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Paedriatrics > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What in unlicensed/off-label prescribing?

A

Formulation administered via route not intended
Used for indication not intended
Used at different dose to that recommended
Below stated recommended age limit
Medicines without a license

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2
Q

Why are neonates/infants more sensitive to drugs than adults?

A

Organ system immaturity

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3
Q

Why is prescribing in young children difficult?

A

Enhanced metabolism and excretion

Clearance can change significantly in a single dose regimen

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4
Q

What SSRI when used in children for treatment of depression is associated with 4x increase in suicide compared with placebo?

A

Paroxetine

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5
Q

What must you think about re: drug absorption and bioavailability in children if wanting to administer by oral route?

A 
Reduced gastric acid
Delayed gastric emptying
Absorption not reached adult values until 6-8mo
High hepatic clearance
First pass elimination reduced
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6
Q

What must you think about re: drug absorption and bioavailability in children if wanting to administer by percutaneous route?

A

Percutaneous route is enhanced in infants/children

Think when damaged skin or steroids!

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7
Q

What must you think about re: drug absorption and bioavailability in children if wanting to administer by rectal route?

A

Used when vomiting/unwilling

Avoids first-pass metabolism

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8
Q

What must you think about re: drug absorption and bioavailability in children if wanting to administer by IV route?

A

Delayed/uncertain delivery

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9
Q

Why is the body composition important when thinking about drug distribution?

A

Newborns = high extracellular fluid volume
Total body water high
Fat content low

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10
Q

In terms of drug dosage, why is high extracellular fluid volume important?

A

Larger initial doses on a mg/kg body weight to achieve correct plasma conc.
After loading dose, dosage interval increased or daily dose decreased to compensate for decreased hepatic function/decreased renal elimination

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11
Q

What happens to plasma protein binding in neonate?

A

Reduced

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12
Q

What does reduced plasma protein binding in a neonate mean for drugs?

A

Greater unbound or active drug

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13
Q

Why is the blood-brain barrier important in neonates?

A

Not fully developed at birth

Drugs have easy access to CNS

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14
Q

Why are infants especially sensitive to drugs that affect CNS function?

A

Not fully developed BBB = CNS toxicity

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15
Q

Why is it important to know that a neonates liver metabolism is immature?

A

Drugs eliminated by liver have longer half life

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16
Q

How is hepatic metabolism in the neonatal period?

A

Very slow

17
Q

Why is hepatic metabolism very slow in neonatal period?

A

Immaturity of drug metabolising enzymes

18
Q

What time of drugs are neonates especially sensitive to?

A

Drugs eliminated by hepatic metabolism

19
Q

When is the metabolic activity the same as adult activity?

A

By 1yr of age

20
Q

When is metabolic metabolism more rapid and the half life shorter?

A

1-8yr children

21
Q

Why is it important to know metabolic metabolism is more rapid and the half life shorter in 1-8yrs?

A

Some drugs (anti-epileptics) need to be greater dose than in adults

22
Q

What is renal excretion like in neonates?

A

Decreased

23
Q

When are adult values for renal excretion achieved?

A

3-6mo

24
Q

When is tubular function in kidneys same as adults?

A

12mo

25
Q

What does decreased albumin protein levels mean for drugs?

A

Increased free drug levels

26
Q

What does increased free drugs levels mean?

A

Increased reponse

27
Q

What does a decreased hepatic metabolism mean for drugs?

A

Increased response

28
Q

What does a decreased renal elimination mean for drugs?

A

Increased response

29
Q

What does a decreased BBB mean for drugs?

A

Increased CNS effects

30
Q

What metabolic disturbances mean that sensitivity to drugs is increased?

A

Fever
Dehydration
Acidosis

Paedriatrics (19 decks)

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