health and medicine

1. CARE OF PAEDIATRIC, GERIATRIC,
PREGNANT AND LACTATING
Submitted by
SRIVIDYADODDA
16AB1T0023
Pharm. D 2nd year
SUBMITTED TO
Dr. G. RAMESH B.PHARM, PHARM. D (P.B)
Assistant Professor
Department of PHARMACY

2. CONTENTS
CARE OF PAEDIATRIC
CARE OF PREGNANT AND LACTATING
CARE OF GERIATRIC

3. HEALTH
WHO defines health as “state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity”. Its overall objectives are as follows:-
1. Providing guidance and advocacy for health by ethics, EBM etc.
2. Stimulation of appropriate health technology.
3. Setting global norms and standards.
4. Information management.
5. Negotiation and sustenance of national and global partnership.
6. Cooperation to government in strengthening NHPs.

4. PAEDIATRIC CARE:-
Paediatrics is the branch of medicine that involves the medical care of infants, children, and
adolescents. A medical doctor who specializes in this area is known as a paediatrician, or
paediatrician. Pediatricians work both in hospitals, particularly those working in its subspecialties
such as neonatology, and as primary care physicians

5. PHARMACOKINETIC CHANGES
 ABSORPTION:-
GI alteration , low acidity
Increased gastric emptying time
Increased enterohepatic circulation
Irregular peristalitic
Decreased absorption of phenobarbitone in children
Penicillin and amphycillin will have increased absorption
Low bile acid and lipase , so less lipophilic absorption

6.  Distribution:-
More in hydrophilic characteristics than adults because of high percentage of body water.
Less plasma proteins are available, so freer drug and leads to more toxicity. Ex:- diazepam
 Metabolism:-
Less liver cytochrome P450 dependent activity so, chance of getting toxicity. Ex: - grey baby
syndrome caused by chloramphenicol.
 Elimination;-
GFR is less, so, secretion & resulting in less renal clearance.
So, appropriate dosage adjustment is necessary. Ex: - Penicillin, Aminoglycoside.

7. PHARMACODYNAMIC CHANGES
Response of drug may be less in children than adults but mechanism remains same. Due to
immature receptors or immature neurotransmitter.
Ex:- Tetracyclins leads to malformed bones and teeth.

8. CARE OF PREGNANT AND LACTATING
In pregnancy and labour body becomes a complex physiological unit which consists of mother,
placenta and foetus.
These process lead to important variations in pharmacokinetic changes like Absorption,
metabolism, distribution and elimination of few drugs.

9. PHARMACOKINETIC CHANGES
 Absorption
GI ABSORPTION :- reduced intestinal motility, increased gastric and intestinal emptying
time,reduction in gastric acid secretion, increased mucus secretion, total perfusion is increased.
PULMONARY ABSORPTION :- hemodynamic and ventillary changes
HYPERVENTILATION :- increased alveolar drug uptake
INTRAMUSCULAR ABSORPTION :- increased peripheral tissue absorption due to vasodilation.

10.  DRUG DISRTIBUTION :-
o Incresed blood volume and cardiac output
 DRUG ELIMINATION :-
o RENAL DRUG ELIMINATION :- creatinine clearance and drug elimination
o HEPATIC DRUG ELIMINATION :- increased rate of metabolism

11. FACTORS AFFECTING PLACENTAL DRUG TRANSFER
 Physicochemical factors:-
Various physicochemical factors affecting placental drug transfer are
 Lipid solubility
 Molecular size’
 Placental transporter
 Protein binding
 Placental and foetal drug metabolism

12.  The rate at which the drugs crosses the placenta and amount of the drug reaching the
foetus
 The duration of exposure to drugs
 Distribution characteristics in different foetal tissues
 The effect of drugs used in combination
 The stage of placental and foetal development at the time of exposure to drugs.

13. DRUGS TRANSFER TO FOETUS BY :-
Placental transfer may occur by :-
Active diffusion
Passive diffusion
Facilitated diffusion
Placental surface area
Placental metabolism
DRUGS PASSAGE INTO MILK :-
Diffusion from maternal plasma into milk
Higher maternal level plasma means higher breastmilk
Equillibrium will be established by most drugs between milk and plasma

14. DRUGS CONTAINDICATED IN PREGNANCY AND LACTATION
 Anti epileptics
 Anti depressants
 Antibiotics
 Anticancer drugs
 Lithium
 Chloramphenicol
 Atropine
 Thiouracil

15. GERIATRIC CARE MANGEMENT
Geriatric care management (also known as "elder care management", "senior health care
management" and "professional care management") is the process of planning and coordinating
care of the elderly and others with physical and/or mental impairments to meet their long term
care needs, improve their quality of life, and maintain their independence for as long as possible.
It entails working with persons of old age and their families in managing, rendering and referring
various types of health and social care services

16. PHARMACOKINETIC CHANGES
 ABSORPTION:-
Slow due to decreased motility
Altered nutria
Using multiple OTC medication
 DISTRIBUTION:-
Decreased body weight, decreased body fat, decreased body water count
Leads to decreased plasma proteins that lead to more amount of free drug available in blood

17.  METABOLISM:-
Decreased due to less of liver mass, blood flow reduced, ability to recover from injury.
 ELIMINATION:-
Decreased GFR &also decreased tubular secretion.
No. Of serum creatinine level is increased due to less muscle mass. So, narrow therapeutic
drugs shows toxicity. Ex: - lithium, digoxin.

18. PHARMACODYNAMIC CHANGES:-
Response is decreased
Ex: - B-agonist & B-blocker due to the decreased number of receptors
Drugs with anti-cholinergic activity may cause in elder with BPH (Benign Prostatic Hyperplasia)
that lead to increased BP & also temperature regulation is altered.