226. Drug Toxicities Preferentially Occurring in Children Flashcards
What are the unique considerations in pharmacokinetics and pharmacodynamics for neonates, infants, and children?
They have increased risk of drug toxicity due to developmental changes in:
* Organ function
* Protein binding
* Body composition
Which organs are primarily responsible for drug metabolization and clearance in children?
Liver and kidneys
Why are neonates and infants vulnerable to drug toxicity?
Due to:
* Immaturity of hepatic enzymes
* Decreased plasma proteins
* Functionally immature kidneys
What is the role of cytochrome P450 (CYP450) enzymes in drug metabolism for children?
They are crucial for converting prodrugs like codeine into active compounds.
What can result from the genetic heterogeneity in CYP450 enzymes in children?
Vulnerability to toxicity from drugs like codeine
What is Reye syndrome associated with?
Aspirin use in children
What are the phases of Reye syndrome?
- Viral illness
- Protracted vomiting and mental status changes
What is a pathologic feature of Reye syndrome?
Microvesicular fatty accumulation in the liver and other organs
What clinical presentation is associated with Reye syndrome?
Vomiting, dehydration, headache, altered mental status, seizures
How are local anesthetics classified?
Into ester and amide local anesthetics
What characterizes amide local anesthetics?
They are hepatically metabolized and have a longer duration of action.
What is the risk associated with amide local anesthetics in neonates?
Local anesthetic toxicity due to immature hepatic enzymes and decreased α1 acid glycoprotein.
What are the signs of local anesthetic systemic toxicity (LAST) in neonates?
Seizures and/or arrhythmias
What is the treatment for local anesthetic toxicity?
20% lipid emulsion
What does Propofol Infusion Syndrome (PRIS) primarily affect?
Cardiac and skeletal muscle
