Special populations Flashcards
what age range qualifies a person to be “pediatric”
0-18 years old
is treating pediatrics hard? if so why
yes, because 0-18 has such a wide array of body size and functions
what is the challenge in the pediatric populations
to find the correct drug to treat the patient AND identify the dosage forms that are appropriate and convenient for administration, including acceptance by the patient
just because a patient is of geriatric age, will they have geriatric bodies?
no, some people will have the organs of a 45 year old when they are 59
explain the function of your organs as life progresses according to the bell curve
you start off your life and your organs are just starting up, so they are not functioning very well. you reach the middle of your life and you reach the peak functioning of your organs, but as you cross over to the end stages of life your organ function begins to go down again and they slowly start not working as well
are children small adults?
no
what percentage of medications are FDA approved for children use and why is it this number?
20% and it is so low because no one wants to volunteer their children to be tested using various medications that may or may not be safe
what does it mean to be a therapeutic orphan and what patient population is this relevant to?
pediatrics, and it means that they do not have FDA approval for many dosage formulations and are usually left out of the medication guidelines for medications and treatments because they are not FDA approved for use on children
what two considerations must you make for children when it comes to their therapeutic regimen besides pharmacodynamic and pharmacokinetic properties?
is this patient able to use it and is it going to be accepted by the patient? aka can they use it and will they use it?
what is the problem with oral dosage formulations in children and what are some alternative solid dosage formulations?
most children on average can not swallow a tablet until 6 years of age, and even when they can the provider is limited by the formulation that the tablet comes in from the manufacturer. some alternative still solid dosage forms include:
- ODTs
- chewable tablets
- and granules that can be mixed with liquid and drank
what is great about liquid formulations for pediatric patients?
they are easier to swallow and you are also not limited on the dose that comes from the manufacturer. you can dilute it as much as you want to for the child
what are some problems with elixirs and pediatric patients? what are the two bad ingredients they can contain?
they contain ethanol and propylene glycol
what can ethanol do to a child?
they can cause CNS depression, confusion, GI upset
what can propylene glycol cause for children?
hypotension, arrhythmias, and hemolysis
what may happen to the amount of drug that can dissolve in a liquid formulation if you take the alcohol or propylene glycol out of the formulation?
the amount of drug that can dissolve in it will go down because that is what the alcohol was there for
what are other liquid formulation options for children besides elixirs?
solutions, suspensions, and concentrated drops
what are some potential issues with concentrated drops and children? why are they great though?
its easy to give them way too much which can cause a problem in the patient, but they are great for patients who have a very small stomach volume like pediatrics
are there a lot of modified release products for pediatrics?
no
what is bad about suspensions in pediatrics?
they sometimes have a bad taste and the children do not like the gritty texture
what piece of equipment is needed to give parenteral dosage forms to children and why?
syringe pumps, because the amount of drug needed to give to the patient is so small that it has to be diluted to large volumes and then given very slowly, these pumps allow this to be possible
what is intraosseous route? when do we use it and what patient age range can it be used on?
there is a long needle that gets shoved into the center of the bone and the medication is injected there. this is great of emergencies when an IV cannot be started but is only good for patients that are 0-6 years old. it can not be done after that
are transdermal patches okay for pediatric use?
for teenagers yes because their skin has fully matured, but for young patients no because they have a lot better hydration and thinner skin which means more drug is going to get through that normal and that is bad
at what age are you allowed to use nasal drops?
4 yo and younger
at what age are you allowed to use nasal sprays?
4 yo and up
can small patients use DPIs?
no, they do not have the lung power
are suppositories an option for pediatrics?
yes, they are an option for all ages
how old is considered “elderly”? is this threshold absolute?
65 yo and up. no, some people’s bodies are different than their age.
how much of the US population is over 65 yo?
1/10, and it is only getting bigger because people are living longer
how many elderly people are taking prescription medications?
3/4
how much more common are adverse reaction in the elderly?
5 times more likely
what are factors that contribute to the elderly having so many adverse drug reactions?
- polypharmacy
- altered physiological state
- poor adhearance
- increased chance for disease state interactions
what percentage of the elderly have difficulty swallowing?
40%
what is the leading cause of death in patients 65 years or older?
cerebrovascular disease
when you switch a patient from a solid to an oral dosage formulation, what must you consider? what kind of change might have to be made?
if a change in the dosing regimen is needed, especially if they are taking modified release dosage formulations
-smaller more frequent doses
what category of old patients are orally disintegrating tablets used for?
patients suffering from dysphagia and dimentia
what is the skin like in older patients? what does this mean for transdermal drug delivery?
less hydrated, but thinner. this means that drug delivery could be increased or decreased either one
what happens to our muscle content as we age?
it decreases
what happens to our fat content as we age?
it increases for a little bit and then drops off sharply
what are examples of packaging aids used for geriatrics?
dosing packs like we used to make when i worked at Dale’s
