Lifespan Considerations Flashcards
Is generally the period of greatest risk?
The last trimester, 1st trimester
1st trimester
? Involves the highest % of drug absorption by the fetus
(increased blood flow + a larger fetus!)
The last trimester, 1st trimester
The last trimester
Which is true about BREASTFEEDING correct!
Lactation:
◦ A vast amount of drugs can enter breast milk
◦ Drug profiles that can easily cross:
◦ Lipid and Water soluble
◦ Small and Large molecular weight
◦ Non-ionized and Ionized
◦ Avoid long acting drugs (XL, long half lives)
◦ Typically give medications AFTER breastfeeding
◦ A vast amount of drugs can enter breast milk
◦ Drug profiles that can easily cross:
◦ Lipid soluble
◦ Small molecular weight
◦ Non-ionized
◦ Avoid long acting drugs (XL, long half lives)
◦ Typically give medications AFTER breastfeeding
Which is true for REPRODUCTIVE POTENTIAL
◦ Some medications may lead to infertility
◦ Some medications are known to be highly teratogenic
◦ Appropriate education and handling is needed
◦ Some are REMS drugs are needed
◦ May require negative pregnancy tests before and during therapy
◦ Recommendations may include beginning or altering contraceptive
therapies
◦ Famous example is Clopalan (Accutane®)
◦ Famous example is Isotretinoin (Accutane®)
◦ Some medications may lead to infertility
◦ Some medications are known to be highly teratogenic
◦ Appropriate education and handling is needed
◦ Some are REMS drugs are needed
◦ May require negative pregnancy tests before and during therapy
◦ Recommendations may include beginning or altering contraceptive
therapies
◦ Famous example is Isotretinoin (Accutane®)
decreased gastric acid production + slower gastric emptying time
GERIATRICS or NEONATES
NEONATES
GERIATRICS
More blood flow to skin (topical drugs get rapidly absorbed)
GERIATRICS or NEONATES
NEONATES
◦ Limited protein binding sites (until age 1)
GERIATRICS or NEONATES
NEONATES
◦ Decreased body water + mass, more fat content
GERIATRICS or NEONATES
GERIATRICS
◦ Still developing Blood Brain Barrier (drugs may enter the brain)
GERIATRICS or NEONATES
NEONATES
◦ Higher body water content (dilutes water soluble drugs)
GERIATRICS or NEONATES
NEONATES
◦ Decreased protein binding
GERIATRICS or NEONATES
GERIATRICS
◦ Immature liver/kidney function
GERIATRICS or NEONATES
NEONATES
◦ Declined liver/kidney function
GERIATRICS or NEONATES
GERIATRICS
PEDIATRIC
◦? can damage developing cartilage
Systemic Corticosteroids (prednisone), Fluoroquinolones ( levofloxacin) , Tetracycline’s (doxycycline)
Fluoroquinolones ( levofloxacin)
PEDIATRIC
◦ ? can bind to calcium of developing children
Systemic Corticosteroids (prednisone), Fluoroquinolones ( levofloxacin) , Tetracycline’s (doxycycline)
Tetracycline’s (doxycycline)
PEDIATRIC
◦ ? can suppress or delay growth
Systemic Corticosteroids (prednisone), Fluoroquinolones ( levofloxacin) , Tetracycline’s (doxycycline)
Systemic Corticosteroids (prednisone)
•Polypharmacy is common
GERIATRICS or NEONATES
GERIATRICS
6% when on ? drugs
50% chance on ? drugs
100% chance on ? drugs
5, 10, 2
6% when on 2 drugs
50% chance on 5 drugs
100% chance on 10 drugs
The Beers Criteria is for
GERIATRICS or NEONATES
GERIATRICS
NON-PHYSIOLOGIC CONSIDERATIONS
▪ Compliance Decreases with age
▪ Comorbidities, Changes in vision/hearing, Decreased mobility
▪ ENCOURAGE READING GLASSES!
GERIATRICS or NEONATES
GERIATRICS
Which is need for GERIATRICS?
▪ Recommendations to support compliance
▪ Clear and Concise instructions (verbal + written)
▪ Ensure appropriate dosage form
▪ Liquid for difficulty swallowing
▪ Solids for difficulty swallowing
▪ Daily calendar/pill counter
▪ Dispose of medications they are no longer taking
▪ Take-back programs
▪ Flush certain drugs (FDA FLUSH LIST) (fentanyl patch- pets, children)
▪ Mix drugs in sealable bags with cat litter/coffee and throw in trash
▪ Recommendations to support compliance
▪ Clear and Concise instructions (verbal + written)
▪ Ensure appropriate dosage form
▪ Liquid for difficulty swallowing
▪ Daily calendar/pill counter
▪ Dispose of medications they are no longer taking
▪ Take-back programs
▪ Flush certain drugs (FDA FLUSH LIST) (fentanyl patch- pets, children)
▪ Mix drugs in sealable bags with cat litter/coffee and throw in trash
