Drug Therapy Across the Lifespan

Question 1

Lifespan considerations

Answer 1

-Pregnancy
-Breastfeeding
-Pediatric
-Geriatric

Question 2

Teratogens

Answer 2

-Drugs that can disrupt development of fetus or halt pregnancy

Question 3

Pregnancy

Answer 3

-Avoid teratogens
-Only take medicine when necessary

Question 4

First trimester

Answer 4

Period of greatest danger for drug induced development defects

Question 5

Teratogens in first trimester affect

Answer 5

-Congenital gross anatomy defects due to cell multiplication and differentation

Question 6

Second trimester

Answer 6

Disruption of function

Question 7

Teratogens in second trimester affect

Answer 7

brain development

Question 8

Breast feeding

Answer 8

-Risked exposure of drugs from mom (Through milk)

Question 9

With breast feeding consider

Answer 9

-risk:benefit ratio for each drug
-half life
-oral bioavailability
-can be used as pediatric drug therapy

Question 10

When breast feeding only use medication

Answer 10

When necessary

Question 11

Contraindicated drugs for breast feeding

Answer 11

-Cancer chemotherapy
-Immunosuppressants

Question 12

Geriatric Considerations

Answer 12

-Medication use is more common (20-40% prescription)
-More sensitive to drugs than young adults
-Polypharmacy

Question 13

Polypharmacy

Answer 13

-Concurrent medications
-higher risk for adverse effects
-often given more drugs to treat adverse effects of drug interactions

Question 14

Why are geriatric more sensitive to drugs

Answer 14

-Pharmacokinetic changes
-Complex health conditions
-Drug regime adherance

Question 15

Physiological changes in gariatrics

Answer 15

-Cardiovascular, Decrease in blood flow
-Gastrointestinal
-Liver
-Kidney

Question 16

Geriatric Cardiovascular changes affect

ADME

Answer 16

Decreased distribution and absorption

Question 17

Geriatric Gastrointestinal changes

Answer 17

-Increased Ph (altered absorption)
-Decreased peristalsis (delayed gastric emptying/slower GI)

Question 18

Geriatric Liver changes

Answer 18

-Decreased cytochrome P-450, decreased metabolism

Question 19

Geriatric Kidney Changes

Answer 19

Decrease in function, decrease in excretion of H2O soluble drugs

Question 20

Pediatric considerations

Answer 20

1. Thin permeable skin
2. lack of stomach acid
3. lungs lack mucous barriers
4. Poor body temp regulation
5. Immature liver and kidneys

Question 21

Premature Infants

Answer 21

less then 37 weeks gestation

Question 22

Full term infants

Answer 22

37-40 weeks gestation

Question 23

Neonates

Answer 23

First 4 days postnatal

Question 24

infants

Answer 24

5-52 weeks post natal

Question 25

children

Answer 25

1-12 years

Question 26

Adolescents

Answer 26

12-18 years

Question 27

Absorption in pediatric

Answer 27

-less acidic gastric environment
-gastric emptying is slowed/slow peristalsis
-first pass effect is reduced
-topical absorption is faster
-intramuscular absorption is fast and irregular

Question 28

Distribution in pediatrics

Answer 28

-total body water
-lower fat content
-protein binding decreased due to immature liver
-immature BBB allows more drugs to enter brain

Question 29

Total body water (TBW)

Answer 29

-less then 70-80%in full term infants
-less then 85% in premature newborns
-less then 64% in 1-12 years

Question 30

Metabolism in Pediatrics

Answer 30

-Immature liver doesn’t produce enough micro enzymes (CYP) so drug metabolism is reduced

Question 31

Excretion in Pediatrics

Answer 31

kidney immaturity (up to one year)
-affect perfusion, globular filtration rate and tubular secretion
-reduce excretion