Drug Therapy Across the Life Span - Ch. 11, 12 & 13

Question 1

What are the different lifespans that should be taken into consideration regarding drug therapy?

Answer 1

Pregnancy
Breast-feeding
Pediatric
Geriatric (65yrs old and older)

Question 2

What are drugs that are dangerous to fetal development/pregnancy?

Answer 2

Teratogen

Question 3

Teratogen

Answer 3

Drugs and other agents that can disrupt development of the fetus or halt pregnancy

Question 4

What period of pregnancy is at greatest danger for drug-induced developmental defects?

Answer 4

First Trimester

Question 5

What developmental defects can occur during the first trimester?

Answer 5

Congenital gross malformations because of enormous cell multiplication and differentiation

Question 6

What developmental defects occur during the second and third trimesters?

Answer 6

Disruption of function not gross anatomy
e.g, brain development

Question 7

What are breastfed infants at risk for exposure to?

Answer 7

Drugs consumed by mother

Question 8

Is breast milk a usual excretion route?

Answer 8

NO

Question 9

What are some contraindicated drugs to use while breastfeeding?

Answer 9

Cancer chemotherapy
Immunosuppressants

Question 10

What should be limited during breastfeeding?

Answer 10

Alcohol, smoking (nicotine) and caffeine

Question 11

What are the pediatric consideration subgroups?

Answer 11

Premature infants
Full term infants
Neonates
Infants
Children
Adolescents/Young adults

Question 12

premature infants

Answer 12

Less than 37 weeks gestational age

Question 13

Full term infants

Answer 13

37-40 weeks gestational age

Question 14

Neonates

Answer 14

First 4 postnatal weeks

Question 15

Infants

Answer 15

Weeks 5 to 52 postnatal

Question 16

Children

Answer 16

1 to 12 years old

Question 17

Adolescents/Young Adult

Answer 17

12 to 18 years old

Question 18

What should be taken into consideration during absorption in pediatrics?

Answer 18

Gastric environment is less acidic
Gastric emptying is slowed - slow peristalsis
First pass effect is reduced (neonates) - immature liver
Topical absorption is faster through the skin
Intramuscular absorption is faster and irregular

Question 19

What should be taken into consideration during distribution in pediatrics?

Answer 19

Total body water changes in different age groups
Protein binding decreased bc decreased protein made in immature liver
Immature blood-brain barrier allows more drugs to cross into their brain

Question 20

What is the total body water (TBW) in full-term infants?

Answer 20

70%-80%

Question 21

What is the total body water in premature newborns?

Answer 21

85%

Question 22

What is the total body water in children 1-12 years of age?

Answer 22

64%

Question 23

Greater TBW means?

Answer 23

Fat content is lower

Question 24

What should be taken into consideration during metabolism in pediatrics (Newborns, neonates, infants)?

Answer 24

The immature liver does not produce enough microsomal enzymes (CYPs) so the metabolism is reduced

Question 25

What should be taken into consideration during metabolism in pediatrics (Older children)?

Answer 25

May have increased drug metabolism requiring higher doses

Question 26

What should be taken into consideration during excretion in pediatrics?

Answer 26

Kidney immaturity (up to ~1 year) affects perfusion, glomerular filtration rate and tubular secretion = reduced excretion of drugs

Question 27

What are other pediatric considerations?

Answer 27

Skin is thin/permeable The stomach lacks acid to kill bacteria Lungs lack mucus barriers Body temps poorly regulated and dehydration occurs easily Liver and kidneys are immature, impairing metabolism and excretion

Question 28

What should be taken into consideration for geriatric patients?

Answer 28

Use of medication is common 20-40% of all perscription drugs, >40% of OTC drugs Polypharmacy

Question 29

What should you take into consideration with geriatric people who have a polypharmacy?

Answer 29

Chronic illness and conditions Increase risk of drug interactions, adverse effects Some drugs given to treat adverse effect due to drug interactions

Question 30

Which population is more sensitive to drugs?

Answer 30

Geriatric (compared to young adults)

Question 31

Why are geriatric populations more sensitive to drugs?

Answer 31

Pharmacokinetic changes Complex health conditions Polypharmacy Drug regime adherence

Question 32

What cardiovascular changes occur in Geriatric populations?

Answer 32

Decreased CO, Decreased blood flow to organs

Question 33

How is drug pharmacokinetics altered due to cardiovascular changes in Geriatric populations?

Answer 33

Decreased absorption Decreased distribution

Question 34

What gastrointestinal changes occur in Geriatric populations?

Answer 34

Increased pH Decreased peristalsis - delayed gastric emptying, slower lower GI tract

Question 35

How is drug pharmacokinetics altered due to gastrointestinal changes in Geriatric populations?

Answer 35

Altered absorption

Question 36

How is drug pharmacokinetics altered due to liver changes in Geriatric populations?

Answer 36

Decreased cytochrome P-450, decreases metabolism

Question 37

How is drug pharmacokinetics altered due to kidney changes in Geriatric populations?

Answer 37

Reduced function causes a decrease excretion of water soluble drugs and metabolites