adams ch08 lecture

PHARMACOLOGY FOR NURSESPHARMACOLOGY FOR NURSESA Pathophysiological ApproachA Pathophysiological Approach

FOURTH EDITIONFOURTH EDITION

Copyright © 2014, © 2011, © 2008 by Pearson Education, Inc.All Rights Reserved

CHAPTER

Drug Administration Throughout the Life Span

8

Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban

Growth – Progressive Increase in Growth – Progressive Increase in Physical SizePhysical Size

• Stages of growth and physical development

• Predictable sequence


DevelopmentDevelopment

• Development refers to functional changes in physical, psychomotor, and cognitive capabilities.– Psychomotor and cognitive development

tend to be more variable.


Providing Optimum CareProviding Optimum Care

• Understand normal growth and development

• Recognize deviations from the norm• Address health-pattern impairments


Nursing ConsiderationsNursing Considerations

• Individuality of patients• Age, growth, and development of

patients• Relationship to pharmacokinetics and

pharmacodynamics


Drug Administration During Drug Administration During Pregnancy and LactationPregnancy and Lactation

• Many special considerations must be made.

• How to treat illnesses or medical conditions that existed before the pregnancy with drugs

• Changes occur in endocrine, gastrointestinal, cardiovascular, circulatory, and renal systems.


Changes During PregnancyChanges During Pregnancy

• Absorption of drugs– Abdominal/gastric changes affect

absorption.– Inhaled drugs may be absorbed faster.

• Distribution and metabolism– Changes in cardiac output, plasma

volume, and regional blood flow change distribution and metabolism.

• Drug excretion rates may increase.


TeratogenTeratogen

• A substance, organism, or physical agent to which a fetus is exposed that causes permanent abnormality, retardation, or death

• There are no “absolute” teratogens.


Pregnancy PeriodsPregnancy Periods

• Preimplantation period: weeks 1 to 2 of first trimester– Teratogen either causes death of the

embryo or has no effect.• Embryonic period: weeks 3 to 8

– Period of maximum sensitivity to teratogens


Pregnancy PeriodsPregnancy Periods

• Fetal period: weeks 9 to 40 or until birth– Medications have prolonged duration of

action.


Five Pregnancy Categories of Five Pregnancy Categories of DrugsDrugs

• Developed by FDA– No testing on humans is possible, so

data is sometimes limited.• Categories—A, B, C, D, X• Gives no specific clinical information to

help guide nurses or their patients about a medication's true safety


Pregnancy Category A DrugsPregnancy Category A Drugs

• Studies performed with pregnant women

• No increased risk of fetal abnormalities shown


Pregnancy Category B DrugsPregnancy Category B Drugs

• Animal studies have shown no risk to fetus.

• No studies done with pregnant women


Pregnancy Category C DrugsPregnancy Category C Drugs

• Animal studies have shown a risk to fetus.

• No studies done with pregnant women


Pregnancy Category D DrugsPregnancy Category D Drugs

• Risk to fetus shown• Benefits outweigh risk.


Pregnancy Category X Pregnancy Category X Drugs—ContraindicatedDrugs—Contraindicated

• Studies done with animals or pregnant women

• Fetal abnormalities shown


Drugs Secreted into Breast MilkDrugs Secreted into Breast Milk

• Fortunately few instances of harm to infant

• Dangerous drugs usually have safe alternatives.

• Drugs that are ionized, water soluble, or bound to plasma proteins are less likely to enter breast milk.


Table 8.1 Current FDA Pregnancy Category Ratings with Examples

continued on next slide


Table 8.1 (continued) Current FDA Pregnancy Category Ratings with Examples


Factors That Affect Drug Exposure Factors That Affect Drug Exposure Through LactationThrough Lactation

• Time between drug administration and breast feeding

• Mother's use of illicit drugs• Amount of drug administered• Amount that reaches fetus tissue• Infant's ability to metabolize drug


Table 8.2 Current FDA Pregnancy Category Ratings with Examples


Recommendations for Drug Use Recommendations for Drug Use During LactationDuring Lactation

• Drugs with shorter half-lives are preferable.

• Drugs with long half-lives should be avoided.

• Drugs with high protein-binding ability should be selected.

• All OTC herbal products and dietary supplements should be avoided.


Patient EducationPatient Education

• Nurse should place focus on drug education of pregnant or lactating mother.

• Thoroughly informed of risks to self and child


Prenatal Stage and Prenatal Stage and PharmacotherapyPharmacotherapy

• Only when benefits to mother outweigh potential risks to fetus


Infants and PharmacotherapyInfants and Pharmacotherapy

• Birth to first 12 months• Safety of child is primary• Have child ingest all medication;

difficult to estimate how much lost if spit up


Infants and PharmacotherapyInfants and Pharmacotherapy

• Nurse/parent should be aware of special procedures for drug administration.– Example: child should be held and

cuddled while medication is administered.


Figure 8.3 Treating the infant


Toddlers and PharmacotherapyToddlers and Pharmacotherapy

• Period from 1 to 3 years• Proper storage of drugs; no toddler

access to medications• Short, concise explanations; provide

comfort after• Oral drugs can be mixed with foods like

jam or syrup.• Injections are given at specific locations

with toddlers.


Preschoolers and Preschoolers and PharmacotherapyPharmacotherapy

• 3 to 5 years of age• Safe storage = out of reach• Can begin to assist with medications• Brief explanation followed by

administration• Mix oral drugs with food or flavored

beverages


School-Age Children and School-Age Children and PharmacotherapyPharmacotherapy

• Most children healthy in this period• Offer longer, more detailed

explanations• Praise cooperation• Offer choices when appropriate


Figure 8.4 Treating the younger school-age child


Adolescents and Adolescents and PharmacotherapyPharmacotherapy

• Need understanding and respect• Educate about

– Hazards of tobacco and substance abuse

– Sexual intercourse– Eating disorders


Adolescents and Adolescents and PharmacotherapyPharmacotherapy

• Provide important medication information

• Allow time for questions• Need privacy and control


Young Adults and Young Adults and PharmacotherapyPharmacotherapy

• Minimal need for prescription drugs unless chronic diseases or immune-related conditions exist

• Positive medication compliance• Educate about substance abuse and

treatment of sexually transmitted diseases


Middle-Aged Adults and Middle-Aged Adults and PharmacotherapyPharmacotherapy

• Changes begin around 45 years of age• Prescribed drugs for stress-related

illnesses• Numerous life transitions• Positive lifestyle changes could prevent

drug therapy


Figure 8.5 Treating the middle-aged adult


Illnesses Requiring Drug Therapy Illnesses Requiring Drug Therapy for Late Middle-Age Adults for Late Middle-Age Adults

• Cardiovascular disease• Hypertension• Diabetes• Cancer• Obesity


Older Adults and Older Adults and PharmacotherapyPharmacotherapy

• Take multiple medications concurrently, or polypharmacy, is common.

• Some predictable ailments, but much variability remains

• More adverse drug events in geriatric patients

• Reminder aids for administration may be used.


Older Adults and Older Adults and PharmacotherapyPharmacotherapy

• Maintain independence and dignity• Reminder aids for drug administration

may be beneficial.


Figure 8.6 Treating the older adult


Absorption of Drugs Slower Absorption of Drugs Slower in Older Adultsin Older Adults

• Diminished gastric motility• Decreased blood flow to digestive

organs• Increased gastric pH


Distribution Diminished in Older Distribution Diminished in Older AdultsAdults

• Increased body fat• Reduced plasma level• Less body water


Distribution Diminished in Older Distribution Diminished in Older AdultsAdults

• Liver produces less albumin:– Decreased plasma protein-binding

ability– Increased levels of free drugs

Increases potential for drug–drug interaction

• Decreased cardiac output


Metabolism Reduced in Older Metabolism Reduced in Older AdultsAdults

• Reduced first-pass metabolism• Decreased production of liver enzymes• Plasma level elevated• Increases half-life of many drugs• Tissue concentrations increased


Excretion Reduced in Older AdultsExcretion Reduced in Older Adults

• Reduced renal blood flow• Reduced glomerular filtration rate• Decreased active tubular secretion• Decreased nephron function• Decreased drug excretion for drugs

processed by the kidneys