Paediatric prescribing Flashcards

1
Q

What is pharmacokinetics?

A

What the body does to the drug

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2
Q

What’s pharmacodynamics?

A

What the drug does to the body

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3
Q

Principles of pharmacokinetics and expand on them

A

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

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4
Q

What can affect drug absorption in children?

A

Drug absorption in children can be affected by developmental changes in:

  • gut pH
  • gastric emptying
  • intestinal drug-metabolizing enzymes
  • intestinal microflora
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5
Q

What is the rate absorption in very young children?

A

Slower

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6
Q

Gastric pH in neonates - how is it?

A

In neonates and young children there is very little production of gastric pH -> therefore pH is slightly alkaline (less acidic)

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7
Q

Phenytoin in neonates - where is it absorbed

A

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

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8
Q

Water compartment in infants - how is it compared to grown-ups

A

There is more water in infants - 80% of body weight -> then it decreases over the years

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9
Q

Other changes than water (affecting distribution)

A

Changes to:

  • BBB permeability
  • circulating plasma protein
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10
Q

What do we need to consider administrating aminophylline (in an obese person)

A

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
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11
Q

What’s first phase metabolism

A

Phase I metabolism

  • making a drug more active/ modifying it by: oxidation, reduction, hydrolysis or hydration

* cytochrome P450 enzymes catalyse it

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12
Q

What’s phase II metabolism

A

Phase II metabolism

  • conjugation to form polar compounds (water-soluble -> can be excreted)
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13
Q

How are most drugs excreted?

What do we need to consider in e.g. preterm neonate?

A

Kidney

In a preterm neonate/ kidney impairment -> GFR may be already very low -> different/reduced dosing is required

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14
Q

What negative effect do aminoglycosides have?

A

Aminoglycosides -> are eliminated by glomerular filtration BUT they are also nephrotoxic

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15
Q

What do we need to consider in preterm neonates in terms of dosing aminoglycosides/ gentamycin?

A

Longer dosing intervals are required (especially in preterm neonates as GFR is very low)

*this is to avoid accumulation

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16
Q

What is the danger of opioids?

A

May cause respiratory depression

17
Q

Management of opioid overdose

A
  • ABCD (airway management may be needed if GCS is low)
  • Naloxone (a competitive antagonist of opioid)
18
Q

What are the analgesic effects of codeine due to?

A

It is due to codeine being metabolized into morphine

19
Q

What may be the problem with codeine administration

A

Codeine is broken down by CYP2D6 - different alleles = different activity of these enzymes (therefore codeine may have very different effects on people e.g. maybe ultra-rapid metabolized -> OD of morphine and respiratory depression possible)

20
Q

Do we use codeine in children under 12 years?

A

No, as they may have high (ultra-rapid metabolism) activity of enzymes metabolizing codeine -> may lead to death from respiratory depression (as metabolized to morphine and possible morphine OD in ultra-rapid metabolizers)

21
Q

What’s a ‘yellow card’ scheme?

A

Yellow card scheme

It is a way to report adverse reaction of the drug to MHRA*

*Medicines and Healthcare Products Regulatory Agency -> they license the drugs for use in the UK