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Pharmacology For Canadian Health Care Practice, 2nd Canadian Edition Class Notes

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    Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Lilley: Pharmacology for Canadian Health Care Practice, 2nd Canadian Edition Chapter 01: Nursing Practice in Canada and Drug Therapy Instructor’s Manual O VERVIEW Before beginning this course, it is essential to introduce the underlying premise for the entire textbook; that is, how is the nursing process used in the administration of medications? Certainly, using the nursing process helps make drug administration more efficient, more thorough, and more sensitive to the famous “Five Rights.” It also makes certain legal and medical safeguards more automatic. In this chapter, the integration of administration and the nursing process is initiated by reviewing the five phases of the nursing process and its overall purpose. How each phase –– assessment, nursing diagnosis, planning (goals and outcome criteria), implementation, and evaluation –– is initiated is critical to accurate and effective medication administration. The integration of the “Five Rights” of medication administration into drug therapy and the nursing process is presented. In addition, another five rights are addressed in regard to their impact on safe administration practices, including the process of system analysis and the prevention of medication errors. K EY T ERMS Critical thinking, p. 8 Goals, p. 12 Medication error, p. 13 Nursing process, p. 8 Outcome criteria, p. 12 L EARNING O BJECTIVES 1. List the five phases of the nursing process as applicable to drug therapy. 2. Identify the components of the assessment process for patients receiving medications, including the collection and analysis of subjective and objective data. 3. Discuss the process of formulating nursing diagnoses for patients receiving medications. 4. Identify goals and outcome criteria for patients receiving medications. 5. Discuss the key elements of implementation in the administration of medications. 6. Discuss the evaluation process involved in the administration of medications and reflected in the goals and outcome criteria. 7. Develop a collaborative plan of care using the nursing process and medication administration. 8. Briefly discuss the “Ten Rights” of drug administration and the related professional responsibility to patients for safe medication practice. 9. Discuss the additional rights of drug administration required for safe medication practice.

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 1 - 2 C HAPTER O UTLINE AND T EACHING S TRATEGIES Chapter Outline Teaching Strategies Overview, p. 8 As you integrate drug therapy into the nursing process, keep referring students to Box 1 - 1 (Sample Collaborative Plan of Care Related to Drug Therapy Using the Nursing Process) . This will help students to see the integration, using an actual patient. It will also help demonstrate the circular nature of the process. Assessment, p. 8 Analysis of data Ask, “In what way does a thorough drug history involve both subjective and objective data collection?” ( Objective data collection includes completing a list of drugs taken currently and/or in the past, a list of past or present disease processes, and a head - to - toe physical assessment. Subjective data include any problems or adverse effects the patient experienced with past or current drug therapies and a discussion of applicable age - related, social, or developmental issues. ) Nursing diagnoses, p. 11 During the discu ssion of the various classifications of drugs and the diseases they treat, ask students to name a few nursing diagnoses that would be relevant for patients receiving those drugs. Planning, p. 12 Goals and outcome criteria During your discussion of the various classifications of drugs and the diseases they treat, ask students to name a few relevant goals and outcome criteria that would be appropriate for patients receiving those drugs. Be sure these are patient - oriented goals related to the NURSING PROCESS, not goals related to the medical resolution of a disease process. Implementation, p. 12 Right drug Right dose Right time Right route Right patient Right documentation Right reason Medication errors Divide the class in to small teams, and distribute medication orders that are incompletely or incorrectly written (e.g., orders that are missing route, amount of drug, or frequency, or orders that are ambiguous or in illegible handwriting). Examples should cover the “rights” mentioned in the text. Have the teams consider the following questions:

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 1 - 3 Chapter Outline Teaching Strategies • What “right” of medication administration is missing? • What is needed to correct or complete the order? Review with the class what a typical procedure would be if a medication error were to occur in an inpatient setting. Evaluation, p. 16 Create several scenarios that provide assessment data (subjective and objective) and a prescribed medication therapy, then assign small groups to work through the stages of the nursing process with one of the scenarios. You may want to go through the steps in the first scenario with all of the students to emphasize specific points. Be sure to discuss how to monitor the patient’s response to drug therapy. C RITICAL T HINKING A CTIVITIES Have students learn how medication administration is integrated into the nursing process by assigning teams to apply the steps of the nursing process to a specific drug. L EARNING A CTIVITIES Your patient is 33 years old and has been diagnosed with type 1 diabetes mellitus. She requires insulin injections twice a day (in the morning and in the evening), including rapid - and intermediate - acting insulins. 1. In regard to the use of nursing diagnoses, is it acceptable to formulate nursing diagnoses for medication - related issues? Explain your answer. If your answer is in support of the use of nursing diagnoses with medication administration, state the diagnoses that are more commonly used. 2. The same patient has developed problems with the absorption of subcutaneous insulin. Her blood glucose readings vary tremendously during a 24 - hour period, with periods of hypoglycemia and periods of hyperglycemia. She has been laid off from work, has financial difficulties, and needs new eyeglasses for her progressive loss in close - up vision. Develop two nursing diagnoses that would be appropriate for this patient in relation to drug therapy and the nursing process and the specific information presented above. 3. The patient, who has never had the experience of self - administering an injection, requires a subcutaneous injection twice daily. Develop a nursing diagnosis for this patient that focuses on the newness of the treatment regimen. 4. Develop a goal and outcome criteria for this patient. Make sure that they relate to one of the nursing diagnoses that focus on the drug therapy. Also include what would be

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 1 - 4 monitored during the evaluation phase of the nursing process for the specific nursing diagnosis, goal, and outcome criteria you develop. 5. What would be evaluated with drug administration? A NSWERS TO L EARNING A CTIVITIES 1. Yes, it is appropriate to develop nursing diagnoses for patients receiving medications. Nursing diagnoses are not just for issues related to patient care and are easy to develop and apply to many facets of the medication administration process. Some of the more common nursing diagnoses that deal with the nursing process and drug therapy are listed below. ( Note to instructors: The following nursing diagnoses are not complete because each patient is different and because associated nursing diagnoses need to be individualized in accordance with the patient, the disease process, and medication therapy. ) • Constipation related to . . . (usually related to the adverse effects of a medication) • Deficient knowledge (medications) related to first - time use . . . (usually due to first - time use of a specific medication or regimen) • Diarrhea related to . . . (usually related to the adverse effects of a medication) • Risk for falls related to . . . (usually related to the adverse effects of a medication — antihypertensives, for example — and also common with the older adult) • Nausea related to . . . (usually from an adverse effect of a medication) • Nonadherence related to . . . (usually occurs when patients stop taking a medication on their own because of bothersome adverse effects) • Imbalanced nutrition: less or more than body requirements . . . (usually related to the adverse effects of a medication — for example, weight gain from an oral corticosteroid) • Risk for situational low self - esteem related to . . . (usually from not understanding the medications and from a lack of knowledge and experience) • Ineffective therapeutic regimen management (individual) related to . . . (this is also related to bothersome adverse effects — the patient quits taking the medication because of adverse effects and lack of knowledge and is unaware of the impact that sudden withdrawal from the medication may have) • Disturbed thought processes related to . . . (the adverse effects of certain medications such as narcotics and sedatives) 2. Responses can include the following: • Deficient knowledge (medications) related to first - time use . . . (usually related to a lack of experience and information) • Anxiety related to . . . (usually from the patient’s being afraid and fearful of the unknown) • Risk for falls related to possible hypoglycemia and the adverse effects of insulin 3. Deficient knowledge (medications) related to lack of experience and knowledge about the use of insulin and how to administer the injection

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 1 - 5 4. GOAL: The patient will adhere to drug therapy, with therapeutic effects and minimal adverse effects after the first return visit to the physician’s office. OUTCOME CRITERIA: The patient will demonstrate a subcutaneous injection of insulin, using proper technique. The patient will list ways to manage increases and decreases in glucose levels. 5. In the evaluation phase of the nursing process related to drug therapy, the nurse monitors therapeutic effects, adverse effects, and toxic effects. A DDITIONAL R ESOURCES Do not forget the following supplemental teaching and learning resources found at http://evolve.elsevier.com/Canada/Lilley/pharmacology : For instructors • Audience Response Questions • Image Collection • PowerPoint presentation slides • Teaching Tips • Test Bank For students (instructors have access to all student material) • Animations • Answer Keys for Case Studies, Critical Thinking Activities, and Examination Review • Questions from the textbook • Calculators • Category Catchers • Content Updates • Frequently Asked Questions • Audio Glossary • IV Therapy and Medication Error Checklists • Multiple - Choice Review Questions • Nursing Care Plans • Supplemental Resources • WebLinks

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    Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Lilley: Pharmacology for Canadian Health Care Practice, 2nd Canadian Edition Chapter 2: Pharmacological Principles Instructor’s Manual O VERVIEW Nurses need a sound understanding of basic pharmacological principles to appreciate the effects, both positive and negative, that drugs can have on a patient’s health. In order to understand pharmacology, the basic principles of pharmacotherapeutics (the use of drugs and the clinical indications for drugs to prevent and treat diseases) as well as the roles of pharmacokinetics (the study of what the body does to the drug), pharmacodynamics (the study of what the drug does to the body), and pharmacognosy (natural drug sources) must be included. K EY T ERMS Additive effects, p. 37 Adverse drug event (ADE), p. 38 Adverse drug reaction (ADR), p. 38 Adverse effects, p. 38 Agonist, p. 22 Allergic reaction, p. 34 Antagonist, p. 34 Antagonistic effects, p. 37 Bioavailability, p. 23 Biotransformation, p. 30 Chemical name, p. 30 Contraindication, p. 35 Cytochrome P450, p. 30 Dissolution, p. 22 Drug, p. 21 Drug actions, p. 22 Drug effects, p. 33 Drug - induced teratogenesis, p. 39 Drug interaction, p. 37 Duration of action, p. 33 Enzymes, p. 34 Evidence - informed practice (EIP), p. 41 First - pass effect, p. 24 Generic name, p. 21 Half - life, p. 32 Idiosyncratic reaction, p. 38 Incompatibility, p. 37 Medication error (ME), p. 38 Medication use process, p. 38

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 2 - 2 Metabolite, p. 22 Onset of action, p. 33 Parent drug, p. 22 Peak effect, p. 33 Peak level, p. 33 Pharmaceutics, p. 22 Pharmacodynamics, p. 22 Pharmacogenetics, p. 38 Pharmacognosy, p. 22 Pharmacokinetics, p. 22 Pharmacology, p. 21 Pharmacotherapeutics, p. 22 Prodrug, p. 22 Receptor, p. 22 Steady state, p. 33 Substrate, p. 30 Synergistic effects, p. 37 Therapeutic drug monitoring, p. 34 Therapeutic effect, p. 34 Therapeutic index, p. 22 Toxic, p. 22 Toxicity, p. 33 Toxicology, p. 22 Trade name, p. 21 Trough level, p. 33 L EARNING O BJECTIVES 1. Define common terms used in pharmacology (see the listing of terms in the Glossary). 2. Describe the role of pharmaceutics, pharmacokinetics, and pharmacodynamics in drug administration. 3. Discuss the application of the four principles of pharmacotherapeutics to nursing practice as they relate to a variety of patients in different health care settings. 4. Discuss the use of natural drug sources in the development of new drugs. 5. Describe evidence - informed nursing practice. 6. Discuss the role of evidence - informed practice as it relates to pharmacology and medication administration. 7. Develop a collaborative plan of care that considers the phases of pharmacokinetics in carrying out drug therapy. C HAPTER O UTLINE AND T EACHING S TRATEGIES Chapter Outline Teaching Strategies Overview, p. 21 Make a list of generic names of commonly used over - the - counter (OTC) drugs, and give a “quiz” to students to see who can name the trade names of these drugs. You

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 2 - 3 Chapter Outline Teaching Strategies can even toss in a few chemical names for an added challenge. Pharmaceutics, p. 22 Pharmacokinetics, p. 23 Absorption Enteral Sublingual and buccal Parenteral Topical Transdermal Distribution Metabolism Excretion Half - life Onset, peak, and duration Divide the class into groups and assign each group a different drug, ensuring that each assigned drug represents a different class of medication. Have each group outline the pharmacokinetic stages for each drug, using the textbook or other resources. Specify that the stages of absorption, distribution, metabolism, and excretion be covered. Have each group share their findings with the class. Have students illustrate the following principles on posters that can be displayed in the classroom for review: • First - pass effect • Half - life (including a calculation for a specific drug, such as digoxin or theophylline) • Chemical, generic, and trade names • Onset, peak, duration Encourage colourful illustrations of these principles. Pharmacodynamics, p. 34 Mechanism of action Receptor interactions Enzyme interactions Nonselective interactions Set up the following scenario for students: Three patients have been given the same dose of the same drug by the same route. However, one patient develops a disturbing set of reactions, including severe skin rash, vomiting, and (eventually) convulsions. After tending to her immediate needs, you check the drug information again; however, not one of these reactions is listed as an adverse effect of this drug or as an adverse reaction to it. Furthermore, the other two patients did not have this violent reaction to this drug. When you report this to the physician, she asks you, “Have you thought of the possibility of an idiosyncratic reaction?” Where do you find that on the label? What does she mean? ( Answer: You

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 2 - 4 Chapter Outline Teaching Strategies probably will not find it mentioned on the drug label. An idiosyncratic reaction is not the result of a known property of the drug or even a patient allergy. Instead, it is usually caused by abnormal levels of drug - metabolizing enzymes [a complete absence, a deficiency, or an overabundance of the enzyme] ; the reaction is peculiar to that patient. ) Pharmacotherapeutics, p. 35 Acute therapy Maintenance therapy Supplemental therapy Palliative therapy Supportive therapy Prophylactic therapy and empirical therapy Monitoring Therapeutic index Drug concentration Patient’s condition Tolerance and dependence Interactions Adverse drug events Other drug effects Have students illustrate the following principles on posters that can be displayed in the classroom for review: • Adverse drug events • Comparison of additive and synergistic effects • Antagonistic drug interactions • Drug - induced teratogenesis • Carcinogenic effects • Peak and trough levels • Therapeutic index — what is a “low” or “narrow” therapeutic index? Encourage colourful illustrations of these principles. Pharmacognosy, p. 40 Assign students to bring in half - page reports of examples of drugs that are obtained from natural plant or animal sources. Encourage photographs or illustrations of plant sources when possible. Toxicology, p. 40 Assign students to find out about the local resources for poison control. Ask, “Is there an emergency poison control center in your area, and how do you contact it?” Conclusion, p. 41 C RITICAL T HINKING A CTIVITIES 1. The laboratory calls to notify the nurse that a patient’s “trough” level of an antibiotic is higher than the “peak” level. Is this the desired effect? Explain. 2. A patient has been admitted with slight pulmonary edema. She is also anxious and tells the nurse that she left her “glaucoma eye drops” at home. She has no known drug allergies, and she was recently treated for an upper gastrointestinal bleed. She also has osteoarthritis. The physician has ordered the following drugs: digoxin, furosemide,

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 2 - 5 potassium chloride, lorazepam, and oxaprozin. Using this text or a nursing drug handbook, look up the contraindications for each drug. Are there any contraindications for these drugs for this patient? ( Answer: Lorazepam is contraindicated for angle - closure glaucoma; therefore, more information may be needed before giving this drug. Oxaprozin, a nonsteroidal anti - inflammatory drug [NSAID], is contraindicated in cases of active peptic ulcer disease and gastrointestinal bleeding. ) 3. A patient has been treated for hypothyroidism for 10 years after his thyroid gland was removed due to cancer. Does this illustrate acute therapy, palliative therapy, maintenance therapy, or supplemental therapy? Explain. ( Answer: Supplemental therapy ) 4. A patient has a history of depression and has been taking bupropion for eight months, with improvement of symptoms noted. Does this case illustrate acute therapy, palliative therapy, maintenance therapy, or supplemental therapy? Explain. ( Answer: Maintenance therapy ) 5. A patient in her twenty - eighth week of pregnancy is experiencing premature labour and is given an intravenous infusion of terbutaline sulfate to stop the contractions. Does this case illustrate acute therapy, palliative therapy, maintenance therapy, or supplemental therapy? Explain. ( Answer: Acute therapy ) L EARNING A CTIVITIES 1. Define the following terms: a. Half - life b. Plasma protein binding c. First - pass effect d. Incompatibility 2. Define bioavailability and bioequivalent. 3. What are the significant implications of protein binding as it relates to the nursing process and the administration of medications? For example, if a patient is receiving two medications that are “highly protein bound,” what are the major concerns related to these drugs? 4. Do medications given parenterally go through the first - pass effect? Explain your answer. 5. Discuss the nursing implications if a drug is known to have a low therapeutic index. A NSWERS TO L EARNING A CTIVITIES 1. a. Half - life is the time it takes for 50% of the drug to be eliminated from the body. b. Plasma protein binding is a drug characteristic. The term refers to the amount of binding that a drug has to protein molecules (mostly albumin). c. First - pass effect is a process in which drugs that are absorbed via the small intestine are metabolized or broken down prior to systemic absorption and are significantly

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 2 - 6 metabolized when exposed to the liver and its enzymes. As a result, the drug’s effects may be significantly lessened. d. Incompatibility occurs when two parenteral drugs or solutions are mixed together and the result is a chemical deterioration or change in one or both of the drugs. 2. Bioavailability is the amount of drug that is available after absorption; it is directly related to the degree of absorption of the drug (e.g., medications administered intravenously have 100% bioavailability). Two medications that have the same bioavailability are said to be bioequivalent. 3. If two drugs that are “highly protein bound” are given together, there is an increased risk for drug toxicity because the two drugs will compete for protein - binding sites. As a result of this competition, either less of both drugs or less of one drug will bind to the proteins, leaving more free and unbound drug in the circulation to cause drug effects. 4. No, intravenous medications enter the circulation directly and bypass the liver; therefore, they are not exposed to the metabolizing enzymes. As a result, more of the drug is available to exert an effect. 5. The safety of a particular drug is determined by its therapeutic index. A “low therapeutic index” means that the range between a therapeutically active dose and a toxic dose is narrow. In this case, the drug has a higher likelihood than other drugs of causing an adverse reaction; therefore, the nurse should monitor the patient’s response to the drug very closely. A DDITIONAL R ESOURCES Do not forget the following supplemental teaching and learning resources found at http://evolve.elsevier.com/Canada/Lilley/pharmacology : For Instructors • Audience Response Questions • Image Collection • PowerPoint presentation slides • Teaching Tips • Test Bank For Students (instructors have access to all student material) • Animations • Answer Keys for Case Studies, Critical Thinking Activities, and Examination Review • Questions from the textbook • Calculators • Category Catchers • Content Updates • Frequently Asked Questions • Audio Glossary • IV Therapy and Medication Error Checklists

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 2 - 7 • Multiple - Choice Review Questions • Nursing Care Plans • Supplemental Resources • WebLinks

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    Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Lilley: Pharmacology for Canadian Health Care Practice, 2nd Canadian Edition Chapter 3: Considerations for Special Populations Instructor’s Manual O VERVIEW Age has, of course, a significant impact on the effects of medications in a patient, especially for those at either end of the age spectrum (i.e., older adults and children). However, age - related changes are the more significant factors. Pharmacokinetics is altered by organ immaturity in infants. Because of this, most drug references recommend children’s dosages based on “mg/kg” of body weight. However, formulas that involve age, weight, and body surface area (BSA) are also useful for calculating optimum dosages. In older adults, significant physiological changes affect all four phases of pharmacokinetics, and multiple disorders (and physicians) can lead to further complexities in treatment, particularly polypharmacy. In addition, because a fetus is exposed to many of the same substances, including drugs, to which the mother is exposed, it is important to know and understand drug effects in gestational life. Breastfed infants are also at risk for exposure to drugs consumed by the mother. K EY T ERMS Active transport, p. 44 Diffusion, p. 44 Nomogram, p. 46 Older adult, p. 48 Polypharmacy, p. 48 L EARNING O BJECTIVES 1. Discuss the influence of a patient’s age on the effects of drugs and drug responses. 2. Identify drug - related concerns during pregnancy and lactation. 3. Explain the physiological basis for drug - related concerns during pregnancy and lactation. 4. Discuss the process of pharmacokinetics and associated changes in different patient age groups, such as in children, pregnancy, and the older adult in relation to lifespan considerations as well as related physiological concerns. 5. Summarize the impact of age - related changes on pharmacokinetics in drug therapy. 6. Calculate a drug dosage for a child by using a variety of formulas. 7. Identify the importance of a body surface area (BSA) nomogram for children. 8. Develop a collaborative plan of care for drug therapy and the nursing process for patients across the lifespan. C HAPTER O UTLINE AND T EACHING S TRATEGIES Chapter Outline Teaching Strategies

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 3 - 2 Drug therapy during pregnancy, p. 44 Drug therapy during breastfeeding, p. 45 Assign several (or all) students to research at least three drugs to find out whether information on the effects of those drugs on the fetus or the breastfeeding infant exists. Have students report on the U.S. Food and Drug Administration or Motherisk pregnancy safety category for each drug. Considerations for children, p. 45 Physiology and pharmacokinetics Pharmacodynamics Dosage calculations for children Practise dose calculations for infants and children, using the nomogram. Considerations for the older adult, p. 48 Polypharmacy and drug use Physiological changes Pharmacokinetics Absorption Distribution Metabolism Excretion Problematic medications for the older adult Have each student or student team design a case study illustrating polypharmacy. Each “case” should demonstrate how and why this occurs. Next, have the students or teams exchange cases and research the new case study for possible drug interactions. Have teams demonstrate the other risks of polypharmacy by creating a story based on one of the cases in the previous exercise. Have them do the following: 1. Look up the drugs used and find possible adverse effects and interactions 2. Create a story about drug - induced falls or addiction 3. Exchange and write a plan for the prevention of these additional risks Nursing process, p. 53 Assessment Nursing diagnoses Planning Goals Outcome criteria Implementation Evaluation Develop a teaching plan about drug therapy for children of various ages and for older adults. Keep in mind the developmental considerations for each group. C RITICAL T HINKING A CTIVITIES 1. A 25 - year - old woman has a sinus infection but is afraid to take medications because she is breastfeeding her 2 - month - old baby. How will the health care professional decide which medications to prescribe? Would it be different if the woman had a severe case of pneumonia?

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    Instructor's Manual Copyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 3 - 3 2. Mrs. P., aged 89 years, has appointments this week with her primary physician, a rheumatoid arthritis specialist, an ophthalmologist, and a pulmonary specialist. What can be done to prevent possible polypharmacy with Mrs. P.? 3. Jamie, aged 4 years, is refusing to take medication for an ear infection. What measures can be taken to encourage Jamie to take her medication? 4. Mr. T., aged 79 years, is on the following medications: • An antihypertensive • digoxin • A diuretic • Thyroid replacement therapy • An antibiotic Which drugs, if any, may be problematic for Mr. T? Explain your answers. L EARNING A CTIVITIES 1. List one nursing consideration for administering medications to a child. 2. Discuss two of the many changes related to aging and drug therapy that have a profound negative effect on medications in older adults. 3. There is no concern regarding problems with drug metabolism in patients who are 55 to 65 years of age. True or false? Explain your answer. 4. Describe the best approach to calculating dosages for children. 5. Describe the factors that generally cause toxicity of drugs in older adult patients. 6. List the factors that contribute to the safety or potential harm of a drug given during pregnancy. How is the decision made as to whether to give a drug during this time? A NSWERS TO L EARNING A CTIVITIES 1. Answers may vary and can be found in the “Special Populations: Children” box subtitled “Age - Related Considerations for Medication Administration from Infancy to Adolescence.” Many important principles are listed, but it is important to be sure to triple - check all mathematical calculations and dosages. 2. Decreased liver function, renal impairment due to aging, decreased perfusion, altered gastrointestinal secretions, and decreased sensory abilities all have a profound effect on the older adult, along with subsequent toxicity and decreased parenteral and oral absorption. 3. False. Beginning in the third decade of life, liver functioning decreases, thereby decreasing metabolism.

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