Special Populations: Pregnancy, Lactation, Renal, Hepatic, Pediatrics, and Geriatrics

Vocabulary flashcards covering special populations content including pregnancy and lactation, liver and kidney disease, pediatric pharmacokinetics, and geriatric pharmacotherapy.

Gestational Age (GA)

The period of time measured from the first day of the mother's last normal menstrual period (LMP) to birth.

First Trimester

The gestational period of pregnancy spanning weeks 1 through 13.

Second Trimester

The gestational period of pregnancy spanning weeks 14 through 27.

Third Trimester

The gestational period of pregnancy spanning weeks 28 through 40.

Congenital Malformations Background Risk

The baseline population risk of structural birth defects present at birth, estimated at $3\%$ to $5\%$.

Teratogenic Susceptibility Period

The stage of gestation determining vulnerability to teratogens: weeks 1-2 (dividing zygote) are not susceptible to teratogens; weeks 3-8 (embryonic period) are susceptible to major congenital anomalies; weeks 9-38 (fetal period) are susceptible to functional defects and minor congenital anomalies.

FDA Pregnancy Category A

A former FDA letter classification indicating that controlled studies in pregnant women failed to demonstrate a risk to the fetus in the first trimester.

FDA Pregnancy Category X

A former FDA letter classification indicating that studies in animals or humans have demonstrated fetal abnormalities, and the proven fetal risk clearly outweighs any possible benefit.

FDA Pregnancy and Lactation Labeling Rule (PLLR)

An FDA labeling rule effective June 30, 2015, that removed previous pregnancy letter categories (A, B, C, D, X) for prescription drugs and required detailed narrative subsections on Pregnancy, Lactation, and Females and Males of Reproductive Potential.

Relative Infant Dose (RID)

A calculated percentage defined as the absolute infant dose in $\text{mg/kg/day}$ received via breast milk divided by the maternal dose in $\text{mg/kg/day}$; values exceeding $10\%$ generally signal safety concerns requiring evaluation.

Acute Kidney Injury (AKI)

A sudden loss of kidney function caused by decreased renal blood flow, direct kidney damage, or urinary tract blockage.

Chronic Kidney Disease (CKD)

A condition characterized by a glomerular filtration rate (GFR) of less than $60\,\text{mL/min}$ or evidence of kidney damage present for more than 3 months.

Cockcroft Gault Equation

A formula used to estimate creatinine clearance ($\text{CrCl}$) in $\text{mL/min}$, calculated as $\text{CrCl} = \frac{(140 - \text{age}) \times \text{IBW}}{72 \times \text{SCr}} \times 0.85 \text{ (if female)}$.

Child Pugh Score

A scoring system evaluating chronic liver disease severity across 5 clinical parameters: Hepatic Encephalopathy grade, Ascites, Total bilirubin, Serum albumin, and INR, categorized into Grade A (5-6 points), Grade B (7-9 points), and Grade C (10-15 points).

Postnatal Age (PNA)

The age descriptor defined as the time elapsed from birth to the current time.

Postmenstrual Age (PMA)

The sum of Gestational Age (GA) and Postnatal Age (PNA), used to assess organ maturation in premature neonates.

Neonate

The NICHD pediatric age classification describing an infant from birth to 27 days of age.

Pre-term Gestational Age

A classification for infants born at a gestational age of less than $37$ weeks.

Full Term Gestational Age

A classification for infants born at a gestational age between $39$ weeks and $40\,\text{weeks and } 6/7 \text{ days}$.

Allometric Scaling

A pharmacokinetic scaling technique that adjusts clearance and dose based on body weight raised to an exponent (such as $\text{Weight}^{0.75}$) to avoid underdosing smaller individuals and overdosing larger individuals.

Maturation Factor

A mathematical factor describing the age-dependent acquisition of organ function (such as GFR or CYP450 activity) that increases asymptotically toward adult function.

FRAIL Scale Score

A geriatric screening tool assessing frailty based on five criteria: Fatigue, Resistance, Ambulation, Illness, and Loss of Weight.

American Geriatric Society Beers Criteria

A clinical guideline for patients $65$ years of age and older identifying potentially inappropriate medications (PIMs) that should generally be avoided or dose-adjusted based on renal function.

Medication Appropriateness Index

A 10-question evaluation tool assessing individual medication appropriateness regarding indication, effectiveness, dose, directions, practicality, drug-drug interactions, drug-disease interactions, duplication, duration, and cost.

Deprescribing

A systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of a patient's care goals, current level of functioning, life expectancy, values, and preferences.