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Pharmacology 2 > Special Populations > Flashcards

Special Populations Flashcards

1
Q

what occurs to phenytoin as it relates to pregnancy?

A

spike of phenytoin right after birth

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2
Q

what 5 anatomical and functional changes are increased in pregnancy?

A

body weight
fat mass
body water
plasma volume
RBC volume

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3
Q

what 3 anatomical and functional changes are decreased in pregnancy?

A

hematocrit
albumin
alpha-1 acid glycoprotein (AAG)

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4
Q

what 6 physiological changes are increased in pregnancy?

A

cardiac output
GFR
renal blood flow
creatinine clearance
uterine blood flow
hepatic blood flow

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5
Q

what 3 physiological changes are decreased in pregnancy?

A

gastric emptying
intestinal motility
acid secretion

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6
Q

why is there a decrease in plasma drug concentration in pregnancy?

A

increased space and fluid

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7
Q

which hormone in pregnant women is an enzyme inducer, and can then affect drug concentration clearance?

A

progesterone

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8
Q

which hormone in pregnant women is an enzyme inhibitor, and can then affect drug concentration clearance?

A

estrogen

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9
Q

what change in pregnancy leads to a prolonged onset of pharmacological effect?

A

decreased intestinal motility

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10
Q

what can occur during the first trimester of pregnancy due to N/V?

A

constipation from Al antacids and iron

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11
Q

what causes a pregnant patient to have a faster uptake of anesthetics?

A

increased cardiac output = hyperventilation = increased alveolar uptake

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12
Q

what causes a pregnant patient to have a decrease in absorption of drugs in the lower extremities?

A

decreased blood flow to lower extremities in late pregnancy

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13
Q

what causes a pregnant patient to have an increased transdermal absorption of drugs?

A

increased peripheral vasodilation

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14
Q

what protein is present in the placenta that helps pump out drugs from the placenta?

A

P glycoprotein

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15
Q

how is it possible that a fetus can be exposed to a drug the mother is taking?

A

placenta has drug metabolizing enzymes

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16
Q

what 2 factors in drugs allow it to cross the placenta?

A

lipid solubility
ionization

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17
Q

why do weak bases get trapped in fetal circulation?

A

fetal pH is lower (more acidic) than maternal pH

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18
Q

which 4 drugs are at risk for becoming trapped in fetal circulation?

A

meperidine
propranolol
lidocaine
morphine

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19
Q

the fetus has some physiological changes that cause them to be unable to take drugs that have too much protein binding. what is it? (2)

A

fetus has decreased albumin
fetus has decreased alpha-1 acid glycoprotein (transporter)

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20
Q

why do drugs tend to go directly to the placenta?

A

increased cardiac output = increased blood flow to uterus

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21
Q

what pumps drugs back into maternal circulation?

A

placental PgP

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22
Q

during which weeks of gestation are congenital malformations (teratogenesis) at greatest risk?

A

week 3-11

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23
Q

which 10 drugs are CI in pregnancy?

A

ACEI
ARBs
ARNI
statins
warfarin
barbiturates
carbamazepine
phenytoin
valproic acid
tetracycline

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24
Q

drug that was initially used as a sedative, anticonvulsant, and managing morning sickness but is a teratogen? what genetic defect?

A

thalidomide
phocomelia

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25
Q

most human teratogens are also true for _____, BUT reverse is not true

A

animals

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26
Q

labeling for pregnancy, labor and delivery

A

8.1

27
Q

labeling for lactation, including nursing mothers

A

8.2

28
Q

labeling for females and males of reproductive potential

A

8.3

29
Q

during what trimester is the fetus most sensitive?

A

first trimester

30
Q

what is the rule for dosing in pregnant women? (2)

A

use smallest dose
change dose only when changes have implications

31
Q

what drugs are used and considered “fetal therapeutics”? (2)

A

HIV rx
digoxin (fetal tachyarrhythmias)

32
Q

first 4 weeks (less than 31 days old)

A

neonate

33
Q

how many weeks is considered premature?

A

< 36 week gestation

34
Q

1-12 months

A

infant

35
Q

1-12 years old

A

children

36
Q

12-18 years old

A

adolescent

37
Q

65 and older

A

elderly

38
Q

how are drugs transferred to breast milk?

A

passive diffusion

39
Q

what kind of drugs are easily transferred to breast milk? (3)

A

unionized molecules
unbound
lipid-soluble

40
Q

avoid taking drugs, if possible, for at least _____ hours before feeding

A

4

41
Q

which PK diameter do we think about when feeding an infant right before a dose?

A

half-life

42
Q

which 3 drugs have metabolites, which will be present in mother for a longer time?

A

norfluoxetine (300 hours)
normeperidine (90 hours)
morphine-6G

43
Q

how is absorption affected in babies? (2)

A

delayed gastric emptying (PN, N)
increased gastric pH (alkaline)

44
Q

which 2 ages have delayed gastric emptying?

A

premature neonate
neonate

45
Q

which 3 ages have increased gastric pH, making it an alkaline environment?

A

premature neonate
neonate
infant

46
Q

what kind of drugs will have an increase in absorption in premature neonates, neonates, and infants? name them

A

acid-labile drugs

penicillin G
penicillin V

47
Q

when is percutaneous absorption of drugs increased?

A

inflamed skin
occlusive dressing

48
Q

as we move from premature to adult, we lose _____ and start to develop _____

A

fluid
fat

49
Q

water-soluble drugs in babies have a _____ volume of distribution

A

larger

50
Q

volume of distribution in water-soluble drugs ______ with maturation

A

decreases

51
Q

lipid-soluble drugs in babies have a _____ volume of distribution

A

smaller

52
Q

volume of distribution in lipid-soluble drugs _____ with maturation

A

increases

53
Q

which water-soluble drug has a decreased volume of distribution with age?

A

gentamicin

54
Q

which 2 lipid-soluble drugs have an increased volume of distribution with age?

A

midazolam
diazepam

55
Q

what 4 levels are decreased in newborns compared to adults?

A

total protein
albumin
alpha-1 acid glycoprotein
globulin

56
Q

what 2 levels are decreased in infants compared to adults?

A

total protein
globulin

57
Q

what kind of drugs will have a low volume of distribution in newborns?

A

highly protein bound

58
Q

at what age do premature neonates and neonates have similar gastric emptying as adults?

A

6-8 months

59
Q

at what age do neonates and infants have similar maturity of enzymes as adults?

A

6 months

60
Q

why do children have a rapid metabolism of drugs when compared to adults?

A

liver in children during first 2 years is large in relation to their body size

61
Q

what is pediatric dosing based on? (2)

A

weight
body surface area

62
Q

what are the 2 calculations for child dosing?

A

Clark’s rule: (child weight/adult weight) x adult dose
Young’s rule > 2 yrs old: (age/age + 12) x adult dose

63
Q

in an infant, when is GFR the lowest?

A

first 30 days of life

64
Q

why is serum creatinine difficult to use as indicator of renal function in infants?

A

renal function may be worse than serum creatinine since muscle mass is low in infants

Pharmacology 2 (22 decks)

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