Chapter 3

Question 1

Life Span Considerations

Answer 1

• Pregnancy
• Breast-feeding
• Neonatal and Pediatric
• Elderly

Question 2

First trimester is the period of….

Answer 2

Greatest danger for drug-induced development defects

Question 3

Drugs cross the placenta by…

Answer 3

diffusion

Question 4

During the last trimester….

Answer 4

the greatest percentage of maternally absorbed drug gets to the fetus

Question 5

FDA Pregnancy Categories

Answer 5

A, B, C, D, X

Question 6

Category A

Answer 6

Studies indicate no risk to human fetus

Question 7

Category B

Answer 7

Studies indicate no risk to animal fetus, information for humans is not available

Question 8

Category C

Answer 8

Adverse effects reported in animal fetus, information for humans not available

Question 9

Category D

Answer 9

Possible fetal risk in humans reported, however, considerations of potential benefits vs. risk may in selected cases warrant use of these drugs in pregnant women

Question 10

Category X

Answer 10

Fetal abnormalties reported and positive evidence of fetal risk in humans available from animal and or human studies. These drugs should not be used in pregnant women

Question 11

Breast Feeding

Answer 11

Breast fed infants are at risk for exposure to drugs consumed by the mother
*Consider risk-to-benefit ration

Question 12

Neonatal and Pediatric Considerations:

Absorption

Answer 12

• Gastric pH less than acidic
• Gastric emptying is slowed
• Intramuscular absorption faster and irregular

Question 13

Neonatal and Pediatric Considerations:

Distribution

Answer 13

• The younger the person, the greater the % of total body water
• Greater TBW means fat content is lower
• Decreased level of protein binding
• Immature blood-brain-barrier- more drugs enter the brain

Question 14

Neonatal and Pediatric Considerations:

Metabolism

Answer 14

• Liver immature, does not produce enough microsomal enzymes

* Older children may have increased metabolism, requiring higher doses than infants

Question 15

Neonatal and Pediatric Considerations:

Excretion

Answer 15

• Kidney immaturity affects glomerular filtration rate and tubular secretion
• Decreased perfusion rate of the kidneys may reduce excretion of drugs

Question 16

Factors Affecting Pediatric Drug Dosages

Answer 16

• Skin is thin and permeable
• Stomach lacks acid to kill bacteria
• Lungs have weaker mucus barriers
• Body temperatures less well regulated and dehydration occurs easily
• Liver and kidneys are immature, impairing drug metabolism and excretion

Question 17

Methods of Dosage Calculation for Pediatric Patients

Answer 17

• Body surface area method
• using the West monogram
• Body weight dosage calculations
• using mg/kg

Question 18

The Elderly:

Answer 18

• Older than age 65
• Use of OTC medications
• Increased incidence of chronic illnesses
• Polypharmacy

Question 19

Physiologic Changes in the Elderly Patient

Answer 19

• Cardiovascular
• Gastrointestinal
• Hepatic
• Renal

Question 20

The Elderly:

Absorption

Answer 20

• Gastric pH less acidic
• Gastric emptying slowed
• Movement through GI tract slowed
• Blood flow to GI tract reduced
• Use of laxatives may accelerate GI motility

Question 21

The Elderly:

Distribution

Answer 21

• 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)

Question 22

The Elderly:

Metabolism

Answer 22

• Aging liver produces fewer microsomal enzymes, affecting drug metabolism
• Reduced blood flow to the liver

Question 23

The Elderly:

Excretion

Answer 23

• Decreased glomerular filtration rate

* Decreased number of intact nephrons