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Pharmacology I Chapter 3 Life Span Considerations

Pharmacology I Chapter 3 Life Span Considerations. Drug Therapy during Pregnancy & Lactation. First trimester = greatest danger of drug-induced fetal development defects Third trimester = drug transfer to fetus most likely Enhanced blood flow to fetus

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Pharmacology I Chapter 3 Life Span Considerations

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  1. Pharmacology I Chapter 3 Life Span Considerations

  2. Drug Therapy during Pregnancy & Lactation • First trimester = greatest danger of drug-induced fetal development defects • Third trimester = drug transfer to fetus most likely • Enhanced blood flow to fetus • Fetus is exposed to same medications as mother • Not all drugs cross placental barrier • Review Pregnancy Safety Categories(A-X) **

  3. Drug Therapy during Pregnancy & Lactation • Breast-fed infants also at risk for drug exposure • Many drugs easily cross into breast milk • Decision to continue drug during lactation based on risk/benefit ratio • Certain illnesses require medication during pregnancy/lactation • HTN • Diabetes • Epilepsy • Infection

  4. Drug Therapy for Infants and Children • Neonate = newborn • Infant = under 1 year • Child = 1-12 years • Pharmacodynamics altered due to immature organ function • Certain drugs are contraindicated during growth periods (may delay or alter growth) • Example: tetracycline may permanently discolor teeth corticosteroids inhibit growth - newborns

  5. Drug Therapy for Infant Children • Drug dosage is SIGNIFICANTLY different from an adult (both rx and OTC) • Should be based on ideal body weight if obese • Drug dosage must be based on height and weight • For child < 18 years • Ideal body weight vs. actual body weight ?? • > 32% children are overweight (2-19) • Limited studies on children re: dosage and weight • Using IBW on obese child can lead to subtherapeutic dose w/ certain meds • Prescriber must consider pharmacokinetics !!

  6. Drug Therapy for Children • Penicillin • unknown • Cephalosporins • Actual body weight • Digoxin • Ideal body weight • Narcotics • Ideal body weight • Dilantin • Actual body weight for loading dose • Ideal body weight for maintenance doses

  7. 1 kilogram (kg) = 2.2 pounds (lb) • Example: Infant >3 mos = 15 lbs. = 200mg Child = 40 lbs. = 1200 mg Adult = >40kg = 1500-2000mg 220 lbs. is equivalent to ____________ kg ?

  8. Convert 88 lb. to kg ___________________ • Convert 60 kg. to lb ___________________

  9. Drug Therapy for the Elderly • Elderly = Geriatric = Older Adult • Adult >65 • 13% of population • Advanced health care/technology • Ability to prolong life • Growing elderly population • Life expectancy = 78 • Will increase to 82 by 2030

  10. Drug Therapy for the Elderly • 30% of prescription drugs • antihypertensives, cardiac, insulin • 40% of OTC drugs • analgesics, laxatives, antacids • 30-50% use laxatives • Polypharmacy • 1/3 elderly take 8 drugs per day • many take >15 • Average 2-4 OTC drugs/day • Financial concerns • pill splitting, skipped doses • Noncompliance • 40% • Associated w/increased hospitalization

  11. Drug Therapy for the Elderly • Lack of understanding • Medication errors • Visual ability • Timing of medications • Memory issues • Arthritic, weak hands • Illiteracy • Lack of support system • Multiple prescribers • Multiple pharmacies • 1 pharmacy preferred • Drug interactions • OTC • Herbals

  12. Drug Therapy for the Elderly: Physiologic Changes • Cardiovascular • Decreased CO = decreased absorption • Decreased blood flow = decreased absorption • Gastrointestinal • Increased pH (stomach) = altered absorption • Decreased peristalsis = delayed gastric emptying • Hepatic (liver) • Decreased blood flow = decreased metabolism • Decreased enzyme production = decreased metabolism • Renal (kidney) • Decreased blood flow = decreased excretion • Decreased kidney function = decreased excretion

  13. Drug Therapy for the Elderly: Pharmacokinetics • Absorption • Decreased gastric acid secretion • Lower gastric pH, may inhibit absorption of certain meds • Decline in smooth muscle tone • Delayed gastric emptying • Decreased peristalsis • Decreased CO leads to decreased blood flow to GI tract • 40-50% decreased flow to GI tract • Absorptive surface area decreased • Flattening of intestinal villi

  14. Drug Therapy for the Elderly • Distribution • Less body water • Less dilution of drug in blood • Less muscle mass, more adipose tissue • Drugs stored in adipose tissue have longer duration in body • Low albumin level (low protein) • Protein bound drugs will compete for protein molecules • Unbound drug concentrations increase

  15. Drug Therapy for the Elderly • Metabolism • Declines w/ age • Liver loses mass, less blood flow • Decreased ability to metabolize drugs • Prolonged half-life • Dosage adjustments necessary • Excretion • Delayed due to decline in renal function (GFR) • Kidney function must be monitored closely • Dosage adjustments necessary

  16. Drug Therapy for the Elderly • Which of the following age groups is most likely to experience dangerous effects from medications : a. Infants b. Children c. Adults d. Elderly

  17. Drug Therapy for the Elderly: Dosage Considerations • Adjustment of dosage needed • Decreased body weight • Decreased muscle mass • Decreased organ function • Heart, kidney, liver • Elderly have increased sensitivity to CNS depressants • Anxiety meds, antidepressants, sleeping pills, etc.

  18. Drug Therapy for the Elderly: Polypharmacy • Multiple illnesses • Average older adult (1 in 3) takes 8 meds per day • Increased possibility of drug interactions • Anticoagulants, antidepressants, diuretics, antihypertensive, antacids • Increased possibility of drug-food interactions • Review p. 212 Eliopoulos, table 18.2 • Warfarin (Coumadin) – decreased effect w/ high Vitamin K foods (green leafy vegetables)

  19. Drug Therapy for the Elderly: Problematic Meds • Narcotics • Confusion, urinary retention, constipation, fall risk • NSAIDS • Edema, gastric ulceration, renal toxicity • Antidepressants • Sedation, urinary retention • CNS depressants • Sedation, weakness, confusion, fall risk • Diuretics • Dehydration, weakness

  20. Drug Therapy for the Elderly • Nursing Diagnoses • Risk for injury related to adverse medication effects • Knowledge deficit related to ……

  21. Drug Therapy for the Elderly:Patient Education • Encourage patients to carry a list of all meds • Rx and OTC • Inform patients to check w/ Physician prior to mixing Rx meds and OTC meds ! • Encourage patients to use 1 pharmacy • Educate pt. on names of medications, indications, dosage, schedule • Verbal & Written • Teach patients about potential adverse effects & interactions • Remind pt. that adverse effects can occur at any time, even after long period of use

  22. Drug Therapy for the Elderly: Patient Education • Teach pt. – DO NOT take other medications within 2 hours of antacids • Encourage pt. to ask questions to increase level of understanding • Encourage pt. w/ visual deficit/illiteracy to use color coded med. bottles, labels w/ large print • Teach pt. to ask for “easy to remove caps” and “pre-split pills” • Home health – check and review meds @ each visit • Ongoing pt. education

  23. Drug Therapy for the Elderly: Tips for Safe Drug Use • Pill boxes • Prefilled • Containers with timer (beeps) • Color-coded medication bottles • Large print labels • Magnifying glasses • “Easy open” caps • Pill cutters • Pharmacist can also cut pills

  24. http://www.youtube.com/watch?v=R4jqhnUTWvA • Right click, open hyperlink

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