CHAPTER 8 • Embryonic period: weeks 3 to 8
Drug Administration Throughout the Life Span
Growth - Progressive Increase in Physical Size
• Stages of growth and physical development
• Predictable sequence
Development
• Development refers to 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 must be made.
• How to treat illnesses or medical conditions that
existed before the pregnancy with drugs
• Changes occur in endocrine, gastrointestinal,
cardiovascular, circulatory, and renal systems.
Changes During Pregnancy
• Absorption of drugs
-Abdominal/gastric 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 rates may increase.
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.
- Period of maximum sensitivity to teratogens
Pregnancy Periods
• Fetal period: weeks 9 to 40 or until birth
- Medications have prolonged
duration of action.
Five Pregnancy Categories of Drugs
• Developed by FDA
- No testing on humans is possible, so data is
sometimes limited.
• Categories-A, B, C, D, X
• Gives 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
• Animal studies have shown no risk to
fetus.
• No studies done with pregnant women
Pregnancy Category C Drugs
• Animal studies have shown a risk to fetus.
• No studies done with pregnant women
Pregnancy Category D Drugs
• Risk to fetus shown
• Benefits outweigh risk.
Pregnancy Category X Drugs-Contraindicated
• Studies done with animals or pregnant women
• Fetal abnormalities shown
Drugs Secreted into Breast Milk
• Fortunately few instances of harm to infant
• Dangerous drugs usually have safe alternatives.
• Drugs that are ionized, water soluble, or bound to
plasma proteins are less likely to enter breast milk.
RYAN LLOYD C. ESCUETA BSN-2E

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
Recommendations for Drug Use During Lactation
• Drugs with shorter half-lives are preferable.
• Drugs with long half-lives should be avoided.
• Drugs with high protein-binding ability should be
selected.
• AlI OTC herbal products and dietary supplements
should be avoided.
Patient Education
• Nurse should place focus on drug education of
pregnant or lactating mother.
• Thoroughly informed of risks to self and child
Prenatal Stage and Pharmacotherapy
• Only when benefits to mother outweigh potential
risks to fetus
Infants and Pharmacotherapy
• Birth to first 12 months
• Safety of child is primary
• Have child ingest all medication;
difficult to estimate how much lost if spit up
• Nurse/parent should be aware of
special procedures for drug administration.
-Example: child should be held and cuddled
while medication is administered.
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
• Allow time for questions
• Need 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
• Changes begin around 45 years of age
• Prescribed drugs for stress-related illnesses
• Numerous life transitions
• Positive lifestyle changes could prevent drug therapy
Illnesses Requiring Drug Therapy for Late Middle-
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