During what trimester is a pregnant woman most at risk for adverse drug reactions with
potential long term consequences?
1st trimester (fetus most at risk d/t rapid growth)
What is BEERS criteria?
Recommendations of medications inappropriate for elderly (65 and older), prescriber
ultimately decides
What is the CYP450 (cytochrome P450)
liver enzyme system where medications are metabolized, can either be inducers or
inhibitors and create drug-drug interactions
CYP450 inducers
Speed up metabolism of drugs (drug is cleared faster), drug has lesser effect (decrease
blood levels of drug), elevate CYP450 enzymes
Physiological changes during pregnancy that impact pharmacodynamics and
pharmacokinetic properties of drugs?
increase glomerular filtration rate leads to increase durg excretion
increase hepatic metabolism
decrease tone and motility of bowel
increase drug absorption
Examples of medications that can be teratogenic
Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones, vitamin A in
large doses, some anticoagulants, and hormonal medications such as diethylstilbestrol
(DES).
How is absorption of intramuscular medications different in neonates?
slow and erratic due to low blood flow in muscles first few days of life
Why is absorption of medication in the stomach increased in infancy?
delayed gastric emptying
,Some medications that should be avoided in the pediatric patient?
glucocorticoids, discoloration of developing teeth with tetracyclines, and kernicterus with
sulfonamides, levofloxacin (antibiotics)
aspirin (Severe intoxication from acute overdose)
what should be included in medication administration patient education?
dosage size and timing
route and technique of administration
duration of treatment
drug storage
nature and time course of desired responses
nature and time course of adverse responses
finish taking antibiotic
What are some things that put the elderly patient at higher risk for adverse drug
reactions?
reduced renal function
polypharmacy (the use of five or more medications daily)
greater severity of illness
presence of comorbidities
use of drugs that have a low therapeutic index (e.g., digoxin)
increased individual variation secondary to altered pharmacokinetics
inadequate supervision of long-term therapy
poor patient adherence
How can healthcare providers decrease likelihood of an elderly patient experiencing an
adverse drug reaction?
obtaining a thorough drug history that includes over-the-counter medications
considering pharmacokinetic and pharmacodynamics changes due to age
monitoring the patient's clinical response and plasma drug levels
, using the simplest regimen possible
monitoring for drug-drug interactions and iatrogenic illness
periodically reviewing the need for continued drug therapy
encouraging the patient to dispose of old medications
taking steps to promote adherence and to avoid drugs on the Beers list
How can we promote medication adherence with elderly patients?
simplifying drug regimens
providing clear and concise verbal and written instructions
using an appropriate dosage form
clearly labeling and dispensing easy-to-open containers
developing daily reminders
monitoring frequently
affordability of drugs
support systems
Why do nitrates need to be taken no later than 4 PM?
Need nitrate free interval so tolerance doesn't develop
Nine factors that impact outcome of medication?
Gender and race
Genetics and pharmacogenomics
Variability in absorption
placebo effect
Tolerance
patho
age
bodyweight
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