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Special Populations.rtf

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NURS 2050
Cynthia Barkhouse Mckeen

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Special Populations What influences the kind of response produced by medications? o Age o Race and ethnicity o Gender o Genetics o Body weight and composition o Pathophysiology o Kidney disease o Liver disease o GI disorders Pediatrics * Children are not just small adults when it comes to prescribing medications * More sensitive * More individual variation KNOWLEDGE GAP!!! * Few studies to evaluate safety and efficacy * 2/3 of drugs used in children have not been tested in the pediatric population Pharmacokinetics: Neonates and Infants Infants have five immature pharmacokinetic processes: o Absorption o Distribution  Protein binding  Blood-brain barrier o Hepatic Metabolism o Renal Excretion Examples of PK differences -absorption * Gastric emptying is prolonged and irregular * Adult values at 6-8 months * Gastric acidity (very low 24 hours after birth) * Adult values at 2 years * IM injections * Neonates – slow and erratic * Infancy – becomes rapid (more than adults) * Skin absorption * Young and thin – absorption is greater and risk of toxicity Hepatic Metabolism * Newborns – very low (risk of toxicity with medications with hepatic metabolism) * Capacity of the liver increases after 1 month and reaches adult levels a few months later * Young children tend to metabolize drugs faster than adults – elevated until 2 yo and then gradually declines * Reaches that of adults at puberty Unique challenges to administration and adherence in pediatrics * Dosage forms * Pills – can they swallow? can you crush? * Other options? * Measuring * Taste * Administration * Dosing * Check, check and recheck * mg/kg or mg/m * Spoons Systematically Bias Dosing of Liquid Medications * Annals of Internal Medicine 2010; 152:66-7 Aging Populations – PK changes * Absorption * Decreased absorption rates – resulting in delayed response * Distribution * Increased body fat * Decreased lean mass * Decreased total body water * Decreased serum albumin * Metabolism * Decreased hepatic blood flow * Decreased hepatic mass * Decreased activity of some enzymes Aging Populations – PK changes * Elimination (renal) * Decreased renal blood flow * Decreased GFR * Decreased tubular secretion * Decrease in the number of nephrons ****Drug accumulation is the reason for mostADR in the elderly**** ↑ t ½ Aging Population – PD changes * “sensitive” to medications * Changes in receptors * Decrease or increase – perhaps
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