Prescribing For Older Adults And Pregnant Women
It is difficult to prescribe for the elderly.
Older people are frequently prescribed unnecessary drugs, contraindicated drugs, or the incorrect dose for their age group.
Age misconceptions may prevent them from receiving drugs with specific indications and evidence bases.
Inappropriate prescribing can be reduced by conducting regular drug reviews, using electronic prescribing, conducting regular audits, and limiting the number of prescribers.
Even though one-fifth of the UK population is 60 or older, people in this age group receive 59% of dispensed prescriptions and account for more than half of NHS drug costs. Older people frequently have multiple medical problems and take multiple medications. Because aging causes changes in pharmacokinetics and pharmacodynamics, prescribing in this age group can be difficult.
Many randomized controlled trials involving older patients focus on managing a single disease state, such as hypertension or osteoporosis. However, people in this age group frequently have many interacting conditions. They are taking many drugs, so treatment guidance must often be based on consensus and involves extrapolating data from healthier patients. This review highlights some of the challenges in prescribing to older patients and provides recommendations for appropriate prescribing.
Prescription and medication management during pregnancy are among the most common but difficult aspects of obstetric medicine. All medications have risks and benefits, but clinical and medico-legal considerations will influence our prescribing, counseling, and the woman’s decision to use a specific medication, especially during pregnancy.
Good prescribing principles must be followed when prescribing for a woman of childbearing age or a man attempting to father a child.
Clear prescribing principles are an important way to address the challenges of prescribing during pregnancy. These difficulties are related to medications and pregnancy.
The pharmacokinetics of medications can be affected by physiological changes during pregnancy.
Teratogens can cause structural or functional abnormalities in the fetus or child after birth, some of which may not be apparent until later in life.
Consider using a medicine only when necessary.
Use medication only after a risk-benefit analysis has been completed and the expected benefits (usually to the mother) outweigh the risks (usually to the fetus).
Always perform a risk-benefit analysis on an individual patient basis, using the most up-to-date information.
Use the lowest effective dose for the shortest time possible – careful monitoring is required to ensure that the doses used are as low as possible while providing an adequate therapeutic response.
Avoid new medicines as much as possible because there is a lack of information on their use during pregnancy – lack of information does not imply safety.
Avoid polypharmacy; the teratogenicity of a medicine may be increased by co-administration of a second or more medicine. Risk factors may be not only additive but also synergistic.
Avoid using alcohol, tobacco, and other recreational drugs.
The exposure stage is crucial in determining whether or not the embryo is at a vulnerable stage of development.
The type of congenital disability caused by exposure is determined by the stage of development at which the exposure occurs.
Individual medicines can be sensitive at different times:
The first trimester
Avoid using medicines during the first trimester; the period of greatest susceptibility to teratogenic effects (i.e., malformations) is usually the first 12 weeks of pregnancy.
The main risk is structural defects as major structures and organs (such as the brain, spinal cord, arms, and legs) develop.
Third and second trimesters
Some medications pose a risk later in pregnancy when they may affect fetal growth or functional development. Later exposure can also be harmful or toxic to fetal tissues.
Medicines given shortly before or during labor can negatively affect labor or the neonate after delivery, such as withdrawal symptoms.