Pharmacology in the Lifecycle

Mike Ori

• Compare fat, muscle, body water, renal clearance, hepatic clearance, and skin qualities across the lifecycle

Age Fat Muscle Water Renal Hepatic SkinPremie Very low Low Very High Very low Very low Thinner

HyperperfusedIncreased surface area

Neonate Low Low High Very low Very low ThinnerHyperperfusedIncreased surface area

Infant High Low Normal Normal Very high

Child Low Normal Normal High High

Adolescent Low Normal Normal Normal High

Adult Normal Normal Normal Normal Normal Normal

Elder Adult High Low Low Low Low \/ lipid, thin

Comparisons to adult

• Discuss the various methods of drug delivery across the lifecycle

Age IM Transdermal

Rectal Oral - pills Soft/liquid

IV

Premie No Caution Variable No Liquid YesNeonate No Caution Variable No Liquid YesInfant ? Caution ? No Yes YesChild ? ? ? > 6 yo Yes YesAdolescent Yes Yes Yes Yes Yes YesAdult Yes Yes Yes Yes Yes YesElder Adult No Caution Yes Swallowin

g?Yes Yes

• Explain why off-label use of pharmaceuticals is high in pediatrics

• Safety and efficacy studies are typically carried out in healthy young adults therefore evidence based dosing regimens are not available for children. Case studies, expert opinion, and other less rigorous methodologies are commonly relied on.

• Discuss in general terms the pediatric applicability of cockroft-gault, traub-johnson, and the schwartz equation

• Cockroft-gault is for use in adults age 18 and older.

• Schwartz and traub-johnson are both suitable for use in pediatrics

• Describe the status of the blood brain barrier in geriatric patients and relate this to the beers list

• The BBB is not as tight in geriatric patients which results in increase CNS effects of drugs targeted to the CNS and to drugs with CNS side effect.

• Describe the importance of the Beer list in geriatric patients

• Because of diminished eyesight and cognition changes, many geriatric patients prefer choosing beers from a picture list.

• Alternatively, it’s a list of drugs, created by consensus of expert opinion, that should be avoided or used with caution in older adults.

• Describe the hydration status of geriatric patients

• They have lower total body water, impaired baroreceptors, impaired renal concentration capability all of which combined with social factors to limit hydration. As a result, many geriatric patients are hypovolemic, hyponatremic, and hyperkalemic.

• What are the risk factors for elder abuse?

• Cognitively impaired, dependent female living alone

• Vulnerable adult living with others, physically or financially dependent

• Family history of domestic abuse• Caregiver with mental illness or substance abuse• Caregiver forced by circumstance to care for the

elder

• What are potential signs of elder abuse

• Prolonged interval between trauma or illness and presentation

• Suspicious hx of unexplained injuries• Irregular follow-up, lack of adherence• Elder not given opportunity to speak for

themselves• Vulnerable adult: Fearful or withdrawn behavior• Caregiver: indifferent or angry