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Chapter 10. Drug Therapy in Pediatric Patients. Pediatric Patients. All patients younger than16 years Respond differently to drugs than the rest of the population More sensitive to drugs than other patients are Show greater individual variation

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chapter 10

Chapter 10

Drug Therapy in Pediatric Patients

pediatric patients
Pediatric Patients
  • All patients younger than16 years
  • Respond differently to drugs than the rest of the population
    • More sensitive to drugs than other patients are
    • Show greater individual variation
    • Sensitivity due mainly to organ system immaturity
    • Increased risk for adverse drug reaction
pediatric patients1
Pediatric Patients
  • Ongoing growth and development
  • Different age groups: different challenges
  • Two-thirds of drugs used in pediatrics have never been tested in pediatrics.
  • Two laws
    • Best Pharmaceuticals for Children Act—2002
    • Pediatric Research Equity Act of 2003
pediatric patients2
Pediatric Patients
  • 20% of drugs were ineffective in children even though they were effective in adults.
  • 30% of drugs caused unanticipated side effects, some of them potentially lethal.
  • 20% required dosages different from those that had been extrapolated from dosages used in adults.
pharmacokinetics neonates and infants
Pharmacokinetics: Neonates and Infants
  • Absorption
  • Distribution
  • Hepatic metabolism
  • Renal excretion
drug therapy in pediatric patients
Drug Therapy in Pediatric Patients
  • Pharmacokinetics: neonates and infants
  • Determining the concentration of a drug at its sites of action
  • Determining the intensity of duration of response
    • Elevated drug levels = more intense response
    • Delayed elimination = prolonged response
    • Immaturity of organs puts patient at risk for both of these responses.
slide8

Fig. 10-1. Comparison of plasma drug levels in adults and infants.

A, Plasma drug levels following IV injection. Dosage was adjusted for body weight. Note that

plasma levels remain above the minimum effective concentration (MEC) much longer in the

infant. B, Plasma drug levels following subQ injection. Dosage was adjusted for body weight.

Note that both the maximum drug level and the duration of action are greater in the infant.

drug therapy in neonates and infants
Drug Therapy in Neonates and Infants
  • Increased sensitivity in infants due to:
    • Immature state of five pharmacokinetic processes:
      • Absorption
      • Protein binding of drugs
      • Blood-brain barrier
      • Hepatic metabolism
      • Renal drug excretion
pharmacokinetics neonates and infants1
Pharmacokinetics: Neonates and Infants
  • Absorption
    • Oral administration
    • Intramuscular administration
    • Percutaneous absorption
  • Distribution
    • Protein binding
    • Blood-brain barrier
pharmacokinetics neonates and infants2
Pharmacokinetics: Neonates and Infants
  • Hepatic metabolism
  • Renal excretion
pharmacokinetics children age 1 year and older
Pharmacokinetics: Children Age 1 Year and Older
  • Most pharmacokinetic parameters similar to those in adults
  • Drug sensitivity more like that for adults than for children younger than 1 year
pharmacokinetics children age 1 year and older1
Pharmacokinetics: Children Age 1 Year and Older
  • One important difference
    • Metabolize drugs faster than adults
      • Markedly faster until age 2 years; then a gradual decline
      • Sharp decline at puberty
      • May need to increase dosage or decrease interval between doses
adverse drug reactions
Adverse Drug Reactions
  • Vulnerable to unique adverse effects related to organ immaturity and ongoing growth and development
    • Age-related effects
      • Growth suppression (caused by glucocorticoids)
      • Discoloration of developing teeth (tetracyclines)
      • Kernicterus (sulfonamides)
dosage determination
Dosage Determination
  • Dosing is most commonly based on body surface area (BSA).
  • Initial pediatric dosing is, at best, an approximation.
  • Subsequent doses need to be adjusted.
  • See formula on next slide.
dosage determination1
Dosage Determination

Approximate dosage for a child =

Body surface area of the child × adult dose

1.73 m²

promoting adherence
Promoting Adherence
  • Provide patient education in writing.
  • Demonstration techniques should be included as appropriate.
promoting adherence1
Promoting Adherence
  • Effective education should include
    • Dosage size and timing
    • Route and technique of administration
    • Duration of treatment
    • Drug storage
    • The nature and time course of desired responses
    • The nature and time course of adverse responses