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Pharm Brainscapes by Cheryl and Phil > Unit 1: Ch 9, 10 and 11 > Flashcards

Unit 1: Ch 9, 10 and 11 Flashcards

1
Q

What happens to excretion during pregnancy?

A

It is increased

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2
Q

What must be done with drugs to compensate for increased excretion?

A

Dosage must be increased due to accelerated excretion.

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3
Q

In what situations is it best for a pregnant woman NOT to avoid drug therapy?

A

When the mother’s illness can do more harm to the fetus than the drugs would. EX: Asthma, Epilepsy, Diabetes.

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4
Q

What happens to metabolism during pregnancy?

A

Hepatic Metabolism Increases

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5
Q

What happens to drugs that get absorbed in the GI tract during pregnancy?

A

Tone and motility of the bowel decrease during pregnancy. Drugs traveling this route move at a slower rate increasing the time the drug is able to be absorbed. A reduction in dosage may be needed.

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6
Q

Describe major structural teratogenesis

A

The most serious defects. 1-3% of babies born with these. May be immediately observable or discovered later if internal. May require surgery.

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7
Q

Describe minor structural teratogenesis

A

Less serious, don’t necessarily require surgery.

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8
Q

Describe functional teratogenesis

A

Everything looks normal, but the organ doesn’t function correctly. (eg, mental retardation)

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9
Q

If a fetus encounters a teratogen in the first couple of weeks after conception what will happen?

A

It is an all or nothing effect – the zygote will either be unharmed or will die.

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10
Q

If a fetus encounters a teratogen in weeks 3-8 what will happen?

A

Major structural changes may be observed. This is the time when the basic shape of internal organs and other structures is being established. May lead to death or require surgical intervention.

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11
Q

If a fetus encounters a teratogen in weeks 9-38 what will happen?

A

Minor structural or functional defects may occur.

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12
Q

Likelihood of malformation due to teratogen: If drug exposure was NOT during the period of organ development (organogenesis: weeks 3-8) how much risk of damage is expected?

A

Minimal

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13
Q

Just because a baby is born with a malformation does that mean there was teratogen exposure?

A

No

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14
Q

Breastfeeding Moms: Relate to mother that ideally, drugs should not be taken while breastfeeding. But if necessary, instruct the mother to:

A

1.Dose immediately after breastfeeding 2.Avoid drugs with long half-life 3.Avoid sustained release drugs 4.Choose drugs that tend to be excluded from milk 5.Choose drugs least likely to affect infant 6.Avoid drugs that are known to be hazardous 7.Use lowest effective dose for shortest possible time

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15
Q

Which pediatric age group is the most sensitive to drugs?

A

Neonates and Infants (the youngest)

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16
Q

Why are neonates and infants the most sensitive age group to drugs?

A

Their organs are immature and may not be prepared to handle medications.

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17
Q

Why, even when we adjust for weight, are many doses still too high for infants?

A

Children are not just short adults, they have different bodies and process drugs differently.

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18
Q

How do infants differ in absorption in terms of oral drugs?

A

Infants have irregular gastric emptying (sometimes really slow, sometimes very accelerated). Infants have changes in gastric pH. When born they are neutral and then become acidic.

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19
Q

How do infants differ in absorption in terms of IM drugs?

A

Neonates: Slow - because poor blood flow in muscles Infants: fast - absorb IM medications quicker than adults

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20
Q

How do infants differ in absorption in terms of transdermal drugs?

A

Infants and Neonates: faster Drugs absorption through the skin is more rapid and complete in infants than adults b/c their stratum corneum of skin is thin, and blood flow to skin is greater. Increased risk of toxicity for topical drugs.

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21
Q

How do infants differ in distribution in terms of protein binding?

A

Distributes easier. Infants have lower levels of albumin which makes protein bound drugs distribute more easily.

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22
Q

How do infants differ in distribution in terms of the BBB?

A

The Blood Brain Barrier will often not permit the movement of drugs. The BBB is not fully developed in infants, so not as strong of a barrier as in adults.

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23
Q

How do infants differ in terms of metabolism?

A

Slower. Drug-metabolizing capacity of newborns is low. Neonates especially sensitive to drugs that are primarily eliminated by hepatic metabolism.

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24
Q

When does a neonates metabolism start to catch up to adults?

A

Capacity of liver to metabolize increases rapidly after about 1 month, and approaches to adult levels a few months later. Complete maturity by 1 year.

25
Q

How do infants differ in terms of excretion?

A

Slower. Renal drug excretion is reduced significantly at birth Renal blood flow, glomerular secretion, and active tubular are secretion all low at infancy.

26
Q

When do infants achieve adult levels of renal function?

A

Adult levels of renal function achieved by 1 year old.

27
Q

What must be done for infants to compensate for the fact that their renal function is reduced?

A

Give reduced dosages for this reason (or at longer dosing intervals).

28
Q

At age 1 how similar is children’s pharmacokinetics to that of an adult?

A

Most pharmacokinetic parameters in children are similar to those of adults.

29
Q

Do CHILDREN (age 1-12) metabolize drugs faster or slower than adults?

A

FASTER

30
Q

How long is children’s metabolic speed elevated before it starts to slowly decline?

A

Until age 2

31
Q

When does a sharp decline of metabolism take place for children?

A

Puberty

32
Q

What should be done dosage-wise because children have such elevated metabolisms?

A

An increase in dosage or reduction in dosing interval may be needed depending on the situation.

33
Q

What is an example of an ADR affecting growth in children? What drugs cause this?

A

Growth suppression –stunt in growth (caused by glucocorticoids).

34
Q

What is an example of an ADR affecting teeth of children? What drugs cause this?

A

Discoloring of teeth (tetracyclines)

35
Q

What drugs cause kernicterus?

A

Sulfonamides

36
Q

What builds up in the body in a child experiencing kernicterus? Where does it build up?

A

Bilirubin, Brain

37
Q

What specifically causes the build-up of bilirubin in kernicterus?

A

Competition for binding sites

38
Q

Name 6 reasons that over half of the deadly ADR’s occur in elderly clients:

A

a) Due to organ system degeneration, they have altered pharmokinetics
b) They tend to have multiple and severe illnesses
c) Multidrug therapy
d) Comorbidities
e) There is a greater use of drugs with a lower therapeutic index
f) Increased individual variation

39
Q

How do elderly clients differ in terms of absorption?

A

Slower

40
Q

Why is absorption slowed in elderly adults?

A

Due to delayed gastric emptying and reduced splanchnic blood flow.

41
Q

What is splanic blood flow?

A

Includes the blood flow through the stomach, small intestine, large intestine, pancreas, spleen, and liver.

42
Q

What happens to gastric acidity in older adults that affects absorption?

A

It is reduced

43
Q

Why does a reduction in gastric acidity (in older adults) matter in terms of absorption?

A

It alters it

44
Q

What are 3 reasons distribution of drugs is altered in older adults?

A
  1. Increase in body fat
  2. Decrease in lean body mass and total body water
  3. Decrease in albumin levels
45
Q

How does an increase of body fat in older adults affect distribution of drugs?

A

Creates a storage depot for lipid-soluble drugs. This causes plasma levels to decrease so they respond less to the drug.

46
Q

How does a decrease in lean body mass and total body water affect distribution of drugs in older adults?

A

Intensifies.

Causes water-soluble drugs to be distributed in smaller amounts so the concentration is increased and the effects are more intense.

47
Q

How does decreased albumin in older affect distribution of drugs?

A

Intensifies.

With decreased albumin sites of protein binding for the drug are reduced so the free-floating drug elicits an intense response.

48
Q

How is elderly clients differ in terms of metabolism?

A

Decreased.

Drug metabolism declines because of reduced hepatic blood flow, reduced liver mass and decreased hepatic enzyme activity.

49
Q

What happens to half-life in older adults due to decreased hepatic metabolism?

A

Lengthens.

Half lives of certain drugs increase so there is a longer response.

50
Q

How are drugs that elicit first-pass effect different in older adults?

A

Enhanced.

Drugs that undergo first pass metabolism may be enhanced because fewer drugs are inactivated before entering systemic circulation.

51
Q

What is the most important cause of ADR’s in older adults?

A

Drug accumulation secondary to RENAL FUNCTION DECLINE is the most important cause of adverse drug reactions in older adults.

52
Q

Renal function decline in older adults is caused by these 4 things:

  1. _____ blood flow
    (2) _______ filtration rate
    (3) Active ________ secretion
    (4) Number of _________
A

Renal

Glomerular

Tubular

Nephrons

53
Q

What needs to be measured in older adults to determine renal function?

A

Creatinine clearance

54
Q

Why is it super important to assess renal function in older adults taking multiple medications?

A

Accumulation!

Drug accumulation secondary to RENAL FUNCTION DECLINE is the most important cause of adverse drug reactions in older adults.

55
Q

Why do we need to assess serum albumin levels before administering drugs to older adults?

A

When there are decreased serum albumin levels then the drugs can’t bind to the protein albumin. Therefore, the free-floating drug will have a stronger effect.

56
Q

Name 5 reasons that older adults are non-compliant with drugs:

A
  1. Forgetfulness
  2. Failure to understand instructions (intellectual, visual, or auditory impairment).
  3. Inability to pay for medications
  4. Having to take several drugs at several times of the day,
  5. Patient thinks the drug is simply not needed in the dosage prescribed.
57
Q

What are 7 approaches that can improve compliance in older adults?

A
  1. Make doses per day is as few as possible.
  2. Explain it using clear, concise, verbal and written instructions.
  3. Appropriate dosage form (liquid if problems swallowing)
  4. Ask pharmacist to label drug containers using large print, and easy open containers.
  5. Suggest using a pill counter, diary or calendar
  6. Ask if they have access to a pharmacy and can afford the medication.
  7. Monitor for therapeutic responses, adverse reactions and plasma drug levels.
58
Q
A

Pharm Brainscapes by Cheryl and Phil (6 decks)

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