and lactation
drug therapy should be avoided if possible until after if possible
Placenta
is a semi-permeable membrane
water soluble, ionized or drugs bound to plasma proteins are less likely to cross
Fetal membrane
can break down and detoxify certain drugs as they cross the placenta
GI changes during pregnancy
delayed emptying
slowed transit time
decreased gastric acidity
Respiratory changes during pregnancy
increased tidal volume and pulmonary dilation
Distribution and metabolism changes during pregnancy
increased cardiac output
increased blood volume
changes in regional blood flow
alterations in lipid levels
Excretion changes during pregnancy
blood flow to kidneys increases 40%-50%
Teratogen
causes death or abnormality to the fetus
occus in 3% of pregnancies
fetal risk dependent on what part of gestation is happening
First trimester
implantation to 60 days
skeleton and organs form
greatest risk for defects
Second trimester
4-6 months
major organs formed
less risk of defects
Third trimester
7-9 months
increased blood flow to the placenta
membrane becomes thinner
lack of mature metabolic enzymes and efficient excretion mechanisms
Medication and lactation
drugs that are water soluble, ionized or attached to plasma proteins are less likely to enter breast milk
lipid soluble medications pass through breast milk
radioactive drugs=NO BREASTFEEDING
Infancy
birth to 12 months
first 28 days=neonatal
Infant IM injections
vastus lateralis preferred site
gluteal site contraindicated
Infant IV
inserted into the scalp and feet
Toddlerhood
1-3 years
Toddler IM injections
vastus lateralis preferred site
Toddler IV
inserted into the scalp and feet
possibly peripheral site in later toddlerhood
Pre-school
3-5 years
can sometimes comprehend the differance between health and illness and use of medication
Pre-school IM injections
Ventrogluteal site is less painful
Pre-school IV
Peripheral veins
School age
6-12 years old
School age IM
Ventrogluteal
Adolescence
13-16 years old
Young adulthood
18-40 years old
Middle adulthood
40-65 years old
Later adulthood
65+ years old
Later adulthood absorption
decreased absorption
increased gastric pH
Later adulthood distribution
increased body fat causes increased storage of lipid soluble drugs, decreased therapeutic response, decreased cardiac output
Later adulthood metabolism
decreased enzyme production in the liver and decreased viceral blood flow cause decreased metabolism
polypharmacy
taking multiple drugs, using many pharmacies and MD’s
Later adulthood excretion
decreased excretion rate
risk reaching toxic levels due to impaired renal function
