This document discusses care considerations for paediatric, geriatric, pregnant, and lactating patients. It outlines changes to pharmacokinetics and pharmacodynamics that can impact drug therapy for these groups. For paediatrics, absorption, distribution, metabolism and elimination may differ from adults due to developmental factors. Pregnancy can impact absorption, distribution, and elimination of drugs through physiological changes. Factors like placental transport influence fetal drug exposure. Some drugs are contraindicated in pregnancy and lactation due to risks. Geriatric patients experience changes to absorption, distribution, metabolism and elimination due to aging that require dosage adjustments.

1. CARE OF PAEDIATRIC, GERIATRIC,
PREGNANT AND LACTATING

2. 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.
2. Stimulation of appropriate health technology.
3. Setting global norms and standards.
4. Information management.

3. 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

4. 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

5.  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.

6. 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.

7. 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.

8. 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.

9.  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

10. 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

11.  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.

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

13. 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.

14. PHARMACOKINETIC CHANGES
 ABSORPTION:-
Slow due to decreased motility
Altered nutrition need
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

15.  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.

16. 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.