《临床药物治疗学 Clinical Pharmacotherapeutics》阅读资料：Pharmacotherapy of Special Populations（Melody）

Eab 00 Pharmacotherapy of special Populations o000oc0= Melody Ryan, PharmD, MPH Associate professor Pharmacy practice Science and Neurology KENTUCKY College of Pharmacy

Pharmacotherapy of Special Populations Melody Ryan, PharmD, MPH Associate Professor Pharmacy Practice & Science and Neurology

Eab Objectives Define current fda categories for use of medications during pregnancy 00 Review the proposed changes to the current FDA categories o000oc0= Explain the principles of drug transfer across the placenta and into breast milk a. Discuss common conditions associated with pregnancy and review the medications used for treatment KENTUCKY College of Pharmacy

Objectives • Define current FDA categories for use of medications during pregnancy • Review the proposed changes to the current FDA categories • Explain the principles of drug transfer across the placenta and into breast milk • Discuss common conditions associated with pregnancy and review the medications used for treatment

Eab Objectives List physiologic considerations for 00 children Compare pediatric and adult 35: pharmacokinetic properties aF:. Outline pediatric considerations for therapeutic drug monitoring KENTUCKY College of Pharmacy

Objectives • List physiologic considerations for children • Compare pediatric and adult pharmacokinetic properties • Outline pediatric considerations for therapeutic drug monitoring

Eab Objectives Identify the physiologic changes in the older adult that alter the effects of medications 00 Discuss causes of and contributors to polypharmacy aB: Discuss ways to utilize beer's list criteria as a tool, not a rule, in assisting with determination of inappropriate medications in the older adult o(. Give examples of medications and /or medication classes to avoid in older adults KENTUCKY College of Pharmacy

Objectives • Identify the physiologic changes in the older adult that alter the effects of medications • Discuss causes of and contributors to polypharmacy • Discuss ways to utilize Beer’s list criteria as a tool, not a rule, in assisting with determination of inappropriate medications in the older adult • Give examples of medications and/or medication classes to avoid in older adults

Drug Therapy in pregnancy and Lactation o. Maternal pharmacokinetic changes O".Drug use in pregnancy Drug use in lactation o000oc0= KENTUCKY College of Pharmacy

Drug Therapy in Pregnancy and Lactation • Maternal pharmacokinetic changes • Drug use in pregnancy • Drug use in lactation

Eab Pregnancy Between 50 and 70% of O&: women use at least one medication during pregnancy Adherence may be a o000oc0= problem Women concerned about effect of medicine on fetus Risk usually ①○×① overestimated Mitchell AA, et al. Am J Obstet Gynecol 2011, 205: 51 e1-e8 o' Neilsen MJ, et al. Aliment Pharmcol Ther 2010: 32: 49-58 KENTUCKY Nordeng H, et al. Eur J Clin Pharmacol 2010: 66: 207-14 College of Pharmacy

Pregnancy • Between 50 and 70% of women use at least one medication during pregnancy • Adherence may be a problem – Women concerned about effect of medicine on fetus – Risk usually overestimated Mitchell AA, et al. Am J Obstet Gynecol 2011;205:51 e1-e8. Neilsen MJ, et al. Aliment Pharmcol Ther 2010;32:49-58. Nordeng H, et al. Eur J Clin Pharmacol 2010;66:207-14

a Maternal Pharmacokinetic Changes Absorption o4. Gastric emptying and o&: small intestinal motility 00 decreased Particularly in 3 rd trimester o000oc0= ∴· Nausea and vomiting KENTUCKY College of Pharmacy

Maternal Pharmacokinetic Changes - Absorption • Gastric emptying and small intestinal motility decreased – Particularly in 3rd trimester • Nausea and vomiting

a Maternal Pharmacokinetic Changes Distribution of. Plasma volume expansion of50% 00 Vd increase, particularly with smally, medicines decreases serum concentration most o000oc0= important for loading doses Hypoalbuminemia due to dilution, decreased plasma rotein binding increased Cfi also increased availability for metabolism KENTUCKY Loebstein R, Koren G. Ther Drug Monit 2002: 24: 15-22 College of Pharmacy

Maternal Pharmacokinetic Changes - Distribution • Plasma volume expansion of 50% – Vd increase, particularly with small Vd medicines, decreases serum concentration; most important for loading doses – Hypoalbuminemia due to dilution, decreased plasma protein binding, increased Cf ; also increased availability for metabolism Loebstein R, Koren G. Ther Drug Monit 2002;24:15-22

a Maternal Pharmacokinetic Changes Metabolism o. Increased hepatic blood flow o.:,- Increased metabolism of some 00 medicines; particularly in 3rd trimester CYP3A4. CYP2D6, CYP2A6 o000oc0= CYP2C9, and ugt activity increased CYP1A2, CYP2C19 activity decreased Hodge LS, Tracy TS. Expert Opin Drug Metab Toxicol 2007, 3: 557-71 Pavek P, et al. Curr Drug Metab 2009; 10: 520-9 KENTUCKY O).. Dawes M, Chowienczyk PK Best Pract Res Clin Obstet Gynaecol 2001: 15: 819-26. College of Pharmacy

Maternal Pharmacokinetic Changes - Metabolism • Increased hepatic blood flow – Increased metabolism of some medicines; particularly in 3rd trimester • CYP3A4, CYP2D6, CYP2A6, CYP2C9, and UGT activity increased • CYP1A2, CYP2C19 activity decreased Hodge LS, Tracy TS. Expert Opin Drug Metab Toxicol 2007;3:557-71. Pavek P, et al. Curr Drug Metab 2009;10:520-9. Dawes M, Chowienczyk PK. Best Pract Res Clin Obstet Gynaecol 2001;15:819-26

a Maternal Pharmacokinetic Changes Elimination oi. Renal blood flow ad, increases by 25-50% =·G| omerular filtration rate increases by 50% KENTUCKY Loebstein R, Koren G. Ther Drug Monit 2002: 24: 15-22 College of Pharmacy

Maternal Pharmacokinetic Changes - Elimination • Renal blood flow increases by 25-50% • Glomerular filtration rate increases by 50% Loebstein R, Koren G. Ther Drug Monit 2002;24:15-22