Exam 1: Lifespan considerations Flashcards by Ashley Lau

2 populations that are more sensitive to drugs than other patients

Patients who are very young or very old respond differently to drugs than the rest go the population

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What causes drug sensitivity in the very young?

Organ stsem immaturity

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What causes drug sensitivity in elderly?

Organ system degeneration

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Geratrics makes up what % of the US population

20%

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Elderly individuals consume % prescribed & OTC

30 % prescribed

more than 40% OTC

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Issues with geriatric medication

Increasing severity of illnesses
multiple chronic illnesses
Excessive prescribing

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Adverse drug effects are ___ more common in elderly patients than younger adults

7X more common to experience adverse drug reactions

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Geratrics have a greater use of

Drugs with a low therapeutic index

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Polypharmacy

> 5 prescribed medications

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____% of elderly patents do not takes drugs as prescribed

40%

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How to promote adherence

Simplify
Clear and concise instructions
Right dosage
Label largely

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Geriatric patients have an altered

Absorption, distribution, metabolism and excretion of drugs

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Geriatric patients experience gradual decline in organ function, especially the

Renal and hepatic function

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Decline in organ functions has what effect on body?

Increased sensitivity to drugs and wide individual variations in reposer to drug

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What happens to the rate of absorption for geriatric patients

rate of absorption is often slowed

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Factors that result in delayed drug response

Delayed gastric emptying time
decrease GI motility
decrease gastric acidity
decrease absorptive surface area
decrease splanchnic blood flow

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changes in distribution for Geratrics patients

Increase % body fat
Decrease % of lean body mass
D total body water 
D serum albumin 
D Cardiac output

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An increase in fat for elderly patients provides what

storage for lipid soluble drugs which causes a decrease plasma levels of some drugs

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the longer the drug remains in the body, concerns for

toxicity

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Decrease amount of total body water causes

Increase concentration of water soluble drugs, which intensifies effects of some drugs

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Decrease in serum albumin causes

decrease protein binding and possible competition among drugs for binding sites, which increase free drugs and intensifies effects of drugs

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Changes in metabolism for Geratrics patients

Decrease..

Hepatic blood flow
hepatic mass
activity of hepatic enzymes

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Physiological changes of metabolism result in

Decrease in first pass metabolism

Prolonged bioavailability of some drugs

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Changes in excretion Geratrics patients

Decrease

renal blood flow
GFR
tubular secretion
number of nephrons

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Physiological changes in excretion result in

Decrease excretion of drugs, which increase accumulation and leads to potential for adverse reactions

How many pregnant women take medication

2/3 of pregnant women take at least one medication

Common pregnancy related conditions include

Nausea Constipation Gestational diabete pre-eclampsia

Pregnancy disorder

Hypertension diabetes epilepsy and infectious disease

Pregnant women frequently take drugs of abuse such as

alcohol, cocaine, methamphetamine, and heroin

Benefits of treatment for pregnant women must

balance/outweigh the risks

does risk apply to the fetus as well?

Yes, fetus and mother

The health of the fetus depends

on the health of the mother

Pregnancy and asthma

Asthma is more dangerous to pregnant women than the medication, women who fail to take medication are 2x more likely to stillbirth

By the third trimester, what happens to renal blood flow for women?

blood flow increases by 50% -> increase GFC ->accelerated clearance of drugs -> dosage must increase

Plasma proteins in pregnant women are diluted because of

Increase plasma volume

Tone and motility of bowel decrease in pregnancy, causing

intestinal transit time to increase, which causes a possible delayed drug response

almost all drugs can

cross the placenta

The assumption about drugs in pregnant women

any drug taken during pregnancy will reach the fetus

Factors that determine drug passage across the membranes of the placenta are

the same factors the determine drug passage across all other membranes

teratogenesis

Formation of physical abnormalities

mutagenesis

induction of genetic changes

Drug dependent mother =

drug dependency baby

What is secondary to opiates for pain relief during pregnancy

neonatal respiratory depression

What happens during the embryonic period

Basic shape of internal organs and other structures is being establish

Exposure to teratogens during the embryonic period will result in

Gross malformations

What is important during the fetal period

Development of the brain

Teratogen exposure during the fetal period usually disrupted

function rather than anatomy, learning deficits and behavioral abnormalities are concerns

When did FDA require drug labels to include ability to cause birth defects and other effects on reproduction and pregnancy

1975

Category A pregnancy risk category

Remote harm

Category B pregnancy risk category

Slightly more harm

Category C pregnancy risk category

Greater risk than B

Category D pregnancy risk category

Proven risk of fetal harm

Category X pregnancy risk category

Proven to show definite risk of fetal abnormality

Nearly all drugs can enter

breast milk

Factors that ermine entry into the breast milk are the

same factors that determine passage of drugs across membranes

While most drugs can be detects in breast milk,

concentrations are generally too low to be harmful

Strategies to minimize risk for pregnant women taking medication

-Dose immediately after breast feeding avoid long half life choose drug lear likely to affect infant avoid drugs that are known to be hazardous

Premature infants

less than 36 week

full term infants

36-40 weeks

neonates

first 4 postnatal weeks

Infants

Weeks 5 to 52 postnatal

Children

1-12 years

Adolescents

12-17

Children metabolize drug ____ than adults

faster

What determines pediatric dosages

weight (mg/kg)

In neonates & Young infants, drugs responses may

be unusually intense and prolonged

protein binding capacity is

limiting early in life

The BBB is not fully developed at birth which causes

neonates to be especially sensitive to drugs that affect the CNS

Drug metabolizing capacity of neonate is

low because do not have fully developed CYV450-enzyme system

renal excretion of drugs in neonates is

low

What can be used as a quick estimation of pediatric weight and drug doses for emergencies

Broselow color-coded tools