Considerations for Special Populations

Question 1

Which of the following pharmacokinetic factors puts the neonatal patient at risk as related to drug therapy?

a) Immature renal system
b) Hyperperistalsis in the GI tract
c) Functional temp regulation
d) Smallar circulatory capacity

Answer 1

a) Immature renal system

Question 2

Which of the following is one of many physiological differences in infants that affects the amount of drug needed to produce a therapeutic effect?

a) Increased protein circulation
b) Fat composition less than 0.001%
c) more muscular body composition
d) Water composition approximately 75%

Answer 2

d) Water composition approximately 75%

Question 3

Which of the following alterations in pharmacokinetics best explains why the nurse encourages 76yr old Mr. Y to keep a journal of adverse effects experienced from his medications?

a) Less adipose tissue to store fat-soluble drugs
b) Increased kidney excretion of protein-bound drugs
c) More alkaline gastric pH, resulting in more adverse effects
d) Decreased blood flow to the liver with altered metabolism

Answer 3

d) Decreased blood flow to the liver with altered metabolism

Question 4

When the nurse is reviewing a list of medications taken by an 88yr old patient, the patient notes “I get dizzy when I stand up”, and has nearly fainted in the afternoon. Her systolic BP drops 15pts when she stands up. Which of the rolling types of medication may be responsible for these effects?

a) NSAIDs
b) Anticoagulants
c) Antihypertensives
d) Cardiac glycosides

Answer 4

c) Antihypertensives

Question 5

A patient who is 32wks gestation has a cold and calls the office to ask about taking an OTC medication that is rated as pregnancy category A. Which answer is correct?

a) This drug causes problems in the human fetus, so you should not take this medication.
b) Studies indicate that there is no risk to the human fetus, so it’s ok to take this medication as directed.
c) This drug has not caused problems in animals, but no testing has been done in humans. It’s probably safe to take.
d) This drug may cause problems in the human fetus, but nothing has been proven in clinical trials. It’s best not to take this medication.

Answer 5

b) Studies indicate that there is no risk to the human fetus, so it’s ok to take this medication as directed.

Question 6

Select either phenytoin or tetracycline and discuss the potential risks to the fetus or breastfeeding infant in relation to the benefits to the mother.

Answer 6

1. Tetracycline: Potential teratogenic effects, effects on the breastfed infant, and adverse effects on children younger than 8 years include permanent mottling and discoloration of the teeth and a decrease in the linear skeletal growth rate.
   Phenytoin: Potential effects on the fetus include cleft lip, cleft palate, heart defects, mental deficiencies, and hypoplasia of the nails. Phenytoin is relatively safe for women who are breastfeeding, with recommended close observation of the infant for possible effects resulting from transmission via breast milk.

Question 7

A 73yr old nursing home resident is experiencing problems that a nurse thinks are indicative of absorption problems with his oral medication (warfarin sodium). Specifically, the nurse notices that he has been experiencing unusual ‘bleeding’ tendencies over the past few days; however, he tolerated the medication ‘very well’ over the ‘last 3yrs’. Which of the following physiological changes is most likely the basis of his untoward reaction to the warfarin?

a) Increased cardiac output and volume
b) Increased glomerular filtration and renin excretion
c) Decreased gastrointestinal pH with increased peristalsis
d) Decreased liver enzyme production and altered liver perfusion.

Answer 7

2. D. The sudden increased bleeding in this patient could be the result of altered liver function and therefore the altered hepatic metabolism of the medication. As a result, more of the medication is free to cause an effect; in this case, the effect is increased bleeding tendencies.

Question 8

List medications that have a high risk for causing problems (i.e.: adverse effects, toxicity) for the older adult. Discuss problems or complications associated with these drugs or drug classifications.

Answer 8

3. Table 3-4 in the text (see p. 52) contains examples of medications that are problematic for the older adult. Note the following:
   • Analgesics (such as opioids and nonsteroidal anti-inflammatory drugs [NSAIDs]) and sedatives or hypnotics may result in confusion, which could lead to falls or self-injury. These medications may also cause nausea and vomiting, which could lead to fluid and electrolyte disturbances.
   • Anticoagulants, which may lead to major bleeding disorders, are highly protein bound. They have many drug interactions and may lead to toxicity.
   • Anticholinergics may lead to blurred vision and confusion, which could result in self-injury through falls; anticholinergics also lead to constipation and urinary retention.
   • Antihypertensives may result in postural hypotension and possibly syncope, which could result in falls and injury.
   • Diuretics are also problematic in that they cause fluid and electrolyte disturbances and may result in dizziness, falls, and injury.
   • Cardiac glycosides may also be problematic because of loss of appetite, weight loss, and nausea and diarrhea.