Paediatric pharmacology Flashcards
1
Q
Learning outcome
A
- To be aware of differences in drug absorption in paediatric patients
- To understand principles of prescribing in children (including use of the BNFc)
- To know how medication pharmacodynamics changes with each phase of childhood
- To identify problems associated with paediatric prescribing
2
Q
Challenges in paediatric prescribing
A
- Lack of acute dosage data
- Lack of appropriate formulations
- Difficulty detecting ADR
- In utero exposure and transplacental transfer of drugs in post natal period
- Different pharmacodynamics and pharmacokinetics
- Breast fed infants affected by mothers medication
- Lack of patient information
3
Q
Key points in paediatric prescribing
A
- Keep it simple
- Is the therapy needed and what’s the expected effect
- Minimum length to be on medication
- Monitoring efficacy and ADRs
4
Q
Off label and unlicensed
A
- Off label → licensed for human but not for use in children below certage age
- Unlicensed → no license for human use in country
5
Q
Indications for off-label prescribing
A
- Formulation administered via route not intended → capsule to serum
- Medication used for an indication not intended
- Medication used at different dose
- Children below recommended age limit
- Medicines without a license
6
Q
Risks of off-label medications
A
- Increased risk of ADRs and avoidable death
7
Q
Prescribing in neonates and infants
A
- More sensitive to drugs than adults → organ system immaturity
- Higher risk of adverse drug reaction
- Greater individual variability
8
Q
Prescribing in early post-natal period
A
- Rapid growth
- Highly variable alterations in drug metabolism and elimination
- Lower tolerance to ADRs
- Higher incidence of therapeutic errors
- Difficulty identifying efficacy and toxicity
9
Q
Prescribing in infancy
A
- Body weight gain and rapid changes to body water composition
- Alteration to bodyweight to surface ration
10
Q
Prescribing in young adults
A
- Increased metabolism and secretion
- Around 30% of prescribed medications off label
11
Q
Prescribing in adolescence
A
- Sexual development → major changes in body size and composition
- Psychological changes and peer pressure → smoking, alcohol and illicit drugs
12
Q
SSRIs
A
- Paroxetine
- Associated with x4 increase in suicide compared to placebo when treating depression
- Drug used off label
13
Q
Oral medications in paediatrics
A
- Reduced gastric acid and delayed gastric emptying
- Reduced bioavailability in drugs with high hepatic clearance and first pass metabolism
- Variability in drugs with enter-hepatic circulation → cyclosporin
14
Q
Percutaneous medications in paediatrics
A
- Enhanced in infants and children → especially damaged skin
- Think steroids
15
Q
Rectal medications for paediatrics
A
- Those vomiting or unwilling to take oral medications
- Avoids first past metabolism
- Significant variability, few preparation and trauma
