Pediatric Pharmacologic Flashcards
T/f theres a sig difference in absorption
false.
Absorption: no significant difference between children and adults
how do children differ from adults in terms of distribution of durgs
Distribution: school-aged children have higher proportion of total body water & lower total body fat
o Lipophilic drugs have smaller volume of distribution
o Hydrophilic drugs have larger volume of distribution
• Metabolism
o Phase I: ____ effective in children than adults
o Phase II: ___ (difference)
• Metabolism
o Phase I: more effective in children than adults
o Phase II: about the same in children and adults
in children and adults
o Children require ___ weight adjusted doses to achieve similar plasma levels to adults due to ___ metabolism
o But, you should ALWAYS individualized dosing based on empirical evidence
o Children require higher weight adjusted doses to achieve similar plasma levels to adults due to higher metabolism
o But, you should ALWAYS individualized dosing based on empirical evidence
peds ADHD:
first line non stimulating agent? long acting stimulant?
first line: long acting –> methylphenidate, dextroamphetamines
non stimulating –> atomoxetine
MOA of ADHD stimulants
Stimulants work by blocking ___ of ___ + ___, competitively (____) or non-competitively (____) and stimulate release
Stimulants work by blocking reuptake of dopamine + noradrenaline competitively (dextroamphetamine) or non-competitively (methylphenidate) and stimulate release
key side effects of ADHD stimulant for peds
side effects: insomnia, headache, appetite suppression, unmasking tics, growth delays
§ Serious but rare: seizures, cardiac conduction problems, activation of mania
Atomoxetine works by blocking the reuptake of ____→ also blocks ____ reuptake in ____ cortex
o Outcome: same as stimulants (but takes a while)
side effects?
Atomoxetine works by blocking the reuptake of norepinephrine→ also blocks dopamine reuptake in prefrontal cortex
o Side effects: sedation, fatigue, decreased appetite
§ Serious but rare: increased HR, hypotension, activation of suicidal ideation
o No potential of abuse
phase 1 metabolism:
pyschoactive meds are almost all metabolized through liver and gut via enzymes known as cytochrome P450.
inhibitng metabolism 1= decreases the action of CYP. increases the seffect and duration of meds that use this metabolic pathway. To compensate: decrease dose and/or frequency of affected medication
induced of CYP451: increases the aciton of the enzym,e decreasing effect and duration of meds that use this metabolic pathway
first, 2nd, 3rd line depressive disorders
- 1st line: CBT
- 2nd line: fluoxetine, escitalopram, citalopram, sertraline + CBT
- 3rd line: all other SSRIs + CBT
side effects of SSRIs
Side effects: GI upset, headaches, transient increase anxiety, sexual dysfunction
o Serious but rare: seizures, induction of mania or suicidality (especially in paroxetine and venlafaxine)
EXTRA SEROTONIN CAN CAUSE BLEEDING– An increased risk of abnormal bleeding was strongly associated with the degree of serotonin reuptake inhibition. Case reports and observational studies have both shown an association between use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), and abnormal bleeding.
key TCA for pediatric OCD management
clomipramine
first line therapy for OCD. Second line
first line: sertraline, fluoxetine, fluvocamine (SSRIs)
second line: clomipramine (TCA)
side effects of TCA
Side effects of TCA: dry mouth, nausea, constipation, wt gain, sedation, blurred vision
o Serious: seizures, QTc prolongation, induction of mania, increase intraocular pressure, hepatic failure, EPS
first and second line treatment for anxiety
1st line: SSRIs (sertraline, fluoxetine, fluvoxamine) + CBT
• 2nd line: venlafaxine
Mechanism: see SSRI and SNRI sections above
