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 CanadianEditionChapter 01: Nursing Practice in Canada and Drug TherapyInstructor’s ManualOVERVIEWBefore beginning this course, it is essential to introduce the underlying premise for the entiretextbook; that is, how isthe nursing process used in the administration of medications?Certainly, using the nursing process helps make drug administration more efficient, morethorough, and more sensitive to the famous “Five Rights.” It also makes certain legal andmedical safeguards more automatic.In this chapter, the integration of administration and the nursing process is initiated byreviewing the five phases of the nursing process and its overall purpose.Howeach phase––assessment, nursing diagnosis, planning (goals and outcome criteria), implementation, andevaluation––is initiated is critical to accurate and effective medication administration. Theintegration of the “Five Rights” of medication administration into drug therapy and thenursing process is presented. In addition, another five rights are addressed in regard to theirimpact on safe administration practices, including the process of system analysis and theprevention of medication errors.KEYTERMSCritical thinking, p. 8Goals, p. 12Medication error, p. 13Nursing process, p. 8Outcome criteria, p. 12LEARNINGOBJECTIVES1. 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 reflectedin the goals and outcome criteria.7. Develop a collaborative plan of care using the nursing process and medicationadministration.8. Briefly discuss the “Ten Rights” of drug administration and the related professionalresponsibility 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 ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.1-2CHAPTEROUTLINE ANDTEACHINGSTRATEGIESChapter OutlineTeaching StrategiesOverview, p. 8As you integrate drug therapy into thenursing process, keep referring students toBox 1-1 (Sample Collaborative Plan ofCare Related to Drug Therapy Using theNursing Process). This will help students tosee the integration, using an actual patient.It will also help demonstrate the circularnature of the process.Assessment, p. 8Analysis of dataAsk, “In what way does a thorough drughistory involve both subjective andobjective data collection?” (Objective datacollection includes completing a list ofdrugs taken currently and/or in the past, alist of past or present disease processes,and a head-to-toe physical assessment.Subjective data include any problems oradverse effects the patient experienced withpast or current drug therapies and adiscussion of applicable age-related,social, or developmental issues.)Nursing diagnoses, p. 11During the discussion of the variousclassifications of drugs and the diseasesthey treat, ask students to name a fewnursing diagnoses that would be relevantfor patients receiving those drugs.Planning, p. 12Goals and outcome criteriaDuring your discussion of the variousclassifications of drugs and the diseasesthey treat, ask students to name a fewrelevant goals and outcome criteria thatwould be appropriate for patients receivingthose drugs. Be sure these are patient-oriented goals related to the NURSINGPROCESS, not goals related to the medicalresolution of a disease process.Implementation, p. 12Right drugRight doseRight timeRight routeRight patientRight documentationRight reasonMedication errorsDivide the class into small teams, anddistribute medication orders that areincompletely or incorrectly written (e.g.,orders that are missing route, amount ofdrug, or frequency, or orders that areambiguous or in illegible handwriting).Examples should cover the “rights”mentioned in the text. Have the teamsconsider the following questions:

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.1-3Chapter OutlineTeaching Strategies• What “right” of medicationadministration is missing?• What is needed to correct or complete theorder?Review with the class what a typicalprocedure would be if a medication errorwere to occur in an inpatient setting.Evaluation, p. 16Create several scenarios that provideassessment data (subjective and objective)and a prescribed medication therapy, thenassign small groups to work through thestages of the nursing process with one ofthe scenarios. You may want to go throughthe steps in the first scenario with all of thestudents to emphasize specific points. Besure to discuss how to monitor the patient’sresponse to drug therapy.CRITICALTHINKINGACTIVITIESHave students learn how medication administration is integrated into the nursing process byassigning teams to apply the steps of the nursing process to a specific drug.LEARNINGACTIVITIESYour patient is 33 years old and has been diagnosed with type 1 diabetes mellitus. Sherequires 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 diagnosesfor medication-related issues? Explain your answer. If your answer is in support of the useof nursing diagnoses with medication administration, state the diagnoses that are morecommonly used.2. The same patient has developed problems with the absorption of subcutaneous insulin. Herblood glucose readings vary tremendously during a 24-hour period, with periods ofhypoglycemia and periods of hyperglycemia. She has been laid off from work, hasfinancial 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 todrug 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, requiresa subcutaneous injection twice daily. Develop a nursing diagnosis for this patient thatfocuses on the newness of the treatment regimen.4. Develop a goal and outcome criteria for this patient. Make sure that they relate to one ofthe nursing diagnoses that focus on the drug therapy. Also include what would be

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.1-4monitored during the evaluation phase of the nursing process for the specific nursingdiagnosis, goal, and outcome criteria you develop.5. What would be evaluated with drug administration?ANSWERS TOLEARNINGACTIVITIES1. Yes, it is appropriate to develop nursing diagnoses for patients receiving medications.Nursing diagnoses arenotjust for issues related to patient care and are easy to developand apply to many facets of the medication administration process. Some of the morecommon nursing diagnoses that deal with the nursing process and drug therapy are listedbelow. (Note to instructors: The following nursing diagnoses are not complete becauseeach patient is different and because associated nursing diagnoses need to beindividualized in accordance with the patient, the disease process, and medicationtherapy.)• Constipation related to . . . (usually related to the adverse effects of a medication)• Deficient knowledge (medications) related to first-time use . . . (usually due to first-timeuse 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 ontheir own because of bothersome adverse effects)• Imbalanced nutrition: less or more than body requirements . . . (usually related to theadverse effects of a medication—for example, weight gain from an oral corticosteroid)• Risk for situational low self-esteem related to . . . (usually from not understanding themedications and from a lack of knowledge and experience)• Ineffective therapeutic regimen management (individual) related to . . . (this is alsorelated to bothersome adverse effects—the patient quits taking the medication becauseof adverse effects and lack of knowledge and is unaware of the impact that suddenwithdrawal from the medication may have)• Disturbed thought processes related to . . . (the adverse effects of certain medicationssuch as narcotics and sedatives)2. Responses can include the following:• Deficient knowledge (medications) related to first-time use . . . (usually related to a lackof experience and information)• Anxiety related to . . . (usually from the patient’s being afraid and fearful of theunknown)•Risk for falls related to possible hypoglycemia and the adverse effects of insulin3. Deficient knowledge (medications) related to lack of experience and knowledge about theuse of insulin and how to administer the injection

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.1-54. GOAL: The patient will adhere to drug therapy, with therapeutic effects and minimaladverse 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 inglucose levels.5. In the evaluation phase of the nursing process related to drug therapy, the nurse monitorstherapeutic effects, adverse effects, and toxic effects.ADDITIONALRESOURCESDo not forget the following supplemental teaching and learning resources found athttp://evolve.elsevier.com/Canada/Lilley/pharmacology:For instructors• Audience Response Questions• Image Collection• PowerPoint presentation slides• Teaching Tips• Test BankFor 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 CanadianEditionChapter 2: Pharmacological PrinciplesInstructor’s ManualOVERVIEWNurses need a sound understanding of basic pharmacological principles to appreciate theeffects, both positive and negative, that drugs can have on a patient’s health. In order tounderstand pharmacology, the basic principles of pharmacotherapeutics (the use of drugs andthe clinical indications for drugs to prevent and treat diseases) as well as the roles ofpharmacokinetics (the study of what the body does to the drug), pharmacodynamics (thestudy of what the drug does to the body), and pharmacognosy (natural drug sources) must beincluded.KEYTERMSAdditive effects, p. 37Adverse drug event (ADE), p. 38Adverse drug reaction (ADR), p. 38Adverse effects, p. 38Agonist, p. 22Allergic reaction, p. 34Antagonist, p. 34Antagonistic effects, p. 37Bioavailability, p. 23Biotransformation, p. 30Chemical name, p. 30Contraindication, p. 35Cytochrome P450, p. 30Dissolution, p. 22Drug, p. 21Drug actions, p. 22Drug effects, p. 33Drug-induced teratogenesis, p. 39Drug interaction, p. 37Duration of action, p. 33Enzymes, p. 34Evidence-informed practice (EIP), p. 41First-pass effect, p. 24Generic name, p. 21Half-life, p. 32Idiosyncratic reaction, p. 38Incompatibility, p. 37Medication error (ME), p. 38Medication use process, p. 38

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.2-2Metabolite, p. 22Onset of action, p. 33Parent drug, p. 22Peak effect, p. 33Peak level, p. 33Pharmaceutics, p. 22Pharmacodynamics, p. 22Pharmacogenetics, p. 38Pharmacognosy, p. 22Pharmacokinetics, p. 22Pharmacology, p. 21Pharmacotherapeutics, p. 22Prodrug, p. 22Receptor, p. 22Steady state, p. 33Substrate, p. 30Synergistic effects, p. 37Therapeutic drug monitoring, p. 34Therapeutic effect, p. 34Therapeutic index, p. 22Toxic, p. 22Toxicity, p. 33Toxicology, p. 22Trade name, p. 21Trough level, p. 33LEARNINGOBJECTIVES1. Define common terms used in pharmacology (seethe listing of terms in the Glossary).2. Describe the role ofpharmaceutics, pharmacokinetics, and pharmacodynamics in drugadministration.3. Discuss theapplication ofthe four principles of pharmacotherapeutics to nursing practiceas they relate to a variety of patients in different health care settings.4. Discuss theuse of natural drug sources inthe development of new drugs.5. Describe evidence-informed nursing practice.6. Discuss therole of evidence-informed practice as it relates to pharmacology andmedication administration.7. Develop a collaborative plan of care that considers the phases ofpharmacokinetics incarrying out drug therapy.CHAPTEROUTLINE ANDTEACHINGSTRATEGIESChapter OutlineTeaching StrategiesOverview, p. 21Make a list of generic names of commonlyused over-the-counter (OTC) drugs, andgive a “quiz” to students to see who canname the trade names of these drugs. You

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.2-3Chapter OutlineTeaching Strategiescan even toss in a few chemical names foran added challenge.Pharmaceutics, p. 22Pharmacokinetics, p. 23AbsorptionEnteralSublingual and buccalParenteralTopicalTransdermalDistributionMetabolismExcretionHalf-lifeOnset, peak, and durationDivide the class into groups and assigneach group a different drug, ensuring thateach assigned drug represents a differentclass of medication. Have each groupoutline the pharmacokinetic stages for eachdrug, using the textbook or other resources.Specify that the stages ofabsorption,distribution, metabolism,andexcretionbecovered. Have each group share theirfindings with the class.Have students illustrate the followingprinciples on posters that can be displayedin the classroom for review:• First-pass effect• Half-life (including a calculation for aspecific drug, such as digoxin ortheophylline)• Chemical, generic, and trade names• Onset, peak, durationEncourage colourful illustrations of theseprinciples.Pharmacodynamics, p. 34Mechanism of actionReceptor interactionsEnzyme interactionsNonselective interactionsSet up the following scenario for students:Three patients have been given the samedose of the same drug by the same route.However, one patient develops a disturbingset of reactions, including severe skin rash,vomiting, and (eventually) convulsions.After tending to her immediate needs, youcheck the drug information again; however,not one of these reactions is listed as anadverse effect of this drug or as an adversereaction to it. Furthermore, the other twopatients did not have this violent reaction tothis drug. When you report this to thephysician, she asks you, “Have you thoughtof the possibility of an idiosyncraticreaction?” Where do you find that on thelabel? What does she mean?(Answer: You

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.2-4Chapter OutlineTeaching Strategiesprobably will not find it mentioned on thedrug label. An idiosyncratic reaction is notthe result of a known property of the drugor even a patient allergy. Instead, it isusually caused by abnormal levels of drug-metabolizing enzymes [a complete absence,a deficiency, or an overabundance of theenzyme];the reaction is peculiar to thatpatient.)Pharmacotherapeutics, p. 35Acute therapyMaintenance therapySupplemental therapyPalliative therapySupportive therapyProphylactic therapy andempirical therapyMonitoringTherapeutic indexDrug concentrationPatient’s conditionTolerance and dependenceInteractionsAdverse drug eventsOther drug effectsHave students illustrate the followingprinciples on posters that can be displayedin the classroom for review:• Adverse drug events• Comparison of additive and synergisticeffects• 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 theseprinciples.Pharmacognosy, p. 40Assign students to bring in half-pagereports of examples of drugs that areobtained from natural plant or animalsources. Encourage photographs orillustrations of plant sources when possible.Toxicology, p. 40Assign students to find out about the localresources for poison control. Ask, “Is therean emergency poison control center in yourarea, and how do you contact it?”Conclusion, p. 41CRITICALTHINKINGACTIVITIES1. The laboratory calls to notify the nurse that a patient’s “trough” level of an antibiotic ishigher 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 thenurse 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 hasosteoarthritis. The physician has ordered the following drugs: digoxin, furosemide,

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.2-5potassium chloride, lorazepam, and oxaprozin. Using this text or a nursing drughandbook, look up the contraindications for each drug. Are there any contraindications forthese drugs for this patient? (Answer: Lorazepam is contraindicated for angle-closureglaucoma; therefore, more information may be needed before giving this drug.Oxaprozin, a nonsteroidal anti-inflammatory drug [NSAID], is contraindicated in casesof active peptic ulcer disease and gastrointestinal bleeding.)3. A patient has been treated for hypothyroidism for 10 years after his thyroid gland wasremoved due to cancer. Does this illustrate acute therapy, palliative therapy, maintenancetherapy, or supplemental therapy? Explain. (Answer: Supplemental therapy)4. A patient has a history of depression and has been taking bupropion for eight months, withimprovement of symptoms noted. Does this case illustrate acute therapy, palliativetherapy, maintenance therapy, or supplemental therapy? Explain. (Answer: Maintenancetherapy)5. A patient in her twenty-eighth week of pregnancy is experiencing premature labour and isgiven an intravenous infusion of terbutaline sulfate to stop the contractions. Does this caseillustrate acute therapy, palliative therapy, maintenance therapy, or supplemental therapy?Explain. (Answer: Acute therapy)LEARNINGACTIVITIES1. Define the following terms:a. Half-lifeb. Plasma protein bindingc. First-pass effectd. Incompatibility2. Definebioavailabilityandbioequivalent.3. What are the significant implications of protein binding as it relates to the nursing processand the administration of medications? For example, if a patient is receiving twomedications that are “highly protein bound,” what are the major concerns related to thesedrugs?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.ANSWERS TOLEARNINGACTIVITIES1. a.Half-lifeis the time it takes for 50% of the drug to be eliminated from the body.b.Plasma protein bindingis a drug characteristic. The term refers to the amount ofbinding that a drug has to protein molecules (mostly albumin).c.First-pass effectis a process in which drugs that are absorbed via the small intestine aremetabolized or broken down prior to systemic absorption and are significantly

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.2-6metabolized when exposed to the liver and its enzymes. As a result, the drug’s effectsmay be significantly lessened.d.Incompatibilityoccurs when two parenteral drugs or solutions are mixed together andthe result is a chemical deterioration or change in one or both of the drugs.2.Bioavailabilityis the amount of drug that is available after absorption; it is directly relatedto the degree of absorption of the drug (e.g., medications administered intravenously have100% bioavailability). Two medications that have the same bioavailability are said to bebioequivalent.3. If two drugs that are “highly protein bound” are given together, there is an increased riskfor drug toxicity because the two drugs will compete for protein-binding sites. As a resultof 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 isavailable to exert an effect.5. The safety of a particular drug is determined by its therapeutic index. A “low therapeuticindex” means that the range between a therapeutically active dose and a toxic dose isnarrow. In this case, the drug has a higher likelihood than other drugs of causing anadverse reaction; therefore, the nurse should monitor the patient’s response to the drugvery closely.ADDITIONALRESOURCESDo not forget the following supplemental teaching and learning resources found athttp://evolve.elsevier.com/Canada/Lilley/pharmacology:For Instructors• Audience Response Questions• Image Collection• PowerPoint presentation slides• Teaching Tips• Test BankFor 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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Copyright ©2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.Lilley: Pharmacology for Canadian Health Care Practice, 2nd CanadianEditionChapter 3: Considerations for Special PopulationsInstructor’s ManualOVERVIEWAge has, of course, a significant impact on the effects of medications in a patient, especiallyfor those at either end of the age spectrum (i.e., older adults and children). However, age-relatedchanges are the more significant factors. Pharmacokinetics is altered by organimmaturity in infants. Because of this, most drug references recommend children’s dosagesbased on “mg/kg” of body weight. However, formulas that involve age, weight, and bodysurface area (BSA) are also useful for calculating optimum dosages. In older adults,significant physiological changes affect all four phases of pharmacokinetics, and multipledisorders (and physicians) can lead to further complexities in treatment, particularlypolypharmacy. 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 drugeffects in gestational life. Breastfed infants are also at risk for exposure to drugs consumedby the mother.KEYTERMSActive transport, p. 44Diffusion, p. 44Nomogram, p. 46Older adult, p. 48Polypharmacy, p. 48LEARNINGOBJECTIVES1. Discuss the influence of a patient’s age onthe effects of drugs and drug responses.2. Identify drug-related concerns during pregnancy and lactation.3. Explain thephysiological basis for drug-related concernsduring pregnancy and lactation.4. Discuss theprocessof pharmacokinetics and associated changesin different patient agegroups, such as in children, pregnancy, and the older adult in relation to lifespanconsiderations 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 theimportance ofa body surface area (BSA) nomogram for children.8. Develop a collaborative plan of care for drug therapy andthe nursing process for patientsacross the lifespan.CHAPTEROUTLINE ANDTEACHINGSTRATEGIESChapter OutlineTeaching Strategies

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.3-2Drug therapy during pregnancy, p. 44Drug therapy during breastfeeding, p. 45Assign several (or all) students to researchat least three drugs to find out whetherinformation on the effects of those drugs onthe fetus or the breastfeeding infant exists.Have students report on the U.S. Food andDrug Administration orMotheriskpregnancy safety category for each drug.Considerations for children, p. 45Physiology and pharmacokineticsPharmacodynamicsDosage calculations for childrenPractise dose calculations for infants andchildren, using the nomogram.Considerations for the older adult, p. 48Polypharmacy and drug usePhysiological changesPharmacokineticsAbsorptionDistributionMetabolismExcretionProblematic medications for theolder adultHave each student or student team design acase study illustrating polypharmacy. Each“case” should demonstrate how and whythis occurs. Next, have the students orteams exchange cases and research the newcase study for possible drug interactions.Have teams demonstrate the other risks ofpolypharmacy by creating a story based onone of the cases in the previous exercise.Have them do the following:1. Look up the drugs used and find possibleadverse effects and interactions2. Create a story about drug-induced fallsor addiction3. Exchange and write a plan for theprevention of these additional risksNursing process, p. 53AssessmentNursing diagnosesPlanningGoalsOutcome criteriaImplementationEvaluationDevelop a teaching plan about drug therapyfor children of various ages and for olderadults. Keep in mind the developmentalconsiderations for each group.CRITICALTHINKINGACTIVITIES1. A 25-year-old woman has a sinus infection but is afraid to take medications because she isbreastfeeding her 2-month-old baby. How will the health care professional decide whichmedications to prescribe? Would it be different if the woman had a severe case ofpneumonia?

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Instructor's ManualCopyright © 2011 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.3-32. Mrs. P., aged 89 years, has appointments this week with her primary physician, arheumatoid arthritis specialist, an ophthalmologist, and a pulmonary specialist. What canbe done to prevent possible polypharmacy with Mrs. P.?3. Jamie, aged 4 years, is refusing to take medication for an ear infection. What measures canbe 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 antibioticWhich drugs, if any, may be problematic for Mr. T? Explain your answers.LEARNINGACTIVITIES1. 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 profoundnegative effect on medications in older adults.3. There is no concern regarding problems with drug metabolism in patients who are 55 to 65years 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 duringpregnancy. How is the decision made as to whether to give a drug during this time?ANSWERS TOLEARNINGACTIVITIES1. Answers may vary and can be found in the “Special Populations: Children” box subtitled“Age-Related Considerations for Medication Administration from Infancy toAdolescence.” Many important principles are listed, but it is important to besure to triple-check all mathematical calculations and dosages.2. Decreased liver function, renal impairment due to aging, decreased perfusion, alteredgastrointestinal secretions, and decreased sensory abilities all have a profound effect onthe older adult, along with subsequent toxicity and decreased parenteral and oralabsorption.3. False. Beginning in thethirddecade of life, liver functioning decreases, therebydecreasing metabolism.

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