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 cont’d • FDA classifies drugs acc’d to safety during pregnancy—see page 36 • Teratogenic effects occur in first trimester • More drug passes to child during last trimester • Drugs do pass thru breast milk acc’d to their fat solubility and concentration, but in reduced amounts

4. Maternal cont’d • 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. • Children’s dosages are ordered acc’d to wt or BSA—more accurate than age • Dosage should always be checked against safe range recommended by manufacturer.

6. Peds—Pharmacokinetic 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 cont’d • 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 name—may 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 cont’d • Toddlers (1-3) have biggest negative reaction and usually have to be restrained regardless of med route • Preschoolers (3-6) can go either way—may 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 cont’d • 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 < 1). Don’t put in formula or essential food item.

11. Tips cont’d • 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 > 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 cont’d • 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 cont’d • 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 skill—require return demo • Have Poison Control number in plain view and any other contact numbers • Include SO when doing education