Drug Therapy Across the Lifespan Flashcards
Lifespan considerations
-Pregnancy
-Breastfeeding
-Pediatric
-Geriatric
Teratogens
-Drugs that can disrupt development of fetus or halt pregnancy
Pregnancy
-Avoid teratogens
-Only take medicine when necessary
First trimester
Period of greatest danger for drug induced development defects
Teratogens in first trimester affect
-Congenital gross anatomy defects due to cell multiplication and differentation
Second trimester
Disruption of function
Teratogens in second trimester affect
brain development
Breast feeding
-Risked exposure of drugs from mom (Through milk)
With breast feeding consider
-risk:benefit ratio for each drug
-half life
-oral bioavailability
-can be used as pediatric drug therapy
When breast feeding only use medication
When necessary
Contraindicated drugs for breast feeding
-Cancer chemotherapy
-Immunosuppressants
Geriatric Considerations
-Medication use is more common (20-40% prescription)
-More sensitive to drugs than young adults
-Polypharmacy
Polypharmacy
-Concurrent medications
-higher risk for adverse effects
-often given more drugs to treat adverse effects of drug interactions
Why are geriatric more sensitive to drugs
-Pharmacokinetic changes
-Complex health conditions
-Drug regime adherance
Physiological changes in gariatrics
-Cardiovascular, Decrease in blood flow
-Gastrointestinal
-Liver
-Kidney
Geriatric Cardiovascular changes affect
ADME
Decreased distribution and absorption
Geriatric Gastrointestinal changes
-Increased Ph (altered absorption)
-Decreased peristalsis (delayed gastric emptying/slower GI)
Geriatric Liver changes
-Decreased cytochrome P-450, decreased metabolism
Geriatric Kidney Changes
Decrease in function, decrease in excretion of H2O soluble drugs
Pediatric considerations
- Thin permeable skin
- lack of stomach acid
- lungs lack mucous barriers
- Poor body temp regulation
- Immature liver and kidneys
Premature Infants
less then 37 weeks gestation
Full term infants
37-40 weeks gestation
Neonates
First 4 days postnatal
infants
5-52 weeks post natal
children
1-12 years
Adolescents
12-18 years
Absorption in pediatric
-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
Distribution in pediatrics
-total body water
-lower fat content
-protein binding decreased due to immature liver
-immature BBB allows more drugs to enter brain
Total body water (TBW)
-less then 70-80%in full term infants
-less then 85% in premature newborns
-less then 64% in 1-12 years
Metabolism in Pediatrics
-Immature liver doesn’t produce enough micro enzymes (CYP) so drug metabolism is reduced
Excretion in Pediatrics
kidney immaturity (up to one year)
-affect perfusion, globular filtration rate and tubular secretion
-reduce excretion
