drug therapy across lifespan- pharm

Dosing initial pediatric dosing is at best an

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Unformatted text preview: nistration. 27 Dosage Determination Dosing is most commonly based on weight. Dosing Initial pediatric dosing is, at best, an approximation. Subsequent doses need to be adjusted. 28 Dosage Determination Approximate dosage for a child = Body surface area of the child × adult dose Body 1.73 m² 29 Body Surface Area Body Nomogram Nomogram BSA is indicated where the straight line that connects height (on the left) and weight (on the right) intersects the BSA column or, if client is above average size, from weight alone (enclosed area). area). 30 Drug Therapy in Geriatric Patients 31 Geriatric Patients A disproportionately high prescription drug use exists disproportionately in the elderly. in • Only 12% of Americans are 65 years of age or older – yet this Only 12% consumes 31% of prescribed drugs. 12% Experience more adverse drug reactions and drugdrug interactions than younger patients do. Are admitted to the hospital for adverse drug reactions (ADRs) three times more frequently than younger adults. Represent 51% of the deaths and 39% of hospitalizations from ADRs (persons over 60 years). Experience more drug-related incidents than the older adult population (25% of all admissions from a nursing home setting to a hospital are drug-related). 32 Geriatric Patients Altered pharmacokinetics • More sensitive to drugs than younger adults and have wider More variation variation Multiple and severe illnesses • Severity of illness, multiple pathologies Multiple-drug therapy • Excessive prescribing Poor adherence 33 34 Adverse Drug Reactions Seven times more likely in the elderly Seven Account for 16% of hospital admissions Account for 50% of all medication-related deaths Majority are dose related, not idiosyncratic Symptoms in elderly often nonspecific • Dizziness, cognitive impairment 35 Goals of Therapy • Maintain health status using the fewest drugs possible. • Start slow go slow---start on smallest effective dose and titrate up. • Do not use drug if the adverse effects...
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