Pharmacology Across Lifespan: Pediatric and Geriatric Pharmacology

Impact of Age Related Alterations in Metabolism

Pharmacokinetics refers to drug ---- and ----

drug distribution and elimination

Pharmacodynamics refers to drug ---

effect / clinical response

True / False: children are small adults

false

Today ---- % of medications that are approved for adults have pediatric safety and efficacy data

50%

Children's gastric acid secretion is --- than that of adults

less

What does drug distribution depend on?

Total body water

Plasma protein binding

Body lipid content

Which population has higher total body water content: children or adults

newborn = 80%

Which population has lower total body water content: children or adults

adult = 55%

Which population has higher plasma binding protein content: children or adults

adults

Sulfonamides have a greater risk of --- in children due to children having low content of ---

kernicterus

plasma binding protein

Kernicterus

High levels of bilirubin in the bloodstream of neonates, leading to brain damage

There is --- the amount sedation if a child is given the same dose of benzodiazepine compared to an adult

5x

Drug metabolizing enzyme activity is generally --- in neonates, children, and older adults

les

Glomerular filtration, tubular secretion, and renal blood flow is --- in neonates and older adults

lower

--- output is lower in older adults

cardiac

Dosing regimens for neonates is based on --- inversely proportional to ---

body surface area inversely proportional to length

Effects of aspirin on children

Reye's syndrome

Reye's Syndrome

Acute encephalopathy (inflammation of the brain).

Drugs causing Steven Johnson

Physiological age related changes in absorption

diminished salivation

esophageal motility disorders

decreased gastric acidity

decreases gastric emptying

decreased GI blood flow

Impact of Physiological Age Related Changes in Absorption

difficulty swallowing oral solid dosage form

dry mouth symptoms

decreased drug absorption

Clinical Significance:

Physiological changes may necessitate --- alterations in the elderly

significant dosage alterations

Age Related Alterations in Drug Distribution

decreased body size

decreased lean body mass

increased fat

decreased body water

decreased serum albumin

Impact of Age Related Alterations in Drug Distribution

Decreased dosage requirement

Increased volume of distribution of fat soluble drugs

Decreased volume of distribution of water soluble drugs

increased free fraction of drug in serum

Impact of Physiological Age Related Changes in Metabolism

Decreased liver mass

Decreased liver blood flow

Decreased hepatic metabolism

Impact of Age Related Alterations in Metabolism

Reduced drug metabolism

To inactive or inactive metabolites

What are the metabolic pathways in the liver

Phase 1 pathway

---- convert drugs to active or inactive metabolites

phase 1 pathways

Nephrosclerosis / glomerulosclerosis

hardening of small arteries

---- rate declines with aging

glomerular filtration rate

What is the impact of age related changes in glomerular filtration rate?

decrease in drug excretion

increased concentration of drug in the plasma

A normal creatinine levels ---- indicate normal renal function in elderly patients

DOES NOT

Why is serum creatinine maintained in the normal range in elderly patients?

creatinine production and creatinine clearance decline equally xzc

If a drug is hydrophobic, it is generally considered ----

lipophilic

If a drug is hydrophilic, it is generally considered ----

hydrophilic

Polypharmacy is taking. more than --- medications

5

Common drug interaction:

ACE inhibitor and ---

potassium = hyperklamemia

Common drug interaction:

- antiarrythmic and ---

diuretic = electrolyte imbalances

Common drug interaction:

- benzodiazepine and ---

antidepressant or antipsychotic = confusion, sedation, falls

Common drug interaction:

- calcium channel blocker and ---

nitrate = hypotension

Beers Critera is a standard tool for the identification of ----- in order adults

potentially inappropriate medications

potentially inappropriate medications for older adults

first generation antihistamines

tricyclic antidepressants (sertraline)

barbiturates (lamitrigine / levitaracem)

sleeping aiods

NSAIDS

benzodiazepines

Estrogen replacement