Pediatric and Geriatric pharmacology

Pharmaceuticals act of 2002

Requires study of pediatric medications

Off-label use

FDA allows physicians to prescribed approved medication for other intended indications

Pediatric pharmacokinetics

Study of the time course of drug absorption, distribution, metabolism and excretion.

Childs age, health status, underlying disease, hydration, route of administration, nutrition habits, physical maturity, hormones

Influencing factors of absorption

Gastric acidity, emptying (breastfed is faster) motility, surface area, enzyme levels, intestinal flora. Lack of maturation in infancy. Child grows and pH doesn't reach adult acidity until 1-3 years

Route of administration of absorption

Peripheral perfusion, effectiveness of circulation. Occurs at tissue levels. IV directly into the bloodstream.

IM/subQ absorption

Children's skin is thin and porous. Absorbed through the skin.

Topical absorption

Neonates and infants are 70% water

Distribution for body fluid composition.

Neonate a and infants have less body fat

Distribution of body tissue composition

Neonate a and infants have less albumin and fewer protein receptor sites. May be signs of drug toxicity of drugs are highly protein bound.

Protein-binding capacity in distribution

Skin allows rapid distribution of medications. Blood-brain barrier allows medications to pass easily into nervous system and increase toxicity

Effectiveness of barriers in distribution

Maturational level of child varies for child to child.

Metabolism maturation levels

Metabolism of drug before it reaches the systemic circulation

Metabolism first-pass effect

Infants have immature hepatic and renal function compared to adults

Higher metabolic rate

Kidneys, intestines, salivary glands, lungs, sweat glands, and mammary glands

Areas of occurrence in excretion

Infants have decreased renal blood flow, glomerular filtration rate, renal tubular function before 9 months.

Excretion of the kidneys

Water, need to monitor intake and output, renal function and medication effectiveness.

What is needed for medication excretion?

Onset, peak, and duration of effect of a medication

What do the mechanisms of action and effect of a drug on the body include?

Clinical response to medications

Pediatric medication dosing and monitoring are based on?

Atraumatic care

Eliminates physiological and physical distress

When a child is sleeping

When should you never give meds

Honey because of botulism

What should you not give children under one?

Decreased frequency

Children have higher metabolic rates than adults. The nurse realizes that this affects administration of medication for pain in children in all of the following except?

Therapeutic and toxic drug levels

Although adolescents have physical appearance and organ structure and function similar to that of adults, the nurse understands that their bottles continue to grow, requiring the nurse to follow increased vigilance in monitoring what?

Via an oral syringe

A toddler requires an oral medication. It is most appropriate for the nurse to administer the oral medication __________.

Age, weight, and height

Drug calculations for children are based on which factors?

Double

By 2030, the number of older adults will ____ the 2000 number.

Physiologic changes in geriatric

Slower absorption, impaired circulation, delayed transportation, low metabolic rate and drugs are excreted less completely

Use one pharmacy, keep a list of meds, and bring all medications to doctor appointments.

Because of Polypharmacy nurses encourage patients to do what?

Geriatric pharmacology

Adverse reactions, loss of protein-binding sites, decline in hepatic first-pass metabolism, prolonged half-life of the drug because of decreased liver and kidney function.

Pharmacodynamics

Lack of affinity to receptor sites, changes in CNS, changes in # of drug receptors, affinity to receptors to drugs, and compensatory response to physiologic changes is decreased.

Hypnotics

Sleep inducing drug

Insomnia

Difficulty sleeping. 35% of older adults have this

Flurazepam

Hangover effect

Quazepam (doral)

Prolonged half-life

Temazepam (Restoril)

Food delays the action

Triazolam (Halcion)

Short half life in small dose

Oxazepam

One hour before bedtime

Diuretics and antihypertensives

Hydrochlorothiazide

Nonpharmacologic methods

Reduced low blood pressure, exercise, reduce salt, alcohol intake

Calcium blockers, angiotensin-converting inhibitors, and A-II blockers or antagonists

Low incidence of electrolyte imbalance and CNS side effects

Alpha blockers or antagonists

Are infrequently prescribed for older adults because of orthostatic hypotension

Cardiac glycosides

Slow and strengthen the heart. Digoxin. Pulse should be >60 beats per minute. Do not give if below. Consult with physician.

Anticoagulants

Thins the blood. Warfarin, decreased serum albumin, PT INR, risk for falls, drug interactions.

Penicillins and aminoglycosides

Antibacterials include

Penicillins

Cephalosporins, tetracyclines, and sulfonamides. Considered safe for the older adult

Aminoglycosides

Fluoroquinolones and vancomycin. Not frequently prescribed for patients older than 75 years.

Gastrointestinal drugs

Histamine blockers, sucralfate, ranitidine(Zantac), famotidine (Pepcid), and nizatidine. Used to treat peptic ulcer disease. Laxatives, and cimetidine(not for older adults)

Fluid increased intake, consuming high fiber foods and exercise.

What should be encouraged in geriatric pharmacology?

Antidepressants

Tricyclics, fluoxetine, monoamine oxidase inhibitors

Tricyclic antidepressants

Side effects include dry mouth, tachycardia, constipation, and urinary retention and narrow-angle glaucoma.

Fluoxetine

Bicyclic antidepressant

Monoamine oxidase inhibitors

Not often prescribed for older adults

Opioid analgesics

Dose-related adverse reactions, hypotension, respiratory depression, constipation

Education for adherence and nonadherence

Daily contact, insurance, therapeutic effect

Health teaching

Senses to be as sharp as possible, speak in tones patient can here, face patient when speaking, treat patient with respect, use large print and bright colors in teaching aids, review all meds, simple dosage schedule, patient to report improvement or none when using meds

Nursing process

Assessment and common potential nursing diagnoses, panning, nursing interventions, patient teaching, evaluation

Common potential nursing diagnoses

Ineffective health maintenance related to lack of transportation, nonadherence related to lack of insurance

Planning

The older adult will take the prescribed meds as ordered. Drug therapy will be effective with no or few side effects.

Nursing interventions

Monitor laboratory results

Patient teaching

General, self-admin, diet, side effects, cultural considerations

Increased gastrointestinal blood flow

When administering meds to the older adult population, the nurse is aware that the physiologic changes of aging that can affect drug activity include all of the following except?

Increased incidence of allergic response

Adverse reactions and drug interactions occur frequently in older adults due to all of the following except?

Polypharmacy

Older adults are at risk for taking many medications together. This is known as?

Lower cardiac output

Which is a physiologic change seen in the older adult that has an effect on drug administration?

Confusion

An older adult comes to the emergency department after taking cimetidine. It is most important for the nurse to monitor the patient for which effect?

Blood urea nitrogen and creatine

When assessing older adults renal function, which laboratory value will the nurse monitors?