251 Pharma Study Cards - Chap 4 & 7 Flashcards
(53 cards)
Throughout the life spectrum, when is there increased risk of adverse drug effects and toxicity?
at both ends of spectrum of life (pediatric and geriatric)
How do drugs primarily cross the placenta?
Via diffusion
What are the three factors that affect the safety of using medications during pregnancy?
Drug properties
Fetal gestational age
Maternal factors
What is the ‘Pregnancy and Lactation Labelling Rule’?
FDA rule that sets standards for how information about using medicines during pregnancy and breastfeeding is presented in the labeling of prescription drugs and biological products. The pregnancy letter categories – A, B, C, D and X will be replaced by a narrative risk summary based on available data.
What are the 3 subsections within the Pregnancy and Lactation summary?
- Pregnancy
- Lactation
- Females and Males of Reproductive Potential
True or false: Breast milk is the primary route for maternal drug excretion
False. Drug levels in breast milk are usually lower than in maternal circulationExposure depends on volume of consumed milk.
What is the term used for age range of younger than 38 weeks gestation?
Premature or preterm infant
What is the term for age range born but younger than 1 month?
Neonate or newborn infant
What is the term for the age range 1 month to younger than 1 year?
Infant
What is the term for the age range for 1 year to younger than 12 years?
child
What considerations are in place for pediatric patients relative to pharmacokinetics and absorption?
- Gastric pH less acidic until 1 to 2 years of age
- Gastric emptying slowed
- First-pass elimination reduced
- Reduced bile salt formation decreases bioavailability
- Intramuscular absorption faster and irregular
What considerations are in place for pediatric patients relative to pharmacokinetics and distribution?
- Total body water differences result in increased distribution and dilution of water-soluble drugs.
- Greater total body water means lower fat content.
- Decreased level of protein binding
- Immature blood–brain barrier means more drugs enter the brain.
What considerations are in place for pediatric patients relative to pharmacokinetics and metabolism?
- Liver immature; does not produce enough microsomal enzymes
- Older children may have increased metabolism, requiring higher doses or more frequent administration than infants.
- Other factors: liver enzyme production, genetic differences, and substances to which the mother may have been exposed during pregnancy
What considerations are in place for pediatric patients relative to pharmacokinetics and excretion?
- Kidney immaturity affects glomerular filtration rate and tubular secretion.
- Decreased perfusion rate of the kidneys may reduce excretion of drugs.
What factors affect pediatric drug dosage?
- Skin is thin and permeable.
- Stomach lacks acid to kill bacteria.
- Lungs have weaker mucus barriers.
- Body temperatures are less well regulated, and dehydration occurs easily.
- Liver and kidneys are immature, impairing drug metabolism and excretion.
What methods are there for dosage calculation for pediatric patients?
- Body surface area method
- Uses the West nomogram
- Always use weight in kilograms, not pounds.
- Always use height in centimeters, not inches.
- Body weight dosage calculations
- Uses mg/kg
What are some considerations for older adult patients?
- Older adults: older than age 65 years
- High use of medications
- Polypharmacy
- Nonadherence
- Increased incidence of chronic illnesses
- Sensory and motor deficits
What physiological changes occur with the cardiovascular system for older adults?
- Decreased cardiac output = decreased absorption and distribution
- Decreased blood flow = decreased absorption and distribution
What physiological changes occur with the gastrointestinal system for older adults?
- Increased pH (alkaline gastric secretions) = altered absorption
- Decreased peristalsis = delayed gastric emptying
What physiological changes occur with the liver for older adults?
- Decreased enzyme production = decreased metabolism
- Decreased blood flow = decreased metabolism
What physiological changes occur with the kidney for older adults?
- Decreased blood flow = decreased metabolism
- Decreased kidney function = decreased excretion
- Decreased glomerular filtration rate = decreased excretion
What affects absorption in older adults?
- Gastric pH less acidic
- Gastric emptying slowed
- Movement through gastrointestinal (GI) tract slowed because of decreased muscle tone and activity
- Blood flow to GI tract reduced
- Absorptive surface of GI tract reduced
What affects distribution in older adults?
- Lower total body water percentages
- Increased fat content
- Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)
What factors affect metabolism in older adults?
- Aging liver produces fewer microsomal enzymes, affecting drug metabolism.
- Blood flow to the liver is reduced.
- Leads to a prolonged half-life of many drugs
- Potential for accumulation if not monitored
