Pharmacology considerations for special populations
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Questions and Answers

A drug level of 0.3 ng/mL is considered what, if a therapeutic drug level is considered to be between 0.5 to 2 ng/mL?

  • Toxic
  • Subtherapeutic (correct)
  • Therapeutic
  • Tolerant

Why might a dose adjustment be necessary with protein-binding drugs in infants?

  • Protein-binding drugs have increased efficacy in infants.
  • Infants have a decreased protein-binding capacity. (correct)
  • Infants have an increased protein-binding capacity.
  • Protein-binding drugs are contraindicated in infants.

Which of the following routes of administration would be most appropriate for a toddler requiring a course of antibiotics?

  • Tablet
  • Liquid (correct)
  • Enteric-coated tablet
  • Capsule

Why is having knowledge of both genetics and genomics important in understanding drug metabolism?

<p>Genetics only focuses on individual genes, while genomics studies the entire genome, providing a broader view of potential metabolic variations. (D)</p> Signup and view all the answers

When counseling a breastfeeding mother about taking medications, what is the best advice regarding timing of doses?

<p>Take the medicine immediately after breastfeeding or just before the infant’s longest sleeping period. (A)</p> Signup and view all the answers

Which statement best describes the significance of pharmacogenetics?

<p>It studies how drug responses vary based on inherited genetic differences. (C)</p> Signup and view all the answers

Why are pregnant women advised to avoid drugs when possible?

<p>The fetus is exposed to substances in the mothers blood, and some drugs can cause abnormal development of fetal tissues. (C)</p> Signup and view all the answers

A physician is considering prescribing a medication to a pregnant patient. Which of the following should be prioritized before prescribing?

<p>Considering nonpharmacologic treatments before using medicines. (C)</p> Signup and view all the answers

A drug is identified as an ACE inhibitor. What potential risk does this pose to a pregnant woman?

<p>ACE inhibitors are known to be teratogenic. (D)</p> Signup and view all the answers

How does the study of genetics relate to the observed differences in drug metabolism among different racial and ethnic groups?

<p>Significant differences in drug metabolism can occur among racial and ethical groups due to genetic variations. (A)</p> Signup and view all the answers

Why might an overweight patient require a higher drug dosage compared to a patient of average weight?

<p>The increased body mass in overweight patients dilutes the drug concentration, necessitating a higher dosage to achieve therapeutic effects. (A)</p> Signup and view all the answers

How does chronic smoking affect drug metabolism, and what is the underlying reason for this effect?

<p>Chronic smoking induces the production of metabolic enzymes, leading to faster drug metabolism and reduced drug effects. (D)</p> Signup and view all the answers

How could a patient's negative expectations about a medication affect the outcome of their treatment?

<p>Negative expectations can result in a nocebo effect, leading to a less-than-optimal outcome. (B)</p> Signup and view all the answers

What physiological change is most likely responsible for the need for increased dosage of a medication over time to achieve the same therapeutic effect?

<p>Development of tolerance due to psychological dependence. (A)</p> Signup and view all the answers

How does reduced gastric acidity in infants affect the absorption of orally administered drugs?

<p>Reduced gastric acidity slows down the rate of absorption for most drugs, leading to lower plasma concentrations. (D)</p> Signup and view all the answers

How might slower gastric emptying in geriatric patients influence drug absorption and what is the effect of this slower absorption?

<p>Slower gastric emptying may allow increased absorption. (A)</p> Signup and view all the answers

In what way does the difference in stomach emptying rates between men and women influence drug absorption?

<p>Women's slower stomach emptying may allow a drug to stay in contact with absorptive tissue longer. (B)</p> Signup and view all the answers

How does higher total body water content in infants affect drug distribution, particularly in regard to drug dosage?

<p>Higher total body water content requires higher drug doses on a mg/kg basis due to increased drug dilution. (A)</p> Signup and view all the answers

How does reduced protein binding in neonates affect drug distribution and the potential for drug effects?

<p>Reduced protein binding increases the concentration of free drug, potentially leading to enhanced therapeutic or toxic effects. (B)</p> Signup and view all the answers

How do changes in body composition, such as decreased total body water content in older adults, affect drug distribution and drug concentrations?

<p>Decreased total body water content leads to higher drug concentrations, potentially increasing the risk of toxicity. (D)</p> Signup and view all the answers

What is the primary implication of the delayed development of metabolic enzymes in infants regarding medication administration?

<p>Infants are at increased risk of drug toxicity due to their slower metabolism. (D)</p> Signup and view all the answers

How does the decline in liver function, characterized by decreased liver cells and blood flow, affect drug metabolism in older adults?

<p>The decline in liver function slows down drug metabolism, potentially leading to drug accumulation and toxicity. (B)</p> Signup and view all the answers

Why is the reduced renal capacity of preterm infants a major concern in drug excretion, and what adjustments are typically needed?

<p>Reduced renal capacity impairs drug excretion, potentially leading to drug accumulation and toxicity, requiring dosage adjustments and prolonged dosing intervals. (C)</p> Signup and view all the answers

What is the significance of monitoring serum creatinine levels in geriatric patients, and how does it relate to drug excretion?

<p>Serum creatinine levels provide an estimate of renal function, which is crucial for assessing the ability to excrete drugs in geriatric patients. (C)</p> Signup and view all the answers

In the context of pediatric patients, why is it important to measure liquid medications using mL instead of household measures such as teaspoons?

<p>Household measures are less precise than mL, potentially leading to dosing errors in pediatric patients. (D)</p> Signup and view all the answers

Compared to older adults, which age group typically requires closer monitoring for topical drug absorption due to differences in skin permeability?

<p>Infant (A)</p> Signup and view all the answers

Why are fat-soluble topical drugs more readily absorbed in infants compared to water-soluble formulations?

<p>Infant skin has a less developed stratum corneum, allowing easier penetration of fat-soluble substances. (A)</p> Signup and view all the answers

When a toddler requires a course of antibiotics, what medication form is generally considered the easiest to administer, promoting better adherence?

<p>Liquid formulations, allowing for easier swallowing and accurate dosing. (A)</p> Signup and view all the answers

A patient's drug level is measured at 0.40 ng/mL. The therapeutic range for this drug is 0.5 to 2 ng/mL. How would this level be classified?

<p>Subtherapeutic, indicating the drug level is below the desired therapeutic range. (B)</p> Signup and view all the answers

Given that preterm infants have decreased protein-binding capacity, how should the dosage of a highly protein-bound drug be adjusted to account for this?

<p>The dosage should be decreased to prevent toxicity from increased free drug. (A)</p> Signup and view all the answers

Why is it typically recommended to avoid drugs, if possible, during pregnancy?

<p>To avoid potential teratogenic effects on the developing fetus. (B)</p> Signup and view all the answers

Which class of drugs, known for their potential to cause fetal harm, should be avoided during pregnancy due to their effects on blood pressure regulation?

<p>ACE inhibitors (A)</p> Signup and view all the answers

To minimize infant exposure to medication via breast milk, when is the optimal time for a breastfeeding mother to take her prescribed medication?

<p>Immediately after breastfeeding or just before the infant's longest sleeping period. (C)</p> Signup and view all the answers

How does the study of pharmacogenetics enhance our understanding of individual drug responses?

<p>By studying how inherited genetic differences impact drug metabolism and efficacy. (B)</p> Signup and view all the answers

What is a key focus in pharmacogenetic studies that helps explain why certain racial and ethnic groups may respond differently to specific drugs?

<p>Variations in cardiovascular drug metabolism across different populations. (C)</p> Signup and view all the answers

An elderly patient with decreased liver blood flow is prescribed a medication primarily metabolized by the liver. What adjustments, if any, are needed and why?

<p>Decrease the dose to prevent potential drug toxicity due to impaired metabolism. (D)</p> Signup and view all the answers

A patient with a known genetic deficiency in a specific liver enzyme requires a drug that is metabolized by that enzyme. What is the most important consideration when prescribing this drug?

<p>Switch to an alternative medication metabolized by a different enzyme. (B)</p> Signup and view all the answers

A patient taking a medication that is a known inducer of hepatic enzymes is started on a new drug. What effect might the enzyme induction have on the new drug's metabolism and therapeutic effect?

<p>Decreased drug levels and reduced therapeutic effect. (D)</p> Signup and view all the answers

A geriatric patient is prescribed multiple medications, including one with anticholinergic properties. What potential adverse effect is of particular concern in this patient population?

<p>Urinary retention and constipation which can lead to bowel obstruction. (D)</p> Signup and view all the answers

An infant requires an aminoglycoside antibiotic. Considering the developmental stage of renal function in infants, what specific monitoring is crucial during therapy?

<p>Regular assessment of serum creatinine levels and drug concentrations. (D)</p> Signup and view all the answers

A patient with hypoalbuminemia is prescribed a highly protein-bound drug. How might this condition affect the drug's distribution and what adjustments may be necessary?

<p>Increased free drug concentration, potentially leading to toxicity. (A)</p> Signup and view all the answers

A patient who has been taking a medication for several weeks reports that it is no longer as effective as it was initially. What is the most likely explanation for this phenomenon?

<p>Development of drug tolerance. (A)</p> Signup and view all the answers

How do inter-individual variations in metabolic enzyme activity primarily affect drug responses, and what implications does this have for drug dosing?

<p>It alters drug metabolism rates, potentially causing either drug toxicity or therapeutic failure, hence requiring personalized dosing strategies. (A)</p> Signup and view all the answers

How might the presence of peripheral vascular disease in a geriatric patient affect the distribution of a medication administered intramuscularly in the affected limb?

<p>Erratic drug absorption and delayed onset of action. (B)</p> Signup and view all the answers

A patient is prescribed a medication with a narrow therapeutic index. How does this characteristic impact the monitoring and management of this drug therapy?

<p>It necessitates frequent monitoring of drug levels to ensure efficacy without toxicity. (A)</p> Signup and view all the answers

A patient is experiencing the 'nocebo effect' while taking a medication. What is the MOST likely manifestation of this effect?

<p>The patient reports adverse effects that are not pharmacologically related to the drug. (B)</p> Signup and view all the answers

Drug accumulation can occur in the body when the rate of drug administration exceeds the rate of:

<p>Drug metabolism and excretion. (B)</p> Signup and view all the answers

How does reduced gastric acidity in elderly patients affect the absorption of drugs that require an acidic environment for dissolution?

<p>It impairs the absorption of certain drugs, potentially reducing their therapeutic effect. (C)</p> Signup and view all the answers

A geriatric patient with significantly reduced renal blood flow is prescribed a medication that is primarily eliminated through renal excretion. What adjustments should be made to prevent potential toxicity?

<p>Reduce the dose and/or increase the dosing interval to prevent accumulation. (D)</p> Signup and view all the answers

A nurse is preparing to administer a liquid medication to a pediatric patient. Which measuring device should the nurse use to ensure accurate dosing?

<p>A calibrated syringe or oral measuring cup marked in milliliters (mL). (A)</p> Signup and view all the answers

Flashcards

Subtherapeutic drug level

A drug level below the therapeutic range, possibly ineffective.

Teratogens

Drugs that can cause abnormal development in a fetus.

Pregnancy & Substance Avoidance

Instruct patients to avoid drugs, alcohol and tobacco.

Fetal Drug Exposure

The fetus is exposed to substances in the mother’s blood.

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Pharmacogenetics

Study of how inherited genetic differences affect drug response.

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Genome

Complete package of genetic coding of an organism.

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Genetics

Study of how living organisms inherit traits.

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Drug avoidance in pregnancy

Drugs to avoid during pregnancy if at all possible.

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Drugs in breast milk

Some drugs are known to enter breast milk and harm the nursing infant.

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Medication timing for breastfeeding

Take medicine immediately after breastfeeding or just before infant’s longest sleeping period.

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Age-Related Drug Sensitivity

Infants and the very old are generally more sensitive to drugs.

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Body Weight & Drug Dosage

Overweight patients may need higher drug doses for the same effect.

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Gender Differences in Drug Response

Men and women may respond differently to drugs due to physiological differences.

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Metabolic Rate & Drug Metabolism

Higher metabolic rate can lead to faster drug metabolism.

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Illness & Drug Action

Pathologic conditions can alter drug absorption, distribution, metabolism, and excretion.

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Placebo Effect

Positive expectations improving outcomes.

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Nocebo Effect

Negative expectations leading to less optimal outcomes.

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Drug Tolerance

Needing a higher dose of a medication to achieve the original effect.

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Drug Dependence

Unable to stop the ingestion of drugs.

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Cumulative Drug Effect

Drug accumulates when the next dose is given before the previous dose is fully processed.

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Carcinogenicity

The induction of a mutation of living cells to become cancerous.

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Drug Absorption

Process by which drugs enter the body.

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Drug Distribution

Ways drugs are transported in the body.

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Drug Metabolism

Process where the body inactivates medications.

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Drug Excretion

Process by which drugs and their metabolites are eliminated from the body.

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Subtherapeutic level

Lower than the needed amount of the drug in the body to be effective.

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Teratogenic drugs

Drugs that can cause birth defects.

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Drugs During Pregnancy

Avoid if able, pregnancy.

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Fetus/Drug Connection

Transferring the medication from the mother, to the baby.

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Drug Usage in Pregnant Women

Try to do without if at all possible.

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Medication in Breast Milk

Some drugs may transfer during breastfeeding causing harm to baby.

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Breastfeeding Medication Timing

Take right after feeding, or before greatest sleeping period.

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Premature Infants & Absorption

Slower gastric emptying in premature infants can lead to increased drug absorption.

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Neonates & Absorption

Erratic IM absorption and reduced gastric acidity affect drug absorption in neonates.

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Geriatric Absorption issues

Erratic IM absorption, swallowing difficulty, and variable transdermal absorption.

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Gender & Gastric Emptying

Slower emptying can affect how much of the drug is absorbed.

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Infants & Drug Distribution

Higher total body water requires higher doses of water-soluble drugs (mg/kg).

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Geriatric & Drug Distribution

As people age, they have decreased total body water affecting drug distribution.

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Gender & Drug Distribution

Females usually have higher total body fat affecting drug distrubution.

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Infant Metabolism

Enzymes needed for metabolism take weeks to a year to develop in infants.

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Geriatric Metabolism

Liver cells and blood flow decrease reducing metabolism.

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Preterm Infant Excretion

Preterm infants have very reduced renal capacity impacting drug excretion.

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Full Adult Function

Full adult kidney function isn't reached until 9-12 months of age.

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Geriatric Kidney Function

Reduced blood flow, cardiac output, glomerular filtration, and tubular function impede excretion.

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Therapeutic Drug Monitoring

Monitors drug concentration in blood sample.

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Pediatric Dosage

Dosage adjustments are often necessary to accommodate growth.

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Inappropriate Medications

Many drugs can/should not be used with geriatric patients due to side effects.

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