Pharm. Special patients groups

Question 1

Targeted special groups in pharm

Answer 1

Pregnancy

Lactation

Pediatrics

Geriatrics

Question 2

Which two groups have a scarce amount of data about pharmacokinetics/pharmacodynamics and why?

Answer 2

Infant/child populations and pregnant women because nobody is willing to risk that patient population for research.

Question 3

FDA preganancy medication categories

Answer 3

A
B
C
D
X

Question 4

A class medication

Answer 4

Remote possibility of fetal harm

No risk of fetal harm demonstrated in controlled trials

Question 5

B class medicaiton

Answer 5

Animal studies have not demonstrated fetal harm, but human studies have not been done.

Or Animal studies have demonstrated some fetal harm but human studies have been done with no evidence of harm

Question 6

C class medication

Answer 6

Animal studies have demonstrated potential fetal harm, but there are no controlled trials to confirm the event in humans

Question 7

D class medication

Answer 7

Evidence of fetal risk has been demonstrated in humans, but use may be justified in some cases based on benefit:risk

Question 8

X class medication

Answer 8

Teratogens

Studies in animals or humans have demonstrated significant fetal harm or deformation.

Completely contraindicated in women who are pregnant

Question 9

Pregnancy pharmacokinetic changes to oral medications

Answer 9

Decreased gastric motility and gastric secretions

Nausea and vomiting

Question 10

Pregnancy pharmacokinetic changes to transdermal medications

Answer 10

increased blood flow (peripheral vasodilation)

Increased body water

Question 11

Pregnancy pharmacokinetic changes to pulmonary sytem

Answer 11

Cardiac and tidal volumes are increased by approximately 50% = hyperventilations and increased pulmonary blood flow

Question 12

Pregnancy pharmacokinetic changes to distribution

Answer 12

Increased blood volume (30-50%)

INcreased adipose deposition

Decreased albumin concentration

Question 13

Pregnancy pharmacokinetic changes to metabolism

Answer 13

Induced and inhibited CYP enzyme activity related to estrogen and progesterone levels

Question 14

Pregnancy pharmacokinetic changes to elimination

Answer 14

Increased renal blood flow

Question 15

Pregnancy pharmacokinetic changes summary

Answer 15

Changes are rarely clinically significant as dosage adjustments are not typically warranted and difficult to predict

Question 16

Epilepsy in pregnancy

Answer 16

Treatment options are limited as all the medications are harmful to the fetus.

Valproic acid is the only medication that is always stopped during pregnancy.

Question 17

Potential adverse effects noticed in the infant following passive exposure from lactation

Answer 17

Drowsiness/sedation (Analgesics, antihistamins, antidepressants, anti-epileptics)

Diarrhea (antibiotics)

Withdrawal symptoms (antidepressants, nicotine, drugs of abuse)

Question 18

Pharmacotherapy techniques in lactation

Answer 18

Minimizing exposure to the infant (breast feeding during a trough in the medication regimen)

Avoid unnecessary medications

Coordinate medications and feeding schedules (pump and dump schedule)

Question 19

What drugs inhibit prolactin which inhibit lactation?

Answer 19

Oral contraceptives, levadopa, repinirole

Question 20

Why can’t pediatric pharmacology be simplified to small adult principles?

Answer 20

Because children are not small adults! many physiological differences.

Question 21

Geriatric pharmacology population

Answer 21

Adults > 65 yo comprising 13% of the population

it is a growing population

Question 22

Geriatric pharmacokinetic elimination consideration

Answer 22

REduced muscle mass may exaggerate creatinine clearance calculations. (may not have any muscle mass)

Question 23

Beers criteria

Answer 23

Evidence based approach for medications used in elderly populations

Question 24

STOPP criteria

Answer 24

Screening tool of older persons with potentially inappropriate prescriptions

Question 25

Polypharmacy

Answer 25

Complex drug regimens

Question 26

Strategies to avoid polypharmacy

Answer 26

Education, reinforcement, education! Review medication profile routinely

Question 27

Allergies as an adverse event

Answer 27

Immune-mediated response to certain chemical substances No way of predicting initial reaction

Question 28

Side effects as an adverse event

Answer 28

Medications have side effects! Predictable May be caused via same or different mechanism as therapeutic use of drug

Question 29

Adverse drug reaction

Answer 29

Unintended noxious response to a drug when used at normal doses for usual purposes Cannot be predicted

Question 30

Pregnancy summary

Answer 30

Changing kinetics throughout pregnancy Exposure to fetus Non-pharmacologic strategies must be considered Minimal effective dose for the shortest duration Use medications with the best safety profile Risk:benefit

Question 31

Lactation summary

Answer 31

Avoid unnecessary medications Non-pharmacologic strategies must be considered Coordinate medications with feeding schedule Minimal effeective dose for the shortest duration Risk:benefit Monitor the infant for effects

Question 32

Pediatrics

Answer 32

Not small adults!! Diverse population Changing pharmacokinetics Consider age and weight for dosing Use multiple resourses

Question 33

Geriatrics

Answer 33

Sensitive to side effects Beer's criteria STOPP criteria Polypharmacy is a problem