paediatric pharmacology

Question 1

safe + effective use of medicines in children is complicated by

Answer 1

lack of acute dosage data
lack of approp formulations allowing accurate dosage and delivery
difficulty detecting ADRs

Question 2

key prescribing points

Answer 2

• use most simple dosage regime
• pay attention to formulation, route and duration of therapy
• involve parents in prescribing choice
• check with BNFc

Question 3

why cant extrapolate doses for kids based on adult dose data

Answer 3

• pharmacokinetic differences between adult and children
• altered pharmacodynamic response
• effects on growth and development not known
• different specific pathologies

Question 4

off-label medicines

Answer 4

licensed for human use but not for use in children under certain age (16 or 18) or not via a certain route or not for a certain disease treatment

Question 5

unlicensed medicines

Answer 5

no licence for human use in UK

-includes licensed medicines which are reformulated for easy use in children

Question 6

what are the reasons for off-label prescribing

Answer 6

• formulation administered via route not intended
• medicines used for an indication not intended
• medicine used at different dose than recommended
• kid under recommended age
• medicines without licence: incl those made esp for child/used in clinical trials

Question 7

why are neonates/infants more sensitive to drugs than adults

Answer 7

mainly due to organ system immaturity

Question 8

what are neonates/infants more at risk of

Answer 8

adverse drug reactions

Question 9

what do younger patients show

Answer 9

greater individual variation

Question 10

neonate age

Answer 10

0-27 days

Question 11

infant age

Answer 11

28days - 23mo

Question 12

child age

Answer 12

2yrs - 11yrs

Question 13

adolescent age

Answer 13

12yrs - 16/18yrs

Question 14

neonate: phase of physiological immaturity with

Answer 14

• rapid growth
• highly variable alterations in drug metabolism and elimination
• lower tolerance to ARDs
• difficulty in identifying efficacy and toxicity

Question 15

infancy pharmacology

Answer 15

body weight gain and body water composition change rapidly

as foes ratio of bod weight/surface area to organ size and function

Question 16

toddler pharmacology

Answer 16

minor illnesses leading to multiple short courses of therapy

problems with compliance

Question 17

young child pharmacology

Answer 17

enhanced metabolism and excretion

clearance can change significantly during a single dose regimen

Question 18

adolescent pharmacology

Answer 18

sexual development produces major changes which affect drug metabolism
psychological changes and peer pressures results in smoking, alcohol, elicit drug use which alter drug metabolism

Question 19

oral route of administration

Answer 19

• reduced gastric acid + delayed gastric emptying
• absorption via GIT reaches adult by 6-8mo
• bioavailability of drugs reduced + highly variable
• drugs which rely on entero-hepatic circulation highly variable e.g. cyclosporin

Question 20

percutaneous route of administration

Answer 20

enhanced in infants and children, esp w damaged skin or an occlusive dressing

steroids

Question 21

rectal route of administration

Answer 21

used in pts who are vomiting/unwilling to take oral meds

avoid 1st pass metabolism

Question 22

IV route of administration

Answer 22

delayed or uncertain delivery