Drugs in health and disease 3

Question 1

How are drugs prescribed in paediatrics?

Answer 1

By weight - with adult ceiling

For some drugs - body surface area

Question 2

How are pharmacokinetics different in neonates?

Answer 2

Immature liver enzymes - cytochrome P450
Low GFR at birth
Dosage schedules change in first few weeks

Question 3

What do benzodiazepines cause in neonates?

Answer 3

Apnea

Immature liver and respiratory control

Question 4

What can chloramphenicol cause in neonates?

Answer 4

Grey baby reaction - liver immaturity

Question 5

What does aspirin cause in neonates and children?

Answer 5

Reyes syndrome

Question 6

How are drugs delivered in paediatrics?

Answer 6

Avoid unnecessary pain - IM rarely used, long term venous access devices for patients requiring repeated IV infusions

Liquid preparations for young children - cant swallow tablets

Inhaled methods

Question 7

Describe off licence prescribing in paediatrics

Answer 7

Many potentially useful drugs do not have a licence
Below licensed age
Unlicensed indication
Legal but prescriber responsible

Question 8

What do you need to have to prescribe safely in children?

Answer 8

Calculator
BNFc
Flexibility and pragmatism 
Caution - checking habit
Willingness to seek and take advice