Pharmacokinetics in Neonates and Infants

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Questions and Answers

Which adverse drug reaction is specifically associated with Androgens in pediatric patients?

Premature puberty in males (correct)

Tendon rupture

Cartilage erosion

Reye syndrome

What serious condition can aspirin cause in children with viral infections?

Premature puberty

Gray syndrome

Reye syndrome (correct)

Kernicterus

For which class of drugs is growth suppression a potential adverse effect due to prolonged use?

Tetracyclines

Fluoroquinolones

Glucocorticoids (correct)

Phenothiazines

What is an essential consideration when determining dosage for pediatric patients?

Clinical outcome must be monitored for dosage adjustments Signup and view all the answers

What is a primary reason for the increased incidence of adverse drug reactions (ADRs) in older adults?

Reduced renal function leading to drug accumulation Signup and view all the answers

What critical factor must be considered when converting adult drug doses for pediatric use?

Body surface area (BSA) Signup and view all the answers

Which of the following factors significantly contributes to the risk of ADRs in older adults?

Polypharmacy, or treatment with multiple drugs Signup and view all the answers

What is a common symptom of adverse drug reactions in older adults that may complicate diagnosis?

Nonspecific symptoms like dizziness Signup and view all the answers

Which pediatric drug reaction is associated with chloramphenicol?

Gray syndrome Signup and view all the answers

Which adverse effect is notable for sulfonamides in newborns?

Kernicterus Signup and view all the answers

How does delayed gastric emptying affect the absorption of drugs that are absorbed primarily from the stomach?

Enhances absorption Signup and view all the answers

Which of the following could lead to increased variability in drug response in older adults?

Altered pharmacokinetics Signup and view all the answers

What should caregivers be educated about to promote adherence in pediatric patients?

Entire treatment duration Signup and view all the answers

Why might older adults be less comfortable revealing recreational drug use during medical assessments?

Generational taboos in some segments of society Signup and view all the answers

What contributes to the slower and erratic absorption of intramuscular drugs in neonates?

Low blood flow through muscles Signup and view all the answers

Why are infants at increased risk for toxicity from topical drugs?

Enhanced skin absorption Signup and view all the answers

What is a significant consequence of lower protein binding in infants?

Increased concentration of free drugs Signup and view all the answers

At what age do protein-binding capacities in infants reach adult values?

10 to 12 months Signup and view all the answers

What characteristic of the blood-brain barrier in neonates affects drug sensitivity?

High permeability Signup and view all the answers

What happens to the absorption of acid-labile drugs in infants due to gastric acidity levels?

Absorption is increased Signup and view all the answers

What is the effect of irregular gastric emptying on drug absorption?

Unpredictable effect on absorption Signup and view all the answers

What do pharmacokinetic factors in neonates and infants primarily influence?

The concentration of a drug at its site of action Signup and view all the answers

How does drug elimination in infants compare to that in adults?

Drug elimination is delayed in infants Signup and view all the answers

Which of the following pharmacokinetic processes is NOT mentioned as a contributing factor to increased drug sensitivity in infants?

Neural drug metabolism Signup and view all the answers

What significant effect does intravenous drug administration have on infants compared to adults?

Drug levels remain above MEC longer in infants Signup and view all the answers

Why is dosage adjustment for body weight alone insufficient for infants?

Organ systems in infants are not fully developed Signup and view all the answers

Which route of drug administration results in higher plasma levels in infants compared to adults?

Subcutaneous injection Signup and view all the answers

What is the primary reason for heightened drug sensitivity in infants?

Immaturity of pharmacokinetic processes Signup and view all the answers

How does gastrointestinal physiology in infants affect drug administration?

It varies significantly from that in adults Signup and view all the answers

What is the recommended approach for initiating therapy in older adults?

Start low and go slow Signup and view all the answers

Which of the following should be prioritized to reduce adverse drug reactions in older adults?

Monitoring for drug-drug interactions Signup and view all the answers

Why is it important to review the need for continued drug therapy periodically in older adults?

To avoid iatrogenic illness and reduce unnecessary medication Signup and view all the answers

What does the Beers List primarily identify?

Drugs that may cause adverse effects in older adults Signup and view all the answers

What is the recommended action regarding old medications for older adults?

Dispose of them properly Signup and view all the answers

What kind of drugs should generally be avoided in adults older than 65 years, unless benefits outweigh risks?

Medications from the Beers Criteria Signup and view all the answers

What is a key pharmacokinetic or pharmacodynamic change that occurs with aging?

Decreased renal function affecting drug clearance Signup and view all the answers

How can promoting adherence benefit older adults in medication management?

It helps maintain consistent health outcomes Signup and view all the answers

What is the most significant factor contributing to the increased incidence of adverse drug reactions (ADRs) in older adults?

Reduced renal function leading to drug accumulation Signup and view all the answers

Which of the following statements about symptoms of adverse drug reactions (ADRs) in older adults is correct?

Symptoms are often nonspecific and may include dizziness or cognitive impairment. Signup and view all the answers

Which factor can lead to increased variability in drug response in older adults?

Altered pharmacokinetics due to aging Signup and view all the answers

What is one of the main reasons why older adults may not report substance use during medical assessments?

Generational taboos may discourage openness about substance use. Signup and view all the answers

Which of the following factors is NOT commonly associated with increased adverse drug reactions in older adults?

Use of high-therapeutic index drugs Signup and view all the answers

At what age do renal drug excretion levels in children typically reach adult levels?

1 year Signup and view all the answers

Which condition is caused by tetracyclines in pediatric patients?

Discoloration of developing teeth Signup and view all the answers

What is the primary reason dosage must be reduced for neonates regarding drug elimination?

Low hepatic metabolism capacity Signup and view all the answers

How does drug metabolism in children compare to adults in the first two years of life?

Children metabolize drugs faster than adults Signup and view all the answers

What unique adverse effect is most closely associated with glucocorticoids in pediatric patients?

Growth suppression Signup and view all the answers

Which of the following pharmacokinetic factors is notably lower at birth compared to later stages?

Renal excretion Signup and view all the answers

What major change occurs in drug metabolism in children at puberty?

Metabolism sharply declines Signup and view all the answers

What is an important consideration for dosing medications eliminated by hepatic metabolism in pediatric patients?

Reduced doses for enhanced metabolism Signup and view all the answers

What is a potential adverse effect of fluoroquinolones in pediatric patients?

Tendon rupture Signup and view all the answers

Which of the following drug classes is associated with respiratory depression in children under 2 years?

Promethazine Signup and view all the answers

Which adverse effect is linked to tetracyclines in pediatric patients?

Staining of developing teeth Signup and view all the answers

What is a critical consideration when determining dosage for very young pediatric patients?

Body surface area (BSA) Signup and view all the answers

Which of the following can be a serious consequence of administering aspirin to children with chickenpox or influenza?

Reye syndrome Signup and view all the answers

What adverse effect does the use of salicylates in pediatric patients pose?

Acidosis and hyperthermia Signup and view all the answers

Monitoring the patient for therapeutic and adverse responses is especially important in which group?

Neonates and younger infants Signup and view all the answers

Why is it essential to educate caregivers regarding drug storage?

To prevent accidental ingestion or degradation Signup and view all the answers

How does gastric emptying time affect the absorption of drugs primarily absorbed from the intestine in infants?

It delays absorption because of irregular gastric emptying. Signup and view all the answers

What impact does low blood flow through muscle have on intramuscular drug administration in neonates?

It causes absorption to be slow and erratic. Signup and view all the answers

Why are infants at increased risk for toxicity from topical drugs?

They have a higher blood flow to the skin and thinner stratum corneum. Signup and view all the answers

What consequence arises from the low level of serum albumin in infants regarding drug absorption?

Decreased competition with endogenous compounds intensifies drug effects. Signup and view all the answers

What characterizes the blood-brain barrier in infants, affecting their response to CNS-active drugs?

It has incomplete development, allowing easier access for drugs. Signup and view all the answers

At what age do the protein-binding capacities in infants typically reach adult values?

By 10 to 12 months of age. Signup and view all the answers

How does the absorption of acid-labile drugs change after birth in infants due to gastric acidity levels?

Absorption is increased due to low gastric acidity. Signup and view all the answers

Which statement best describes gastric emptying time as it relates to early infancy?

It is prolonged and irregular, gradually improving by 6 to 8 months. Signup and view all the answers

What medication is generally considered ineffective at usual doses and poses a risk for neurotoxicity?

Meperidine Signup and view all the answers

Which class of antidepressants is associated with anticholinergic effects such as urinary retention and cognitive impairment?

Tricyclic Antidepressants Signup and view all the answers

Which medication poses a high risk for orthostatic hypotension and falls due to its α-adrenergic blocking activity?

Doxazosin Signup and view all the answers

What class of drugs is associated with a higher risk for falls and cognitive impairment compared to other hypnotics?

Barbiturates Signup and view all the answers

Which class of medications is associated with an increased risk of Clostridium difficile infection and decreased bone integrity?

Proton Pump Inhibitors Signup and view all the answers

What are common side effects of first-generation antihistamines?

Sedation and urinary retention Signup and view all the answers

What class of medications can lead to both urinary retention and hallucinations as side effects?

Anticholinergics for Urge Incontinence Signup and view all the answers

In which situation should short-term low-dose NSAIDs be avoided?

Chronic heart failure Signup and view all the answers

Which muscle relaxant may not be effective at tolerable dosage and is associated with cognitive impairment?

Carisoprodol Signup and view all the answers

Which of the following antidepressants are less likely to cause cognitive impairment compared to Tricyclic Antidepressants?

SNRIs Signup and view all the answers

What should caregivers do to address the common issue of inaccurate dosing in children?

Estimate the amount of drug lost and readminister it. Signup and view all the answers

What is one strategy to promote medication adherence specifically for children?

Use a reward system such as stickers. Signup and view all the answers

Why is it important for parents to complete the full course of medication even if symptoms improve?

To ensure the child is fully healed and prevent relapse. Signup and view all the answers

What practice can help avoid the risk of multiple dosing when administering medication to a child?

Maintain a drug administration chart. Signup and view all the answers

Which approach is suggested to make unpalatable medications more acceptable to children?

Refrigerate the medication, if applicable. Signup and view all the answers

Which of the following is a recommended strategy for healthcare providers to enhance medication adherence?

Consider drug costs and insurance coverage in medication choices. Signup and view all the answers

What type of educational material can be given to caregivers to help teach children about their medication?

Age-appropriate reading or coloring books. Signup and view all the answers

What should be proactively addressed to improve medication adherence in older children and adolescents?

Developing trust and respect in patient-provider relationships. Signup and view all the answers

What is a key factor that complicates drug therapy in older adults?

Increased sensitivity to drugs Signup and view all the answers

Why is individualized treatment essential for older patients?

To monitor and adjust for desired and adverse responses Signup and view all the answers

What primarily causes drug interactions and adverse drug reactions in older adults?

Altered pharmacokinetics and multiple drug therapy Signup and view all the answers

What age-related physiological change affects drug absorption in older adults?

Increased gastric pH Signup and view all the answers

What is a common challenge in drug therapy for older adults?

Wider individual variation in drug response Signup and view all the answers

Which of the following is NOT a reason for the high consumption of prescribed drugs among older adults?

Decreased severity of illnesses Signup and view all the answers

How does aging affect the metabolism of drugs?

It usually slows down drug metabolism Signup and view all the answers

What is the main goal of drug therapy in older adults with chronic illnesses?

Reduce symptoms and improve quality of life Signup and view all the answers

What effect does delayed gastric emptying have on drugs absorbed primarily in the stomach?

Enhances their absorption Signup and view all the answers

Why does protein binding of drugs in infants tend to be lower?

Endogenous compounds compete for binding sites Signup and view all the answers

How does transdermal drug absorption in infants compare to older children and adults?

It is more rapid and complete Signup and view all the answers

What is a consequence of the blood-brain barrier not being fully developed at birth?

Drugs can easily access the CNS Signup and view all the answers

At what age do protein-binding capacities in infants typically reach adult values?

10 to 12 months Signup and view all the answers

What is a major characteristic of drug absorption after intramuscular injection in neonates?

It is slow and erratic Signup and view all the answers

How does gastric acidity in infants affect the absorption of acid-labile drugs?

It increases their absorption Signup and view all the answers

What might result from the combination of low serum albumin and competing endogenous compounds in infants?

Increased risk of drug toxicity Signup and view all the answers

What is the recommended approach for initiating therapy in older adults?

Initiate therapy with low doses and titrate upward gradually Signup and view all the answers

Which of the following should be regularly monitored to adjust drug dosages in older adults?

Clinical responses and plasma drug levels Signup and view all the answers

What is a primary purpose of the Beers List in medication management for older adults?

To highlight drugs with a high likelihood of causing adverse effects Signup and view all the answers

Which measure helps promote adherence to medication regimens among older adults?

Employing the simplest medication regimen possible Signup and view all the answers

What action should be taken regarding old medications in older adults?

Encourage the patient to dispose of them Signup and view all the answers

Which of the following factors may contribute to increased drug-drug interactions in older adults?

Common use of multiple medications Signup and view all the answers

Why is it important to periodically review the need for continued drug therapy in older adults?

To identify unnecessary medications and reduce polypharmacy Signup and view all the answers

What is a key consideration when using medications listed in the Beers Criteria for older adults?

They should generally be avoided unless benefits outweigh risks Signup and view all the answers

Which of the following medications is considered effective for moderate to severe pain?

Morphine Signup and view all the answers

What potential adverse effect is associated with tricyclic antidepressants?

Urinary retention Signup and view all the answers

Which of the following is a side effect commonly associated with first-generation antihistamines?

Sedation Signup and view all the answers

What is a common risk associated with the use of benzodiazepines?

Delirium Signup and view all the answers

Which medication is specifically indicated for urge incontinence?

Tolterodine Signup and view all the answers

Which drug class carries a higher risk for cognitive impairment in older adults?

Sedative-hypnotics Signup and view all the answers

Long-term use of proton pump inhibitors is associated with which of the following risks?

Clostridium difficile infection Signup and view all the answers

What is a common side effect of muscle relaxants?

Cognitive impairment Signup and view all the answers

Which of the following medications is known for its risk of neurotoxicity when used at usual doses?

Meperidine Signup and view all the answers

What is a characteristic adverse effect of non-steroidal anti-inflammatory drugs (NSAIDs) when used long-term?

Kidney damage Signup and view all the answers

What potential risk is associated with prolonged use of glucocorticoids in pediatric patients?

Growth suppression Signup and view all the answers

Which adverse effect is particularly noted for phenothiazines in infants?

Sudden infant death syndrome Signup and view all the answers

What is the primary risk associated with the use of tetracyclines in pediatric patients?

Staining of developing teeth Signup and view all the answers

What should be monitored to ensure optimal dosage adjustments in pediatric patients?

Therapeutic and adverse responses Signup and view all the answers

What drug is associated with central nervous system toxicity in infants?

Hexachlorophene Signup and view all the answers

Which method is commonly used to extrapolate pediatric dosages from adult doses?

Body surface area (BSA) Signup and view all the answers

What adverse reaction occurs with nalidixic acid in pediatric patients?

Cartilage erosion Signup and view all the answers

What education topic is crucial for caregivers of pediatric patients to promote adherence?

Duration of treatment Signup and view all the answers

What effect does diminished liver function have on the half-lives of certain drugs?

It increases the half-lives. Signup and view all the answers

Why is creatinine clearance preferred over serum creatinine levels for assessing renal function in older adults?

Creatinine clearance considers the decline in muscle mass. Signup and view all the answers

What is the primary cause of adverse drug reactions (ADRs) in older adults?

Reduced renal excretion. Signup and view all the answers

What approach should be taken when treating older children and adolescents to improve their medication adherence?

Signup and view all the answers

Which factor varies significantly among individuals and impacts drug metabolism?

Genetic differences. Signup and view all the answers

What is a notable pharmacodynamic change observed in older adults concerning beta-adrenergic blocking agents?

Decreased effectiveness of the drugs. Signup and view all the answers

Which method is sometimes used for medication adjustments instead of creatinine clearance for certain drugs?

Estimated glomerular filtration rate (eGFR). Signup and view all the answers

What does a decline in renal function in older adults generally affect?

Active tubular secretion. Signup and view all the answers

What observation supports the possibility of altered pharmacodynamics in older adults?

Diminished response to certain drugs. Signup and view all the answers

What is a primary reason older adults experience higher drug sensitivity?

Altered pharmacokinetics due to organ system degeneration Signup and view all the answers

Which factor contributes to the increased incidence of adverse drug reactions (ADRs) in older adults?

Multiple and severe illnesses Signup and view all the answers

What is the recommended approach for managing drug therapy in older adults?

Individualize treatment and monitor for responses Signup and view all the answers

What principle factor is primarily responsible for increased variability in drug response among older adults?

Age-related changes in pharmacokinetics Signup and view all the answers

How does the aging process generally affect pharmacokinetics?

Can alter absorption, distribution, metabolism, and excretion of drugs Signup and view all the answers

Why is it vital to monitor older patients when adjusting their drug regimens?

To minimize the risks of adverse drug reactions Signup and view all the answers

What underlying issue can result from poor adherence in older adults regarding medication use?

Greater risk of drug-drug interactions Signup and view all the answers

What can help older adults connect with others managing similar health issues?

Setting up networks for support and encouragement Signup and view all the answers

Which medication is considered effective for mild pain management?

Codeine Signup and view all the answers

What is a common risk associated with the use of Tricyclic Antidepressants?

Cognitive impairment Signup and view all the answers

Which antihistamine is likely to cause sedation and orthostatic hypotension?

Diphenhydramine Signup and view all the answers

Which class of drugs is most closely associated with physical dependence and higher risk for cognitive impairment?

Benzodiazepines Signup and view all the answers

Long-term use of Proton Pump Inhibitors has been linked to which of the following risks?

Clostridium difficile infection Signup and view all the answers

Which of the following muscle relaxants is associated with anticholinergic effects?

Cyclobenzaprine Signup and view all the answers

Which medication is the primary choice for moderate to severe pain management?

Oxycodone Signup and view all the answers

What side effect is commonly associated with first-generation antihistamines?

Urinary retention Signup and view all the answers

What serious risk is associated with the chronic use of benzodiazepines?

Delirium Signup and view all the answers

Which of these Alzheimer’s disease drugs is not indicated for use in urge incontinence management?

Prasosin Signup and view all the answers

What should caregivers do if a child spills medication during administration?

Estimate the amount lost and readminister that amount. Signup and view all the answers

What is a recommended strategy for promoting medication adherence in children?

Introduce medication reminders like calendars or pillboxes. Signup and view all the answers

When multiple people are involved in administering medication to a child, what should be avoided?

Multiple dosing of the same medication. Signup and view all the answers

Which tip is effective for administering unpalatable medication to children?

Use a treat to mask the taste or distract the child. Signup and view all the answers

Why is it crucial for parents to complete the full course of prescribed medication for infections?

Symptoms may decrease before the infection is fully eradicated. Signup and view all the answers

What should be considered when prescribing medications for children?

Drug costs and insurance coverage are significant factors. Signup and view all the answers

Which strategy can help improve medication adherence among older children and adolescents?

Simplifying medication regimens whenever possible. Signup and view all the answers

What should be done to address potential adverse effects of medications in pediatric patients?

Proactively address them and involve the patient in management. Signup and view all the answers

Study Notes

Pharmacokinetics in Neonates and Infants

Drug pharmacokinetics affect the concentration at drug action sites, influencing response intensity and duration.
Elevated drug levels result in more intense responses; delayed elimination prolongs effects.
Organ systems for drug regulation are immature in neonates, increasing risk for intense and prolonged drug effects.
Infants show slower decline in plasma drug levels after intravenous administration compared to adults, prolonging therapeutic effects.
Subcutaneous drug administration results in higher and prolonged drug levels in infants than adults.

Factors Affecting Drug Sensitivity in Infants

Heightened drug sensitivity in infants is not solely due to body size; it's influenced by immature:
- Drug absorption mechanisms
- Protein binding capacity
- Blood-brain barrier function
- Hepatic metabolism
- Renal excretion

Drug Absorption in Infants

Oral Administration: Gastric emptying is delayed and irregular in infants, affecting drug absorption variability. Gastric acidity is low during early infancy, enhancing absorption of acid-labile drugs.
Intramuscular Administration: Slow absorption in neonates due to low muscle blood flow; becomes quicker in early infancy.
Transdermal Absorption: Infants absorb drugs through skin more rapidly due to thinner skin and increased skin blood flow, raising toxicity risk from topical drugs.

Distribution and Drug Response

Protein Binding: Lower serum albumin levels and competition from endogenous compounds lead to higher free drug concentrations in infants, necessitating reduced dosages to avoid intense effects. Binding capacity reaches adult levels by 10-12 months.
Blood-Brain Barrier: Immature in newborns, allowing easier drug access to the CNS, which can heighten the risk of CNS effects; dosages must be reduced for CNS-active medications.

Special Pediatric Adverse Drug Reactions

Androgens: Can cause premature puberty in males, risk of reduced adult height.
Aspirin: Risks include severe intoxication and Reye syndrome in children with viral infections.
Fluoroquinolones: Associated with tendon rupture.
Nalidixic Acid and Tetracyclines: Risks include cartilage erosion and tooth staining, respectively.

Dosage Determination in Pediatrics

Pediatric dosages are often approximated from adult dosages due to rapid changes in pharmacokinetics; body surface area (BSA) is commonly used for dosage calculations.
Initial doses may need adjustments based on clinical outcomes and plasma concentrations, particularly in neonates.

Promoting Adherence to Medication

Caregiver education is crucial on:
- Dosage timing and size
- Administration techniques
- Duration of therapy
- Drug storage and responses expected
Written instructions reinforce verbal guidance.

Adverse Drug Reactions (ADRs) in Older Adults

ADRs are significantly more prevalent in older adults, leading to high rates of hospital admissions and medication-related deaths.
Factors contributing to higher ADR risk include:
- Reduced renal function leading to drug accumulation
- Polypharmacy and greater illness severity
- Comorbidities affecting drug metabolism
- Inadequate long-term therapy supervision

Reducing ADRs in Older Adults

Thorough Drug Histories: Include OTC medications and supplements to reduce interaction risks.
Start Low, Go Slow: Initiate treatments at lower doses and gradually increase.
Regular Monitoring: Keep track of clinical responses and adjust dosages based on outcomes and plasma levels.

Beers List and Medication Caution

The Beers List outlines potentially inappropriate medications for older adults due to high ADR risks; clinicians should weigh benefits against risks on an individual basis.
The presence of these medications in treatment must be justified by significant benefits.

Specific Drugs to Avoid in Older Adults

Indomethacin and Ketorolac are linked to risks of gastrointestinal bleeding and renal failure; caution is advised for long-term use of non-selective NSAIDs.

Drug Absorption in Infants

Drug absorption may vary based on drug physicochemical properties.
Gastric emptying time is prolonged in early infancy, normalizing by 6 to 8 months.
Delayed gastric emptying enhances absorption for stomach-absorbed drugs but delays it for intestine-absorbed drugs.
Gastric acidity is low for the first 24 hours after birth, not reaching adult levels for 2 years, increasing absorption of acid-labile drugs.

Intramuscular and Transdermal Absorption

Intramuscular absorption in neonates is slow due to low muscle blood flow, improving as infants grow.
Transdermal absorption is quicker in infants due to thinner skin and higher blood flow, raising the risk for toxicity from topical medications.

Distribution and Protein Binding

Albumin levels are low in infants, leading to less protein binding; drugs usually bound in adults have higher free concentrations in infants.
The blood-brain barrier is underdeveloped at birth, increasing sensitivity to CNS-active drugs, warranting reduced dosages.

Hepatic Metabolism

Newborns have limited drug-metabolizing capacity, requiring dosage reductions for drugs metabolized by the liver.
Hepatic metabolism matures within the first year of life, progressing rapidly after 1 month.

Renal Excretion

Renal excretion is significantly reduced at birth; renal function reaches adult levels by the end of the first year.
Drugs eliminated renally must be dosed lower or at longer intervals during infancy.

Pharmacokinetics in Older Children

By age 1, children exhibit pharmacokinetic parameters similar to adults but metabolize drugs faster.
Drug metabolism is notably high until age 2, then gradually declines, impacting dosing strategies for hepatic-excreted drugs.

Adverse Drug Reactions in Pediatrics

Pediatric patients face unique adverse drug reactions due to organ immaturity and development, necessitating careful drug selection.
Notable adverse reactions include potential growth suppression from glucocorticoids and tooth discoloration from tetracyclines.

Dosage Determination

Dosage selection for pediatric patients is complex, especially for neonates with rapidly changing pharmacokinetics.
Dosages can be extrapolated from adult sizes based on body surface area (BSA) but need adjustments based on clinical response.

Promoting Adherence

Engaging caregivers and children in understanding medication adherence is crucial, addressing dosage size, administration technique, duration, storage, and expected responses.

Adverse Drug Reactions in Older Adults

Adverse drug reactions (ADRs) are significantly more common in older adults, accounting for many hospital admissions and medication-related deaths.
Contributing factors include drug accumulation due to renal function decline, polypharmacy, and increased illness severity.

Strategies to Reduce ADRs

Avoidance of high-risk medications and preference for safer alternatives can minimize ADR incidence in older adults.
Nonpharmacologic alternatives and education on medication use can improve adherence and reduce risks.

Notable Medications and Effects

Certain drugs, like glucocorticoids and tetracyclines, can cause specific adverse effects based on age and developmental stage.
Example drugs and their associated risks include:
- Aspirin: Reye syndrome in children
- Chloramphenicol: Gray syndrome in infants
- Fluoroquinolones: Risk for tendon rupture
- Antidepressants and Benzodiazepines: Risk for cognitive impairment and falls in older adults.

Drug Absorption in Infants

Drug absorption can be affected by the physicochemical properties of the drug.
Gastric emptying in infants is prolonged and varies; typically reaches adult values by 6-8 months.
Delayed gastric emptying increases absorption for stomach-absorbed drugs but delays absorption for intestine-absorbed drugs.
Gastric acidity is low for the first 24 hours post-birth, reaching adult levels by age 2, enhancing absorption of acid-labile drugs.

Intramuscular and Transdermal Absorption

Intramuscular drug absorption in neonates is slow and erratic due to low muscle blood flow; improves by early infancy.
Infants exhibit more rapid and complete transdermal absorption due to a thinner stratum corneum and higher skin blood flow, increasing toxicity risk from topical medications.

Drug Distribution and Protein Binding

Limited protein binding in infants due to lower serum albumin and competitive endogenous compounds (fatty acids, bilirubin).
Higher free drug concentrations in infants can enhance effects, necessitating reduced dosages.
Protein-binding capacity reaches adult levels by 10-12 months.

Blood-Brain Barrier

Not fully developed at birth, allowing easier access for drugs and chemicals to the CNS, increasing sensitivity to CNS-affecting medications.
Drugs like morphine and phenobarbital require reduced dosages in infants.

Medication Administration Strategies

Caregivers should be trained to accurately administer medication and address common dosing issues.
Encourage completion of prescribed courses, especially for infections, even if symptoms improve early.

Strategies to Promote Adherence

Providers should prescribe medications that are once-daily or consider costs and insurance.
Caregivers can use reminders, reward systems, and techniques to make medication more palatable.
For older children, simplify regimens and involve them in their care to build trust and adherence.

Drug Use in Older Adults

Older adults, comprising 12.8% of the US population, consume 33% of prescribed drugs due to more severe illnesses and multiple pathologies.
Drug therapy faces challenges due to increased sensitivity, variations, adverse drug reactions (ADRs), and drug-drug interactions.

Pharmacokinetic Changes in Older Adults

Aging progressively declines organ function, affecting drug absorption, distribution, metabolism, and excretion.
Individualized treatment is crucial to monitor responses and adjust regimens accordingly.

Measures to Reduce ADRs

A thorough drug history is essential; consider over-the-counter and herbal medication.
Start therapy with low doses, titrate carefully, and monitor for interactions and necessity of ongoing therapy.
Avoid drugs from the Beers Criteria unless benefits significantly outweigh risks.

Beers Criteria and Potentially Inappropriate Medications

Prioritize caution with identified drugs, which can cause adverse effects in older adults.
Specific drugs such as certain NSAIDs, first-generation antihistamines, and muscle relaxants are linked to significant concerns for this population.

Alternatives to High-Risk Medications

Choose safer alternatives for pain management, antidepressants, antihypertensives, and incontinence medications when prescribing for older adults.
Encourage nonpharmacologic approaches where applicable to support overall wellbeing and manage symptoms.

Adverse Drug Reactions in Pediatric Patients

Androgens: Can cause premature puberty in males and reduced adult height due to early epiphyseal closure.
Aspirin/Salicylates: Risk of severe intoxication from overdose, leading to acidosis, hyperthermia, respiratory depression; linked to Reye syndrome during chickenpox or influenza.
Chloramphenicol: Associated with gray syndrome in neonates and infants.
Fluoroquinolones: Potential for tendon rupture.
Glucocorticoids: Prolonged use can suppress growth.
Hexachlorophene: May lead to CNS toxicity in infants.
Nalidixic acid: Can cause cartilage erosion.
Phenothiazines: Associated with sudden infant death syndrome (SIDS).
Promethazine: Risk of significant respiratory depression in children under 2 years.
Sulfonamides: Link to kernicterus in neonates.
Tetracyclines: Can stain developing teeth.

Dosage Determination in Pediatrics

Pediatric dosing is complex due to fast-changing pharmacokinetics, particularly in young patients.
Limited pediatric dose standardization; extrapolation from adult doses is common, often using body surface area (BSA) as a guide.
Initial doses are approximations and may require adjustments based on clinical outcomes and drug concentrations.
Ongoing monitoring is essential, especially for neonates and young infants.

Promoting Adherence to Medication

Caregiver involvement is crucial for correct dosing; effective education is necessary.
Key topics for discussion include dosage size/timing, administration route and technique, treatment duration, and storage.
Providing written instructions reinforces verbal guidance.
Demonstrations of administration techniques help ensure caregiver understanding.
Emphasizing completion of prescribed treatments even if symptoms improve is important.

Strategies to Enhance Medication Adherence

For Providers:
- Prescribe once-daily medications when possible and consider drug costs.
- Use drug information sheets and provide educational materials for children.
For Caregivers:
- Suggest reminders for doses, like pillboxes or calendars.
- Use rewards systems (stickers) to motivate children.
- Offer tips for making unpleasant medications more palatable.
For Older Children/Adolescents:
- Simplify medication regimens.
- Build trust and respect with the patient.
- Teach necessary skills for self-management.

Drug Use in Older Adults

Older adults (65+) make up 12.8% of the US population but consume 33% of prescribed drugs.
High drug usage due to multiple illnesses, severity of conditions, and excessive prescribing.
Increased sensitivity to drugs and higher risk for adverse drug reactions and interactions; changes in pharmacokinetics play a role.

Pharmacokinetic Changes with Aging

Organ function declines progressively with age, affecting absorption, distribution, metabolism, and excretion of drugs.
Reduced liver function may enhance oral drug responses due to diminished first-pass metabolism.
Renal function declines, leading to drug accumulation and increased ADR incidence; creatinine clearance, not serum creatinine levels, should be assessed for renal function.

Pharmacodynamic Changes in Older Adults

Alterations in receptor properties indicate altered drug sensitivity; beta-blockers may be less effective in older patients.

Common Medications and Alternatives

Mild Pain Relief: Acetaminophen, low-dose NSAIDs are preferred; Meperidine is generally ineffective and risky.
Antidepressants: First-generation tricyclic antidepressants pose risks such as cognitive impairment; SSRIs and SNRIs are safer.
Antihistamines: First-generation agents have more anticholinergic side effects; second-generation options cause fewer issues.
Antihypertensives: α1 blockers can cause orthostatic hypotension; safer alternatives exist (thiazide diuretics, ACE inhibitors).
Sedative-Hypnotics: Barbiturates and benzodiazepines have high risks for dependence and cognitive impairment; safer options include non-benzodiazepine agents.
Urge Incontinence Drugs: Oxybutynin can cause significant anticholinergic effects; behavioral therapies may be preferable.
Muscle Relaxants: Anticholinergic side effects are common; alternative treatment options include non-pharmacologic measures.
Proton Pump Inhibitors: Long-term use linked to increased infection and fracture risks; alternative therapies should be considered.

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Description

This quiz explores the pharmacokinetic factors that influence drug therapy during pregnancy and in neonates and infants. It highlights the balance between benefits and risks while considering the unique physiological responses of young patients. Understanding these principles is crucial for safe medication management in vulnerable populations.