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Therapeutics III > Intro to Pediatrics - Block 4 > Flashcards

Intro to Pediatrics - Block 4 Flashcards

1
Q

What are the classifications of a pre-term vs term newborn?

A

Pre-term: <37 weeks

Term: >37 weeks

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2
Q

Classifications of neonates?

A

Birth - 1 month

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3
Q

Classification of Infant?

A

1 month - 2 yr

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4
Q

Classifications of a child?

A

2-12 YO

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5
Q

Classification of adolescent?

A

12-18 YO

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6
Q

Growth charts used from birth to 36 months?

A
  1. Length
  2. Weight
  3. Head circumference
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7
Q

Growth charts use for 2-20 YO?

A
  1. Height
  2. Weight
  3. BMI
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8
Q

Describe the development of neonates and how they get older?

A
  • Babies would lose water weight within the first 7 days of life do to stress and adjustment.
  • Birth weight is regained by 10 days, however, if 10% of birth weight that is an indication for dehydration or malnutrition
  • Babies have a lot of water and as they age they gain more protein and fat
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9
Q

How do vitals differ in neonates than infants and adolescents?

A

HR: generally higher
RR: generally higher
BP: generally lower

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10
Q

What is the difference between PK and PD?

A

PK: what the body does to the drug (ADME)
PD: What the drug does to the body (Ligand, receptor, tissue)

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11
Q

How does the PK change in pediatrics?

A

ADME varies by age even when normalized by body weight

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12
Q

How does PD change in pediatrics?

A

Differences receptor sensitivity and density

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13
Q

PO factors that impact absorption?

A
  1. Gastric pH
  2. Gastric motility
  3. Bowel length and absorptve area
  4. Enzymes and bile salts
  5. Microbial flora
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14
Q

GI/PO factors that impact absorption in neonates?

A

Gastric motility and emptying: reduced gastric emptying and poorly coordinated intestinal cotractility
* Adult pattern onset at 6-8 months
* Drug absorption is dependent on disintegration, dissolution, and formulation

Intestinal drug-metaolizing enzymes: Lower
Biliary function and pancreatic enzymes (amylase and lipase): Underdevelopment affects ability to solubilize lipophilic drugs

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15
Q

Gastric factors that impact absorption in neonates?

A

Neonates have higher gastric pH:
* Acid labile drugs are less broken down -> increased F
* Weak acids are neutralized -> decreased bioavailability

Gastric pH will decrease at age 2

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16
Q

Rectal factors that impact absorption in neonates?

A

Increased pulsatile contractions -> decreased holding time

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17
Q

Transdermal facotrs that impact absorption in neonates?

A

Enhanced skin permeability due to:
1. Greater skin hydration
2. Subcutaneous perfusion
3. Increased BSA to mass ratio

18
Q

Intramuscular facotrs that impact absorption in neonates?

A

Erractic yet effective due to reduced skeletal muscle blood flow and contraction offset by high density of capillaries

19
Q

Gastric pH in neonates (compared to adults)

A

Increased:
* Decreased F (weak acids)
* Increased F (weak bases)

20
Q

Gastric emptying time in neonates (compared to adults)

A

Increased delaying absorption

21
Q

CYP3A4 acitivity in neonates (compared to adults)?

A

Decreased (increased F)

22
Q

GST acitivity in neonates (compared to adults)?

A

Increased (decreased F)

23
Q

Intestinal drug transporters in neonates (compared to adults)?

A

Decreased (decreased F)

24
Q

Hydration of epidermis in neonates (compared to adults)?

A

Increased (increased F)

25
Q

TBW in infants and adults?

A

Premature: 85%
Full term: 78%
Adults: 60%

26
Q

ECF volume in infants and adults?

A

Premature: 50% of BW
4-6 month old: 35%
1 YO: 25%
Adults: 19%

27
Q

Plasma protein in neonates?

A

Decreased plasma protein concnetration
Lower binding capcity of protein
Decreased affinity of proteins for drug binding
Competition for certain binding sites by endogenous compounds

28
Q

Body fat contents in neonates?

A

Gradually increases as body water decreases

29
Q

What is Vd?

A

Amount of drug that leaves the plasma into other compartments that dependent on:
1. Hydro or lipophilicity of drug
2. PPB
3. Tissue binding

High: extensive drug distribution
Low: drug remain in the plasma

30
Q

Body water and fat ration in neonates (compared to adults)?

A

Increased:
* High Vd (hydrophilic drugs)
* Low Vd (lipophilic drug)

31
Q

PPB in neonates (compared to adults)

A

Decreased (Increased free drug)

32
Q

Describe the distribution of gentamicin in neonates?

A

Hydrophilic drug and high Vd: requiring more drug to maintain serum concentration

33
Q

What is the difference between Phase 1 and 2?

A

Phase 1: covalent modification of drug to increase polarity (oxidation, reduction, hydrolysis)
Phase 2: Conjugation of polar groups to increase polarity

  • Both used to enhance elimination
34
Q

Most important organ for drug metabolisn?

A

Liver

35
Q

Ezyme activity of neonates?

A

No CYP development (decreased phase 1)

Phase 2: GST activity

36
Q

Hepatic metabolism in neonates (compared to adults?

A

Slower in neonates and infants than children and adults

37
Q

What are the components of renal clearance?

A

Glomerular filtration + tubular secretion - tubular reabsorption
* Adult GFR reached at 1 yr
* Tubular mechanisms take longer than 1 yr to develop

38
Q

How do we calculate eGFR?

A
39
Q

Renal excretion in neonates (compared to adults)?

A
40
Q

Dosage adustment based on elimination (neonates)?

A

Decreased elimination: decreased dose and increased intervals
Increased elimination: increased dose and decreased intervals

41
Q

How would you dose pediatrics?

A

Predominately in children less than 2 YO
* doses normalized by body weight or BSA and allometric scaling is used in >2YO

Therapeutics III (40 decks)

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