Lifespan Flashcards by Ashley Elder

What are ways to reduce drug risks for people who are breastfeeding?

Refer to Narrative Summary of benefits and risks of medication for use during pregnancy and lactation
Decrease # of meds mom is on
Utilize smallest dose possible
Try to stick to meds safe for baby (otherwise pump and dump)

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What categories determine the risk of a drug to a pregnant women and the baby?

Categories A,B, C, D and X

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What are category A drugs?

Human trials have shown no risk to fetal development (don’t use much as drug trials don’t occur in pregnant women)

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What are category B drugs?

In animals, drug showed no negative effects to developing fetus

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What are category C drugs?

Show some risk to fetus, but benefits outweigh risk

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What are category D drugs?

Should only be used in life-threatening situations due to possible significant consequences to fetus and the pregnancy in general

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What are category X drugs?

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Do pediatric patients respond differently to drugs than the rest of the population?

Yes

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Are pediatric patients more sensitive to drugs?

Yes

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Do pediatric patients show a great need for individualization?

Yes

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What are pediatrics drug sensitivity mostly due to?

Oran immaturity

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Are pediatric patients at a greater risk for ADRs?

Yes

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Pediatric relationships with drugs changes as what?

They grow and develop

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Are drug trials done on pediatric patients?

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What is different in oral absorption of drugs with pediatrics?

Delayed gastric emptying for several months

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What is different with absorption of intramuscular drugs and pediatrics?

It is delayed in first few days of life then faster in infants

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What is different about percutaneous absorption in pediatrics?

Increased in infants

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What is different in the distribution related to protein binding in pediatric patients?

A decrease in albumin levels due to immature liver = less binding site availability?

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What is different in distribution related to the BBB of pediatrics?

Not fully developed= easy access for drugs causing an increase in CNS effects

What is different in metabolism of drug in pediatric patients?

The drug metabolizing capacity of newborn is low

- Neonates =especially sensitive to drugs primarily eliminated by hepatic metabolism

When does the ability to metabolize drugs by hepatic metabolism occur in pediatric patients?

Increases rapidly

When do infants have complete liver maturation? (Plays a role in metabolism of drugs)

By 1 year

Is the ability to excrete drugs significantly reduced at birth?

Yes

Why is the ability to excrete drugs significantly reduced at birth?

low renal blood flow
low glomerular filtration
low active tubular secretion

For pediatric patients drugs eliminated primarily by renal exception must be given how?

In reduced dosage and/or at longer dosing intervals

When are adult levels of renal function in pediatric patients achieved?

By 1 year

What is significant about the blood brain barrier (BBB) in pediatric patients?

Not fully developed, making it easier for drugs to effect CNS (More risk for ADRs and toxicity)

What are changes in absorption related to geriatric patients?

- % of oral dose that is absorbed doe not change with age - rate of absorption may slow - delayed gastric emptying

Why does having an increased % of body fat and decreased % of lean body mass change the distribution of drugs in geriatric patients?

Body fat is a storage depot for lipid-soluble drugs

Why does having a decrease total body water in geriatric patients have a effect on distribution of drugs?

Distributed in smaller volume; thus, concentration is increased and effects can be more intense

Why does having a reduced concentration of serum albumin I. Geriatric patients effect drug distribution?

(May be significantly reduced in the malnourished) | -causes decrease protein binding of drugs and increase in level of free drugs

Due to altered metabolism in geriatric patients what happens to the half-life of drugs ?

-half-life of some drugs may increase, causing prolonged responses

What is different in excretion of drugs in geriatric patients?

Their renal function undergoes progressive decline begging in early adulthood

In relation to renal function what is there a reduction of in geriatric patients?

- renal blood flow - glomerular filtration (GFR) - active tubular secretion - number of nephrons

In regards to excretion of drugs in geriatric patients what is drug accumulation secondary to renal disease the most important cause of?

ADRs

When should renal function be assessed in geriatric patients?

With drugs that are eliminated primarily by the kidneys

What labs refer to renal function?

- Creatinine - GFR - BUN

In the elderly why should you check creatinine clearance or GFR and not serum creatinine?

Lean muscle mass (source of creatinine) declines

In geriatric patients creatinine levels may be normal even though kidney function is what?

Greatly reduced ( in general look at for stability and/or improvement)

Why is polypharmacy a problem in the elderly?

Elderly have a disproportionately high prescription drug use (More ADRs and drug toxicity)

What does medication nonadherence mean?

- not starting a med - skipping doses - splitting doses - taking extra doses - self-discontinuation

What risk factors decrease drug adherence in the elderly?

- depression - cognitive impairment - missed visits - lack of response to meet (perceived or real) - poor relationships with healthcare system

What are some reasons for intentional medication non-adherence in the elderly?

- Expense - Side Effects - Patients one conviction that the drug is unnecessary or the dosage is too high

What may help increase medication adherence in the elderly who have unintentional non-adherence?

- Simplified drug regimens - Appropriate dosage form - Clearly labeled and easy-to-open containers - Daily reminders - Support system - Frequent monitoring

What are strategies to improve intentional medication non-adherence in the elderly?

- Use teach-back techniques - Build trust - Involve patient in decision making