Pharmacology

Question 1

What are unlicensed/ off label medications?

Answer 1

• Formulation administered via a route not intended
• Medicines used for an indication not intended
• Medicines used at a different dose to that recommended
• Children below stated recommended age limit
• Medicines without a licence, including those being used in clinical trials

Question 2

How often are unlicensed drugs used in children?

Answer 2

In hospitals

• 60-90% are off-label
• 10-50% are off label

Question 3

Consequences of using unlicensed drugs?

Answer 3

• Altered pharmacodynamic responses
• Effects on growth ad development
• Pharmacokinetic response different between adults and children

Question 4

Considerations

Answer 4

• Neonates are more sensitive to drugs than adults
• Neonates are at increased risk for ADRs
• younger patients show greater individual variation

Question 5

Pharmacology in the early post-natal period?

Answer 5

• Rapid growth
• Variable alteration in metabolism and elimination
• Lower tolerance to ADRs
• Difficulty in efficacy and toxicity

Question 6

What is one of the main problems with pharmacology in toddlers?

Answer 6

COMPLICANCE

Question 7

What affects absorption in neonates

Answer 7

Decrease gastric emptying and motility

Question 8

What affects distrubution in neonates

Answer 8

Body composition:

• Higher Extracellular fluid
• Total body weight
• Fat content is low

Plasma protein binding is reduced so more unbound active drug

BBB- not fully developed at birth so more chance of CNS toxicity

Question 9

What affects drug metabolism

Answer 9

Hepatic function

• Liver metabolism is immature
• Immaturity of drug metabolism
• Oxidation and glucorinidation are reduced

Question 10

What affects drug elimination

Answer 10

• Renal excretion
• Less glomerular filtration
• Less tubular function

Question 11

At what age is adult renal/ tubular function acquire in children?

Answer 11

Renal: 3-6 months
Tubular: 12 months

Question 12

What happens for most drugs at 12 months

Answer 12

T1/2 is increased

Question 13

At what stage does child presentation begin to appear like child presentation?

Answer 13

In children: 2 yrs to 11 yrs