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Tuesday, February 24, 2009

Pediatric and Geriatric Pharmacology


Pediatric and Geriatric Nursing Pharmacology lecture notes

Pediatric Pharmacology
Gastric pH alkaline at birth and does not reach adult acidity until age 1-3y
Gastric emptying prolonged in neonates
Greater GI surface area can increase absorption in infants and young children
Topicals more readily absorbed due to thinner, more porous skin in infants and young children

Pediatric Pharmacology
Children under 2y require higher doses of water soluble medications and lower doses of lipid soluble medications
Infants have less albumin and need less of highly protein bound drugs

Pediatric Pharmacology
Infants have slower metabolic rate but then this speeds up in children
First pass effect can be problematic – sometimes resulting in oral route being bypassed in favor of another route (ex. Rectal)
Reduced function until about 9m of age
Can be reduced again in adolescence

Pediatric Pharmacology
Pediatric Medication Administration
Dosing based on:
Weight (kg)
Body surface area (BSA)
Consider developmental age when administering medications
Use topical analgesics prior to painful injections

Drug Therapy in Geriatric Patients
Elderly patients constitute 12% of the population but use 31% of the nation’s prescribed drugs

Drug Complications in the Elderly
Contributing factors to drug complications are
Altered pharmacokinetics
Multiple illnesses
Multiple drug therapy/polypharmacy
Poor compliance

Altered Pharmacokinetics

Geriatric Pharmacology
Absorption is slowed
Distribution changes due to loss of water and increase in adipose tissue
Metabolism is slowed due to diminished liver function
Excretion is slowed due to diminished kidney function and decreased cardiac output
Decreased hepatic metabolism
Renal Excretion
In the elderly, the proper index of renal function is creatinine clearance, not serum creatinine
Reduced renal excretion

Adverse Drug Reactions
Seven times more likely in elderly
16% of hospital admissions
50% of all medication-related deaths

Polypharmacy – the use of multiple drugs together
Contributes to:
Renal dysfunction
Liver dysfunction

Monitoring for Adverse Drug Reactions
Take thorough drug history
Low dosing
Plasma level monitoring
Simplest regimen
Review drug treatment schedule

Promoting Compliance
Simple drug regimen
Verbal and written instructions
Appropriate dosage form
Clear labeling
Daily reminders
Support system
Frequent monitoring

Geriatric Pharmacology
Effects of Selected Drugs in Older Adults

Hypnotics / Sedatives
More sensitive to medication – need lower doses
Diuretics and Anti-hypertensives
More prone to electrolyte disturbances, orthostatic hypotension
Cardiac Glycosides
Lower dose needed due to reduced renal function
Highly-protein bound – bleeding problems can occur as elderly often have less protein reserves

Geriatric Pharmacology
Effects of Selected Drugs in Older Adults
Dose may need to be reduced due to decreased renal function
Gastrointestinal drugs
Laxative use can cause electrolyte disturbances
Cimetidine (Tagamet) – many drug interactions
TCAs less useful – strong anticholinergic properties

Patient Education
Medication generic and trade names
Diet changes
Side Effects
Cultural / Home / Work Considerations

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Welcome to my blog!I am a nursing student in an accelerated BSN nursing program. This is where i review my nursing classes by putting down nursing lecture notes. I hope you find it useful and thanks for visiting.