Paediatric clinical pharmacology

Question 1

ages of a neonate

Answer 1

birth to 1m

Question 2

age of an infant

Answer 2

1m-2y

Question 3

age of a child

Answer 3

2-12y

Question 4

age of an adolescent

Answer 4

12-18y

Question 5

issues with neonates

Answer 5

Particularly at risk of drug toxicity
Immature drug handling by body (pharmacokinetics)
Changing drug effects (pharmacodynamics)

Question 6

issues with infants

Answer 6

Can’t describe effects or side effects of drugs - difficult to know if they are working!
Administration issues

Question 7

issues with children

Answer 7

Physical and intellectual development may be affected by medicines

Question 8

issues with adolescents

Answer 8

Sexual development may be affected by medicines

Compliance issues

Question 9

what is adherance

Answer 9

Medication adherence, or taking medications correctly, is generally defined as the extent to which patients take medication as prescribed by their doctors. Includes taking medication on time and understanding the directions.

Question 10

improving adherence

Answer 10

Concordance

• Careful discussion of risks and benefits
• Get child on board and taking responsibility

Acceptability
-Oral administration
-Liquids for younger children - oral syringe
-Beware sugar - dental hygiene
-Consider masking taste with food
– Beware food-drug interactions/ putting child off food
-Don’t put medicines in infant feed

Injections

• Avoid painful IM injections
• Topical anaesthesia for IV lines
• Chronic use - central lines, daily subcutaneous injections…

Question 11

issues with children and administering meds

Answer 11

Children sleep for more hours than adults
Children go to school
Parents like to give their children ‘natural’ or complementary medicines
Many medicines are not licensed for use in children

Question 12

what do you need to know about PK when thinking about meds and children

Answer 12

PK

Toxicity

Question 13

what affects PK in children

Answer 13

changes in metabolic capacity

developmental changes in distribution sites

changes in GI function

renal function

skin

Question 14

monitoring response to meds

Answer 14

Symptoms
Signs
Investigations

Question 15

explanations about why children sometimes have better prognosis than adults for some diseases

Answer 15

Pharmacodynamics
Different disease biology
Ph+ (bad type) paeds 3%, adults 18%
Different comorbidities
Children may be more able to withstand toxicity of high dose  treatment

Different treatment regimens
Children
higher doses, earlier and more intensive CNS therapy
more attention to detail including dose intensification,
scheduling of dosing

Question 16

examples of adverse drug reactions specific to children

Answer 16

Systemic corticosteroids: Growth retardation
Aspirin: Reye’s syndrome
Chloramphenicol: Grey baby syndrome
Tetracyclines: Stain teeth
Radioactive iodine: Delayed-onset cancers
Drugs altering immune system e.g. etanercept: Delayed-onset cancers

Question 17

what is reye’s syndrome

Answer 17

Reye’s syndrome- rapid onset encephalopathy: nausea, vomiting, drowsiness, change in personality, LOC- 90% cases are associated with aspirin- only prescribe aspirin in very specific cases