CHAPTER 8 • Embryonic period: weeks 3 to 8

Drug Administration Throughout the Life Span - Period of maximum sensitivity to teratogens
Pregnancy Periods
Growth - Progressive Increase in Physical Size • Fetal period: weeks 9 to 40 or until birth
• Stages of growth and physical development - Medications have prolonged
• Predictable sequence duration of action.

Development Five Pregnancy Categories of Drugs

• Development refers to functional changes in • Developed by FDA
physical, psychomotor, and cognitive - No testing on humans is possible, so data is
capabilities. sometimes limited.
- Psychomotor and cognitive development • Categories-A, B, C, D, X
tend to be more variable. • Gives no specific clinical information to help guide
nurses or their patients about a medication's true
Providing Optimum Care safety
• Understand normal growth and development
• Recognize deviations from the norm Pregnancy Category A Drugs
• Address health-pattern impairments • Studies performed with pregnant women
• No increased risk of fetal abnormalities shown
Nursing Considerations
• Individuality of patients Pregnancy Category B Drugs
• Age, growth, and development of patients • Animal studies have shown no risk to
• Relationship to pharmacokinetics and fetus.
pharmacodynamics • No studies done with pregnant women

Drug Administration During Pregnancy and Pregnancy Category C Drugs

Lactation • Animal studies have shown a risk to fetus.
• Many special considerations must be made. • No studies done with pregnant women
• How to treat illnesses or medical conditions that
existed before the pregnancy with drugs Pregnancy Category D Drugs
• Changes occur in endocrine, gastrointestinal, • Risk to fetus shown
cardiovascular, circulatory, and renal systems. • Benefits outweigh risk.

Changes During Pregnancy Pregnancy Category X Drugs-Contraindicated

• Absorption of drugs • Studies done with animals or pregnant women
-Abdominal/gastric changes affect absorption. • Fetal abnormalities shown
- Inhaled drugs may be absorbed faster.
• Distribution and metabolism Drugs Secreted into Breast Milk
- Changes in cardiac output, plasma volume, • Fortunately few instances of harm to infant
and regional blood flow change distribution • Dangerous drugs usually have safe alternatives.
and metabolism. • Drugs that are ionized, water soluble, or bound to
• Drug excretion rates may increase. plasma proteins are less likely to enter breast milk.

Teratogen
o A substance, organism, or physical agent to which a
fetus is exposed that causes permanent
abnormality, retardation, or death
o There are no "absolute" teratogens.

Pregnancy Periods
• Preimplantation period: weeks 1 to 2 of first
trimester
-Teratogen either causes death of the embryo
or has no effect.
RYAN LLOYD C. ESCUETA BSN-2E
 • Birth to first 12 months
• Safety of child is primary
Factors That Affect Drug Exposure Through • Have child ingest all medication;
Lactation difficult to estimate how much lost if spit up
• Time between drug administration and • Nurse/parent should be aware of
breast feeding special procedures for drug administration.
• Mother's use of illicit drugs -Example: child should be held and cuddled
• Amount of drug administered while medication is administered.
• Amount that reaches fetus tissue
• Infant's ability to metabolize drug Toddlers and Pharmacotherapy
• Period from 1 to 3 years
• Proper storage of drugs; no toddler access to
medications
• Short, concise explanations; provide comfort after
Oral drugs can be mixed with foods like jam or syrup.
• Injections are given at specific locations with
toddlers.

Preschoolers and Pharmacotherapy

• 3 to 5 years of age
• Safe storage = out of reach
• Can begin to assist with medications
• Brief explanation followed by administration
• Mix oral drugs with food or flavored beverages

School- Age Children and Pharmacotherapy

o Most children healthy in this period
o Offer longer, more detailed explanations
o Praise cooperation
o Offer choices when appropriate

Adolescents and Pharmacotherapy

• Need understanding and respect
• Educate about
- Hazards of tobacco and substance abuse
- Sexual intercourse
- Eating disorders
• Provide important medication information
Recommendations for Drug Use During Lactation
• Allow time for questions
• Drugs with shorter half-lives are preferable.
• Need privacy and control
• Drugs with long half-lives should be avoided.
• Drugs with high protein-binding ability should be
Young Adults and Pharmacotherapy
selected.
• AlI OTC herbal products and dietary supplements • Minimal need for prescription drugs unless chronic
should be avoided. diseases or immune-related conditions exist
• Positive medication compliance
• Educate about substance abuse and treatment of
Patient Education
sexually transmitted diseases
• Nurse should place focus on drug education of
pregnant or lactating mother.
Middle- Aged Adults and Pharmacotherapy
• Thoroughly informed of risks to self and child
• Changes begin around 45 years of age
Prenatal Stage and Pharmacotherapy • Prescribed drugs for stress-related illnesses
• Numerous life transitions
• Only when benefits to mother outweigh potential
• Positive lifestyle changes could prevent drug therapy
risks to fetus
Illnesses Requiring Drug Therapy for Late Middle-
Infants and Pharmacotherapy
RYAN LLOYD C. ESCUETA BSN-2E
 Age Adults
• Cardiovascular disease
• Hypertension
• Diabetes
• Cancer
• Obesity
Older Adults and Pharmacotherapy
• Take multiple medications concurrently, or
polypharmacy, is common.
• Some predictable ailments, but much variability
remains
• More adverse drug events in geriatric patients
• Reminder aids for administration may be used.
• Maintain independence and dignity
• Reminder aids for drug administration may be
beneficial.

Absorption of Drugs Slower in Older Adults

• Diminished gastric motility
• Decreased blood flow to digestive organs
Increased gastric pH

Distribution Diminished in Older Adults

• Increased body fat
• Reduced plasma level
• Less body water
• Liver produces less albumin:
- Decreased plasma protein-binding
ability
- Increased levels of free drugs
" Increases potential for drug-drug
interaction
• Decreased cardiac output

Metabolism Reduced in Older Adults

• Reduced first-pass metabolism
• Decreased production of liver enzymes
• Plasma level elevated
• Increases half-life of many drugs
• Tissue concentrations increased

Excretion Reduced in Older Adults

• Reduced renal blood flow
• Reduced glomerular filtration rate
• Decreased active tubular secretion
• Decreased nephron function
• Decreased drug excretion for drugs processed by the
kidneys

RYAN LLOYD C. ESCUETA BSN-2E