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 🚫