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44 Cards in this Set
- Front
- Back
Dose adjustments in liver dz incl?
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LFTs; bilirubin/direct bili; serum albumin;
use Child-Puge score Norm 5-6 Med 7-9 Severe over 9 |
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physio & patho changes in older pts can influence what?
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pharmacokinetic & pharmacodynamic properties of meds via:
incr. toxicity unexpected pharm effects |
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Factors when choosing drugs for old ppl
Renal function |
decr. creatinine clearance
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Factors when choosing drugs for old ppl
Liver function |
Decr. blood flow, enzyme activity, clearance
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Factors when choosing drugs for old ppl
Body composition |
Decr. lean body mass; fat; serum albumin
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Factors when choosing drugs for old ppl
CNS |
altered cogn. status
incr. sensitivity to meds |
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Factors to consider with geriatric pts
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1. inability to tolerate certain formulations
2. comorbidities (drug-dz interactions) 3. polypharmacy (drug-drug int) 4. nonadherence: tolerance of meds; affording meds |
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Ref for geriatric pts (3)
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Geriatric dosage handbook
- monograph info - dose adjustments based on renal/liver function; ADR risk Beers' Criteria Assessing Care of Vulnerable Elders (ACOVE) ---> management of key dz ie diabetes; nutrition |
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What to look for while monitoring geriatric pts
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Dosing
Therapeutic duplication drug selection ADR: constipation; incontinence; malnutrition; dementia; altered mental status; incr fall risk |
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Drugs in Pregnancy REF? (3)
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Briggs' Drugs in Pregnancy and Lactation
Drugs for Pregnant and lactating women (Weiner) Reprorisk System |
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What does Briggs' incl?
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alphetical/generic
monographs: name/class; risk factor; fetal risk summary; recommendation; breastfeeding summary & rec; references |
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What does Drugs for Pregnant and lactating women (weiner) incl?
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alphabetized generics;
Monographs: name/class; indications; mech; dosage; contraindi; maternal considerations; fetal consid; breastfeeding safety; drug interactions; ref; summary of risk factors |
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What does REPRORISK incl?
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Part of micromedex - 4 database
Shepard's - catalog of teratogenic agents, chemicals, viruses, pollutants TERIS - teratogen info; drugs; environ agents REPROTEXT - industrial chemicals REPROTOX - Physical & chem environ; lactation info; relevant for toxicology info |
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What are pregnancy registries?
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contains prospective observational studies
-women are observed early in pregnancy and thruout --- no interaction. Compares data on babies of women taking a med vs not taking med |
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what det fetal risk?
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Stage of pregnancy
Drug conc in mother MW of drug lipid solubility ionization of drug at phys pH protein binding placental blood flow & surface area 1st trimester is riskiest time to take medication. |
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FDA preg. risk factors: A
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controlled studies do not demonstrate risk in 1st trimester; no evidence of risk in 2-3rd trimesters; possibility of harm is remote
ie. electrolytes, vitamins |
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FDA preg. risk factors: B
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In ANIMAL studies; no risk; no controlled studies in preg. wormen or
Animal studies showed adverse effects not confirmed in controlled studies in 1st, no evidence of risk in 2nd, 3rd ie. penicillin |
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FDA preg. risk factors: C
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Animal studies: AE on fetus; no controlled studies in women OR
Studies in women; animals unavailable give drug only if benefit > risk ie. quinolones |
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FDA preg. risk factors: D
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Positive evidence of human fetal risk
benefits may outweigh risk ie. tetracyclines, NSAIDS |
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FDA preg. risk factors: X
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Evidence of risk in animals or humans or both
risk in pregnancy outweighs benefit ie. warfarin |
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Fetal Risk Recomm. in BRIGGS
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Compatibility: compatible; maternal benefit >> risk
Risk: low, mod, high, human data/animal data Contraindi: 1st, 2nd, 3rd, overall. |
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REF for Drugs in LACTATION? (3)
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Gold standard: Medications and Mother's Milk
Briggs' LactMed database |
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Med and Mother's milk
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Gold standard
Incl: name; uses; recomm. of American Academy of Pediatrics; drug monograph; pregnancy risk category; Dr. Hale's lactation risk category |
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Dr. hale's Lactation risk categories? L1
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Safest - controlled studies; no risk to infant; harm is remote; OR
product not orally available in infant |
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Dr. hale's Lactation risk categories? L2
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Safer: limited studies show NO incr in AE in infant
evidence of risk likely to follow product use is remote |
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Dr. hale's Lactation risk categories? L3
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Mod. Safe: No controlled studies and risk is possible.
Controlled studies show minimal AE (non-threatening) give ONLY benefit >> risk |
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Dr. hale's Lactation risk categories? L4
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***ALL new drugs are placed in this category
Possibly Hazardous: positive evidence of risk benefits may outweigh risk |
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Dr. hale's Lactation risk categories? L5
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Contraindicated: studies document risk;
medication has high risk of causing signif change RISK >> Benefit |
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Additional info in Medication & Mother's Milk incl?
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Doses: theoretic vs. relative infant dose
drug interactions alternatives adult dosage drug characteristics |
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Briggs's lactation recommendation? Compatible
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drug not excreted in signif amount
or not expected to cause toxicity |
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Briggs's lactation recommendation? Hold breast feeding
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+/- excreted; maternal benefit > risk
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Briggs's lactation recommendation? Probably compatible
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No or limited human data;
Drug not a signif risk |
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Briggs's lactation recommendation? Potential toxicity (Mother also)
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Clinically signif risk may exist
Breastfeeding not recommended |
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Briggs's lactation recommendation? Contraindicated
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+/- human experience
data suggest severe toxicity may occur in infant OR contraindicated b/c mother's condition being treated |
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LactMed Database incl?
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Database within TOXNET; part of national library of medicine
-provides info on: drug levels; effects on infant and lactation; AAP category; alternatives |
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Drug characteristics that det. transfer into milk
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1. degree of protein binding (want high)
2. conc. in maternal plasma 3. MW (want high MW) 4. lipophilicity (want low) 5. half-life (want low) |
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General Principles concerning meds and breastfeeding
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neonates & infants more at risk
avoid unnecessary meds choose meds w/ published data if relative infant dose <10%; safe to use |
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REF for neonates
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NEOFAX
organized by therapeutic class info incl: -dose & admin; uses; monitoring; AEs/precautions; pharmacology; special considerations; references |
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Pediatric REF: Harriet Lane
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4 sections
1. Ped acute care 2. diagnostic & therapeutic info 3. reference 4. formulary contains normal lab values for each age group |
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Ped REF: Ped Dosage Handbook
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Meds alphabetically
- has breastfeeding considerations and product availability -Appendices of: 1. immunization guidelines 2. oral meds cannot be crushed 3. ped HIV - Therapeutic category |
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Ped REF: the Teddy Bear Book
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Neonates --> adolescents
Info incl: dose adjustments in organ dysfunction max dose IV push intermittent infusion continuous infusion IM admin Max conc Cautions regarding IV admin |
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Ped REF: Pediatric Drug Formulations
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tablets + capsules --> oral liquid or suspensions
info incl: dosage form; source; conc; stability; storage info; labeling; ingredient strength quantity; recipe for preparation |
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Peds Vaccination Schedules? where to find?
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CDC has most updated info
updated annually approved by diff committees Includes recommended schedules and catch up schedules |
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Considerations for pediatric pharmacy
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drugs may be marketed but not extensively tested
-dosage may not be available ****dosage must be individualized by age, weight, body surface area |