drugs in older people and pregnacy 0.0 / 5 ? Pharmacydrugs in older people and pregnacyUniversityNone Created by: RscottqubCreated on: 07-01-20 14:16 older people have decreased muscle and organ mass. total body fluid . motility of GIT. delayed emptying 1 of 44 older people have increased fat mass 2 of 44 absorption in older people amount of absorption is not decreased, but RATE of absorption is slower 3 of 44 factors affecting absorption in older people decreased gastic motilitly . decreased blood flow. decreased SA, increased gastric pH 4 of 44 IM absorption older people have more connective tissue - so decreased rate of absorption 5 of 44 percutaneous absorption (via skin) less skin hydration, tougher harder skin - decreased rate of absorption 6 of 44 Factors affecting distribution in older ppl decreased total body water. increased body fat. less serum albumin . more a1-glyco 7 of 44 effect of less total body water water sol drugs have lower VoD. so will have high plasma conc - may need ,lower dose 8 of 44 higher fat effect lipid soluble drugs have high VoD- longer t1/2 - longer time intervals m,ay be required inbetween doses 9 of 44 less albumin effect more free drug available - need to reduce dose . toxicity 10 of 44 affect on liver with age decreases in size 11 of 44 affect of age on hepatic blood flow reduced - 30% in elderly 12 of 44 CYP enzymes are imparied with age 13 of 44 so phase 1 metabolism is highly affected by age , whereas phase II conjugations arent affected as much by age 14 of 44 1st PM is more significant for what type of durgs lipid soluble 15 of 44 elderly ppl may have reduced bioavailability of prodrugs which require activating in liver 16 of 44 Elimination drugs are excreted slower in elderly. so decrease dose or increase the interval between doses 17 of 44 why is excretion rate slower ? reduced renal flow. reduced GFR. reduced tubular function 18 of 44 renal function is expressed by creatine clearance. elderly have less of this anyway. so many will have renal impairment but not neccessarily a red flagged creatine levels 19 of 44 acute illness can effect renal clearance- and doses should be adjusted if patient becomes acutely ill 20 of 44 pharmacodynamics in older ppl- older ppl have altered sensitivity, homeostatic changes 21 of 44 elderly ppl are how many times more likely to experience adverse drug reactions x2 / x3 22 of 44 why is this ? reduced renal and hepatic function. polypharmacy. adherence . 23 of 44 pregnancy is how long 40 weeks from date of last period 24 of 44 1st trimester 0-12 weeks 25 of 44 2nd trimester 13-29 weeks 26 of 44 3rd trimester 30-40 weeks 27 of 44 pregnant women have altered ADME 28 of 44 what type of molecules pass placenta easiest small, non ionised, lipid sol 29 of 44 polypharmacy in pregnancy should be avoided 30 of 44 in 1st trimester try to avoid all drugs if possible 31 of 44 if have to use drugs in pregnancy we use the smallest dose, for the shortest possible time 32 of 44 pharmacokinetic changes in pregnancy decreased GI motility. increased lung function. increased skin blood circulation. increased excretion 33 of 44 T/F - pregnancy can improve or worsen a chronic condtion True 34 of 44 Absorption decreased gastric secretions in 1+2 tri. - increase in pH --> affect ionisation 35 of 44 another thing to consider re; absorption in pregnancy morning sickness - cannot be absorbed if constantly vom 36 of 44 reasons for an increase in absorption in pregnacy increased CO, increased lung func, increased intestinal flow 37 of 44 pregnant women - plasma vol increases 38 of 44 total body water increase by around 8L 39 of 44 effect of this can dilute drugs - therefore increase in dose required 40 of 44 2 main proteins drugs bind to albumin (weak acids) and a1-acid glycoproteins (bases) 41 of 44 what happens to the amount of plasma proteins in pregnant women decreases due to increased volume - therefore more free drug available - dose reduction may be required 42 of 44 does metabolism return to normal after birth of child yes - so therefore dose is often ammended after birth 43 of 44 excretion is increased dueing pregnancy - due to increase in GFR by 50% 44 of 44
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