Paediatric Pharmacology Flashcards
Children demonstrate significant differences in their response to medicines when compared with adults and more importantly when compared with each other and
- This means both the therapeutic and adverse effects.
- Side effects may be bizarre or the child may have difficulty in describing them
These differences are due mainly to what?
altered pharmacokinetics and altered pharmacodynamics.
The safe and effective use of medicines in children is complicated by what?
a lack of acute dosage data
a lack of appropriate formulations allowing accurate dosage and delivery
difficulty in detecting ADRs
how may babies be exposed to drugs through the mother?
- In the immediate postnatal period problems may arise through in utero exposure and transplacental transfer of drugs to the infant
- Breast fed infants can be affected by their mothers medication
Key Prescribing Points:
- When prescribing drugs for children use the most ______ dosage regimen
- Pay attention to formulation, _____, and duration of therapy
- Involve _______ in your prescribing choice
- Always check with the ____
simple
route
parents
BNFc
what causes the drug problems in a child?
Pharmacokinetic differences between adults and children
Altered pharmacodynamic responses
Effects on growth and development not known
Different specific pathologies
- 70% of medicines have never been studied in children
- Many medicines used to treat children are used off-label or unlicensed both of which are associated with a 3.5 fold increased risk of childhood morbidity and mortality
what is Off Label and Unlicensed?
- Off label medicines are licensed for human use but not for use in children below a certain age such as 16 or 18 years or via a certain route or for a certain disease
- Unlicensed medicines have no licence for human use in this country - This includes licensed medicines which are reformulated for easy use in children
what are the reasons for Off-label Prescribing?
- Formulation administered via a route not intended
- Medicines used for an indication not intended
- Medicines used at a different dose to that recommended
- Children below stated recommended age limit
- Medicines without a licence
•So when you prescribe or use a medicine in a child there is often little or no robust data available describing what?
efficacy, toxicity or adverse drug reactions.
Of label medicines use gives rise to an _________ rate of ADRs and avoidable deaths
increased
- Neonates/infants are more sensitive to drugs than adults - due mainly to organ system ________
- Neonates/infants are at ________ risk for adverse drug reactions
- Young patients show greater individual ________
immaturity
increased
variation
what is shown here?
Infant more likely to have toxicity as the half life of the drug is being prolonged as in infant there is reduced clearance of the drug
The early post natal period (0-27 days) - what needs to be though about when prescribing in this age gorup?
Phase of physiological immaturity with
- rapid growth
- highly variable alterations in drug metabolism and elimination
- lower tolerance to ADRs,
- difficulty in identifying efficacy and toxicity
Higher incidence of therapeutic errors
Almost all medicines (98%) used during this phase are prescribed and used off label
Infancy (1-23 Months) - what needs to be though about when prescribing in this age gorup?
- This is an extension of the first stage, but the type and severity of disorders being treated are different
- Body weight gain and body water composition change rapidly as does the ratio of bodyweight or surface area to organ size and function.
Toddler - what needs to be though about when prescribing in this age gorup?
This stage is associated with minor illnesses, leading to multiple short courses of therapy.
Problems with compliance
The young child (2-11 years) - what needs to be though about when prescribing in this age gorup?
Enhanced metabolism and excretion
Clearance can change significantly during a single dose regimen
About 30% of prescribed medicines are off label
