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![Page 1: Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 10 Drug Therapy in Pediatric Patients.](https://reader036.fdocuments.net/reader036/viewer/2022081007/56649e105503460f94afb78e/html5/thumbnails/1.jpg)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Chapter 10
Drug Therapy in Pediatric Patients
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2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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
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3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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
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4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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.
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5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Pediatric Patients
• (less than 36 weeks’ gestational age)Premature infants
• (36–40 weeks’ gestational age)Full-term infants
• (first 4 postnatal weeks)Neonates
• (weeks 5–52 postnatal)Infants
• (1–12 years)Children
• (12–16 years)Adolescents
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6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Pharmacokinetics: Neonates and Infants
Absorption Distribution Hepatic metabolism Renal excretion
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7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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.
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8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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 thatplasma 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.
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9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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
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10Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Pharmacokinetics: Neonates and Infants
Absorption Oral administration Intramuscular administration Percutaneous absorption
Distribution Protein binding Blood-brain barrier
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11Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Pharmacokinetics: Neonates and Infants
Hepatic metabolism Renal excretion
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12Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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
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13Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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
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14Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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)
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15Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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.
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16Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Dosage Determination
Approximate dosage for a child =
Body surface area of the child × adult dose1.73 m²
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17Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Promoting Adherence
Provide patient education in writing. Demonstration techniques should be included
as appropriate.
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18Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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