Neonates, Paediatrics and Adolescents Flashcards
What are the age categorisations for premature babies, newborns, infants, child and adolescent?
Premature babies- less than 36 weeks' gestation Newborn- 0 to 27 days old Infant - 28 days to 23 months child- 2 years to 11 years adolescent - 12 to 16/18 years old
Why is it important to discuss the treatment options carefully with a child and the Childs carer?
allows them to help distinguish the adverse effects of prescribed drugs from the effects of the medical disorder.
What the absorption factors to consider for oral, IM and percutaneous drug delivery
Oral
- can be affected by slower gastric emptying times and this can take 6-8 months to reach adult levels
- first pass metabolism can be increased for some drugs
- the absorptive surfaces of the gut can have developmental changes and drug absorption can be affected by pH and GI motility
IM
- absorption can be erratic due to decrease in muscle mass and variability of blood flow tp/from injection site
percutaneous
- increase absorption when younger patient due to thinner stratum corner and increased skin hydration
What the distribution factors to consider for water soluble and protein bound drugs?
Water- soluble drugs
- higher VoD= lower conc. of drug
- higher doses per kg should be given to infants and children than to adults for some of the drugs e.g. gentamicin
Protein bound drugs
- plasma proteins are reduced in neonates
- reduced plasma-protein binding causes more ‘free’ drugs
- drugs with great unbound conc. are diazepam, morphine and phenytoin
What does age of a child mean for their total body water
younger the child, the greater their total body water a % of their weight
How can caffeine be used clinically with neonates? What’s its half life for preterm infants?
caffeine can help stimulate breathing in neonates only for unto 1 month but then becomes of little clinical use due to rapid metabolism increase
its half life is 20-36 hours and used clinically for apnoea of prematurity
How long does it take for GFR and renal function to reach adult valves? What does this mean for drugs excreted by the kidney?
it takes 6 months as GFR in neonates in 30-40% of an adult so drugs will accumulate when excreted from the kidney
What is the formula for calculating dosing for children?
dose = (Childs body SA/adult body SA) x adult dose
When is body surface area used to express dosing for children?
for narrow therapeutic index drugs
e.g. chemotherapy, immunosuppression
doses change as children grow
What type of formulation is better for children?
Liquids are better tolerated than tablets
Flavoured oral medication can be helpful and SF should be used when possible
Which route is better for administration in children?
IV is better than IM and more tolerated
Rectal can be used if oral isn’t tolerated
Why is IM route discouraged for neonates and young children?
due to lack of suitable muscle and unpredictable absorption
What are the two special routes for administration for children?
Intraosseous route
- uses highly vascularised bone marrow to deliver drugs/fluids
- used in emergency
Buccal route
- non-invasive
What information do parents need to know for the medication
- what it is for
- when to take it
- how to take it
- common side effects and what ones to be aware of
What are the 3 elements of the physician-parent-child communication?
Informativeness- quantity and quality of health info provided by physicians
Interpersonal sensitivity- affective behaviours that reflect the doctors attention to child feelings/concerns
Partnership building- extent to which physician invites parent or child to express worries/thoughts/suggestions
