L19 CAM & Special populations2025_formatted_text

DENT 3005: Introduction to Pharmacology - CAM¹

Dr Thuy Linh Truong thuy.truong@uwa.edu.au

Other Interactions²³

SUBSTANCE + DRUG	INTERACTION SEVERITY	POTENTIAL EFFECT
Calcium + Doxycycline	Moderate	Reduced anti-infective effectiveness
Calcium + Tetracycline	Moderate	Reduced anti-infective effectiveness
Evening Primrose + Aspirin	Moderate	Enhanced bleeding
Evening Primrose + Ibuprofen	Moderate	Enhanced bleeding
Ginkgo biloba + Aspirin	Major	Enhanced bleeding
Ginkgo biloba + Ibuprofen	Major	Enhanced bleeding

Distribution⁴

• Lower plasma proteins → ↑ free drug levels in infants & elderly
• Neonates: risk of toxicity from high protein-bound drugs
• Kernicterus risk → bilirubin displacement
• Body composition changes with age
  • Infants: more body water, less fat
  • Elderly: less water, more fat

Metabolism⁵

• Infants: immature liver enzymes $\to$ slower clearance
• Some drugs can induce enzyme activity (e.g. anti-seizure meds)
• Children 1–9 yrs: $\uparrow$ metabolism $\to$ higher clearance
• Elderly: reduced microsomal enzyme activity $\to$ slower metabolism

Excretion⁶

• Neonates: immature kidneys &arr; slower drug clearance
• Dosing intervals need adjusting
• Elderly: declining renal function with age
• Risk of drug accumulation & toxicity

Clinical Considerations for Special Populations⁷

Paediatric: dosage considerations

• Children $\ne$ small adults
• Dose not simply scaled by weight
• Organ maturity matters
• Best practice: dose by body surface area
• Some drugs require specialised paediatric dosing guidelines

Geriatric: clinical considerations⁸

• Multiple comorbidities & polypharmacy
• Risk of drug interactions & adverse effects
• Falls & fractures linked to some drugs
• Non-adherence common
  • Cognitive decline
  • Social isolation
  • Financial/transport issues

Special populations: key takeaways⁹

• Pregnancy: absorption & distribution altered, but variable
• Paediatrics: immature systems $\to$ careful dosing, $\uparrow$ risk of toxicity
• Elderly: declining organ function & polypharmacy $\to$ higher risk
• Safe care = understanding pharmacokinetics across lifespan

References¹⁰

• Ritter JM, Flower RJ, Henderson G, Loke YK, MacEwan D, Robinson E, editors. Rang & Dale’s pharmacology. 10th ed. Edinburgh: Elsevier; 2023
• Becker DE, Reed KL. Pharmacology and Therapeutics for Dentistry. 7th ed. St. Louis: Elsevier; 2017
• Bullock S, Manias E. Fundamentals of pharmacology. 8th ed. Frenchs Forest, NSW: Pearson Australia; 2017
• Stringer JL. Basic concepts in pharmacology. 6th ed. New York (US): McGraw Hill Medical; 2022 Feb 18
• American Dental Association. The ADA practical guide to patients with medical conditions. 2nd ed. Hoboken (NJ): Wiley; 2016. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1002/9781119121039
• Little JW. Complementary and alternative medicine: Impact on dentistry. J Am Dent Assoc. 2004 Aug;135(8):1134-44 doi:10.14219/jada.archive.2004.0367
• Pharmaceutical Society of Australia. Australian Pharmaceutical Formulary and Handbook: A Guide to Best Practice. 25th ed. Canberra: Pharmaceutical Society of Australia; 2021
• Kennedy D, Batagol R. Drug safety in pregnancy. Aust Prescr. 2025;48(1):5–9. DOI:10.18773/austprescr.2025.008
• Therapeutic Goods Administration. Australian categorisation system for prescribing medicines in pregnancy. TGA; updated 28 March 2025. Available from: https://www.tga.gov.au/products/medicines/find-information-about-medicine/prescribing-medicines-pregnancy-database/australian-categorisation-system-prescribing-medicines-pregnancy

Footnotes

1. Original PDF page 1: L19 CAM & Special populations2025, p.1 ↩

2. Original PDF page 2: L19 CAM & Special populations2025, p.2 ↩

3. Original PDF page 12: L19 CAM & Special populations2025, p.12 ↩

4. Original PDF page 24: L19 CAM & Special populations2025, p.24 ↩

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9. Original PDF page 29: L19 CAM & Special populations2025, p.29 ↩

10. Original PDF page 30: L19 CAM & Special populations2025, p.30 ↩