Pharma Pediatric Considerations

Question 1

Caffeine

Answer 1

• Found naturally in a wide variety of prodcuts: coffee, tea, chocolate
• Manmade: sodas, energy drinks
• Usually intake 200mg/day in the US

Question 2

Caffeine possible MOA

Answer 2

• reversible blockade of adenosine receptors (most likely)
• Enhancement of calcium permeability in the sarcoplasmic reticulum
• Inhibition of cyclic nucleotide phosphodiesterase resulting in accumulation of cyclic AMP

Question 3

Caffeine Clinical Effects

Answer 3

• CNS: nervousness, insomnia, tremors
• CV: dysrhythmia
• Blood vessels: CNS = vasoconstriction; Periphery = vasodilation
• Bronchi: relaxation of bronchial smooth muscle
• Kidney: diuretic
• Reproduction: risk for birth defects, low birth weight risk

Question 4

Caffeine Therapeutic uses

Answer 4

• Neonatal Apnea
• Promoting wakefulness
• Headaches

Question 5

Caffeine Pharmacokinetics

Answer 5

-readily absorbed from GI tract
-Peak plasma levels within 1 hour
-Half life 3-7 hours
Hepatic elimination

Question 6

Alcohol

Answer 6

• toxic alcohols: methanol, isopropyl alcohol, ethylene glycol
• drinking alcohol = ethanol (ethyl alcohol)

Question 7

Alcohol CNS effects

Answer 7

Depression of CNS function and activation of the reward system

• targets GABA receptors: enhances GABA mediated inhibition
• Targets Glutamate receptors: block glutamate-mediated excitation
• Targets serotonin receptors: activates receptors promoting release of DA = reward circuit

Question 8

Alcohol Pharmacokinetics

Answer 8

• Absorption: readily absorbed from stomach and intestines - food decreases absorption
• Distribution: nonionic and water soluble: it goes everywhere - crosses BBB with ease
  (women: lower % total body water vs men
• Metabolism: Liver and stomach

Question 9

ETOH elimination

Answer 9

• Most drugs exhibit first order kinetics: as drug levels rise, amount of drug metabolized per unit of time increases as well
• As ETOH content of blood increases, there is almost no change in the speed of breakdown - metabolized at a constant amount regardless of how much alcohol is present (around 1 drink per hour
• Liver can metabolize about 15 mL of alcohol per hour

Question 10

Marijuana

Answer 10

• prepared from Cannabis sativa
• greatest concentration of psychoactive substances found in flowering tops of females
• Highly lipid soluble - content variable in different preparations
• Activates cannabinoid receptors in brain: highest concentration rec in brain regions associated with pleasure, memory, thinking, concentration, appetite, sensory perception, time perception, coordination of movement
• causes release of DA

Question 11

3 principle effects of marijuana

Answer 11

euphoria, sedation, hallucinations

Question 12

Adverse effects of marijuana

Answer 12

may cause tachycardia, acute bronchodilation, long term use causes decrease in hippocampus and amygdala

Question 13

Pediatric Pharmacokinetics

Answer 13

IM absorption: slow and erratic in neonates but becomes more rapid in early infancy vs neonates and adults

Transdermal absorption: more rapid and complete in infants vs older children and adults

Question 14

Pharmacokinetic changes in childhood

Answer 14

• Distribution: limited protein binding; BBB not fully developed
• Metabolism: capacity of newborns is low; capacity approaches adult level by a few months of age and complete liver maturation occurs by year 1; children > 1 year metabolize fater than adults - peaks around 2 years of age
• Significantly reduced at birth; adult level of renal function achieved by 1 year