stewart special populations and PPCP

PPCP

Pharmacists' Patient Care Process

1. collect

2. assess

3. plan

4. implement

5. follow up: monitor/evaulate

potential drug therapy problems in geriatric pts

1. duplicate therapy

2. dosing= too high bc lower kidney fxn

3. non-adherence: affordability, swallowing, understanding

which characteristics of geriatric pts may potentially lead to ADRs

1. altered PK/PD

2. impaired renal fxn

3. reduced hepatic blood flow

4. increased fat, less lean mass

5. receptor sensitivity

decongestants risk factors

hypertension. arrhythmia

antihistamines/ anticholinergic risk factors

cognitive dysfunction, disrupted sleep, confusion, hallucinations

risk factor for:

-magnesium antacids

- aluminum antacids

-Mg: diarrhea

- Al: constipation

PPI risk factors

bone loss, fracture

stimulant laxative risk factors

electrolyte imbalance

what is first line therapy in pregnant pt

non-drug therapy (most cross placenta)

teratogenic

producing malformations (in the developing embryo)

greatest risk for malformations in the fetus as a result of drugs is during the _______ trimester

1st; majority of organ development

why is non-adherence a major drug therapy problem for pregnant population

nausea and vomiting

-> eat small, frequent meals and snacks. avoid any triggers

clinical OTC recommendations for pregnant population

1. allergies

2. pain

3. acid reflux

4. nausea

1. 1st/2nd gen antihistamines are ok

2. acetaminophen is ok; NSAIDs have potential risk during last trimester

3. H2 and PPIs are ok

4. B6+doxylamine for nausea OR ginger

which popular combination is often given to pregnant pt for nausea

10-25mg VitB6 and doxylamine 12.5-25mg every 8hrs

which pain med is not recommended for pregnant pt?

NSAIDs (tylenol preferred) in last trimester

when should breastfeeding pts take meds if needed

- after nursing or before baby sleeps

- avoid extra strength, long acting, ER

what would be better for a nursing mom and why

a. low dose tylenol

b. extra strength tylenol

c. low dose motrin

d. extra strength motrin

c

-low dose so it does not reach milk-> baby

-for lactating moms, ibuprofen is preferred bc low levels in milk and short half life [compare to pregnant mom where tylenol is preferred]

which analgesics are compatible for pregnant pts? breastfeeding?

pregnant= acetaminophen

breastfeeding= ibuprofen (low level in milk and short half life)

t/f: medications such as loperamide, famotidine, dextromethorphan, and pseudoephedrine are all compatible with lactating pts

true (but note Pseudoephedrine may decrease breast milk production)

why do many drug labels not have clear recommendations for lactating women

pregnant/lactating pts are often excluded from studies-> less data

which ages are the following

neonates

infants

children

adolescents

neonates: <1month

infants: 1 month- 2 years

children: 2-12 years

adolescents: 12-16yrs

what are the most common meds given in pediatrics

cough and cold

t/f: FDA recommends against self care for children younger than 2, therefore if a 1yr old pt needs self care, it is a referal

false. while FDA recommendation is true you can still give med, you just need to calculate right dose

- verify age, weight, caregiver factors

in children, antihistamines and CNS depressants may cause

hyperactive/ excited (paradox effect)

in children, sympathomimetics may cause

sedation

how is a medicine dropper properly used in infants

-squirt into side of cheek, not throat, so they do not choke

t/f: an infant's medication may be placed in formula for easy delivery

false. do not place in formula bc if child does not like taste they may stop taking the formula in the future

t/f: referring to medication as candy is an easy way to encourage toddlers to take medication

false

t/f: homeopathic and herbal therapies should be discouraged to lactating patients

true. consider nonpharm options and drugs with shortest half life