NURS 5334 ADVANCED
PHARMACOLOGY MODULE 2
QUESTIONS & ANSWERS
physiologic changes during pregnancy & drug impact - ANSWER- 3rd trimester = renal
blood doubles, renal excretion accelerated
- tone and mobility of bowel decreases -> prolongation of drug effects
placental drug transfer - ANSWERall drugs can cross the placenta, some cross more
easily than others
adverse reactions during pregnancy - ANSWERcan adversely affect both pregnant pt
and fetus
- heparin -> osteoporosis
- prostaglandins -> stimulate uterine contraction
- some pain relievers can be used during delivery can cause respiratory depression in
baby
teratogenesis birth defects - ANSWERgross malformations = cleft palate, clubfoot,
hydrocephalus
neurobehavioral & metabolic anomalies
3 stages of teratogenesis development - ANSWER1. conception through week 2
2. embryonic period week 3-8 = gross malformations
3. fetal period week 9-delivery = functions disrupted w/ teratogen exposure
embryonic stages - ANSWER
identification of teratogens - ANSWERdifficult to identify, 3 criteria must be met:
1. The agent must be present during the critical stage of development
2. The agent produces a particular pattern of birth defects in animal studies.
3. The agent crosses the placenta and there is a dose-response relationship.
responding to teratogen exposure - ANSWERDetermine when the drug was taken
Determine when the pregnancy began
-Weeks 3-8 (organogenesis) is most crucial time
Determine type of malformation expected
Conduct 2 US and consult FDA to determine severity
,how to decrease risk of drug effects during breastfeeding - ANSWER- take drugs
immediately after breastfeeding
- avoid drugs w/ long half-lives
- choose drugs that tend to be excluded from milk, least likely to affect infant
- avoid hazardous drugs
pediatric response to drugs - ANSWER- more sensitive to drugs
- greater individual variation
- sensitivity d/t organ system immaturity
- increased risk for adverse rxns
determining the intensity of duration of drug response in neonates & infants - ANSWER-
elevated drug levels = more intense response
- delayed elimination = prolonged response
- immaturity of organs = risk for both^
comparison of plasma drug levels in adults and infants - ANSWER
increased sensitivity in infants caused by immature state of... - ANSWERabsorption,
protein binding of drugs, BBB, hepatic metabolism, renal drug excretion
infant absorption: oral administration - ANSWERprolonged and irregular gastric
adult function at 6-8 months
infant absorption: gastric acidity - ANSWER- very low 24 hours after birth
- does not reach adult values for 2 years
- low acidity = absorption of acid-labile drugs is increased
infant absorption: intramuscular admin - ANSWERslow, erratic, delayed absorption as
results of low blood flow in 1st few days of life
in early infancy, absorption of IM drugs more rapid than neonates & adults
infant absorption: transdermal - ANSWERmore rapid & complete for infants than older
children & adults
- stratum corneum of infant's skin is thin
- blood flow to skin is greater in infants than older patients
- infants increased risk for toxicity from topical drugs
infant distribution: BBB - ANSWER- not fully developed at birth
- drugs have easy access to CNS
- infants especially sensitive to drugs that affect CNS function
- dosage should be reduced for drug actions outside the CNS if those drugs are capable
of producing toxicity as a side effect
, infant hepatic metabolism - ANSWER- drug-metabolizing capability of newborns is low
- liver's capability to metabolize drugs increases fast @ 1mo
- complete liver maturation occurs at 1yr
infant renal excretion - ANSWER- low renal blood flow, glomerular filtration, & active
tubular secretion
- drugs eliminated by renal excretion must have reduced dosing and/or longer dosing
intervals
- adult level renal function occurs at 1yr
pharmacokinetics in children - ANSWERmetabolize drugs faster than adults till 2yrs,
then gradual decline
sharp decline at puberty
may need to increase or decrease interval between doses
adverse drug reactions in children - ANSWER- glucocorticoids -> growth suppression
- tetracyclines -> discoloring of teeth
- sulfonamides -> kernicterus
- fluoroquinolones -> musculoskeletal d/o's
- SSRIs - > black box increased SI
- OTC cough and cold meds not recommended in kids <2yrs
dosage determination in children - ANSWERchild's BSA x adult dosage/ 1.73m2 = child
dose
older adults: altered pharmacokinetics - ANSWERmore sensitive to drugs than younger
adults & w/ greater variation in pharmacokinetics
multiple & severity of illness, multiple pathologies
multiple-drug therapy (excessive prescribing)
poor adherence
older adults: absorption - ANSWER- rate of absorption slows w/ age
- delayed gastric emptying & reduced splanchnic blood flow
older adults: distribution - ANSWER- increased body fat % (storage depot for lipid-
soluble drugs)
- decreased lean body mass %
- decreased total body water (distributed in smaller volume, concentration increased &
effects more intense)
- reduced concentration of serum albumin -> decreased protein binding of drugs &
increased levels of free drugs
PHARMACOLOGY MODULE 2
QUESTIONS & ANSWERS
physiologic changes during pregnancy & drug impact - ANSWER- 3rd trimester = renal
blood doubles, renal excretion accelerated
- tone and mobility of bowel decreases -> prolongation of drug effects
placental drug transfer - ANSWERall drugs can cross the placenta, some cross more
easily than others
adverse reactions during pregnancy - ANSWERcan adversely affect both pregnant pt
and fetus
- heparin -> osteoporosis
- prostaglandins -> stimulate uterine contraction
- some pain relievers can be used during delivery can cause respiratory depression in
baby
teratogenesis birth defects - ANSWERgross malformations = cleft palate, clubfoot,
hydrocephalus
neurobehavioral & metabolic anomalies
3 stages of teratogenesis development - ANSWER1. conception through week 2
2. embryonic period week 3-8 = gross malformations
3. fetal period week 9-delivery = functions disrupted w/ teratogen exposure
embryonic stages - ANSWER
identification of teratogens - ANSWERdifficult to identify, 3 criteria must be met:
1. The agent must be present during the critical stage of development
2. The agent produces a particular pattern of birth defects in animal studies.
3. The agent crosses the placenta and there is a dose-response relationship.
responding to teratogen exposure - ANSWERDetermine when the drug was taken
Determine when the pregnancy began
-Weeks 3-8 (organogenesis) is most crucial time
Determine type of malformation expected
Conduct 2 US and consult FDA to determine severity
,how to decrease risk of drug effects during breastfeeding - ANSWER- take drugs
immediately after breastfeeding
- avoid drugs w/ long half-lives
- choose drugs that tend to be excluded from milk, least likely to affect infant
- avoid hazardous drugs
pediatric response to drugs - ANSWER- more sensitive to drugs
- greater individual variation
- sensitivity d/t organ system immaturity
- increased risk for adverse rxns
determining the intensity of duration of drug response in neonates & infants - ANSWER-
elevated drug levels = more intense response
- delayed elimination = prolonged response
- immaturity of organs = risk for both^
comparison of plasma drug levels in adults and infants - ANSWER
increased sensitivity in infants caused by immature state of... - ANSWERabsorption,
protein binding of drugs, BBB, hepatic metabolism, renal drug excretion
infant absorption: oral administration - ANSWERprolonged and irregular gastric
adult function at 6-8 months
infant absorption: gastric acidity - ANSWER- very low 24 hours after birth
- does not reach adult values for 2 years
- low acidity = absorption of acid-labile drugs is increased
infant absorption: intramuscular admin - ANSWERslow, erratic, delayed absorption as
results of low blood flow in 1st few days of life
in early infancy, absorption of IM drugs more rapid than neonates & adults
infant absorption: transdermal - ANSWERmore rapid & complete for infants than older
children & adults
- stratum corneum of infant's skin is thin
- blood flow to skin is greater in infants than older patients
- infants increased risk for toxicity from topical drugs
infant distribution: BBB - ANSWER- not fully developed at birth
- drugs have easy access to CNS
- infants especially sensitive to drugs that affect CNS function
- dosage should be reduced for drug actions outside the CNS if those drugs are capable
of producing toxicity as a side effect
, infant hepatic metabolism - ANSWER- drug-metabolizing capability of newborns is low
- liver's capability to metabolize drugs increases fast @ 1mo
- complete liver maturation occurs at 1yr
infant renal excretion - ANSWER- low renal blood flow, glomerular filtration, & active
tubular secretion
- drugs eliminated by renal excretion must have reduced dosing and/or longer dosing
intervals
- adult level renal function occurs at 1yr
pharmacokinetics in children - ANSWERmetabolize drugs faster than adults till 2yrs,
then gradual decline
sharp decline at puberty
may need to increase or decrease interval between doses
adverse drug reactions in children - ANSWER- glucocorticoids -> growth suppression
- tetracyclines -> discoloring of teeth
- sulfonamides -> kernicterus
- fluoroquinolones -> musculoskeletal d/o's
- SSRIs - > black box increased SI
- OTC cough and cold meds not recommended in kids <2yrs
dosage determination in children - ANSWERchild's BSA x adult dosage/ 1.73m2 = child
dose
older adults: altered pharmacokinetics - ANSWERmore sensitive to drugs than younger
adults & w/ greater variation in pharmacokinetics
multiple & severity of illness, multiple pathologies
multiple-drug therapy (excessive prescribing)
poor adherence
older adults: absorption - ANSWER- rate of absorption slows w/ age
- delayed gastric emptying & reduced splanchnic blood flow
older adults: distribution - ANSWER- increased body fat % (storage depot for lipid-
soluble drugs)
- decreased lean body mass %
- decreased total body water (distributed in smaller volume, concentration increased &
effects more intense)
- reduced concentration of serum albumin -> decreased protein binding of drugs &
increased levels of free drugs
