Paediatric pharmacology

Question 1

• 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

Answer 1

.

Question 2

What guidelines are used to prescribe in children

Answer 2

BNFc

Question 3

How medication *pharmacodynamics + pharmacokinetics changes with each phase of childhood

• early post-natal
• infant
• toddler
• young child
• adolescence

*body’s response to the drug, not ADME

see slide 49

Answer 3

Post-natal

• lower tolerance of ADRs
• higher TBW and lower fat content so different drug distribution affected so need larger dose
• reduced plasma protein binding so greater free unbound (active) drug
• BBB not fully developed so risk of CNS toxicity
• immature liver metabolism so those eliminated by liver have longer half life

Infancy
-metabolism increases (drug metabolising enzymes in liver, e.g. CYP1A2, increase)

Young child
-enhanced metabolism + excretion

Adolescence
-sexual development increases liver drug metabolism (so need greater doses of some drugs)

Question 4

Problems associated with paediatric prescribing

Answer 4

.