Transcript Developmental Considerations in Pharmacology

Developmental Considerations
in Pharmacology
Lilley Chapter 3
Pharmacology
Nursing 117
Maternal Considerations
Use of meds is generally discouraged.
 Placental barrier protects against some
drugs. Transfer across the membrane
depends on chemical properties of drug
and length of time drug stays in
maternal bloodstream. Usually fetal
drug levels are between 50-100% of
maternal levels.
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Maternal cont’d
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FDA classifies drugs acc’d to safety during
pregnancy—see page 36
Teratogenic effects occur in first trimester
More drug passes to child during last
trimester
Drugs do pass thru breast milk acc’d to their
fat solubility and concentration, but in
reduced amounts
Maternal cont’d
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Drugs need during pregnancy include
maternal vitamins (Hot tx), iron, and folic
acid. Folic acid is recommended 3-6 months
before conception.
OK drugs during pregnancy include Tylenol,
anticoags (x last trimester), insulin, antacids,
H2 blockers, and some types of the following:
antiemetics, asthma meds, antihypertensives,
antibiotics, and laxatives.
Neonatal/Pediatric
Considerations
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¼ of drugs approved for adults have
approved doses for children
However, 75% of adult meds are also given
to children based on clinical studies and
approved protocols, not FDA approval.
Children’s dosages are ordered acc’d to wt or
BSA—more accurate than age
Dosage should always be checked against
safe range recommended by manufacturer.
Peds—Pharmacokinetic
Differences
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Immaturity of GI, kidneys, liver, blood-brain
barrier
Body fluid to fat ratio is higher
Absorption slower R/T slower GI transit time,
higher pH of gastric secretions, irregular
peristalsis, immature enzyme production
Topical/transdermal meds absorbed faster
R/T thinner skin
Pharmacokinetic Differences
cont’d
Distribution affected R/T decreased
albumin levels, causing more free drug
 Increased metabolism causes increased
metabolism of drugs
 Excretion affected R/T immature kidney
function, slowing excretion and
increasing the chance for toxicity
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Neonatal/Pediatric Med
Administration Tips
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Identify child using wrist band, not by asking
name—may not know full name, be reluctant
to tell you, or may want to pretend to be
someone else.
Cooperation will depend on developmental
age, temperament, previous experiences,
degree of illness, coping mechanisms, and
caregiver support
Administration Tips cont’d
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Toddlers (1-3) have biggest negative reaction
and usually have to be restrained regardless
of med route
Preschoolers (3-6) can go either way—may
need some element of control in the situation
School-age and adolescents (6-18) need
more info, control, and have their fears
addressed R/T pain, body image, and privacy
Tips cont’d
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Most meds are oral because least invasive,
but IV route most predictable
Oral syringe more accurate than spoon
Place med in buccal area, blow in face, hold
nose and chin, stroke neck, or use nipple
Can crush pills unless time-released or
enteric-coated and put in non-nutritive food
(x honey < 1). Don’t put in formula or
essential food item.
Tips cont’d
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Injections are to be given using proper
restraint to ensure safety.
Never give injection to sleeping child.
Injections may be seen as punishment in
younger children.
Vastus lateralis is preferred site. No
dorsogluteal until walking x 1 yr.
EMLA cream covered with Tegaderm 1-2h
before administration to numb injection site
Bandaids and praise are important
Adult Considerations
Most drug information published is
based on studies done on adults.
 Other considerations are especially
highlighted
 Be sure to check drug dosages for
safety by comparing to drug book.
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Geriatric Considerations
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Patients > 65 take at least 30% of all Rxs
70% take at least 1-2 drugs/day
30% take at least 5 drugs/day with a 36%
chance of an adverse reaction
40 % take more than 8 drugs/day with 100%
chance of interactions. Does not include OTC
30% of hospital admissions of older adults
are for adverse med reactions
Polypharmacy is term for multiple drug use.
May be caused from seeing more than 1 MD,
or overprescribing by 1 MD
Geriatrics cont’d
Physiologic changes of aging can affect
drug action
 Of all adverse reactions, most profound
are CNS and CV systems
 Many adverse reactions could be
avoided with slow titration to a dosage
of 50% of adult dosage
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Risk Factors with Med Therapy
in Older Adults
Physiologic changes (p. 42 table 3-3)
 Pharmacokinetic changes (p. 42)
 Medications/Conditions (p. 43 table 34)
 Polypharmacy and the Elderly (p.46)
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Tips for Med Administration in
Older Adults
Assess for difficulty reading, opening
bottles, handling small pills, hearing
impairments that cause them not to
hear all instructions
 Multiple drug regimens may be too
complex to handle
 Child-proof caps may be too difficult
 Calendars or pill dispensers are helpful
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Tips for Older Adults cont’d
Give water before and after
 Position upright if not contraindicated
 Check with penlight to make sure tablet
is not stuck
 Give meds last to patients who require
extra time
 When giving IMs, assess for adequate
muscle mass
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Med Education for Older
Adults
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Give written instructions in larger letters with
black letters on white background.
Make chart with med name, amount, time,
and simple side effects listed
Have client repeat name of med, what it is
for, and dosing instructions
Show how to use pill dispensers or anything
that requires skill—require return demo
Have Poison Control number in plain view and
any other contact numbers
Include SO when doing education