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NURS 8024 Pharmacology EXAM 1 SUMMARY NOTES WITH QUESTIONS AND ANSWERS RATED A. NURS 8024 Pharmacology EXAM 1 SUMMARY NOTES WITH QUESTIONS AND ANSWERS RATED A. £13.85
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NURS 8024 Pharmacology EXAM 1 SUMMARY NOTES WITH QUESTIONS AND ANSWERS RATED A. NURS 8024 Pharmacology EXAM 1 SUMMARY NOTES WITH QUESTIONS AND ANSWERS RATED A.
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Module
NURS 8024
Institution
NURS 8024
NURS 8024 Pharmacology EXAM 1
SUMMARY NOTES WITH QUESTIONS
AND ANSWERS RATED A.
NURS 8024 Pharmacology EXAM 1
SUMMARY NOTES WITH QUESTIONS
AND ANSWERS RATED A.
Pediatric patients can be exposed to drugs in three ways
✔✔direct administration
breast milk
transplacental
Pediatric patients are at risk for ADRs such as
✔✔paradoxical reactions
Drug contraindications in pediatric patients include
✔✔• Tetracyclines (teeth staining <9 yrs)
• Aspirin- Reyes syndrome
• Valproic acid (liver toxicity <2 yrs)
Considerations for medication distribution for pregnant and nursing
women include
✔✔Risk vs benefit x 2
- consider timing of exposure to fetus
- no real placental barrier (99% drugs cross placenta)
Breastfeeding can be temporarily interrupted as drug concentrations are
generally low
,Common known medication hazards in pregnancy include
✔✔• Isotretinoin (Accutane)- severe defects w/ sm. dose
• REMS- requires 2 forms of birth control
• Angiotensin converting enzyme inhibitors (ACEI) - renal abnormalities
• Caffeine: fetal growth, bone development,
• Nicotine- smoking - Physical and mental growth retardation
Drug passage across the placenta dependent on
✔✔• lipid solubility & degree of drug ionization
• Lipophilic drugs typicallly diffuse easily across the placenta - entering
fetal circulation
• Molecular size and weight
• Plasma protein binding
Metabolic activity of placenta may
✔✔create toxic metabolites → placenta can potentially augment toxicity (
ethanol, benzpyrenes)
6 factors affecting placental drug transfer and fetal effects include
✔✔1.Physicochemical properties of the drug
2. Rate at which the drug crosses the placenta and the amount of drug
reaching the fetus
3. Duration of exposure to the drug
4. Distribution characteristics in different fetal tissues
5. Stage of placental and fetal development at the time of exposure to the
drug
6. Effects of drugs used in combination
,teratogenic
✔✔producing malformations (in the developing embryo)
Teratogenic Mechanisms
✔✔• Drugs may have a direct effect on maternal tissues & secondary or
indirect effects on fetal tissues
• Interference w/ oxygen or nutrient transpoort through the placenta- effect
on rapidly metabolizing tissues in fetus and Direct actions on the
processes of differentiation in developing tissues
• vitamin A (retinol) has been shown to have important differentiation-
directing actions in normal tissues - vitamin A analogs
Continued exposure to teratogenic mechanisms may cause
✔✔cumulative effects or affect organs in varying stages of development
as in the chronic consumption of alcohol. 1st and 2nd trimesters
→ fetal alcohol syndrome
• Potentially affects CNS, growth, facial development
Most important factor in teratogenicity determinants
✔✔Timing of Exposure
Exposure to teratogens during the embryonic phase
✔✔3-8 wks, most critical
• Major organogenesis- risk of major malformations
• Can sustain multiple defects from 1 exposure due to many organ systems
developing in parallel
, Exposure to teratogens during the fetal stage 9weeks-term
✔✔organs grow and mature
• Damage more likely functional, mental development or growth
retardation
• Can be delayed behavioral effects
Other factors affecting fetal teratogenicity include
✔✔maternal factors -fetal genotype - genetic variability in absorption,
metabolism,
distribution & fetal response will determine effect
Dose response relationships
Specificity of agent
Drug interactions - 2 teratogens given together may precipitate a different
effect than each one separately
Drugs to avoid while pregnant
✔✔ACEI - renal damage
Cocaine - ↑ risk of spontaneous abortion, abruptio placentae, and
premature labor; neonatal cerebral infarction, decreased school
performance
ETOH - fetal alcohol syndrome, neurodvelopmental defects
Methotrexate - multiple congenital malformations
Valproic acid- neural tube defects, cardiac and limb malformations
Warfarin
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