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Prescribing in the Young, the Old and the Pregnant (Elderly…

- - - - Embryonic (17-57d) → structural defects
        
        Fetogenic (maturation) → relatively less dangerous
  - - - Labetalol
        
        Methyldopa
        
        Nifedipine
        
        Hydralazine :check:
    - - Use insulin and/or metformin :check:
    - - Folic acid pre-conception
        Use :check: lamotrigine (or CBZ)
      - Drug levels tend to fall in pregnancy
        ↑ risk of malformations (6% vs. 2%)
        ↑ risk of haemorrhagic disease of the newborn (↓K)
    - - 1st trimester: LMWH :check:
        
        2nd trimester – 36wks: LMWH or warfarin :check:
        
        36wks – term: LMWH :check:
        
        Term onwards: warfarin :check:
- - - - ↓ body water → ↑ [water soluble drugs]
      - ↑ body fat → ↓ [fat soluble drugs]
      - ↓ albumin → ↑ [protein-bound drugs]
      - ↓ wt. so standard dose → ↑ [drug]
    - - ↓ oxidation
      - ↓ first-pass metabolism (e.g. propranolol)
      - ↓ induction of liver enzymes
      - ↑ age → ↑ t½ of hepatically metabolised drugs e.g. Warfarin