Safe Administration of Drugs throughout the Life Cycle Flashcards
RNUR/PNUR 1030
What are the 4 phases of lifespan changes that have dramatic pharmacokinetic changes?
Pregnancy
Newborn
Pediatric
Older Adult
Drugs cross the placenta by
diffusion
What are factors affecting safety with drug therapy during pregnancy?
Drug Properties (chemistry, dosage, concurrently administered drugs)
Fetal gestational age
Maternal Factors
In the first trimester, the fetus is at the greatest risk for
drug-induced developmental defects
In the first trimester, what is developing at their most rapid rate?
Skeleton, muscle, limbs, and visceral organs
What should you NOT do during drug therapy in your first trimester of pregnancy?
Self treatment of illness
In the third trimester of pregnancy, what is a concern during drug therapy?
The greatest percentage of maternally absorbed drug gets to the fetus
Any change in the mom’s physiology can
affect the amount of drug to which the fetus may be exposed to.
Example: Changes in liver and kidney functions
The FDA does not have safety categories. INSTEAD, drug manufactures must
identify specific risks in PREGNANCY and BREASTFEEDING.
What are the three subsections in the prescribing phase for pregnancy labeling information?
Pregnancy
Lactation
Female and Males of reproductive potential
Breastfed infants are at risk for
exposure to drugs consumed by the mother
Drug levels in breast milk are usually
lower than those in the maternal circulation
What should you consider regarding drug therapy while breastfeeding?
Risk-to-benefit ratio
Infants and children generally require
lower doses than adults. (Duh, they are smaller)
Pediatric patients handle drugs much differently because
of the immaturity of their vital organs.
What category is between BIRTH and 1 MONTH of age?
Neonate
What category is between 1 MONTH and 12 MONTHS of age?
Infant
What category is between 1 and 12 YEARS of age?
Child
In pediatrics, altered maturity of organs can
affect drug dosage
In pediatrics, Tetracycline may
permanently discolor teeth
In pediatrics, system steroids may
suppress growth
(think of smol peepee)
In pediatrics, Gastric pH is less acidic until
1 to 2 years of age
In pediatrics, Gastric emptying slowed can affect
absorption in neonate and pediatric patients
In pediatrics, What route of drug administration is faster and irregular?
Intramuscular
In pediatrics, Greater total body water means
lower fat content
(when talking about dosing lower because of distribution)
What alters metabolism and excretion of drugs in pediatrics?
Immature liver and kidneys
In pediatrics, what causes more drugs to enter the brain which then alters metabolism and excretion?
Immature blood brain barrier
Factors Affecting Pediatric Drug Dosages:
Skin is
thin and permeable
Factors Affecting Pediatric Drug Dosages:
Stomach
lacks acid to kill bacteria
Factors Affecting Pediatric Drug Dosages:
Body temperatures
less well regulated and dehydration occurs easily
Factors Affecting Pediatric Drug Dosages:
Liver and kidneys are
immature, impairing drug metabolism and excretion
In pediatrics: ALWAYS CONSIDER
organ maturity
What are 4 methods of dosage calculations in pediatric patients?
Body surface area method
Always use weight in KILOGRAMS
Always use CENTIMETERS
Body weight dosage calculations
What is the most commonly used body weight dosage calculation in pediatrics?
mg/kg
Example: 30mg/kg, patient weighs 20kg
They would get 600mg
What occurs with advancing age?
Decline an organ function
Drug therapy in OLDER adults is most likely to result in
Adverse effects and toxicity
Who is considered an older adult?
Age 65 years and older
What percentage of older adults is on at least one medication?
87%
What percentage of older adults is on at least five medication’s
36%
With older adults, taking multiple medication’s can
Increase the risk of drug interactions
What is the term used for simultaneous use of multiple medications?
Polypharmacy
What is important to educate the patient or caregiver when dealing with poly pharmacy?
The dangers of multiple drug use
More complicated medication regimens with older adults can
Predispose the patient to self medication errors
Older adults gastric pH is
Less acidic and gastric emptying slowed
In older adults, blood flow to the
G.I. tract reduced and absorptive surface reduced (which results in decreased absorption and distribution)
In older adults, what can affect medication distribution in the body?
Lower total body water percentages and increase fat content.
Older adults, decrease in total body, water leads to
Decrease distribution of some drugs, as antibiotics may lead to risk of toxicity
In older adults, decreased production of proteins by the liver results in
Decreased protein binding of drugs, which increases circulation of free drugs
Older adults, microsomal enzymes are decreased due to
Decrease production by the aging liver
Older adults, liver blood flow is reduced, which decreases
Hepatic metabolism
An older adults, decreased metabolism, leads to
Potential for drug toxicity
In older adults, glomerular filtration is decreased by
40 to 50% (which affects excretion of drugs)
An older adult is difficult for drugs to be excreted due to
Decrease blood flow and number of intact nephrons are decreased
An older adults drugs are cleared less effectively because of
Decreased excretion
What is an important indicator of renal function?
Creatinine clearance
An older adults, if creatinine clearance is abnormal
Drug dosages may need to be adjusted
What are two pediatric considerations for safe medication administration?
Mixing medication’s to disguise, the taste and age-appropriate terminologies for the child
What are five safety considerations with pediatric patients and medications?
Avoid oral aspiration, injury with injections, teach parents about the medication, alert, parents for any side effects, and keep all medication’s out of the reach of children
What are four steps to take if there’s a poisoning in the home?
Poison prevention, education is essential, do not induce vomiting, do not use home activated, charcoal, and if poisoning occurs, call the poison control center or 911
What are older adult considerations for safe administration of medication’s?
Take as directed, do not double up doses, or discontinue without guidance from a prescriber
What did you take into consideration prior to teaching an elderly patient about medication’s?
- Appropriate time – not in pain & not tired
- Prepare the patient before teaching
Glasses
Hearing aid - Private, comfortable & quiet, well-lit environment
- Keep lesson clear & brief
- Allow for questions, feedback & return demo
- Provide handouts to reinforce information
To promote compliance when teaching an elderly patient, you should
Assess knowledge deficit, assess any confusion, concerning drugs, financial concerns, or how they can pay for meds
