Drug Therapy Across the Life Span - Ch. 11, 12 & 13 Flashcards
What are the different lifespans that should be taken into consideration regarding drug therapy?
Pregnancy
Breast-feeding
Pediatric
Geriatric (65yrs old and older)
What are drugs that are dangerous to fetal development/pregnancy?
Teratogen
Teratogen
Drugs and other agents that can disrupt development of the fetus or halt pregnancy
What period of pregnancy is at greatest danger for drug-induced developmental defects?
First Trimester
What developmental defects can occur during the first trimester?
Congenital gross malformations because of enormous cell multiplication and differentiation
What developmental defects occur during the second and third trimesters?
Disruption of function not gross anatomy
e.g, brain development
What are breastfed infants at risk for exposure to?
Drugs consumed by mother
Is breast milk a usual excretion route?
NO
What are some contraindicated drugs to use while breastfeeding?
Cancer chemotherapy
Immunosuppressants
What should be limited during breastfeeding?
Alcohol, smoking (nicotine) and caffeine
What are the pediatric consideration subgroups?
Premature infants
Full term infants
Neonates
Infants
Children
Adolescents/Young adults
premature infants
Less than 37 weeks gestational age
Full term infants
37-40 weeks gestational age
Neonates
First 4 postnatal weeks
Infants
Weeks 5 to 52 postnatal
Children
1 to 12 years old
Adolescents/Young Adult
12 to 18 years old
What should be taken into consideration during absorption in pediatrics?
Gastric environment is less acidic
Gastric emptying is slowed - slow peristalsis
First pass effect is reduced (neonates) - immature liver
Topical absorption is faster through the skin
Intramuscular absorption is faster and irregular
What should be taken into consideration during distribution in pediatrics?
Total body water changes in different age groups
Protein binding decreased bc decreased protein made in immature liver
Immature blood-brain barrier allows more drugs to cross into their brain
What is the total body water (TBW) in full-term infants?
70%-80%
What is the total body water in premature newborns?
85%
What is the total body water in children 1-12 years of age?
64%
Greater TBW means?
Fat content is lower
What should be taken into consideration during metabolism in pediatrics (Newborns, neonates, infants)?
The immature liver does not produce enough microsomal enzymes (CYPs) so the metabolism is reduced
What should be taken into consideration during metabolism in pediatrics (Older children)?
May have increased drug metabolism requiring higher doses
What should be taken into consideration during excretion in pediatrics?
Kidney immaturity (up to ~1 year) affects perfusion, glomerular filtration rate and tubular secretion = reduced excretion of drugs
What are other pediatric considerations?
Skin is thin/permeable
The stomach lacks acid to kill bacteria
Lungs lack mucus barriers
Body temps poorly regulated and dehydration occurs easily
Liver and kidneys are immature, impairing metabolism and excretion
What should be taken into consideration for geriatric patients?
Use of medication is common
20-40% of all perscription drugs, >40% of OTC drugs
Polypharmacy
What should you take into consideration with geriatric people who have a polypharmacy?
Chronic illness and conditions
Increase risk of drug interactions, adverse effects
Some drugs given to treat adverse effect due to drug interactions
Which population is more sensitive to drugs?
Geriatric (compared to young adults)
Why are geriatric populations more sensitive to drugs?
Pharmacokinetic changes
Complex health conditions
Polypharmacy
Drug regime adherence
What cardiovascular changes occur in Geriatric populations?
Decreased CO, Decreased blood flow to organs
How is drug pharmacokinetics altered due to cardiovascular changes in Geriatric populations?
Decreased absorption
Decreased distribution
What gastrointestinal changes occur in Geriatric populations?
Increased pH
Decreased peristalsis - delayed gastric emptying, slower lower GI tract
How is drug pharmacokinetics altered due to gastrointestinal changes in Geriatric populations?
Altered absorption
How is drug pharmacokinetics altered due to liver changes in Geriatric populations?
Decreased cytochrome P-450, decreases metabolism
How is drug pharmacokinetics altered due to kidney changes in Geriatric populations?
Reduced function causes a decrease excretion of water soluble drugs and metabolites
