Lecture 5- ADME in Special Populations

Question 1

What is drug absorption like in babies?

Answer 1

• blood flow at site of absorption
• biochemical and physiological changes in the GI tract

Question 2

What is DRUG DISTRIBUTION like in babies?

Answer 2

• higher percentage of water than adults
• immature blood brain barrier
• lower albumin levels –> key carrier protein for drugs

Question 3

What is DRUG METABOLISM like in babies?

Answer 3

• LESS enzymes
• SLOWER clearance rates
• LONGER half-lives
• Dose-response relationship to change during first few weeks after birth

Question 4

What is drug EXCRETION like in babies?

Answer 4

LOWER glomerular filtration rate
SLOWER excretion

Question 5

How does one give drugs to babies?

Answer 5

• ELIXIRS –> alcoholic solutions
• SUSPENSIONS –> drug particles shaken with a solution

Question 6

What is the problem with drug administering during LACTATION?

Answer 6

-some meds can go into breast milk (lipid-soluble can, NOT plasma bound)
- take meds 1-2 hours before or 3-4 hours after breastfeeding (questionable)

Question 7

what are some meds that can cause problems during Nursing infants?

Answer 7

• sedatives
  -antibiotics
  -heroin
  -narcotics
  -alcohol
  -lithium

Question 8

What is a good dose for babies?

Answer 8

• depends on body surface area, age or body weight
• definetly a lot less then adult doses

Question 9

Does AGE affect the Pharmacokinetic process?

Answer 9

YES!

Question 10

What are some physiological changes in the elderly?

Answer 10

everything DECREASES!
heart, liver, kidneys, stomach, intenstines all of it!

Question 11

what are some Pharmacokinetic changes in elderly?

Answer 11

SLOWER absorption
Increased body fat, reduced lean body mass, reduced water content
heart fialure and liver function decrease
DECREASE cardiac output

Question 12

What are some pharmacodynamic changes in elderly?

Answer 12

• Changes in CNS –> change in receptors –> more/less sensitive to drug
• average BP increases
• blood glucose levels INCREASE
• temp regulation impaired

Question 13

What is “Yohimbe”?

Answer 13

• natural supplement
• to treat erectile dysfunction
• NOT standardized
• cannot take if you have: hypertension, any problems with liver or kidneys, peptic ulcer

Question 14

What is Polypharmacy?

Answer 14

when multiple medications prescribed

Increases chances of…
- drug-drug interactions
- drug-nutrient interactions
- liver dysfunction
-malnutrition
- confusion
- falls

Question 15

Are elderly people more likely to make a mistake or forget when taking multiple medications?

Answer 15

YES!

Question 16

What are changes in “antihypertensives” in elderly?

Answer 16

cause
- hyperglycemia
-hyperuricemia
- hypokalemia

Question 17

What are changes in “cardio glycosides” in elderly?

Answer 17

can be TOXIC

Question 18

What are changes in “antiarrhymthic drugs” in elderly?

Answer 18

increases risk of TOXICITY

Question 19

What are changes in “anticoagulants” in elderly?

Answer 19

increase risk of BLEEDING

Question 20

What are changes in “sedatives/hypnotics” in elderly?

Answer 20

eliminated more slowly due to decrease in renal function

Question 21

What are changes in “antidepressants/antipsychotics” in elderly?

Answer 21

older ones should be AVOIDED

Question 22

Should NSAIDs be used carefully in elderly?

Answer 22

YES

Question 23

What can corticosteroids cause?

Answer 23

osteoporosis

Question 24

What can increased laxative use cause?

Answer 24

electrolyte imbalances

Question 25

What is “NON-COMPLIANCE”?

Answer 25

when people don’t stick with their drug regime readily

Question 26

Why does “non-compliance” happen?

Answer 26

• forgetfulness
• fear of adverse effects
• confusion
• physical disabilities
• inability to read directions
• inadequate health-care and prescription coverage
  -socioeconomic factors

Question 27

Can drugs affect all stages of pre- and postnatal development ?

Answer 27

Yes, specifically the FIRST trimester

Question 28

What are some things that can be harmful to the developing fetus?

Answer 28

1. smoking
2. alcohol
3. OTC meds
4. improper nutrition

Question 29

WHEN can we administer meds during pregnancy and lactation?

Answer 29

if you have…
1. gestational diabetes
2. hypertension
3. UTI
4.STI
5. High-risk pregnancy

Question 30

What should we think about before administering meds to pregnant women?

Answer 30

1. Can it cross the placenta?
2. Are there any physiological or anatomical changes during pregnancy due to hormones?
3. Is there any changes in cardiac output, plasma volume, regional blood flow, and renal blood flow?

Question 31

What are some toxic effects during pregancy?

Answer 31

-infertility
- low birth weight
- premature
- birth defects
-spotnaneous abortion

Question 32

Is ADME mostly affected by mother or fetus?

Answer 32

Mother

Question 33

how is fetus exposed to toxic effects?

Answer 33

amniotic fluid

Question 34

Can drugs cross the placenta?

Answer 34

Yes, EXCEPT for conjugated steroid and peptide hormones

Question 35

What is the key to prevention for using drugs during pregnancy?

Answer 35

EDUCATION!!!

Question 36

What are the 4 principles concerning drug’s potential to induce developmental disorders?

Answer 36

1. Dose-effect relationship
2. Species Susceptibility
3. Period of Development
4. Modes of action

Question 37

What are some recreational drugs that can affect the breast milk?

Answer 37

1. alcohol –> changes taste
2. nicotine –> leads to poor nursing and supply, baby vomits and is restless
3. opiates –> baby gets ADDICTED
4. caffeine –> metabolized slowly in baby, high amounts cause irritability, sleep probs, poor iron absorption
5. cannabis–> stored in brain and fat, affect motor development
6. cocaine –> causes problems with heart rhythm and excitation/trembling

Question 38

What is the thoughts on vaccines during pregnancy and lactation?

Answer 38

give BEFORE pregnancy
no contraindications during lactation