1. What factors place an infant and child at risk when prescribing medications?
1. Inattention to weight based dosing increases potential for harm.
2. Immature organ function, renal and hepatic
3. Limited study on medication use in children
2. What adverse drug reactions (ADRs) are the elderly at risk of developing?
1. Toxicity secondary to decreased renal and hepatic function which causes decreased clearance and metabolism.
2. Polypharmacy risk due to drug to drug interaction
3. Unintentional overdose.
3. What are the ADRS related to special populations?
1. Geriatric Population:
1. Slowed absorption and clearance
1. Decreased GI acidity, motility
2. Reduced hepatic and renal function
3. Body composition
1. Decreased mass, increased fat
5. Reduced activity levels
6. Less effective blood brain barrier
2. Pediatric Population:
1. Immature Organs
1. Hepatic and renal function are reduced
1. Reduced glomerular filtration
2. Decreased tubular secretion and reabsorption
2. Blood brain barrier immature
3. Pregnant Population:
1. Hormonal Impact
1. Decreased GI tone, gastric emptying, and peristalisis
1. Increase tidal volume
2. Pulmonary vasodilation
3. Increased absorption of inhaled drugs
4. Inhaled drug absorption is increased
1. Increased heart rate
2. Increased circulatory volume
1. Hypoalbuminemia due to dilution
3. Increased plasma lipid levels
1. Impacts transport/distribution of drugs
4. Impact on fetus
1. Non-lipophilic drugs enter fetal circulation
2. Potential for medications to enter breastmilk
4. Which medications interact with St. John’s Wort?
1. Warfarin, antidepressants, antiretrovirals, CNS depressants, analgesics, phenytoin
5. How does doxazosin work?
1. Doxazosin relaxes the smooth muscle in the blood vessel walls, thereby causing vessels to dilate, lowering blood pressure.
6. What is the action and effect of beta blockers?
1. They occupy beta-receptor sites and prevent catecholamines and other beta agonists.
2. Heart rate is decreased at the SA node.
3. The atria and ventricles decrease contractility and conduction velocity.
4. Decreases angina, rapid arrhythmias, BP, and reflex orthostatic tachycardia.
7. What are the adverse effects of beta blockers?
2. CHF with pulmonary edema
4. Fatigue, Weakness, drowsiness
5. Blood glucose alterations
6. Anxiety, depression, insomnia, nightmares
7. Bronchospasm, dyspnea
8. Dry Mouth
9. Muscle and joint pain
10. Pruritic rashes
11. Facial swelling
8. What effect will result with rapid withdrawal of a beta blocker?
3. Ventricular arrhythmias
9. What patient teaching should be provided when prescribing clonidine or any centrally acting adrenergic blocker?
1. Take as prescribed, don’t skip doses or double up
2. Suddenly stopping this medication can be life-threatening.
3. Food may affect metoprolol and propanalol—take with or without food consistently
4. Do not take OTC medications without consulting a provider, especially cold medications
10. What are the adverse effects of a beta 1 selective blocker?
1. Bronchospasm, heart failure, prolonged hypoglycemia, bradycardia, heart block, intermittent claudication, and Raynaud's phenomenon. Neurological reactions include depression, fatigue, and nightmares.
11. What effect is produced with cholinergic blockers?
1. Increased heart rate, reduced PR interval
2. Smooth muscle relaxation, bronchodilation, reduced GI tone and peristalisis, potential for urinary retention
3. Dry mouth
4. CNS excitation, agitation, hallucinations, delirium
5. Papillary constriction, mydriasis