special populations

who are they

older adults, pregnant individuals, breastfeeding people, and pediatrics

older adults

• absorption

• reduced absorption. = delayed drug response

older adults

• distribtion

• increased fat - prolongs effects of lipid-soluble drugs

older adults

• metabolism

• reduced liver metabolism - prolonged half-life and response

• more drugs enter systemic circulation. -higher bioavability

excretion

• decreased renal function - drug accumulation and risk for toxicity

• reduced renal flow

older adults

• pharmacodynamics

• increased intensity, more common ADRs

• use drugs with low TI

• low medication adherence

older adults

• pharmcotherapy

• increase half-life

• polypharmacy. -risk of drug interactions

beer’s criteria

inappropriate medications for older adults

older adults

• medication safety

• start with low doses, regularly review meds, and monitor renal and hepatic function

• adherence barriers: cost, cognition

• weight loss, bowel changes

pregnancy

• absorption

• prolongs drug absorption

• increased gastric pH

pregnancy

• distribution

• dilutes drug concentration - may need higher doses

• increased body fat: prolongs effect of lipid-soluble drugs

pregnancy

• metabolism

• increase hepatic metabolism: faster metabolism

pregnancy

• elimination

• increased renal blood flow and GFR: lower drug concentrations

pregnancy

• pharmacodynamic

• may have reduced effects

• increased intensity/ sensitivity

• susceptibile to ADRs

pregnancy:

• pharmacotherapy

• increased blood volume

• can transfer to placenta (lipid-soluble, small molecules can cross placenta more easily)

• low effective drug to reduce fetal exposure

pharmacokinetics during lactation

• can pass through diffusion

• use drugs low in lipid solubility and high protein binding

• sedation, bowel changes

peds

• absorption

delays in absorption

peds:

• distribution

• higher body water and lower fat in infants

• greater access to CNS

peds:

-metabolism

• slower drug metabolism - prolonged half-life

peds

• elimination

• prolonged drug elimination

peds

• pharmcodynamic

• increased sensitivities

• effects vary based on age group

• increased risk of ADRs

• weight-based dosing

peds

• med safety

• get accurate dose

• double check high-risk med

• educate caregiver

• prefer liquids, IM when needed