Pediatrics, Pregnancy, and Older Adults Flashcards
the production of congenital abnormalities (birth defects) in the fetus
teratogenesis
Genetic factors account for about 25% of all congenital anomalies. Of the genetically based anomalies, _____ is the most common.
Down’s syndrome
Gross malformations are produced by exposure to teratogens during the embryonic period (roughly the ____ trimester)
first
Teratogen exposure during the fetal period (i.e., the second and third trimesters) usually disrupts ______ rather than gross anatomy
function
Why shouldn’t NSAIDs be taken during pregnancy?
NSAIDs may cause premature closure of the ductus arteriosus
To prove that a drug is a ______, three criteria must be met:
*The drug must cause a characteristic set of malformations
*It must act only during a specific window of vulnerability (e.g., weeks 4 through 7 of gestation)
*The incidence of malformations should increase with increasing dosage and duration of exposure
teratogen
In December 2014, the FDA issued the _____ ___ ______ _____ (PLLR) which provided new guidance for labeling. This rule phased out the Pregnancy Risk Categories; however, these Pregnancy Risk Categories continue to be prevalent in the literature (A, B, C, D, X).
The PLLR requires three sections for labeling: (1) pregnancy, (2) lactation, and (3) females and males of reproductive potential.
Pregnancy and Lactation Labeling Rule (PLLR)
The factors that determine entry into breast milk are the same factors that determine passage of drugs across membranes. Accordingly, drugs that are ______ _______ enter breast milk readily, whereas drugs that are ionized, highly polar, or protein bound do not.
lipid soluble
Less than ___% of birth defects are caused by drugs
Less than 1% of birth defects are caused by drugs
What proportion of drugs have not been tested in children?
two-thirds
IV administration in children vs. adults
longer duration in children
IM injection in infants
faster onset than adults
Drug absorption through the skin is more rapid and complete in infants than in older children and adults. The stratum corneum of the infant’s skin is very thin, and blood flow to the skin is greater in infants than in older patients. Because of this enhanced absorption, infants are at an increased risk for toxicity from ____ drugs.
transdermal/topical
How is protein binding different in infants and how does this intensify the effects of drugs?
The binding of drugs to albumin and other plasma proteins is limited in the infant. As result, the concentration of free levels of such drugs is relatively high in the infant.
Protein-binding capacity reaches adult values within 10 to 12 months
Why are infants especially sensitive to drugs that affect CNS function?
The blood-brain barrier is not fully developed
When do the liver and kidneys fully mature?
1 year old
Although pharmacokinetically similar to adults, children do differ in one important way: They metabolize drugs _____ than adults.
faster
For drugs that do not have an established pediatric dosage, the dosage can be extrapolated from adult dosages. The method of conversion used most commonly is based on _________
body surface area (BSA)
In children ____ and older, most pharmacokinetic parameters are similar to those in adults. Hence, drug sensitivity is more like that of adults than the very young
1 year of age
In older adults, the proper index of renal function is _____ _______, not serum creatinine levels.
creatinine clearance
How is absorption, distribution, metabolism and excretion different in older adults?
Metabolism Reduced liver function may prolong drug effects.
Excretion Reduced renal function delays excretion. This is the most important cause of adverse drug reactions in older adults.
Tools that help identify potentially inappropriate drug choices for elderly patients
Beers list
START and STOPP criteria
In 2009, the FDA launched the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) - what is it?
A data bank that has collected data on over a million babies exposed to meds in utero. Project is ongoing as of 2023
What conditions are crucial to treat during pregnancy where medication may be necessary?
Asthma
Epilepsy
Hypothyroidism (inadequate thyroxine is associated with miscarriage and impaired infant IQ)
Diabetes
