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Clinical PK Exam 3 > Pediatric Developmental Pharmacology & Clinical PK > Flashcards

Pediatric Developmental Pharmacology & Clinical PK Flashcards

1
Q

Is percutaneous skin thick or thin in pre-term neonate

A

thinner

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2
Q

In percutaneous skin is perfusion greater or less in neonates

A

greater

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3
Q

in percutaneous skin is hydration greater or less in neonates

A

greater

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4
Q

In percutaneous skin is BSA greater or less in neonates?

A

greater

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5
Q

What are some potential implications of topically applied medications in neonates

A

increased absorption that leads to increase toxicity

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6
Q

How is water loss controlled or prevented?

A
  1. using a product that holds moisture in
  2. incubator (humidity control)
  3. IV fluids
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7
Q

T/F rectal absorption is not realiable

A

False, it is reliable because neonates cannot take a pill

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8
Q

what are the benefits of rectal absorption?

A

Increased bioavailability in neonates

  • limited first pass metabolism
  • decreased hepatic metabolism
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9
Q

What type of suppositories are best to give neonates?

A

quick melting suppositories

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10
Q

Why is IM absorption unpredictable?

A
  1. decreased muscle mass
  2. decreased muscle activity
  3. decreased blood flow
  4. increased capillary density
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11
Q

Why is it not good to give neonates rectal suppositories?

A

neonates have a pulsating rectum

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12
Q

What medications may be given IM to neonates

A
  1. Immunizations*
  2. aminoglycosides
  3. beta lactams
  4. palivizumab
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13
Q

what is the significance of intrapulmonary in neonates?

A
  1. lung architecture changes over time

2. majority as localized treatments

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14
Q

When are lungs fully developed in a pediatric patient?

A

7-8 years of age

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15
Q

Do medications administered via nebulizer or inhaler have systemic absorption?

A

yes

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16
Q

what are neonates pH at birth?

A

neutral (~7)

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17
Q

within 24-48h of birth what are neonates pH?

A

~1-3

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18
Q

during neonates first week of life what is there pH?

A

neutral

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19
Q

What are neonates gastrointestinal affected by?

A
  1. gastric pH
  2. biliary function
  3. motility
  4. gastric emptying
  5. surface area
  6. blood flow
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20
Q

What is gastric pH determined by?

A
  1. Solubility of medications
  2. Ionization of medications
  3. Stability of medications
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21
Q

Which gastric pH is more important in neonates

A

Stability

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22
Q

Is Vitamin D2 absorbed better in term neonates or preterm neonates

A

term

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23
Q

Why is there lower bile salts in GI biliary tract

A
  1. Decreased lipophilic medication absorption

2. Decreased lipid vehicle based medication absorption

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24
Q

When do villi mature

A

around 20 weeks gestation

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25
Q

if a patient is born at 23 weeks will they have more or less villi

A

less villi

26
Q

when does gastric emptying increase in neonates

A

first week of life

27
Q

when do neonates motility reach adult fucntion

A

around 6 months of life

28
Q

Is there an increase or decrease in contractility in neonates

A

decrease

29
Q

Is there a decrease or increase spread of medication to absorption sites in neonates

A

decrease

30
Q

does blood flood increase or decrease with age ?

A

increase

31
Q

does blood flow increase or decrease with feeding

A

increase

32
Q

does the concentration gradient change with blood flow

A

yes

33
Q

what percent of total body weight is water in preterm neonates

A

85%

34
Q

what percent of total body weight is fat in preterm neonates

A

1%

35
Q

What percent of total body weight is water in term neonates

A

75%

36
Q

What percent of total body weight is fat in term neonates

A

15%

37
Q

What percent of extracellular water is in neonates

A

40& of total body weight

38
Q

what percent of extracellular water is in adults

A

20% of total body weight

39
Q

Are hydrophilic medications higher or lower in neonates

A

higher

40
Q

Are lipophilic meds typically lower or higher in neonates

A

lower

41
Q

compare a neonate to an adult

A
  1. decreased plasma proteins
  2. lower binding capacity
  3. decreased affinity for medications
42
Q

What are the implications of a neonate compared to an adult

A
  1. greater drug effect
  2. increased clearance
  3. greater toxicity risk
43
Q

what are some examples of phase 1 enzymatic processes

A
  1. oxidation
  2. hydrolysis
  3. hydroxylation
  4. reduction
44
Q

What percentage is CYP3A responsible for medication metabolism?

A

~50%

45
Q

which CYP enzyme is the primary member until 6 months of age

A

3A7

46
Q

when does CYP3A reach adult function

A

around 1 year of life

47
Q

what are the substrates of CYP2C?

A
  1. 2C9

2. 2C19

48
Q

How much is CYP2C responsible of medication metabolism

A

~20%

49
Q

when does 2C9 reach adult function

A

5 months of age

50
Q

when does 2C19 reach adult level

A

10 years of age

51
Q

what does phase 2 of the enzymatic process consist of

A
  1. conjugation
  2. glucuronidation
    - matures by 3 years of age
    - exceeds adult function during childhood
  3. sulfation
    - matures at birth
  4. alcohol dehydrogenase
    - matures at 5 years of age
  5. methylation
    - infants, not adults
52
Q

what does theophylline make in neonates

A

caffine

53
Q

what are the 3 metabolism outcomes

A
  1. activating medication
  2. inactive medication
  3. form active metabolites
54
Q

what is elimination affected by

A
  1. glomerular filtration
  2. tubular secretion
  3. tubular reabsorption
55
Q

At what age does tubular secretion reach adult function

A

12 months of life

56
Q

when does glomerular filtration increase

A

first 2 weeks of life

57
Q

when does glomerular filtration reach adult function

A

8-12 months of life

58
Q

how long is neonates serum creatinine equivalent to mothers

A

~ 1 week

59
Q

what does k stand for in the GFR equation

A

age constant

60
Q

what does L stand for in the GFR equation

A

length in cm

61
Q

what does PCr = to? in the GFR equation

A

SCr

62
Q

Does serum therapeutic concentrations of aminoglycosides and vancomycin, are they different from pediatrics, neonate, and adult, do they vary based on age?

A

No, they are the same

Clinical PK Exam 3 (5 decks)

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