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1. identification of teratogens: difficult to identify, 3 criteria must be met:
1. The agent must be present during the critical stage of development
2. The agent produces a particular pattern of birth defects in animal studies.
3. The agent crosses the placenta and there is a dose-response relationship.
2. 3 stages of teratogenesis development: 1. conception through week 2
2. embryonic period week 3-8 = gross malformations
3. fetal period week 9-delivery = functions disrupted w/ teratogen exposure
3. physiologic changes during pregnancy & drug impact: - 3rd trimester = renal blood
doubles, renal excretion accelerated
- tone and mobility of bowel decreases -> prolongation of drug effects
4. placental drug transfer: all drugs can cross the placenta, some cross more easily than others
5. adverse reactions during pregnancy: can adversely affect both pregnant pt and fetus
- heparin -> osteoporosis
- prostaglandins -> stimulate uterine contraction
- some pain relievers can be used during delivery can cause respiratory depression in baby
6. teratogenesis birth defects: gross malformations = cleft palate, clubfoot, hydrocephalus
neurobehavioral & metabolic anomalies
7. responding to teratogen exposure: Determine when the drug was taken
Determine when the pregnancy began
-Weeks 3-8 (organogenesis) is most crucial time
Determine type of malformation expected
Conduct 2 US and consult FDA to determine severity
8. how to decrease risk of drug effects during breastfeeding: - take drugs immediately
after breastfeeding
- avoid drugs w/ long half-lives
- choose drugs that tend to be excluded from milk, least likely to affect infant
- avoid hazardous drugs
, NURS 5334 Advanced Pharmacology Module 2 exam predictor 2026 Ques
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9. pediatric response to drugs: - more sensitive to drugs
- greater individual variation
- sensitivity d/t organ system immaturity
- increased risk for adverse rxns
10. determining the intensity of duration of drug response in neonates &
infants: - elevated drug levels = more intense response
- delayed elimination = prolonged response
- immaturity of organs = risk for both^
11. comparison of plasma drug levels in adults and infants:
12. increased sensitivity in infants caused by immature state of...: absorption, protein
binding of drugs, BBB, hepatic metabolism, renal drug excretion
13. infant absorption: oral administration: prolonged and irregular gastric
adult function at 6-8 months
14. infant absorption: gastric acidity: - very low 24 hours after birth
- does not reach adult values for 2 years
- low acidity = absorption of acid-labile drugs is increased
15. infant absorption: intramuscular admin: slow, erratic, delayed absorption as results of low
blood flow in 1st few days of life
in early infancy, absorption of IM drugs more rapid than neonates & adults
16. infant absorption: transdermal: more rapid & complete for infants than older children & adults
- stratum corneum of infant's skin is thin
- blood flow to skin is greater in infants than older patients
- infants increased risk for toxicity from topical drugs
17. infant distribution: BBB: - not fully developed at birth
- drugs have easy access to CNS
- infants especially sensitive to drugs that affect CNS function
- dosage should be reduced for drug actions outside the CNS if those drugs are capable of producing toxicity as a
side effect
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18. infant hepatic metabolism: - drug-metabolizing capability of newborns is low
- liver's capability to metabolize drugs increases fast @ 1mo
- complete liver maturation occurs at 1yr
19. infant renal excretion: - low renal blood flow, glomerular filtration, & active tubular secretion
- drugs eliminated by renal excretion must have reduced dosing and/or longer dosing intervals
- adult level renal function occurs at 1yr
20. pharmacokinetics in children: metabolize drugs faster than adults till 2yrs, then gradual decline
sharp decline at puberty
may need to increase or decrease interval between doses
21. adverse drug reactions in children: - glucocorticoids -> growth suppression
- tetracyclines -> discoloring of teeth
- sulfonamides -> kernicterus
- fluoroquinolones -> musculoskeletal d/o's
- SSRIs - > black box increased SI
- OTC cough and cold meds not recommended in kids <2yrs
22. dosage determination in children: child's BSA x adult dosage/ 1.73m2 = child dose
23. older adults: altered pharmacokinetics: more sensitive to drugs than younger adults & w/
greater variation in pharmacokinetics
multiple & severity of illness, multiple pathologies
multiple-drug therapy (excessive prescribing)
poor adherence
24. older adults: absorption: - rate of absorption slows w/ age
- delayed gastric emptying & reduced splanchnic blood flow
25. older adults: distribution: - increased body fat % (storage depot for lipid-soluble drugs)
- decreased lean body mass %
- decreased total body water (distributed in smaller volume, concentration increased & effects more intense)
- reduced concentration of serum albumin -> decreased protein binding of drugs & increased levels of free drugs