Drug Therapy Across the Life Span Flashcards by laura jones

Q

how much pregnant patients take at least one medication?

A

2/3s

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Q

Kidney changes in pregnancy

how does it affect drugs

A

third trimester renal blood flow is doubles

accelerated clearance of blood

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Q

Liver changes in preg.

A

hepatic metabolism of drugs increase

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Q

GI tract

A

tone and motility decrease

increases transit time= more time for drugs to be absorbed

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Q

Adverse reactions during pregnancy

Heparin (anticoagulant)

A

osteoporosis

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Q

Adverse reactions during pregnancy

Warfarin (anticoagulant)

A

fetal hemorrhage

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Q

Adverse reactions during pregnancy

Aspirin (antiplatelet)

A

increases risk of serious bleeding during childbirth

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Q

Adverse reactions during pregnancy

Misoprostol

A

spont. abortion

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Q

Adverse reactions during pregnancy

heroin, alcohol, etc.

A

drug dependent infant

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Q

Adverse reactions during pregnancy

Opioid pain relievers during delivery

A

depress neonate respiration

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Q

Teratogenesis

A

birth defects.
- physical AND neurobehavioral, and metabolic abnormalities

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Q

What are the 3 major period in fetal development?

A

1) preimplantation: conception to week 2

2) embryonic period: 3-8 weeks

3) fetal period: week 8 through term

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Q

Teratogens exposure on

1) preimplantation period

2) embryonic period

3) fetal period

A

1) all or nothing –> high dose results in death

2) gross malformations

3) function rather than gross anatomy
- growth and development of the brain

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Q

proven teratogens

A

thalidomide: fast acting teratogen (single dose can cause malformation)

alcohol: repeated high doses for gross malformation

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Q

FDA categories for a drugs probable risk to fetus

A

Category A: least dangerous- studied on pregnant patients

B, C, D:
progressively more dangerous

Category X
- MOST dangerous
- fetal risk far OUTWEIGHS therapeutic benefit

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Q

factors that determine entry into breast milk?

A

lipid soluble drugs
highly polar, ionized drugs or protein bound do not

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Q

what should nursing mothers do if they cannot avoid drug in pregnancy?

A

dose after feeding
avoid drugs with long half life
avoid sustained-release drugs
use lowest effect dosage

Q

what primarily causes drug sensitivity in young pt?

A

organ system immaturity
- increased risk of ADR

Q

pediatric patients

A

up to 16 yoa

Q

premature infants

A

less than 36 weeks (9 months)

Q

full term infants

A

36-40 weeks (9-10 months)

Q

neonates

A

first 4 postnatal weeks (1st month)

Q

Infants

A

5-52 weeks (1-12 months)

Q

Children

A

1-12 years

Adolescence

12-16

how do drugs affect neonates

Elevated drug levels = more intense response Drug elimination delayed = response prolonged

iv injections in infants compared to adults

remains above minimum effective concentration for much longer

subcutaneous injection in infants vs adults

both maximal level and duration are greater

absorption in neonates and infants

gastric emptying is prolonged and irregular -stomach: enhanced due to delayed gastric emptying - intestinal absorption: delayed IM - first days postnatal: slow erratic due to low BF through muscles - infancy: more rapid than adults and neonates Transdermal Admin - infants: more rapid and complete --> stratum corneum thin and blood flow to skin is greater

Distribution in Neonates and Infants

Protein binding: limited (decreased albumin) - less binding = greater free levels of drug BBB: not fully developed = easy access to CNS

Metabolism in neonates/ infants

metabolized in liver drug metabolizing capacity of newborns is low = neonates extra sensitive

Excretion neonates/ infants

most excreted by Kidney renal drug excretion REDUCED

metabolizim in children vs adults

metabolize faster BBB not fully developed = easy access to CNS

Adverse Drug Rxn in children

organ system immaturity

Dosage Determination in children

Body surface Area BSA

What percent of older adults of all perscription drugs and OTC

20-40% >40%

major issues with older adults

1) altered pharmacokinetics 2) multiple and severe illnesses 3) Multidrug therapy 4) poor adherence to

absorption in seniors

rate of absorption is slower- delayed gastric emptying - drug response delayed

Distribution factors for seniors

1) increased body fat 2) decreased lean body mass 3) decreased total body water 4) reduced serum albumin

Metabolism in seniors

hepatic drug metabolism declines - DRUG ACCUMULATION -**ADR in seniors

ADRs in seniors factors

1) drug accumulation secondary to reduce renal function 2) polypharmacy 3) greater sensitivity to illness 4) comorbidities