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Biopharmaceutics 2 > Pediatric & Geriatric Pharmaceutics > Flashcards

Pediatric & Geriatric Pharmaceutics Flashcards

1
Q

Define Paediatric Pharmaceutics.

A

Branch of pharmaceutical science specific to the use if medication in children, including dosage forms, pharmacokinetics/pharmacodynamics and special medicinal needs appropriate to young patients/consumers

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2
Q

In 1999, the FDA established regulations regarding labelling o new products for the safety of children. What else did the new regulations allow the FDA to do?

A

Require pediatric testing of-already marketed drugs when the drug is frequently prescribed to children.

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3
Q

List the five subgroups of pediatric population based on age.

A 
Intrauterine- conception to birth
Neonate- birth to 1 month
Infant- 1 month to 2 years
Child- 2 years to onset of puberty
Adolescent- onset of puberty to adult
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4
Q

How are the most accurate doses decided for paediatrics?

A

Utilizing age and weigh

*surface area has no practical advantage

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5
Q

Does gastric acid output increase or decrease with age?

A

Lowest gastric acid output is observed in neonate of 10-30 days. Values approach adult levels by three months.

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6
Q

What other physiological features affect absorption in Neonates?

A

Gastric emptying time and intestinal transit time are erratic in Neonates. Pancreatic enzyme activity is low (lipid soluble drugs poorly absorbed).

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7
Q

When does the colonization and metabolic activity of GI flora approach adult values and what drug has an increased bioavailability due to this?

A

2-4 yrs

Digoxin

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8
Q

What reactions in metabolism are delayed in Neonates but are adult level by 4-6 months?

A

Phase 1 reactions

Oxidation, n-demethylation

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9
Q

When do conjugation pathways approach adult values?

A

3-4 yrs, can see prolonged half lives

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10
Q

What does renal excretion of drug depend on?

A

Glomerular filtration, tubular secretion and tubular absorption

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11
Q

When does tubular secretion approach adult values?

A

Between 2 -6 months, greatest variability of drug disposition

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12
Q

How do adverse reactions differ in the pediatric population?

A

In type and incidence, due to immature metabolic pathways

Ex) theophylline, antibiotics, antihistamines

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13
Q

What excipients/additives can be an issue in pediatric patients?

A

Dyes and sweeteners; hypersensitivity

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14
Q

Give example of dyes that are known for hypersensitivity reactions.

A

FD&C Yellow #5 and #6

Tartrazine-induced bronchoconstriction (ASA-cross sensitivity)

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15
Q

What is the most popular sweetener?

A

Sucrose
Chewable may contain up to 20-60%
Liquids may contain up to 85%

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16
Q

This preparation can represent a substantial carbohydrate load to children with diabetes.

A

Oral liquid

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17
Q

Why is lactose not recommended as a sweetener pediatric populations?

A

High incidence of lactose intolerance.

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18
Q

This ingredient is second only to water in its use in liquid preparations, acting a preservative and flavoring agent.

A

Ethanol

May also enhance the oral absorption of some active ingredients

19
Q

What is the largest level of ethanol in the blood suggested for children in single dose?

A

25mg/dL because they have a limited ability to metabolize and detoxify ethanol

20
Q

What is the preferred route of administration for children?

A

Oral administration

21
Q

Younger than what age have difficulty or are unable to swallow solid oral dosage forms?

A

5 years old

22
Q

What are the downsides to liquid dosages?

A

Unstable and have short half lives.

Difficulty in accurate measurement and administration

23
Q

What is an alternative formulation that is widely accepted by children under three and their parents?

A

Chewable tablets and sprinkle capsules

24
Q

Consider the benefits and the risks of rectal administration in paediatrics.

A

Wide variability in the rate and extent of absorption in children
Inflexibility of fixed dose.
Not promoted for paediatrics

25
Q

Consider the benefits and the risks of transdermal administration in paediatrics.

A

Stratum corneum is fully developed at birth ad similar permeability to adults.
Preterm Neonates have underdeveloped epidermal barrier and are at risk for excessive absorption.

26
Q

Consider the benefits and the risks of parenteral administration in paediatrics.

A

IM injection absorption is erratic in Neonates (small muscle mass, inadequate perfussion)
Amount of volume directly related with discomfort (too small=isotonic, too large= multiple injection)

27
Q

Consider the benefits and the risks of pulmonary administration in paediatrics.

A

Effective in pediatrics for local but systemic needs to be studied more.

28
Q

What are important factors in the elopement of dosage forms for pediatrics?

A

Smell, taste, texture, and aftertaste

Cherry, orange, strawberry and bubblegum are most common

29
Q

What is the critical void in pediatric drug therapies that remains?

A

Effective drug delivery systems

30
Q

Define Geriatric Pharmaceutics.

A

Branch of pharmaceutical science specific to the use of medications in the elderly, including dosage forms, pharmacokinetics/pharmacodynamics and special medicinal needs appropriate to aging patients/consumers

31
Q

Old age is defined as “advanced years of life when strength and vigor decline”. What are the official are classifications?

A

Young-old group: 65-74 yrs
Middle-old group: 75-84 yrs
Old-old group: over 85 yrs

32
Q

What is the issue with enteric-coated formulations in elderly patients?

A

There is a decrease in gastric secretion, raising the pH, resulting in premature dissolution.
Elevated pH can also lead to incomplete absorption of weakly acidic compounds

33
Q

What attribute to increase half-life of drugs through the liver in elderly patients?

A

Decreased hepatic blood flo, liver size and Phase 1 metabolism.
Increased incidence of liver dysfunction

34
Q

What else will increase the half life due to slowed elimination?

A

Renal function deterioration

35
Q

What are three physical limitations unique to the geriatric population that can interfere with effective drug delivery?

A

Dexterity (arthritis, tremors, natural frailty and weakness)
Vision (impaired, may hinder ability to self-administer medications)
Swallowing & Chewing (dry-mouth, loss of teeth, esophageal lesions, decreased bulk and tone of oral musculature)

36
Q

What is the preferred formulation for elderly?

A

Solid dosage forms, particularly tablets

37
Q

Consider the benefits and the risks of oral dosage forms for administration in geriatrics.

A

Chewable: not recommended, decrease chewing ability
Capsules: not recommended, mucosal adherence
SL and Buccal: reduced bioavailability due to dry mouth
Liqiuds: beneficial if difficulty swallowing solids, but accurate measurement needed.

38
Q

Consider the benefits and the risks of transdermal dosage forms in geriatrics.

A

Elderly have decreased transdermal absorption because skin is different.

39
Q

Consider the benefits and the risks of parenteral dosage forms in geriatrics.

A

Effective, but not well received due to invasiveness and administration

40
Q

What are the six alternative delivery systems for geriatrics?

A

Granules: not effected by changes in gastric emptying rate
Coated tablets: less likely to adhere to esophageal mucosa, “caplets”
Effervescent tablets
Soluble tablets: placed in mouth and fast dissolving or placed in water
Gel preparations
Concentrated oral solutions: volume less than 5mL, can b mixed with food or drink. (Taste and poor solubility issues)

41
Q

Why is patient compliance a major concern in the elderly?

A

Multiple medications, various physical impairments

42
Q

How can we increase geriatrics adherence?

A

Taste preference

Package and label design (unable to open or cannot read, keep in mind elderly dexterity and visual decline)

43
Q

What is included in a elderly friendly packaging?

A

Unit dose packages, avoiding tamper-proof containers
Use matte surfaces to minimize glare
Print instructions in light colours on dark backgrounds
Use distinct spacing between letters and increase thickness

44
Q

What are one compliance aids that can be used in the elderly?

A 
Calendar packs (when, what and why)
Drug-reminder cards

Biopharmaceutics 2 (7 decks)

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