Paediatric prescribing Flashcards
What is pharmacokinetics?
What the body does to the drug
What’s pharmacodynamics?
What the drug does to the body
Principles of pharmacokinetics and expand on them
ADME
A - absorption -> process of a substance entering blood circulation
D - distribution -> dissemination of the substances throughout the fluids and tissues of the body *water or fat/lipid compartment
M - metabolism -> transformation of the parent into daughter compounds
E - elimination / excretion -> the removal of the substances from the body
What can affect drug absorption in children?
Drug absorption in children can be affected by developmental changes in:
- gut pH
- gastric emptying
- intestinal drug-metabolizing enzymes
- intestinal microflora
What is the rate absorption in very young children?
Slower
Gastric pH in neonates - how is it?
In neonates and young children there is very little production of gastric pH -> therefore pH is slightly alkaline (less acidic)
Phenytoin in neonates - where is it absorbed
Phenytoin is not absorbed well in more alkaline environment -> absorption from GI tract is less effective (due to higher gastric pH)
* loading dose needed IV (in neonates) before dosing by mouth
Water compartment in infants - how is it compared to grown-ups
There is more water in infants - 80% of body weight -> then it decreases over the years
Other changes than water (affecting distribution)
Changes to:
- BBB permeability
- circulating plasma protein
What do we need to consider administrating aminophylline (in an obese person)
Aminophylline
- it is almost completely distributed in the water compartment
obese person - has more kgs, but the same amount of water (as thin) but larger lipid compartment*
- e.g. if someone is obese and we base a dose of aminophylline on actual body weight - > we may overdose of aminophylline -> arrhythmias
- therefore Aminophylline should be administrated om ideal body weight
What’s first phase metabolism
Phase I metabolism
- making a drug more active/ modifying it by: oxidation, reduction, hydrolysis or hydration
* cytochrome P450 enzymes catalyse it
What’s phase II metabolism
Phase II metabolism
- conjugation to form polar compounds (water-soluble -> can be excreted)
How are most drugs excreted?
What do we need to consider in e.g. preterm neonate?
Kidney
In a preterm neonate/ kidney impairment -> GFR may be already very low -> different/reduced dosing is required
What negative effect do aminoglycosides have?
Aminoglycosides -> are eliminated by glomerular filtration BUT they are also nephrotoxic
What do we need to consider in preterm neonates in terms of dosing aminoglycosides/ gentamycin?
Longer dosing intervals are required (especially in preterm neonates as GFR is very low)
*this is to avoid accumulation