Pharmacology in Special Populations - Pediatric Patients Flashcards
What are some pharmacokinetic concepts you have to remember when treating pediatric patients?
- absorption
- distribution
- metabolism
- elimination
In pediatric patients, the stomach pH is (1) than adult pH until around 2 years of age
- higher
Since pediatric patients have a higher stomach pH, does this make the acid in their stomach more basic or more acidic?
more basic
Since pediatric patients (before age 2) have a higher stomach pH, how can this affect drugs?
- drugs normally destroyed by stomach acid are left intact
- weak acids are more ionized leading to lower bioavailability
- weak bases have improved bioavailability
In pediatric patients, (1) is slower in the first few days of life?
gastric emptying
Because gastric emptying is slower in the first few days of life for pediatric patients, drugs absorbed in the stomach may produce (1), and drugs absorbed in the small intestine may show (2)
- higher plasma concentration
- delayed response
Compared to adults, intestinal transit time is (1) in neonates but (2) in older infants
- slow
- faster
Neonates produce (1), impairing the absorption of some (2)
- less bile
- lipophilic drugs
In pediatric patients, intestinal surface area is (1)
- decreased
Skin absorption is (1) through infant stages, what does this mean?
- high
babies are mostly made of water, so they absorb stuff through skin very quick-can lead to toxicity
In pediatric patients, what is highly variable due to inconsistent perfusion of skeletal muscle and decreased muscle mass?
IM absorption
What type of infants have especially unpredictable IM absorption?
sick, premature infants
What type of drugs initially get taken up with the bile system?
lipophilic drugs
(1) is high in neonates and decreases with age?
total body water
Preterm neonates may be up to (1)% water?
85%
Extracellular water is (1)% in neonates vs. (2)% in adults
- 40%
- 20%
Because total body water is so high in neonates, volume of distribution can be (1) for water-soluble drugs
higher
(1) is less than 15% in newborns and increases with age?
body fat
Because body fat is lower in newborns, volume of distribution can be (1) for lipophilic drugs
lower (smaller)
Because the neonatal blood brain barrier is not fully mature, what can this lead to?
this can lead to drugs more readily passing through the BBB in neonates than they would in adults
(can lead to brain damage)
Protein binding in pediatric patients tends to be (1) and (2)
- reduced (and)
- structurally different
Highly protein bound (1) drugs in pediatric patients compete for binding sites occupied by (2) resulting in (3) or (4)
- acidic
- bilirubin
- jaundice
- kernicterus (brain damage)
In pediatric patients, what develops at different stages and affects drug metabolism? (intestinal first-pass is impaired as well)
cytochrome system
In pediatric patients, phase II reactions are (1)
immature
In pediatric patients, (1) activity reaches adult levels by age 3-4
glucuronidation
In pediatric patients, (1) for some drugs (2) adult levels during toddler years?
- drug metabolism
- increases above
GFR is (1) in neonates than in adults and preterm babies have even (2) GFR
- lower
- lower
Toddler GFR is (1) than adults, so they may require (2) (mechanism is not fully understood)
- higher
- higher dosing
(1) and (2) is immature in pediatric patients. Why?
- tubular secretion (and)
- reabsorption
kidneys are immature and not fully functional
When treating pediatric patients, you have to make sure you are considering that children are not (1)
small adults
Pediatric patients are physiologically (1), because (2) is not complete
- unstable
- organ development
Pediatric medications are often prescribed using (1) and/or (2)
- body weight
- BSA (body surface area)
What may be toxic to pediatric patients that are in medications?
excipients (extra ingredients in drug besides active ingredient-alcohol could be an excipient)
