special pops notes wk 3 ch 3

Question 1

are the majority o drugs approved for kids?

who are drug experiments conducted on

Answer 1

no 75% not approved for kids or neonates

• Most drug experements are conducted on adults 13-65

Question 2

t or f most pregnant women abstain fro taking any drugs during preg

Answer 2

false-Most pregnant women take 3-5meds during preg

Question 3

___trimester is most dangerous for dev defects

Answer 3

first

Question 4

do drugs and nutrients get to fetus more thru diffusion or active transprt

Answer 4

more through diffusion

Question 5

t or f if woman is healthy and preg is normal then it is ok to self treat minor illness

Answer 5

 Discourage self Tx of even minor illness during prego, esp during first trimester

Question 6

what 3 things does safety of drug during preg depend on

Answer 6

o drug properties
o fetal gestational age,
o maternal factors

Question 7

gestational age as a factor that impacts drug therapy during prego

when is hgihgest % of materanally absorbed drug getting to fetus

Answer 7

(vulnerable in first trimester d/t organ formation and during last trimester the greatest % of maternally absorbed drug gets to fetus)

Question 8

what maternal factors affect druf safety in preg

Answer 8

(kidney, liver and genetic)
 Maternal factors affect drug metab – such as kidney or liver fx issues, maternal genotype eg G6PD deficiency which can cause ADE when exposed to OTC like aspirin

Question 9

t or f to ensure accuracy most drugs are tested on pregnant moms to determine preg category

Answer 9

false- Often have to use animal studies to test drugs d/t ethics eg preg categories

Question 10

what primary factors impact drug transfer to fetus

Answer 10

o drug’s chem properties
o drug dosages,
o concurrently administered drugs.

Question 11

primary drug characteristics that inc the likelihood that a drug given to a breastfeeding mother will end up in the breast milk

Answer 11

o fat solubility,
o low molecular weight,
o nonionization,
o high concentration.

Question 12

t or f

drug levels in breast milk are lower than maternal circulation

Answer 12

ttrue
mom’s excrete drugs in other ways than simply through the breast milk.
o Actual amount of drug depends largely on vol ingested

Question 13

preg categories

Answer 13

o Category A – studies indicate no risk to the human fetus
o Category B – studies indicate no risk to animal fetus; info in humans not available
o Category C – Adverse effects reported in animal fetus; info in humans not available
o Category D – possible fetal risk in humans reported; consideration of potential benefit vs risk may warrant use of these drugs in prego women.
o Category X – fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and human studies. Don’t use in prego women.

Question 14

woman has very serious medical condition and is prescribed preg category x do you give right away or not give and speak to dr

Answer 14

dont give
o Category X – fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and human studies. Don’t use in prego women.

Question 15

you have category B drug to give but woman says “im not taking that if theres risk it harms fetus” what do you tell her

Answer 15

o Category B – studies indicate no risk to animal fetus; info in humans not available

Question 16

various age ranges and the term for each eg preterm

infant

Answer 16

 Younger than 38 week gestation – Premature or preterm infant
 Younger than 1 month – Neonate or newborn infant
 1 month to younger than 1 year – Infant
 1 year to younger than 12 years - child

Question 17

which 1 factor is most responsible for pharmacokinetic/dynamic differences in kids

Answer 17

 Immaturity of organs is the physiological factors

Question 18

d/t organ immaturity some drugs may be more toxic for kids

Answer 18

 Again, organ maturity plays a role. Some drugs may be more toxic than others.
o Ex: phenobarbital, morphine, aspirin

Question 19

t or f there are no drugs that kids tolerate as well or better than adults

Answer 19

 Drugs that children tolerate as well or better than adults include atropine, codeine, digoxin, and phenylephrine.

Question 20

what factors affect pharmacodynamics in kids

Answer 20

-organ maturity
- Sensitivity of receptor sites may vary with age
 Rapidly developing tissues may be more sensitive to certain drugs. So, certain drugs are contraindicated during the growth years.

Question 21

what drugs are contraindicated in growing years and what do they do

Answer 21

o Ex. Tetracycline may discolour a young person’s teeth; systemic corticosteroids may suppress growth; fluoroquinolone abx may damage cartilage leading to gait problems

Question 22

whih factors affect kids dosage calculations significantly

Answer 22

o Skin is thinner and more permeable
o Stomach lacks acid to kill bacteria
o Lungs have weaker mucous membranes
o Body temp is less well regulated and dehydration occurs easily
o Liver and kidneys are immature and so drug metabolism and excretion are impaired

Question 23

which method is most accurate to calculate drug dose for kid

Answer 23

 Formulas involving weight, age, and body surface area (BSA) are the most common basis for calculations,

with BSA being the most accurate.

Question 24

what is nec to calc BSA method

Answer 24

o Drug order with drug name, dose, route, time, and frequency.
o Info regarding available dosage forms
o Child’s height in cm and weight in kg
o Recommended adult drug dosage

Question 25

what is the West nomogram

Answer 25

 The West nomogram is a graph/tool that uses the child’s height and weight to determine the child’s BSA. The info is then put into the BSA formula to get the right dose.

Question 26

is it enough just to know max daily dose for drug? what else do you need?

Answer 26

o Get child’s weight in kg’s
o Use drug guide to determine usual dosage range per day, and find out max daily dose & safe range
o determine total amount of drug to admin per dose per day
o compare prescribed dosage with calculated safe dose – call doc if a problem

Question 27

how is absorption affected in kids

Answer 27

 Gastric pH is less acidic because acid-producing cells in the stomach are immature until ~1-2 yrs.
 Gastric emptying is slowed because of slow or irregular peristalsis
 First-pass elimination by the liver is reduced because of liver immaturity = dec liver enzymes
 Intramuscular absorption is faster and irregular

Question 28

how is distrib affected in kids

Answer 28

 total body water is 70-80% in full-term infants, 85% in premature newborns, and 64% in children 1-12 yrs of age.
 Fat content is lower in young pt’s because of greater total body water
 Protein binding is dec because of dec production of protein by the immature liver
 More drugs enter the brain d/t immature blood brain barrier (BBB)

Question 29

metab in kids is different how

Answer 29

 Dec liver enzymes = poorer drug metabolism
 Older children may have inc metab and require higher doses once liver enzymes are produced
 many variables affect metab in premature infants, infants, and children, incl the status of liver enzyme prod, genetic differences, and what the mother has been exposed to during prego

Question 30

excretion in kids

Answer 30

 GFR and tubular secretions and reabsorption are all dec in young pt’s d/t kidney immaturity
 Perfusion to the kidneys may be dec and results in red kidney fx, concentrating ability, and excretion of drugs.

Question 31

prob not imp but aside from pharm effects of drugs how should you admin drugs in terms of prep etc for infants, otddlers, SA, teens

Answer 31

• Infants: safe and secure positioning, self soothing meas eg pacificier
• Toddlers: brief concrete explanation, accept aggressive behave as normal in limits, comfort after, allow play to process it
• Preschoolers: brief concrete explanation, comfort after, play to release aggression, magical thinking, parents role is to comfort and give understanding
• School age: explain, comfort, explore feelings thru therapeutic play, set behave limits, give activities to release anger, teach them, give complete picture
• Adolesc: prep pt in advance, allow to express feelings and spend time alone, help them explore self/illness, encourage self expression and participation in procedures

Question 32

older adults consume lg % of prescription drugs and OTC..how much?

what fraction of o adults take >8meds a day and what is this called

Answer 32

 Older adults consume 20-40% of all prescription drugs, and 40% of OTC drugs.
 1 in 3 older adults take more than 8 different drugs a day = polypharmacy as each drug treats different illnesses.

Question 33

what is the polypharmacy cascade

Answer 33

 Drugs contribute to side effects ->more drugs

Question 34

CV and GI physio changes in system of O adult

Answer 34

 CV: dec CO = dec absorption and distribution
o Dec blood flow = dec absorption and distribution
 GI: inc pH = altered absorption
o Dec peristalsis = delayed gastric emptying

Question 35

liver and kidney physio changes in system of O adult

Answer 35

	Liver: dec enzyme prod = dec metabolism
o	Dec blood flow = dec metabolism
	Kidney: dec blood flow = dec excretion
o	Dec function = dec excretion
o	Dec GFR = dec excretion

Question 36

what are the most important labs to monitor for o adult taking drugs

Answer 36

 Most important labs to monitor are kidneys (creatinine and BUN) and liver (ALT & AST)

Question 37

pharmacokinetic changes in o adult

absorption

Answer 37

gastric pH is less acidic because of a gradual decline in prod of HCl acid in stomach
o Gastric emptying is slowed because of a dec in smooth muscle tone and motor activity
o Movement through GI is slower because of dec muscle tone and activity (constipation) but older adult on laxatives may speed up peristalsis too much and dec absorption. Bran and high fibre also do this
o Blood flow to GI is reduced 40-50% d/t dec CO and dec blood flow
o Absorptive surface area is dec because the aging process blunts and flattens villi
o Once drugs are absorbed, they go through blood stream to site of action, but that depends on CO, BP, and patency of blood vessels.

Question 38

pharmacokinetic changes in o adult distribution

Answer 38

In older adults, there is a dec in total body water content = concentrations of highly water-soluble drugs may be higher in older adults d/t less water for drugs to be diluted in.
o Lean muscle mass decreases, body fat increases. So, drugs such as hypnotics and sedatives that area primarily distributed to the fat will have a prolonged effect.
o Drugs distributed by blood are carried by proteins, specifically albumin.
 Due to dec liver fx, dec protein intake, and poor GI absorption, protein-binding sites are reduced and drugs aren’t distributed as well, leaving higher levels of unbound drugs in the blood (that are active).
o The effects of highly protein-bound drugs may be enhanced if their doses are not adjusted to accommodate any reduced serum albumin concentrations.
o Highly protein-bound drugs include warfarin and phenytoin, and many others.

Question 39

pharmacokinetic changes in o adult metab

Answer 39

 METABOLISM: dec liver fx = dec liver enzymes = dec metabolism.
o Liver blood flow is reduced by approx. 1.5% per year after 25 yoa, which dec liver metabolism.
o These factors contribute to prolonging the half-life of many drugs, which can result in drug accum if serum drug levels are not closely monitored (warfarin, phenytoin).

Question 40

pharmacokinetic changes in o adult excretion

Answer 40

 EXCRETION: this is reduced in older adult as GFR dec 40-50% in older adults, combined with dec blood flow, leading to extremely delayed drug excretion and possibly drug accumulation.
o With dec liver fx, doses of drugs should be altered to minimize toxicity.

Question 41

according to ____ ____ which drug classes may be inappropriately prescribed, ineffective, or cause adverse drug reactions in older adults.

Answer 41

o opioids,
o Anticholinergics
o Anticoagulants-bleeding, drug interactions, dietary interactions
o Antidepressants-sedation and strong anticholinergic effects
o antiHTN
o cardiac glycosides (digoxin)
o CNS depressants
o NSAID’s-edema, kidney toxicity
o sedatives, hypnotics-inc risk for falls confusion etc
o thiazide diuretics-lyte imbal, dehydration

Question 42

which meds have drug-disease interactins for O adults with bladder outflow obstr and chronic constipation

Answer 42

• Bladder flow obstr-anticholinergics, antihistamines, decongestants, anti dep
• Chronic constipation-CCb, tricyclic antidep, anticholinergics

Question 43

which meds have drug-disease interactuon for o adults w COPD and clotting disorder

Answer 43

• COPD-long acting sedative hypotics, narcotics, beta blocker
• Clotting disorders-NSAIDS, aspirin, antiplatelet

Question 44

drugs that interact with depression, and heart failure and HTN (same for last two

Answer 44

• Depression-some antiHTN: methyldopa, reserpine, quenethidine
• HF and HTN-sodium, decongestants, amphetamines, OTC cold

Question 45

dugs that interact w insomnia for o adult

Answer 45

• Insomnia-decongestants, bronchodilators, MAO inhib

Question 46

drugs that interact w parkinsons for o adult

Answer 46

• Parkinsons-antipsych, phenothiazines

Question 47

drug-disease interaction for o adult

syncope and falls

Answer 47

• Syncope and falls-sedatives, hypnotics, narcotics, CNS dep, muscle relaxants, antidep, antiHTN