LC - Principles in Geriatric & Pediatric Pharmacology Flashcards
born before 37 weeks gestational age
Premature:
: 1 day-1 month old
Neonate
Infant age
1 mo- 1 year
Geriatric age
> 65
inefficient _____________ leads to accumulation –> shock (Grey Baby syndrome)
chloramphenicol glucuronidation
CYP 450 Inducer
Chronic alcohol use St. John’s wort Phenytoin Phenobarbital Nevirapine Rifampin Griseofulvin Carbamazepine
Chronic alcoholics Steal
Phen-Phen and Never
Refuse Greasy Carbs
CYP 450 Inhibitor
Acute Alcohol Abuse Ritonavir Amiodarone Cimetidine/ciprofloxacin Ketoconazole Sulfonamides Isoniazid (INH) Grapefruit juice Quinidine Macrolides (except azithromycin)
Hepatically eliminated drugs have clearances __________ in children than in adults
that vary more widely
Drugs are cleared more rapidly in children (in general), whether eliminated via renal or hepatic processes
Renal clearance of drugs is ___________ in children
more predictable
Drugs are cleared more rapidly in children (in general), whether eliminated via renal or hepatic processes
Drugs are cleared ________in children (in general), whether eliminated via renal or hepatic processes
more rapidly
_______________(including topical agents) are potent inhibitors of growth
Anti-inflammatory corticosteroids
Intellectual development can be impaired by ___________
barbiturates
Decrease gastric emptying and GI motility
Drugs with anticholinergic actions - diphenhydramine, TCADs
Increase gastric emptying and GI motility
Metoclopramide, stimulant laxatives
Decrease in hepatic mass and blood flow - ____ per year after age 40
1%
Can decrease first pass metabolism of drugs with high extraction ratio (i.e., blood flow dependent)
Phase II reactions (conjugation, glucuronidation) are minimally affected by aging
Examples?
Lorazepam, oxazepam, temazepam
Worst offenders of Beers
amitriptyline, diazepam, doxepin
Begin with recommendations for appropriate drug use
Look for therapeutic duplication
Optimize monotherapy
Then add drug from different class
START (Screening Tool to Alert doctors to Right Treatment)
Within a therapeutic classification, drugs are designated as potentially inappropriate, the clinical concern is identified, and therapeutic alternatives are suggested
STOPP (Screening Tool of Older Person’s potentially inappropriate Prescriptions)
Tinnitus, vertigo:
Worsened by
aspirin, aminoglycosides, ethacrynic acid
Hypotension:
Worsened by
beta-blockers, calcium channel blockers, diuretics, vasodilators, antidepressants
Psychomotor retardation:
Worsened by
benzodiazepines, antihistamines, antipsychotic agents, antidepressants
Pharmacology of Urination
GO: Stimulate M – block α1
STOP: ___________
Block M or stimulate α1 - β2-3
Overflow (from urinary retention)
Treated with:
a-adrenergic antagonists [tamsulosin]
Stress (from urethral sphincter insufficiency unmasked by coughing sneezing, lifting, sneezing)
Worsened by
a-adrenergic antagonists (prazosin, doxazosin)
Pharmacology of Urination
GO: ______________
STOP: Block M or stimulate α1 - β2-3
stimulate M – block α1
Urge (from detrusor hyperreflexia with sphincter dysfunction – Overactive Bladder)
Worsened by
cholinergic drugs for dementia (AChEIs), diuretics
Urge (from detrusor hyperreflexia with sphincter dysfunction – Overactive Bladder)
Treated with
antimuscarinic agents [tolterodine]
Constipation
Worsened by
opioid analgesics
antimuscarinic agents
1st gen antihistamines (esp. diphenhydramine)
CCBs- verapamil