The document discusses principles of pharmacotherapy in neonates and pediatric populations. It notes key differences in pediatric physiology compared to adults, including higher heart and respiratory rates in neonates/infants. Patients are classified based on age ranges. Absorption, distribution, metabolism and elimination of drugs can also differ in pediatric patients compared to adults due to developmental factors. The document stresses the importance of considering these pharmacokinetic differences as well as appropriate dosing formulations when selecting and administering drug therapy to pediatric patients.
1) Pediatric patients have unique considerations for drug therapy due to ongoing development processes. Their organ systems, especially liver and kidney function, are still maturing and may metabolize and eliminate drugs differently than adults.
2) Some infamous past drug disasters in pediatrics, like the teratogenic effects of thalidomide, helped establish modern drug regulations requiring demonstrated safety and efficacy for pediatric populations.
3) Key pharmacokinetic processes like absorption, distribution, metabolism and elimination vary substantially between pediatric age groups from neonates to adolescents due to developmental differences, necessitating careful study of appropriate dosing.
This document discusses drug therapy in children and outlines several key points. It notes that pediatric pharmacokinetics differ from adults due to immature organ systems. Absorption, distribution, metabolism and excretion of drugs is often slower or less developed in children. The document also discusses different pediatric dosage forms and challenges in drug administration for children due to palatability, dosing accuracy and safety concerns. Alternative treatment options are sometimes used but can compromise drug efficacy and safety.
- Drug therapy in pediatric patients presents unique challenges due to physiological differences compared to adults that influence pharmacokinetics. Organs such as the liver and kidneys are immature at birth and do not reach adult functionality until approximately 1 year of age. This results in altered absorption, distribution, metabolism, and excretion of drugs in neonates and infants.
- Due to organ immaturity, neonates and infants experience more intense and prolonged responses to drugs. They are at higher risk for adverse effects from drugs cleared primarily by the liver or kidneys. Careful monitoring is needed when dosing pediatric patients.
- Initial pediatric doses are approximations, often based on body surface area calculations. Frequent assessment and potential dose adjustments are
This document discusses safe administration methods for pediatric medications. Key points include calculating weight in kilograms, checking that medication dosages fall within safe ranges listed in drug references, using infusion pumps for young children on IV fluids or medications, and properly diluting and administering IV medications like vancomycin over the appropriate time period. Safe fluid intake and avoiding overload is also emphasized.
This document discusses several important pharmacokinetic differences between pediatric patients and adults that are important to consider when prescribing medications to children. It notes that gastric acid production, digestive enzyme levels, and gastrointestinal absorption can vary significantly in infants and young children compared to adults. Metabolism and elimination pathways are also immature at birth and develop over time. These developmental differences mean that drug dosing often needs to be adjusted based on a child's age to ensure both efficacy and safety.
The document discusses general prescribing guidelines for pediatric patients. It covers classification of pediatric age groups from premature neonates to adolescents. Key differences in pediatric patients that impact drug absorption and pharmacokinetics compared to adults include higher gastric pH, irregular gastric emptying, reduced intestinal motility and surface area in neonates. These factors can result in unpredictable and variable absorption of orally administered drugs in young pediatric patients. The document also notes developmental changes in body composition and organ systems that influence drug metabolism and clearance at different pediatric ages.
Population pharmacokinetics (PopPK) is the study of variability in plasma drug concentrations between and within patient populations receiving therapeutic doses of a drug.
• Population modelling provides estimates of typical drug levels and drug effects (PK or PK/PD parameters) in a specific population by identifying sources of variability (covariates) in a population and then quantifying the impact of each covariate through a modelling system.
• Population pharmacokinetics can be used to assist with therapeutic drug monitoring (TDM) and the principles of dosage adjustments.
• Population analysis identifies and quantitates this difference, assesses whether this difference will alter the dose-concentration-effect relationship, and then consequently determines if dose adjustment is needed.
• A dosing regimen based on Pop PK or PK/PD analysis should be included in the drug label.
1) Pediatric patients have unique considerations for drug therapy due to ongoing development processes. Their organ systems, especially liver and kidney function, are still maturing and may metabolize and eliminate drugs differently than adults.
2) Some infamous past drug disasters in pediatrics, like the teratogenic effects of thalidomide, helped establish modern drug regulations requiring demonstrated safety and efficacy for pediatric populations.
3) Key pharmacokinetic processes like absorption, distribution, metabolism and elimination vary substantially between pediatric age groups from neonates to adolescents due to developmental differences, necessitating careful study of appropriate dosing.
This document discusses drug therapy in children and outlines several key points. It notes that pediatric pharmacokinetics differ from adults due to immature organ systems. Absorption, distribution, metabolism and excretion of drugs is often slower or less developed in children. The document also discusses different pediatric dosage forms and challenges in drug administration for children due to palatability, dosing accuracy and safety concerns. Alternative treatment options are sometimes used but can compromise drug efficacy and safety.
- Drug therapy in pediatric patients presents unique challenges due to physiological differences compared to adults that influence pharmacokinetics. Organs such as the liver and kidneys are immature at birth and do not reach adult functionality until approximately 1 year of age. This results in altered absorption, distribution, metabolism, and excretion of drugs in neonates and infants.
- Due to organ immaturity, neonates and infants experience more intense and prolonged responses to drugs. They are at higher risk for adverse effects from drugs cleared primarily by the liver or kidneys. Careful monitoring is needed when dosing pediatric patients.
- Initial pediatric doses are approximations, often based on body surface area calculations. Frequent assessment and potential dose adjustments are
This document discusses safe administration methods for pediatric medications. Key points include calculating weight in kilograms, checking that medication dosages fall within safe ranges listed in drug references, using infusion pumps for young children on IV fluids or medications, and properly diluting and administering IV medications like vancomycin over the appropriate time period. Safe fluid intake and avoiding overload is also emphasized.
This document discusses several important pharmacokinetic differences between pediatric patients and adults that are important to consider when prescribing medications to children. It notes that gastric acid production, digestive enzyme levels, and gastrointestinal absorption can vary significantly in infants and young children compared to adults. Metabolism and elimination pathways are also immature at birth and develop over time. These developmental differences mean that drug dosing often needs to be adjusted based on a child's age to ensure both efficacy and safety.
The document discusses general prescribing guidelines for pediatric patients. It covers classification of pediatric age groups from premature neonates to adolescents. Key differences in pediatric patients that impact drug absorption and pharmacokinetics compared to adults include higher gastric pH, irregular gastric emptying, reduced intestinal motility and surface area in neonates. These factors can result in unpredictable and variable absorption of orally administered drugs in young pediatric patients. The document also notes developmental changes in body composition and organ systems that influence drug metabolism and clearance at different pediatric ages.
Population pharmacokinetics (PopPK) is the study of variability in plasma drug concentrations between and within patient populations receiving therapeutic doses of a drug.
• Population modelling provides estimates of typical drug levels and drug effects (PK or PK/PD parameters) in a specific population by identifying sources of variability (covariates) in a population and then quantifying the impact of each covariate through a modelling system.
• Population pharmacokinetics can be used to assist with therapeutic drug monitoring (TDM) and the principles of dosage adjustments.
• Population analysis identifies and quantitates this difference, assesses whether this difference will alter the dose-concentration-effect relationship, and then consequently determines if dose adjustment is needed.
• A dosing regimen based on Pop PK or PK/PD analysis should be included in the drug label.
The document discusses pharmacology considerations for pediatric populations. It describes the different age groups in pediatrics and how drug absorption can vary between neonates, children, and adults for certain drugs. Several age-related pharmacokinetic differences are outlined between premature neonates, neonates, infants, children, and adolescents. The document also discusses pediatric drug dosage methods including Clark's rule and Young's rule to approximate dosages based on weight and age. Compliance challenges are noted along with recommendations to improve medication administration in children.
This document provides an overview of principles of neonatal and pediatric pharmacology. It discusses pediatric ages and developmental stages. It then covers topics of pediatric pharmacokinetics including absorption, distribution, metabolism and excretion. Factors such as organ maturation, body composition and plasma protein binding affect how drugs are processed in pediatric patients compared to adults. The document also reviews monitoring parameters and considerations for pediatric drug therapy including dose calculations, choice of formulations, disease conditions, adverse reactions and counseling.
This document summarizes the pharmacology of several endocrine and reproductive drugs. It describes the mechanisms of action, indications, and side effects of hormones that regulate the thyroid, adrenal glands, diabetes treatment including insulin and oral hypoglycemics, and reproductive hormones including contraceptives. Nursing responsibilities are outlined for monitoring patients and educating about safe administration and side effect management.
Delayed Puberty Topics in Adolescent Gynecology Delayed Puberty Topics in A...MedicineAndHealth14
This document discusses delayed puberty in adolescent girls. It begins by outlining normal pubertal development and defining delayed puberty. Delayed puberty is then classified into three categories: hypergonadotropic hypogonadism (43%), hypogonadotropic hypogonadism (31%), and eugonadism (26%). For evaluation and management, the document recommends obtaining a history, physical exam, initial labs (TSH, prolactin), and a progestational challenge to determine gonadotropin levels and identify underlying causes. Treatment strategies aim to correct the underlying pathology, prevent disease complications, and provide sex steroids.
Geriatric,obese and pediatric patients PharmacokineticsAreej Abu Hanieh
This document discusses factors that influence pharmacokinetics and pharmacodynamics in geriatric, obese, and pediatric patients. It notes that variability in patient response is a major issue and is influenced by both intrinsic factors like age, weight, and disease state as well as extrinsic factors like concomitant medications and diet. For each patient group, it summarizes key changes to absorption, distribution, metabolism, and excretion of drugs due to physiological differences compared to adults. For example, in geriatric patients renal clearance typically declines in parallel with decreasing kidney function, while drug distribution is often altered in obese patients due to changes in body composition and size.
PHARMACOKINETICS AND PHARMACODYNAMICS OF
ANAESTHETIC DRUGS IN PAEDIATRICS (based on the article that came up in INDIAN JOURNAL OF ANAESTHESIA, OCTOBER 2004)
Drug therapy in pregnancy and lactationVishnupriya K
This slide share will provide drugs which are used and which are contraindicated during pregnancy and lactation, also give information about side effects and malformations if pregnant women's used some drugs.
Dose Adjustment in renal and hepatic failurePallavi Kurra
This document discusses dosage adjustments for patients with renal or hepatic failure. It covers:
1) Causes, classification, and measurement of renal failure including glomerular filtration rate (GFR) and creatinine clearance. Dosage adjustments are recommended based on GFR for various drug classes.
2) Causes, classification, and liver function tests for hepatic failure. Considerations for dosage adjustments in patients with hepatic impairment include drug elimination pathways and protein binding.
3) Formulas for estimating creatinine clearance from serum creatinine levels, including the Cockcroft-Gault and modification of diet in renal disease (MDRD) methods.
The kidney plays an important role in regulating fluids, electrolytes, and removing waste from the body. Impairment of kidney function affects drug pharmacokinetics. Common causes of kidney failure include disease, injury, drug toxicity, infections, diabetes, toxins, and reduced blood flow. Acute kidney problems or trauma can lead to uremia where filtration is impaired, causing excess fluid and waste to accumulate. Uremic patients may have changes in drug absorption, distribution, and clearance. Dosage adjustments are often needed based on a patient's kidney function and drug properties to safely treat uremic patients.
1) Pregnancy causes significant alterations in a woman's anatomy, physiology, and pharmacokinetics that impact drug disposition. These include changes in absorption, distribution, metabolism and excretion of drugs.
2) Drugs can cross the placenta and expose the developing fetus, with the extent of transfer dependent on the drug's properties and placental physiology. The fetus undergoes its own metabolism and clearance of drugs.
3) Understanding how pregnancy impacts a drug's pharmacokinetics is important for developing evidence-based dosing guidelines to ensure safe medication use during pregnancy. Physiologically based pharmacokinetic models can incorporate anatomical and physiological changes to predict a drug's disposition.
Gestational diabetes (GDM) is glucose intolerance first identified during pregnancy. Risk factors include BMI over 30, previous large or diabetic baby, family history of diabetes. GDM is identified through a 75g oral glucose tolerance test. It is associated with risks like large baby, shoulder dystocia, preeclampsia. Treatment like insulin lowers risks. Other types of diabetes may present as GDM and require identification. Mild maternal hyperglycemia increases risks incrementally without a clear threshold.
This document discusses pediatric pharmacology, including:
- Age groups from neonate to adolescent
- Differences in absorption, distribution, metabolism and excretion of drugs in children compared to adults
- Slower gastric emptying and hepatic function in neonates affects drug absorption and clearance
- The blood-brain barrier is more permeable in neonates, increasing drug penetration to the brain
- Renal function is immature at birth but matures rapidly in the first year of life
- Understanding developmental changes is crucial for safe and effective pediatric prescribing
Paediatric (pediatrics) medication-drugs therapy in pediatricsRavish Yadav
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
This document discusses drugs used during pregnancy, including their effects, risks, and FDA categories. It covers topics like pharmacokinetics and pharmacodynamics changes during pregnancy, placental transfer of drugs, and effects on the fetus including teratogenesis. Specific commonly used drug classes are mentioned for treating conditions like asthma, hypertension, epilepsy and diabetes in pregnancy. The risks and safety categories of many individual drugs are provided. The goal is to provide an overview while discussing important considerations for drug use during this critical period.
This document discusses oral contraceptives, including their definition, types, mechanisms of action, effects, and pharmacokinetics. The two main types are combined oral contraceptives containing estrogen and progestogen, and progestogen-only pills. Combined pills prevent pregnancy primarily by suppressing ovulation and thickening cervical mucus. Progestogen-only pills work mainly by changing cervical mucus. Common side effects include nausea, weight gain, and changes in menstruation. Oral contraceptives are metabolized in the liver and can interact with certain drugs like antibiotics. Emergency contraception is also discussed.
Pediatric Pharmacology:Pharmacokinetics and pharmacodynamics .pptxAzad Haleem
This document discusses several key topics related to pediatric pharmacology:
- It outlines age classifications in childhood and describes differences in absorption, distribution, metabolism and excretion of drugs between neonates, infants, children and adolescents compared to adults.
- Specific examples are provided of how drug properties like protein binding and hepatic/renal function impact drug levels at different ages.
- Indications for drug monitoring are outlined for medications with a narrow therapeutic window.
- The importance of considering drug interactions is emphasized, especially for drugs metabolized by the liver.
- Factors determining excretion of drugs into breast milk and safety for breastfeeding are summarized.
- A short list of drugs contraindicated in breastfeeding
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptxkavitharaninachiya
This document provides guidelines for prescribing medications to pediatric patients. It discusses that children differ from adults in their response to drugs due to immature organ systems. Proper dosing and administration methods are important, especially for neonates. The document outlines classifications of pediatric patients and factors that affect drug absorption, distribution, metabolism, and excretion in children. It recommends the oral route when possible and provides guidance on writing prescriptions, calculating doses, and monitoring pediatric patients.
The document discusses pharmacology considerations for pediatric populations. It describes the different age groups in pediatrics and how drug absorption can vary between neonates, children, and adults for certain drugs. Several age-related pharmacokinetic differences are outlined between premature neonates, neonates, infants, children, and adolescents. The document also discusses pediatric drug dosage methods including Clark's rule and Young's rule to approximate dosages based on weight and age. Compliance challenges are noted along with recommendations to improve medication administration in children.
This document provides an overview of principles of neonatal and pediatric pharmacology. It discusses pediatric ages and developmental stages. It then covers topics of pediatric pharmacokinetics including absorption, distribution, metabolism and excretion. Factors such as organ maturation, body composition and plasma protein binding affect how drugs are processed in pediatric patients compared to adults. The document also reviews monitoring parameters and considerations for pediatric drug therapy including dose calculations, choice of formulations, disease conditions, adverse reactions and counseling.
This document summarizes the pharmacology of several endocrine and reproductive drugs. It describes the mechanisms of action, indications, and side effects of hormones that regulate the thyroid, adrenal glands, diabetes treatment including insulin and oral hypoglycemics, and reproductive hormones including contraceptives. Nursing responsibilities are outlined for monitoring patients and educating about safe administration and side effect management.
Delayed Puberty Topics in Adolescent Gynecology Delayed Puberty Topics in A...MedicineAndHealth14
This document discusses delayed puberty in adolescent girls. It begins by outlining normal pubertal development and defining delayed puberty. Delayed puberty is then classified into three categories: hypergonadotropic hypogonadism (43%), hypogonadotropic hypogonadism (31%), and eugonadism (26%). For evaluation and management, the document recommends obtaining a history, physical exam, initial labs (TSH, prolactin), and a progestational challenge to determine gonadotropin levels and identify underlying causes. Treatment strategies aim to correct the underlying pathology, prevent disease complications, and provide sex steroids.
Geriatric,obese and pediatric patients PharmacokineticsAreej Abu Hanieh
This document discusses factors that influence pharmacokinetics and pharmacodynamics in geriatric, obese, and pediatric patients. It notes that variability in patient response is a major issue and is influenced by both intrinsic factors like age, weight, and disease state as well as extrinsic factors like concomitant medications and diet. For each patient group, it summarizes key changes to absorption, distribution, metabolism, and excretion of drugs due to physiological differences compared to adults. For example, in geriatric patients renal clearance typically declines in parallel with decreasing kidney function, while drug distribution is often altered in obese patients due to changes in body composition and size.
PHARMACOKINETICS AND PHARMACODYNAMICS OF
ANAESTHETIC DRUGS IN PAEDIATRICS (based on the article that came up in INDIAN JOURNAL OF ANAESTHESIA, OCTOBER 2004)
Drug therapy in pregnancy and lactationVishnupriya K
This slide share will provide drugs which are used and which are contraindicated during pregnancy and lactation, also give information about side effects and malformations if pregnant women's used some drugs.
Dose Adjustment in renal and hepatic failurePallavi Kurra
This document discusses dosage adjustments for patients with renal or hepatic failure. It covers:
1) Causes, classification, and measurement of renal failure including glomerular filtration rate (GFR) and creatinine clearance. Dosage adjustments are recommended based on GFR for various drug classes.
2) Causes, classification, and liver function tests for hepatic failure. Considerations for dosage adjustments in patients with hepatic impairment include drug elimination pathways and protein binding.
3) Formulas for estimating creatinine clearance from serum creatinine levels, including the Cockcroft-Gault and modification of diet in renal disease (MDRD) methods.
The kidney plays an important role in regulating fluids, electrolytes, and removing waste from the body. Impairment of kidney function affects drug pharmacokinetics. Common causes of kidney failure include disease, injury, drug toxicity, infections, diabetes, toxins, and reduced blood flow. Acute kidney problems or trauma can lead to uremia where filtration is impaired, causing excess fluid and waste to accumulate. Uremic patients may have changes in drug absorption, distribution, and clearance. Dosage adjustments are often needed based on a patient's kidney function and drug properties to safely treat uremic patients.
1) Pregnancy causes significant alterations in a woman's anatomy, physiology, and pharmacokinetics that impact drug disposition. These include changes in absorption, distribution, metabolism and excretion of drugs.
2) Drugs can cross the placenta and expose the developing fetus, with the extent of transfer dependent on the drug's properties and placental physiology. The fetus undergoes its own metabolism and clearance of drugs.
3) Understanding how pregnancy impacts a drug's pharmacokinetics is important for developing evidence-based dosing guidelines to ensure safe medication use during pregnancy. Physiologically based pharmacokinetic models can incorporate anatomical and physiological changes to predict a drug's disposition.
Gestational diabetes (GDM) is glucose intolerance first identified during pregnancy. Risk factors include BMI over 30, previous large or diabetic baby, family history of diabetes. GDM is identified through a 75g oral glucose tolerance test. It is associated with risks like large baby, shoulder dystocia, preeclampsia. Treatment like insulin lowers risks. Other types of diabetes may present as GDM and require identification. Mild maternal hyperglycemia increases risks incrementally without a clear threshold.
This document discusses pediatric pharmacology, including:
- Age groups from neonate to adolescent
- Differences in absorption, distribution, metabolism and excretion of drugs in children compared to adults
- Slower gastric emptying and hepatic function in neonates affects drug absorption and clearance
- The blood-brain barrier is more permeable in neonates, increasing drug penetration to the brain
- Renal function is immature at birth but matures rapidly in the first year of life
- Understanding developmental changes is crucial for safe and effective pediatric prescribing
Paediatric (pediatrics) medication-drugs therapy in pediatricsRavish Yadav
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
This document discusses drugs used during pregnancy, including their effects, risks, and FDA categories. It covers topics like pharmacokinetics and pharmacodynamics changes during pregnancy, placental transfer of drugs, and effects on the fetus including teratogenesis. Specific commonly used drug classes are mentioned for treating conditions like asthma, hypertension, epilepsy and diabetes in pregnancy. The risks and safety categories of many individual drugs are provided. The goal is to provide an overview while discussing important considerations for drug use during this critical period.
This document discusses oral contraceptives, including their definition, types, mechanisms of action, effects, and pharmacokinetics. The two main types are combined oral contraceptives containing estrogen and progestogen, and progestogen-only pills. Combined pills prevent pregnancy primarily by suppressing ovulation and thickening cervical mucus. Progestogen-only pills work mainly by changing cervical mucus. Common side effects include nausea, weight gain, and changes in menstruation. Oral contraceptives are metabolized in the liver and can interact with certain drugs like antibiotics. Emergency contraception is also discussed.
Pediatric Pharmacology:Pharmacokinetics and pharmacodynamics .pptxAzad Haleem
This document discusses several key topics related to pediatric pharmacology:
- It outlines age classifications in childhood and describes differences in absorption, distribution, metabolism and excretion of drugs between neonates, infants, children and adolescents compared to adults.
- Specific examples are provided of how drug properties like protein binding and hepatic/renal function impact drug levels at different ages.
- Indications for drug monitoring are outlined for medications with a narrow therapeutic window.
- The importance of considering drug interactions is emphasized, especially for drugs metabolized by the liver.
- Factors determining excretion of drugs into breast milk and safety for breastfeeding are summarized.
- A short list of drugs contraindicated in breastfeeding
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptxkavitharaninachiya
This document provides guidelines for prescribing medications to pediatric patients. It discusses that children differ from adults in their response to drugs due to immature organ systems. Proper dosing and administration methods are important, especially for neonates. The document outlines classifications of pediatric patients and factors that affect drug absorption, distribution, metabolism, and excretion in children. It recommends the oral route when possible and provides guidance on writing prescriptions, calculating doses, and monitoring pediatric patients.
The document discusses several key points about pharmacokinetics in geriatrics and paediatrics:
1) Physiological changes that occur with aging can impact drug absorption, metabolism, distribution and excretion in geriatric patients. This includes reduced function of the GI tract, liver and kidneys.
2) In paediatrics, drug absorption, distribution, metabolism and excretion are different compared to adults due to developmental changes. Liver and kidney function is immature at birth and develops over time.
3) When treating geriatric and paediatric patients, pharmacokinetic differences must be considered to optimize drug therapy and minimize adverse effects. Dosage adjustments may be needed for some drugs in these
1. Pharmacokinetics such as absorption, distribution, metabolism, and excretion differ in children compared to adults due to developmental differences. Renal blood flow, glomerular filtration, and tubular function are decreased in neonates and infants compared to older children and adults.
2. Drug administration and dosages in pediatric patients consider factors like age, weight, and surface area. Dosages are often calculated using Clark's and Young's rules. Common dosage forms for children include elixirs and suspensions.
3. Adherence to drug regimens can be challenging in pediatric patients and may involve careful measurement, administration supervision, and addressing issues like spilling or spitting out medication. Overall dos
Pediatric pharmacology by dr.azad al.kurdiAzad Haleem
This document discusses several key topics in pediatric pharmacology:
1) Dosing methods for children include weight-based and surface area-based calculations since clinical drug data for children is often limited. Surface area dosing is generally more accurate.
2) Drug monitoring is important for medications with narrow therapeutic windows to ensure safe and effective levels. Common drugs monitored include antiepileptics and antibiotics.
3) Drug interactions can impact medication levels and effects through induction or inhibition of liver enzymes. Incompatibilities between injectable drugs must also be considered.
4) Most drugs are considered safe during breastfeeding as exposure risk to infants is low, but some medications like cancer drugs are contraindicated. The benefits of breast
This document discusses key aspects of pediatric pharmacology and drug administration. It defines a pediatric patient as under 16 years of age and under 50 kg. Several factors make drug dosing and effects different in children compared to adults, including differences in absorption, distribution, metabolism and excretion due to immature organ systems. The document provides guidance on drug administration and dosage calculation for different pediatric age groups from infants to adolescents. It emphasizes the importance of developmental considerations, family involvement, and minimizing psychological stress when providing drug therapy to children.
Pharmacokinetic variability occurs due to differences in drug absorption, distribution, metabolism, and excretion between individuals. Several factors influence this variability including age, body weight, pregnancy, and disease states. Drug metabolism and excretion are often lower in newborns compared to adults due to immature organ systems and lower enzyme levels. Plasma protein binding is also lower in newborns which increases drug distribution. Renal function is reduced in newborns leading to slower drug clearance. These developmental differences can increase the risk of adverse drug reactions in newborns if dosages are not appropriately adjusted.
The document discusses various factors used to determine drug dosages for pediatric and geriatric patients, including age, weight, body surface area, and medical condition. It provides examples of calculating dosages based on these factors and describes special considerations for cancer chemotherapy dosing, such as using standard regimens, abbreviations for drugs, and dosing based on body weight or surface area.
The document discusses important considerations for pediatric drug handling. It covers pharmacokinetic parameters like absorption, distribution, metabolism, and excretion that differ in children compared to adults due to developmental changes. The document emphasizes the need for pediatric clinical trials to determine appropriate drug dosages, formulations, and administration methods for children of different ages. Monitoring growth, vital signs, and laboratory parameters is also important for safe drug therapy in children.
Pharmacology for pediatric anaesthesia [autosaved]DeepakGupta825
This document discusses pharmacology considerations for pediatric anesthesia. It covers several key topics:
1) Developmental pharmacology - Drugs affect infants and children differently due to factors like body composition, organ maturity, and blood-brain barrier development. This impacts drug dosing, distribution, and elimination.
2) Inhalational agents - Sevoflurane and isoflurane are commonly used and have advantages like rapid induction/recovery, but sevoflurane can cause renal damage with prolonged use.
3) Intravenous agents - Propofol, ketamine, midazolam, fentanyl and other opioids are discussed. Propofol requires higher doses in children and should not be used for prolonged sedation in those under 12
- Drug dosage in pediatric patients is influenced by the unique physiology of childhood including rapid growth and development which affects pharmacokinetics.
- Factors like absorption, distribution, metabolism and excretion differ in children compared to adults and influence the pharmacokinetic profile of drugs.
- Common analgesics used in pediatric patients include paracetamol, ibuprofen, and naproxen, with paracetamol being the first line for mild to moderate pain.
Pharmacologic considerations in pediatric dentistryasjad ansari
This document discusses several key points regarding pharmacology considerations in pediatric dentistry:
1. Children have different anatomy, physiology, and pharmacokinetics compared to adults which impacts drug dosing and effects. Factors like organ maturation, body water content, and metabolic enzyme levels vary significantly with age.
2. Drug absorption, distribution, metabolism and excretion can all be altered in children compared to adults. This includes differences in gastric emptying, plasma protein binding, liver and kidney function.
3. Accurately calculating drug dosages for children is important due to their developing bodies. Several formulas are presented to estimate dosages based on age, weight and body surface area. Careful monitoring
This document discusses several key points regarding pediatric pharmacy practice:
- Children represent a significant portion of the global population but have poorly developed organ functions and are at higher risk for toxicity and adverse drug reactions. Historical events like the sulfanilamide elixir death and thalidomide tragedy demonstrate this risk.
- Pediatric patients require specialized pharmacist care due to age-related variability in drug absorption, distribution, metabolism, and excretion, as well as higher risk of dosing errors due to non-standard doses, need for compounding and dilutions, and less tolerance for mistakes.
- The roles of pediatric pharmacists include dosing calculations and consultations, medication history reviews, discharge counseling, drug
FDA 2013 Clinical Investigator Training Course: Clinical Discussion of Specia...MedicReS
FDA 2013 Clinical Investigator Training Course: Clinical Discussion of Special Populations
Ryan P. Owen, Ph.D.. Office of Clinical Pharmacology, Office of Translational Sciences,CDER
Pediatrics involves the care of infants, children, and adolescents. Knowledge of appropriate pharmacokinetics and pharmacodynamics in pediatric patients is lacking due to ethical issues in clinical trials. Dosages must account for the rapid physiological changes that occur during development, including variations in absorption, distribution, metabolism, and excretion of drugs across the different pediatric age groups. Careful dosage calculation based on body weight or surface area is necessary to ensure drug safety and efficacy in children.
This document discusses neonatal hypoglycemia, including transitional hypoglycemia that commonly occurs in healthy newborns versus more prolonged pathologic hypoglycemia. It describes the differences in recommendations from the Pediatric Endocrine Society and American Academy of Pediatrics for evaluating and managing neonatal hypoglycemia. Specifically, it highlights the lack of an agreed upon definition for neonatal hypoglycemia and differences in the recommended blood glucose threshold that warrants treatment. It also reviews risk factors for neonatal hypoglycemia and signs and symptoms.
This document discusses neonatal hypoglycemia, including transitional hypoglycemia that commonly occurs in healthy newborns versus more prolonged pathologic hypoglycemia. It reviews the physiology of glucose homeostasis in newborns and risk factors for hypoglycemia. Guidelines from the Pediatric Endocrine Society and American Academy of Pediatrics for screening and managing neonatal hypoglycemia are compared, noting differences in the recommended blood glucose thresholds that should prompt treatment.
Drug use in paediatric & geriatric patientsViraj Shinde
This document discusses drug use in paediatric and geriatric patients. It covers changes in pharmacokinetics and pharmacodynamics that occur during development and aging. In paediatrics, absorption, distribution, metabolism and excretion of drugs are often altered compared to adults due to developmental changes. In geriatrics, changes like reduced organ function and body composition affect pharmacokinetics and increase sensitivity to drugs. The document provides examples of these changes and their implications for dosing and drug selection in both populations.
This document provides information and formulas for calculating pediatric drug and fluid dosages based on adult doses. It discusses Fried's Rule and Young's Rule for calculating drug dosages for infants and children based on their age. Clark's Rule calculates drug dosages based on a child's weight. It also provides the Parkland Burn Formula for calculating fluid replacement after burns based on burn percentage and body surface area. Examples are provided for calculating appropriate pediatric doses and fluid amounts using these formulas.
Similar to Principles of pharmacotherapy in neonates and paediatric population21 (20)
Clinical trial regulations for clinical development of traditionalDrSatyabrataSahoo
Clinical trials of traditional herbal medicines present several challenges due to issues such as variable plant ingredients, lack of standardization, and safety concerns. However, these challenges can be addressed by applying current clinical trial guidelines and methodologies, such as conducting double-blind, placebo-controlled studies according to good clinical practice standards. Modern manufacturing techniques can also help standardize traditional medicine preparations for clinical testing. With proper study design and oversight, reliable data on the efficacy and safety of traditional medicines can be obtained through well-conducted clinical trials.
This document provides an overview of observational studies. It defines observational studies as studies where there is no intervention and includes cohort, case-control, and cross-sectional study designs. Cross-sectional studies determine exposure and outcome simultaneously, while case-control studies compare cases and controls based on past exposure. Cohort studies follow subjects over time, beginning with exposed and unexposed groups to evaluate subsequent outcomes. Well-designed observational studies can provide valid results for investigating relationships when randomized controlled trials are not possible or practical.
This document discusses phase 0 clinical trials, also known as microdosing studies. Phase 0 trials involve administering very low, non-therapeutic doses of an experimental drug to small groups of subjects to obtain preliminary pharmacokinetic and pharmacodynamic data before proceeding to full phase 1 trials. The goals are to accelerate drug development, eliminate unsuitable drug candidates early to save costs and reduce unnecessary risk to subjects and use of animals in testing. Regulatory guidelines have been established for microdosing studies. While microdosing offers benefits, limitations include potential for false predictions and difficulty motivating subject participation due to lack of intended therapeutic benefit. Ethical considerations also need to be addressed for these early-stage trials.
- Omega-3 fatty acids exert various beneficial cardiometabolic effects through diverse mechanisms of action. They can reduce inflammation, lower triglycerides, inhibit platelet aggregation, improve endothelial function, stabilize plaques, and reduce arrhythmias.
- Supplementation of up to 1 gram per day of omega-3 fatty acids from fish oil is generally well tolerated, except for occasional dysgeusia. It does not increase the risk of bleeding.
- While some recent large trials did not show effects of omega-3 fatty acids on cardiovascular outcomes, current guidelines still encourage omega-3 fatty acid supplementation for risk reduction in conditions like coronary artery disease and heart failure.
This document summarizes G protein-coupled receptors (GPCRs) and ligand-gated ion channels. It notes that GPCRs are the largest family of receptors, with seven transmembrane domains that activate G proteins to trigger intracellular signaling pathways. Ligand-gated ion channels directly form ion channels when activated by neurotransmitters like acetylcholine and GABA. Second messengers downstream of GPCR signaling like cAMP and phosphoinositides are also discussed.
This document discusses mood disorders like mania, depression and bipolar disorder. It provides details about lithium carbonate, which is a primary drug used to treat mania and bipolar disorder but has a low therapeutic index. The document summarizes lithium's mechanism of action, efficacy, adverse effects, drug interactions and monitoring considerations. It also mentions alternatives to lithium like various anti-convulsants and atypical antipsychotics that are now commonly used to control mania.
- When two drugs exhibit a constant potency ratio in producing an effect, their combination will produce a linear additive isobole that can distinguish synergistic and antagonistic interactions.
- The additive isobole is based on the historical concept of dose equivalence.
- When one drug is a partial agonist, the additive isobole calculated using dose equivalence requires large enough doses to produce the maximum effect, resulting in non-linear isoboles.
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Principles of pharmacotherapy in neonates and paediatric population21
1. Principles of Pharmacotherapy in
Neonates and Paediatric
Population
Dr Satyabrata Sahoo
DM Clinical Pharmacology Resident
Dept of Clinical & Experimental
Pharmacology, CSTM Kolkata
11/16/2021 1
2. Introduction
• Differences in physiology in paediatric
populations compared with adults
• That Influence the concentration of drug within
the plasma or tissue
• Paediatric population includes-
1.Preterm & Term neonates(0-27 days)
2.Infants & Toddlers(28 days to 23 months)
3.Children(2 years to 11 years)
4.Adolecsents(12 years to 17 years)
• Partially different from adults according to pk pd
profile
11/16/2021 2
3. Classification of Pediatric Patients
•Pediatric patients less than 18 years of age.
•Unlike an adult patient, a pediatric patient’s age can be
expressed in days, weeks, months, and years.
• Patients are classified based on age and may be further
described based on other factors, including birth weight and
prematurity status .
Growth and Development
•Children are monitored for physical, motor, cognitive, and
psychosocial development through clinical recognition
•The Centers for Disease Control and Prevention (CDC) Growth
Charts are used to plot head circumference, weight, length or
stature, and body mass index for a graphical representation of a
child’s growth compared to the general pediatric population
11/16/2021 3
4. Differences in Vital Signs
•Normal values for heart rate and respiratory rate vary
•Heart rates are highest in neonates and infants, ranging from 95 to 180
beats per minute (bpm) and decrease with age, reaching adult rates (60–
100 bpm) around 10 years of age.
•Respiratory rates are also higher in neonates and infants (24–38
breaths/min), decreasing with age to adult rates around 15 years of age
(12–20 breaths/min).
•The American Academy of Pediatrics (AAP) recommends rectal
temperature measurement in children 4 years of age or younger, using a
digital thermometer.
•For children 4 years of age or older, axillary or oral temperature
measurement is appropriate as the child is more able to cooperate when
asked.
11/16/2021 4
5. Fluid Requirements
Fluid requirement and balance are important to
monitor in pediatric patients, especially in
premature neonates and infants.
Maintenance fluid requirement can be
calculated based on body surface area for
patients greater than 10 kg with a range of
1,500 to 2,000 mL/m2/day.
However, a weight-based method of
determining normal maintenance fluid for
children is often used .
11/16/2021 5
6. Maintenance Fluid Calculations by Body weight
PATIENT BODY WEIGHT MAINTAINANCE FLUID REQUIREMENT
Less than 10 kg 100 ml/kg/day
11-20 kg 1000ml +50 ml/kg over 10 kg
Greater than 20 kg 1500 ml + 20 ml/kg over 20 kg
11/16/2021 6
7. Effects Of Pharmacokinetic And Pharmacodynamic Differences
On Drug Therapy
•Drug selection strategy may be similar or different depending on
age and disease state
• Pediatric patients may require the use of different medications
from those used in adults .
• For example, phenobarbital - neonatal seizures, but not often
used for treatment of seizures in adults.
• There also exist commonalties between pediatric and adult
patients, such as therapeutic serum drug concentrations required
to treat certain diseases.
• For example, gentamicin peak and trough serum concentrations
needed to treat Gram-negative pneumonia are the same in children
as in adults.
•The appropriate selection and dosing of drug therapy for a
pediatric patient depends on specific factors such as age, weight,
height, disease being treated, comorbidities, organ function, and
available drug dosage forms.
11/16/2021 7
8. •Equations proposed to calculate pediatric doses based on
adjusted age or weight such as Clark’s, Fried’s, or Young’s Rule
should not be routinely used to calculate pediatric doses
• Because they account for only one factor of difference, age or
weight, and lack integration of the effect of growth and
development on drug pharmacokinetics and pharmacodynamics
in this population.
11/16/2021 8
9. Absorption
• Oral absorption may be reduced in premature infants and neonates
due to differences in gastric acid secretion and pancreatic and biliary
function.
• Full-term neonates have a gastric pH of 6 to 8 at birth and pH 1 to 3 by
48 hours of age.
• Gastric acid output per kilogram is lower in premature infants and
increases with age to adult levels by 6 months of age.
• Low gastric acid secretion increased serum concentrations of weak
bases and acid-labile medications, such as penicillin, and decreased
serum concentrations of weak acid medications, such as
phenobarbital.
• Additionally, gastric emptying time and intestinal transit time are
delayed in premature infants.
• Pancreatic exocrine and biliary function are also reduced in newborns
• Topical or percutaneous absorption in neonates and infants is
increased due to a thinner stratum corneum.
• Application of topical medications should be limited to the smallest
amount possible.
11/16/2021 9
10. • Intramuscular absorption in premature and full-term infants can be
erratic
• Rectal absorption can also be erratic and is not a commonly
recommended route of administration if there are other routes
available (e.g., oral).
• This route is useful in cases of severe nausea and vomiting or status
epilepticus.
• Bioavailability increases as the blood supply bypasses the liver from
the lower rectum directly to the inferior vena cava.
• Availability of rectal dosage forms varies, with acetaminophen
suppositories and diazepam gel as examples of medications used by
the rectal route in pediatric patients.
11/16/2021 10
11. Volume of Distribution
• In pediatric patients, apparent volume of distribution
(Vd) is normalized based on body weight and expressed
as L/kg.
• Neonates and infants have a lower normal range for
serum albumin (2–4 g/dL, 20–40 g/L), reaching adult
levels after 1 year of age.
• This affects highly protein-bound drugs such as
phenytoin, resulting in lower total serum
concentrations needed to achieve therapeutic,
unbound serum concentrations.
•As premature neonates have lower body adipose
composition compared to older children and adults,
they have a decreased Vd for lipid-soluble drugs such as
midazolam and require lower doses by body weight.
11/16/2021 11
12. Metabolism
• Drug metabolism is slower at birth in full-term infants compared
to adolescents and adults, with further delay in premature
neonates.
• Phase I reactions and enzymes, such as oxidation and alcohol
dehydrogenase, are impaired in premature neonates and infants
• Glucuronidation by the uridine diphosphate glucuronosyl
transferases, on the other hand, is immature in neonates and
infants
• Adverse effects including cyanosis, ash gray color of the skin,
limp body tone, and hypotension, also known as “gray baby
syndrome” with use of chloramphenicol.
• Products containing benzyl alcohol or benzoic acid should be
avoided in neonates due to immature glycine conjugation,
resulting in accumulation of benzoic acid.
• Acetylation via N-acetyltransferase reaches adult maturation at
around 1 year of life.
11/16/2021 12
13. Elimination
• Renal drug clearance is reduced in infants and slowest in premature neonates
• Glomerular filtration rate (GFR) is lowest in premature neonates
• For example, vancomycin - 18 to 24 hours in a low birth weight (LBW) premature
neonate, every 6 hours in children with normal renal function, and every 8 to 12
hours in adult patients with normal renal function.
• Children with cystic fibrosis also present with greater renal clearance of drugs such
as aminoglycosides
• The use of the Cockroft-Gault or Jelliffe equations for estimating CrCl in adults is
not recommended for patients less than 18 years of age.
• Schwartz’s equation is a common method of estimating pediatric CrCl for LBW
infants up to 21 years of age .
• Urine output is also a parameter used to assess renal function in pediatric
patients, with a urine output of greater than 1 to 2 mL/kg/h considered normal.
11/16/2021 13
15. Specific Considerations In Drug Therapy
• In addition to differences in pharmacokinetics and
pharmacodynamic parameters, other factors including
dosage formulations, medication administration techniques,
and parent/caregiver education should be considered when
selecting drug therapy
11/16/2021 15
16. Routes of Administration and Drug Formulations
• Depending on age, disease, and disease severity,
different routes of administration may be
considered.
• When oral drug therapy is needed, one must also
consider the type of dosage form available.
• Most hospitals caring for pediatric patients
compound formulations in their inpatient
pharmacy.
• A list of community pharmacies with
compounding capabilities should be maintained
and provided to the parents and caregivers
before discharge from the hospital.
11/16/2021 16
17. Common Errors in Pediatric Drug Therapy
• Prevention of errors in pediatric drug therapy
begins with identification of possible sources.
• Decimal errors
• The use of the “rule of six” was previously used
to calculate infusions of medication such as
inotropes for critically ill patients in hospitals.
• Prevention of medication errors is a joint effort
between health care professionals and
parents/caregivers.
11/16/2021 17
18. CAM and OTC Medication Use
• An estimated 31% to 84% of children with cancer, 74% with autism
spectrum disorder, 71% with asthma, and 15% seen in the
emergency department utilize CAM or other OTC products.
• It is critical to realize that there are limited data establishing efficacy
of various CAM therapies in children. Example-Colic
• Symptoms of excessive crying usually improve by the third month
of life and often resolve by 9 months of age.
• No medication has been approved by the FDA for this condition.
This condition is self-limiting and infants will outgrow it as they age.
• Clinicians should respect parents’/caregivers’ beliefs in use of CAM
and OTC products and encourage a discussion with the intention of
providing information regarding their risks and benefits to achieve
desired health outcomes as well as optimize medication safety.
11/16/2021 18
19. Off-Label Medication Use
• Pharmacotherapy in pediatric patients often
includes use of approved and unapproved
(off-label) drugs.
• This includes the use of a medication in the
treatment of illnesses not listed on the
manufacturer’s package insert
• Such off-label use in infants and children is
frequently based on limited data.
11/16/2021 19
20. • Currently, there is a lack of pediatric dosing,
safety, and efficacy information for over 75%
of drugs approved in adults.
• Off-label use occurs in both outpatient and
inpatient settings.
• About 80% of hospitalized pediatric patients
receive at least one off-label medication.
• FDA regulatory changes, such as patent
exclusivity, provide incentives for a
pharmaceutical manufacturer to market drugs
for pediatric patients.
11/16/2021 20
21. Medication Administration to Pediatric Patients
and Caregiver Education
• Considering the challenges in cooperation from infants
and younger children, medication administration can
become a difficult task for any parent or caregiver.
• The means or devices for measuring and administering
medications by the caregivers should also be closely
considered.
• Oral syringes are accurate and offered at most
community pharmacies for measurement of oral liquid
medications.
• Oral droppers
• Comprehensive and clear parent/caregiver education
improves medication adherences, safety, and therapeutic
outcomes.
11/16/2021 21
22. Summary
• There are less Clinical trials in paediatric population
especially neonates and infants due to ethical issues
• There is not much data published.
• Off label use of drugs in paediatric population
increasing day by day
• Pharmcokinetic and pharmacodynamic profile varies
• Paediatric physician should prescribe rationally for
benefit of patients
• Paediatric populations should be included more and
more in clinical trials for rational treatment in future
11/16/2021 22
23. References
1. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2006. National vital
statistics reports; vol 56 no 7. Hyattsville, MD: National Center for Health Statistics.
2007.
2. Committee on the Future of Emergency Care in the United States Health System.
Emergency Care for Children, Growing Pains. Executive Summary. The Institute of
Medicine, 2007, http://books.nap.edu/catalog/11655.html.
3. Cherry DK, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care
Survey: 2005 Summary. Advance data from vital and health statistics; no. 387.
Hyattsville, MD: National Center for Health Statistics. 2007.
4. Kozak LJ, DeFrances CJ, Hall MJ. National Hospital Discharge Survey: 2004 annual
summary with detailed diagnosis and procedure data. National Center for Health
Statistics. Vital Health Stat 13(162). 2006.
5. American Academy of Pediatrics, Committee on Fetus and Newborn. Age
terminology during the perinatal period. Pediatrics 2004;114: 1362–1364.
6. Center for Disease Control Growth Charts, 2000. Developed by the National Center
for Health Statistics in collaboration with the National Center for Chronic Disease
Prevention and Health Promotion. http://www.cdc.gov/growthcharts.
11/16/2021 23
LESS pancreatic secretion bile salts decrease ba of erythromycin.Due to increased ionisation.Increased cutaneous perfusion and greater body surface to weight.increased absorption steroid lidocaine adverse effect
due to variable perfusion, poor muscle contraction, and decreased muscle mass compared to older patients.
Extracellular fluid and total body water per kilogram of body weight are increased in neonates and infants, resulting in higher Vd for water-soluble drugs such as aminoglycosides and decreases with age.
Therefore, neonates and infants often require higher individualized doses by weight (mg/kg) than older children and adolescents to achieve the same therapeutic serum concentrations.
Among phase II reactions, sulfate conjugation by sulfotransferases is well developed at birth in term infants.
due to immature renal function, resulting in the need for longer dosing intervals for renally cleared medications, such as vancomycin, to prevent accumulation. This equation utilizes patient length (cm), serum creatinine (mg/dL), and a constant, k, which is dependent on age for all patients and also gender for those greater than 2 years of age.
Appropriate stability and diluent selection data should be obtained from the literature.
Reports have shown that nearly 50% of medication errors in the United States in neonatal and pediatric critical care units are attributable to prescribing and transcribing errors..
Over 50% of parents/caregivers do not disclose this use to the physicians. CAM can include mind-body therapy (e.g., imagery, hypnosis), energy field therapies (e.g., acupuncture, acupressure), massage, antioxidants (e.g., vitamins C and E), herbs (e.g., St. John’s wort, kava, ginger, valerian), prayer, immune modulators (e.g., echinacea), or other folk/home remedies.
. For example, colic is a condition of unclear etiology in which an infant cries inconsolably for over a few hours in a 24-hour period, usually during the same time of day.
Off-label use of medication is the use of a drug outside of its approved labeled indication.
It is appropriate to use a drug off-label when no alternatives are available; however, clinicians should refer to published studies and case reports for available safety, efficacy, and dosing information.
Medicine cups are not recommended for measuring doses for infants and young children due to possible inaccuracy of measuring smaller doses. Household dining or measuring spoons are not accurate or consistent and should not be used for administration of oral liquids.