T12

Question 1

placental drug transfer PK considerations

Answer 1

drug properties
placental transporters
protein binding
placental and fetal drug metabolism

Question 2

placental drug transfer PD considerations

Answer 2

maternal drug actions
therapeutic drug actions in the fetus
predictable toxic drug actions in the fetus
teratogenic drug actions

Question 3

teratogenic drugs

Answer 3

ACE inhibitors
carbamazepine
ethanol
isotretinoin
methadone
misoprostol
phenytoin
tetracycline
thalidomide

Question 4

phenobarbital in lactation

Answer 4

hypnotic doses can cause sedation in the infant

Question 5

prednisone

Answer 5

low maternal doses 5mg/d probably safe
> 15 mg/d should be avoided

Question 6

tetracycline

Answer 6

possibility of permanent staining of developing teeth in the infant. should be avoided during lactation

Question 7

reducing the risk of medications in lactation

Answer 7

30-60 minutes after nursing or 3-4 hours before the next feeding

Question 8

pediatric absorption

Answer 8

age after birth
blood flow at site of administration
gastric acid secretion
peristalsis

Question 9

pediatric distribution

Answer 9

body composition
reduced plasma protein binding

Question 10

pediatric metabolism

Answer 10

slow clearance and prolonged elimination half-lives

Question 11

pediatric excretion

Answer 11

alter frequency of administration based on GFR (glomerular filtration rate)

Question 12

calculating pediatric doses by age

Answer 12

adult dose x age/age+12

Question 13

calculating pediatric doses by weight (kg)

Answer 13

adult x weight/70

Question 14

calculating pediatric doses by weight (lb)

Answer 14

adult x weight/150

Question 15

BSA dosing

Answer 15

1mg/kg (adult) x BSA x weight in kg
ex. BSA = 0.3m^2 x 1 mg/kg adult = 0.18mg/kg x 6 kg = 1.08mg

Question 16

geriatric absorption

Answer 16

decreased gastric acid
slower GI motility
delayed gastric emptying
reduced splanchnic blood flow

Question 17

geriatric distribution

Answer 17

increased body fat
decreased muscle mass
decreased total body water
decreased serum albumin

Question 18

geriatric metabolism

Answer 18

decreased hepatic metabolism
decreased hepatic blood flow
decreased hepatic mass

Question 19

geriatric elimination

Answer 19

reduced renal function

Question 20

geriatric risk of ADRs

Answer 20

10% w 1 drug
nearly 100% w 10 drugs
start at low doses and titrate slowly, deprescribe when indicated

Question 21

polypharmacy

Answer 21

simultaneous use of multiple drugs to treat a single ailment

multi-morbidity
failure to detect ADRs
drug interactions

Question 22

considerations when counseling

Answer 22

cost
expected benefits
adverse events
access to care
cultural and religious sensitivity
medical literacy
patient disability

Question 23

promoting adherence in adults

Answer 23

shared decision making
proper counseling for the pt and family members
optimize medication regime when possible
pill boxes or reminders
regular follow up