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44 Cards in this Set

  • Front
  • Back
Dose adjustments in liver dz incl?
LFTs; bilirubin/direct bili; serum albumin;

use Child-Puge score
Norm 5-6
Med 7-9
Severe over 9
physio & patho changes in older pts can influence what?
pharmacokinetic & pharmacodynamic properties of meds via:

incr. toxicity
unexpected pharm effects
Factors when choosing drugs for old ppl

Renal function
decr. creatinine clearance
Factors when choosing drugs for old ppl

Liver function
Decr. blood flow, enzyme activity, clearance
Factors when choosing drugs for old ppl

Body composition
Decr. lean body mass; fat; serum albumin
Factors when choosing drugs for old ppl

CNS
altered cogn. status
incr. sensitivity to meds
Factors to consider with geriatric pts
1. inability to tolerate certain formulations
2. comorbidities (drug-dz interactions)
3. polypharmacy (drug-drug int)
4. nonadherence: tolerance of meds; affording meds
Ref for geriatric pts (3)
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
What to look for while monitoring geriatric pts
Dosing
Therapeutic duplication
drug selection
ADR: constipation; incontinence; malnutrition; dementia; altered mental status; incr fall risk
Drugs in Pregnancy REF? (3)
Briggs' Drugs in Pregnancy and Lactation

Drugs for Pregnant and lactating women (Weiner)

Reprorisk System
What does Briggs' incl?
alphetical/generic

monographs: name/class; risk factor; fetal risk summary; recommendation; breastfeeding summary & rec; references
What does Drugs for Pregnant and lactating women (weiner) incl?
alphabetized generics;

Monographs: name/class; indications; mech; dosage; contraindi; maternal considerations; fetal consid; breastfeeding safety; drug interactions; ref; summary of risk factors
What does REPRORISK incl?
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
What are pregnancy registries?
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
what det fetal risk?
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.
FDA preg. risk factors: A
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
FDA preg. risk factors: B
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
FDA preg. risk factors: C
Animal studies: AE on fetus; no controlled studies in women OR

Studies in women; animals unavailable

give drug only if benefit > risk

ie. quinolones
FDA preg. risk factors: D
Positive evidence of human fetal risk

benefits may outweigh risk

ie. tetracyclines, NSAIDS
FDA preg. risk factors: X
Evidence of risk in animals or humans or both

risk in pregnancy outweighs benefit

ie. warfarin
Fetal Risk Recomm. in BRIGGS
Compatibility: compatible; maternal benefit >> risk

Risk: low, mod, high, human data/animal data

Contraindi: 1st, 2nd, 3rd, overall.
REF for Drugs in LACTATION? (3)
Gold standard: Medications and Mother's Milk

Briggs'

LactMed database
Med and Mother's milk
Gold standard

Incl: name; uses; recomm. of American Academy of Pediatrics; drug monograph; pregnancy risk category; Dr. Hale's lactation risk category
Dr. hale's Lactation risk categories? L1
Safest - controlled studies; no risk to infant; harm is remote; OR

product not orally available in infant
Dr. hale's Lactation risk categories? L2
Safer: limited studies show NO incr in AE in infant

evidence of risk likely to follow product use is remote
Dr. hale's Lactation risk categories? L3
Mod. Safe: No controlled studies and risk is possible.

Controlled studies show minimal AE (non-threatening)

give ONLY benefit >> risk
Dr. hale's Lactation risk categories? L4
***ALL new drugs are placed in this category

Possibly Hazardous: positive evidence of risk

benefits may outweigh risk
Dr. hale's Lactation risk categories? L5
Contraindicated: studies document risk;

medication has high risk of causing signif change

RISK >> Benefit
Additional info in Medication & Mother's Milk incl?
Doses: theoretic vs. relative infant dose
drug interactions
alternatives
adult dosage
drug characteristics
Briggs's lactation recommendation? Compatible
drug not excreted in signif amount
or
not expected to cause toxicity
Briggs's lactation recommendation? Hold breast feeding
+/- excreted; maternal benefit > risk
Briggs's lactation recommendation? Probably compatible
No or limited human data;

Drug not a signif risk
Briggs's lactation recommendation? Potential toxicity (Mother also)
Clinically signif risk may exist

Breastfeeding not recommended
Briggs's lactation recommendation? Contraindicated
+/- human experience
data suggest severe toxicity may occur in infant OR
contraindicated b/c mother's condition being treated
LactMed Database incl?
Database within TOXNET; part of national library of medicine
-provides info on:
drug levels; effects on infant and lactation; AAP category; alternatives
Drug characteristics that det. transfer into milk
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)
General Principles concerning meds and breastfeeding
neonates & infants more at risk
avoid unnecessary meds
choose meds w/ published data

if relative infant dose <10%; safe to use
REF for neonates
NEOFAX
organized by therapeutic class
info incl:
-dose & admin; uses; monitoring; AEs/precautions; pharmacology; special considerations; references
Pediatric REF: Harriet Lane
4 sections
1. Ped acute care
2. diagnostic & therapeutic info
3. reference
4. formulary

contains normal lab values for each age group
Ped REF: Ped Dosage Handbook
Meds alphabetically
- has breastfeeding considerations and product availability
-Appendices of:
1. immunization guidelines
2. oral meds cannot be crushed
3. ped HIV
- Therapeutic category
Ped REF: the Teddy Bear Book
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
Ped REF: Pediatric Drug Formulations
tablets + capsules --> oral liquid or suspensions

info incl:
dosage form; source; conc; stability; storage info; labeling; ingredient strength quantity; recipe for preparation
Peds Vaccination Schedules? where to find?
CDC has most updated info
updated annually
approved by diff committees
Includes recommended schedules and catch up schedules
Considerations for pediatric pharmacy
drugs may be marketed but not extensively tested
-dosage may not be available

****dosage must be individualized by age, weight, body surface area