Pediatric Pharmacology Flashcards
What aspects regarding drug disposition are impacted by immaturity?
- absorption
- distribution
- metabolism
- elimination
Factors affecting drug absorption
- gastric pH- delayed acid prodution in preterms
- GI motility- slower motility
- rectal anatomy- small size; increases 1st pass clearance
Thin skin does what to absorption?
promotes increased absorption
Intramuscular or subcutaneous absorption is decreased when?
perfusion is decreased
Factors affecting drug distribution
- body composition- more water, less fat
- protein binding- less protein in sicker infants makes drugs more bioavailable
- lower plasma pH
- bilirubin
- disease states
Factors affecting drug metabolism
reduced hepatic enzyme function
Factors affecting drug elimination
- decreased GI motliity
2. renal immaturity
If you are concerned about possible sepsis, what drug combo do you choose?
ampicillin (gram +) and gentamicin (gram -)
Adverse effects of gent?
nephrotoxicity and ototoxicity
Importance of monitoring gent levels
“peak kills the bug, trough kills the kidney” so monitor trough level carefully
After ampicillin and gent, nosocomial infection suspected, what antibiotic do you use?
- Add Vancomycin (gram +) because MRSA and staph epidermidis coverage
- Add cefotaxime (gram -)
Why monitor vanc levels?
- high trough is important for clinical effect
For fungal infections such as candida consider what antibiotics?
- Amp B
- Fluconazole
- Echinocandins
26 week infant in resp distress requring intubation and mechanical ventilation like needs?
Surfactant (curosurf, infasurf, survanta)
What are potential side effects of endotracheal surfactant administration?
bradycardia and oxygen desaturation