Drugs in pregnancy, paediatrics and old people Flashcards
Name two things that must be considered during absorption in paediatric patients.
- gastric pH is less acidic, and slower to empty
- first pass effect elimination is reduced due to immature liver and kidneys
- topical absorption is faster due to thin skin
- intramuscular absorption is faster and irregular
How are drugs influenced during breast feeding?
Drugs pass readily through breast milk are influenced by drug molecule size, affinity for plasma proteins, maternal drug dose, amount of milk consumed, time interval between absorption of drug and baby’s feed.
Name two things that must’ve considered during distribution of drugs in paediatrics.
- fat content is less, because of greater total body water content
- more response to fat-soluble drugs
- more protein binding decreased due to immature liver
- immature blood-brain barrier, so more drugs enter the brain
What do we need to consider in paediatrics for metabolism and excretion?
Metabolism: level of microsomal enzymes decreased.
Excretion: reduced renal function and concentrating ability.
During paediatric dosing, what must we consider?
- dose of a child is NEVER equivalent to adult
- not linear
- cannot scale the dose
- age and bodyweight is used
- mg/kg dose or mg/kg/24hrs
- many medications are available in liquid mixture form
- care in calculating volume of mixture given
What must you also consider with paediatric patients?
- information appropriate to age
- family’s response to illness
- identification by wrist band NOT verbally
- be firm, confident, and honest
- use smallest amount of fluid to ensure dose taken: oral route preferred
- promote compliance through simple schedules
What are physiological changes we must consider in older adults?
CVS: decreased cardiac output and blood flow, decreased absorption and distribution.
GIT: increased gastric pH, decreased blood flow, peristalsis and absorptive area, delayed gastric emptying, decreased absorption, decrease in hepatic first pass
Liver: decreased enzyme production and blood flow, decreased metabolism
Renal: decreased blood flow and function, decreased excretion
Fat content: increased
Total body water: decreased
Beta adrenergic sites and CVS: less sensitivity to some drugs
Sensory loss: sight, hearing, taste smell
Memory loss
Name two drug considerations in the older adult.
- prescribed drug regimes may be complicated
- over-prescribing
- multiple prescribing
- poor preparation of clients to self-administer
- insufficient communication - misunderstanding
