Paediatric And Older Adults Flashcards
What is the physiological change seen in paediatric population concerning: Protein binding
Less proteins available for drug binding (not fully developed liver to carry out the large synthetic scale of protein, also they have reduced muscle mass=less proteins).
What does it mean to have unconjugated bilirubin. How is unconjugated bilirubin transported.
It it metabolised haemoglobin that releases bilirubin which is in unconjugated form. It is lipid soluble and binds to albumin (as well as high density lipoproteins).
What is the clinical implication that can arise due to high levels of bilirubin in circulation.
Kernicterus due to unconjugated bilirubin in the brain, particularly the basal ganglia.
What is the protein binding % ceftriaxone.
95% protein bound.
What is sulphonamides mainly bound to.
Albumin
True or false: The therapeutic window for phenytoin in neonates is lower than that of adults.
True (Phenytoin therapeutic window in neonates: 6-12 mg/L vs Adults 10-20mg/L). Due to lower protein binding sites thus greater free fraction.
True or false: The therapeutic window of theophylline in children is the same as in adults.
True- as the synthetic capacity of children increases they have large protein present compared to neonates.
What are the two drugs that cause kernicterus.
Sulphonamides
Ceftriaxone
Care of the Paediatric
A. Phenytoin
B. Ceftriaxone
C. Paracetamol
D. Chloramphenicol
E. Gentamicin
F. Phenobarbital
G. Theophylline
For the statements below concerning the symptoms relating to toxicity/side effect select the most appropriate corresponding option from the list above. Each option may be used once, more than once, or not at all.
Is most likely to increase unconjugated bilirubin levels leading to kernicterus.
B. Ceftriaxone displaces unconjugated bilirubin from albumin and HDL proteins increasing its deposition into the basal ganglia.
Care of the Paediatric
A. Phenytoin
B. Ceftriaxone
C. Paracetamol
D. Chloramphenicol
E. Gentamicin
F. Phenobarbital
G. Theophylline
For the statements below concerning the symptoms relating to toxicity/side effect select the most appropriate corresponding option from the list above. Each option may be used once, more than once, or not at all.
Is most likely to require lower therapeutic window in neonates:
A. Phenytoin because there is less binding proteins thus greater free fraction of drug.
Define total body water (TBW) and how it presents in neonates.
Extracellular and intracellular fluid compartments. In neonates there is larger ECV than pre-school children (70% neonates vs 61% pre-school).
Why would drugs like diazepam and ceftriaxone have pronounced effect in neonates.
BBB is neonates are more permeable to lipid soluble drugs.
The pKa of theophylline is 8.6: where is the drug likely to distribute in neonates based on their physiology.
Theophylline will distribute in TBW.
pKa of Gentamicin is 12.55: where is this drug likely to distribute in neonates based on their physiology.
Distribute preferentially in ECV due to it being ionised. Thus less will be found in plasma and circulation.
When inserting IV line into paediatric population what are the potential risk that can occur and why.
Due to their smaller veins there is greater risk of air emboli, infection, inflammation and phlebitis.
Which statement is NOT true in paediatric population.
a. Dense capillary network causing increased drug release
b. Less synthetic capacity for protein production.
c. Increased skin hydration
d. Less muscle mass causing unpredictable absorption.
(a) Paed population have poorly perfused muscle thus it can form a sustained drug release profile.
In terms of intramuscular absorption what are the physiological changes seen in the neonates and pre-school children.
Less muscle mass: therefore unpredictable absorption and very painful
Muscle is poorly perfused: Drug is released very slowly into the systemic circulation (Can do sustained release format).
In terms of Oral PK what are the gastric changes that occur in the paeds population.
Delayed gastric emptying and transit time.
Reduced gastric acid secretion: high pH (at birth pH=7).
Care of the Paediatric
A. Phenytoin
B. Ceftriaxone
C. Paracetamol
D. Chloramphenicol
E. Gentamicin
F. Phenobarbital
G. Theophylline
For the statements below concerning the symptoms relating to toxicity/side effect select the most appropriate corresponding option from the list above. Each option may be used once, more than once, or not at all.
It is most likely to require dose/kg dosing due to large Vd:
G. Theophylline has a large Vd because it preferentially distributes in the TBW than plasma and tissue thus higher dose is required. (+E. Gentamicin has large Vd due to distribution in ECV thus larger dose is required).
Care of the Paediatric
A. Phenytoin
B. Ceftriaxone
C. Paracetamol
D. Chloramphenicol
E. Phytomenadione
F. Phenobarbital
G. Theophylline
For the statements below concerning the symptoms relating to toxicity/side effect select the most appropriate corresponding option from the list above. Each option may be used once, more than once, or not at all.
Can be administered as a sustained drug release format in neonates:
E. Phytomenadione because neonates have poorly perfused muscle thus sustained released format can be utilised.
