Pediatric Pharm

Question 1

Challenges in pediatric pharm

Answer 1

• lack of adequate neonatal and pediatric studies (only 25% FDA approved drugs have specific indications)
• identifying optimal dose (children are not little adults)
• lack of suitable pediatric dosage forms (some injectables must be diluted)
• adherence to medication regimen (better in >3 yo,

Question 2

Some drugs that cause pediatric problems

Answer 2

Chloramphenicol: gray baby syndrome
Thalidomide: phocomelia
Sulfonamide: kernicterus
Tetracycline: tooth staining and discoloration
Benzyl alcohol: Gasping syndrome

Question 3

GI absorption of ped pharm

Answer 3

• pH dependent passive diffusion: full term infant has a gastric pH from 6-8 at birth but decreases to 1-3 within 48h
• Gastric emptying: slow in premature infant which can lead to increase absorption d/t more prolonged GI transit time
• Beta glucoronidase in GI tract of neonates-cleaves glucuronide conjugated compounds to free form which can be reabsorbed (chloramphenicol)
• larger GI tract SA
• older infants and kids may have faster and more complete absorption than some adults

Question 4

IM absorption of ped pharm

Answer 4

neonates: slow, erratic and unpredictable absorption

older infants and children: may have faster and more complete abosprtion

Question 5

transdurmal absorption of ped pharm

Answer 5

skin permeability increases in infants d/t increase H2O content of dermis, decrease thickness of stratum corneum, and large relative SA compared to adults which leads to increase potential for drug toxicity because of increased absorption

Question 6

Distribution of ped pharm

Answer 6

Determined by physiochemical properties of the drug and physiologic factors of the patient

• the younger we are the more total body water we have as a percentage of our body THEREFORE higher doses per Kg of hydrophilic drugs may be needed d/t larger Vd
• body fat is lower in neonates therefore lipophilic drugs have smaller Vd than adults and therefore lower drug dosage
• alt protein status: lower binding capacity of protein and increased competition between drugs and bilirubin for albumin

Question 7

Metabolism of ped pharm

Answer 7

slower in infants compared to older children and adults
-generally slower CP450 enzyme system from birth to 1yo
-higher from 1-9 years
tapers off as a teen

Question 8

Elimination of ped pharm

Answer 8

glomerular filtration, tubular secretion and reabsorption takes up to 1 year to fully develop therefore elimination in infants is slower than adults

Question 9

Black Box warning with codeine post tonsillectomy or adenoidectomy

Answer 9

• ultrarapid metabolizers can develop higher morphine levels despite usual doses which increases effect
• poor metabolizers produce lower morphine levels and may not have adequate pain relief
• kids often have obstructive sleep apnea and higher risk of breathing problems
• if opiate is needed morphine is easier