Prescribing for Pediatric Patients Flashcards
Premature neonate
Born at or < 36 wks
Term neonate
Born at or > 36wks
Neonate
Birth - 1 month
Infant
> 1 month - 1 year
Child
> 1 - 11 years
Adolescent
12 - 16/18 years
What are the pharmacokinetic differences of absorption in pediatric patients?
There is a lot of variation in gastric pH, there is significantly less acid during the first 2-3 years of life. Meaning gastric emptying time is slower in neonates, and faster in adults.
How does the delivery of drug from site of administration to systemic circulation differ between adolesence and adults? (3)
- Pediatric patients have an underdeveloped stratum corneum (outer skin layer), increased body fat to skin ratio resulting in faster transdermal absorption compared to adults
- Reduced body fat to muscle ratio leads to less or erratic IM absorption
- Inhalation anesthetics have more rapid onset than adults
What is the body water % in the premature neonate?
85%
How does the volume of distribution vary between pediatric patients and adults?
- At 1 year of age, the TBW is close to that of the adult (55-60%)
- ECF to TBW per kg of body weight are increased compared to adults, resulting in higher volume of distribution for water soluble drugs
- Peds have smaller fat and muscle compartments
How does pediatric cardiac output compare to that of the adult?
CO is higher at birth, leading to faster circulation time and more rapid distribution to the site of action
How does the duration of lipid soluble drugs like propofol and fentanyl compare to the adult?
There is less distribution because pediatric patients have a higher percentage of total body water compared to total body fat so the lipid soluble drugs stay around longer
How does the ECF/ICF compare to that of the adult?
ECF/ICF = 50% so there is a larger intracellular volume than normal (1/3)
Plasma protein drug binding is ________ in pediatrics
Reduced, albumin and a-1 acid glycoprotein are reduced in concentration and have different affinity for drugs. Billirubin also competes for binding sites, and highly protein bound drugs can displace billirubin in neonates (sulfonylureas, phenytoin) and can result in CNS toxicity
Metabolism via CYP450 is ________ in pediatric patients
Reduced, meaning slower metabolism of certain benzodiazepines, barbituates, amide local anesthetics resulting in longer duration of action. Some enzymes are hyperactive at age 3y (CYP2D6) and have active metabolites such as morphine, prolonging duration and respiratory depression.
How does elimination, and specifically renally cleared drugs differ from that of the adult?
Proximal tubular secretion development and GFR is delayed up until about 3-12 years of age. Drugs metabolized by the kidney may be prolonged (use smaller doses of Abx)
What is the main difference in the nicotinic receptor at the NMJ in the pediatric patient compared to the adult?
In mature innervated muscle, the “fetal and immature” y subunit is replaced by e
Fetal receptors (or upregulated receptors) have enhanced response to depolarizing agents (succinylcholine) and relative resistance to nondepolarizing agents (rocuronium)
Drugs commonly used as premedication to allay anxiety, block vagal reflexes, reduce airway secretions, produce anemia, provide prophylaxis against aspiration of gastric contents, and provide analgesia and anesthesia
Generally, all neuromuscular blocking agents have _______ onset in pediatric patients vs. adults
faster, by about 50% and shorter circulation time
Adverse effects of succinlycholine in pediatrics, when is it indicated? (4)
Nondepolarizing agents in pediatrics compared to adults
Reversal agents in pediatric patients
Use of atropine during induction
Use of benzodiazepines in pediatric premedication
Use of dexmedetomidine as premedication in pediatrics
Use of ketamine as premedication and induction anesthetic in pediatrics
Dosing differences of propofol in pediatrics compared to adults
Dosing differences of opioids in neonates compared to older children and adults
Opioid reversal in pediatric patients
Maintenance IV requirements in pediatrics
Deficit IV requirements in pediatrics
Incidence of PONV in neonates and adolescence based on type of surgery
Antiemetic dosing in pediatrics
Management of hyperkalemia in pediatric patients
Management of perioperative anaphylaxis in pediatrics
Management of laryngospasm in pediatrics
Management of MH in pediatrics
