Medication Errors & Risk Reduction

Pharmacology for Nurses: A Pathophysiologic
Approach
Fifth Edition
Chapter 8
Drug Administration
Throughout the Life Span
Copyright © 2017, 2014, 2011 Pearson Education, Inc. All Rights Reserved
Growth—Progressive Increase in Physical
Size
• Stages of growth and physical development

• Predictable sequence
Development
• Development—functional changes in physical,

psychomotor, and cognitive capabilities
– Psychomotor and cognitive development tend to be
more variable
Providing Optimum Care
• Understand normal growth and development

• Recognize deviations from the norm
• Address health-pattern impairments
Nursing Considerations
• Individuality of patients
• Age, growth, and development of patients
• Relationship to pharmacokinetics and
pharmacodynamics
Drug Administration During Pregnancy
and Lactation
• Many special considerations

– Changes in endocrine, gastrointestinal,
cardiovascular, circulatory, and renal systems
– How to treat conditions that existed before the
pregnancy
– How to treat conditions that arise during pregnancy
– Passage of drugs through placenta or into breastmilk
Changes During Pregnancy
• Absorption of drugs
– Hormonal changes affect absorption
– Inhaled drugs may be absorbed faster
• Distribution and metabolism
– Changes in cardiac output, plasma volume, and
regional blood flow change distribution and
metabolism
• Drug excretion
– Rate of excretion may increase
Teratogen
• A substance, organism, or physical agent to which an

embryo or fetus is exposed that causes permanent
abnormality in structure or function and causes
retardation or death
• No absolute teratogens; risk increases with dose
Pregnancy Periods and Teratogens
• Preimplantation period: weeks 1 to 2 of first trimester

– Teratogen either causes death of embryo or has no
effect
• Embryonic period: weeks 3 to 8
– Teratogens have maximum impact
Pregnancy Periods
• Fetal period: weeks 9 to 40 or until birth

– Blood flow increases and placental membranes thin,
maximizing substance transfer to fetus
– Medications have prolonged duration of action within
fetus
Five Pregnancy Categories of Drugs
• Developed by FDA
– No testing on humans is possible, so data sometimes
limited
• Categories—A, B, C, D, X
• Give no specific clinical information to help guide nurses
or their patients about a medication's true safety
Pregnancy Category A Drugs
• Studies performed with pregnant women

• No increased risk of fetal abnormalities shown
Pregnancy Category B Drugs
• Studies in animals have shown no risk to fetus, but no

studies done with pregnant women OR
• Animal studies show adverse effect, but adequate and
well-controlled studies in pregnant women have failed to
show risk
Pregnancy Category C Drugs
• Animal studies have shown a risk to fetus, and no studies

done with pregnant women OR
• No animal studies conducted and no adequate, well-
controlled studies in pregnant women
Pregnancy Category D Drugs
• Risk to fetus shown

• If benefits outweigh risk, may be acceptable
Pregnancy Category X Drugs—
Contraindicated
• Studies done with animals or pregnant women

• Fetal abnormalities shown
• Drug contraindicated in women who are or may become
pregnant
Table 8.1 Current FDA Pregnancy
Category Ratings with Examples (1 of 2)
Risk Category Interpretation Drugs
A Adequate, well-controlled studies in pregnant Prenatal multivitamins, insulin, thyroxine, folic

women have not shown an increased risk of acid
fetal abnormalities to the fetus in any trimester
of pregnancy.
B Animal studies have revealed no evidence of Penicillins, cephalosporins, azithromycin,
harm to the fetus; however, there are no acetaminophen, ibuprofen in the first and
adequate and well-controlled studies in second trimesters
pregnant women.
OR
Animal studies have shown an adverse effect,
but adequate and well-controlled studies in
pregnant women have failed to demonstrate
risk to the fetus in any trimester.
C Animal studies have shown an adverse effect Most prescription medicines; antimicrobials
and there are no adequate and well-controlled such as clarithromycin, fluoroquinolones, and
studies in pregnant women. Bactrim; selective serotonin reuptake inhibitors
OR (SSRIs); corticosteroids; and most
No animal studies have been conducted and antihypertensives
there are no adequate and well-controlled
studies in pregnant women.
Table 8.1 Current FDA Pregnancy
Category Ratings with Examples (2 of 2)
Risk Category Interpretation Drugs
D Adequate well-controlled or observational Alcohol, ACE inhibitors, angiotensin receptor

studies in pregnant women have demonstrated blockers (ARBs) in the second and third
a risk to the fetus. trimesters, gentamicin, carbamazepine,
cyclophosphamide, lithium carbonate,
However, the benefits of therapy may outweigh methimazole, mitomycin, nicotine, nonsteroidal
the potential risk. For example, the drug may anti-inflammatory drugs (NSAIDs) in the
be acceptable if needed in a life-threatening third trimester, phenytoin, propylthiouracil,
situation or serious disease for which safer streptomycin, tetracyclines, valproic acid
drugs cannot be used or are ineffective.
X Adequate well-controlled or observational Clomiphene, fluorouracil, isotretinoin, leuprolide,
studies in animals or pregnant women have menotropins, methotrexate, misoprostol,
demonstrated positive evidence of fetal nafarelin, oral contraceptives, raloxifene,
abnormalities or risks. ribavirin, statins, temazepam, testosterone and
thalidomide, and warfarin
The use of the product is contraindicated in
women who are or may become pregnant.
There is no indication for use in pregnancy.
Drugs Secreted into Breast Milk
• Fortunately few instances of harm to infant

• Dangerous drugs usually have safe alternatives
• Drugs with high protein-binding ability are less likely to
enter breast milk
Factors That Affect Drug Exposure
Through Lactation
• Time between drug administration and breast feeding

• Mother's use of illicit drugs
• Amount of drug administered
• Amount that reaches fetus tissue
• Infant's ability to metabolize drug
Table 8.2 Selected Drugs Associated with Serious
Adverse Effects During Breast-Feeding (1 of 2)
Reported Effect or Reasons for
Drug Concern
atenolol (Tenormin) Cyanosis, bradycardia, hypotension
ciprofloxacin Pseudomembranous colitis
codeine Death, bradycardia, neonatal apnea
dapsone (Aczone) Hemolytic anemia
doxepin (Sinequan) Sedation and respiratory arrest
erythromycin Pyloric stenosis
fluoxetine (Prozac) Sedation, lethargy, poor feeding
indomethacin (Indocin) Seizures
lithium (Eskalith) T-wave abnormalities
naproxen (Naprosyn, others) Prolonged bleeding, hemorrhage, animi
Table 8.2 Selected Drugs Associated with Serious
Adverse Effects During Breast-Feeding (2 of 2)
Reported Effect or Reasons for
Drug Concern
paroxetine (Paxel) Hyponatremia
phenytoin (Dilantin) Methemoglobinemia
sulfasalazine (Azulfidine) Bloody diarrhea
valproic acid (Depakene, Depakote) Thrombocytopenic purpura, anemia
Data from: “Safety During Breastfeeding: Drugs, Foods, Environmental

Chemicals, and Maternal Infections,” by C. M. Berlin and J. N. van den Anker,
2013, Seminars in Fetal & Neonatal Medicine, 18, pp. 13–18; and “Safe Use
of Medications in Breastfeeding Mothers,” by E. Grant, and P. Golightly, 2010,
Prescriber, 21, pp. 70–73.
Recommendations for Drug Use During
Lactation
• Administer drug after breast-feeding

• Teach mother to avoid alcohol, illicit drugs, tobacco
• Drugs with shorter half-lives are preferable
• Drugs with long half-lives should be avoided
• Select drugs with high protein-binding ability
• Avoid all OTC herbal, dietary supplements
Patient Education
• Focus on drug education of pregnant or lactating mother

• Thoroughly inform mother of risks to self and child
Prenatal Stage and Pharmacotherapy
• Only when benefits to mother outweigh potential risks to

fetus
Infants and Pharmacotherapy (1 of 2)
• Birth to first 12 months

• Safety of child is primary
• Have child ingest all medication; difficult to estimate how
much lost if spit up
Infants and Pharmacotherapy (2 of 2)
• Nurse/parent should be aware of special procedures for

drug administration
– Example: child should be held and cuddled while
medication is administered
Figure 8.3 Treating the Infant
Source: Pearson Education, Inc.
Toddlers and Pharmacotherapy
• Period from 1 to 3 years

• Teach parent about proper storage of drugs; no toddler
access to medications
• Give toddler short, concise explanations; provide comfort
after
• Oral drugs can be mixed with foods like jam, syrup, or
fruit puree
• 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
School-Age Children and Pharmacotherapy
• Between 6 and 12 years old

• Most children healthy in this period
• Offer longer, more detailed explanations
• Encourage cooperation
• Offer choices when appropriate
Figure 8.4 Treating the Younger School-
Age Child
Source: George Dodson/Pearson Education, Inc.
Adolescents and Pharmacotherapy (1 of 2)
• Between ages 13 and 16 years old

• Need support, approval, and presence
• Educate about
– Hazards of tobacco and substance abuse
– Sexual intercourse
– Eating disorders
Adolescents and Pharmacotherapy (2 of 2)
• Provide important medication information

• Allow time for questions
• Allow privacy and control
Young Adults and Pharmacotherapy
• Minimal need for prescription drugs unless chronic

diseases or immune-related conditions exist
• Positive medication compliance
• Educate about substance abuse and treatment of
sexually transmitted diseases
Middle-Aged Adults and Pharmacotherapy
• Health changes begin around 45 years of age

• Prescribed drugs for stress-related illnesses
• Numerous life transitions
• Positive lifestyle changes could prevent drug therapy
Figure 8.5 Treating the Middle-Aged Adult
Source: Rob/Fotolia
Illnesses Requiring Drug Therapy for Late
Middle-Age Adults
• Cardiovascular disease
• Hypertension
• Obesity
• Arthritis
• Cancer
• Anxiety
Older Adults and Pharmacotherapy
• Commonly take multiple medications concurrently

(polypharmacy)
• 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
Figure 8.6 Treating the Older Adult
Source: Barabas Attila/Fotolia
Absorption of Drugs Slower in Older Adults
• Diminished gastric motility

• Decreased blood flow to digestive organs
• Increased gastric pH
Distribution Diminished in Older
Adults (1 of 2)
• Increased body fat

• Reduced plasma level
• Less body water
Distribution Diminished in Older
Adults (2 of 2)
• 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
• Half-life of many drugs increased
• 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
Copyright

Medication Errors &amp; Risk Reduction

Enviado por

Dados do documento

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Medication Errors &amp; Risk Reduction

Enviado por

Direitos autorais:

Formatos disponíveis

Pharmacology for Nurses: A Pathophysiologic

• Stages of growth and physical development

• Development—functional changes in physical,

• Understand normal growth and development

• Many special considerations

• A substance, organism, or physical agent to which an

• Preimplantation period: weeks 1 to 2 of first trimester

• Fetal period: weeks 9 to 40 or until birth

• Studies performed with pregnant women

• Studies in animals have shown no risk to fetus, but no

• Animal studies have shown a risk to fetus, and no studies

• Risk to fetus shown

• Studies done with animals or pregnant women

A Adequate, well-controlled studies in pregnant Prenatal multivitamins, insulin, thyroxine, folic

D Adequate well-controlled or observational Alcohol, ACE inhibitors, angiotensin receptor

• Fortunately few instances of harm to infant

• Time between drug administration and breast feeding

Data from: “Safety During Breastfeeding: Drugs, Foods, Environmental

• Administer drug after breast-feeding

• Focus on drug education of pregnant or lactating mother

• Only when benefits to mother outweigh potential risks to

• Birth to first 12 months

• Nurse/parent should be aware of special procedures for

Source: Pearson Education, Inc.

• Period from 1 to 3 years

• Between 6 and 12 years old

Source: George Dodson/Pearson Education, Inc.

• Between ages 13 and 16 years old

• Provide important medication information

• Minimal need for prescription drugs unless chronic

• Health changes begin around 45 years of age

• Commonly take multiple medications concurrently

Source: Barabas Attila/Fotolia

• Diminished gastric motility

• Increased body fat

• Liver produces less albumin:

• Reduced first-pass metabolism

• Reduced renal blood flow

Você também pode gostar

Medication Errors & Risk Reduction

Medication Errors & Risk Reduction