1. Lifespan and Cultural Modifications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 1 Chapter 5

2. Learning Objectives Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 2 Identify specific considerations in administering medications to pediatric, pregnant, breastfeeding, or elderly patients

3. U.S. Food and Drug Administration (FDA) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 3 Establishes standards that require drug companies to provide consumers with specific drug information Information is printed on product package insert (PPI) Information includes: Description of therapeutic response Side effects Adverse effects Possible drug interactions

4. The Pediatric Patient Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 4 Variables have a profound impact on drug action and effect Neonates (less than 1 month of age) Small body mass Low body fat content High body water volume Increased membrane permeability

5. The Pediatric Patient (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 5 Variables have a profound impact on drug absorption No gastric acid present at birth No intestinal bacteria or enzyme function present Delayed gastrointestinal transit time Immaturity of liver, kidney, and renal excretion systems

6. Question 1 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 6 Drug effect in a neonate differs from that in an adult because of the newborn’s: 1. Larger head to body mass ratio. 2. High body fat content. 3. High body water volume. 4. Decreased membrane permeability.

7. Absorption Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7 Three principles in the pediatric patient The physiologic status (muscle mass and use) of the infant or child determines the blood flow at the site of intramuscular or subcutaneous drug administration. Compared with older children and adults, premature infants have immature and unstable body processes. A newborn’s skin, particularly that of premature infants, has a greater ability to absorb some chemicals because of its greater hydration.

8. Distribution Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 8 Two factors The chemical properties of the drug (do not vary) The physiologic factors specific to the patient (do vary)

9. Metabolism Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 9 The majority of drug metabolism, or biotransformation, takes place in the liver. In general, drug metabolism in infants is much slower than in older children and adults. Until 3 to 4 years of age, children have the ability to increase production of liver enzymes. Neonates have a decreased ability to metabolize drugs.

10. Excretion Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 10 Renal system may still be immature at birth Decreased glomerular filtration Decreased tubular secretion Decreased tubular reabsorption System still maturing over the first year of life Drug clearance can be compromised

11. Adverse Drug Reactions Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 11 Children are exposed to drugs directly and indirectly Transplacentally during pregnancy or delivery Direct administration Through ingested breast milk

12. The Geriatric Patient Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 12 Reacts differently to medications than younger adults do Drugs absorbed, metabolized, and excreted more slowly and less completely (stair – stepping) Variability in drug response and clearance related to aging organ systems and overall health or illness Patients age differently; body responses vary

13. Geriatric Patient Teaching Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 13 Drug nonadherence related to: Drug cost Difficulty obtaining drugs Diminished cognitive abilities Lack of desire to take on schedule Depression Feelings of being overwhelmed with physical needs Physical disabilities requiring assistance to administer

14. Question 2 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 14 Drugs metabolized by the __________ should be used with caution in elderly patients. 1. stomach 2. liver 3. pancreas 4. small intestine

15. Learning Objectives Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 15 Identify specific considerations in administering medications to pediatric, pregnant, breastfeeding, or elderly patients Identify special considerations for providing care to individuals from different cultures Describe specific nursing behaviors that assist in helping patients succeed with their medication plans

16. Medications Used by Women Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 16 Females differ from males in hormonal makeup Medication needs are often related to: Genital tract infections Menstruation Infertility Pregnancy Menopause

17. Medications and Pregnancy Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 17 1961, thalidomide Teratogenic = likely to cause fetal or embryonic damage or malformations Few “safe” medications during pregnancy Check drug book for pregnancy catergory Pregnancy X- do not give!! Weigh benefit of drug for mother against risk to fetus

18. Medications, Pregnancy, and Breastfeeding Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 18 Some medications cross the immature blood-brain barrier of the fetus Some medications cross the placenta to the fetus Some medications pass into breast milk to the baby during nursing

19. Childhood Immunizations Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 19 Essential for personal and national protection Factors related to delay in receiving Health care provider belief of need to delay related to symptoms of mild illness Parental refusal from concern over adverse effects

20. Medications Used Throughout the Lifespan Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 20 Antidiabetic agents Antihypertensive agents Cholesterol-lowering drugs Smoking-cessation products Weight-loss drugs Antidepressant medications Impotence drugs Aspirin Caffeine

21. Question 3 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 21 What percent of cases of childhood asthma have been linked to the effects of passive smoking? 1. 30% 2. 40% 3. 50% 4. 60%

22. Cultural Influences Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 22 Cultural assessment includes determining Values Religion Dietary practices Family lines of authority Family life patterns Beliefs and practices related to health and illness

23. Medication Nonadherence Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 23 Six major reasons for client nonadherence Medications are for prevention Increases with prolonged therapy Treatment requires significant changes in behavior Poor patient understanding Complexity of treatment plan Unpleasant side effects

24. Chapter 6 Self-Care: Over-the-Counter Products, Herbal Therapies, and Drugs for Health Promotion Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 24

25. Documenting Patient Health Care Practices Nursing knowledge of products OTC and prescription interaction Container labels Complementary and alternative medicine (CAM) 25 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. ***$6 billion spent on nonprescription remedies Common influences Friends Advertisements

26. Pros and Cons Safety, purity, and effectiveness Natural estrogens – phytoestrogens (flaxseed, red clover sprouts, and soy flour) Time Variability in each dose Council for Responsible Nutrition Refer to Tables 6-2, 6-3, 6-4 26 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

27. QUESTIONS? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 27