Certain people should exercise extreme care in taking medications because their bodies are likely to process them differently. These include infants and children, seniors, pregnant or nursing women, immunocompromised individuals such as those suffering from HIV infection or AIDS, and people with liver or kidney disease.
Medications in Infants and Children
When it comes to medications infants and children are not just small adults. They cannot simply be given smaller dosages of a medication, for example. Much more complex calculations must be done that take into account such factors as weight and relative maturation of organs that are critical to metabolizing and excreting medications (that is, the liver and kidneys). The capacity to digest, store, and eliminate medications evolves quickly in the newborn period. Many medications have not been tested or widely used in children, although this situation may be changing due to governmental pressure to initiate such investigations. Sometimes a medication will actually affect a child in a completely different way than it will an adult. Methylphenidate (Ritalin), for example, functions as a stimulant in adults but calms hyperactive children.
Talk to your doctor before giving a child less than 2 years old any over-the-counter medication. Consider carefully whether a child of any age really needs the medication you are considering giving them. Do not give aspirin to a child or teenager under age 18. This is particularly important if she is suffering from a fever of unknown cause, a cough, sore throat, cold, a viral infection, or chickenpox symptoms. Giving aspirin to a child with any of these conditions poses the risk of a rare but potentially fatal disease called Reye's syndrome. Carefully examine the ingredients listed on an over-the-counter medication as some unexpected ones contain aspirin. Look for the presence of alcohol in medications and carefully avoid giving these to small children. Acetaminophen is a good choice for children under age 18 suffering from pain or a fever. Whenever you give your child a medication, check the label twice to confirm the dosage for your child's age. Do not give her more than one over-the-counter medication; many contain identical ingredients that can result in hazardous accumulations.
Select liquid medications for children less than 5 years old whenever possible because they may have difficulty swallowing a pill. Only give chewable tablets to children more than 2 years old who have enough teeth to chew a tablet well. If yourchild spits out medication that you have just given her, consider it a partial dose and call the doctor or pharmacist for directions. Do not automatically give a second dose to make up for the lost medication.
Medications in the Person Over Age 65
As we get older, the way our bodies metabolize and respond to medications changes. There are several reasons for these changes. The capacity of the liver to break down medications and the capacity of the kidneys to excrete them is often compromised, which poses the risk of medications accumulating to dangerous levels and causing adverse reactions. Dosages for seniors must often be lowered for this reason. As the body ages, its ability to maintain constant, even levels of a medication also deteriorates. Certain parts of the body, such as the nervous system and brain, become more sensitive to a medication's actions. Immune system changes may cause unexpected reactions in some cases. The digestive system may also become less efficient, which interferes with the absorption of medications. Medication dosages may ultimately need to be readjusted more frequently to avoid or minimize adverse reactions.
Failure to take a medication correctly or on schedule is another major problem with seniors. Sometimes this problem is attributed to everyday forgetfulness was a dose already taken? and other times to senility, drowsiness, or other problems. Seniors also tend to have prescriptions for multiple medications, which increases the risk for adverse reactions among medications as well as errors in taking them all properly. For seniors taking several medications each day, the prospect of coordinating them can be daunting indeed. Work with your doctor to make your dosage schedule as uncomplicated as possible; opt for single daily doses of a medication whenever possible and for taking as many of the medications as possible at a designated time so that you are less likely to forget any one in particular. Your doctor and pharmacist should be able to help you make these consolidations when possible. Your doctor should be encouraged, when necessary, to review the various medications you are taking and confirm that they are all still relevant and necessary.
There are a number of other important measures you can take. Make sure all of your medication containers are clearly labelled with the medication name and directions in oversized, easily legible type. Informational leaflets should come with the medication; keep these together. The pharmacist may be able to dispense medication in easy-to-open containers. Use of weekly pillboxes should help prevent confusion about what medications have already been taken for the day, thus preventing double dosing.
Medications in the Pregnant or Nursing Woman
Most women today recognize that pregnancy and nursing are important times to avoid unnecessary medications including basic over-the-counter medications such as aspirin given the risks that many medications pose to unborn children or nursing infants. Almost all medication crosses the critical filter between mother and child the placenta and enters the fetal bloodstream. The rapidly growing and developing fetus can occasionally be very vulnerable to the effects of a medication the mother takes. Reactions can range from birth defects or mild developmental deformities to slowed growth or death. Sometimes medication affects the pregnant woman adversely or interferes with the normal progression of labor. The potential for harm to the developing fetus has shown to be greatest at exactly the time that many women are not even aware that they are pregnant the first 3 months of gestation. Medications that pose a risk to the normal development of the fetus are called teratogens. Although investigators have assessed the safety of some medications for use during pregnancy, there is scant evidence for safe use during pregnancy for the majority of medications. Limiting your intake of all medications is wise for this reason. Alcohol, nicotine, caffeine, and recreational drugs should be avoided.
If you become pregnant do not suddenly stop taking prescription medications you regularly take for a chronic or serious condition such as epilepsy; talk over your pregnancy plans with your doctor and together you may be able to find a safe solution for modifying your medication regimen. Similarly, consult your doctor before starting any medication (prescription or over-the-counter) during the time you are trying to conceive. Some medication is considered safe to the mother or fetus during one of the three trimesters of pregnancy but potentially damaging in another.
Most medications can pass to a baby through breast milk as well; the medication finds its way into the milk through the fine blood vessels that surround the breast's milk-producing glands. However, only occasionally does the infant get enough of a medication in breast milk to produce any effect. If you plan to nurse, talk to your doctor about the medications you take.
When it comes to good medical care, teenagers constitute one of the most neglected age groups. They no longer seem to belong in the pediatrician's office and they are too young to be accepted into an adult practice. Many teenagers remain on medications that were appropriate for them when they were younger asthma medications are a good example of this although they may have outgrown the condition or need a different amount of medication now that their bodies are larger and more mature. As with every other age group, a doctor should review the medications an adolescent takes. It is also wise to ask your doctor to review with your adolescent the health risks involved in the use of illegal drugs and alcohol.
Medications in the Person With HIV Infection
One of the challenges that HIV-infected people face is taking a cocktail of medications on time, several times a day, in some cases with certain foods only. You may have trouble complying with what will likely be a dizzying regimen, and you may struggle with side effects produced by many of the medications. If you still feel well, you may especially resent or resist taking medications.
Standard care for people infected with HIV now involves medications designed to prevent opportunistic infections (infections caused by a virus, bacterium, or other pathogen that is not usually harmful to a person with normal immune function) as well as medications designed to block the virus from replicating. Complying with the regimen may be one of your most challenging tasks and also one of the most important measures that you can take to ensure continued health. Missing doses can have serious consequences because the virus can take advantage of even minimal drops in the level of medications designed to prevent it from replicating.
Given the difficulty in discerning which medication should be blamed for a side effect or a negative interaction with another medication, medications should be added one at a time when possible. Scientists continue to search for ways to simplify the HIV medication regimen by looking into strategies for consolidating various medications into single pills.
Medications in the Person With Liver or Kidney Disease
The liver and kidneys are critical to the normal processing of medications. One of the primary responsibilities of the liver is to break down certain medications into forms that the body can then eliminate. When the liver fails to function normally, as in the case of severe cirrhosis, for example, the liver's ability to metabolize medication is impeded and dangerously high levels of certain medications may accumulate, which can cause potentially adverse reactions.
Similarly, people with poor kidney function are at increased risk for side effects. When kidneys fail to function properly and process medications as needed for elimination through the urine, dangerous accumulations in the body can occur. The protein loss caused by some types of kidney disease can also complicate the situation, because a number of medications rely on protein to bind to in the bloodstream. With less protein to bind to, the medication is free to circulate through the body and may cause unwanted side effects or damage.
People with liver or kidney disease should check with a doctor before taking any medication including those that are over-the-counter. The doctor will attempt to avoid prescribing medications that may actually strain or damage these organs further, she may prescribe adjusted doses to avoid unwanted medication accumulations
