Lifespan Drugs

• Pharmacotherapy across the Lifespan is an extension of holistic medicine, where each person is an individual with many ways to approach individual variation in pharmacotherapeutic response
• Drug therapy during pregnancy


  • Postponed until pregnancy is over, except for serious conditions like epilepsy, hypertension, gestational diabetes, and infections
  • 90% of women take at least one medication during pregnancy, must weigh benefits against risks
• Physiologic changes during pregnancy that affect pharmacotherapy


  1. Changes in absorption

  2. Changes in distribution and metabolism

  3. Changes in drug excretion
• Teratogen


  A substance, organism, or physical agent to which an embryo or fetus is exposed that causes permanent abnormality in structure or function and causes retardation or death
• Gestational age and drug therapy


  1. Preimplantation period: weeks 1 to 2, teratogen either causes death of embryo or has no effect

  2. Embryonic period: weeks 3 to 8, teratogens have maximum impact

  3. Fetal period: weeks 9 to 40, blood flow increases and placental membranes thin, maximizing substance transfer to fetus, medications have prolonged duration of action within fetus
• Pregnancy drug categories


  Developed by FDA, categories A, B, C, D, X, give no specific clinical information to help guide nurses or their patients about a medication's true safety
• Pregnancy Category A drugs


  • Studies performed with pregnant women, no increased risk of fetal abnormalities shown
• Pregnancy Category B drugs


  • Studies in animals have shown no risk to fetus, but no studies done with pregnant women OR animal studies show adverse effect, but adequate and well-controlled studies in pregnant women have failed to show risk
• Pregnancy Category C drugs


  • Animal studies have shown a risk to fetus, and no studies done with pregnant women OR no animal studies conducted and no adequate, well-controlled studies in pregnant women
• Pregnancy Category D drugs


  • Risk to fetus shown, if benefits outweigh risk, may be acceptable
• Pregnancy Category X drugs


  • Contraindicated, studies done with animals or pregnant women have shown fetal abnormalities
• Drugs in each pregnancy category


  • Category A: prenatal multivitamins, insulin, thyroxine, folic acid

  Category B: penicillins, cephalosporins, azithromycin, acetaminophen, ibuprofen in the first and second trimesters

  Category C: most prescription medicines, antimicrobials, SSRIs, corticosteroids, most antihypertensives

  Category D: alcohol, ACE inhibitors, angiotensin receptor blockers, gentamicin, carbamazepine, lithium carbonate, NSAIDs in the third trimester

  Category X: clomiphene, fluorouracil, isotretinoin, oral contraceptives, warfarin
• Pharmacotherapy of the lactating patient


  Fortunately few instances of harm to infant, dangerous drugs usually have safe alternatives, drugs with high protein-binding ability are less likely to enter breast milk
• Factors that affect drug exposure through lactation


  1. Time between drug administration and breastfeeding

  2. Mother's use of illicit drugs

  3. Amount of drug administered

  4. Amount that reaches fetus tissue

  5. Infant's ability to metabolize drug
• Pharmacotherapy of infants


  Birth to first 12 months, safety of child is primary, have child ingest all medication, difficult to estimate how much lost if spit up, nurse/parent should be aware of special procedures for drug administration
• Drug Exposure through Lactation


  • Time between drug administration and breastfeeding
  • Mother's use of illicit drugs
  • Amount of drug administered
  • Amount that reaches fetus tissue
  • Infant's ability to metabolize drug
• Pharmacotherapy of Infants


  • Birth to first 12 months
  • Safety of child is primary
  • Have child ingest all medication; difficult to estimate how much lost if spit up
  • Nurse/parent should be aware of special procedures for drug administration
• Pharmacotherapy of Toddlers


  • Period from 1 to 3 years
  • Teach parent about proper storage of drugs; no toddler access to medications
  • Give toddler short, concise explanations; provide comfort after
  • Oral drugs can be mixed with foods like jam, syrup, or fruit puree
  • Injections are given at specific locations with toddlers
• Pharmacotherapy of Preschoolers and School-Age Children


  • Preschoolers: 3 to 5 years, safe storage, can begin to assist with medications, brief explanation followed by administration
  • School-age children: Between 6 and 12 years, most children healthy, offer longer, more detailed explanations, encourage cooperation, offer choices when appropriate
• Pharmacotherapy of Adolescents


  • Between ages 13 and 16 years
  • Need support, approval, and presence
  • Educate about hazards of tobacco and substance abuse, sexual intercourse, eating disorders
  • Provide important medication information
  • Allow time for questions
  • Allow privacy and control
• Pharmacotherapy of Young and Middle-Aged Adults


  • Young adults: Minimal need for prescription drugs, positive medication compliance, educate about substance abuse and treatment of sexually transmitted infections
  • Middle-aged adults: Health changes begin around 45 years, prescribed drugs for stress-related illnesses, numerous life transitions, positive lifestyle changes could prevent drug therapy
• High Alert Medications


  • Insulin
  • Digoxin
  • Heparin
  • Narcotics & Chemotherapy drugs
  • Potassium (black topped vials)
  • Blood products
• Always read labels 3 times!
• Pediatric Calculations


  • Use BSA and unit of medication per kilogram (most accurate)
  • Recommended dosage over 24 hour period (mg/kg/day) or recommended dosage for single dose (mg/kg/dose)
• Determination of Correct Dose


  1. Weigh the child

  2. Convert lbs. to kg (divide by 2.2)

  3. Check drug reference for safe dose range (10-20 mg/kg of body weight)

  4. Calc. low safe dose

  5. Calc. high safe dose

  6. Determine if ordered dose is within safe dose range
• Ordered dose lower but safe to give


  Recommended Single Dose: 2,500 mg, Ordered: 2,000 mg, Recommended Total Daily: 7,500 mg/day, Ordered: 6,000 mg/day
• Low and High Range


  Low range: 25kg x 10 mg= 250 mg, High range: 25kg x 15 mg= 375 mg
• Dose by Body Surface Area (BSA)


  Child's metabolic rate and growth, Commonly used for chemotherapy, Recommended doses usually specify mg/BSA/dose, Use the West Nomogram
• BSA Formula


  Child's BSA X Average adult dose = Child's dose, 1.73 m² (average adult BSA)
• Safe Dose Range problem


  Weigh child, Calculate low and high safe dose range, Determine if ordered dose is within safe range