MMT: pediatric pharmacology Flashcards
(20 cards)
What drugs are associated with kernicterus?
Sulfonamides and ceftriaxone
What is kernicterus?
Deposition of bilirubin in the basal ganglia of the brain
Describe thalidomide.
Drug used for morning sickness that led to extreme defects in limb development in babies
Why do we often not do IM administration of drugs in pediatric patients, especially preterm babies?
Their absorption of IM administered drugs is funky due to their minimal muscle mass and the reliance on blood flow to the area. Should perfusion rapidly increase, drug levels could be toxic.
Describe percutaneous absorption in pediatric patients.
It is increased in neonates due to an underdeveloped epidermal barrier. This makes this administration method useful, but carries potential for toxicity.
Describe GI absorption in neonates.
Gastric pH is higher than that of adults, which can alter GI absorption. This can lead to higher concentration of acid-labile drugs and potentially lead to toxicity. They also have slower gastric emptying, so prolonged contact between the drug and gastric mucosa may also increase absorption.
Describe how body composition plays into drug dosage in pediatric patients.
Neonates have a much higher percentage of total body water, which can change doses of water-soluble drugs. They often need a higher dose per unit of body weight due to their larger water content. They also have lower fat content which may impact drug therapy.
Describe plasma protein binding of drugs in neonates.
The expression of proteins and the ability to bind is lower, leading to higher concentrations of free drug. This increases risk for toxicity and for drug to alter physiology in the neonate.
Relate plasma protein binding and bilirubin.
The lack of binding ability in neonates leaves free drug, which can compete for bilirubin binding sites and displace bilirubin binding to albumin. This may lead to kernicterus.
Compare speed of drug metabolism in neonates to adults.
They metabolize drugs much slower due to less developed liver/enzyme ability. This leads to risks of toxicity.
What is grey baby syndrome?
Complication associated with chloramphenicol. Neonates have decreased capability of UGT that normally adds sugars to the drug to help break it down. The drug elevates and alternative sulfation pathway occurs that leads to toxic metabolite buildup.
What is UGT1A1?
Enzyme that helps break down bilirubin; we have a lower expression of it as neonates, so excess bilirubin may be an issue and lead to kernicterus.
Describe theophylline in neonates.
Theophylline has to be dosed very carefully due to a narrow therapeutic window. It is excreted by the kidneys, which are underdeveloped in neonates. These two factors increase toxicity risk.
What do we use in neonates as an alternative to theophylline?
Caffeine! Safer, metabolized better, and has a wider therapeutic window and half life.
Describe drug metabolism in toddlers.
Toddlers have an increase in BMR, which may increase their rate of drug metabolism. As a result, we may have to increase the dosage for the drug to be effective.
Describe GFR in relation to drugs in neonates.
Super low. It starts to go up as we age, but the low GFR means we have a lower ability to clear drugs as neonates which can lead to toxicity.
Describe GFR in relation to drugs in toddlers.
Toddlers can have a higher GFR than adults, leading to increased excretion of drug. This may cause them to need increased doses.
What is the best way to get accurate calculations for drug dosage in kids?
Body surface area!
The use of which drugs has increased in pediatric populations?
Asthma, ADHD, contraception.
What meds are given to newborns?
Vitamin K, topical erythromycin, hepB vaccine.
