Developmental Considerations in Pharmacology

1
Developmental Considerations in Pharmacology

• Lilley Chapter 3
• Pharmacology
• Nursing 117

2
Maternal Considerations

• Use of meds is generally discouraged.
• Placental barrier protects against some drugs.
  Transfer across the membrane depends on chemical
  properties of drug and length of time drug stays
  in maternal bloodstream. Usually fetal drug
  levels are between 50-100 of maternal levels.

3
Maternal contd

• FDA classifies drugs accd to safety during
  pregnancysee page 36
• Teratogenic effects occur in first trimester
• More drug passes to child during last trimester
• Drugs do pass thru breast milk accd to their fat
  solubility and concentration, but in reduced
  amounts

4
Maternal contd

• Drugs need during pregnancy include maternal
  vitamins (Hot tx), iron, and folic acid. Folic
  acid is recommended 3-6 months before conception.
• OK drugs during pregnancy include Tylenol,
  anticoags (x last trimester), insulin, antacids,
  H2 blockers, and some types of the following
  antiemetics, asthma meds, antihypertensives,
  antibiotics, and laxatives.

5
Neonatal/Pediatric Considerations

• ¼ of drugs approved for adults have approved
  doses for children
• However, 75 of adult meds are also given to
  children based on clinical studies and approved
  protocols, not FDA approval.
• Childrens dosages are ordered accd to wt or
  BSAmore accurate than age
• Dosage should always be checked against safe
  range recommended by manufacturer.

6
PedsPharmacokinetic Differences

• Immaturity of GI, kidneys, liver, blood-brain
  barrier
• Body fluid to fat ratio is higher
• Absorption slower R/T slower GI transit time,
  higher pH of gastric secretions, irregular
  peristalsis, immature enzyme production
• Topical/transdermal meds absorbed faster R/T
  thinner skin

7
Pharmacokinetic Differences contd

• Distribution affected R/T decreased albumin
  levels, causing more free drug
• Increased metabolism causes increased metabolism
  of drugs
• Excretion affected R/T immature kidney function,
  slowing excretion and increasing the chance for
  toxicity

8
Neonatal/Pediatric Med Administration Tips

• Identify child using wrist band, not by asking
  namemay not know full name, be reluctant to tell
  you, or may want to pretend to be someone else.
• Cooperation will depend on developmental age,
  temperament, previous experiences, degree of
  illness, coping mechanisms, and caregiver support

9
Administration Tips contd

• Toddlers (1-3) have biggest negative reaction and
  usually have to be restrained regardless of med
  route
• Preschoolers (3-6) can go either waymay need
  some element of control in the situation
• School-age and adolescents (6-18) need more info,
  control, and have their fears addressed R/T pain,
  body image, and privacy

10
Tips contd

• Most meds are oral because least invasive, but IV
  route most predictable
• Oral syringe more accurate than spoon
• Place med in buccal area, blow in face, hold nose
  and chin, stroke neck, or use nipple
• Can crush pills unless time-released or
  enteric-coated and put in non-nutritive food (x
  honey lt 1). Dont put in formula or essential
  food item.

11
Tips contd

• Injections are to be given using proper restraint
  to ensure safety.
• Never give injection to sleeping child.
• Injections may be seen as punishment in younger
  children.
• Vastus lateralis is preferred site. No
  dorsogluteal until walking x 1 yr.
• EMLA cream covered with Tegaderm 1-2h before
  administration to numb injection site
• Bandaids and praise are important

12
Adult Considerations

• Most drug information published is based on
  studies done on adults.
• Other considerations are especially highlighted
• Be sure to check drug dosages for safety by
  comparing to drug book.

13
Geriatric Considerations

• Patients gt 65 take at least 30 of all Rxs
• 70 take at least 1-2 drugs/day
• 30 take at least 5 drugs/day with a 36 chance
  of an adverse reaction
• 40 take more than 8 drugs/day with 100 chance
  of interactions. Does not include OTC
• 30 of hospital admissions of older adults are
  for adverse med reactions
• Polypharmacy is term for multiple drug use. May
  be caused from seeing more than 1 MD, or
  overprescribing by 1 MD

14
Geriatrics contd

• Physiologic changes of aging can affect drug
  action
• Of all adverse reactions, most profound are CNS
  and CV systems
• Many adverse reactions could be avoided with slow
  titration to a dosage of 50 of adult dosage

15
Risk Factors with Med Therapy in Older Adults

• Physiologic changes (p. 42 table 3-3)
• Pharmacokinetic changes (p. 42)
• Medications/Conditions (p. 43 table 3-4)
• Polypharmacy and the Elderly (p.46)

16
Tips for Med Administration in Older Adults

• Assess for difficulty reading, opening bottles,
  handling small pills, hearing impairments that
  cause them not to hear all instructions
• Multiple drug regimens may be too complex to
  handle
• Child-proof caps may be too difficult
• Calendars or pill dispensers are helpful

17
Tips for Older Adults contd

• Give water before and after
• Position upright if not contraindicated
• Check with penlight to make sure tablet is not
  stuck
• Give meds last to patients who require extra time
• When giving IMs, assess for adequate muscle mass

18
Med Education for Older Adults

• Give written instructions in larger letters with
  black letters on white background.
• Make chart with med name, amount, time, and
  simple side effects listed
• Have client repeat name of med, what it is for,
  and dosing instructions
• Show how to use pill dispensers or anything that
  requires skillrequire return demo
• Have Poison Control number in plain view and any
  other contact numbers
• Include SO when doing education