Lecture 18: Paediatric/Geriatric Pharmacology

Question 1

Sulfate conjugation is well developed in children (2-12 yrs.). (pediatric pharmacokinetics: metabolism)

Answer 1

Acetaminophen

Question 2

_________/______ uses this pathway more than glucuronidation in children (bc sometimes glucuronyl transferase is not well developed in children)

Answer 2

Acetaminophen/paracetamol

Question 3

Since the total body water is high in neonates (newborn up to 30 days), the Vd is increased (pharmacokinetics: distribution is different in neonates), so water soluble drugs like __________ needs dosage adjustment.

Answer 3

Aminoglycosides (Gentamicin)

Question 4

In newborns, renal function is reduced (GFR is 20% of an adults and tubular secretion is lower), so many drugs have a longer half life in neonates

Answer 4

Aminoglycosides (Gentamicin)

Question 5

Gentamicin half life is:

Answer 5

18 hours in premature
6-10 hours in full term
2 hours in adults

Question 6

In the elderly, excretion of drugs is decreased bc there is a decrease in kidney size, renal blood flow, number of functional neurons, reduced GFR and tubular secretion.

Answer 6

Aminoglycosides (Gentamicin), Digoxin

Question 7

Renal blood flow reduction causes age related reduction in rate of elimination of drugs and drug accumulation in the elderly.

Answer 7

Aminoglycosides (Gentamicin), Digoxin

Question 8

There is a decrease in the clearance of drugs/metabolites so increased half life of __________.

Answer 8

Aminoglycosides (Gentamicin), Digoxin

Question 9

The plasma protein serum albumin is lower in the elderly, so weak acidic drug binding is lower (plasma free concentration increases)

Answer 9

Anticoagulants:
Ex: Warfarin

Question 10

Loading doses of highly bound acidic drugs should be reduced

Answer 10

Anticoagulants:
Ex: Warfarin

Question 11

Sensitivity of beta receptor response mechanism declines with age, leads to reduced affinity to ________ & ________.

Answer 11

β1-agonists, β-blockers

Question 12

Homeostatic responses are diminished in the elderly= impaired cardiovascular reflexes.

Answer 12

β1-agonists, β-blockers

Question 13

Orthostatic hypertension is more frequent in the elderly taking beta blockers (antihypertensives).

Answer 13

β1-agonists, β-blockers

Question 14

Slow clearance and prolonged half life of this drug in children leads to adverse effects like kernicterus.

Answer 14

Diazepam

Question 15

Kernicterus may develop due to lack of glucuronidation reaction (phase II) bc glucuronyl transferase enzyme is deficient in newborns.

Answer 15

Diazepam

Question 16

In the elderly, there is a decrease in lean body mass, total body water (by 10-15%) and an increase of body fat (by 15-30%). Therefore Vd of lipid soluble drugs (like diazepam) increases.

Answer 16

Diazepam

Question 17

Has an increased half life in the elderly.

Answer 17

Diazepam