Waller - Intro to Peds Pharm

Question 1

What percentage of FDA approved drugs are approved for pediatric use?

Answer 1

<50%

Question 2

What complication are sulfonamide abx associated with in pediatric pts?

Answer 2

These abx displace bili from protein binding sites, resulting in more free bili. The free bili will cross the BBB and result in encephalopathy and kernicterus

Question 3

What complication is chloramphenicol associated with in pediatric patients?

Answer 3

Gray baby syndrome

Abd distension, vomiting, diarrhea, respiratory distress

Question 4

How does the ratio of gastric volume compare between peds and adults?

Answer 4

Gastric volume is comparatively lower in peds

Question 5

How do gastric acid differences in peds affect oral drug absorption?

Answer 5

Higher gastric acid pH and decreased amount

Increased absorption of acid-labile drugs (i.e. PCN, erythromycin) - drugs aren’t broken down as much

Decreased absorption of weakly acidic drugs (phenobarb, phentoin)

Question 6

What are the differences in total body water in neonates compared to older children?

Answer 6

The younger the child, the greater the percent total body water. This means hydrophilic drugs will distribute further and dilute out more the younger the child is.

Question 7

How is body fat different in neonates compared to older children?

Answer 7

Neonates have less % body fat compared to older children. Therefore, the dose of lipophilic drugs is lower in neonates compared to older children.

Question 8

How is protein binding different in newborns compared to older children?

Answer 8

Neonates have decreased protein binding due to lower levels of albumin and other plasma proteins. Therefore, there is more free drug available. Also, drugs can displace bilirubin from proteins and increase free bili in blood

Question 9

How do pediatric pts handle Phase II metabolism?

Answer 9

Glucoronidation pathways are undeveloped.

Sulfation pathways are well developed and compensate for lack of glucoronidation.

Question 10

What is true of Phase I metabolic pathways in pediatric pts?

Answer 10

Different enzymatic pathways develop at different ages as the child gets older.

Question 11

MOA of ampicillin

Answer 11

β-lactam that inhibits cell wall synthesis

Question 12

MOA of gentamicin

Answer 12

Inhibits bacterial protein synthesis

Question 13

MOA of third generation cephalosporins

Answer 13

β lactams that inhibit cell wall synthesis

Question 14

MOA of IVIG

Answer 14

Mostly IgG, some IgA and IgM

Protects recipient against infection and suppresses inflammatory and immune mediated processes