Chapter 12: Drug Therapy in Pediatric Patients Flashcards
how old are paediatric patients
all patients younger than 16 years old
how do pediatric patients respond differently to drugs
- more sensitive
- show greater individual variation
- sensitivity mainly due to organ system immaturity
- increased risk for adverse drug reations
elevated drug levels =
more intense response
delayed elimination =
prolonged response
pharmacokinetics
determine the concentration of a drug at its sites of action and thus determines the intensity of the duration of the response
increased sesnativity in infants is cuased by immature state of which 5 pharmacokinetic processes
- absorption
- protein binding of drugs
- blood brain barrier
- heptic metabolism
- renal drug excretion
oral administration in neonates and infants
- prolonged gastric emptying time
when do pediatric patients gain normal adult function of their gastric emptying
6 to 8 months
gastric acidity in Neonates and Infants
- very low 24 hours after birth
- does not reach adult value for 2 years
when do infants reach adult values for gastric acidity
2 years
low acidity
absorption of acid-labile drugs is increased
Intramuscular administration in neonates and infants
- slow
- erratic
- delayed absorption (low blood slow during first few days of life)
transdermal absorption in neonates and infants
- more rapid and complete (stratum corneum is thin, blood flow to skin is greater)
- increased risk
Protein binding in neonates and infants
- binding of drugs to albumin and other plasma proteins is limited
- amount of serum albumin is relatively low
Endogenous compounds complete with drugs for available binding sites in neonates and infants
- limited drug/protein binding in infants
- reduced dosage needed
when do infants reach adult protein binding capacity
10-12 months
blood brain barrier in neonates and infants
- not fully developed at birth
- especially sensative to drugs at the CNS (dosage should be reduced)
where are most drugs metabolized
liver
drug metabolizing capacity of infants
low
complete liver maturation occurs at what age
1 year of age
where are most drugs excreted
the kidneys
excretion in neonates and infants
- low renal blood flow, glomerular filtration and active tubular secretion
drugs eleiminated primarily by renal excretion must be given
at a reduced dosage or at longer dosing intervals
adult levels or renal function are achieved by
1 year
Pharmacokinetics: children age 1 year and older
metabolize drugs faster than adults
are children more vulnerable to unique adverse effects
yes
growth suppression is caused by
glucocorticoids
discoloration of developing teeth can be caused by
tetracyclines
kernicterus can be caused by
sulfonamides
dosing for pediatric patients when converting from adult doses is based on
body surface area
Dosage determination for a child formula
(body surface area x adult dose) / 1.73m
client should recieve information in
writing
effective education should include:
- dosage size and timing
- route and technique administration
- duration of treatment
- drug storage
- nature and time course of desired responses
- nature and time course of adverse effects
