Typed Notes Lecture

• Drug therapy during pregnancy


  Postponed until pregnancy is over, except for serious conditions like epilepsy, hypertension, gestational hypertension, gestational diabetes, infections
• 90% of women take at least one medication during pregnancy
• Weighing benefits vs risks of drug exposure during pregnancy


  Looking at risks associated with exposing the fetus to a particular drug
• Physiologic changes during pregnancy that affect pharmacotherapy


  • Changes in absorption, distribution, metabolism, and excretion of drugs
• Teratogen


  Substance, organism, or physical agent that if an embryo or fetus is exposed causes permanent abnormality in structure or function and causes retardation or death
• Teratogenic risk


  Increases with dose
• Gestational age and drug therapy


  • Preimplantation period: teratogen either causes death of embryo or has no effect
  • Embryonic period: teratogens have maximum impact due to major organs being formed
  • Fetal period: blood flow increases and placental membranes thin maximizing substance transfer to fetus, medications have prolonged duration of action within fetus
• Pregnancy drug categories


  • Category A: Very safe, no increased risk to fetus
  • Category B: Studies in animals show no risk to fetus
  • Category C: Animal studies show risk to fetus, no studies in pregnant women
  • Category D: Risk to fetus shown, risk vs benefit
  • Category X: Do not use in pregnant women
• Pharmacotherapy of lactating patient


  Drugs with high protein binding ability are less likely to enter breast milk, factors affecting drug exposure through lactation include time between drug administration and breastfeeding, mother's use of illicit drugs, amount of drug administered, amount that reaches fetal tissue, infant's ability to metabolize drug
• Recommendations for drug use during lactation


  • Administer drug after breastfeeding
  • Avoid alcohol, illicit drugs, tobacco
  • Prefer drugs with shorter half-life
  • Avoid drugs with long half-life
  • Select drugs with high protein-binding ability
  • Avoid OTC herbal and dietary supplements unless discussed with HCP
• Pharmacotherapy of infants (birth to 12 months)


  • Safety of child is primary focus, child should ingest all medication, nurse/parent should be aware of special procedures for drug administration
• Pharmacotherapy of toddlers (1-3 years)


  • Teach parent about proper storage of drugs, give short concise explanations, provide comfort, oral drugs can be mixed with foods, injections given at specific locations
• Pharmacotherapy of preschoolers (3-5 years) and school age children (6-12 years)


  • Preschoolers: safe storage, can begin to assist with medications, brief explanation followed by administration

  School-age: offer longer, more detailed explanations, encourage cooperation, offer choices
• Pharmacotherapy of adolescents (13-16 years)


  • Need support, approval, and presence, educate about hazards of substance abuse and safe sex, provide important medication information, allow time for questions, allow privacy and control
• Pharmacotherapy of young (minimal need for prescription drugs) and middle aged adults (prescribed drugs for stress related illnesses, numerous life transitions)


  • Positive medication compliance, educate about substance abuse and treatment of sexually transmitted infections, positive lifestyle changes could prevent drug therapy
• High alert medications


  • Insulin
  • Digoxin
  • Heparin
  • Narcotics and chemotherapy drugs
  • Potassium
  • Blood products
• Pediatric dose calculation


  Determine correct dose using BSA and medication per kg, recommend dosage over 24 hr period and for single dose, dose by weight or BSA