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Drug action across the life span, Chapter 3

Chapter 3

AB
What are common terms used to refer to individuals of different ages up to 5 years old?Fewer than 38 weeks=premature, 0-1 months=newborn or neonate, 1-24 months=infant or baby, 1-5 years=young child
What is the meaning of gender-specific medicine?is a new area of pharmacology that studies the differences in the response of females and males to prescribed drugs.
What are the underlying rationales for the erratic absorption of intramuscular (IM) drugs in both the neonate and the geriatric population?are differences in muscle mass and blood flow to muscles and muscular inactivity in the bedridden patient.
What is passive diffusion?is the most common mechanism associated with drug absorption. It requires no cellular energy and involves the movement of a drug from an area of high concentration to an area of low concentration.
What is carrier-mediated diffusion?or facilitated transport of diffusion, occurs when the drug molecules combine with a carrier substance such as an enzyme or other protein. (glucose combining with insulin)
What is active transport?involves the movement of drug molecules from an area of low concentration to an area of high concentration. This process requires cellular energy to accomplish the movement.
What are the two factors that influence drug absorption from the GI tract?Passive diffusion and gastric emptying time influence the absorption of drugs in the intestinal tract. Both are dependent on pH.
What is the gastric pH in a premature infant?6-8
What is the pH for a newborn?6-8; decreases to 2-4 in 24 hours
What is the pH for an infant?1-3
What is the ph for an adult?1-3
What is the ph for and elder?pH is increased due to decreasing number of acid-secreting cells
What does gastric emptying time in a premature infant, adult, and elder have in common?they have slower gastric emptying time, therefore, the drug is in contact with the absorption tissue longer. This may result in more absorptive and a higher serum concentration of the drug in the blood
What does hydrolysis mean?is the chemical alteration or decomposition of a compound with water.
In the newborn, what factor affects the absorption of drugs during the process of hydrolysis?In an infant, the absence of enzymes needed for hydrolysis of certain drugs influences the ability of the drug to be absorbed.
If gastric emptying time increases, what happens to the speed of absorption of a drug?the faster the gastric emptying time, the less time the drug has to be absorbed; therefore drug absorption is decreased.
What is the purpose of perfoming therapeutic drug monitoring?Assays measure blood levels of specific drugs, providing a means to identify needed dosage adjustments.
What effect does the route of drug administration have on drug absorption?is affected by: dosage form, route, solubility of the drug, GI function, the condition of the absorptive surface, blood flow to and from the site.
What are the accurate methods of measuring oral liquid medications?use medicine cups, droppers, provided with a specific medication, or oral syringes to measure liquid forms of oral medications accurately
What nursing actions are appropriate when "off label use" of medications is prescribed?"off-label use" of medications is legal; however nurses should check reliable references or with the pharmacist for further information. In all cases, monitor the patient carefully for side effects or adverse effects whenever the medicine is administered.
Why is transdermal absorption of a drug in an elder difficult to predict?there is decreased dermal thickness that may increase drug absorption; however there may be drying, wrinkling, and decreased hair follicles that decrease absorption. There is often decreased cardiac output, which results in decreased blood flow to the tissues (decreased tissue perfusion), which results in decreased drug absorption.
What factors affect drug distribution?is dependent on pH, body water concentration (ICF, ECF and total body water) presence & quantity of fat tissue, protein binding, cardiac output,and regional blood flow.
Who has the highest % of total body water, preemie, infant, 1 yr old, male adultpreemie! younger the higher % of total body water
What effect will a higher % of total body water have on drug absorption?means drugs that are water-soluable will be more rapidly distributed and the individual may require a higher dose of these drugs. Fat-soluable drugs would be poorly absorbed.
What is lipid-soluable?have an affinity for fat tissue in the body and will often have a longer half-life.
What is water-soluable?have an affinity for body fluids and are quickley absorbed and excreted through the kidneys; water soluable drugs often have a shorter half-life.
What is protein binding?occurs when a drug binds to proteins in the body, such as albumin. When "bound", the drug is not "free" or actively available for use at the receptor sites for action
What happens to the concentration of albumin in the body after age 40?total albumin concentration decreases after age 40, while other proteins increase. This results in an increase in unbound drug making more free drug available for action and metabolism.
What happens to the rate of drug metabolism in the elderly?the number of functioning hepatic cells and the blood flow decreases with aging, resulting in slower drug metabolism. As drug metabolism decreases, drug doses must be reduced to prevent accumulation of the drug, producing toxicity.
How functional is the renal filtration system of perterm infants and of full-term newborns when compared to that of an adult?at birth, preterm infants have approximately 15% of the renal capacity of an adult and full term infants have approximately 35%.
What effect do age and renal function have on drug dosages?drug doses must be adjusted so an adequate, therapeutic serum blood concentration is maintained. Increased age and decreased renal function often require a reduced dosage.
What test is used as the best predictor to estimate renal function in the elderly?the urine creatinine test is used to estimate renal function in the elderly.
What is polypharmacy?is the use of multiple drugs concurrently (at the same time) multiple pharmacies/doctors
What is the safest method of initiating newly prescribed medications to a geriatric patient?drug dosage should be initiated at 1/3 to 1/2 the normal adult dose and whenever available, therapeutic drug monitoring should be completed.
What are the principles of drug administration that are specifically applicable to a pregnant patient?take a drug history of all prescribed meds and OTC meds and "street drugs" being taken. Ask specifically about any herbal remedies or nutritional supplements being taken, ask about the use of alcohol, tobacco, herbal products during pregnancy


Pamela Sue

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