L31: Groups Vulnerable to ADRs
Elderly
Children
Pregnant Women
Polypharmacy
Memory Impairment
Aging
Co-morbidities
Pharmacokinetics of Drugs
Phamacodynamics of drugs
⬇Renal Function
Altered Volume of Distribution (Vdist)
Efficiency of Blood-Brain Barrier reduced
Baroreceptor function impaired
Density/Number of Receptors ⬇
Increase total peripheral resistance
Increase body fat, Lipophilic drug, Vdist ⬆
Hydrophilic Drug, Vdist ⬇
Digoxin ❗
Diazepam
Hepatic Function ⬇,1st Pass Metabolism ⬇
Drug Clearance ⬇
Drug Concentration ⬆*Opposite for pro-drugs
GTN
morphine
Propranolol
Drug Clearance⬇
Drug Half-Life ⬆
Drug Concentration ⬆
Digoxin ❗
allopurinol
bisphosphonates
⬇ Beta-Adrenoceptors
⬇response to Beta agonist drugs
Salbutamol (Asthma)
Increase susceptibility to sedatives
Vulnerable to postural hypotension
Less responsive to arterial vasodilators
Increase risk of DDI
Overdose
Osteoporosis
COPD (non-selective beta blockers)
Infants (1-12 months)
Adolescents
Neonates (<1 month)
Metabolic & Clearance Immature
Increase half-life & concentration of drugs > ADRs
Grey Baby Syndrome ❗
Chloramphenicol (Antibiotic) ❗
Tetracyclines 🚫 ❗
Aspirin 🚫 ❗
Enamel Dysplasia
Inhibit Bone Growth
Discolor Teeth
Reye's syndrome (toxic encephalopathy)
Increase renal blood flow and glomerular filtration rate
Lower Albumin concentration
Increase hepatic drug metabolism
Thyroid hormones increase
Increase Renal Clearance
Increase Drug Clearance
Teratogenic Effects on feotus > Category X Drugs:
Isotretinoin 🚫 ❗
Thalidomide 🚫 ❗
⛔ Drugs
Wafarin ❗
ACE Inhibitors ❗
Amiodarone ❗
Medications
Antibiotics
Antipsychotics
Narcotics
Chemotherapeutic agents
Sedatives
Anti-Hyperglycemic Agents
Anticoagulants
Teratogenic Risk
Neonatal Goitre & Thyroid Dysfunction
Fetal Death
Warfarin, Aspirin 🚫