Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm > Lifespan Considerations- Quiz 1 > Flashcards

Lifespan Considerations- Quiz 1 Flashcards

1
Q

Risks of prescribing in pregnancy

A

-Is it a teratogen?
-Is there a threat embryonically or when the organs are
being formed?
-What does the agent do to the fetus?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Main Pregnancy Considerations

A

-Fluid: Total body weight increases by 7-9 liters (40% mom, 60% to amniotic fluid, placenta and fetus, Retains NA)
-GI: Delay in gastric emptying (prolonged drug absorption and lower peak drug concentrations)
-Cardio: Heart enlarges by about 12% (Myocardium undergoes hypertrophy and Capacity of the heart for blood increases 10%; increased HR)
-Renal: -GFR increases 40-50%
(Reaches 150% of normal)
-Greater elimination of amino acids,
glucose, protein, water soluble vitamins, certain drugs
-Resp: Hyperemia of nasopharynx
-Higher O2 demands
-Stimulant effect of progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pharmacokinetic changes of pregnancy: absorption

A

-Prolonged gastric transit time
-Change in gastric pH
-Decreased gastric tone/ mobility
-Increased absorption through
skin, lungs & mucous membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pharmacokinetic changes of pregnancy: distribution

A

-Increased HR, CO, & blood volume
-Increased total body water = greater Volume distribution
-Ratio of albumin to water decreases
(alters protein binding capacity)
-Half life usually prolonged
-Assume that drugs will “hang around longer” in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pharmacokinetic changes of pregnancy: metabolism and elimination

A

-Metabolism promoted by
progesterone
-Hepatic metabolism increased
-Elimination—GFR ↑ [drugs excreted
rapidly]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Factors that Affect Placental Transfer of Medications

A

-Are they lipid soluble?
-What is the ionized state?
-What is the molecular weight?
-Are the drugs protein bound?
-Maternal BP, maternal position, is there fetal cord compression?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How Teratogenic a Drug Is

A

-Category A (most favorable)
-Category B
-Category C
-Category D (Least favorable)
-Category X (Can never justify giving this to a pregnant woman)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Category A Pregnancy Drugs

A

-Controlled studies failed to
demonstrate risk to fetus—1 st or later trimesters
-Safe for use in pregnancy
-Fetal harm appears remote
-Examples—levothyroxine, folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Category B Pregnancy Drugs

A

-Animal studies not demonstrated a fetal risk—but no adequate studies in pregnant women
-Animal studies showed adverse effects other than decreased fertility but not confirmed in humans
-Examples—acetaminophen, amoxicillin, metformin, NPH insulin, Insulin aspart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Category C Pregnancy Drugs

A

-Animal studies revealed teratogenic,
embryocidal or other AE on fetus
-No adequate or well controlled studies in pregnant women
-“Risk vs Benefit”
- Examples—albuterol, ciprofloxin, furosemide, propranolol, labetalol, pseudoephedrine, trazadone

NOTE- fluroquinolones have black box warning for ADULTS– do not give to pregnant women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Category D Pregnancy Drugs

A

-Positive evidence of human fetal
risk through controlled/observational studies in pregnant women
-Benefits MAY justify risks
-Examples—ETOH, phenytoin,
warfarin, reserpine, Levophed, thiazides, lithium, tetracycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Category X Pregnancy Drugs

A

-Well controlled or observational
studies in animals or pregnant
women demonstrated fetal
abnormalities
-Use of Product Contraindicated
-Fetal risk outweighs benefits
-Examples—estrogen, progestins,
misoprostol, warfarin, statins, Accutane, ACE’s, Thalidomide,
Cocaine, Anticancer drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Herbs that are likely to be SAFE during pregnancy

A

-Red Raspberry Leaf,
-Peppermint Leaf
-Ginger root
-Slippery Elm Bark,
-Psyllium
-Garlic
-Capsicum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

General Drug Rules in the Pregnant Patient

A

-Few drugs a possible
-Only if clear need
-Delay until after first trimester
-Smallest dose for shortest time
-Monitor mother & fetus
-Avoid combination medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drugs for common ailments that can be used during pregnancy

A

-Headache –Acetaminophen
-Urinary tract infection—PCN or a
Cephalosporin
-Hypertension—Labetalol, Nifedipine
-Gastric problems—Calcium antacids, H2 antagonists
-Nausea—B6, meclizine,
diphenhydramine, metoclopramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lactation Considerations

A

-All drugs to some degree enter breast milk
-Lipid soluble most readily concentrate in the breast milk
(milk fat 3-5% of total milk volume)
-LMW more easily than HMW pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Drugs Contraindicated While Breastfeeding

A

-Amphetamines
-Cocaine, heroin, and marijuana
-Anticancer drugs
-Nicotine
-Lithium
-Methotrexate
-Ergotamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ways to Minimize Infant Exposure to drugs

A

-Avoid sustained-release or long acting drugs
-Schedule drug so least amount possible gets into milk
-Take drug immediately after
breastfeeding
-Choose a drug that produces lowest
levels of drug in milk
-Watch for signs of drug reaction in infant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Commonly Prescribed
During Breastfeeding

A

-Allergic Rhinitis: Beclomethasone; Fluticasone
-HTN: HCTZ; Metoprolol
-MDD: Zoloft; Paxil
-DM: Insulin; Glyburide; Glipizide
-Epilepsy: Dilantin; Tegretol
-Pain: Ibuprofen; Tylenol; Codeine
-Asthma: Cromolyn; Singular
-Contraception: Barrier or progestin only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Physiologic factors to consider in babies/ children

A

-Neonates: increased gastric Ph, decrease bile production, immature circulation, little muscle tissue
-Infants: increased gastric emptying time, little muscle tissue
-Children: Increased GI motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Considering the Physical factors in young children

A

-TBW greater in infants & small child (70-80%)
-Less body fat (5-12%)
-Protein binding is ↓
-Serum albumin lower
-Immature blood brain barrier
-Lower BP affects blood flow to tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Considering the Physical
Factors in young children: Metabolism and elimination

A

Metabolism:
-Immature liver/ Lack or ↓ activity of liver enzymes (metabolism of drugs is
low until age 1 year)
-Half life prolonged in younger kids
-Half life in older child can be shorter
due to ↑ metabolic rate (higher doses may be needed to off set ↑ in rate)
-Temp regulatory mechanism
unstable & fluctuates
-Faster resting respiratory rate

Elimination:
-Drug elimination ↓ until 1
-GFR 30-40% of adult rate
-Decreased drug excretion = longer half life
-Perfusion of kidneys often low
-Antibiotics & analgesics excreted slowly
-Decreased Ability to concentrate
urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Considering the Physical
Factors for young children overview
(Must consider age, weight and surface area)

A

-When considering drug use—the following age groups should be used:
-Neonates—birth to one month
-Infants—1 month to 2 years
-Children—2 years to 12 years
-Adolescents—12 years to 18 years
-Check weight of the pediatric patient
-Confirm whether the weight is appropriate for the age
-If there is any difference in the weight relative to the age—find out about underlying disease states—
CP [under weight as a baby]
-Check if there is a need to calculate the dose based on BSA
-Weight of baby should be rechecked at each visit before prescribing

24
Q

Developmental difference and changes in children to consider

A

-Larger body surface area
-Metabolic rate twice high as adults
-25 % infants weight is muscle mass
-Peripheral circulation less developed
-Heart rate more rapid
-Increased gastric pH
-Immature hepatic enzyme capacities
-Reduced albumin concentration
-Unstable glucose concentrations
-Unable to concentrate bilirubin
-Ineffective renal concentration before 12-18 months
-BBB not mature > 2 years
-Immature immune system
-Smaller body size (height and weight)
-Body Surface Area (BSA)
-Greater body fluid than adults

25
Q

Selecting the Appropriate Pediatric
Dose

A

Pediatric Prescribing Guidelines:

-Check if there is any underlying other diseases before prescribing a drug for presenting symptoms
-Is important to know the presence of underlying disease that may influence pharmacokinetics of a drug that the NP is going to give for the presenting disease symptoms
-Children are not mini-adults
-Ped doses should be obtained from a pediatric dosage reference text—NOT extrapolated from adult dose
-Prescribed regimens should be tailored to the child’s daily routine
-Where possible, treatment goals should be set up in collab with child

26
Q

Guidelines for correct prescription of pediatric meds

A

-While mentioning the dose in the
prescription, always put a zero in front of the decimal points e.g. 0.5g (better to write 500mg) and never omit a zero before the decimal point
-Do not prescribe liquids in mL unless
indicated in your drug reference
-If prescribing in mL, specify the concentration
-Always rewrite a prescription when
dose or timing altered

27
Q

Calculations of pediatric doses

A

-Clark’s formula—
Dose = weight in pounds
[divided by 150] X Average adult dose
-Fried’s formula—
Dose = Age in months
[divided by 150] X Average adult dose
-Young’s formula—
Dose = Age in years
[divided by age + 12] X Average adult dose
-NOTE* with overweight children calculate based on ideal body weight*

28
Q

BSA Calculations

A

-Body surface area estimates are more accurate for calculation of pediatric doses than body weight since many physiological phenomena correlate better to body surface area
-Body surface area may be calculated
from height and weight by means of a nomogram or using Body surface area (BSA) calculator

-The formula used for pediatric patients based on the weight Body surface area (BSA) (m 2 ):
√Ht in cm X Wt. in kilogram [divided by 3600]
-Pediatric dose calculation based on body surface area: Pediatric dose = B SA of the child X Adult dose [divided by 1.73]

29
Q

Routes of admin for kids

A

-If rectal, specify “pediatric suppository”
-Topical—increased absorption d/t proportionately larger skin surface area—increased more if skin is inflamed
-Parenteral–IV preferred for neonates

30
Q

Adverse reactions that are unique to pediatrics

A

-ASA (Reye’s Syndrome)
-Chloramphenicol (Gray baby syndrome)
-Oral Glucocorticoids (prednisone) (can affect growth/development)
-Fluoroquinolones (Ciprofloxacin) (Poss tendon rupture)
-Tetracyclines (discolor teeth)

31
Q

Aging and drug absorption

A

-Amount absorbed [bioavailability] isn’t changed, but absorption may be slowed
-Peak serum concentrations may be lower and delayed

  • Exceptions—
    drugs with extensive first-pass
    effect—bioavailability may increase and serum concentrations may be higher because less drug is extracted by the liver, which is smaller with reduced blood flow
32
Q

Factors that affect drug absorption

A

-Route of administration
-What is taken with the drug
-Comorbid illnesses
-Divalent cations [Ca++, Mg+, Fe+] can affect absorption of fluoroquinolones
-Enteral feedings interfere with absorption of some drugs [e.g., phenytoin, levothyroxine]
-Increased gastric pH may increase or decrease absorption of some drugs
-Drugs that affect GI motility can affect absorption

33
Q

Effects of Aging on Volume
of Distribution (vd)

A

-Age-associated changes in body comp can alter drug distribution
-Lower body water → lower Vd for hydrophilic drugs [Ethanol, lithium]
-Lower lean body mass → lower Vd for drugs that bind to muscle [Digoxin]
-Higher fat stores → higher Vd for lipophilic drugs [Diazepam,trazodone]
* Lower [albumin] → higher percent of drug that is unbound [active]

34
Q

Drug Metabolism

A

-Liver is the most common site of drug metabolism
-Metabolic clearance of a drug by the liver may be reduced because:
-Aging decreases liver blood flow, size and mass
-Drug clearance is reduced for drugs subject to phase I pathways

35
Q

Why the metabolic pathway matters

A

-Phase I pathways:
convert drugs to metabolites with <, =, or > pharmacologic effect than parent compound

-Phase II pathways:
convert drugs to inactive
metabolites that do not accumulate (with few exceptions, drugs metabolized by phase II pathways
are preferred for older patients as they’re less likely to build up)

36
Q

Cytochrome P-450 Family:
CYP3A4 and CYP2D6

A

CYP3A4 is involved in more than 50% of drugs on the market

  • CYP3A4 is:
    ➢ Induced by rifampin, phenytoin, and carbamazepine
    ➢ Inhibited by macrolide antibiotics, nefazodone, itraconazole,
    ketoconazole, and grapefruit juice

CYP2D6 is involved in the metabolism of 25%- 30% of marketed medications–minimal age-related changes
* CYP2D6 is involved in metabolism of many psychotropic drugs, and can be inhibited by many agents
* Some people are poor metabolizers

37
Q

Why is kidney function critical for drug elimination?

A

-Most drugs exit the body via kidney
-Reduced elimination → drug accumulation and toxicity
-Aging and common geriatric disorders can impair kidney function

38
Q

What are the effects of aging on the kidney?

A

-Decreased kidney size
-Decreased renal blood flow
-Decreased number of functioning nephrons
-Decreased renal tubular secretion
Result—decreased kidney function

39
Q

Why does Serum Creatinine not Reflect Creatinine Clearance?

A

-Decreased lean body mass → lower creatinine production and GFR

Result: In older people, serum creatinine stays in normal range, masking change in creatinine
clearance (CrCl)

40
Q

What are the 2 ways to measure creatinine clearance?

A
  1. Measure
    * Time-consuming
    * Requires 24° urine collection
  2. Estimate
    * Usually done with the Cockroft-Gault equation :

(weight in kg)(140 – age)
______________________x (0.85 if female)
(72) (stable serum creat in mg/dL)

41
Q

BEERS CRITERIA

A

-Intend to improve drug selection and reduce exposure to inappropriate medications in older adults
-Recommendations are evidence-based and in 5 categories:

➢ Drugs to avoid
➢ Drugs to avoid in patients with specific diseases or syndromes
➢ Drugs to use with caution
➢ Selected drugs whose dose should be adjusted based on kidney
function
➢ Selected drug-drug interactions

42
Q

RISK FACTORS FOR ADEs

A

-6 or more chronic conditions
-12 or more doses of drugs/day
-9 or more medications
-Prior adverse drug event
-Low body weight or low BMI
-Age 85 or older
-Estimated CrCl < 50 mL/min

43
Q

Most common drug types that cause ADE’s

A

-Cardiovascular drugs, diuretics, NSAIDs, hypoglycemics, and anticoagulants
- ≥95% of ADE’s are considered
predictable

44
Q

What is an ADE prescribing cascade?

A

-When there is an adverse drug effect from a medication that is misinterpreted as a new medical condition and thus another med gets prescribed to treat that
-Ex: Reglan-caused parkinsonism, Levadopa gets added additionally

45
Q

What are the most common effects of drug-drug interactions?

A

-Neuropsychologic (delirium)
-Arterial hypotension
-Acute kidney failure

46
Q

Adverse Drug Interactions that Increase the Risk of Harm Part 1

A
  1. ACE inhibitor + potassium-sparing
    diuretic = Risk Hyperkalemia
  2. Anticholinergic + anticholinergic= risk for Cognitive decline
  3. Calcium channel blockers +
    erythromycin or clarithromycin= risk for Hypotension and shock
  4. Concurrent use of ≥3 CNS active
    drugs= risk for Falls and fractures
  5. Digoxin + erythromycin,
    clarithromycin, or azithromycin= risk for Digoxin toxicity
  6. Lithium + loop diuretics or ACE
    inhibitor = risk for Lithium toxicity
47
Q

Adverse Drug Interactions that Increase the Risk of Harm Part 2

A
  1. Peripheral alpha1 blockers + loop
    diuretics= risk of Urinary incontinence in women
  2. Phenytoin + SMX/TMP = risk for Phenytoin toxicity
  3. Sulfonylureas + SMX/TMP,
    ciprofloxacin, levofloxacin,
    erythromycin, clarithromycin,
    azithromycin, and cephalexin= risk for Hypoglycemia
  4. Tamoxifen + paroxetine (other
    CYP2D6 inhibitors) risk for
    Prevention of converting
    tamoxifen to its active
    moiety, resulting in increased breast cancer related deaths
48
Q

Adverse Drug Interactions that Increase the Risk of Harm Part 3

A

1.Theophylline + ciprofloxacin= Theophylline toxicity risk
2.Trimethoprim (alone or as
SMX/TMP) + ACE inhibitor or ARB or
spironolactone =Hyperkalemia risk
3. Warfarin + SMX/TMP, ciprofloxacin,
levofloxacin, gatifloxacin, fluconazole, amoxicillin cephalexin, and amiodarone= Bleeding risk
4. Warfarin + NSAIDs= GI bleeding risk

49
Q

Original Beers criteria

A

(1991) Evaluate inappropriate Rx used in NH residents in “common” situations, but under “certain circumstances” might be appropriate (e.g., using amitriptyline to treat pt with both Parkinson’s disease and depression)
-Clinical research on use of Potentially Inappropriate medications (PIMs)

50
Q

Beers grading criteria

A

-Strong (Benefits clearly outweigh harms, adverse events, and risks
– or – harms, adverse events, and risks clearly outweigh benefit)
-Weak (Benefits balanced with harms, adverse events, and risks.)
-Insufficient (Evidence inadequate to determine net harms, adverse events, and risks.)

51
Q

What is not included in Beers?

A

-Drugs with risks not unique to elderly
-PIMs specific to elderly
-Drugs used with patients in the
hospice and palliative care setting

52
Q

What are the main drugs you should question for the elderly per Beers?

A
  1. Anticholinergics
  2. Benzos
  3. Sedatives
  4. NSAIDS
  5. PPI’s
  6. Anti-Psychotics
  7. Sulfonylureas
  8. Muscle relaxants
  9. Dig
  10. Sliding Scale insulin
  11. Estrogens
    -NOTE * SHE STATES DONT EVER GIVE MEGACE TO ELDERLY (THROMBOTIC EVENTS)
53
Q

What are the main drug/disease syndrome complications in the elderly per Beers?

A
  1. Syncope (ACE/a-blockers)
  2. Insomnia (oral decongestant)
54
Q

What are the drugs to be used with caution associated with per Beers?

A

-Dabigatran (bleeding)
-Drugs linked to SIADH/ hyponatremia (SSRI/TCA/ anti-psychotics)

55
Q

Key Principles on
How To Use the Beers Criteria

A

-Meds in the Beers Criteria are potentially inappropriate, not definitely inappropriate.
-Read the rationale and recs
statements for each criterion.
-Understand why medications are included in the Beers Criteria, and adjust your approach to those
medications accordingly
-Optimal application of the Beers Criteria involves identifying potentially inappropriate meds,
and where appropriate offering safer nonpharm and pharm therapies.
-Should be a starting point
for a comprehensive process of identifying/ improving medication appropriateness and safety
-Access to meds in the Beers Criteria should not be excessively restricted by prior authorization and/or health plan coverage policies.
-The Beers Criteria are not equally applicable to all countries.

Pharm (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions