Module 1 special populations

Question 1

pregnancy

Answer 1

research is lacking
medications cross placenta
trimester matters
teratogenic effects 
benefit/risk

Question 2

pediatrics

Answer 2

meds can impact long-term growth and development
weight based dosing
route-based decision making

Question 3

common problems in geriatric patients

Answer 3

immobility
isolation
impaired senses
inadequate nutrition 
immunodeficiency 
instability

Question 4

geriatrics and absorption

Answer 4

• slower gastric emptying and dec. gastric acid -> variable absorption
• dec. blood flow to muscles and subQ fat -> unpredictable absorption of IM and subQ meds

Question 5

geriatrics and distribution

Answer 5

• inc. risk dehydration
• dec. albumin production -> dec. protein binding -> inc. Vd
• lower body water -> dec. Vd for hydrophilic drugs
• inc. body fat and dec. muscle -> larger Vd for lipophilic drugs
• half-life and loading doses change

Question 6

geriatrics and metabolism

Answer 6

liver function dec.
inc. potential for drug interactions
co-morbid diseases
poor nutrition

Question 7

excretion and geriatrics

Answer 7

dec. renal function

need to calculate creatinine clearance or GFR when dosing drugs

Question 8

pharmacodynamic changes in geriatrics

Answer 8

changes in receptor binding affinity, up-regulation, or down regulation

• dec. CO and vascular changes
• exaggerated hypotension is common
• inc. risk bradycardia or tachyarrhythmias

Question 9

obesity and pharmacokinetics

Answer 9

inc. lipophilic Vd

drug doses off of ideal body weight, not total body weight

Question 10

classification of BMI

Answer 10

underweight: <18.5
normal weight: 18.5-24.9
overweight: 25.9-29.9
obesity 1: 30.0-34.9
obesity 2: 35.0-39.9
obesity 3: >40

Question 11

obesity and hydrophilic drugs

Answer 11

will distribute to the muscle compartment

- if loading dose needed, use lean body mass

Question 12

obesity and lipophilic drugs

Answer 12

will distribute to fat
have larger Vd in obese patients
loading doses should be dosed by ideal body weight

Question 13

drug toxicity and on-target effects

Answer 13

drug binds to intended receptor but in the wrong tissue or at an inappropriate concentration

Question 14

drug toxicity and off-target effect

Answer 14

drug binds to wrong receptors

Question 15

idiosyncratic toxicity

Answer 15

rare event with no obvious mechansim

Question 16

harmful immune response

Answer 16

hypersensitivity reaction

Question 17

toxic metabolites

Answer 17

drug metabolism can produce active metabolites that have harmful effects