Special Population Considerations Flashcards
1
Q
over the last several decades, 1st trimester use of perscription medications increased over ___%
A
60%
2
Q
in general, medications should be ____ during pregnancy
A
avoided
3
Q
when to use medication during pregnancy (1)
A
when necessary
4
Q
what percent of birth defects may be a result of a medication
A
2-3%
5
Q
pregnant women are what is considered a ____ _____ in medicine
A
vulnerable population
6
Q
most medications are not ____ for pregnancy
A
tested
7
Q
the placental barrier is a ______ membrane
A
semi-permeable
8
Q
the placental barrier (2)
A
- site of metabolism for some drugs
- has protective effect on fetus
9
Q
drugs that have crossed the placenta enter the fetal umbilical cord via the _____
A
umbilical vein
10
Q
40-60% umbilical venous flow goes to ___ ____
A
fetal liver
11
Q
by entering the fetal liver prior, this allows for _____ ______ before entering fetal circulation
A
partial metabolism
12
Q
factors affecting placental drug transfer (5)
A
- stage of placental/fetal development
- physiochemical properties of drug
- rate at which drug crosses placenta
- duration of exposure to drug
- distribution characteristics
13
Q
what type of drugs tend to readily diffuse across the placenta and enter fetal circulation?
A
lipophilic
14
Q
drug passage is dependent on (2)
A
- lipid solubility
- degree of ionization
15
Q
drugs of what size easily cross the placenta
A
250-500MW
16
Q
drugs of what size cross the placenta with difficulty
A
500-1000
17
Q
drugs of what size are restricted from crossing the placecnta
A
> 1000
18
Q
certain transporters pump drugs back into maternal circulation and others are upregulated
A
drug transporters
19
Q
what might affect the rate of transfer and amount transferred
A
protein binding
20
Q
in some cases, like when using corticosteriods to simtulate fetal lung matuation the (fetus/mom) is the target of drug therapy
A
fetus
21
Q
corticosteroids stimulate
A
fetal lung maturation in expected preterm birth
22
Q
by using corticosteroids it reduces the occurence of ____ _____ _____ _____
A
infant respiratory distress syndrome
23
Q
what is the period of optimal benefit for corticosteroids in preterm fetus’
A
24 hrs after dose, up to 7 days
24
Q
other benefits of corticosteroids in fetus (3)
A
- decrease risk of inter-ventricular hemorrhage (brain bleed)
- decrease risk of systemic infections
- lower neonatal mortality rate
25
what is the most important factor in premature fetus?
lung maturation
26
antenatal steroids are
before birth
27
what do antenatal steroids work on?
type II pneumocytes in alveoli of the lungs
28
what does antenatal steroids do (2)
1. increase maturation
2. increase production of surfactant
29
chronic maternal opioid use can lead to
dependence in the fetus (neonatal abstinence syndrome)
30
associated risks of opioid use during pregnancy (7)
1. preeclampsia
2. increased risk of defects
3. increased risk placental abruption
4. problems with fetal growth
5. miscarriage / stillbirth
6. sudden infant death syndrome
7. maternal cardiac arrest
31
teratogenicity allows you to (2)
1. exert effects at certain stage of fetal development
2. show dose-dependent incidence
32
substance or process resulting in characteristic set of malformations
teratogenic
33
teratogenic mechanisms negative outcomes(4)
1. direct effect on maternal tissues
2. interference with oxygen/nutrients passage through placenta & rapidly metabolizing
3. direct actions on processes of differentiation in developing tissues
4. deficiency of a critical substance (enzyme inhibition)
34
a shit ton of development occurs in the fetus from ____ weeks
1-8ish
35
gestation is divided into four stages, name then
1. blastocyst
2. organogenesis
3. histogenesis and maturation
4. labor and delivery
36
days/weeks for gestation
1. blastocyst
2. organogensis
3. histogenesis and maturation
4. labor and delivery
1. 0-16 days
2. 17-60 days
3. 2nd and 3rd triemester
4. birth (duh)
37
blastocyst (days, what occurs if exposed to teratogen)
0-16
teratogen exposure may result in pregnancy termination
ALL or NONE phenomena
38
organogenesis (days, what occurs if exposed to teratogen)
17-60 days
teratogen exposure during stage can cause gross structural malformation
39
histogenesis (what occurs, what happens if teratogen exposure occurs)
ongoing growth and fetal development
teratogen exposure = effects on growth and development
40
examples of effects of teratogen exposure during histogenesis and maturation (3)
pre-term labor and delivery, IUGR, low birth weight
41
effects of teratogen exposure during labor and delivery stage
behavioral changes
42
Pitocin/fentanyl associated with decreased _____ in ____ ____ _____
suckling in skin to skin contact
43
what was thalidomide perscribed for?
sleep aid and for nausea and vomiting, used for morning sickness in pregnant women
44
when did thalidomide become OTC in Germany?
1957
45
why did they approve thalidomide?
it worked in rats lol
46
what was the adverse effect of thalidomide
phocomelia
47
when was the first case of phocomelia reported?
1961
48
what is phocomelia?
congenital absence or underdevelopment of extremities. affecyed >10,000 children, ~50% survived
49
what is thalidomide used for now?
first line for multiple myeloma
50
when was the USFDA drug classification system established?
1979
51
how many categories in the FDA classification system?
5, ABCDX
52
Classification of:
A
B
C
D
X
A: no risk on human studies
B: no evidence of risk on animal studies
C: risk cannot be ruled out, concerning animal data
D:positive evidence of human fetal risk, can be justified in certain circumstances
X: contraindicated in pregnancy
53
the pregnancy letter category system is overly _____
simplistic
54
how did they fix the pregnancy grading system?
pregnancy and lactation labeling (PLLR)
55
PLLR assisted healthcare providers in what way?
1. assess benefit vs risk
2. changing content/format of information of drug labeling
56
updated labeling categories (3)
1. Pregnancy
2. Lactation
3. Females and Males of Reproductive potential
57
meds pass through the breast milk via _____ _____
passive diffusion
58
factors affecting distribution of breastfeeding/lactation and drug therapy
1. breast milk is more acidic than plasma
2. weakly acidic drugs less likely to pass through membrane
3. meds that are high protein bound, low lipid solubility, or large molecular weight do not enter breastmilk
59
drugs that are prescribed directly to ____ are usually safe
infants
60
doses transferred via breastmilk are ____ than therapeutic doses
much lower
61
breastfed infants are generally not affected by medications with poor _____ bioavailability
oral (like insulin or heparin)
62
to avoid interactions while breastfeeding, breastfeeding _____ to medication administration is good
PRIOR
63
the greatest exposure to drug therapy during breastfeeding occurs within the ____ _____ ____ after med admin
first few hours
64
drugs with longer half lives are more likely to maintain _____ levels in breastmilk
higher
65
how much of the medication dose transfers to infant while breastfeeding?
1-2%
66
what medications decrease breast milk volume
1. dopamine agonists (bromocriptine)
2. decongestants (Zyrtec, Claritin, Allegra)
3. estrogens (contraceptives)
67
bromocriptine is assosiated with maternal
death (from MI)
68
what is lactmed
online website to see how medicines interact with infant through breastmilk
69
what is the definition of a premature neonate (age)
<37 weeks
70
full term neonate
37-42 weeks
71
postnatal age
< 28 days
72
infant age
28-1 year
73
pediatric child age
1-12 years
74
pediatric adolescent age
13-17 years
75
pediatric absorption factors to think about (3)
1. blood flow at site of admin
2. Skin thickness/hydration
3. Gastric acid production
76
blood flow at site of administration
1. reduced muscle mass
2. diminished peripheral perfusion
(can result in erratic absorption)
77
skin thickness and hydration
enhanced absorption with topical products
78
gastric acid production
reduced in infants, increased pH in stomach (more basic)
79
when do infants achieve adult gastric acid values
3 years
80
when do preterm infants produce gastric acid
32 weeks
81
what type of absorption is affected by gastric acid production
oral
82
distribution factors in neonate (3)
1. higher percent of body weight in form of water
2. extracellular water is increased
3. total body fat is greater in full term vs preterm
83
water soluble drugs will have an _____ volume of distribution in neonates
increased
84
adjust dose based on patients
weight
85
in lipophilic drugs adipose tissue acts as a _____ _____
drug reservoir
86
if a preterm infant has a lower body fat there will be
increased risk for high serum concentration
87
is protein binding increased or decreased in neonates and infants?
reduced
88
a decreased amount of bound drug in infants and neonates means that there will be an _____ amount of free drug
increased
89
drugs given to neonates with jaundice displaces ______ from _______
bilirubin from albumin
90
bilirubin entering the brain =
kernicterus
91
is the liver mature at infant birth?
no
92
why do we have a dosage schedule for children, aka not dosing children like "mini adults"
their livers are not fully developed - that would be bad
93
if we dosed children like mini adults what would happen?
increased risk of drug toxicity
94
what other major organ is immature at birth?
kidney
95
how is the kidney immature at birth?
anatomically, functionally, nephrogenesis occurs til 35 weeks gestation
96
Glomerular filtration rate in newborns important to knows (4)
1. much lower in newborns than infants/children
2. even lower in neonates before 34 wks gestation
3. functional improves within 1st week of life
4. drug dependent on renal function cleared SLOW in first weeks of life
97
how does pediatric dosing work?
mg/kg or mg/m2
98
when calculating a pediatric dose you DO NOT
exceed adult doses
99
is there a standard dose for kids?
NO, calculated by body or surface area
100
what are the types of pediatric oral liquids?
1. Elixers
2. suspension
101
difference between an elixir and a suspension
elixer contains alcohol to help dissolve better. Suspension has undissolved particles... you gotta shake!!
102
common volumes for oral liquids in pediatric doses
teaspoon = 5 mL
tablespoon = 15 mL
103
what are 4 compliance considerations to tell parents when giving a child an oral medication
1. use calibrated medication syringe - not a spoon lol
2. choose a convenient dose forms and make a schedule
3. educate when to re dose
4. make sure they FINISH the antibiotic (if thats what theyre taking)
104
does the functional capacity of organ systems decline as get older? if so what age do you think it starts?
yes, 45
105
geriatric patients do not LOSE functions at an accelerated rate they ACCUMULATE more _______
deficiencies
106
absorption in geratric patients is altered due to (3 things)
1. altered nutrition habits
2. increased consumption of OTC meds
3. slower gastric emptying
107
the altered absorption factors in geriatric patients are altered mainly due to
increased gastric pH
108
distribution of medication in geriatric patients affected due to (a million things, name a few lol)
1. decreased lean body mass
2. decreased total and percentage body water
3. increased percent body fat
4. reduced concentration of serum albumin
5. decreased blood flow
6. decreased liver function --> 7. decreased metabolism
109
metabolism of meds in geriatric patients is affected by
1. capacity of liver does not consistently decline with age for all drugs
2. greatest change in PHASE 1 REACTIONS - conjugation less affected
3. decreased blood flow to liver and regeneration
110
excretion of meds in geriatric patients is affected by
1. age-related decline in renal function
2. prolongation of half-life in drugs = accumulation
111
are elderly at risk to experience an adverse drug reaction, if so why?
yes, they take a shit ton of drugs and dont know what half of them do, mix and match is fun in pill form!
112
what are some potential explanations to adverse drug reactions? (other than fun pill mix and match)
1. poly-pharmacy
2. error in prescription
3. error in drug use (noncompliance, cost, forgetfulness, etc)
4. OTC meds
113
prescribing cascade =
when you get a side effect to a med, and you fix it with a new med. then your new med causes a side effect so you get a med for the med that you were using to fix the side effect of the first med. works sometimes - not often lol there are better ways to avoid this problem.
114
tips for managing polypharmacy (5)
1. keep an accurate updated list
2. inform doc of any supplements you start
3. understand why you take the medication
4. simplify meds, discontinue ones you don't need
5. take ALL AS PRESCRIBED
115
promoting adherence in drug therapy in geriatric patients
1. clearly label, easy open containers
2. daily reminders
3. ensure a support system is in place
4. frequently monitor patients
