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Pharmacology Ch. 3
Chapter 3 Life Span Considerations
12
Pharmacology
Undergraduate 3
08/31/2013

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Term

Active transport

Definition
The active (energy-requiring) movement of a substance between different tissues via biomolecular pumping mechanisms contained within cell membranes.
Term

Diffusion

Definition
the passive movement of a substance (e.g., a drug) between different tissues from areas of higher concentration to areas of lower concentration.
Term

Elderly

Definition
Pertaining to a person who is 65 years of age or older.
Term

Neonate

Definition
Pertaining to a person younger than 1 month of age; newborn infant.
Term

Nomogram

Definition
A graphic tool for estimating drug dosages using various body measurements.
Term

Pediatric

Definition
Pertaining to a person who is 12 years of age or younger.
Term

Polypharmacy

Definition
The use of many different drugs concurrently in treating a patient, who often has several health problems.
Term

Three factors that contribute to the safety or potential harm of drugtherapy during pregnancy

Definition
  1. Drug properties- impact drug transfer to the fetus include the drug's chemistry, dosage, and concurrently administered drugs.
  2. Fetal gestational age- an important factor in determining the potential for harmful drug effects to the fetus. The fetus is at greatest risk for drug-induced developmental defects during the first trimester of pregnancy. During the last trimester the greatest percentage of maternally absorbed drug gets the fetus.
  3. Maternal factors- Any change in the mother's physiology that could impact the pharmacokinetic characteristics of drugs can affect the amount of drug to which the fetus may be exposed.
Term

Pregnancy safety categories

Definition
  • Category A- Studies indicate no risk to human fetus.
  • Category B- Studies indicate no risk to animal fetus; information for humans is not available.
  • Category C- Adverse effects reported in animal fetus; information for humans is not available.
  • Category D- Possible fetal risk in humans reported; however, consideration of potential benefit vs. risk may, in selected cases, warrant use of these drugs in pregnant women.
  • Category X- Fetal abnormalities reported and positive evidence of fetal risk in human available from animal and/or human studies. These drugs should not be used in pregnant women.
Term

Pharmacokinetic changes in the neonate and pediatric patient

Definition
  • Absorption
    • Gastric pH is less acidic because acid-producing cells in the stomach are immature until approximately 1 to 2 years of age.
    • Gastric emptying is slowed because of slow irregular peristalsis.
    • First-pass elimination by the liver is reduced because of the immaturity of the liver amd reduced levels of microsomal enzymes
    • Intramuscular absorption is faster and irregular.
  • Distribution
    • Total body water is 70% to 80% in full-term infants, 85% in premature newborns, and 64%in children 1 to 12 years of age.
    • Fat content is lower in young patients because of greater total body water.
    • Protein binding is decreased because of decreased production of protein by the immature liver.
    • More drugs enter the brain because of an immature blood-brain barrier.
  • Metabolism
    • Levels of microsomal enzymes are decreased because the immature liver has not yet started producing enough.
    • Older children may have increased metabolism and require higher dosages once hepatic enzymes are produced.
    • Many variables affect metabolism in premature infants, infants, and children, including the status of liver enzyme production, genetic differences, and substances to which the mother was exposed during pregnancy.
  • Excretion
    • Glomerular filtration rate and tubular secretion and resorption are all decreased in young patients because of kidney immaturity.
    • Perfusion to the kidneys may be decreased, which results in reduced renal function, concentrating ability, and excretion of drugs.
Term

Prescribing cascade

Definition
This is where a provider prescribes a medication to treat the adverse effects of another medication.
Term

Pharmacokinetic changes the Elderly Patient

Definition
  • Absorpton
    • Gastric pH is less acidic because of a gradual reduction in the production of hydrochloric acid in the stomach.
    • Gastric emptying is slowed because of a decline in smooth muscle tone and motor activity.
    • Movement throughout the gastrointestinal (GI) tract is slower because of decreased muscle tone and motor activity.
    • Blood flow to the GI tract is reduced by 40% to 50% because of decreased cardiac output and decreased perfusion.
    • The absorptive surface area is decreased because the aging process blunts and flattens villi.
  • Distribution
    • In adults 40 to 60 years of age, total body water is 55% in males and 47% in females; in those over 60 years of age, total body water is 52% in males and 46% in females.
    • Fat content is increased because of decreased lean body mass.
    • Protein (albumin) binding sites are reduced because of decreased production of proteins by the aging liver and reduced protein intake.
  • Metabolism
    • The leves of microsomal enzymes are decreased because the capacity of the aging liver to produce them is reduced.
    • Liver blood flow is reduced by approximately 1.5% per year after 25 years of age, which decreases hepatic metabolism.
  • Excretion
    • Glomerular filtration rate is decreased by 40% to 50%, primarily because of decreased blood flow.
    • The number of intact nephrons is decreased.
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