Special Populations

Question 1

what occurs to phenytoin as it relates to pregnancy?

Answer 1

spike of phenytoin right after birth

Question 2

what 5 anatomical and functional changes are increased in pregnancy?

Answer 2

body weight
fat mass
body water
plasma volume
RBC volume

Question 3

what 3 anatomical and functional changes are decreased in pregnancy?

Answer 3

hematocrit
albumin
alpha-1 acid glycoprotein (AAG)

Question 4

what 6 physiological changes are increased in pregnancy?

Answer 4

cardiac output
GFR
renal blood flow
creatinine clearance
uterine blood flow
hepatic blood flow

Question 5

what 3 physiological changes are decreased in pregnancy?

Answer 5

gastric emptying
intestinal motility
acid secretion

Question 6

why is there a decrease in plasma drug concentration in pregnancy?

Answer 6

increased space and fluid

Question 7

which hormone in pregnant women is an enzyme inducer, and can then affect drug concentration clearance?

Answer 7

progesterone

Question 8

which hormone in pregnant women is an enzyme inhibitor, and can then affect drug concentration clearance?

Answer 8

estrogen

Question 9

what change in pregnancy leads to a prolonged onset of pharmacological effect?

Answer 9

decreased intestinal motility

Question 10

what can occur during the first trimester of pregnancy due to N/V?

Answer 10

constipation from Al antacids and iron

Question 11

what causes a pregnant patient to have a faster uptake of anesthetics?

Answer 11

increased cardiac output = hyperventilation = increased alveolar uptake

Question 12

what causes a pregnant patient to have a decrease in absorption of drugs in the lower extremities?

Answer 12

decreased blood flow to lower extremities in late pregnancy

Question 13

what causes a pregnant patient to have an increased transdermal absorption of drugs?

Answer 13

increased peripheral vasodilation

Question 14

what protein is present in the placenta that helps pump out drugs from the placenta?

Answer 14

P glycoprotein

Question 15

how is it possible that a fetus can be exposed to a drug the mother is taking?

Answer 15

placenta has drug metabolizing enzymes

Question 16

what 2 factors in drugs allow it to cross the placenta?

Answer 16

lipid solubility
ionization

Question 17

why do weak bases get trapped in fetal circulation?

Answer 17

fetal pH is lower (more acidic) than maternal pH

Question 18

which 4 drugs are at risk for becoming trapped in fetal circulation?

Answer 18

meperidine
propranolol
lidocaine
morphine

Question 19

the fetus has some physiological changes that cause them to be unable to take drugs that have too much protein binding. what is it? (2)

Answer 19

fetus has decreased albumin
fetus has decreased alpha-1 acid glycoprotein (transporter)

Question 20

why do drugs tend to go directly to the placenta?

Answer 20

increased cardiac output = increased blood flow to uterus

Question 21

what pumps drugs back into maternal circulation?

Answer 21

placental PgP

Question 22

during which weeks of gestation are congenital malformations (teratogenesis) at greatest risk?

Answer 22

week 3-11

Question 23

which 10 drugs are CI in pregnancy?

Answer 23

ACEI
ARBs
ARNI
statins
warfarin
barbiturates
carbamazepine
phenytoin
valproic acid
tetracycline

Question 24

drug that was initially used as a sedative, anticonvulsant, and managing morning sickness but is a teratogen? what genetic defect?

Answer 24

thalidomide
phocomelia

Question 25

most human teratogens are also true for _____, BUT reverse is not true

Answer 25

animals

Question 26

labeling for pregnancy, labor and delivery

Answer 26

8.1

Question 27

labeling for lactation, including nursing mothers

Answer 27

8.2

Question 28

labeling for females and males of reproductive potential

Answer 28

8.3

Question 29

during what trimester is the fetus most sensitive?

Answer 29

first trimester

Question 30

what is the rule for dosing in pregnant women? (2)

Answer 30

use smallest dose change dose only when changes have implications

Question 31

what drugs are used and considered "fetal therapeutics"? (2)

Answer 31

HIV rx digoxin (fetal tachyarrhythmias)

Question 32

first 4 weeks (less than 31 days old)

Answer 32

neonate

Question 33

how many weeks is considered premature?

Answer 33

< 36 week gestation

Question 34

1-12 months

Answer 34

infant

Question 35

1-12 years old

Answer 35

children

Question 36

12-18 years old

Answer 36

adolescent

Question 37

65 and older

Answer 37

elderly

Question 38

how are drugs transferred to breast milk?

Answer 38

passive diffusion

Question 39

what kind of drugs are easily transferred to breast milk? (3)

Answer 39

unionized molecules unbound lipid-soluble

Question 40

avoid taking drugs, if possible, for at least _____ hours before feeding

Answer 40

4

Question 41

which PK diameter do we think about when feeding an infant right before a dose?

Answer 41

half-life

Question 42

which 3 drugs have metabolites, which will be present in mother for a longer time?

Answer 42

norfluoxetine (300 hours) normeperidine (90 hours) morphine-6G

Question 43

how is absorption affected in babies? (2)

Answer 43

delayed gastric emptying (PN, N) increased gastric pH (alkaline)

Question 44

which 2 ages have delayed gastric emptying?

Answer 44

premature neonate neonate

Question 45

which 3 ages have increased gastric pH, making it an alkaline environment?

Answer 45

premature neonate neonate infant

Question 46

what kind of drugs will have an increase in absorption in premature neonates, neonates, and infants? name them

Answer 46

acid-labile drugs penicillin G penicillin V

Question 47

when is percutaneous absorption of drugs increased?

Answer 47

inflamed skin occlusive dressing

Question 48

as we move from premature to adult, we lose _____ and start to develop _____

Answer 48

fluid fat

Question 49

water-soluble drugs in babies have a _____ volume of distribution

Answer 49

larger

Question 50

volume of distribution in water-soluble drugs ______ with maturation

Answer 50

decreases

Question 51

lipid-soluble drugs in babies have a _____ volume of distribution

Answer 51

smaller

Question 52

volume of distribution in lipid-soluble drugs _____ with maturation

Answer 52

increases

Question 53

which water-soluble drug has a decreased volume of distribution with age?

Answer 53

gentamicin

Question 54

which 2 lipid-soluble drugs have an increased volume of distribution with age?

Answer 54

midazolam diazepam

Question 55

what 4 levels are decreased in newborns compared to adults?

Answer 55

total protein albumin alpha-1 acid glycoprotein globulin

Question 56

what 2 levels are decreased in infants compared to adults?

Answer 56

total protein globulin

Question 57

what kind of drugs will have a low volume of distribution in newborns?

Answer 57

highly protein bound

Question 58

at what age do premature neonates and neonates have similar gastric emptying as adults?

Answer 58

6-8 months

Question 59

at what age do neonates and infants have similar maturity of enzymes as adults?

Answer 59

6 months

Question 60

why do children have a rapid metabolism of drugs when compared to adults?

Answer 60

liver in children during first 2 years is large in relation to their body size

Question 61

what is pediatric dosing based on? (2)

Answer 61

weight body surface area

Question 62

what are the 2 calculations for child dosing?

Answer 62

Clark's rule: (child weight/adult weight) x adult dose Young's rule > 2 yrs old: (age/age + 12) x adult dose

Question 63

in an infant, when is GFR the lowest?

Answer 63

first 30 days of life

Question 64

why is serum creatinine difficult to use as indicator of renal function in infants?

Answer 64

renal function may be worse than serum creatinine since muscle mass is low in infants