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Pharm

Ch. 3 & 4

QuestionAnswer
Pregnancy First Trimester-greatest danger for drug induced developmental defects. Drugs cross placenta by diffusion. Last trimester-greatest percentage of absorbed drug gets to fetus.
Breast-feeding Infants are at risk for exposure to drug consumed by mother (in small amount). Weight risk-to-benefit ratio.
(P) Absorption Gastric pH is less acidic (pH is higher). Gastric emptying is slowed. Intramuscular absorption faster and irregular.
(P) Distribution The younger the person, the more % of total body water. Lower fat content. Decreased level of protein binding-more free drugs. Immature blood brain barrier-more drug gets to brain.
(P) Metabolism Immature liver doesn't produce enough microsomal enzymes.
(P) Excretion Immature kidneys affects glomerular filtration rate and tubular secretion. Decreased perfusion rate of the kidneys may reduce excretion.
Pediatric drug dosages Skin is thin (permeable). Stomach lacks acid to kill bacteria. Weaker mucus barriers in lungs. Body temp not well regulated (dehydrate easy). Immature liver and kidneys (impaired metabolism and excretion.
Methods of dosage calculations Body surface area method (West nomogram). Body weight dosage method (mg/kg). Always use weight in KILOGRAMS!
Elderly Over age 65. Use of OTC meds. Increased chronic illnesses. Sensory and motor deficits. Polypharmacy.
Physiologic changes in the Elderly Cardiovascular (weakens). Gastrointestinal (slows). Hepatic. Renal.
(E) Absorption Gastric pH less acidic. Gastric emptying slowed. Movement through GI tract slowed. Blood flow to GI tract reduced. Laxatives may accelerate GI motility.
(E) Distribution Lower total body water percentages. Increased fat content. Liver produces less protein-more free drugs.
(E) Metabolism Aging liver produces fewer microsomal enzymes. Reduced blood flow to liver.
(E) Excretion Decreased glomerular filtration rate. Decreased number of intact nephrons.
(E) Problematic medications Analgestics (pain relief). Anticoagulants. Anticholinergics (inhibit parasympathetic nerve impulses). Antidepressants. Antihypersensitives (BP). Cardiac glycosides (treat cardiac failure). Sedatives. Thiazide diuretics (pee)
S. Drug Legislation Federal Food and Drug Act. Sherley Amendment. Harrison Narcotic Act (schedules). Federal Food, Drug, and Cosmetic Act.
U.S. Drug Legislation Durham-Humphrey Amendment. Kefauver-Harris Amendment. Controlled Substance Act. Orphan Drug Act. Health Insurance Portability and Accountability Act (HIPPA)
Informed consent
U.S. FDA drug approval process Preclinical testing. Clinical studies. Investigational drug studies. Expedited drug approval.
Clinical phases Phase I (optimal drug dosage range, healthy people). Phase II (small number, have disease). Phase III (clinical effectiveness, results reported). Phase IV (on market, black label warning)
Ethical Nursing Practices ANA code of ethics for nurses. INC code of ethics for nurses.
Cultural considerations Assess influence of cultural beliefs, values, and customs. Drug polymorphism (how they feel about medication). Compliance level with therapy. Environmental considerations. Genetic factors. Varying responses to specific drugs.
Cultural considerations (Continued) Changing national demographics. INfluence of ethnicity and genetics. Rapid and slow acetylators.
Cultural Assessment Health beliefs and practices. Past uses of meds. Folk remedies (Native Americans). Home remedies. OTC drugs. Herbal remedies. Usual response to illness. Response to treatment. Religious practices and beliefs. Dietary habits.
Category A Studies indicate no risk for human fetus
Category B Studies indicate no risk for animal fetus; information for humans is not available
Category C Adverse effects reported in animal fetus; information for humans is not available
Category D Fetal abnormalities reported and positive evidence of fetal risk in human available from animal and/or human studies. Drugs should not be used in pregnant women.
Created by: maggardba
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