Wk 2 - Pediatrics Flashcards
Pre-Term: Neonate: Infancy: Child: Adolescent:
Pre-Term: <36 weeks gestational age Neonate: birth to one month old Infancy: 1 month to 1 year Child: 12 months to age 12 Adolescent: age 12 to 18
__% of critically ill children receive at least one off-label drug
88%
2003 Best Pharmaceuticals for Children Act
All New Drug Applications include pediatric assessment unless waiver
6 month extension on patent if manufacturer studies a given drug in children
Full Term Newborn: intracellular water ________ of body weight
75-80%
5 months old: intracellular water ________ of body weight
68% (adult is 60%)
Fat ______ by 4-5 months
doubles
Protein increases and fat decreases in year ___
2
Neonates have low muscle mass and erratic blood flow, so have ________ with ____ medications
slower absorption
IM meds
Neonates have _____ absorption with _______ meds
better
rectal meds
Neonates have _______ hepatic metabolizing enzymes
immature
Neonates have increased absorption of topical meds due to larger ________
BSA to body mass ratio
thinner stratum corneum
Increased hydration / perfusion to skin
Neonates/infants have ______ gastric pH, therefore have higher bioavailability of _____ meds, and weak acids may require _______
higher
acid labile
higher doses
Efflux transporters low at birth, increase to adult level at age ___. Low P-gp in neonates/infants means increased exposure to ______.
2
CNS
Gastric motility is _____ in first week, with gradual ______, resulting in ______ for medications
Slow
Increase
Longer time to reach peak concentrations
Early infants have greater total body water and less body fat, meaning Vd higher for _______ and Vd lower for _______
hydrophilic drugs
lipophilic drugs
Neonates / infants have low levels of ______ including _______, resulting in
protein
albumin
alpha1-acid glycoprotein
increased unbound drug (concern for drugs with high protein binding)
In neonates, highly protein bound drugs can compete with _______, resulting in __________, so these antibiotics are avoided in <2 months old.
bilirubin
hyperbilirubinemia
Ceftriaxone/sulfonamides
CYP450 enzymes develop to ___ months. Midazolam (CYP___) activity increases from 1.2 to ___mL/min/kg.
3
CYP3A4, CYP3A5
9mL/min/kg
Half-life changes seen in early life. Phenytoin half-life prolonged in pre-term ___ hrs, first week ___ hrs, second week ___ hrs.
72
20
8
Children <10 years have _____ hepatic clearance, and require ______ weight based dosing
higher
higher
Tubular secretion matures in ______ months, and may require ________
first 12 months
less frequent dosing intervals if excretion via golmeruli
Infant GFR ___mL/min, adult values at _____
2-4mL/min
8-12 months
Pharmacodynamics and pharmacogenomics ____
• Poorly understood in children
• May be age dependent differences in
drug/receptor interactions Pharmacogenomics:
• PG may be big influence, but also not recognized or well understood at birth
KIDS list is ______, and includes
Key potentially Inappropriate Drugs in pediatrics
Codeine
Topical corticosteroids
Tetracycline
Cough and cold medication not recommended for use in children less than ____ years due to an increased risk of serious side effects
18
Opioids like codeine and hydrocodone contraindicated in children under
6
Tramadol contraindicated for _________ in children under _______, and cautious use in those with sleep apnea between ages _______ for other conditions.
tonsillectomy and adenoidectomy
under 18 years
12-18
