PM3C OVERLAP: Medicines in children Flashcards
What routes of administration would you avoid in children? why?
Intramuscular route as they have a small muscle mass (painful) which is poorly perfused, could cause erratic absorption from the muscle.
topical less used as they have an immature epidermis so could get significant transdermal absorption
How do children have reduced absorption?
Reduced gastric acid secretion and delayed gastric emptying time so slower passage through
What is the water and fat content in children / pre term neonates compared to adults? why is this significant?
Higher water content (50%).
Lower fat content (3%)
Significant for drugs hat distribute into water or fat
What is the albumin levels in children?
Lower albumin than adult
Why can children have more transfer of drugs into the brain?
Immature blood brain barrier
What metabolic reactions mature over the first 1-6 months, and what reactions mature at 3 years old?
Why is this significant
Phase I reactions mature over first 6 months which is hydroxylation, hydrolysis, oxidation
Phase II reactions do not mature until ~3 years old - glucuronidation, sulfation
signficance: less hepatic blood flow and higher risk of overdose in paracetamol, metronidazole so need OD dosing up to 26 weeks - metabolise slower
26-34 weeks BD
34+ weeks TDS
What is the renal system like in a neonate?
Immature function - decreased renal blood flow, GFR, tubular secretion - take longer to excrete e.g. penicillins, aminoglycosides
What are the 3 ways of dosing in children
- age considers ADME but may not reflect development or weight
- weight - good. but not extremes of bodyweight - generally based on this
- surface area
Why would you avoid benzoyl alcohol excipient parenterally?
Can cause fatal toxic syndrome in pre term neonates, liver not as perfused.
Why avoid propylene glycol?
Severe adverse effects if elimination impaired e.g. renal failure, neonates
What could you use for inhalation in children?
spacers for co-ordination
breath actuated
DPI
Why do you not use codeine in <12 (or <18 if had a tonsillectomy for sleep apnoea)
It is linked to apnoea and death
Why do neonates need special care in the 1st 28 days?
Risk of toxicity is increased by reduced drug clearance and differing target organ sensitivity
Should parents add medicines to infants feed?
Advise against - drug may interact with milk, and ingested dose may be reduced if the child dose not drink it all.
If you have a liquid - when would you use an oral syringe?
If volume <5mL
