topic 3 (NSG-318)

what does pharmacokinetics mean?

what the body does to the drug: absorption, distribution, metabolism, excretion (ADME)

why are pediatric pharmacokinetics different from adults?

immature organs, different body composition, and ongoing growth/development

which pediatric age group is at the highest risk for medication toxicity?

neonates and infants

what is a neonate?

birth-27 days

what is an infant/toddler?

28 days to 23 months

why is oral drug absorption unpredictable in neonates?

alkaline stomach pH and slower gastric emptying

when does gastric pH reach adult levels?

around 2-3 years old

when does gastric emptying become more adult like

around 6-8 months

why do neonates absorb topical medications more easily?

thin skin and larger surface area to body weight ratio

what happens if too much topical medication is applied to an infant?

increased risk for toxicity

why do infants often need larger weight based doses of water soluble drugs?

they have more total body water 75%

what percentage of body water do infants have?

about 75%

what percentage of body water do adults have?

about 60%

why are infants at greater risk for drug toxicity from protein bound drugs?

lower protein levels = more free drug circulating

why are infants more sensitive to CNS medications

immature blood brain barrier

which organ is primarily responsible for pediatric drug metabolism?

liver

why do infants metabolize drugs more slowly?

immature liver enzymes and reduced hepatic blood flow

around what age does liver function approach adult levels?

around 1 year

which organ is primarily responsible for pediatric drug exemption?

kidneys

what is a newborn's GFR compared to adults?

30% of adult function

when does kidney function reach adult levels?

around 12 months

what can happen if a neonate receives a renally cleared medication too frequently?

drug accumulation and toxicity

what is pharmacodynamics?

what the drug does to the body

what four concepts are included in pharmacodynamics?

mechanism of action, onset, peak, duration

why is drug response unpredictable in children?

organ maturity and ADME change as they grow

why must pediatric medications be closely monitored?

drug effects and side effects can be unpredictable

how are most pediatric doses calculated?

mg/kg or mg/m2

what is the biggest danger of weight based dosing?

calculation errors

what should be done after giving a pediatric medication?

monitor for therapeutic effects and adverse effects

what is the 1 safety rule for pediatric dose calculations?

double check all calculations

who should verify pediatric calculations whenever possible?

a second nurse

what measurement system should caregivers use at home?

metric system only

why should household spoons never be used?

inaccurate dosing

what device is most accurate for children under age 6

oral syringes

where should oral liquid medication be directed

buccal side of cheek

why not squirt medicine directly into the throat?

risk of gagging and aspiration

which medications should never be crushed?

enteric-coated and extended release medications

why cant extended release medications be crushed?

dose dumping and toxicity

why should honey never be mixed with medications for infants under 1 year?

risk of botulism

what is off label use

using a medication outside FDA approved pediatric indications

why is off label use common in pediatrics

limited pediatric research

which route is preferred in children?

oral route

which route provides the most reliable absorbtion?

IV route

preferred IM injection site in children?

vastus lateralis and ventrogluteal

what is atraumatic care?

reducing physical and psychological stress for children and families

should you inject a sleeping child?

never

why shouldn't procedures be done on sleeping children?

damages trust and increases anxiety

what are examples of pain reduction techniques

EMLA cream, distraction, relaxation, imagery

what is family centered care?

including families in education, monitoring and medication decisions

what should families be taught about every medication?

purpose dose timing side effects and how measure correctly

what is the guiding principle for geriatric medication dosing

start low and go slow

why are older adults more vulnerable to toxcity

age related physiologic changes alter drug hangling

what body composition changes occur with aging

less body water, less lean mass, more body fat

what happens to water soluble drugs in older adults

higher concentration in bloodstream

what happens to fat soluble drugs in older adults?

longer duration and accumulation

what happens to liver function with aging?

decreased size, blood flow and metabolism

what happens to kidney function with aging?

decreased GFR and drug elimination

why can serum creatinine be misleading in older adults?

less muscle mass may keep creatinine "normal"

what should be checked instead of relaying only on creatinine?

GFR/eGFR

what happens to the blood brain barrier with aging

become more permeable

what CNS effects become more common in older adults?

confusion dizziness sedation falls

why are older adults prone to orthostatic hypotension

blunted compensatory reflexes

what medication class commonly causes orthostatic hypotension

antihypertensives

what medication class increases GI bleeding risk

NSAIDs

what medication class increases bleeding risk

anticoagulants and antiplatelets

what is polypharmacy

taking 5+ medications or more medications than necessary

what risks are associated with polypharmacy

falls, delirium, interactions, adverse reactions, hospitalizations

what tool identifies potentially inappropriate medications in older adults

BEERS criteria

what does the BEERS criteria help identify

drugs to avoid, dose adjustments and risky interactions

what is the nurses role regarding BEERS criteria?

advocate for safer medication choices

what is medication reconcilliation?

reviewing all prescription, OTC and herbal medications

why should older adults use one pharmacy

better monitoring for interactions and duplicate therapy

what should older adults bring to every appointment?

updated medication list

what OTC trend increases medication risks in older adults

frequent use of OTC medications and supplements

what may new confusion indicate in an older adult

adverse drug effect

what adherence barriers are common in older adults

memory issues, cost, vision problems, hearing problems, complex schedules

what intervention helps with memory related medication issues

pill organizers and caregiver assistance

what teaching materials work best for older adults?

larger print, high contrast east to read materials

how should nurses communicate with older adults

clearly, respectfully, face to face

what is elderspeak

patronizing or infantilizing communication that should be avoided