Chapter 03: Life Span Considerations

Overview
Age has, of course, a significant impact on the effects of medications in a patient, especially for those at
either end of the age spectrum—the elderly and pediatric patients. However, age-related changes are the
more significant factors. Pharmacokinetics are altered by organ immaturity in infants. Because of this,
most drug references recommend pediatric dosages based on “mg/kg” of body weight. However,
formulas that involve the age, weight, and body surface area (BSA) are also useful for calculating
optimum dosages. In elderly patients, significant physiologic changes affect all four phases of
pharmacokinetics, and multiple disorders (and physicians) can lead to further complexities in treatment,
particularly polypharmacy. In addition, because a fetus is exposed to many of the same substances as the
mother, including drugs, it is important to know and understand drug effects during gestational life.
Breast-fed infants are also at risk for exposure to drugs consumed by the mother.

Critical Thinking Activities

1. A 25-year-old woman has a sinus infection, but is fearful of taking medications because she is breast-
feeding her 2-month-old baby. How will the health care provider decide about medications to prescribe?
Would it be different if the woman had a severe case of pneumonia?

2. Mrs. P., age 89, has appointments this week with her primary physician, a specialist for rheumatoid
arthritis, an ophthalmologist, and a pulmonary specialist. What can be done to prevent possible
polypharmacy with Mrs. P.?

3. Jamie, age 4, is refusing to take medication for an ear infection. What measures can be taken to
encourage Jamie to take her medication?

4. Mr. T., age 79, is on the following classes of medications:

 An antihypertensive
 Digoxin
 A diuretic
 Thyroid replacement therapy
 An antibiotic

Which drugs, if any, may be problematic for Mr. T? Explain your answer.

Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Ch 3 Study Guide w/ Answers 3-2
Case Study

R.M., a 77-year-old retired librarian, sees several physician specialists for a variety of health problems.
She uses the pharmacy at a large discount store but also has prescriptions filled at a nearby pharmacy,
which she uses when she does not feel like going into the larger store. Her medication list is as follows:

Thiazide diuretic, prescribed for peripheral edema

Potassium tablets, prescribed to prevent hypokalemia
Beta-blocker, prescribed for hypertension
Warfarin, taken every evening because of a history of deep vein thrombosis
Thyroid replacement hormone because of a history of hypothyroidism
Multivitamin tablet for seniors

1. What medications may cause problems for R.M.? Explain.

2. What measures can be taken to reduce these problems?

R.M. visits the pharmacy to pick up some medications for a cold. She has chosen a popular over-the-
counter decongestant, an antihistamine preparation, and a nonsteroidal antiinflammatory drug for her
“aches and pains.”

3. Should she use these medications? If not, what advice would you give to her about choosing over-the-
counter medications?
Ch 3 Study Guide w/ Answers 3-3
Quiz

1. List the factors that affect the pediatric patient’s response to drug therapy.

2. List the factors that affect the elderly patient’s response to drug therapy.

3. During which trimester of pregnancy is the fetus at greatest risk for drug-induced developmental
defects?

4. You have an order to give a 5-year-old child, who has asthma, a loading dose of PO aminophylline,
5 mg/kg, and then start 4 mg/kg every 6 hours as maintenance dosage. The child weighs 25 kg. The
tablets are available in 100-mg, 125-mg, 200-mg,
250-mg, and 300-mg strengths.

a) What dose would you give for the loading dose?

b) What dose would you give for each maintenance dose?

c) While he is on the maintenance therapy, how much will he receive in a

24-hour period?

5. Are over-the-counter (OTC) drugs a concern for elderly patients? Explain your answer.