Drug Administration During Pregnancy And In The Elderly

The fact that the drugs may harm the mother, fetus or both should be borne in mind. The main dangers to the growing fetus include:
1. Destruction of the embryo and abortion, e.g, quinine, cytotoxic drugs.
2. Congenital defects and disorders of organs development, e.g, thalidomide, radioactive drugs, anticancer drugs.
3. Incorporation into the tissues of the fetus, e.g, tetracycline into the teeth.
4. Pharmacological effects on the fetus by drugs which cross the placenta, e.g, antithyroid drugs may cause thyroid dysfunction in the newborn. Hormone administered to the mother may affect the fetus.

Apart from the damage caused to the embryo, from the damage caused to the embryo, the mother is more susceptible to the toxic effects of several drugs during pregnancy e.g, tetracyclines are more likely to produce hepatic damage during pregnancy.

In general, it is a golden rule to withhold medication to a pregnant woman unless absolutely indicated.

Drug administration in the elderly: Old subjects are likely to have multiple pathological lesions and hence they are susceptible to the cumulative adverse effects of several drugs which are concurrently administered.

Elderly persons behave erratically to drugs. Since their weight is low, the ordinary does may prove to be toxic. Absorption from he alimentary tract may not be predictable. Moreover, impairment of functions of the liver and kidney lead to their accumulation in the body. In addition, the Organ systems may also show increased sensitivity, e.g, aged persons are more prone to develop cardiotoxicity of digitalis and ototoxicity, of the aminoglycosides. Adverse effects of drugs constitute a major cause of morbidity in old persons and therefore great care is required for prescribing drugs to them. Aged women with history of allergic diathesis are particularly susceptible to develop drug toxicity. An early sign of drug toxicity is mental confusion and disorderly behavior which should not be ignored. Drug compliance is generally poor in the older age groups due to their physical disability, mental confusion and economic dependence. Particular care, therefore, is to be taken to ensure that drug schedules are followed.

Hospitalization should be avoided as far as possible since older persons cannot adapt to the hospital environment. As a consequence they develop confusion and disorientation. Moreover, hospitalization and immobilization lead to complications like respiratory infection, urinary retention, fecal and urinary incontinence, falls, venous thrombosis, embolism and strokes. Confinement to bed should be kept to the minimum and the patient should be ambulated as early as possible.

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