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Drug use in special situations
• Geriatric drug therapy
• Pediatric drug therapy
• Drugs in Pregnancy &Lactation
GERIATRIC DRUG THERAPY
Geriatric (elderly) patients use more medications compared
to younger patients because they have more symptoms of
disease.
Clinical changes in elderly:
• Lean body mass diminishes by 20-30%.
• Fat free mass diminishes.
• Total albumin is reduced in elderly by 20%.
• There is 12% loss of tissue bone in male & 25% in female.
• The brain achieves its optimal potential at 16-20 years after
which there is slow decline in capabilities.
• Insulin clearance reduces.
• Blood concentrations, basal output & metabolic turnover of
major harmones like estrogen, testosterone, thyroxine,
androgen, angiotensin & aldosterone have reported to
decline with age.
Effect of aging on drugs
• Many of the Adverse Drug Reactions
encountered in elderly are the result of the
dose related pharmacokinetic changes.
• The aging process influences drug response by
interfering with fraction of drug absorbed (f),
plasma drug half life (t1/2), volume of
distribution (Vd) and drug clearance (CL) from
the body.
Factors governing drug use in special situations:
PHARMACOKINETICS
Age related changes influencing Absorption
• Reduced gastric acid secretion
• Impaired drug absorption
• GI motility & intestinal blood flow is reduced
• Collateral circulation bypassing liver
• Reduced active transport mechanism
Age related changes influencing Distribution
• Reduction in serum albumin concentration
• Reduction in erythrocyte binding
• Smaller volume of distribution due to reduced body water
• Increased volume of distribution for lipophilic drug due to
more fat

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The WHO International Drug Monitoring Program was established in 1963 in response to the thalidomide disaster. It currently has 143 member countries that submit adverse drug reaction reports to the global pharmacovigilance database VigiBase managed by the Uppsala Monitoring Centre (UMC) as a WHO collaborating center. The UMC analyzes VigiBase data to identify new safety signals, conducts research, and provides tools and training to support member countries' pharmacovigilance activities. The overall goals are to identify unknown adverse drug reactions and ensure medicines are used safely worldwide.

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Age related changes influencing Metabolism
• Reduction in liver mass
• Reduced hepatic metabolizing enzymes
• Reduced liver blood flow
• Decrease in cytochrome P450
Age related changes influencing Elimination
• Reduction in total number of functioning nephrons
• Reduced renal plasma flow
• Reduced glomerular filtration rate
• Impaired renal tubular secretion
Age related PHARMACODYNAMIC changes in
elderly
• Depletion of neurotransmitters
• Decrease in baroreceptor activity
• Reduced responsiveness to beta adrenergic
receptors
• Increased pain tolerance
• Changes in laboratory values
PEDIATRIC DRUG THERAPY
• Drug treatment for infants & children requires
knowledge of drug response in early years of life.
Pharmacokinetic Factors:
• Pharmacokinetic changes occurs from few
months to 3 or 4 years of life.
Absorption
• Rate of absorption may be increased by the use
of liquid preparations.
Distribution
• Total volume of body water & extracellular fluid
related to body weight are greatest during
neonatal period & infancy.
• Blood brain barrier may be functionally
incomplete in neonates, which permits increased
penetration by some drugs
Metabolism
• Metabolism of most drugs proceeds comparatively
slowly in first few weeks of life & later increases up
to 2-3 years of life.
• After they reduce gradually until adolescence.

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Elimination
• Drug metabolites are eliminated primarily through
bile or the kidneys. Renal elimination depends on:
A. Plasma protein binding
B. Renal blood flow
C. GFR
D. Tubular secretion
• All of these factors are altered in the first 2 yr of life.
Renal plasma flow is low at birth (12 mL/min) and
reaches adult levels of 140 mL/min by age 1 yr.
Similarly, GFR is 2 to 4 mL/min at birth, increases to
8 to 20 mL/min by 2 to 3 days, and reaches adult
levels of 120 mL/min.
Calculation of doses
• Individual dose = body weight(kg) × average adult dose
70
• Young’s Formula
• Child dose = age × adult dose
age + 12
• Diling’s Formula
• Child Dose = age × adult dose
20
DRUGS IN PREGNANCY & LACTATION
• The use of drugs during pregnancy must be
avoided unless absolutely necessary.
• The foetus or neonate must always be kept in
mind as a potential recipient of the drug.
• Placental barrier is selective membrane but
cannot block all the drugs from passing to
foetus.
FDA pregnancy category list

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Regulatory requirements for new drug approval are in place to ensure medications are safe and effective for consumers. Regulatory affairs evaluate drug development, production, and marketing. Key functions include monitoring legislation changes and ensuring manufacturing and marketing practices comply with regulations. Stringent approval processes were implemented after tragic incidents revealed drug safety issues. Notable regulatory bodies include the FDA in the US and CDSCO in India. Approval involves non-clinical and clinical trials to assess safety, efficacy, and quality before marketing applications like an NDA can be submitted for review. Compliance with regulatory standards is necessary throughout the drug development and approval process.

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Pharmacovigilance
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The document discusses various methods used in pharmacovigilance including spontaneous reporting systems, case series, stimulated reporting, active surveillance methods like sentinel sites and drug event monitoring, use of registries, observational studies like cross-sectional, case-control and cohort studies, targeted clinical investigations and descriptive studies. It also outlines the key aims and shared responsibilities of pharmacovigilance among drug companies, regulatory authorities, doctors, pharmacists and nurses.

Teratogens
• A teratogen is an agent, which can cause a
birth defect.
• Teratogens are agents including viruses, drugs,
chemicals, stressors, and malnutrition, which
can impair prenatal development and lead to
birth defects or even death.
• Examples: Thalidomide, Phenytoin, Alchohol,
Viruses like Varicella, etc
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Pediatrics, Geriatrics, Pregnancy, Lactation

  • 1. Drug use in special situations • Geriatric drug therapy • Pediatric drug therapy • Drugs in Pregnancy &Lactation
  • 2. GERIATRIC DRUG THERAPY Geriatric (elderly) patients use more medications compared to younger patients because they have more symptoms of disease. Clinical changes in elderly: • Lean body mass diminishes by 20-30%. • Fat free mass diminishes. • Total albumin is reduced in elderly by 20%. • There is 12% loss of tissue bone in male & 25% in female. • The brain achieves its optimal potential at 16-20 years after which there is slow decline in capabilities. • Insulin clearance reduces. • Blood concentrations, basal output & metabolic turnover of major harmones like estrogen, testosterone, thyroxine, androgen, angiotensin & aldosterone have reported to decline with age.
  • 3. Effect of aging on drugs • Many of the Adverse Drug Reactions encountered in elderly are the result of the dose related pharmacokinetic changes. • The aging process influences drug response by interfering with fraction of drug absorbed (f), plasma drug half life (t1/2), volume of distribution (Vd) and drug clearance (CL) from the body.
  • 4. Factors governing drug use in special situations: PHARMACOKINETICS Age related changes influencing Absorption • Reduced gastric acid secretion • Impaired drug absorption • GI motility & intestinal blood flow is reduced • Collateral circulation bypassing liver • Reduced active transport mechanism Age related changes influencing Distribution • Reduction in serum albumin concentration • Reduction in erythrocyte binding • Smaller volume of distribution due to reduced body water • Increased volume of distribution for lipophilic drug due to more fat
  • 5. Age related changes influencing Metabolism • Reduction in liver mass • Reduced hepatic metabolizing enzymes • Reduced liver blood flow • Decrease in cytochrome P450 Age related changes influencing Elimination • Reduction in total number of functioning nephrons • Reduced renal plasma flow • Reduced glomerular filtration rate • Impaired renal tubular secretion
  • 6. Age related PHARMACODYNAMIC changes in elderly • Depletion of neurotransmitters • Decrease in baroreceptor activity • Reduced responsiveness to beta adrenergic receptors • Increased pain tolerance • Changes in laboratory values
  • 7. PEDIATRIC DRUG THERAPY • Drug treatment for infants & children requires knowledge of drug response in early years of life. Pharmacokinetic Factors: • Pharmacokinetic changes occurs from few months to 3 or 4 years of life. Absorption • Rate of absorption may be increased by the use of liquid preparations.
  • 8. Distribution • Total volume of body water & extracellular fluid related to body weight are greatest during neonatal period & infancy. • Blood brain barrier may be functionally incomplete in neonates, which permits increased penetration by some drugs Metabolism • Metabolism of most drugs proceeds comparatively slowly in first few weeks of life & later increases up to 2-3 years of life. • After they reduce gradually until adolescence.
  • 9. Elimination • Drug metabolites are eliminated primarily through bile or the kidneys. Renal elimination depends on: A. Plasma protein binding B. Renal blood flow C. GFR D. Tubular secretion • All of these factors are altered in the first 2 yr of life. Renal plasma flow is low at birth (12 mL/min) and reaches adult levels of 140 mL/min by age 1 yr. Similarly, GFR is 2 to 4 mL/min at birth, increases to 8 to 20 mL/min by 2 to 3 days, and reaches adult levels of 120 mL/min.
  • 10. Calculation of doses • Individual dose = body weight(kg) × average adult dose 70 • Young’s Formula • Child dose = age × adult dose age + 12 • Diling’s Formula • Child Dose = age × adult dose 20
  • 11. DRUGS IN PREGNANCY & LACTATION • The use of drugs during pregnancy must be avoided unless absolutely necessary. • The foetus or neonate must always be kept in mind as a potential recipient of the drug. • Placental barrier is selective membrane but cannot block all the drugs from passing to foetus.
  • 13. Teratogens • A teratogen is an agent, which can cause a birth defect. • Teratogens are agents including viruses, drugs, chemicals, stressors, and malnutrition, which can impair prenatal development and lead to birth defects or even death. • Examples: Thalidomide, Phenytoin, Alchohol, Viruses like Varicella, etc
  • 15. THANK YOU FOR YOUR ATTENTION!