Lesson 7 – Pharmacology in Special Populations

Lesson 7 Overview

Focuses on pharmacological considerations for special populations and patient-specific factors.

Special Populations

Pediatric, geriatric, pregnant, renal-impaired, and hepatic-impaired patients.

Additional Topics

Pharmacogenetics, polypharmacy, cultural factors, and patient-specific implementation.

Pediatrics in Pharmacology

Children process drugs differently than adults; dosing is weight-based.

Weight-Based Dosing

Pediatric drug doses must be calculated carefully using the patient’s weight.

Drug Sensitivity in Children

Children may be more sensitive to side effects (e.g., respiratory depression from opioids).

Pediatric Formulations

Use child-appropriate formulations and devices for safe administration.

Pediatric Administration Tips

Use pediatric-specific protocols and consider medical control when needed.

Geriatric Pharmacology

Aging affects drug absorption, metabolism, and excretion.

Increased Sensitivity

Older adults are more sensitive to drugs, especially CNS depressants.

Polypharmacy Risk

Geriatric patients are often on multiple medications, increasing drug interaction risk.

Comorbidities in Geriatrics

Multiple conditions can alter drug effects and increase side effect risks.

Start Low, Go Slow

Begin with low doses and titrate slowly in geriatric medication administration.

Pregnancy and Medications

Pregnancy alters how drugs are absorbed, distributed, and metabolized.

Drug Safety in Pregnancy

Drugs are categorized by risk to the fetus (FDA Categories A, B, C, D, X).

EMS-Safe Medications in Pregnancy

Acetaminophen and some antihypertensives are generally considered safe.

Risk-Benefit Evaluation

Always weigh fetal and maternal risks and benefits before administering meds.

Protocol Adherence

Always follow protocols and consult medical control for pregnant patients.

Renal Impairment in Pharmacology

Kidney disease impairs drug excretion, risking drug buildup and toxicity.

Dose Adjustments in Kidney Disease

Many drugs require lowered doses when renal function is impaired.

Identifying Renal Issues

Know the patient’s history of kidney disease to anticipate complications.

Informing the ED

Always report renal impairment to the receiving facility for medication planning.

Liver Function in Pharmacology

The liver is key to drug metabolism; damage affects drug clearance.

Hepatic Impairment Effects

Drug duration and potency can increase due to poor liver function.

CNS Sensitivity

Patients with liver disease may be more affected by CNS depressants.

Protein Binding Disruption

Liver disease alters protein binding, impacting drug distribution.

Report Liver History

Always share known hepatic impairment with the receiving team.

Pharmacogenetics Definition

The study of how genes affect a person’s drug metabolism and response.

Metabolism Variability

Some people metabolize drugs too fast or too slow due to genetic traits.

Example: Codeine

Ultra-rapid metabolizers can convert codeine to morphine quickly, risking toxicity.

Genetics in EMS

Genetic info is usually unavailable, but EMTs should understand its future importance.

Future in Personalized Medicine

Pharmacogenetics may soon impact field care decisions.

Polypharmacy Definition

The use of multiple medications by a single patient.

Risk of Interactions

Polypharmacy increases the chance of drug interactions and side effects.

Common in Elderly

Older adults and patients with chronic conditions are more likely to be affected.

Medication History Importance

Always gather a full med list and note any recent changes.

Communication with ED

Share the full list of medications with receiving providers.

Cultural Impact on Pharmacology

Culture can affect how patients view and use medications.

Ethnic Differences

Genetic differences in metabolism can exist between ethnic groups.

Beliefs and Adherence

Cultural values may influence acceptance of certain medications or treatments.

Traditional Medicines

Herbal or alternative medicines may interact with prescribed drugs.

Culturally Competent Care

Respect, awareness, and interpreters are key to safe, inclusive care.

Case: Elderly with Dizziness

Review the medication list carefully; look for signs of polypharmacy or interactions.

Case: Pregnant with Asthma

Choose safe drugs, evaluate maternal-fetal risks, follow protocol.

Case: Pediatric with Renal Impairment

Adjust dosing carefully and consider drug choice to avoid accumulation.

Key Takeaway

Special populations require tailored medication decisions using protocols and medical guidance.