Pharm Special Patient Populations

a state of complete physical, mental, and social well-being

health

polypharmacy

the use of 5+ medications

multimorbidity leads to _

polypharmacy

legacy prescribing

continuing medications that should be discontinued but are not

most common medication category for polypharmacy

pain medications

pharmacokinetic changes in geriatrics (5)

-reduced gastric motility

-leaner body mass

-lower body water

-decreased blood flow

-decreased renal/hepatic function

geriatric pharmacodynamic changes

-increased sensitivity to drug classes

-increased adverse effects

-altered receptor function

age-related changes in geriatrics

sensory impairment

swallowing issues

dexterity

declining cognitive function

medication errors can occur when?

any time in the medication process

medication error vs adverse drug event

ADE causes harm due to medication exposure

common denominator of medication errors and adverse drug events

preventability

high alert medications definition

medications that are commonly used but have high risk

examples of high alert meds

insulin

oral anticoagulants

antiplatelents

opioids

beers criteria

classes of medications that are potentially inappropriate

antipsychotics can have what effect on elderly patients

symptoms of Parkinson's

cholinesterase inhibitors can cause what side effects

diarrhea

urinary frequency/urgency

calcium channel blockers side effect in elderly

lower extremity edema

use _ to assess drug appropriateness for elderly patients

beers criteria

assess geriatric doses for _

renal and hepatic clearance

which conditions are commonly underdosed in geriatric populations

alzheimers

heart failure

CAD

A-fib

HTN

HLD

beers criteria supports _

deprescribing and optimizing medication use

geriatric syndromes (6)

cognitive impairment

mobility impairment

frailty

falls

incontinence

depressive symptoms

concern with sulfonyureas

high risk of hypoglycemia

concern of diphenydramines

CNS impairment

urinary retention

constipation

concern of NSAIDs for elderly

decreased clearance

GI bleeding

worsening HTN, HF

muscle relaxant concerns

anticholinergic effects

sedation

fractures

prescribing considerations for pediatrics

-approved for children?

-appropriate dose based on weight

-counseling parents for adverse effects

absorption differences in pediatrics (4)

gastric emptying

intestinal integrity

intestinal transit time

gut pH

how does the gut pH change in pediatrics

more acidic at birth

pediatric drug metabolism differences

less liver enzymes

lower GFR

most common pediatric medication error

use of an adult formulated medication

need to change original dose

outpatient pediatric medication errors

incorrect dosage

incorrect frequency

drug inadequate for disease

incorrect route

dosing for pediatrics

mg/kg

how is CKD staged

using GFR

diagnostics to tell physiological condition of kidneys

GFR and albuminuria together

creatinine clearance tends to _ kidney function

overestimate

most accurate measure in determining drug clearance

creatinine clerance

drugs to consider under renal impairment

direct oral anticoagulants

low molecular weight heparin

antibiotics

diabetes meds

digoxin

colchicine

5 variables of child-pugh score

bilirubin

albumin

INR

ascites

hepatic encephalopathy

metric that assesses liver function

child-pugh score

increased liver pressure leads to _

decreased drug metabolism

how is albumin affected by hepatic impairment

decreased

how is CYP450 affected by hepatic impairment

decreased

medications to consider for hepatic impairment

APAP

NSAIDs

protein-bound meds

sedatives

pain meds

factors that effect drug passage into breastmilk

molecular weight

drug concentration

lipid solubility

protein binding

ionization

Vd

half life

factors affecting infant pharmacokinetics

neutral gastric pH

slower transit time

less fat digestion

more permeable BBB

less CYP enzymes

slower elimination

different gut bacteria

drugs that stimulate prolactin release

domperidone

metocloparmide

preferred drug characteristics for lactating women

short half life

highest protein binding

low lipid solubility